Surgery; its theory and practice . stcharacteristic changes are found in the cartilages. These at firstappear nodular and cracked, but subsequently become roughened,fibrous and villous-looking, and are finally rubbed away by thefriction of the articular surfaces of the joint on each other. Suchchanges appear to be due to fibroid degeneration, or splitting ofthe matrix into fibres, and the multiplication, enlargement, andfatty degeneration of the cartilage cells. Thus it will be per-ceived that the process by which the cartilages are destroyed inchronic osteo-arthritis differs materially from t
Surgery; its theory and practice . stcharacteristic changes are found in the cartilages. These at firstappear nodular and cracked, but subsequently become roughened,fibrous and villous-looking, and are finally rubbed away by thefriction of the articular surfaces of the joint on each other. Suchchanges appear to be due to fibroid degeneration, or splitting ofthe matrix into fibres, and the multiplication, enlargement, andfatty degeneration of the cartilage cells. Thus it will be per-ceived that the process by which the cartilages are destroyed inchronic osteo-arthritis differs materially from the so-called ulcer-ation of cartilage which occurs in the inflammatory joint-affectionspreviously described, and in which the matrix undergoes liquefac-tion and softening consequent upon its invasion by the granula-tion-tissue derived from the synovial membrane and bone. Inchronic osteo-arthritis the synovial membrane, at first dry, be-comes slightly thickened and vascular, and moderately distended 250 DISEASES OF SPECIAL with turbid synovial fluid which at times resembles train oil. Inthe meanwhile the synovial fringes become hvpertrophied, andassume the form of pedunculated processes, often containing littlemasses of cartilage or bone. These little masses may subsequentlybecome detached and form loose bodies^?^•85. in the joint (Fig. 85). The articular surfaces of the bone become smooth,hard, polished, eburnated or porcellan-eous in appearance and variously alteredin shape—changes apparently depend-ing in part on friction and mechanicalpressure, and in part on the formationof new bone in the cancellous spaces,whereby the bone is rendered harderand is capable in consequence ofreceiving a higher polish. Whilst, how-ever, new bone is being formed immedi-ately beneath the polished surface, rare-faction and atrophy are going on a littledeeper in the bone leading to the short-ening and distortion so commonly ob-served. Hence, for example, the flat-tening and enlargeme
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Keywords: ., bookcentury1800, bookdecade1890, booksubjectsurgery, bookyear1896
