t 
154 A. ZDNDEL. 
tion, the removal of the cartilage is no more necessary, for then 
the cicatrization is readily obtained by stimulating the sloughing 
of the necrosed tissue or by removing it.* 
With cartilaginous quittor there is always plastic infiltration of 
the cellular tissue surrounding the cartilage. V^ery often the 
wall of the synovial capsula of the articulation of the foot is 
somewhat thickened, and in that case there is less risk of injuring 
it during the operation.—(Key.) 
III.— Progress , Duration and Termination .—Left to itself, 
the caries of the fibro-cartilage may last for a long time, through 
difficulty in determining its true nature. Spontaneous cure, how¬ 
ever, is not impossible, as Renault proved it, and as many prac¬ 
titioners have seen it, especially in young and healthy subjects, 
when the disease is mild at its onset and affects parts of the or¬ 
gans where the fibrous element predominates, as in the posterior 
portion of the cartilage. This fortunate result follows the 
sloughing of the “ bourbillon ” which makes its appearance under 
the shape of a greenish particle. 
But, ordinarily, the disease progresses slowly, destroying the 
cartilage by degrees, and the diseased process ceases only when 
the caries has reached the ligament of the joint, which it some¬ 
times also attacks. The tissue of the fibro-cartilages has not the 
force of reaction possessed by other inflamed structures, and 
which is so well marked in cellular tissue. A process of suppura¬ 
tion, such as rapidly eliminates the mortified structure, cannot 
very readily take place in it, and when by natural forces the 
carious spot is eliminated, and pushed outwards, the. surrounding 
tissues are most commonly already affected. These undergo the 
same alterations, are eliminated in the same manner, and so until 
the entire cartilage is destroyed. This process of caries by rep- 
tation may last a year. 
In its progressive stage, the disease may spread to surrounding 
parts, such as the os pedis, the plantar aponeurosis, the ligament 
of the joint, or the sesamoid sheath, all of which may become 
the seat of inflammation. They are diagnosticated by the greater 
pain and more marked lameness, symptoms which are compara¬ 
tively light in the simple necrosis of the cartilage. 
