The history of aseptic bone necrosis includes important contributions by Hunter, Russell, Goodsir, Paget, König, Axhausen, Phemister, and Chandler. Only after Pasteur discovered bacteria in abscesses could a nonbacterial or aseptic necrosis be conceptualized. Techniques and information gained from the study of bone grafts led to important steps in the recognition of aseptic necrosis. The use of the X-ray and careful pathologic correlation enabled a wide group of radiographically distinct lesions to be recognized as bone necroses. Although many identifiable diseases can underlie aseptic necrosis, the cause of most cases is unknown.