American practice of surgery : a complete system of the science and art of surgery . hoidfever. Whatever view may be held, however, by different authorities, the state-ment may be made quite confidently that in every case of typical acute osteo-myelitis in growing youths that portion of the shaft immediately adjacent to INFLAMMATORY AFFECTIONS OF BONE. 277 the epiphysis (Fig. 133) becomes affected very early in the progress of the disease,and if any necrosis results it is quite certain to involve that portion of the dia-physis which is in immediate continuity with the epiphyseal cartilage. Ino
American practice of surgery : a complete system of the science and art of surgery . hoidfever. Whatever view may be held, however, by different authorities, the state-ment may be made quite confidently that in every case of typical acute osteo-myelitis in growing youths that portion of the shaft immediately adjacent to INFLAMMATORY AFFECTIONS OF BONE. 277 the epiphysis (Fig. 133) becomes affected very early in the progress of the disease,and if any necrosis results it is quite certain to involve that portion of the dia-physis which is in immediate continuity with the epiphyseal cartilage. Inother words, necrosis of the middle section of the shaft in this disease, withoutnecrosis of the terminal portions adjacent to one or other epiphysis, is point, also, is of much practical importance in view of the line of treat-ment recently advocated by Nichols, and will be referred to again under theheading of Treatment. As an apparent exception also to the above statement may be mentionedthose extremely rare cases in which a disease possessing the same main charac-. Fig. 133.—Case of Acute Osteomyelitis Commencing at the Epiphysis of the Great Trochanterof the Femur. Although this was the only focus of inflammation, the case was of the fulminatingtype and ended fatally on the sixth day, with multitudes of pytcmic. abscesses, a, Epiphyseal lineof head of femur (unaffected); b, c, epiphysis of great trochanter, in which the disease commenced;d, bone from which the periosteum has been separated by pus; e, lower limit of the that the medulla is unaffected. (Original.) teristics affects the epiphysis alone and not the shaft. These cases will be con-sidered under a separate caption as cases of Acute Epiphysitis. The points mainly in dispute having now been disposed of. one may be per-mitted to pass to a discussion of those aspects of the pathological process uponwhich all are practically agreed. By reason of the resisting character of bonetissue an
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