American practice of surgery : a complete system of the science and art of surgery . the medium of the perios-teum clothing its outer surface. These vessels,like those of the preceding group, are also terminalin character, and seem to be confined to the neigh-borhood of the epiphysis on the distal side of theepiphyseal line without having any free communi-cation with the other vessels. The vessels comprising the metaphyseal group(Fig. 132, b) are smaller and shorter than the othersand enter the end of the shaft near the end of thediaphysis, with the same characteristics as termi-nal vessels as
American practice of surgery : a complete system of the science and art of surgery . the medium of the perios-teum clothing its outer surface. These vessels,like those of the preceding group, are also terminalin character, and seem to be confined to the neigh-borhood of the epiphysis on the distal side of theepiphyseal line without having any free communi-cation with the other vessels. The vessels comprising the metaphyseal group(Fig. 132, b) are smaller and shorter than the othersand enter the end of the shaft near the end of thediaphysis, with the same characteristics as termi-nal vessels as characterize the other groups. From these pictures Lexer demonstrates thatthe areas in which osteomyelitis most often beginsare supplied by terminal branches from all three of these arterial groups, but concludes that these areas, owing to the limited degreeof anastomotic communication between the groups, are peculiarly susceptibleto the lodgment of bacteria-laden emboli. He endeavors to explain the fre-quency of tuberculous disease in the same localities upon the same basis of. Fig. 132.—Femur of a ChildFour Weeks Old. (From Lexer,in Archir f. klin. Chir., 1903, , p. 9, and Bd. lxxiii., p. 4S1.)a, a, Epiphyseal arteries; b, b,metaphyseal arteries; c, c, dia-physeal or main nutrient will be observed that there isno free anastomotic communica-tion between these various groups. 272 AMERICAN PRACTICE OF SURGERY. blood supply by terminal circulation. The argument is an excellent one andappears to be well founded on an anatomical basis, hut the attempt to explainboth tuberculous and OSteomyelitic foci upon the same hypothesis is not alto-gether fortunate because tuberculous foci are almost invariably in the epiphy-sis, and osteomyelitic foci are almost equally constant on the diaphyseal sideof the epiphyseal cartilage. Continuing his investigations into the circulation of older children andadults. Lexer found that all three groups tend to become smaller and sm
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