104 SUPPURATION. 



that every microorganism that possesses pyogenic properties is capa- 

 ble of causing a typical osteomyelitis in man. 



Rinne (" Ber Eiterungsprocess und seine Metastasen," Archiv 

 fur klin. Chirurgie, B. xxxix. S. 21), who failed in producing metas- 

 tatic abscesses with pure cultures of pus-microbes, rendered four 

 rabbits pysemic by injecting osteomyelitic pus directly into the 

 venous circulation. He used pus later from a case of acute osteomye- 

 litis with grave symptoms, and diluted it with distilled water, and 

 of such a mixture he injected a syringeful into one of the auricular 

 veins of four rabbits. One died in twenty-four hours with symp- 

 toms of toxaemia, and the autopsy showed nothing but a beginning 

 pneumonia of the left lung. The other three animals died seven to 

 ten days after the injection, and in all of them the necropsy showed 

 suppurating foci in the kidneys and the heart muscle. No abscesses 

 in muscles or suppuration in joints. The plate cultures made from 

 the pus used for the experiments showed the staphylococcus aureus 

 albus and bacillus pyocyaneus. With the exception of the albus, 

 all of the microbes were also cultivated from the pus of the metas- 

 tatic abscesses in rabbits. 



In a later examination (Ibid., p. 271) the same author expresses 

 the opinion that the indirect causes of suppurative osteomyelitis are 

 changes brought about in the medullary tissue by the microbes and 

 their ptomaines of general febrile diseases, such as typhus, scarla- 

 tina, diphtheria, etc., which prepare the soil for the action of pus- 

 microbes, or the disease is produced by direct extension from a 

 localized suppurative lesion, as a furuncle, through lymphatic vessels 

 or along vessel sheaths or nerve trunk to the medullary tissue. 



The structure and location of the capillary vessels in the vicinity 

 of the epiphyseal cartilage in young persons determine the localiza- 

 tion of pus-microbes in this part of the long bones, and, almost 

 without exception, the inflammatory process starts from here. 



The rapid local diffusion of the process is largely due to the 

 unyielding nature of the tissues around the primary focus, and to 

 the fact that the bloodvessels are directly concerned in the exten 

 sion of the process by becoming the channels for the dissemination, 

 their contents forming the nutrient medium for the pus-microbes. 

 Thrombo-phlebitis is a constant and early condition in every case 

 of acute osteomyelitis. Coagulated blood is an excellent culture 

 substance for the pus-microbes, and it serves the double purpose of 

 a nutrient substance, and a medium for the local spread of the dis- 

 ease. General dissemination and metastatic foci in distant organs, 

 or in other bones, are often observed because the pus-microbes 

 re-enter the vascular system again, and by so doing cause a coagu- 

 lation-necrosis of the intima and thrombosis; and subsequently 



