Lymphatic drainage of bone with special reference to osteomyelitis.

The immediate interest in the problem under investigation was aroused while the author was interning at the Children’s Memorial Hospital. In the course of following several cases of acute haematogenous osteomyelitis it was stated by one of the attending staff that it was his clinical impression that the appearance of lymphadenopathy did not occur until the infective process has spread beyond the confines of the bone involved to the surrounding soft tissues.[...] Certainly if the lymphatic glands do not become enlarged until the tissues about the involved bone become infected, lymphadenopathy would give some indication of the extent of the disease. This has become particularly important since the advent of chemotherapy, and the use of the antibiotics as a possible sole means of controlling the pathological process. Preliminary review of the standard texts of anatomy and pathology showed that there was no great stress placed upon the existence, or a function of a lymphatic system within the skeletal structure. The presence of such a lymphatic drainage would be of importance also in the ectogenous type of osteomyelitis that is found in compound fractures, or in infective processes lying close to bone.[...]The purpose of this investigation has been to determine whether there is a lymphatic distribution in bone, and if so what its relationship is to the general lymphatic structure.[...