Attention is again called to the fact that bone and joint tuberculosis is a systemic disease.

The point is stressed that a positive diagnosis is essential to correct treatment and accurate interpretation of results.

Of 164 consecutive patients, seen during the past year, clinically diagnosed as having bone and joint tuberculosis, 100 were established cases, fifty had no pathological or bacteriological reports, and in fourteen the guinea-pig inoculation and pathological results were negative.

Pulmonary lesions in substantiated bone and joint tuberculosis average 40 per cent. in our series,—27 per cent. with adult pulmonary or parenchymal lesions, and 13 per cent. with active childhood pulmonary tuberculosis. Patients over sixteen years of age averaged 37.3 per cent.; those under sixteen years, 44 per cent.

When the pulmonary lesion is determined from the age of the patient at onset of the bone and joint lesion, those under sixteen years—sixty patients—averaged 42 per cent. and those over sixteen years—forty patients—averaged 40 per cent.

Eight per cent. of our cases had renal tuberculosis.

More frequent urinalyses, guinea-pig inoculation, and special search for tubercle bacilli are urged in the treatment of patients having an acid urine containing no organisms, but in which white and red blood cells are found by the usual staining methods.

A negative tuberculin skin test, especially if negative to repeated increasing dosage of a recently prepared or fresh solution of old tuberculin or tuberculoprotein trichloracetic, is of definite diagnostic value.