1. From the standpoint of optimum therapeutic results and of the prevention of possible local or general complications, the importance of the early diagnosis of tuberculosis of the bones and joints cannot be overemphasized.

2. Because of the inherent limitations of the available physical and roentgenographic methods of examination, the diagnosis of orthopaedic forms of tuberculosis is difficult to establish.

3. Similar limitations are encountered in many cases of pulmonary tuberculosis, the demonstrable evidence of which would give a clue to the diagnosis of an obscure bone or joint disease. Not all active tuberculous lesions of the lung are visible on the standard postero-anterior chest roentgenogram. Small lesions, which may be discharging numerous tubercle bacilli into the blood circulation, may remain obscured by the heart shadow, the mediastinal structures, or the diaphragm.

4. For the sake of accurate diagnosis, it is imperative to resort to methods which are of value in uncovering these hidden sources of tubencle bacilli. Roentgenograms of the chest taken at various angles, such as oblique and lateral exposures, or special apical detail film, are of assistance, but roentgenographic shadows in the lung fields do not identify the etiology of the lesion.

5. The available data in the literature, as well as the authors' experience with over 2,000 cases of pulmonary tuberculosis, indicate that examination of the fasting gastric contents for tubercle bacilli is an indispensable diagnostic procedure. The same method is applicable to orthopaedic forms of tuberculosis.

6. Exanmination of the fasting gastric contents should be carried out periodically, at intervals of from three to six months, to ascertain the course of the original tuberculous focus in the lung.

7. The conception of complete healing of a tuberculous lesion of a bone or joint should be expanded. No patient should be classified as cured until repeated bacteriological examinations of the gastric contents reveal no tubercle bacilli. Although this may prolong the treatment, there cannot be any doubt that this added regimen is of value in consolidating the healing of the orthopaedic lesion, as well as that of the original source of the disease.

8. Securing gastric contents for bacteriological examination is a simple procedure which can be carried out by the physician or by a trained attendant, with very slight discomfort to the patient.

9. the detection of tubercle bacilli in the fasting gastric contents is as competent and reliable by culture as by animal inoculation.

10. A higher number of positive results are obtainable when five consecutive gastric specimens are examined than where fewer samples are studied. A greater number of positive results may be expected from examination of pooled specimens than from separate examinations.

11. In a group of patients with various forms of orthopaedic tuberculosis, an attempt was made to corroborate the diagnosis by the bacteriological examination of the fasting gastric contents. Out of this group of twenty-two patients, tubercle bacilli were found in seven (31.8 per cent.).

12. With improved laboratory technique and with more frequent examinations of this type, a higher percentage of positive findings may be expected.