1. Nine hundred and fourteen cases of tuberculosis of the spine are analysed and the late results ascertained three or more years after discharge from hospital.

2. The relative frequency with which the various segments of the spine are involved has been found. Cervical disease was present in 3·5 per cent of cases, thoracic in 43·l per cent, lumbar in 32·9 per cent, thoraco-lumbar in 16· 7 per cent and lumbo-sacral in 3·8 per cent.

3. The mortality rate was 16·7 per cent. In patients with multiple lesions 25·5 per cent died, compared with 12·3 per cent in the group without complications. When chronic secondarily infected abscesses and sinuses were present the mortality rate was 19·1 per cent, and of patients with paraplegia 24·8 per cent died.

4. In the late results the working capacity of 390 patients was ascertained. It was full in 86 per cent, partial in 5·8 per cent and nil in 8·2 per cent.

5. An attempt has been made to determine the site of the primary bone focus from the radiograph. Early "epiphysial" changes were present in 33 per cent ; the central focus beginning in the spongy tissue of a vertebral body was present in 11·6 per cent; subperiosteal lesions were present in 2·1 per cent; and infection of the neural arch was present in only 0·5 per cent. In 52·8 per cent, however, widespread destruction had taken place when the patient first came under observation.

6. The ill effect of complications upon the prognosis is stressed—especially in the cases of multiple foci of active tuberculosis, secondarily infected abscesses and sinuses, and paraplegia. Paraplegia occurred in 31·2 per cent of the cases of thoracic disease.

7. An attempt has been made to determine the frequency with which tuberculosis of the spine heals by spontaneous bony fusion of the affected vertebral bodies. It was found in 27·3 per cent of the cases in the present series.

8. Reasons for further treatment after the initial discharge of the patient are examined.

1. Three hundred and twenty cases of tuberculosis of the hip joint have been analysed and the late results assessed three or more years after discharge from hospital.

2. The primary bone focus involved the acetabulum alone in 39·3 per cent; the acetabulum and femoral head in 34·1 per cent; the head of femur alone in 19·2 per cent, and the femoral neck alone in 7·4 per cent. In 101 cases widespread destruction of the joint had taken place by the time the patient first came under observation.

3. Premature epiphysial fusion round the knee joint of the affected side occurred in 23 per cent of all patients under the age of fifteen years.

4. When hip disease was complicated by multiple foci of active tuberculosis or by secondarily infected abscesses and sinuses, the prognosis was seriously worsened.

5. Significant late deformity occurred in 38·3 per cent of patients discharged with "sound" fibrous ankylosis, and in 60·5 per cent of those with an unstable fibrous ankylosis.

6. Of 187 patients observed for more than three years after discharge from hospital 174 returned to full activity, seven were partly incapacitated and six were totally incapacitated.

7. Analysis of the late results suggests that the prognosis is best when an adequate period of conservative treatment is followed by some form of arthrodesis operation.

1. Fifty cases of arthrodesis of the hip joint in tuberculous arthritis are analysed; in forty cases the late end-result has been ascertained two or more years after operation.

2. The indications for arthrodesis are discussed. The operation should not be performed when disease is active; it should not be undertaken before the age of twelve to thirteen years; it is not advisable in elderly patients; it may be contra-indicated when there are multiple foci of infection. Subject to these limitations every patient with unsound ankylosis after adequate conservative treatment should be treated by arthrodesis; painful fibrous ankylosis and late onset of deformity are definite indications.

3. Three types of operation have been used: intra-articular arthrodesis; extra-articular ilio-femoral arthrodesis; combined intra- and extra-articular arthrodesis. Extra-articular ilio-femoral arthrodesis is preferred, deformity being first corrected by traction or osteotomy.

4. Post-operation complications were few; the mortality rate was low (2 per cent.).

5. There was bone ankylosis with solid incorporation of the graft in 87·5 per cent., failure of union of the graft (to the trochanter) in 10 per cent., and destruction of the graft in 2·5 per cent.

6. Late end-results show full working capacity in 87·5 per cent. of patients, part working capacity in 2·5 per cent. and inability to work in 7·5 per cent.

The writer wishes to express his thanks to Professor Harry Platt and Professor T. P.. McMurray for criticism and advice in the preparation of this paper, and to Dr F. C. S. Bradbury, Central Consultant Tuberculosis Officer of the Lancashire County Council, for permission to publish these cases.