Tlie changes in the bones and joints can be realized fairly well from one of the many rontgcnographs made by my colleague, Dr. II. D. Carman. The bones show rarefaction as is common in cases of chronic arthritis. Besides the erosion, cupping, and exostosis of the articulating ends, there is the not uncommon change in the shape of the heads of the bones, so that the heads of the humerus and femur, and the condyles of the femur and head of the tibia seem elongated. The shafts of the long bones

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... unusually thin and slender and the metacarpal bones and phalanges have cupping and broadening of the articular surfaces and narrowing of the shafts, somewhat suggestive of achondroplasia. It seems to me impossible to exclude the latter process, but I present the case without further comment. It is a familiar clinical fact that chronic joint troubles form one of the most frequent and rebellious of diseases. The appli¬ cation of laboratory methods to the diagnosis of the several varieties and the rational treatment dependent upon it have reduced many of these to categories which are fairly well understood and yield good results. Thus the tuberculous, Neisserian, and specific joints tell their own story, but after eliminating them there remains a large class in which but little progress has been made. This is the class grouped by various writers under the headings, rheuma¬ toid arthritis, chronic articular rheumatism, arthritis deformans, and so on, conditions having in common an obscure or doubtful etiology and a prognosis for the most part unfavorable. The activities of certain workers, particularly perhaps Goldthwaitc and his collaborators in this field, have brought some order out of chaos, but it should be noted in passing, and with no credit to the internists and laboratory men, that it remained for orthopedists to suggest the simplest classifications and to practise the most rational therapy. It is due chiefly to the above men, for example, that we recognize in these obstinate cases the importance of a focus of infection in a tooth or tonsil, and that regulation of the diet along broad and intelligent lines is of the utmost value