Acute Osteitis-Neligan and Elderkin BRIrr hospital. This issue can be obscured by the occasional mild case-commoner in younger children and smaller bones, as described by Bremner and Neligan (1958)-in which delay in terms of days or even weeks may be relatively harmless. In the much commoner severe cases in older children the target period for admission is the first 48 hours after the start of the pain. Then an effective antibiotic will produce a complete cure without any need for local intervention in about 90 % of cases (present series plus 41 such cases reported by Bremner and Neligan in 1958). Even up to 96 hours after the onset a relatively short course of antibiotic treatment, usually supplemented by removal of pus, will result in a relatively quick return to full activity. We know that in three-quarters of cases the family doctor has seen the patient within the first of these target periods, and in almost all within the second.When there is delay in diagnosis we have evidence (Bremner and Neligan, 1958) that the commonest cause is the doctor's failure to appreciate that there is both a systemic illness and a local lesion in a bone, near but not in a joint, giving rise to the diagnostic sign of " one-finger tenderness." Any suspicion of osteitis should be the indication for immediate referral to hospital. The diagnosis may often be difficult, and should be confirmed by the most experienced observer available; only in hospital can the fullest possible bacteriological information and the most effective regime of antibiotic administration be made available, and local surgical intervention may become necessary at any time. It matters little to whom the case is referred, so long as all those who may be primarily concerned in the casualty, paediatric, and orthopaedic departments are fully alert to the requirements of diagnosis and treatment, and ready to call for help when required. In view of the nature of the disease some form of collaboration between orthopaedic surgeon and paediatrician seems desirable (Annan and Sweetnam, 1962).We believe that such collaboration, in support of effective action by the family doctors, who are the first to see these patients, can still produce satisfactory results in the great majority in spite of the emergence of penicillin-resistant organisms. The results of the present investigation support this view and underline the importance of immediate referral to hospital, followed by purposeful use of the most effective antibiotics currently available, and prompt removal of any pus which forms in the subperiosteal space. SummaryReference to the recent literature on the subject suggests that there is widespread disagreement about the correct treatment of acute osteitis in children, and that the incidence of unsatisfactory results is about 30 %. Both these very disturbing findings appear to be attributable to the dearth of planned studies of suitably selected cases.We report the findings of a retrospective study of the methods and results of treatment in a consecutive series of 38 cas...

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