1. An account of experiences in seventy-five cases with a new method of treatment of low back pain and sciatica caused by intervertebral disc lesions has been presented. The method is based on the fact that chymopapain, a proteolytic enzyme, can break down displaced intervertebral disc material without deleterious effects upon adjacent tissues.

2. Chymopapain was injected into intervertebral discs by the postero-lateral or preferably the lateral approach. Two milligrams per disc constitute an effective dose. The enzyme was administered to seventy-five patients who were potential candidates for laminectomy. These patients were followed for four to thirty months and results were graded as "good" (76 per cent), "fair" (15 per cent) and "poor" (9 per cent).

3. Although untoward reactions have been encountered, none of these has been attributable to chymopapain.

4. Our investigations have convinced us that enzymatic dissolution of a lumbar intervertebral disc lesion is a safe, effective method of relieving sciatica and low back pain in selected cases.

A white child with a long history of illness from the age of six was thought at first to have Hodgkin's disease. There followed an acute illness with lesions involving glands, lungs, bone and skin. Mycobacterium avium-intracellulare group (Battey) was isolated from various lesions at the age of thirteen. After six years of continuous treatment the patient, now eighteen, is living a normal life.

1. Chronic tuberculous osseous lesions were induced consistently in eight- to ten-week-old unvaccinated guinea-pigs by the insertion of Gelfoam impregnated with mycobacterium tuberculosis into the metaphysial region through a drill hole in the distal part of the femur. Typical tuberculous lesions developed by three weeks and many of them were followed for twelve weeks or more.

2. This experimental model establishes a reliable method of producing a localised lesion at a predetermined site without early death of the animal. The model is sufficiently similar to the human lesion, and may offer a reliable system for further investigations.

3. It was observed that streptomycin penetrates readily into tuberculous osseous lesions. The concentration of streptomycin found in the tuberculous lesion after a single intramuscular injection was much higher than the concentration considered sufficient to have an inhibitory effect on the human type of mycobacterium tuberculosis.

1. Ten patients with neurological evidence of damage to the intrathecal sacral nerve roots of the cauda equina by verified lumbar disc prolapse are described.

2. The nature of the bladder paralysis has been investigated by cystometry and the findings contrasted with published opinions.

3. The prognosis of the bladder paralysis has been established by review up to six years after removal of the disc prolapse. No evidence of recovery of complete bladder paralysis has been found, but the consequences of persistent bladder paralysis have been much less severe than previous reports have stated. Reasons have been suggested for this.

4. Principles of recognition and management of bladder paralysis due to cauda equina lesions have been stated and methods suggested.

We have reviewed 37 patients under the age of 18 years with lesions of the lumbar posterior end plate. All but one were active in sport, and most were seen because of low back pain. An abnormality was commonly found at the inferior rim of the body of L4 and at the superior rim of the sacrum. All adjacent intervertebral discs showed a decrease of signal intensity on the T2-weighted MRI. In 12 patients there was no interposed tissue at the posterior end-plate lesions. When disc material had migrated posteriorly none protruded beyond the posterior margin of the end plate, the dissociated portion of which was the main element compressing neural tissue. The posterior end-plate lesion should be regarded as a vertebral non-articular osteochondrosis.

1. Pain at the front of the radial side of the wrist may be caused by various lesions of the tendon and sheath of the flexor carpi radialis tendon.

2. The diagnosis may be established by testing resisted movement at the wrist and by the effect of injecting local anaesthetic into the tendon sheath.

3. In women over the age of fifty the lesion is associated with osteoarthritis of the joint between the scaphoid and the trapezium.

4. Osteoarthritis of the joint between the scaphoid and the trapezium is found in about 25 per cent of women over the age of fifty.

5. If the pain is not relieved by simple conservative measures it can usually be cured by incision of the tendon sheath.

6. The histological changes in the tendon sheath are similar to those found in tenovaginitis of the abductor pollicis longus and tibialis posterior tendons.

1 . Young Wistar rats fed on a diet containing 0·3 per cent semicarbazide hydrochloride developed the characteristic lesions of osteolathyrism. This consisted of kyphoscoliosis, displacement of epiphyses and dislocations of joints. A pathological study of the skeletal lesions showed widening, disorganisation and tears of the epiphysial plate with the zone of maturing cartilage showing the greatest increase in width. The severe kyphoscoliosis was due to a derangement and displacement at and through the epiphysial plates of the twelfth thoracic or first lumbar vertebra.

2. Some of the compounds that are known to produce osteolathyrism in laboratory animals are beta aminopropionitrile, amino acetonitrile, mercaptoethylamine and semicarbazide. The mode of action of the lathyrogenic compounds was analysed in the light of a number of experiments done in this laboratory.

3. lt is possible that they interfere with the metabolism of the epiphysial plate. There appears to be a decreased polymerisation of the ground substance of the epiphysial cartilage, but the exact metabolic reaction involved is not known. Other chemicals of similar structure, with the same reactive groups, did not show lathyrogenic properties. It is concluded that it is not a particular chemical structure, configuration or specific reactive group that is responsible for the production of osteolathyrism. The chemistry of the lesions still remains to be solved.

1. Based on studies in seventy-five patients, a technique is described for body surface activity measurements over localised skeletal lesions up to one month after injection of the λ-emitting isotopes Ca⁴⁷ and Sr⁸⁵.

2. The activity was high over skeletal lesions like fracture, metastatic cancer, eosinophilic granuloma, chondroma, osteomyelitis and Paget's disease.

3. The high isotope uptake is interpreted as evidence of an increased rate of bone tissue turnover.

4. These findings suggest that external counting of Ca⁴⁷ and Sr⁸⁵ may be used for quantitation of the rate of formation of normal and pathological bone tissue. A special application would be localisation and delineation of metastatic cancer in cases where radiographic evidence is uncertain or non-existent.

A prospective study was made of 100 knees which had been operated on for various kinds of internal derangement. An observer, who did not know the clinical condition of the knee, recorded whether or not there were articular lesions of the femoral condyles. Lesions were found to be localised to a triangular area on the medial condyle and to a strip on the lateral condyle. Similar lesions have been described in association with flexion deformities in rheumatoid and osteoarthritic knees. Lesions were found in 49 out of 50 knees which had been locked for more than three days. They were also found in 29 knees in which there appeared to be full extension before operation, but where there was either a torn meniscus with a history of intermittent locking or serious anterolateral instability. In these cases it was considered that the final "screw-home" mechanism of full extension had been lost. Lesions were not present in 10 knees which appeared locked, but in nine of these the interval between injury and operation was less than three days. Lesions were not found in eight knees where there was full extension and no history of locking or instability. In four knees with a plica syndrome similar lesions were present