1. A report is presented of the method and results of treatment of sixty-nine consecutive cases of infection of the hand.

2. Excision and primary suture, combined with chemotherapy and immobilisation in plaster, was the method of treatment.

3. The results, from the point of view of rapidity and completeness of recovery, justify consideration of the method for further use.

1. One hundred patients with dislocation of the hip joint have been reviewed, many having been re-examined at intervals ranging from two to five years after injury.

2. There were forty-six simple dislocations, forty-three dislocations with fracture of the acetabular rim, seven dislocations with fracture of the acetabular floor, and five dislocations with fracture of the femoral head.

3. Complete recovery, as judged by clinical and radiographic examination, was observed in 76 per cent. of simple dislocations, 63 per cent. of dislocations with fracture of the acetabular rim, and 40 per cent. of dislocations with fracture of the femoral head; in no case of dislocation with fracture of the acetabular floor was recovery complete.

4. Only in one case did myositis ossificans develop, and that was the only case treated by "massage and movements" throughout the first ten weeks after injury.

5. Avascular necrosis of the femoral head was recognised in a smaller proportion of patients than had been expected, but since the follow-up review extended only to four years after injury the results, in this respect, are unreliable. The incidence of this complication after injury to the hip joint cannot be assessed unless the follow-up period is at least five to ten years.

6. Early traumatic arthritis developed in 26 per cent. of patients—in 15 per cent. of simple dislocations, 25 per cent. of dislocations with fracture of the acetabular margin, 60 per cent. of dislocations with fracture of the femoral head, and 100 per cent. of dislocations with fracture of the acetabular floor.

7. When central or posterior dislocations are accompanied by fracture of the acetabular floor, early arthrodesis is the treatment of choice.

8. Displacement of marginal acetabular fragments is usually corrected by manipulative reduction or by traction.

9. Sciatic paralysis in dislocation of the hip joint is nearly always due to damage of the nerve by a displaced acetabular fragment. In such cases, if the fragment is not replaced accurately by manipulation or traction, operative reduction is urgently indicated.

Arthrodesis of the hip joint performed between the ages of twelve and fifteen years, is the most satisfactory treatment for cases of pathological dislocation after acute suppurative arthritis in infants.

1 . Attention is drawn to the not infrequent occurrence of downward subluxation of the shoulder joint accompanying fractures of the upper end of the humerus.

2. Such cases fall into early or late groups according to the time of onset of the subluxation.

3. The subluxation often disappears spontaneously, but it may persist and cause disability. It cannot safely be disregarded.

4. The etiology is discussed and experiments are described which lead to the conclusion that the subluxation is due chiefly to lack of tone in the scapulo-humeral muscles supporting the weight of the limb.

5. It is suggested that the use of a collar and cuff sling as a method of treatment for fractures of the shoulder is not without danger. A triangular sling usually prevents or cures the displacement.

1. Fifty dislocations and fracture-dislocations of the pelvis have been reviewed.

2. Complications were unusual. Two patients with rupture of the bladder died; two with rupture of the urethra survived. Of eight patients with retroperitoneal haemorrhage four died; the treatment advised is controlled blood transfusion maintaining a blood-pressure of not more than 100 mm.

3. Two types of pelvic disruption should be distinguished: 1) pubic injury with sacro-iliac dislocation; 2) pubic injury with fracture near the sacro-iliac joint. The first is twice as common as the second.

4. In each type, displacement is maintained by extension of the hip and outward roll of the limb. This may be controlled by the Watson-Jones plaster method but the pelvic sling technique is preferred and was used in all cases in this series.

5. The prognosis in fracture-dislocations is very good; nearly all patients went back to heavy work.

6. The prognosis in sacro-iliac dislocations is not so good; only half the patients went back to heavy work and there was often persistent sacro-iliac pain. Sacro-iliac arthrodesis is advised in those cases.

1 . Twenty-four patients complaining of severe pain after nerve injuries have been considered from a diagnostic and therapeutic point of view.

2. The typical syndrome of causalgia develops only when the median or internal popliteal nerves are injured. It is doubtful whether pain associated with injury in the peripheral part of the limb, or of the brachial plexus, should be classed as causalgia.

3. The importance of novocaine block of the sympathetic ganglia as a diagnostic test is stressed, and its usefulness as a therapeutic measure is considered.

4. Sympathectomy is shown to be a reliable method of treatment in suitable cases.

5. The limited field of application of radiotherapy is also indicated.

1. The technique of compression-arthrodesis of the knee joint is described.

2. Fifteen consecutive cases are reported in which clinical union was detected at the first inspection from twelve days to six weeks after operation. By this method the total period of disability is reduced to three months.

3. Three mechanical factors which might be responsible for this very early clinical union are examined: compression is believed to be the main factor, although fixation is also important.

4. A fallacy is exposed in the use of bone grafts for arthrodesis of the knee; the graft is less osteogenic than the substance of the bones which form the joint, and it provides inefficient internal fixation.

5. A theory is suggested that compression, even in the presence of slight movement, acts by producing a fixed "hinge" without shearing movement; at this point a bridgehead of flexible osteoid tissue is established in which ossification inevitably takes place despite slight bending movement.

6. A second theory is suggested that high compression forces stimulate early union by liberating bone salts at points of maximum pressure through the action of osteoclasts, and that the local excess of bone salts is redeposited under cellular activity within a range of a few millimetres where there is no pressure.

1. Between 1936 and 1945, 525 patients with sciatic pain were treated at the Princess Elizabeth Orthopaedic Hospital, Exeter. Of these, 225 had neurological signs and they were selected for review; 147 were traced.

2. Of these, 123 were treated by means of plaster jackets and twenty-four were treated by other methods. The late results of treatment in the two groups were about the same, roughly one-third being "cured," one-third "relieved," and one-third "not relieved."

3. Nevertheless examination of the immediate results suggests that protection by means of a plaster jacket had at least a palliative effect, relieving acute symptoms and allowing early rehabilitation. Moreover it should be emphasised that in limiting the investigation to cases of sciatica with evidence of nerve root pressure only the more severe cases have been included.

4. Permanent relief after immobilisation in plaster was greatest when the duration of symptoms was short, and when the patient was treated during his first attack. It was least in patients who showed all three signs of nerve root pressure—diminished ankle jerks, hypo-aesthesia, and muscle hypotonicity.

5. Absence of tendon reflexes due to nerve root pressure, and areas of hypo-aesthesia, tend to remain permanently; but diminution of reflexes and loss of muscle power may recover.

1. Two inches of lengthening may be gained in the femur, and three inches in the tibia and fibula, without complication.

2. More than this may be secured at the risk of temporary external popliteal paresis.

3. Lengthening of the tibia and fibula is more certain and more easy to control than lengthening of the femur.

4. Traction, and counter-traction through the bone, with complete lateral rigidity, are essential to success.

5. In applying this technique to the femur there is a danger of knee stiffness. The farther from the knee the skeletal traction pins are inserted, the less is the risk. The operation should therefore be planned as high as possible in the shaft of the femur.

6. The most delicate structure, and the one least tolerant of stretching, is the external popliteal nerve.

7. An oblique osteotomy, started by closely spaced drill-holes, is the best.

8. Certain vascular complications experienced by other surgeons are attributable to subperiosteal bone exposure, and to dividing the periosteum and fascial structures transversely.

The technique of the transfibular approach for arthrodesis of the ankle joint is described. The results of this operation in a series of thirty cases shows that the procedure is reliable if the technique is carried out faithfully. The two cases in which a first operation failed can both be explained by errors of technique or after-treatment.

A method of nailing the femoral neck is described which combines efficiency with simplicity, both in method and in apparatus.

1. The work of Kellgren (1939) and Lewis and Kellgren (1939) on the production of segmental pain by stimulation of structures near the mid-line of the back has been reviewed, and! a number of experiments have been carried out with the object of testing the validity of their conclusions.

2. On both anatomical and experimental grounds there is reason to believe that pain produced in this manner does not arise, as was assumed by Lewis and Kellgren, from irritation of the interspinous ligaments, but is rather due to the stimulation of nerve trunks in the vicinity. The views of Kellgren (1941, 1942) on the etiology of pain in certain cases of sciatica, and on the part played by intervertebral ligaments in the production of pain in the back, have been discussed. They have been shown to rest on an inadequate foundation.

3. The importance in investigations of this kind of a detailed anatomical survey has been emphasized.

Benign giant-cell synovioma, the most frequent example of which is the well-known myeloid tumour of tendon sheaths, is used as a text for the discussion of the true significance of the so-called "xanthoma" cell. These cells are the result of the phagocytosis of cholesterol esters and are of varied histogenesis. Some are undoubtedly of neoplastic origin; most of them are not, being usually histiocytic, fibrocytic, serosal or endothelial. There is no such thing as a specific xanthoma cell.

The term "xanthosis" might well be used to designate this process of infiltration of tissue with cholesterol fat, and the prefix "xantho-" or the adjective "xanthic" in tumour terminology, as for example in "fibro-xantho-sarcoma," "xanthic neurofibroma," and so on.