1. The progress of recovery after transposition of the ulnar nerve has been studied in forty-six patients with ulnar neuritis of traumatic or mechanical origin.

2. In assessing the results, the lesions were divided into three grades according to the severity of the neurological signs: Grade I, minimal lesions with no detectable motor weakness; Grade II, intermediate lesions; Grade III, severe lesions with paralysis of one or more of the ulnar intrinsic muscles.

3. The earliest and most constant result after operation was the relief of discomfort and ulnar paraesthesiae.

4. The degree of motor recovery varied according to the severity of the lesion at the time of the operation. In Grades I and II cases, all the muscles (with one exception) were acting against gravity and resistance at the final examination. In Grade III cases, the recovery was usually far from complete. Recovery of sensibility was uniformly good.

5. In a further six patients with persistent symptoms after transposition, relief was obtained by free mobilisation and placing the nerve deep to the flexor origin.

Joint débridement, by excision of synovial membrane, osteophytes, degenerate cartilage, loose bodies, and frequently the patella, has relieved the symptoms of osteoarthritis of the knee joint twenty-three times in a series of thirty-five operations reviewed after periods of one to nine years. The operation is considered a useful measure when symptoms resist conservative treatment.

The case histories of these Black Notley patients show that no serious harmful effects have been caused by pregnancies going to full term. Most of the patients had normal confinements; Caesarian sections were few and were usually done for obstetric reasons, not for fear of reactivation of the disease. This experience bears out a remark made to me by Marcel Galland. When asked if Caesarian sections were required for women who became pregnant after treatment at Berck for skeletal tuberculosis, he replied: "Jarnais! Tout passe!"

Two patients in the series had artificial abortions, and one aborted spontaneously. Two of these three patients did not do as well as other patients whose pregnancies went to full term.

Quite another question is whether the onset of skeletal tuberculosis sooii after pregnancy may be attributed to the pregnancy. In a group of women of child-bearing age, it would be difficult to distinguish between post hoc and propter hoc in considering this question. One patient of this series, H. Q. (Case 25), was admitted eight months pregnant with active tuberculosis of the knee; but pain in the joint had started fifteen months before admission, and the onset of disease no doubt preceded the pregnancy. Some of the patients admitted to Black Notley were mothers of young children hut there is no note of any pregnancy having preceded the onset of tuberculosis by a short interval. The follow-up reports of the married patients compare favourably with those of the unmarried.

Further, it may be argued that pregnancy increases resistance to tuberculosis. Such a belief was current from the time of Hippocrates until the middle of the nineteenth century, and clinical evidence can be quoted in favour of such a view. In America, Lyman (1943) followed up 1,818 women who had been treated for tuberculosis in a sanatorium; many had married despite medical advice to the contrary. Lyman found that the late results of treatment were four times as good in the married patients as in the single women. Lyman says, "When we consider that the married group established this record in spite of the fact that 192 out of 315 gave histories of pregnancies (averaging 2·25 children each), it is clear that some factor not yet accounted for has exerted a profound influence in their cases."

I have speculated elsewhere as to what this factor may be (Wilkinson 1949). But it seems clear that increased sterol circulation in the body is associated with increased reticulo-endothelial activity (Fraser 1935). Thus reticulo-endothelial proliferation has been observed in the lesions of lupus following the administration of calciferol (Dowling, Gauvain and Macrae 1948). An increase of blood cholesterol is found during pregnancy. The sex hormones are sterols and might be expected to be raised in the marital state; it is perhaps significant that marital contacts form a group relatively immune to tuberculosis.

There would appear to be good grounds for reassuring the married woman who has suffered from skeletal tuberculosis regarding the prospect of normal pregnancy. Many letters received from patients in a follow-up of this sort are poignant documents. There is no doubt that the majority of these women desire children as ardently as normal women, and that a safe confinement following skeletal tuberculosis is an excellent form of rehabilitation.

1. Full recovery after fracture of the head of the radius in children may be expected in cases with tilting of the radial head from 30 to 60 degrees, whether treated by early manipulative or by operative reduction.

2. Manipulative reduction is facilitated by knowledge of the direction of displacement and tilting of the radial head, which can be determined by the study of appropriate radiographs.

3. When the upper radial epiphysis is completely displaced from the shaft, some permanent loss of movement is to be anticipated even when accurate reduction has been secured by operation. Early fusion and some deformity of the radial head are also to be expected. This is not surprising in view of the risk to the blood supply of the displaced head, particularly in those cases treated by operative reduction.

Spondylolisthesis without a defect in the neural arch, the "pseudo-spondylolisthesis" of Junghanns, usually affects the fourth lumbar vertebra. The essential lesion is an increase in the angle between tile inferior facets and the pedicles which allows subluxation at the inferior joints. The forward displacement averages less than one centimetre.

It commonly produces a clinical picture of backache and sciatica, but may present with. a "drop foot," and in unusual instances compression of the cauda euluina may occur.

Patients seen in the early stages without signs of nerve root compression are best treated by localised spinal fusion. Late fusion may afford no relief because of secondary changes in the spine, but these patients obtain some benefit from a corset. Laminectomy is indicated for severe symptoms in patients who show signs of nerve root compression; it should be followed by spinal fusion.

1. A condition of fibrous dysplasia of the jaws occurring in four brothers and a sister has been under observation since 1931.

2. Three of the five patients have been operated upon for correction of grotesque deformity, with satisfactory results.

3. The pathological nature of the disorder is discussed.

1. Two cases of osteochondritis dissecans affecting several joints are described.

2. There is no evidence that injury, congenital anomaly or constitutional disturbance played any part in the etiology of either case.

1. Maffucci's syndrome consists of dyschondroplasia (Ollier's disease) in association with cavernous haemangiomata and phlebectasia. Twenty-two cases have hitherto been described.

2. A further case is recorded with autopsy findings showing the characteristic features of the syndrome. Death was caused by a chondrosarcoma of the sphenoid, which led to subarachnoid haemorrhage, cranial nerve palsies, crossed hemiplegia and cavernous sinus thrombosis with almost total pituitary necrosis.

1. An attempt has been made to rationalise the selection of the site of amputation for gangrene in primary peripheral vascular disease.

2. There is a good chance of the survival of a below-knee stump if the circulation in the skin of the proposed flaps appears adequate clinically, and if the blood supply to the muscles is obviously good at amputation.

3. If the popliteal pulse is present before operation, below-knee amputation should succeed. The absence of a popliteal pulse, however, does not exclude below-knee amputation.

4. Below-knee stumps should be about four inches long in amputations for peripheral vascular disease.

5. Tests for determining the state of the circulation are also necessary before choosing the level for above-knee amputations.

Rupture of a ligament usually occurs along a definite line, but is associated with considerable intrinsic damage to the remote parts of the ligament. In spite of this, healing occurs by regeneration of regular collagen to form a new ligament with good tensile strength, provided the ends of the torn ligament are in reasonable apposition, and provided the blood supply is adequate.

When lateral instability of the knee after a recent injury suggests that a collateral ligament has been ruptured, wide displacement of the torn ends should be suspected. Accurate replacement can be guaranteed only by surgical intervention; operative repair therefore seems to be justifiable on anatomical grounds. If operation is contemplated it should be undertaken within the first week after injury when it is easy to achieve accurate repair, which later becomes impossible because of shrinkage and friability of the tissue. In order to preserve blood supply, the areolar covering should be disturbed as little as possible, and the least possible amount of fine suture material should be used to anchor the torn ends in position. Nevertheless when the tear involves the upper attachment, ischaemia of the damaged ligament may prevent normal healing, whatever the treatment adopted.