At the end of this short study we have to sum up our views about the use of the acrylic prosthesis for arthroplasty of the hip. Some fatalities and a proportion of bad or poor results make this operation one to be undertaken only by surgeons well trained in the surgery of the hip and only on patients who really need it. However, the tolerance of the tissues to acrylic resin and the fixation of the stem in the neck of the femur promise to be lasting. We know that a much longer time is necessary to confirm these general statements, which proceed from an experience of only five years and the study of six hundred cases.

1. Dissections have been made of the cervico-brachial region.

2. The possible causes of the scalenus anterior syndrome are discussed and an attempt is made to relate them to the anatomical findings.

3. It is suggested that a more suitable description is the "first rib syndrome," and that the most logical treatment is to remove part of the offending first rib.

1. The technique of nucleography, in which a radio-opaque watery solution of iodine is injected into the nucleus pulposus for contrast-radiography, is described.

2. The merits of the procedure in demonstrating the shape and condition of nucleus are discussed.

1. The steps of the operation of spinal osteotomy, as carried out with the patient in the lateral posture, are described.

2. Details of post-operative management are given.

3. The major risks of the operation are discussed and precautions suggested.

1. Two cases of deposition of calcium in the medial ligament of the knee are described. Pain was a prominent feature in both.

2. A review of the literature suggests this is an uncommon condition.

3. The condition closely resembles supraspinatus calcification, and the etiology is probably similar.

4. Both cases were treated by operation, with complete relief of symptoms.

1. A case of Volkmann's ischaemic contracture, in which function was greatly improved by a muscle slide operation, is described.

2. The possibility of regeneration of muscle after ischaemia is reviewed in the light of recent research.

3. Injection experiments suggest that the forearm flexors, like the gastroenemius,are supplied by end arteries.

While it is not denied that immobilisation of a diseased joint may be essential, there is a growing mass of evidence that immobilisation in recumbency of the whole patient has severe effects both in the neighbourhood of the actual lesion and upon the skeleton as a whole. Further search for measures to counteract the undesirable skeletal effects of recumbency is much needed.

1. Cases of rickets and osteomalacia caused by kidney tubule defects have been classified into six sub-groups according to the various disturbances of tubule function concerned.

2. The manifestations, treatment and prognosis appropriate to the sub-groups have been considered.

3. The name "tubular rickets" (or osteomalacia) is suggested for these cases of mainly tubule dysfunction in contrast to "glomerular rickets" (or osteomalacia) which might be used to distinguish cases in which defect in the glomeruli overshadows and precedes that in the tubules.

Amputation or post-mortem specimens from eight cases of joint tuberculosis, with immobilisation changes in bone, have been studied by fine-detail slab radiographs and subsequent histological examination. The findings in three of these cases are presented in detail.

The immobilisation changes take the form of a true osteoporosis, which is strikingly focal in nature. In the adult the sites of most marked involvement include the subcortical bone adjacent to articular surfaces and the bone in the neighbourhood of the obliterated epiphysial plates.

Areas of permanent change in bone structure may result, although commencing "repair" is seen in the form of newly developed bone trabeculae in the osteoporotic areas.

In one case, where immobilisation occurred at an early age, changes in the growing epiphysial plates were produced in addition to osteoporosis. This is correlated with the known susceptibility of growing epiphysial cartilage to a wide variety of damaging agents.

Radiologically, it is important to discriminate between these immobilisation changes and the bone destruction which might be produced by extension of the tuberculous lesion itself.

A Judet-type arthroplasty of the hip was performed. The patient died fourteen days after the operation. The upper end of the femur was examined and showed extensive necrosis surrounding the stem of the prosthesis.

There are a host of other muscles in both upper and lower limbs whose form and structure will repay careful study. Study of a macerated bone can at most teach one the precise bony attachment of a muscle. It tells nothing of other non-osseous attachments, nothing of the form of the living muscle that gives shape to the limb, and nothing of the surface structure of the muscles, knowledge of which can be used not only to recognise them at operation but to understand their normal function in relation to neighbouring parts.