Streptomycin and the newer antibiotics have already belied the pessimistic agnosticism of 1947. In certain instances, notably in disease of the knee and hip and in some cases with draining sinuses, it appears that they are sufficient to produce a quiescence which may be a cure. For the rest it remains to map out in detail what has in part been explored. In particular it is essential to confirm how far antibiotics enable surgeons to treat tuberculosis upon the basic principles applicable to other infections of bone without fear of secondary infection: where there is diseased bone, to remove it: where there is pus, to relieve the tension and evacuate it. The surgeon fears not so much the infection itself as the inability of the tuberculous soil ordinarily to deal with secondary infection. With the control of the diseased soil the risk should be no greater than that of any other surgery of bone.

The early case and the advanced case; age and site of disease; these and other variables must subdivide basic method. What is the best application of the new "combined operation" to a child of three with thoracic Pott's disease and a globular abscess? What is the wisest plan for a man of forty with old disease in his lumbar vertebrae and discharging sinuses? We begin to see what we could do. At the present the question still remains: What should we do?

Streptomycin and iso-nicotinic acid hydrazide are two powerful drugs lethal to tubercle bacilli, when access to the infected tissues is free. For early disease, before ischaemia and necrosis become established, they are curative: afterwards they are not. In this paper the use of surgery to augment their action has been discussed. The development of such methods may well revolutionise the treatment of skeletal tuberculosis. Therein lies a danger because attempts to cure the patient by exterminating the tubercle bacilli in his lesion may lead to a precarious recovery: treatment directed against the bacilli may greatly facilitate a real cure if constitutional treatment is also applied to make the patient immune. Revolutionary though the change may become, it will not be so great as the revolution which occurred thirty years ago when open-air hospitals were first provided for patients with skeletal tuberculosis. The first patient ever seen on a surgical ward by the author, when he was a student, suffices still as an example. A child with tuberculosis of the cervical spine was admitted from out-patients with multiple discharging sinuses from the neck which was supported in a sodden plaster jacket. "Whoever," said the house surgeon dramatically, "removes that plaster, will kill that child." Most unfortunately his words were true. Many other such patients could, in those days, be seen in the wards of city hospitals. It was largely due to the work of Sir Robert Jones, friend of children, that the value of constitutional treatment became recognised. With the combination of the old knowledge and the development of the new, a new chapter in the treatment of skeletal tuberculosis has opened and rapid restoration of function and permanent cure can now take the place of long and sometimes crippling illness.

The evolution of an idiopathic scoliosis is determined by the site of the primary curve and by the age of onset. It is significant that thoracic primary curves are commonly severe and the early onset of this curve accentuates this feature. Early operation based on prognosis is practised but sufficient time has not yet elapsed to justify any conclusions.

1. Radiographic changes in bone structure which follow the insertion of an unplasticised acrylic prosthesis of the Judet type are described.

2. Technical details of the operation and their relation to these changes are discussed.

3. Although the period of observation is short it is suggested that after initial loosening the prosthesis becomes stabilised owing to local bone reaction.

1. The clinical and post-mortem findings are described of a patient who sustained a hyperextension injury of the neck with paraplegia.

2. There was no radiological evidence of fracture: osteoarthritis of the spine was present.

3. Evidence is presented that the cord was damaged from behind by the lamina of the vertebra below a tear in the anterior longitudinal ligament.

1. The technique of correction of mandibular protrusion and retrusion by osteotomies through the rami of the mandible is described and illustrated.

2. The best age for the operation, and the factors that might favour or prevent relapse, are discussed.

3. Illustrative cases are described.

1. A study of 2,200 patients receiving electro-convulsive therapy showed that fifty-three sustained fractures or dislocations—an incidence of 2·4 per cent. Of the fifty-three injuries, twenty-one occurred in the spine, fifteen in the neck of femur, fifteen in the upper end of humerus, one in the coracoid process; one dislocated jaw required anaesthesia for its reduction (other cases of transient dislocation of the jaw are excluded).

2. The incidence, site, and type of spinal fractures are recorded, and the relation of the fracture to the first convulsion is noted. No late changes were found in the spines of patients examined two years or more after treatment. A neutral position of the spine during the convulsion is believed to diminish the risk of fracture.

3. Fracture of the neck of the femur is a serious injury in these patients. In one case the injury was bilateral.

4. The fifteen cases of fracture-dislocation of the upper humerus are analysed. They included two cases of posterior dislocation of the humeral head; the possible mechanism of this is explained and a method of prevention suggested.

5. Fifty-three patients with chronic epilepsy with psychosis were examined. Four cases of fractured spine were discovered. The site of fracture was different from that of fractures caused by convulsive therapy and a reason for this is suggested. The type and mechanism of the fracture are similar in the two groups.

1. A case of post-tetanic kyphosis is reported.

2. The clinical and radiographic features are described.

3. The theories of the mechanism of production of the deformity are discussed.

1. The mechanism of production of injury to the lateral condyle epiphysis is discussed.

2. A technique of closed reduction of rotational displacements of the epiphysis is described. Nine cases in which the method was successful are noted.

3. It is suggested that the injury should be classified with dislocation of the elbow.

1. A case of fibrous dysplasia in a woman aged fifty, with unilateral skeletal lesions, cutaneous pigmentation and possibly accelerated skeletal growth, is described.

2. At necropsy, the bony changes were found to be complicated by many of the changes of lipoid granulomatosis. Disseminated plaques of demyelinisation were found in the central nervous system.

3. The implications of the case are discussed.

1. A lateral intermuscular approach to the hip joint is described for replacement of the head of the femur by a prosthesis.

2. Advantages claimed for it are that it is attended by little or no shock, because the operation is rapid and relatively bloodless; that adequate exposure can be gained without dividing muscle or tendon; and that muscle function is unimpaired and so walking can be allowed early. The exposure is easily extended if unexpected difficulty is encountered.

3. Prosthetic replacement of the femoral head through this incision is advocated as a primary measure for elderly or unfit patients with fractured femoral neck.

Radiological and histological examinations are described in a full term stillborn infant with punctate epiphysial dysplasia diagnosed in utero as achondroplasia.

1. A case is described of the marble bone disease of Albers-Schönberg in a woman of forty-one who died from subarachnoid haemorrhage. Several congenital abnormalities were present.

2. No significant abnormality of the chemical composition of the bones was discovered.

3. The long bones were more resilient, stronger, softer and of higher specific gravity than normal and the abnormal compact bone of the skull was less resilient, weaker, harder and of about the same density as normal bones.

4. The simple investigation of determining the breaking strength of cortical bone yielded results similar to the more complex investigations and if applied to a larger series of cases could provide sound data on which to base speculations about this condition.