1. Metabolic balance studies in two cases of the Fanconi syndrome are presented.

2. The actions of sodium bicarbonate and calciferol on the calcium and phosphorus balance were observed separately in the two cases.

3. The results show that sodium bicarbonate alone corrects acidosis and decreases the loss of calcium in the urine.

4. Calciferol in high dosage will increase intestinal absorption of calcium and phosphorus, but the urine calcium excretion then increases and vitamin D alone does not, therefore, give a positive balance adequate for complete healing and normal growth.

5. Alkalies and calciferol together put these cases into strongly positive calcium and phosphorus balance and promote healing of rickets, osteomalacia and pseudo-fractures.

6. Large doses of sodium bicarbonate in tablet form correct acidosis, do not adversely affect intestinal absorption of calcium, and facilitate accurate dosage and convenient administration.

7. Alkali therapy may lower serum potassium and precipitate symptoms of hypokalaemia in potassium-losing patients. This is thought to have been the cause of symptoms in several cases reported in the literature.

1. The distribution of the permanent paresis and paralysis in the muscles of 203 lower limbs affected by poliomyelitis is analysed and related to the destruction of motor nerve cells in the grey matter of the lumbo-sacral cord.

2. The tibialis anterior and tibialis posterior and the long muscles of the toes are more often paralysed than paretic; these muscles are innervated by short motor cell columns. Muscles such as the hip flexors and hip adductors that are more often paretic than paralysed are innervated by long cell columns.

3. Muscles innervated by the upper lumbar spinal segments are more frequently affected than those innervated by the sarcal segments. This agrees with the segmental incidence of motor cell destruction found in poliomyelitic spinal cords.

4. Each muscle or muscle group is associated in paralysis with other specific muscles. For instance, the long toe extensors with the peronei and the calf muscles (triceps surae) with the biceps femoris. Associated muscles are innervated by adjacent motor cell columns. The probability of recovery in a paralysed muscle can be determined by reference to the degree of involvement in its associated muscles.

5. The distribution of the paralysis in an individual lower limb is determined by the site and size of foci of motor cell destruction. The cell loss in certain common patterns of paralysis is described.

6. The practical application of these findings is discussed.

1. A realignment operation is described for the treatment of recurrent dislocation of the patella.

2. In twenty-three patients (twenty-seven knees) operation prevented further dislocation. The physical and functional condition of the knees two to twenty years after operation is described.

3. Patello-femoral osteoarthritis was not a clinical complication in any of these patients. This finding is discussed.

4. Genu recurvatum developed in four patients operated upon between the ages of ten and thirteen years. The cause of this deformity is discussed. It is concluded that the realignment operation should not be performed under the age of fourteen years.

5. In three patients operation failed to control the recurrent dislocation.

1. Forty patients out of sixty-nine operated upon between 1932 and 1952 by displacement osteotomy for congenital dislocation of the hip, ununited fracture of the neck of the femur, and osteoarthritis of the hip have been reviewed and the results analysed.

2. The factors responsible for the success of the operation are discussed and the technique of operation is described.

1. A measuring instrument is described which enables the surgeon to determine the anteroposterior diameter of the vertebral canal during operation.

2. Developmental narrowness of the lumbar vertebral canal is shown to exist and to be caused by an abnormally short antero-posterior diameter.

3. In patients with a narrow, although not abnormally narrow, lumbar vertebral canal, slight deformities such as posterior spur formation or small disc protrusions may produce particular symptoms, which are interesting from a clinical as well as from a medico-legal point of view.

The characteristics of enchondromata of long bones are mentioned and the special features of a malignant chondroma of the calcaneum are described. The management of such a case is discussed.

1. The indications for the use of lively splints in upper limb paralysis instead of reconstructive surgery are discussed.

2. Examples of lively splints used for the elbow, wrist and hand are described and illustrated.

1. A case of low back pain due to a sacral extradural cyst is reported. Radiographs of the sacrum showed an ovoid expansion of the sacral canal. Myelography and exploratory laminectomy revealed an extradural cyst associated with a defect in the dural root sleeve surrounding the second left sacral roots. Relief of symptoms followed evacuation of the cyst and repair of the defect.

2. The differential diagnosis of the condition, the varieties of extradural cyst, and the features which distinguish them from perineurial cysts are described.

1. Two cases of fatigue fracture of the ulna are reported.

2. Three cases previously reported are reviewed and a striking similarity with one of the present cases is noted.

3. In all cases the mechanism of injury appears to have been the same.

1. A case of multiple pseudo-cystic tuberculosis of bone presenting as a generalised disease of the skeleton in a child is reported.

2. The response to streptomycin and para-amino-salicylic acid is shown.

3. A possible explanation of the etiology of this rare disease is suggested.

1. Three cases of hereditary sensory neuropathy are reported.

2. Neuropathic destruction of joints and chronic infected ulcers are the primary problems of management.

3. This entity must be considered in the differential diagnosis of trophic ulcerations of the extremities.

A short experience with melamine resin plaster-of-Paris bandages is described. The bandages make a lighter splint with a saving of material and time, and the splint is more durable.

Clinical trials and experiments with a new plaster-of-Paris bandage which can be used in the normal manner are described. Only about two-thirds of the usual number of bandages are required to produce a plaster case of equivalent strength.

1. An experimental technique for the transplantation of epiphysial cartilage in the rabbit is described.

2. Autogenous transposition of the distal epiphysial cartilage of the ulna was followed by normal growth in five of eighteen animals.

3. Homogenous transplantation was unsuccessful in all the animals studied.

4. Homogenous grafting gives rise to an immunity reaction confined to the reserve Zone of the cartilage.

5. It is suggested that the difference between the fate of homogenous grafts of epiphysial and non-epiphysial cartilage lies in the vascularity of the former.

After the simultaneous administration of radiocalcium and radiophosphorus to young rats the rate of deposition of calcium and of phosphorus in various skeletal parts was computed. Agreement was found between the two sets of data. No difference was thus found in the metabolism of the calcium and of the phosphorus of the bone salt.

1. An attempt has been made to correlate the radiographic appearances and the morbid anatomy of the cystic changes that occur in the head of the femur in advanced osteoarthritis.

2. The suggestion is made that these lesions are foci of traumatic bone necrosis. Repair may be complicated by the subsequent entrance of synovial fluid through defects in the surface.

1. Experiments using radio-isotope techniques show that whenever an orthopaedic appliance is inserted into the body tiny fragments of the instruments used to handle it become detached and welded on to the surface of the buried metal.

2. There is evidence that these particles of non-passive tool-metal may cause a small but continuing dissolution of the stainless metal to which they are attached, and that this dissolution, although too small to be detected as visible corrosion, may produce an adverse tissue reaction.

3. In samples of human tissue taken from sites adjacent to buried metal the greatest level of tissue reaction and the highest concentration of iron were found near those parts of the appliances that had been handled with the tools and received the greatest amount of transferred metal.

4. Spectroscopic analyses of similar samples confirmed that the concentration of metal in the tissues surrounding a buried appliance correlates closely with the distribution on its surface of transferred tool metal. Particularly high concentrations of chromium, nickel, and cobalt were found near regions where the transfer had been heavy. The dissolution was not limited to the non-passive foreign metal; the stainless appliance was also dissolved in those regions.

5. The influence of the manner of handling the tools on the amount and distribution of transfer has been studied, and suggestions are made whereby the transfer might be reduced.

1. The utilisation of radioactive sulphur in vivo has been demonstrated both macroscopically and microscopically during the preosseous stage of bone repair.

2. The labelled mucopolysaccharide complex, chondroitin sulphuric acid, has been studied during the formation of the medullary and periosteal blastemata in the healing of a fracture.

3. The appearance and possible significance of mast cells adjacent to a fracture, and resulting from the stimulus of trauma, are discussed.

4. Cortisone has been seen to affect the formation of the periosteal cartilaginous blastema and subsequent process of endochondral ossification, with liberation of increased amounts of chondroitin sulphuric acid which was calcified rather than ossified.