The organisation of accident services must be undertaken by the state as a quasi-military operation.

To provide the whole country with integrated accident services on the lines suggested in this memorandum will clearly mean the expenditure of considerable sums of money over many years. Nevertheless, a beginning must be made; and the British Orthopaedic Association recommends that Her Majesty's Government should authorise each Regional Hospital Board, in conjunction with Boards of Governors of Teaching Hospitals. to set up forthwith at least one comprehensive accident service within its area. In the fullness of time such units would be multiplied and integrated to form a nation-wide accident service. If the Government so desired, the Association would be willing to nominate an Advisory Panel to assist in the organisation of such an accident service.

1. The progressive radiographic changes in twenty-five patients suffering from Perthes' disease of the hip are described.

2. The prognostic value of lateral views of the hip is emphasised, and the present concepts of pathogenesis in the light of recent observations are discussed.

1. A case of vertebra plana (Calvé) is described and serial radiographs throughout the course of the disease are presented.

2. The initial radiographs showed a vertebra of normal depth which collapsed to a thin disc in fifteen days. Since the symptoms had begun twelve days before the first examination the total time taken to reach this stage was twenty-seven days.

3. The literature has been reviewed for evidence of the underlying pathology of vertebra plana. In the case described biopsy of the affected vertebral body was not carried out, and thus the nature of the underlying change could not be determined.

1. Fifteen patients with spina bifida occulta are described in whom the fifth lumbar spinous process was pressing on the fibrous membrane that closes the spina bifida, or on the bony stumps of the defective lamina.

2. That this is a cause of low back pain, with or without pain referred to the lower limbs, is supported by the findings at operation and the results of treatment.

3. Eleven patients were treated by operation; in each the spinous process of the fifth lumbar vertebra pressed against the spina bifida, either directly or through the vestigial remnant of the first sacral spinous process.

4. In eight cases the fibrous membrane was adherent to the dura mater; in one case the nerve roots were adherent.

5. Excision of the fifth lumbar spinous process and the membrane across the breach of the spina bifida was an effective method of treatment.

The following preliminary conclusions seem possible.

1. In early cases of Pott's disease of the thoracic spine in children the treatment should include chemotherapy, recumbency and costo-transversectomy. An exception may be made if severe destruction has led to subluxation of the column, when more radical surgery is indicated.

2. Combination of conservative treatment with costo-transversectomy can prevent spread of the disease along the vertebral column, and can lead to regression of this "spondylitis anterior."

3. The abscess can be totally eradicated and the risk of recrudescence therefore diminished.

1. The radiological features of skeletal hydatid disease are discussed. Osseous lesions occur in about 1 to 2 per cent of cases, bone being involved only after the embryos have passed the filters provided firstly by the liver and secondly by the lungs. At first, ill defined areas of translucency appear which are not diagnostic. In developed lesions, clear-cut destructive areas, with a surrounding sclerotic reaction, become visible. The cysts thin and expand the cortex and tend to spread throughout an affected bone. In advanced stages the cortex is ruptured, and exuberant hydatid cyst growth takes place in the adjacent soft tissue. Around this an ectocyst forms, which may later calcify, indicating death of the parasite. The progress of the disease is very slow.

2. Three cases of affection of the thoracic spine are described, and the differential diagnosis is considered, particularly from plasmacytoma and neurofibroma. Each case presented with cord pressure symptoms. Operative decompression relieved these totally in one case, incompletely in another, and not at all in the third and most advanced case.

3. With rapid and easy travel in the modern world hydatid disease is liable to be seen in areas where it is not endemic.

1. An operation is described for the relief of irreversible claw toes associated with prominent and painful metatarsal heads.

2. The operation is suggested as an alternative to amputation of the toes.

3. The results of the operation done on twenty patients who have been followed up for a year or longer are reported.

1. A family is described of which several members in four generations suffered epiphysial growth disturbances of an unusual kind in the capital epiphyses of the femur, with shortness of stature.

2. This disorder forms one of a group of epiphysial growth disturbances which embraces several recognised disorders, whose effects on the epiphyses vary in severity. They may occur sporadically or they may be inherited as recessive or dominant characters.

3. Differentiation depends on the behaviour of the joint line–in other words, whether the epiphysis starts to show defects through inability to sustain the stress of weight bearing. In the most serious cases the picture is that of Morquio-Brailsford's disease; when the changes are less severe the appearance may be that of bilateral Perthes' disease. Differential diagnosis is no longer possible in later life, because the ultimate condition of the defective femoral heads is the same. Only in the hereditary cases is one able, by studying the capital epiphyses of the hip in childhood, to differentiate between the changes like those of Perthes' disease on the one hand, and micro-epiphysial dysplasia without necrosis on the other.

1. The results of compression arthrodesis of the ankle performed on fifty-five patients (four bilateral) are presented.

2. Fifty per cent of these ankles were immobilised for a total period of no more than eight weeks.

3. Bony fusion occurred in 91 per cent.

4. The subjective result was good or excellent in 88 per cent.

5. The theoretical disadvantages of the transverse incision are not serious in practice.

6. The best position for arthrodesis of the ankle is at, or close to, the right angle.

1. Myositis ossificans as a complication of tetanus is described.

2. Ossification in mesodermal tissue is briefly discussed.

1. The method of treatment of a mallet finger deformity by immobilisation in a plaster in the position of hyperextension of the distal interphalangeal joint and flexion of the proximal interphalangeal joint is, on the whole, unsatisfactory because the splint is difficult to apply, it may need to be changed frequently, and it is sometimes complicated by pressure sores.

2. In many cases the deformity is still present after six weeks of adequate immobilisation, but gradual improvement from the contraction of fibrous tissue occurs for up to six months.

Therefore an assessment of the results of any method of treatment should be made only after an interval of at least six months.

3. The subjective end results at the end of six months are satisfactory whether or not there has been efficient immobilisation in hyperextension. Few patients have any disability and only rarely is this sufficient to cause interference with normal activities. A high proportion of patients show slight persistent deformity and limitation of movement, and this is seemingly uninfluenced appreciably by the type or duration of treatment.

4. The only treatment necessary for most cases of mallet finger is the application of elastic adhesive strapping or a straight spatula splint in order to relieve the initial discomfort from the injury.

1. The hip joint usually acts as the fulcrum of a lever system.

2. The centre of gravity of supported parts, which is usually medial to the hip joint, exerts a rotational effect upon the pelvis. If pelvic position is to be maintained this force must be counterbalanced by hip muscles.

3. The force transmitted by the hip joint is the sum of the supported body weight and the tension in the balancing muscles. This force often exceeds the total weight of the body.

4. In some circumstances the loss of one pound of body weight relieves the hip joint of three pounds pressure.

5. A long femoral neck is an advantage to hip function, but in arthroplasty this must not lead to mechanical failure such as breaking or loosening of the prosthesis, or fracture of the bone.

6. Medial displacement of the femoral head upon the pelvis may cause a great decrease in joint pressure, but medial displacement alone of the shaft upon the head and neck does not influence the mechanics of the joint.

7. The position of the centre of gravity of supported parts is easily altered by slight variations in spinal position. Great changes in hip joint pressure are caused by small coronal spinal movements, but the advantage to man of being able to walk with the eyes steady outweighs the mechanical disadvantage to which his hip is subjected.

8. A femoral abduction osteotomy improves the mechanics of a hip joint deformed in adduction.

9. A walking stick or a crutch is most helpful in relieving joint pressure and reducing the work done by hip muscles.

1. Based on studies in seventy-five patients, a technique is described for body surface activity measurements over localised skeletal lesions up to one month after injection of the λ-emitting isotopes Ca⁴⁷ and Sr⁸⁵.

2. The activity was high over skeletal lesions like fracture, metastatic cancer, eosinophilic granuloma, chondroma, osteomyelitis and Paget's disease.

3. The high isotope uptake is interpreted as evidence of an increased rate of bone tissue turnover.

4. These findings suggest that external counting of Ca⁴⁷ and Sr⁸⁵ may be used for quantitation of the rate of formation of normal and pathological bone tissue. A special application would be localisation and delineation of metastatic cancer in cases where radiographic evidence is uncertain or non-existent.

1. Severe osteolathyrism has been induced in chicks of different ages by a diet containing 50 per cent seeds of Lathyrus odoratus.

2. In these chicks, most of which became paraplegic after seven days, a meningeal tumour, articular and bony deformities, spontaneous fractures and osteoporosis have been observed.

3. In cartilage the lesion involves depletion of both neutral and acidic polysaccharides.

4. The primary effect on bone consists of changes in the osteoblasts and in the osteocytes involving cytoplasmic granulation and vacuolation, "mineralisation" and eventual disintegration of the cells.

5. These events are followed by osteoporosis. abnormal mineral deposits in the marrow spaces and reactive callus-like activation of the periosteum.

6. The role of the osteoblast and of the osteocyte in mineral transit and deposition is reconsidered.

1 . Young Wistar rats fed on a diet containing 0·3 per cent semicarbazide hydrochloride developed the characteristic lesions of osteolathyrism. This consisted of kyphoscoliosis, displacement of epiphyses and dislocations of joints. A pathological study of the skeletal lesions showed widening, disorganisation and tears of the epiphysial plate with the zone of maturing cartilage showing the greatest increase in width. The severe kyphoscoliosis was due to a derangement and displacement at and through the epiphysial plates of the twelfth thoracic or first lumbar vertebra.

2. Some of the compounds that are known to produce osteolathyrism in laboratory animals are beta aminopropionitrile, amino acetonitrile, mercaptoethylamine and semicarbazide. The mode of action of the lathyrogenic compounds was analysed in the light of a number of experiments done in this laboratory.

3. lt is possible that they interfere with the metabolism of the epiphysial plate. There appears to be a decreased polymerisation of the ground substance of the epiphysial cartilage, but the exact metabolic reaction involved is not known. Other chemicals of similar structure, with the same reactive groups, did not show lathyrogenic properties. It is concluded that it is not a particular chemical structure, configuration or specific reactive group that is responsible for the production of osteolathyrism. The chemistry of the lesions still remains to be solved.

The main findings in this experimental work on rats fed on lathyrus odoratus (sweet-pea) meal are as follows:

1. Growth is retarded.

2. The growth plate is disorganised and normal ossification at the metaphysis is interfered with.

3. The small blood vessels are seriously affected and probably contribute quite largely to the disorganisation and lack of calcification.

4. Alkaline phosphatase activity is increased.

5. Raising of the periosteum and laying down of new bone result in exostoses. The possible underlying etiology and the role of cement substance, endocrine factors and the blood vessels are discussed.