I have tried to describe the functional attainments of amputees using conventional prostheses. I have outlined the work we have been doing on pneumatic arms for infants and children. I have discussed some of the practical problems in applying pneumatic and myo-electric systems to adults. The inescapable conclusion that one must reach is that two basic clinical requirements must be met before really significant advance is made in this field. Firstly, we must find a method of providing sensory information from the prosthesis. Secondly, we must find a way of utilising more control sites. So far we have only been able to make use of direct movements or myo-electric signals. In the high level bilateral subjects more controls are required than appear to be available. Capener has suggested, in more than one discussion that I can recall, the possibility of using the voice and I have no doubt that a subject could be trained to reserve certain frequencies for prosthetic controls. It may be that we will have to think along some such lines as this.

1. A prosthesis under myo-electric control is described.

2. An advanced technique of proportional control of such a prosthesis is outlined.

1. A bio-electrically controlled limb for forearm amputees is described.

2. The technique of its use and its advantages are listed.

1. The Hendon motor and the Hendon valve are described.

1. A description of the planning for the application of a powered prosthesis to a child with bilateral upper limb deficiency is given.

2. Details of twenty such children are recorded.

1. The working of an electrically powered prosthesis is described.

2. The advantages of this method are discussed.

1. The University of Cape Town leg is described.

2. A brief discussion of the principles of a powered lower limb prosthesis is given.

1. The various methods of powering orthoses are described.

2. The details of control systems are given.

3. The applications of these systems are described.

1. Orthotic systems for the upper limb are described.

2. Two patients are described to illustrate the value of the systems.

Future devices will be more reliable, although more versatile and complex. They will require less attention and maintenance, but more skill when maintenance or repair is necessary. They will require less training of the patient before he can use them successfully and will be more immediately responsive to his wishes, giving smooth, integrated movements, varying with the intensity and direction of his effort.

1. Thirty-four patients with severe lumbo-sacral subluxation have been studied. Twenty-nine of these came for advice between the ages of nine and nineteen, and of these, twenty-five developed symptoms and signs of a characteristic syndrome.

2. The details of the syndrome are described: the essential features are spinal stiffness, a lordotic gait, resistance to straight leg raising, and in some cases evidence of interference with cauda equina or nerve root.

3. The danger of attempted reduction by traction is stressed, as well as the difficulties to be encountered during posterior lumbo-sacral fusion.

4. The reasons for operating are given; the results of spinal fusion were satisfactory.

5. The traditional apprehension concerning the effect of severe subluxation on childbirth has probably been over-stressed.

6. The tendency to slip was almost completely arrested by spinal fusion.

1. The follow-up reports of ninety-one joints affected by rheumatoid arthritis and treated by synovectomy showed that seventy-three joints remained free of pain. Forty-nine out of ninety-one joints retained useful function after a period averaging three and a half years.

2. The average duration of the disease before admission was eight and a half years.

3. The joints causing most distress were selected for operation. Better results might have been obtained if these patients had received constitutional treatment, splintage and synovectomy earlier. Many of these patients had advanced disease which was continuing to advance at the time of their admission, in spite of previous treatment. Many accepted a trial of treatment in a long stay hospital as a last hope.

4. The return of forty-eight out of sixty-two patients to unassisted or nearly unassisted activity and the maintenance of this state in thirty-nine out of fifty-four shows that the success of the pilot scheme conducted in cooperation with Dr W. S. Tegner and Dr R. M. Mason of the London Hospital has been confirmed by further experience.

1. A rationale of subtrochanteric osteotomy with derotation and varus angulation in the treatment of Perthes' disease is suggested.

2. Three months after operation the child returns to a normal unrestricted life.

3. The anatomical results in twelve such operations with an average follow-up of two years and five months are presented. In five children the results were "very good," in four "good," in one "fair" and in one "bad."

4. These results seem to compare favourably with those observed after conservative treatment of two, three or more years duration.

1. A survey of 112 cases of residual poliomyelitis with leg shortening of 2·5 centimetres or more is reported.

2. In eighty-seven patients paralysed in early infancy the fibular shortening was greater than the tibial shortening.

3. The absence of the normal "to and fro" motion of the fibula causes delay in the appearance of the fibular epiphyses and retards fibular development.

4. The shortening of the fibula in infancy causes deformity at the ankle, in the tibia itself and at the knee.

5. At the ankle the poorly developed lateral malleolus causes wedging of the lower tibial epiphysis and valgus at the ankle, which is often unstable.

6. At the knee progressive genu valgum is produced and in the tibia lateral torsion occurs.

7. The clinical significance of these deformities in relation to reconstructive procedures is stressed.

1. Three cases of traumatic thrombosis of the iliac arteries and one case of a false aneurysm of the internal iliac artery following closed injuries are described.

2. Results of the treatment of these cases are discussed.

1. A case of femoral artery occlusion after fracture of the femur occurring several days after internal fixation with a medullary nail is described.

2. Arterial reconstruction was undertaken seventeen days after the internal fixation, twenty-seven days after the injury, with restoration of flow and recovery of the limb.

1. Forty cases of congenital constriction bands are reported and certain patterns of abnormality and their management are discussed.

2. Attention is drawn to the relative frequency with which this condition occurs in the Malays of Singapore.

1. One hundred babies under the age of one year with untreated structural idiopathic scoliosis have been studied and the outcome assessed.

2. Ninety-two recovered spontaneously. Five developed progressive curves of bad prognosis and three developed secondary structural (double primary) scoliosis.

3. It is suggested that intrauterine moulding may cause the deformity.

1. The records of forty-nine patients with idiopathic structural scoliosis in infancy treated by a combination of splinting and physiotherapy have been reviewed.

2. Nine curves (18·3 per cent) failed to respond to treatment and five of these progressed.

3. The percentage of good results (81·7 per cent) shows no improvement on the natural course of the condition.

1. A primary subacute type of staphylococcal osteomyelitis has been described. It is the commonest form of osteomyelitis seen in East Africa, and the incidence appears to be increasing in Great Britain.

2. A review of the literature indicates that this is not a new disease but that in the past there has been some confusion in terminology.

3. The causative organism is a coagulase positive staphylococcus, but in a few instances a coagulase negative one has been isolated. The staphylococcus is thought to be of reduced virulence and in East Africa it is likely that the population has acquired an increased resistance to the staphylococcus.

4. Two radiologically distinct groups are recognised, depending on whether a bone abscess is present or not. In the first group there are two types of localised abscesses: the familiar Brodie's lesion and the less well recognised large bone abscess that occurs in the metaphysis of a long bone. While the pathology of the two types is similar, the radiological features are quite distinct. The lesions in the second group are characterised by extensive diaphysial changes, with or without metaphysial involvement, and an obvious abscess cannot usually be demonstrated.

5. The main clinical features are the long history, often weeks or months, before diagnosis; insignificant or absent general reaction to the infection and minimum physical signs.

6. Vertebral body osteomyelitis in adults is included because it generally presents as a subacute infection; the difficulties in distinguishing it from a tuberculous infection are outlined.

7. The most useful diagnostic aids are the staphylococcal antibody titres (especially in vertebral infections) and the erythrocyte sedimentation rate. A limited surgical exposure is usually required if the causative organism is to be isolated and empirical antibiotic therapy is to be avoided. The total and differential white blood count are so often normal in these patients that they are considered to be of no diagnostic value.

8. Curettage and local antibiotics together will cure the localised bone abscess. Other lesions may be effectively treated by systemic antibiotics alone, but in the later stages removal of sequestra and infected granulation tissue may be necessary. In this instance it is essential to make a planned incision and to cut a window in the bone large enough to expose the whole of the lesion; primary suture of the wound is advocated.

1. Tarsal coalition often presents with the clinical picture of a peroneal spastic flat foot, but may present with a painful varus foot and spasm of the tibial muscles.

2. Three cases of tibialis spastic varus foot are described with a calcaneo-navicular bar as the associated anomaly.

3. Complete excision of the bar with interposition of the origin of the extensor digitorum brevis muscle appears to be a satisfactory method of treatment when carried out at a sufficiently early age.

Although an osteosarcoma appears to be a solitary lesion clinically, as in this instance, only routine radiographic skeletal survey in such cases will detect multiple osseous involvement. Ross (1964) reported that in ninety-eight cases of osteosarcoma arising in apparently normal bone, fifteen showed metastases to other bones, a much higher incidence than previously recorded. It is also possible that multicentric osteosarcomata, although undoubtedly rare, may be discovered more often if a radiological survey is done. In many large series of osteosarcomata no mention of a skeletal survey has been made, and, while this is routine in some centres, it is not yet general practice.

1. After almost seventeen years the three metal prostheses remain in approximately the original position in which they were inserted.

2. All three patients are ambulatory and two of them pleased with the result.

3. The youngest patient, now fifty-six, has a solid ankylosis of the hip and leads an active life free of pain.

4. In view of the attritional changes which have been seen to occur as a result of the reaction of bone to metal, it is suggested that resection replacement operations should be reserved for the primary treatment of certain fractures in the elderly and in those patients who are expected to be mostly inactive for the rest of their life. As a rough guide, it is considered that the operation should not be carried out under the age of seventy.

1. On the basis of radiographic studies the incidence of degenerative change in the intervertebral disc in primitive squatting populations is considerably less than that found in civilised peoples.

2. The suggestion is made that lordosis is implicated in the pathogenesis of degeneration, but further studies are required.

1. At necropsy the arterial distribution within the head and neck of the femur was investigated by arteriographic injection in fifty-seven uninjured hips of mostly elderly subjects.

2. Before injection all vessels to the head except for one or more particular groups were divided.

3. The superior retinacular arteries were found to be the most important arterial supply to the head. Through the widely distributed branches of their lateral epiphysial vessels (superior capital) they supplied the superior, medial, central and usually the lateral parts of the head: through anastomoses they could also supply the anterior and posterior segments, the subfovea and the inferior sector, which receive separate contributions. Sometimes the inferior or the lateral connections were defective.

4. The arteries in the ligamentum teres were either absent or unimportant for the head in most subjects. Either the vessels in the ligament never reached the head or they supplied only a limited subfoveal zone. In only one out of sixteen specimens was the whole head injected through the vessels of the ligamentum teres.

5. The inferior retinacular arteries were found to be of subsidiary importance and generally supplied a variable infero-lateral part of the head, particularly posteriorly. In a small number there was an anastomotic supply to other parts of the head, but only in two out of sixteen specimens was nearly all the head injected through these vessels.

6. The regular anastomotic supply from the superior retinacular arteries to the subfovea and to the inferior part of the head was in curious contrast to the infrequent anastomotic filling of the lateral epiphysial arteries from the inferior retinacular or ligamentum teres arteries.

7. Vessels within the femoral neck sometimes supplied the lateral part of the head but never the medial three-quarters.

8. The neck of the femur received important branches from the superior retinacular arteries but only in a small number (15 per cent) was part of it entirely dependent on this supply.

1. A hypothesis outlining an auto-immune mechanism for antibody production against autogenous nucleus pulposus is presented.

2. Auto-antibodies to autogenous nucleus pulposus have been experimentally produced in rabbits.

3. These antibodies are cell-bound within lymphoid cells and are greatest in primary lymph nodes. This antibody is demonstrated by a positive pyronin reaction.

4. Lymphoid cells fixed in Carnoy's fluid and stained for pyronins also show a distinct natural yellow fluorescence. This fluorescence occurs only in the cytoplasm of those cells which are pyronin-positive and presumably producing antibody.

5. The lymph node phase of the reaction is greatest at four days and is sustained for three weeks. A secondary generalised lymph node response occurs in all lymph nodes at six weeks.