1. One hundred and twenty cervical spines removed at routine necropsy from elderly patients dying in a general hospital have been examined.

2. There was some degree of degeneration of intervertebral discs in 110 cases–in forty-six this was severe.

3. Degenerative disc disease was found at an earlier age in men; mild damage preceded severe degeneration and collapse by about a decade.

4. Discs of the lower spine were most frequently and most severely affected.

5. Alterations of the normal cervical lordosis were produced by disc disease in thirty-two cases.

6. Osteoarthritis of the apophysial joints was found in seventy-eight, and by contrast to disc degeneration was commonest in the mid-cervical and upper cervical regions. In eighteen it was severe.

7. Degeneration and scarring of nerve roots was frequently associated with diseased discs; apophysial joint arthritis was found to be an important additional factor when it occurred in the lower cervical region.

8. No nerve root changes could be attributed to ischaemia resulting from narrowing or distortion of the vertebral arteries.

9. Cystic arachnoidal diverticula which excavate the posterior root ganglia were found in thirty-six cases.

1. Arthrography demonstrates two types of injury to the capsule in acute anterior dislocations of the shoulder.

2. The first is a capsular rupture which does not appear to lead to recurrent dislocation of the shoulder unless there is concomitant humeral head damage. In this group healing is complete in ten days and it should be safe to start exercises early.

3. The second is associated with labral detachment from the glenoid and most heal with immobilisation for three weeks. Failure to heal leads to recurrent dislocation. It is not known whether immobilisation had any influence on healing of the lesion in these patients and this remains the subject of further investigation.

4. In recurrent anterior dislocation of the shoulder there is constant enlargement of the subscapular bursa, the outline of which becomes continuous with the inferior pouch. Axial arthrographs show either an absence of the glenoid labral outline or an enlarged entrance to the subscapular bursa.

5. Ruptures of the supraspinatus portion of the tendinous cuff were seen in five patients out of a total of twenty-seven acute dislocations, suggesting that this associated injury is more common than was previously believed.

POSTERIOR DISLOCATIONS

6. When the dislocation is voluntary there is marked elasticity of the capsule but the joint is only unstable in one direction when examined under anaesthesia. Both shoulders appear equally affected when examined radiologically under general anaesthesia even though the patient only has the ability to dislocate one.

7. All patients with voluntary dislocation had a curious voluntary muscle control and were able to contract the anterior and posterior parts of deltoid separately. Each dislocation was preceded by scapular movement.

8. No evidence of increased joint laxity was found in other joints in any of the patients.

9. In two patients with acute dislocations the defect of the humeral head was seen after the initial dislocation and in the third patient it occurred at the time of the second dislocation. In all three there was a spill of fluid beneath the subscapularis but no leakage into the axilla as occurred in anterior dislocation with capsular rupture. The capacity for healing appeared greater than in anterior dislocations with labral detachment; one patient treated in a sling had a better functional result than another treated with the shoulder in lateral rotation.

1. The importance of recognising osteochondral fractures of the femoral condyle in the adolescent knee joint is emphasised.

2. The mechanism of the formation of the fractures is discussed. Essentially, a powerful rotary and compressive force shears off cartilage and subchondral bone. The absence of lateral condylar lesions in the experimental group lends support to the theory that the patella may cause the fracture by impingement.

3. On the basis of the mechanism a clinical classification of osteochondral fractures of the femoral condyles is presented.

4. Early surgery is recommended. The arguments for removal or replacement of the fragment are discussed.

1. A case is described of severe birth injury to the sternomastoid muscle in a breech-delivered two-day-old infant. The affected muscle showed widespread haemorrhage, fragmentation and necrosis of its fibres, and disruption and disorganisation of the endomysial sheaths.

2. Disruptive muscular trauma of this type is known to lead to florid fibroblastic proliferation with formation of a large mass of scar tissue. It is suggested that the "sternomastoid tumour" of infancy develops as a sequel to such trauma occurring during birth.

3. The theories of birth trauma and of ischaemia, in the etiology of the "sternomastoid tumour" of infancy and of congenital muscular torticollis, are not mutually exclusive but may be complementary, the circumstances causing the trauma also leading to ischaemic damage.

1. In seventeen cases of tuberculosis of the hip in children with severe destruction of the joint arthroplasty was done using full thickness skin from the abdominal wall as the interposing material.

2. The results, after a follow-up on the average of three years, show that one-third of the cases are very satisfactory, one-third are fair and one-third show no movement.

1. Prehension is a complex mechanism for which both movement and sensation are required.

2. Two basic grips are considered: the digital pinch and palmar grasp, which are simpler expressions of the precision grip and the power grip. For the digital pinch the minimum requirement is a thumb or a reconstructed thumb, and a finger to which it can oppose. For palmar grasp mobile fingers are necessary so that they can wrap round the object grasped.

3. The restoration of prehension is considered under the following headings: mutilation of the fingers; mutilation of the thumb; and mutilation of both together.

4. The various methods of reconstruction are described that are appropriate to each type of mutilation, so as to provide restoration of length, mobility and sensation.

5. The indications for the various main methods to compensate for loss of the thumb are discussed. These methods include pollicisation and osteoplastic repair with neurovascular island flap.

1. Cases are presented to show that blackthorn inflammation is not uncommon in the West Midlands.

2. The pathology is that of a chronic non-suppurative inflammation.

3. Cases are divisible into three groups on the basis of their history. In the third group, with no history of blackthorn trauma, diagnosis may be very difficult.

4. Removal of the blackthorn fragments causes prompt resolution of the inflammation.

1. Three cases of a benign osteoblastic lesion of bone are described. An outstanding feature of each was the hyperostosis of adjacent bones or synovitis in an adjacent joint.

2. The clinical, radiological and histological features resembled osteoid osteomata more than benign osteoblastoma in each case.

3. The significance of this observation is questioned in relation to the pathogenesis of osteoid osteoma.

1. A case of an osteoid osteoma in the terminal phalanx of a finger is recorded.

2. Unusual features were enlargement of the finger with nail hypertrophy, sweating, and premature fusion of the epiphysis.

1. A case of pseudomalignant osseous tumour of soft tissue is reported.

2. The relationship between this condition and myositis ossificans is discussed and the importance of differentiating it from osteosarcoma is stressed.

1. The case histories of four siblings affected by osteogenic sarcoma are described.

2. The lesions appeared over a period of twelve years. The ages of the patients at the onset of symptoms were fifteen, twenty, eleven and twenty-two years.

3. The diagnosis of osteogenic sarcoma was in each case established by radiological and histological methods.

4. Two patients survived for eight and sixteen years after treatment and both are still alive and well.

1. A patient with ectopic bone in the upper arm associated with multiple congenital anomalies is reported.

2. The previous cases of congenital abnormalities in patients with ectopic bone formation have been indicated and the problem of etiology has been discussed.

1. Three cases of Colles's fracture complicated by ulnar nerve paralysis are described.

2. Observation at operation in two cases and studies in a cadaver demonstrated a close relationship of the ulnar nerve to a fracture line at the lower end of the radius when the distal fragment is displaced dorsally and radially. It is surprising that this injury has not been observed and commented on previously.

1. Tetracycline labelling methods have been used to measure the rate of growth in length and the rate of growth in width of the tibia of the normal rat.

2. The main limitations of the tetracycline methods are that in very young animals the bands of labelled bone are indistinct and remodelling occurs quickly; in animals nearing maturity, the growth in width is very slow and periods of at least fourteen days are required to give reliable results.

3. The tetracycline labelling methods can be used also to determine changes in the basic processes of bone formation and bone resorption.

1. In growing rats oestrogen, cortisone and thyroxine in high doses suppress bone formation, and this effect is probably part of a general suppression of body growth.

2. Growth hormone and thyroxine in small doses stimulate both body growth and bone formation.

3. Testosterone has no effect on bone formation.

4. Oestrogen and cortisone suppress bone resorption. The effect of cortisone may be modified in conditions of calcium depletion.

5. Thyroxine appears on the other hand to increase bone resorption.

6. Testosterone has no effect on bone resorption.

1. The present study is an attempt to analyse and apportion significance to the role of inductive mechanisms in bone transplantation.

2. The experimental model used in the present work is that of the composite homograftautograft of cancellous bone previously described (Burwell 1964a).

3. Iliac bone was removed from hooded rats and washed free from its marrow. The bone was then treated by various physical and chemical methods (some of which have been used by other workers to prepare bank bone), namely freezing (-20 degrees Centigrade, -79 degrees Centigrade, -196 degrees Centigrade); freeze-drying (without sterilisation, sterilisation with high energy radiation, sterilisation with ß-propiolactone); decalcification (with E.D.T.A.); irradiation (in the frozen state at a dose of 4 million rads); boiling in water; immersion in merthiolate solution; extraction of organic components with ethylenediamine: and calcining at 660 degrees Centigrade. The treated bone was then impregnated with fresh autologous marrow procured from the femoral shaft of the Wistar rat into which the treated composite graft was to be implanted. The grafts were inserted intramuscularly and removed for study after two, six and twelve weeks.

4. After fixation, serial sectioning and staining, each graft was examined microscopically, and the proportion of new bone/grafted bone scored using an arbitrary scale (0-4). The mean score (and the standard error of the mean score) was then plotted for each treated composite graft and also for several types of fresh cancellous bone grafts.

5. It was found (Fig. 2) that the various treated composite grafts formed a spectrum of bone-forming capacities–the maximum scores being attained by the frozen and freeze-dried composite grafts, the lowest scores by the "deproteinised" composite grafts.

6. The reasons for these differences are discussed. It is concluded that cancellous bone, after transplantation, has the property to induce and promote osteogenesis in marrow; moreover, that this property is contained in the organic components of bone.

7. From the standpoint of inductive mechanisms, cancellous bone treated by freezing or freeze-drying seems to be the most suitable devitalised bone for grafting purposes; bone which has been boiled or merthiolated less suitable; and "deproteinised" bone the least suitable.

8. Freeze-dried bone sterilised physically (by high energy radiation) or chemically (by ß-propiolactone) did not form significantly less new bone than did freeze-dried bone which had not been sterilised.

9. Remodelling mechanisms in bone transplantation are briefly discussed and attention drawn to the deficiencies of present knowledge. The quantitative studies of other workers have indicated that freeze-dried bone may be more rapidly remodelled than is frozen bone.

10. The importance of fresh red marrow in promoting osteogenesis in bone transplantation and in the healing of certain fractures, is emphasised. It seems likely that the interrelationship of bone and marrow revealed by experiment has wider significance not only in health and in response to injury but also in causation of certain idiopathic bone disorders.

1. Electron-probe microanalysis shows that corrosion of an 18 per cent chromium-8 per cent nickel-3 per cent molybdenum stainless steel implant and of some pure metal implants may affect not only the surrounding tissues but also the individual cells.

2. Metallic contamination from surgical tools is confirmed.

3. Electron-probe microanalysis is shown to be a useful tool for studying individual biological cells.

4. The principles of electron-probe microanalysis are described.

1. Four cases of epidermal cysts of the terminal phalanges of the fingers are reported.

2. The literature is reviewed and the etiological factors discussed.