1. An analysis has been made of the clinical features and investigations in ninety-five cases of primary intraspinal tumours.

2. Loss of muscle power was the commonest symptom, and was often ignored until late in the course of the disease.

3. Two-thirds of the patients had no pain in the spinal region, although five of these had either extensive growths or radiographical evidence of bone erosion by tumour.

4. One-third of the patients had urinary symptoms, and two of them had acute retention initially attributed to prostatic obstruction.

5. In eighteen cases posture and gait were abnormal. The case histories of five of these patients are recorded, and they emphasise the importance of recognising lumbar spasm and hamstring tightness in young patients as signs of a cauda equina neoplasm.

6. All patients had some detectable sensory, motor, or reflex changes, and these were mostly bilateral.

7. Radiography, and cerebrospinal fluid manometry and analysis, were helpful in establishing the diagnosis.

8. Hysteria should not be diagnosed until all efforts have been made to prove otherwise.

1. Thirty-five children suffering from a mild illness with narrowing of an intervertebral disc have been studied.

2. Backache was the presenting symptom in only a small proportion of children, vague aching in the legs being almost as common at the onset.

3. Stiffness of the affected part of the spine is often present, but there may be no abnormal signs in the back.

4. Radiographs reveal a narrowed disc space with adjacent bony changes. There is usually progressive narrowing of the disc space which may go on to fusion of the affected vertebrae. Less commonly there is reconstitution of the affected disc.

5. The symptoms and signs quickly subside with immobilisation in recumbency and this treatment should be continued until the blood sedimentation rate returns to normal.

6. Adults who have suffered from discitis in childhood are probably more prone to develop backache.

7. The etiology remains uncertain.

1. It is now more than three years since a group of ninety-one patients with transcervical fracture of the neck of the femur were examined for osteoporosis at the time of injury using a histological or a radiographic technique, or a combination of both methods.

2. After patients with basal fractures were excluded, ninety fractures in eighty-eight patients were available for review and sixty-six (74 per cent) were adequately followed up.

3. In this series the fate of the fracture did not appear to be influenced by the presence or absence of osteoporosis, or by the degree of osteoporosis.

4. The incidence of osteoporosis increased with advancing age, but this increased incidence did not appear to be responsible for the greater proportion of failures after the age of sixty-five.

5. In this series of patients examination for osteoporosis was made by methods which were believed to be the best available at the time. The possibility that these are not absolutely reliable cannot be ruled out.

1. The results in 211 fractures of the shaft of the femur in adults treated by internal fixation have been reviewed.

2. A comparison has been made between the effects of early internal fixation within the first six days of injury and delayed fixation.

3. Eighty-five fractures treated by early fixation gave a rate of non-union of 23 per cent; in 126 fractures treated by delayed fixation the rate was 0·8 per cent.

4. Delayed operation is therefore advocated for the majority of femoral shaft fractures for which internal fixation is indicated.

1. A series of twenty-one cases of re-fracture of the femoral shaft has been examined and analysed.

2. Liability to re-fracture may be increased if the original injury is caused by great violence, but it does not seem to be affected by the method of primary treatment.

3. Over 60 per cent of the re-fractures were avoidable. In some, re-fracture was caused by premature institution of vigorous mobilisation; in others, warning cracks were visible on radiographs before re-fracture.

4. In the remaining patients re-fracture appears to be unpredictable and unavoidable.

5. Re-fracture is best treated by the simplest methods.

1. General joint laxity affecting more than three joints was found in 7 per cent of normal schoolchildren. Similar laxity was found in fourteen of a random series of forty-eight girls, and in nineteen of twenty-six boys, with non-familial congenital dislocation of the hip. Such laxity was also found in four of seven girls and five of seven boys with familial (first degree relative affected) congenital dislocation of the hip.

2. It is concluded that persistent generalised joint laxity, which is often familial, is an important predisposing factor to congenital dislocation of the hip in boys. It is less important in girls, except perhaps in familial cases, as in girls there is an alternative temporary hormonal cause of joint laxity.

Premature epiphysial fusion is a common complication of injury of the capitulum in childhood and sometimes results in valgus deformity. Premature fusion can either follow the normal pattern of fusion, perhaps being accelerated on the capitular side, or it can be confined to the capitulum and metaphysis. An optimistic prognosis with regard to valgus deformity and the possible onset of ulnar neuritis cannot be made in view of this complication, even in the undisplaced or perfectly reduced and immobilised cases.

1. Two boys with osteochondritis of the humeral capitulum are described.

2. Similarities between this condition and Perthes' disease are noted.

3. From a review of the reported cases it is concluded 1) that osteochondritis of the capitulum occurs almost exclusively in boys between the ages of four and ten years; 2) that treatment and immobilisation are unnecessary; and 3) that advanced maturation of the epiphysis of the radial head is a possible sequel.

1. A study of fifty patients with dislocations of the lunate bone or perilunar dislocations has been made. The period of observation was adequate in thirty-eight.

2. The injuries generally occur in young or middle-aged men after unusually severe trauma.

3. Associated injuries are frequent, and the most common of these is damage to the median nerve.

4. In one-third of the cases the nature of the lesion was not initially diagnosed or the initial treatment was inadequate.

5. A dislocated lunate bone may be replaced even at a late stage and even if the displacement is severe so long as there is some soft-tissue attachment. The anterior approach may safely be used for the replacement.

6. The lunate bone may be removed without involving the necessity for arthrodesis of the wrist.

7. Open reduction should be employed for trans-scaphoid dislocations whenever exact realignment and good fixation cannot be achieved by closed methods.

8. Excision of the proximal row of the carpus gives the possibility of salvage of a reasonable degree of function, and may be preferable to arthrodesis or removal of only part of the proximal row.

1. Nine cases of disturbance of the relationship between the scaphoid and the radius and between the scaphoid and the lunate bones are described.

2. Persistent dislocation of the scaphoid bone may follow reduction of perilunar dislocations or of other dislocations of the proximal row of the carpus. It may be obvious, as in waist-deep dislocation, or may be solely a rotational dislocation which may be difficult to diagnose.

3. Uncorrected rotational dislocation of the scaphoid bone caused significant disability in six of seven cases.

4. Aids to the diagnosis of this condition are described and a vigorous approach to the problem of correction is advocated.

5. The experience of other workers in this field is reviewed and discussed.

1. Fifty-eight adult patients who had been treated for radial head fractures by excision of the head of the radius have been reviewed at periods varying between two and nineteen years after operation.

2. Symptoms referable to the inferior radio-ulnar joint were present in half of the patients and the mechanisms of the disorder in these patients are discussed in the light of a radiographic study.

3. We feel it justifiable to conclude from our observations that this complication of surgical treatment of radial head fractures deserves greater attention than has been given to it in the past, and that it is of sufficient importance to be taken into consideration when planning the management of these fractures, especially the less severe injuries.

4. Prosthetic replacement of the proximal end of the radius is the logical and, indeed, the only way in which the distal radio-ulnar joint subluxation can be avoided, but no clearly defined indications for the routine use of a prosthesis as a primary procedure can be suggested on the basis of this investigation.

1. Five new cases of Apert's syndrome are presented, and the general features of the disease are discussed and correlated with these. The bony changes in the elbow and the delay in ossification are striking. The incidence in Singapore seems to be higher than elsewhere and the patients are all Chinese males.

2. In Singapore the disease is sporadic but seems to appear about once every three years.

1. Lateral radiographs of fifty-seven club feet and seventeen normal feet were taken in forced flexion and forced extension. On these, the arcs traversed by the talus, the sole and the calcaneus were measured, as was the talo-calcaneal angle.

2. It was found that the ankle in club feet usually contributed more than half of the total sagittal movement of the foot.

3. Occasional cases were encountered in which the ankle was so damaged that it contributed only half or less than half of this movement. In such cases wedge excision of the ankle joint is theoretically justified in preference to wedge tarsectomy.

4. The talo-calcaneal angle is much reduced in club foot, and this element of deformity is extremely resistant to manipulative treatment. The reasons for this and a possible method of treatment are discussed.

1. Previous immunological studies have shown that homografts of fresh marrow-free iliac bone are only weakly, if at all, antigenic.

2. In view of this finding an attempt was made to produce a foreign bone graft capable of forming new bone as readily as an iliac autograft by the following method. Living cells of high osteogenic potential and of autologous type were introduced into the graft by combining homologous fresh marrow-free iliac bone with the animal's own red marrow to form a fresh composite homograft-autograft of cancellous bone.

3. Such fresh composite homograft-autografts were inserted into a muscular site in Wistar rats and removed for microscopical examination at intervals of one to seven days and at two, six and twelve weeks after transplantation.

4. It is found that bone and marrow together as a fresh composite homograft-autograft form considerably more new bone than do either of the components of the graft transplanted separately. Homografts of fresh marrow-free iliac bone form, in general, a small amount of early phase and late phase new bone. Autografts of red marrow transplanted alone to a muscular site formed new bone in thirteen to thirty experiments (43 per cent).

5. The stimulus to osteogenesis, and the cellular source of osteoblasts, in marrow autografts is discussed in the light of present knowledge. The concept is suggested that after its transplantation there develops in marrow an inductive system leading to osteoblastic differentiation and bone formation. It is proposed that the necrosis of a portion of a marrow graft liberates osteogenic substances which are taken up by primitive wandering cells derived from littoral cells lining the vascular sinusoids of the surviving portions of the marrow which are induced, thereby, to differentiate as osteoblasts.

6. The cellular source of osteoblasts in a fresh composite homograft-autograft of cancellous bone is discussed. It is deduced that the new bone is derived mainly from the contained marrow of the graft, by mechanisms similar to those leading to osteoblastic differentiation in transplanted autografts of marrow.

7. The stimulus to the greater formation of new bone by fresh composite autograft-homografts than by autografts of marrow transplanted alone is discussed. Two explanations are suggested: 1) a more extensive necrosis of marrow in a composite homograft-autograft than in marrow transplanted alone; and 2) an inductive effect of bone upon marrow.

8. The new bone formed by autografts of fresh marrow-containing iliac bone, it is concluded, is derived not only from osteoblasts on the surfaces of the grafted bone but also from primitive wandering cells derived from littoral cells lining the vascular sinusoids of the surviving portions of its marrow.

9. Mechanisms which may play a role in the histogenesis of woven bone are discussed.

10. The significance of the relation of bone and marrow is considered briefly in the light of knowledge concerning the venous patterns of bone and marrow.

1. The behaviour of various types of cortical bone graft has been studied in rabbits by histological and injection techniques.

2. The results suggest that penetration of the graft by blood vessels plays an important part in the incorporation of autogenous and homogenous grafts.

3. Autogenous and homogenous grafts are both incorporated–the latter more slowly than the former–but heterogenous grafts are rejected. The reasons for this rejection are discussed.