105ossification was in progress (Fig. 69). Function appearance of the shoulder remained unchanged. of the shoulder, however, did not seem to be H e had stability and reasonable strength. There greatly impaired. Improvement was steady, and was some restriction of scapula movements and, a subsequent radiograph (Fig. 70) taken eight in consequence, of arm movements, though this months after operation showed further consolida-restriction was not as marked as one would imagine, tion of the bony link between the clavicle and and the condition appeared definitely preferable coracoid processes. A t this stage the clinical to that of persistent acromio-clavicular dislocation.

scaphoid, and capitate, which has the largest. The metacarpals and the phalanges of the second to fifth digits are broadened and have hardly any cortex. There are cysts up to I cm. in diameter in the heads of the metacarpals, the bases and heads of all the phalanges, and the base of the terminal phalanx of the thumb (Fig. 49). FIG. 49.-Showing right hand with cysts in the scaphoid and capitate and affection of the 2nd to 5th metacarpals and all the phalanges. Left hand for comparison. COMMENTA typical case of polyostotic fibrous dysplasia has been described. The patient, who is 70, is the oldest recorded in the literature, and demonstrates that the disease does not shorten its victim's expectation of life, but merely causes deformities and spontaneous fractures. Both traumatic and pathological fractures have united in average time in this case. The involvement of the carpus and tarsus, and the sclerosis of the cortex and medulla of the tibia are unusual features. The only endocrine changes were the delayed breaking of his voice at 20 years of age.The patient has ostosclerosis, and it is tempting to try to establish a connexion between the two dictions. Radiographs of his temporal bones, moreover, tend to confirm this.

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