MORTALITY AND SMOKING MDCBRfSH 1455to 20 cigarettes a day) in September, 1951. In another instance, the doctor had described himself as smoking 3j oz. of pipe tobacco a week, but a friend, who signed the death certificate and had known him for 25 years, stated he had previously been one of the heaviest smokers of both cigarrettes and pipe he had ever known. Such factors not only could not produce an exaggeration of the true relationship but must lead to an understatement of it by inflating the mortality among light smokers and reducing the mortality among heavy smokers. The investigation has not, as yet, continued long enough to show whether there is a relationship between smoking and the mortality from any other disease, but from the preliminary figures it would seem unlikely that there is any as close as that observed with lung cancer. The numbers of deaths, however, from some potentially interesting diseases are as yet small (for example, from cancer of the buccal cavity and larynx and from duodenal ulcer). There have, on the other hand, been a large number of deaths attributable to coronary thrombosis. It seems clear that smoking cannot be a major factor in their production, but the steady increase in mortality with the amount of tobacco smoking recorded suggests that there is a subgroup of these cases in which tobacco has a significant adjuvant effect. SummarAt the end of 1951 some 40,000 men and women on the British Medical Register replied to a simple questionary relating to their smoking habits. On that basis they were divided into non-smokers and three groups of smokers (including ex-smokers) according to the amount they smoked at that time (or when they gave up).The certified causes of death of those men and women who have since died have been supplied by the Registrars-General of the U.K. over the ensuing 29 months. This preliminary report is confined to the deaths among the 24,389 men over the age of 35.Though the numbers of deaths at present available are small the resulting rates reveal a significant and steadily rising mortality from deaths due to cancer of the lung as the amount of tobacco smoked increases. There is also a rise in the mortality from deaths attributed to coronary thrombosis as the amount smoked increases, but the gradient is much less steep than that revealed by cancer of the lung. The other groups of deaths so far analysed reveal no gradient (other forms of cancer, other forms of cardiovascular disease, respiratory diseases, all other causes).The figures for cancer of the lung are in conformity with those found previously in an extensive inquiry into the smoking histories of patients with cancer of the lung and with other diseases.The death rates of doctors here reported are, almost certainly, artificially low. There is evidence that this is due to a reluctance, or inability, of persons suffering from a fatal illness to reply to the questionary. In spite of this defect and the present small numbers of deaths, we thought it necessary, in view of the nature of the results, to lay t...

1. Acute osteomyelitis is defined. 2. An analysis of 113 cases is given. 3. An effective programme of treatment was evolved from experience over a period of nine years. 4. Recommendations regarding a programme of treatment are given.

1. Fifty-one cases of fracture of the odontoid have been analysed. Forty were reported by other surgeons; eleven were new cases first reported by us. 2. Fracture of the odontoid in young children is an epiphysial separation. It occurs up to the age of seven years. As in epiphysial separations elsewhere, it unites readily, and remodelling occurs when reduction has been incomplete, so that normal anatomy is restored. 3. In adults forward displacement is twice as common as backward displacement. 4. Immediate paralysis is commoner if backward displacement occurs, but late neurological disorders are seen only after fractures with forward displacement. 5. Failure of bony healing is not dangerous if treatment has resulted in firm fibrous union, for there is neither excessive abnormal mobility nor progressive subluxation, either of which could injure the spinal cord or medulla. Neurological disorders developing after the fracture are the result of mobility from inadequate early treatment. It is the results of inadequate early treatment which have given this fracture a sinister reputation. 6. The fracture should be reduced by skeletal traction through a skull caliper. The reduction should be maintained for six weeks by continuous traction, and this should be followed by a period of six weeks in a plaster. 7. The increasing definition of the fracture-line seen in the radiographs of some patients indicates non-union.

1. Continued follow-up of the 113 children with acute osteomyelitis previously reported and a study of a further thirty-eight proven cases has not changed our opinion that the correct management is rest and effective antibiotics. Operation should be undertaken only if pus is detectable clinically. 2. Bacteriological evidence shows that the flora causing this disease are less sensitive to benzylpenicillin than ten years ago and that a proportion are also likely to become resistant to methicillin and cloxacillin. 3. The most effective antibiotic combination used was fusidic acid and erythromycin. This lowered the failure rate to 10·5 per cent in thirty-eight proven cases. Two of the four failures were in haemophilus infections. No staphylococcal infection of a long bone became chronic, and all lesions were healed within three months of onset. 4. The duration of treatment (twenty-one days) and the method of splintage (removable plaster slabs) remained the same as in the previous series. 5. Careful watch must be kept on the incidence of haemophilus infections. If it rises, increasing the erythromycin or adding ampicillin may be necessary. 6. Use of the newer aqueous suspension of fusidic acid may lower the incidence of troublesome vomiting (12 per cent in this series). 7. Only 7 per cent of staphylococcus aureus infections in this hospital, and 17 per cent of such infections in our thirty-eight cases were sensitive to benzylpenicillin. It is thought that this drug has outlived its usefulness in osteomyelitis. 8. It is recommended that, on diagnosis, fusidic acid aqueous suspension 5 millilitres should be given three times a day to children aged one to five, and 10 millilitres twice a day for children aged six to twelve, with erythromycin stearate 30 milligrams per kilogram of body weight each day in divided doses.

Open 27 13 10 4 Closed 90 49 29 12 Total 117 62 39 16 DEROTATION OSTEOTOMY IN THE MANAGEMENT OF CONGENITAL DISLOCATION OF THE HIP