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The resting B.P.s of patients with complete paraplegia and tetraplegia are recorded at their first check-up. The results are plotted for all the cervicals, each thoracic level and all the lumbar lesions. There is a progressive rise in systolic blood pressure from the cervical down to the lumbar lesions, with a striking linear relationship. The gradient of the regression line is 1.97 and the correlation coefficient is 0.921. The diastolic blood pressure shows a similar linear relationship. The gradient of the regression line is 1.25 and the correlation coefficient is 0.922.

A double blind cross-over trial of Valium against Amytal and Placebo was carried out on 22 patients with spasticity due to spinal cord injuries. Observations were made by six independent observers. Valium was significantly more effective than Amytal or Placebo. There was a low incidence of side-effects.

Six hundred and twelve patients with closed spinal injuries are described. The incidence of various types of fracture and fracture-dislocation and the degree of reduction achieved by postural reduction is analysed in relation to the initial and late neurological lesions. The average time that the patients were kept in bed is given for the various types of skeletal injury. Only 4 patients developed late instability of the spine.

1. Definition of the level of a lesion. Wherever para- and tetraplegic patients are treated, the exact neurological level ought to be established and, together with a description of the skeletal injury, used to define the lesion.Of the two different methods of defining the neurological level method (a) giving the number of the most distal uninvolved segment of the cord is unequivocal. It should, wherever possible, be adopted, particularly in centres planned in future.All future publications should state whether they employ method (a) or (b).2. Assessment of active power in individual muscles is, in the great majority of centres, carried out according to the scale of the British Medical Research Council. This method should be adopted universally in future.3. The description of incomplete lesions, apart from recording all individual detail, relies on a number of subheadings (anterior, central and posterior cord-syndromes, Brown-Sécard).An additional method of classification in practical terms of independence and functional ability will be internationally discussed.4. A firm prognosis as to the chances of neurological recovery in initially complete lesions might best be postponed for three weeks in paraplegia, for six weeks in tetraplegia. In initially incomplete lesions it may be wise to wait at least six months.5. In new lesions a rise—or fall—of level by more than three segments within hours, days or weeks of injury is seen in a, generally small, percentage of cases.6. In old lesions genuine recovery of power in a muscle completely paralysed for two years after injury is seen occasionally in cauda equina lesions.7. A rise of neurological level several years after injury, at times the occurrence of cervical signs above a free interval in dorso-lumbar lesions, is seen infrequently.8. Severe permanent increase in spasticity several years after injury—without discoverable cause—is seen as rarely as the opposite, spontaneous gradual transformation from a spastic into a flaccid lesion.See also: Discussion by Michaelis.

Proximal myotomy of iliopsoas in cases of severe spastic flexion contracture at the hip has given reliable results, namely permanent correction of the contracture and reduction of spasticity, in 24 operations on 14 patients. In one patient onesided spasticity of external oblique complicated the clinical symptoms, and this was treated by transverse myotomy with a good result.