Mortality, morbidity, health, functional, and psychosocial outcomes were exa mined in 834 individuals with long term spinal cord injuries. All were treated at one of two British spinal injury centres: the National Spinal Injuries Centre at Stoke Mandeville Hospital or the Regional Spinal Injuries Centre in Southport; all were 20 or more years post injury. Using life table techniques, median survival time was determined for the overall sample (32 years), and for various subgroups based on level and completeness of injury and age at injury. With the number of renal deaths decreasing over time, the cause of death patterns in the study group as it aged began to approximate those of the general population. Morbidity patterns were found to be associated with age, years post injury, or a combination of these factors, depending upon the particular medical compli cation examined. A current medical examination of 282 of the survivors revealed significant declines in functional abilities associated with the aging process. Declines with age also were found in measures of handicap and life satisfaction, but three quarters of those interviewed reported generally good health and rated their current quality of life as either good or excellent.

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Injuries sustained as a result of horse riding are common. Serious injuries to the nervous system are the most dangerous. An analysis has been made of 11 papers, new ®gures produced by surveying Stoke Mandeville, Oswestry and Odstock spinal units and by searching the internet to determine their frequency and distribution. Head injuries outnumber spinal injuries by ®ve to one. In contrast to other sporting accidents, there are more lumbar and thoracic than cervical injuries and more women are injured than men (though this may just be a re¯ection of the fact that there are more women riders than men). Of all horse riding activities, jumping is most likely to produce a spinal injury.

SUMMARY Between 1944 and 1984 20 patients were admitted to a spinal injuries centre with a diagnosis of traumatic paraplegia. They subsequently walked out and the diagnosis was revised to hysterical paraplegia. A further 23 patients with incomplete traumatic injuries, who also walked from the centre, have been compared with them as controls. The features that enabled a diagnosis of hysterical paraplegia to be arrived at were: (1) They were predominantly paraplegic, (2) There was a high incidence of previous psychiatric illness and employment in the Health Service or allied professions, (3) Many were actively seeking compensation. The physical findings were a disproportionate motor paralysis, non anatomical sensory loss, the presence of downgoing plantar responses, normal tone and reflexes. They made a rapid total recovery. In contrast, the control traumatic cases showed an incomplete recovery and a persistent residual neurological deficit. Investigations apart from plain radiographs of the spinal column were not warranted, and the diagnosis should be possible on clinical grounds alone.

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Summary Two unrelated British families suffering from a distinctive form of familial spmtic paraplegia associated with wasting of the hands are described. I wish to record my gratitude for the encouragement and advice that I received from Dr Michael Kremer, under whose care the patients were admitted and investigated. I would like to thank Prof. Lionel Penrose, who throughout the investigation helped and advised me on the genetic aspects of the work. I wish also to thank Mr Ainslie and Mr Goldsmith for referring the propositus Mr A.; Mr Northfield and Lord Brain for allowing me to quote from their original notes on Mrs R. when she attended the London Hospital; Miss Ruth Marshall for carrying out the blood‐group studies; Dr Julia Bell and Dr A. Carmichael for discussing these families with me; Mr Frank Beck for translating the German papers quoted, and Dr Russell Doggart for his advice and criticism.