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in the first hour (Westergren); erythrocytes 4,400.000 per c.mm.; haemoglobin 9.6 g. per 100 ml.; P.C.V. 31%; total and differential white counts normal; plasma albumin 2.3 g. and globulin 2.9 g. per 100 ml.; blood urea nitrogen 11 mg.

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SummaryAn investigation amongst full-time newborn babies in two nurseries has been carried out in an attempt to discover the tsLual routes of spread of Stapli. aur(eius.Initially 53 babies were all found to be nasal carriers by the 10th day, and 11 out of 12 of these babies also carried staphylococci in their stools. Examination of bedding suggested that this was not the immediate source of staphylococci, and prevention of possible contamination from the staff by the use of chlorhexidine handcream or gowns made little difference.The use of triple dye to the umbilicus and individual gowns for each baby, both as separate and as combined measures, prodluced a reduction in the nasal carriage rate on the 12th day of life by about 25-30%.No evidence was obtained that babies gained staphylococci from their mothers, but there was evidence that staphylococci on the mothers' breasts came from their babies.We wouild like to thlank Dr. At birth babies were allotted at random to one of these two nurseries. In one nursery (the " masked " nursery) a strict masking and gowning regime was in operation. in the other (the " unmasked " nursery) no masks or gowns were worn. The attendant staff was common to both nurseries. In the masked nursery all personnel entering the nursery.whether doctors, nurses, or clcaners. donned a mask and gown. The masks consisted of four layers of gauze with a i cellophane ' insert, and extended below the chin. The nursing staff changed their masks at least every hour. The masks were autoclaved in a drum and when required were renmoved from the drum with sterile forceps. The instructions were that while being worn the mask should not be touLched at all bn hand. On discarding, the masks were dropped into a lidded receptacle containing antiseptic. Gowns donned before entering the nursery were put on in an ante-room, where they were kept hanging when not in Luse.In addition to the gown worn on entering the nursery each cot carried a folded gown which was worn when the baby in that cot was being handled. All gowns were changed every 24 hours or when soiled. They were not autoclaved, but one sta,2e of the laundering was to raise the temperature of the washing water to 200°F. (930 C.) for 10 minutes. In the unmasked nursery nurses wore their ordinary uniform, the apron of which was changed daily or when soiled.For the first two days the babies were taken to their mothers for feeding. In the case of the babies fr-om the masked nursery the mothers were masked and gowned with the baby's " individual" gown. Thereafter the mothers fed their infants in the nurseries, and again in the masked nur-sery they were appropriately masked and gowned.Mothers were permitted to handle their own babies only. If any baby developed an infection in either nursery he was immediately removed to an isolation nursery. The babies from the masked nursery were bathed in a bathroom kept for them only; those in the unmasked nursery were bathed in another bathroom. There was thus no direct contact between the babies from the two nurseries. ...

SYNOPSIS Haemophilus aphrophilus was isolated from the blood of a 31-year-old man with subacute bacterial endocarditis. Subsequently the patient died with acute tubular necrosis of the kidney, probably secondary to cardiac failure. The characteristics of the species are described and pathogenicity to mice is reported for the first time.Amongst the many infections caused by species of haemophilus, only rarely has endocarditis been reported. The incidence of Haemophilus in subacute bacterial endocarditis lies between 0 5 and 1 % (Keith and Lyon, 1963), and the species most often involved are H. influenzae and H. parainfluenzae. Endocarditis due to a third species, H. aphrophilus, was first described in London (Khairat, 1940), and recently interest in this organism has been shown in America although fewer than 30 cases of H. aphrophilus endocarditis have been reported. Since the original account, before the advent of antibiotics, no infection due to H. aphrophilus had been reported in Britain until microorganisms resembling this species were described in reports (Speller, Prout, and Saunders, 1968;Vickerstaff, Pease, and Rogers, 1968) which suggested the possibility that the presence of such organisms may remain undetected unless appropriate methods are used. Therefore we considered it of value to describe the features of H. aphrophilus isolated from a recent fatal case of endocarditis. CASE REPORTA 31-year-old man was admitted to hospital with a history of haematuria for two weeks and ankle swelling for two months. One year previously he had experienced a bout of fever, rigors, and flitting joint pains, and was thought to have had rheumatic fever, after which he had continued to feel unwell. On admission to hospital he had gross congestive cardiac failure, with haematuria and a petechial rash on the hands, torso, and legs. The teeth were carious and the gums septic. The haemoglobin was 4-4/100 ml and the white cell count 16,000/cmm with 91% neutrophils. The blood urea level was 52 mg/100 ml.A diagnosis of subacute bacterial endocarditis with mitral incompetence was made, and two blood cultures were taken. Both yielded Haemophilus aphrophilus. Treatment was begun with ampicillin together with