No abstract

1. A high meningococcus carrier-rate in a military unit denotes that dangerous overcrowding exists in this unit.2. Severe overcrowding (i.e. when beds are less than 1 foot apart) is usually accompanied by a carrier-rate (serological) of at least 20 per cent.(Twenty per cent. is the danger line indicated in the War Office Memorandum on Cerebro-spinal Fever, March 1917.)3. A carrier-rate of this height will usually imply that the mobilization standard of 40 square feet has been infringed, and also that beds are less than 1 foot apart.4. A carrier-rate of 20 per cent. (without awaiting the occurrence of any actual cases of the disease) should be regarded as a signal for prompt and effective action to abolish overcrowding, and to improve ventilation, and to increase the distance between the beds to at least 2½ feet.5. The distance between beds is of paramount importance.6. Carrier-rates of between 10 and 20 per cent. are unsatisfactory and imply a certain degree of overcrowding. They must be watched with suspicion, and the mobilization standard strictly enforced.7. Under the same conditions of overcrowding “non-contact” carrier-rates are the same as “contact” carrier-rates.8. Quite a moderate degree of “spacing out” of beds, combined with simple methods for improving ventilation are highly efficient agents in reducing high carrier-rates.9. When, however, a unit shows a high carrier-rate, insistence on the restoration of the mobilization standard is not sufficient.“Spacing out” must be carried further; and a distance of at least 2½ feet between beds insisted on.The “peace” standard of 3 feet between beds and 60 square feet of floor space with 600 cubic feet of air space would, of course, be still more effective.10. The mobilization standard, introduced for a grave emergency, is the lowest possible concession to military necessity, which can be allowed with safety.

Management of sore throat requires robust decision-making to balance successfully the conflicting risks of unnecessary antibiotic use against those of untreated bacterial infection. We present a case of fulminant sepsis caused by Streptococcus constellatus, presenting as a sore throat, initially managed conservatively. Despite subsequent appropriate anti-microbial therapy and surgical drainage, contiguous spread ultimately involved the deep neck spaces, mediastinum and thoracic wall, and was complicated by severe aspiration pneumonia, pharyngocutaneous and bronchopleural fistulation. The complexity and widespread extent of the infected spaces, in conjunction with the catabolic response to sepsis, created a life-threatening situation. Surgical closure of the pharyngeal defect, using a pectoralis-major pedicle flap, was successfully undertaken to ensure source control of the infection and heralded a complete recovery. We describe our management of this case, discuss the current approach to the management of patients presenting with a sore throat, and review the literature on S. constellatus infections.

On South Cararb~a's 12.2 xjiIBic~n acre:s of tirnixrland, 1% 1rnilRiosk cubic feet of firnk,r wcrn: lost aa7tnua.U~ &13 rnorta6ty ancl crall k,t*ic.cn 1 9 ' 7 8 md 19%. "rhe cstknatetl m.r~uaB rna~raetuhay loss wz; $973 irniJhon. Among broad mmaaaga:.ment t p : s --. natural pline, planted pine,, upbnd hardwmdq, and hsttondand Rl:ardwcxds --t&r,e peatest loss rxxzaxr-red in 11;8&usal pine stantis.About three;-foiraaartk~j of the loss w m r c d in xanuauindnastri:d private forests, Fu~~iforrn nuds ; Bpc6 caused grcatcst damagc to pines, but shoot. and sten~-h~rim~g inseds, liitiieleaf dkcasc, pitct~ canker, arral pine bark ketles also camset1 major Kossec;. A sigqifica~~k kncrcasc isa 1~11(2~.(iiPiky of tmeh upland and tmttc>anlani& haralwihixk was aitributed to a complex of factors that indudes s t a~~n d p a n e~"~ m d ~4;).0~ght..