The strict implementation of HICPAC guidelines may not always be appropriate for children at risk of beta-lactam resistant gram-positive infections. Hospital guidelines need to be tailored to the patient population and microbial susceptibility patterns of each institution. Appropriate cultures should be obtained at the time glycopeptide treatment is begun so that duration of exposure can be limited.

No abstract

SEVERE DERMATITIS AFTER NOVARSENOBILLON. TFBICALJN 773 from the first, and we should keep our suspicion alive until repeated examinations for the spirocliaete have yielded a succession of negative results. Theoretically the spiroclhaete ouglht to be discoverable from the time of inoculation. Practically it is readily discoveted in an untreated sore witlin a day or two of its appearance. Even in a sore that lhas been dressed constantly with antiseptics, patience and repeat3d examninations will sooner or later reveal it. As thie time factor is of incalculable importance in the treatment of syphilis, much misery, serious ill lhealtlh, and possibly tragedy, may be avoided if the diagnosis is established early.

AUG. 30, 1919] NOVARSENOBILLON-INTRAVENOUS OR INTRAMUSCULAR?CASE II. P. A., air mechanic R.A.F., aged 28, was admitted to hospital on April 19th, 1918, complaining of pain in the left side of his chest and in his back. XIe stated that he had felt quite well up to two days before admission. Some impairment of resonance was found over the base of the left lung, and small crepitations were audible over the lower lobes of both lungs. It was noted that the physical signs in the lungs varied considerably from day to day. On April 25th at 11 a.m. he, for the flrst time, complained of stiffness in his legs. He had walked into the ward, and nothing had previously occurred to draw attention to his limbs. It was now found that there was great loss of power in both legs, the patient was delirious at times, and the skin over the lower limbs was insensitive to cotton-wool touch and pin-prick.At 7.30 p.m. he was more sensible. Both lower linbs were now completely paralysed, and there was absence of sensation to cotton-wool and pin-prickup to the level of the ninth thoracic nerve. Tendon reflexes and abdominal reflex were absent. By lumbar puncture clear cerebro-spinal fluid was obtained, which was found to contain no cells when centrifugalized, except an occasional epithelial element. There was now retention of urine, and the bladder had to be emptied twice a day by catheter. The sputum was examined for tubercle bacilli, with negative result. The paralysis spread, and on April 29th the level of anaesthesia had reached the level of the sixth dorsal nerve area, and on May 1st to the area of the fourth dorsal. Lumbar puncture now yielded thick grumous pus, which passed with difficulty through the needle. A definite bulging, due apparently to a collection of pus, had appeared over the left side of the back. On May 3rd he was quite conscious, but the anaesthesia had extended up to the level of the third thoracic nerve, the abdomen was distended from flatus, and there was paralysis of the abdominal muscles. He became weaker and died on May 4th at 11 p.m., in the act of taking a drink.Post-mortem Examiinakion (by Captain Horsburgh, R.A.M.C., Pathologist to the Hospital). The body is of a well-developed man. On incising the muscles of the back large quantities of thick pus escaped from the substance of the muscles. The spinal cord was exposed throughout its length, and was found to be in a bath of the same type of pus. When the theca was opened only a little pus was found round the cord itself. The consistence of the cord was soft and flabby, suggesting to the naked eye considerable degeneration. The brain was removed and the meninges carefully examined, but no sign of meningitis was found.When the thorax was opened considerable adhesions were prbsent on both sides of the chest, between the lungs and the chest wall. The left lung showed a tuberculous cavity about the size of a walnut, situated in the apex of the upper lobe, and a few smaller and more superficial caseous nodules. On the left side, where the lung was in relation to t...