A fully automated obstetrical medical record system (OBAR) has been designed to communicate prenatal and postnatal data between clinics operated throughout Jefferson County by the Department of Health (Maternity and Infant Care Project), the University's Division of Maternal and Fetal Medicine, and the two hospitals serving the clinic's population (Cooper Green Hospital and the University of Alabama Hospitals). The project has had two primary goals -I) implementation of an entirely automated prenatal and perinatal medical record system; and 2) development of capabilities for routine and special reporting relevant to the administrative and clinical research objectives of the associated groups.The system serves over 4000 pregnancies and SOOOO visits per year. The computerized system entirely replaces a paper-based system that was plagued by problems, e.g., clinic records incorrectly filed or not filed at all, nonavailability of records, and inconsistent and poor record keeping. Implementation tasks were divided into two phases. The first, accomplished during 1976-1978, included a redesign of the paper-based systems, the development of a database system to operate on an IBM mainframe host, implementation of the perinatal (labor, delivery and discharge) functions, and evaluation of the feasibility of implementing the prenatal portions of the system. The second phase, accomplished during 1978 -1979, consisted of developing software for the front-end processor to accomplish multi-terminal, multi-locational input and output to the database. All inputs, wheresoever they originate, are communicated to and collated within the database and available for output as a prenatal summary or a perinatal discharge summary.A Data General Eclipse S l 1 3 0 (192 KB, RDOS) serves as a front-end processor to the system, driving data entry and displaying patient summaries. The database resides on an IBM 303 1. New summaries are created after each patient transaction; they are then transmitted to the S/130 for storage on its associated disk drive. The hardwarelsoftware strategy achieves inexpensive and reliable data entryldata output while utilizing the functionality of a complex medical database previously developed in our laboratory.The system has achieved its primary goal of making patient records immediately available whereever a patient encounter occurs. Managing timely data entry is, of course, a continuing challenge. The project's implementation significantly challenged the management skills of the Health Department's officials. The project stimulated reorganization of work patterns, lines of authority and accountability procedures. The conspicuous demand for timely and complete data entry, the provision of exception reports and an aggressive quality control program gradually revitalized the achievements of clinic and hospital personnel. Frequent and extensive communication by the managers in each area, plus their commitments to the project's implementation, were the essential ingredients for successfully accomplishing this underta...

Septicaemia due to Neisseria meningitidis may be overwhelming and has a high mortality, especially in children. A case is described of rapidly fulminating mening‐ococcal septicaemia without meningitis in a previously well 14 year old girl who died within hours of the onset of illness. Clinical features of meningococcal septicaemia, the pathology, and the principles of management are described. The recent introduction of monoclonal IgM antitoxin may play a significant role in the future management of this condition.