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\s=b\ Reye's syndrome occurred simultaneously in three siblings. All had characteristic changes in liver histology ascertained by light and electron microscopy.

THE STUDY of the control of skin infections of the newborn infants was started in the winter of 1948-49, when the incidence of pyoderma neonatorum in the nurseries of the Vancouver General Hospital reached a rate of 121 cases per 1000 live-births. At that time the nursery techniques were improved and there was a change from "dry" skin care to the application of 1% ammoniated mercury ointment. This did not prove to have a lasting beneficial effect. From January 1, 1948 until April 30, 1952, the incidence of pyoderma varied in a most unpredicted manner. From May 1, 1952 until December 31, 1956, various methods of skin care were used experimentally to determine the effect of these on the pyoderma rate in the nurseries. During these observations, a study was made of various other aspects of the epidemiology of pyoderma neonatorum: 1. Studies of staphylococcal contamination of the environment. a) Nasal carrier rate of infants, mothers, nurses and other personnel. b) Nursery air. c) The intact skin of normal infants versus infants with pyoderma. d) Mothers' hands and bedding. e) Nurses' hands and gowns. f) Babies' tubs and bedding. 2. Identification by phage-typing and antibiotic resistance of the organisms isolated. a) From pustules. b) From nasal carriers. 3. Observation of the cytology of exudate from pustules (bacterial and nonbacterial). THE NURSERIES In the Women's Pavilion of the Vancouver General Hospital are six regular nurseries providing from 21.0 to 31.0 square feet per bassinet. The number of bassinets per nursery ranges from 12 to 22. The daily census shows that the per cent of occupancy ranges from 61 to 81.

SUMMARY A sibship is described in which the four affected children have had episodes of convulsions and coma associated with intercurrent viral infections. Although a metabolic disorder is strongly suspected, investigations have revealed no such abnormality. Three of the four siblings have now outgrown the disorder but are left with minor abnormalities on neurological and psychological examinations on a suspected organic basis. RÉSUMÉ Encéphalopathie récurrente dans une fratrie à la suite d'une infection virale Quatre frères et soeurs ayant eu des convulsions et un coma associèà des infections virales intercurrentes font l'objet d'une description. Quoiqu'on ait soupçonné fortement un trouble métabolique, aucune investigation n'a pu révéler d'anomalies. Trois des enfants ont maintenant surmonté leur prédisposition mais conservent des symptomes et signes d'un disfonctionnement cérébral à minima. ZUSAMMENFASSUNG Gehäuftes Auftreten einer Encephalopathie bei Geschwistern nach Virusinfektionen Es werden vier Geschwister beschrieben, die zu Krämpfen und Koma in Verbindung mit interkurrenten Virusinfekten neigten. Obwohl man eine Stoffwechselerkrankung sehr stark vermutete, haben diesbezügliche Untersuchungen keinen Hinweis dafür ergeben, Drei der Kinder haben diese Praedisposition überwunden, haben jedoch Symptome und Zeichen einer geringen cerebralen Dysfunktion zurückbehalten. RESUMEN Encefalopatia recurrente en hermanos después de infecciones virales Se describen cuatro hermanos con tendencia a las convulsiones y coma, en asociación con infecciones virales intercurrentes. Aunque hay la fuerte sospecha de que se trata de una alteración metabólica las investigaciones no han revelado tal anomalia. Tres de los niños han superado su predisposición pero quedan con síntomas y signos de disfunción cerebral mínima.