No abstract

Colonic Perforation after in that in the resected specimen in Case 3 there were numerous red patches on the antimesenteric border of the descending colon. These were acutely congested patches that had not actually infarcted, and in Case 4 similar patches in the sigmoid colon actually showed full-thickness necrosis which had not perforated, presumably because of the proximal perforation. Why these lesions should be more common in the colon than in the small bowel is difficult to explain if the condition is due to vascular changes resulting from back pressure. Cases 1, 3, and 4 perforated in inferior mesenteric vein territory, but Case 2 involved superior mesenteric vein territory, and Schaffer (1960) described a case in which there was an " unexpectedly excellent result " in a " miracle baby " who had two ileal perforations closed at laparotomy, and these occurred after an exchange transfusion. More small-bowel perforations may be reported once the association between bowel perforation and exchange transfusion becomes more appreciated; but it may be that the more complex venous system of the small bowel damps down any sudden rises in portal pressure more effectively than the large-bowel venous system. Continuous monitoring of the injection pressure during exchange transfusion could avoid large and dangerous pressure variations.

Staphylococcal colonization and infection were studied prospectively in infants, mothers and households after childbirth at home and in hospital. Infants were treated prophylactically with frequent applications of ‘Ster-zac’ hexachlorophane dusting powder. Some were treated in addition with ‘Naseptin’ nasal disinfectant cream.The incidence of staphylococcal sepsis in infants was much less than before the adoption of hexachlorophane prophylaxis. The sepsis rate was further reduced when ‘Naseptin’ was used in addition to hexachlorophane. Of the two prophylactic agents, hexachlorophane was the more convenient and probably the more effective. ‘Naseptin’ was difficult to employ correctly and unsuitable for routine use.The treatment of infants with disinfectants reduced nasal carriage markedly in infants and to a smaller extent in mothers. Both agents contributed to the reductions which persisted for some weeks after treatment ceased.Breast abscesses were almost entirely confined to mothers of infants who became nasal carriers by the second week of life.Staphylococcal colonization of infant's skin was greater when they wore impervious garments, probably because skin moisture increased.

A simple bed-making routine results in considerable dissemination from both wool and cotton fabrics. Spread to other beds appears to occur both by direct contact and by the aerial route. The number of viable organisms recovered from the infected bedding fell by 90% after the first 72 hours. The significance of these results and those of other workers in relation to the problem of hospital crossinfection is discussed. We are indebted to Dr R. L. Willing, medical superintendent, Northfield Infectious Diseases Hospital, and to members of the nursing staff, whose interest and cooperation made this experiment possible. Our thanks are also due to Dr. Bermard Nicholson, medical superintendent, Royal Adelaide Hospital, for supplies of hospital bedding.

MRICAL 847 patients with glandular fever almost invariably develop a rash if given ampicillin,25 and the same is true to a lesser extent for some other antibiotics. A survey of the literature shows that there has been a particularly high incidence of rashes in patients treated with ampicillin for Sabnonella infections. It has been postulated that some of the rashes may be produced by endotoxin released by rapid lysis of bacteria, though there is little evidence to support this. Many of these patients received high dosage, but we have been unable to show a significant relationship between dosage and incidence. An intensive investigation is being undertaken in an attempt to provide information on many of the unexplained features of the rash associated with ampicillin therapy.-I am, etc., E. T. KNUDSEN.