Pulmonary thromboembolism has an incidence of more than 69/100 000 population but may be underdiagnosed because of the non-specific character of its symptoms and difficult differential diagnosis. The prognosis is worse if the pulmonary thromboembolism is massive and associated with haemodynamic instability, whereupon mortality rises to over 50%. Cardiogenic shock supervenes and cardiopulmonary arrest is often inevitable. This emergency can only be prevented by aggressive therapy with thrombolytic agents. The case history is described of a 25-year-old woman in cardiogenic shock leading to prehospital cardiac arrest in which intravenous access was impossible. Resuscitation drugs were given by the intraosseous route and, with a suspected diagnosis of massive pulmonary thromboembolism, it was decided to start thrombolysis by the same route before transport to hospital. The treatment was a complete success, and the patient was discharged from hospital with no sequelae after 39 days.

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~2THE BRITISH JOURNAL OF TUBERCULOSIS \Vhat we want to get rid of is " the intolerance and limitation of outlook" against which Sir German Sims "Woodhead has so eloquently protested. After all, this " intolerance" is not found amongst those who have really counted in the study of tuberculosis in recent times. tf we glance at the volumes and articles that have attracted universal attention within, say, the last year, we find that the points of general agreement are much more numerous than the points of difference. Calmette, Borel, Fishberg, Bushnell, Sergent what marked unanimity they show on essential points.If we can only keep to the fundamentals, concentrate on principles rather than details, show that the ward, the laboratory, and the statistical bureau are complementary to each other rather than separate or antagonistic, we may kindle, even during a short course of study, the flame of enthusiastic curiosity that should inspire a life of observation and research.

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