Further experience of reactions, especially of a cerebral nature, in conjunction with triple vaccination: a study based on vaccinations in Sweden 1959-65.

17-Tract Infections-Gardner et al. MREDICALJHURNA children carries a poor prognosis. Their work thus suggests that repeated direct measurements of arterial blood-gas and pH levels might do much to improve the management of children with severe respiratory tract infections; we would add that repeated electrolyte determinations might also be of value. The use of modern microtechniques greatly reduces the extent to which such investigations disturb a sick child. The mortality rate associated with respiratory tract infections in childhood seems more likely to be reducible by such an approach than by any other at present available to us. Summary Of 22 children with respiratory tract infections who died in Newcastle and Durham hospitals during a 27-month period, 19 were less than 1 year old. Nine had major congenital abnormalities. Bacterial infections were apparently responsible for only 6 of the 22 deaths. Respiratory syncytial virus was the only potential pathogen isolated from eight of the children ; it was isolated from necropsy lung specimens in seven of these cases, including all four cases of pneumonia with no apparent bacterial cause ; and it was also isolated from the upper respiratory tract and the lung of a child with haemo-philus epiglottitis. No other viruses were incriminated in any of the 22 cases. Sudden and substantially irreversible collapse was a common feature, especially in the cases not apparently caused by bacteria. Investigation of the blood-gas levels and biochemical changes in such children is suggested as the most promising approach to improved management. We gratefully acknowledge the use of clinical notes and reports by numerous colleagues at the Royal Victoria Infirmary (11 cases), Newcastle General Hospital and Drybum Hospital, Durham (five cases each), and Walker Gate Hospital, Newcastle (one case) ; also of necropsy reports on the five Dryburn Hospital patients by Dr. and of histological sections of the lungs from all these patients. We are indebted to many of our laboratory colleagues for technical assistance , and also to the Scientific and Research Subcommittee of the United Newcastle upon Tyne Hospitals for their continued support.