Skin lesions with histopathology similar to that seen in lesions in man have been produced in calves by the experimental inoculation of cultures of Myco. ulcerans. Sensitization of infected calves to mammalian tuberculin as well as to ulceranin has been demonstrated.

It is considered unlikely that cattle are a reservoir of infection for man.

The expenses of this investigation were met by a research grant from the Board of Management, Alfred Hospital.

We are indebted to Dr A. V. Jackson, Director of Pathology, Alfred Hospital, for the reports on histopathology.

A fever clinic within a hospital plays a vital role in pandemic control because it serves as an outpost for pandemic discovery, monitoring and handling. As the outbreak of coronavirus disease 2019 (COVID-19) in Wuhan was gradually brought under control, the fever clinic in the West Campus of Wuhan Union Hospital introduced a new model for construction and management of temporary mobile isolation wards. A traditional battlefield hospital model was combined with pandemic control regulations, to build a complex of mobile isolation wards that used adaptive design and construction for medical operational, medical waste management and water drainage systems. The mobile isolation wards allowed for the sharing of medical resources with the fever clinic. This increased the capacity and efficiency of receiving, screening, triaging and isolation and observation of patients with fever. The innovative mobile isolation wards also controlled new sudden outbreaks of COVID-19. We document the adaptive design and construction model of the novel complex of mobile isolation wards and explain its characteristics, functions and use.

Information on the kinetics of the serum antibody response to infection with Yersinia enterocolitica is essential to allow the estimation and comparison of seroconversion rates in a diversity of pools of cross-sectional serum antibody measurements. Data from 94 patients with acute enteritis caused by Yersinia infection were used. The follow-up period for the longitudinal study was 36 months, addressed by questionnaire. An indirect enzyme-linked immunosorbent assay method was adapted to determine the concentration of antibodies against Y. enterocolitica in human sera. A mathematical within-host model was used to describe the interaction between pathogen and immune system and the waning of immunity after clearing of the pathogen. All observed antibodies (IgG, IgM, IgA) reached peak levels shortly after infection and then decayed slowly indicating that the median levels decreased only little during the observation period. Estimated maximum peak antibody levels were highest in IgG. Seroresponse curves of all antibodies showed large individual variation between patients. There was no apparent pattern of variation with age, nor any notable difference between genders. Estimated half-times were very long for all antibodies, and their posterior distributions were highly skewed. IgA appeared to have the most persistent antibody response, compared with IgG and IgM. Median peak levels of all three antibodies were similar. There was no significance found between peak antibody levels and severity of symptoms of gastrointestinal infection and severity of joint pain. Our findings allow the use of cross-sectional serum antibody measurements as biomarkers, to estimate seroconversion rates. Such seroincidence estimates include asymptomatic seroconversions, thereby avoiding under-reporting, and allows the comparison of infection pressures among countries, independent of their healthcare and surveillance systems.

1. Considerable differences in antigenic efficiency are encountered among batches of (1) diphtheria toxoid, and (2) Cl. welchii (perfringens) toxins prepared under standardized conditions. These differences were revealed in the results of hyperimmunization of horses.

2. Such differences in antigenic efficiency in batches of diphtheria toxoid were also detected by means of injections into guinea-pigs. Two injections, each of 2 Lf doses, were given at an interval of 28 days, and the response measured by means of antitoxin titrations on bleedings taken 10 days later.

3. A general correlation was found between antigenic efficiency as measured by these two methods.

4. A method is described for comparing the affinity for antitoxin, of batches of diphtheria toxoid, by determining the test dose of mixtures containing 9 Lf doses of toxoid and 1 Lr dose of a fixed toxin. The greater the avidity of the antitoxin, the more toxoid entered into combination with it.

5. A correlation was found to exist between affinity for antitoxin and antigenic efficiency of toxoid, as measured both by the response of horses to hyperimmunization and the response of guinea-pigs to two spaced injections.

6. It is tentatively suggested that crude toxoids may contain molecules possessing varying degrees of affinity for antitoxin, due to slight steric structural differences.

Arthur William Bacot was born in London on April 28th, 1866, the third son and fourth child of Edmund Alexander and Harriet Bacot.

Neuraminidase inhibitor (NI) dispensing has emerged as a possible automated data source for influenza surveillance. We aimed to evaluate its timeliness, correlation, and predictive accuracy in relation to influenza activity in Quebec, Canada, 2010–2013. Our secondary objective was to use the same metrics to compare NI dispensing to visits for influenza-like illness (ILI) in emergency departments (EDs). Provincial weekly counts of positive influenza laboratory tests were used as a reference measure for the level of influenza circulation. We applied ARIMA models to account for serial correlation. We computed cross-correlations to measure the strengths of association and lead-lag relationships between NI dispensing, ILI ED visits, and our reference indicator. Finally, using an ARIMA model, we evaluated the ability of NI dispensing and ILI ED visits to predict laboratory-confirmed influenza. NI dispensing was significantly correlated (R = 0·68) with influenza activity with no lag. The maximal correlation of ILI ED visits was not as strong (R = 0·50). Both NI dispensing and ILI ED visits were significant predictors of laboratory-confirmed influenza in a multivariable model; predictive potential was greatest when NI counts were lagged to precede laboratory surveillance by 2 weeks. We conclude that NI dispensing data provides timely and valuable information for influenza surveillance.

The ability to predict upper respiratory infections (URI), lower respiratory infections (LRI), and gastrointestinal tract infections (GI) in independently living older persons would greatly benefit population and individual health. Social network parameters have so far not been included in prediction models. Data were obtained from The Maastricht Study, a population-based cohort study (N = 3074, mean age (±s.d.) 59.8 ± 8.3, 48.8% women). We used multivariable logistic regression analysis to develop prediction models for self-reported symptomatic URI, LRI, and GI (past 2 months). We determined performance of the models by quantifying measures of discriminative ability and calibration. Overall, 953 individuals (31.0%) reported URI, 349 (11.4%) LRI, and 380 (12.4%) GI. The area under the curve was 64.7% (95% confidence interval (CI) 62.6–66.8%) for URI, 71.1% (95% CI 68.4–73.8) for LRI, and 64.2% (95% CI 61.3–67.1%) for GI. All models had good calibration (based on visual inspection of calibration plot, and Hosmer–Lemeshow goodness-of-fit test). Social network parameters were strong predictors for URI, LRI, and GI. Using social network parameters in prediction models for URI, LRI, and GI seems highly promising. Such parameters may be used as potential determinants that can be addressed in a practical intervention in older persons, or in a predictive tool to compute an individual's probability of infections.

Of 28 multi-resistant isolates of Staphylococcus aureus collected during 1986 from hospitals in major cities around Australia, 27 were found to contain the same prophage (denoted phage 604). Hospital isolates carrying three or fewer resistance markers, and community isolates carrying one or no resistance markers, did not carry this prophage. Phage 604 does not confer antibiotic resistance on its lysogens, nor does it increase virulence in chick embryo assays. Phage 604 appears to be a correlate of antibiotic multi-resistance in S. aureus in Australia, and may provide a molecular marker for incipiently epidemic strains of this bacterium in Australian hospitals.

Reactions to the pertussis component of the original commercial batches of quadruple vaccine against poliomyelitis, diphtheria, tetanus and pertussis (Quadrilin, Glaxo Laboratories) gave some cause for concern. Severe reactions were found to be more common in infants under 6 months of age than in older infants.

A modified quadruple vaccine, which has been used in N. Ireland since October 1964, was found to give rise to significantly fewer and milder reactions. This vaccine when given in three doses separated by intervals of 6–9 weeks and 6 months to fifty-eight infants most of whom were 6–7 months of age at the start of immunization was found to give a satisfactory immunological response.

The risk of metronidazole treatment failure in Clostridium difficile infection (CDI) patients with chronic kidney disease (CKD) or end-stage renal disease in Korea has not been established. We evaluated 481 patients who had been admitted to two secondary hospitals with a diagnosis of, and treatment for, CDI during 2010–2016. CDI patients were divided into three groups according to CKD status: non-CKD (n = 363), CKD (n = 55) and those requiring dialysis (n = 63). Logistic regression analyses were performed to examine the association of CKD status with treatment failure. CDI patients receiving dialysis tended to have increased odds of metronidazole and overall treatment failure compared to non-CKD patients; adjusted odds ratios and 95% confidence intervals were 2.09 (1.03–4.21) and 2.18 (1.11–4.32) for metronidazole and overall treatment failure, respectively. However, CKD patients did not have increased odds of metronidazole or overall treatment failure compared to non-CKD patients, even where severe CDI was more prevalent in CKD patients. The incidence of symptomatic ileus or toxic megacolon did not differ among groups. Our results suggest that initial metronidazole therapy may be considered in CDI patients with non-dialysis CKD, but should not be considered in CDI patients undergoing dialysis.

A population-based study investigated the burden of illness, including the duration of illness associated with laboratory-confirmed cases of campylobacteriosis in two health unit areas. Questionnaire data were collected for 250 cases. The median duration of illness was 8 days and 66% of cases reported symptoms of moderate severity or greater. A Cox proportional hazards model identified antimicrobial use factors associated with a significantly increased rate of symptom resolution (shorter duration of illness): macrolides for less than the recommended number of days, ciprofloxacin for at least 3 days, and antimicrobials not recommended for campylobacteriosis. The impact of antimicrobial use was consistent regardless of when, during the course of illness, the antimicrobial use began. The effectiveness of ciprofloxacin in these results may be due to the low prevalence of resistance to ciprofloxacin in isolates from this study. The effect of antimicrobials not recommended for campylobacteriosis should be further investigated.

The public health response to sporadic hepatitis A virus (HAV) infection, hepatitis A, can be complex especially when the index case is a child and no obvious source is identified. Identifying an infection source may avoid mass immunisation within schools when transmission is found to have occurred within the household. Screening of asymptomatic contacts via venepuncture can be challenging and unacceptable, as a result non-invasive methods may facilitate public health intervention. Enzyme-linked immunoassays were developed to detect HAV immunoglobulin M (IgM) and immunoglobulin G (IgG) in oral fluid (ORF). A validation panel of ORF samples from 30 confirmed acute HAV infections were all reactive for HAV IgM and IgG when tested. A panel of 40 ORF samples from persons known to have been uninfected were all unreactive. Two hundred and eighty household contacts of 72 index cases were screened by ORF to identify HAV transmission within the family and factors associated with household transmission. Almost half of households (35/72) revealed evidence of recent infection, which was significantly associated with the presence of children ⩽11 years of age (odds ratio 9.84, 95% confidence interval: 2.74–35.37). These HAV IgM and IgG immunoassays are easy to perform, rapid and sensitive and have been integrated into national guidance on the management of hepatitis A cases.

Bacterial dysentery (BD) brings a major disease burden to developing countries. Exploring the influence of temperature and its interaction with other meteorological factors on BD is significant for the prevention and early warning of BD in the context of climate change. Daily BD cases and meteorological data from 2008 to 2018 were collected in all nine prefecture-level cities in Jilin Province. A one-stage province-level model and a two-stage city-specific multivariate meta-pooled level distributed lag non-linear model were established to explore the correlation between temperature and BD, then the weather-stratified generalised additive model was used to test the interaction. During the study period, a total of 26 971 cases of BD were developed. The one-stage and two-stage cumulative dose-response ‘J’ curves overlapped, and results showed a positive correlation between temperature and BD with a 1–6 days lag effect. Age group ⩾5 years was found to be more sensitive to the effects. Moreover, there was a significant interaction between temperature, humidity and precipitation (P = 0.004, 0.002, respectively) on BD under high temperature (>0 °C), reminding residents and policymakers to pay attention to the prevention of BD in situations with both high temperature and humidity, high temperature and precipitation during the temperate monsoon climate.

This prospective, multicentre study was conducted between September and October 2003 in 38 French departments of internal medicine, infectious disease and hepatogastroenterology and included 406 consecutive HBV-infected patients (positive HBsAg), half of whom were HIV-infected (53%). The aim was to outline the main characteristics of hepatitis B virus (HBV)-human immunodeficiency virus (HIV) co-infected patients in French hospitals. HBV-HIV co-infected patients (85% were receiving HAART; mean CD4 count 447±245/μl, HIV RNA load <400 copies/ml, 67% of patients), compared to HIV-negative patients, were more often male, injecting drug users, HBeAg-positive and HCV-HIV co-infected (P<10−4). They underwent liver biopsy less often (31% vs. 51%, P<10−4), particularly those with severe immunodeficiency. They received anti-HBV treatment more often (75% vs. 45·7%, P<10−4), mainly lamivudine and tenofovir. Significant improvements in the management of such patients are awaited mainly in the appraisal of liver disease by either liver biopsy or non-invasive alternatives to liver biopsy.

Men engaged in slaughtering and dressing meat show a higher incidence of Brucella abortus agglutinins than those in similar age and sex groups who are otherwise employed, where titres of 1 in 20 and upwards are observed.

This applies especially to men who deal with cattle and sheep; no such increased incidence has been noted in men dealing with pigs.

It would seem that a titre in the vicinity of 1 in 40 serves to indicate evidence of Brucella infection definitely greater than that likely to be found in the generality of the community.

Indigenous, foodborne transmission of hepatitis E has been increasing across industrialised countries. Public Health England has conducted enhanced surveillance in England and Wales since 2003.This report gives an account of acute infections from 2010 to 2016 and describes modification made to the methods of surveillance to account for changes in reporting behaviours and improve ascertainment.

1. It is inadmissible to study the “Danysz Effect” on tetanolysin owing to its rapid deterioration.

2. The so-called “equivalents” of toxin and antitoxin deduced by Arrhenius and Madsen are arbitrary.

3. No evidence has yet been advanced that the “Danysz Effect” has a limiting value when the time of contact of the first fraction of toxin with the antitoxin is prolonged.

4. If a limiting value of the “Danysz Effect” exist that calculated by Arrhenius is probably erroneous.

5. The monomolecular formula used by Arrhenius is merely an interpolation.

6. The “Danysz Effect” is much better represented by a bimolecular formula.

7. No confirmation of the “equivalents” of toxin and antitoxin has as yet been obtained from the “Effect.”

8. Expediency appears to be the only justification for assuming that the “Effect” is due to either a modified antitoxin or to a modified toxin, viz. epitoxonoid.

9. All the phenomena of the “Effect” hitherto advanced have their counterpart in the staining of paper, porcelain, etc., by anilin dyes.

Surgical site infection (SSI) following cardiovascular surgery has been well documented, possibly owing to its highly invasive nature, but SSI following surgery on the thoracic aorta has not. This study aimed to describe the epidemiology and assess risk factors associated with the latter in Japan using a national database for SSI. Data on surgery on thoracic aorta performed between 2012 and 2014 were extracted from the Japan Nosocomial Infections Surveillance (JANIS) database. Risk factors were assessed initially by univariate analysis, and then entered into a logistic regression model for final evaluation. The cumulative incidence of SSI was 4.1% (146/3538) and staphylococci were the most frequent pathogens isolated. Factors such as the duration of operation, emergency surgery and male gender were significantly associated with SSI. These findings differ from previous studies on open heart and coronary artery bypass surgery, in which the American Society of Anesthesiologists (ASA) score was significantly associated with SSI, but gender was not. This study suggests that risk stratification in the JANIS system might be improved by incorporating additionally identified factors for risk adjustment, when comparing the incidence of SSI between hospitals.

1. In a controlled experiment prontosil was used in the treatment of four cases of streptococcal tonsillitis. These cases subsequently developed acute rheumatism.

2. Two cases of otitis media and one case of streptococcal pneumonia, not in the controlled experiment, were treated with sulphonamide and sulphapyridine respectively. These cases developed rheumatism as a complication.

3. Haemolytic streptococci were recovered from twelve cases of respiratory tract infection which subsequently developed acute rheumatic fever.

1. Fifteen apparently healthy persons were exposed to air enriched with positive or negative ions at 78° F. and 87° F. Average ion counts at 78° F. were 12,324 positive ions per ml. and 5,451 negative ions per ml. The averages at 87° F. were 14,865 positive ions per ml. and 5,442 negative ions per ml. Relative humidity was kept at 50% and air motion was 28 ft./min.

2. Seven sensations related to comfort (thermal sensation, humidity sensation, sensible perspiration, air motion, pleasantness, mood and fatigue) were recorded, pulse rate and oral temperature were measured.

3. In the experiments at 78° F. mood was improved (P < 0·001) by positive ionization. All other qualities remained unaffected by positive ionization. No effect was found under negative ionization at the ion concentration applied.

4. In the experiments at 87° F. five sensations (thermal sensation, sensible perspiration, pleasantness, mood and fatigue) were significantly (P < 0·001) improved by ionized air. In general, as can be seen from the significantly differences between grand means, the subjects felt cooler, perspired less, felt more pleasant, were in a better mood, and felt less fatigued under the influence of air enriched with ions.

Air motion sensation, humidity sensation, pulse rate and oral temperature were not affected by ionization.

5. As different individuals may vary in their response to ionization, individual preferences were tested. These tests indicated that at 87° F. six out of the fifteen persons tested preferred ionized air (P < 0·001). One person preferred air not enriched with ions (P = 0·0091).