Experiments I–VIII.

I shows that under the conditions shown the plates were covered with innumerable colonies 7 feet above ground level to ground level. The beds and trestles were used to keep the hut always uniform.

II shows that 8 feet above ground, i.e. on top of the crossbeams, the same conditions obtain.

III, IV, V, and VI show that the same condition exists in the area between the beds or trestles. The beds make no difference, better or worse.

VII shows practically the same condition high up on the beam between the beds. The inverted plates naturally show less colonies, as the organisms mostly fall on to the plates.

VIII confirms the above.

There is only one conclusion to draw from these experiments, and that is that practically speaking there is no difference in the number of organisms on the ground floor and 8 feet above it, in the ordinary men’s sleeping huts, Barrack Design 230/14.

The following investigation was undertaken during November and December 1911 with the object of determining the source of infection in a series of cases of anthrax which occurred in the same yarn mill. The investigation resulted in proving that anthrax spores were present in a variety of East India wool and in the yarn manufactured therefrom.

1. The incidence of haemolytic streptococci in the patients of a Hospital School for rheumatic children was determined over a period of 1 year.

2. In the total of 1644 throat and 1644 nasal swabs, group A strains were isolated from 20 throat and two nasal swabs. Eighty-seven strains of Lancefield's groups C and G and 54 strains of groups other than A, C, or G were isolated

3. There was no evidence of cross-infection.

4. Factors contributing to the low incidence of group A strains and the absence of cross-infection are discussed.

5. The carriage of groups C and G strains did not appreciably affect the erythrocyte sedimentation rate.

6. Although no direct evidence is available, the experience of the present study suggests that the incidence of streptococci in an institution for rheumatic children may be reduced by: (a) bacteriological screening before admission; (b) regular swabbing and Lancefield's grouping of streptococci isolated for the early detection of group A strains; and (c) administration of penicillin or sulphadiazine prophylactically to even a limited number of children.

We thank Prof. R. S. Illingworth for his advice in the writing of this paper, Dr J. L. Emery for laboratory facilities, Dr R. E. O. Williams for his advice in the planning of the investigation, and the matron and sisters of Ash House Hospital School, Sheffield, for their assistance.

The expenses of the investigation were defrayed by a grant from the Medical Research Council.

This paper records the results of systematic pneumococcus typing over a 7-year period in children from 4 days to 12 years of age in the R.H.S.C., Glasgow. Strains typed include those from respiratory tract lesions, from pus in middle ears, meninges, joints, serous sacs and miscellaneous purulent foci. A series of strains from normal throats serves for comparison.

The constant prevalence year by year of types 6, 19, 1 and 23 in all types of disease is striking. On dividing the cases into those under and over 2 years, the incidence of type 1 in the older children is four times that in the younger group. Conversely in those over 2 the incidence of the higher types (21–32) is only half that in the younger patients. No other significant difference in type distribution is observed on comparing the two age groups. Group IV pneumococci are commonly carried in the healthy nasopharynx, and are potential pathogens in young children in whom broncho pneumonia is generally an endogenous infection. There is evidence that the same type of pneumococcus frequently invades the entire respiratory tract and the middle ears. Only thirty of our cases were in the neonatal period and the apparent immunity of the newborn to the pneumococcus is discussed.

The clinical and molecular epidemiology of glycopeptide-resistant Enterococcus faecium was investigated during an outbreak on a renal unit. Forty-nine patients were colonized or infected during a 15-month period. Sites of colonization included faeces, urine, intravenous (IV) catheter tips and wound swabs. Ten patients had infections, which included five bacteraemias and three episodes of peritonitis. Pulsed-field gel electrophoresis of 43 patient isolates of glycopeptide-resistant E. faecium identified seven strains during the first 7 months of the outbreak. Three of these strains affected five or more patients. One strain accounted for 17/43 isolates. Isolates that were possibly related to another renal unit strain were cultured from patients at two other Manchester hospitals. These isolates were epidemiologically-related, and may represent a single Manchester epidemic strain. Of five patients who had multiple isolates of glycopeptide-resistant E. faecium, three had isolates representing a single strain and two were colonized or infected by more than one strain.

The incidence of reported infections of non-typhoid Salmonella is affected by biases inherent to passive laboratory surveillance, whereas analysis of blood sera may provide a less biased alternative to estimate the force of Salmonella transmission in humans. We developed a mathematical model that enabled a back-calculation of the annual seroincidence of Salmonella based on measurements of specific antibodies. The aim of the present study was to determine the seroincidence in two convenience samples from 2012 (Danish blood donors, n = 500, and pregnant women, n = 637) and a community-based sample of healthy individuals from 2006 to 2007 (n = 1780). The lowest antibody levels were measured in the samples from the community cohort and the highest in pregnant women. The annual Salmonella seroincidences were 319 infections/1000 pregnant women [90% credibility interval (CrI) 210–441], 182/1000 in blood donors (90% CrI 85–298) and 77/1000 in the community cohort (90% CrI 45–114). Although the differences between study populations decreased when accounting for different age distributions the estimates depend on the study population. It is important to be aware of this issue and define a certain population under surveillance in order to obtain consistent results in an application of serological measures for public health purposes.

The British Standard Technique for Determining the Rideal-Walker Coefficient of Disinfectants (no. 541—1934), in laying down the procedure to be adopted with regard to the test typhoid bacillus culture, recommends that a fresh culture be obtained each month from the National Collection of Type Cultures. In all probability this is the best procedure; it does, however, sometimes happen that a test is required urgently when a fresh culture is not available. The following notes upon our own experience in maintaining cultures may therefore be of some interest. It is our practice to obtain fresh cultures whenever we are called upon to carry out other than routine tests unless a recent one has been obtained, and many of these cultures have now been running for a number of years. On the arrival of the culture from the N.C.T.C. it is subcultured on to an agar slope and “incubated” at room temperature in a dark cupboard. 2% agar is used in a broth prepared by the tryptic digestion of ox heart. Further subcultures are made at intervals of one month. It is our usual practice to start a series of broth cultures from such slopes not less than 14 days after sowing.

The use of the hypergeometric distribution in calculations of sample volumes for safety testing is criticized. Alternative interpretations of the concept of ‘infective ml. doses’ lead to slightly different solutions, the simplest of which, involving the exponential function, is recommended for general use.

The Arizona Department of Health Services identified unusually high levels of influenza activity and severe complications during the 2015–2016 influenza season leading to concerns about potential increased disease severity compared with prior seasons. We estimated state-level burden and severity to compare across three seasons using multiple data sources for community-level illness, hospitalisation and death. Severity ratios were calculated as the number of hospitalisations or deaths per community case. Community influenza-like illness rates, hospitalisation rates and mortality rates in 2015–2016 were higher than the previous two seasons. However, ratios of severe disease to community illness were similar. Arizona experienced overall increased disease burden in 2015–2016, but not increased severity compared with prior seasons. Timely estimates of state-specific burden and severity are potentially feasible and may provide important information during seemingly unusual influenza seasons or pandemic situations.

Two hundred and sixty-four samples of sera obtained from normal healthy persons belonging to different age groups were examined for haemagglutination-inhibiting antibodies against reovirus types 1–3 to assess the prevalence of reovirus infection in the northern part of India.

Reovirus infection appeared as early as 6 months to 1 year of age. With reovirus types 1 and 2, the maximum incidence of 67 and 48% respectively occurred by the age of 10–20 years, whereas with type 3 infection the maximum incidence (73%) was reached by the age of 25 years. The incidence of reovirus type 2 infection in all the age groups was remarkably low in this series. A drop in the incidence of reovirus type 2 infection was also noticed after the age of 20 years.

The difference in geometric mean titre of antibody in different ages against reovirus type 2 was highly significant, suggesting probably that most of the infection occurred by the age of twenty years. The difference in the geometric mean value of the titres of antibody against types 1 and 3 was not significant in different age groups. The levels of antibody against types 1 and 3 in all the age groups were almost the same, suggesting that infection, specially with reovirus type 3, was occurring in all the age groups even beyond 20 years of age.

The authors wish to express their sincerest thanks to Dr Leon Rosen, Pacific Research Section, National Institute of Allergy and Infectious Diseases, Honolulu, Hawaii, for the supply of prototype strains of reoviruses, to Drs B. K. Aikat, Director Professor of Pathology, R. N. Chakravarti, Department of Experimental Medicine, O. N. Bhakoo, and Sucheta Thukral, Department of Paediatrics, Post- Graduate Institute of Medical Education and Research, Chadigarh, for their invaluable help and co-operation, to Prof. P. V. K. Iyer, Department of Mathematics, Panjab University, and to Mr H. D. Gupta, Biostatistician, Post-Graduate Institute of Medical Education and Research, Chadigarh for their statistical analysis of the results.

The authors gratefully acknowledge the helpful criticism and suggestion of Dr C G. Pandit, Ex-Director, Indian Council of Medical Research, during the preparation of the paper.

The authors acknowledge also the technical assistance of Mr Jagmohan Lai Pipat, Mr Gurmeet Singh Khatra, and Mr Amar Singh Saini.

This work was partly supported by the Research Grant of the Indian Council of Medical Research sanctioned to one of the authors (S. R. P.).

Two phenotypes of human influenza A(H1N1) virus are currently circulating in Japan. One (group 1) agglutinates both chicken and goose red blood cells (CRBC and GRBC), the other (group 2) agglutinates GRBC but not CRBC. In the 1995/6 season, group 2 viruses accounted for 70% of the H1N1 viruses isolated in MDCK cells. The 1995/6 viruses were located on two branches of the genetic tree. One branch contained both group 1 and group 2 viruses and the other branch contained only group 2 viruses. Group 2 viruses had aspartic acid at residue 225 in the haemagglutinin (HA) protein, the key amino acid residue for group 2 phenotype. The HA protein of group 1 viruses had a change from aspartic acid to asparagine at residue 225 and the expressed HA protein of these viruses adsorbed CRBC. Serial passage of group 2 viruses in MDCK cells or embryonated chicken eggs caused these viruses to gain the ability to agglutinate CRBC. MDCK-adapted viruses had the same amino acid sequences of HA polypeptide as the original ones, but egg-adapted viruses had changed amino acid sequences. The expressed HA protein from one egg-adapted virus that originally belonged to group 2 adsorbed CRBC.

1. That there is reason to believe that sporadic cases of cerebro-spinal fever occurred in Hong Kong previous to the outbreak of the epidemic in 1918.

2. That the epidemic followed a widespread infection of influenza colds.

3. That the mortality out of a total of 1040 cases was 85–48 per cent.

4. That the most susceptible age was found to be the age period under five years.

The younger the individual, the greater the susceptibility, with the added proviso that the extremes of life suffered most.

5. That once the epidemic was established, a drop in the temperature, steadily maintained, accompanied by an increase in the saturation of the air as regards moisture, associated with a lack of sunshine, was found to be followed after a lag of a few days, by a rise in the number of cases. This lag showed a tendency to increase as the epidemic progressed, from three to four days at the beginning to six to seven days at the end of the epidemic.

6. That the number of cases in any given area varied directly with the overcrowding in that area, and this bears out the contention that overcrowding is one of the most important features in the epidemiology of cerebro-spinal fever.

7. That the housing conditions in Hong Kong are such as to necessitate immediate action on the part of the Government, to safeguard the public health of the colony.

8. That new entries to Hong Kong formed a large proportion of the cases, and that this appears to be an important factor in the epidemiology of the disease.

9. That the poorest, most hard worked and badly housed portion of the community suffered most in the epidemic.

10. That the recognition and isolation of carriers is impracticable in an epidemic of any considerable dimensions.

11. That in the present condition of the knowledge of the means by which infection is spread, the wearing of a screen composed of some impervious material such as celluloid would seem to afford complete protection to the wearer against droplet infection.

12. That known carriers should be compelled to wear this screen until such time as they are proved free from the meningococcus. Thus protected, the carrier could pursue his usual avocation and the community be safeguarded from infection at a minimum of expense.

We evaluated the incidence rate of culture-positive central nervous system tuberculosis (CNS TB) in France in 2007 and its time trend between 1990 and 2007. We used a capture–recapture analysis by using data recorded in 2007 by the mandatory notification system and the national network of the National Reference Centre (NRC). The 2007 sensitivity of the NRC was 79·4%. The previous sensitivity for 2000 (75·6%) and that for 2007 yielded a pooled estimate of 77·4% (95% confidence interval 64·8–88·0), which was used to extrapolate the number of culture-positive CNS TB cases from those reported in four surveys (1990, 1995, 2000, 2007). The extrapolated number of culture-positive CNS TB cases fell from 90 to 35 between 1990 and 2007, and the extrapolated incidence rates fell from 1·6 to 0·55 cases/million (P < 0·001). This favourable trend should be closely monitored following the change of the BCG vaccination policy in 2007.

With regard to the influence of malarial infection on the Wassermann test some controversy prevails:

Wassermann and Lange (1913) refer to Meyer and Bonfiglio who, working in Italy, obtained a positive reaction in 80 per cent. of the cases where the blood contained parasites; in some of their cases positive reactions were obtainable for several months after the disappearance of fever and parasites. For this reason Wassermann and Lange advise to put every case, coming from a malaria-infected country and showing a positive reaction, under quinine treatment and to repeat the test after a lapse of six weeks.

In 1956–58 septic lesions in men of the R.A.F. accounted for about 3% of all admissions to sick-quarters or hospital and about 5% of admissions excluding respiratory disease; 1% of all men in the service were admitted with sepsis each year. Incidence fell with age, particularly up to the age of 25 years. The rates for women were about 50% higher.

Recruits experienced more than twice as much sepsis as trained men and boy apprentices. Officers had only half the admission rate of other ranks. These contrasts could have been explained by differences in age. There was no evidence of seasonal variation in the incidence of sepsis, but in recruits and boy apprentices epidemics of sepsis unrelated to season occurred.

I am indebted to Dr J. C. McDonald and Professor R. E. O. Williams for helpful criticism, to Professor P. Armitage for statistical advice and to the Director-General, Royal Air Force Medical Services, for permission to publish the results.

1. The appearance and disappearance of typhoid bacilli in the faeces in these four cases bore no relation to changes in the diet nor to the physical state of the stools, but the later they appeared the shorter was the duration of their appearance.

On the disappearance of typhoid bacilli from the stools the intestinal flora tended to become more simple.

2. B. coli was the only organism invariably present at every examination.

3. Streptococci were very much more abundant in the earlier stages of the disease, when milk formed the greater part of the diet, than in the later stages.

4. In two cases where boils occurred on the body the causative organism had previously been isolated in large numbers from the faeces.

5. With stools slightly alkaline to litmus the flora in these cases was relatively simple and fermentative in type. There is no apparent advantage, therefore, in giving a high carbohydrate diet except in cases of marked alkalinity and putrefaction.

Influenza C virus antigen could be detected by immunofluorescence in chick amniotic epithelium 4 hr. after inoculation with undiluted amniotic fluid. Antigen could be detected in the nucleus of rhesus monkey kidney tissue cultures 10 hr. after infection. Only cytoplasmic fluorescence was observed 17–21 hr. after infection.

The pattern of replication was similar to that reported for group I myxoviruses, indicating that the virus is correctly classified as an influenza virus.