Some medical-historic aspects of the later Napoleonic wars, 1812-15.
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Biomedical subjects
Publications and source records attributed to B Taylor.
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A double-blind randomized controlled trial of amoxycillin, co-trimoxazole, and placebo was conducted on 197 children presenting with presumed viral respiratory infections. Routine throat swabs were taken to exclude streptococcal diseases. The three disease categories studied--nasopharyngitis, pharyngotonsillitis, and bronchitis (including laryngotracheobronchitis)--showed a generally similar pattern of resolution irrespective of treatment. Nevertheless, seven out of 66 children receiving placebo were withdrawn from the trial with unremitting symptoms or complications thought to require antimicrobial treatment. Only two of 56 children receiving amoxycillin and none of 75 receiving co-trimoxazole were withdrawn. Three other children receiving amoxycillin and three receiving placebo were seen during the trial but further treatment was not thought to be necessary. Thus the return consultation rate in children receiving placebo therapy was 15% compared with 4% for those receiving antimicrobial treatment. Antimicrobial treatment was associated with less nasal discharge on the eighth day of treatment. Placebo treatment allowed an earlier return to normal activity. There was a high incidence of possible side effects on all regimens including placebo. It is concluded that the benefits of antimicrobial treatment in presumed viral respiratory infections are marginal, and they should not be routinely prescribed for these conditions.
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The assessment of a case of blunt abdominal trauma can be complicated by many factors, and the resultant inaccurate or delayed diagnoses have contributed to the unacceptable mortality for this type of injury. Recently several useful diagnostic techniques have been developed that, if applied intelligently, may be instrumental in decreasing the high mortality among patients who present with ambiguous abdominal signs after sustaining blunt trauma. Although hematologic investigation and routine radiography have facilitated detection of intraperitoneal injury, peritoneal lavage has become the single most helpful aid. Scanning procedures are sometimes useful in recognizing splenic and hepatic defects especially; these may be confirmed or clarified by angiography. Although ultrasonography may be no more valuable than scintigraphy in outlining splenic and hepatic abnormalities, it is an important technique, especially in the diagnosis of retroperitoneal masses of traumatic origin. Laparoscopy also may be helpful in investigation if surgeons become more familiar with the procedure.
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In a prospective study of the development of reaginic allergy, infants of allergic parents were either subjected to an allergen-avoidance regimen from birth for six months or managed conventionally. The group on the allergen-avoidance regimen had less eczema at six months and one year than did the control group at six months. They also had a lower mean serum-total-IgE level at six weeks.
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The inhibitory activity of netilmicin against 500 isolates of gram-negative bacteria was compared with those of gentamicin and tobramycin. Netilmicin was considerably less active than tobramycin and slightly less inhibitory than gentamicin for Pseudomonas aeruginosa but was at least as active against Escherichia coli and Klebsiella pneumoniae as were the other two antibiotics. A few Klebsiella and Serratia isolates resistant to gentamicin and tobramycin were inhibited by netilmicin. All three antibiotics were strongly bactericidal for E. coli, K. pneumoniae and P. aeruginosa but had less lethal activity against the otherwise susceptible Serratia isolates tested. Some necessary precautions in reading minimal inhibitory concentrations on agar media are stressed, and some possible advantages of a 4-h bactericidal test, using a constant antibiotic concentration, are defined.
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