Child care and the family doctor.
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Biomedical subjects
Publications and source records attributed to R G Mitchell.
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Six cases of Lancefield Group G streptococcocal arthritis are described. Two cases had pre-existing chronic arthritis (one rheumatoid) with infection of a joint prosthesis. Three cases had neoplastic disease before or at the same time as septic arthritis. Skin reactions, including cellulitis and scarlatiniform rash were prominent in five cases. One patient may have acquired a Group G streptococcus from her dog. Five cases responded well to penicillin and the sixth who was allergic to that drug was cured by erythromycin. This unusual cause of septic arthritis is being recognized more frequently in the United Kingdom.
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In the search to reduce the prevalence and severity of handicap in childhood, a high priority should be accorded to identifying and eradicating possible causes of brain damage; to achieving a uniformly high standard of perinatal care; and to eliminating other causes of disability. At he same time attempts must be made to improve attitudes to handicapped children and to support parents in their efforts to minimise the effects of disability. It should be accepted that expectations of perfection in the newborn infant set an impossibly high standard and are likely to create that rejecting environment which itself increases handicap.
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Non-toxigenic clostridia, Clostridium butyricum but occasionally C. paraputrificum, were isolated from mainly extra-alimentary sites of 28 babies in maternity hospital over a period of 40 weeks. During that time, C. butyricum was isolated from the blood of two babies who died of necrotising enterocolitis and of two babies without referable symptoms. Otherwise these organisms appeared to be of no pathogenic significance.
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Legionnaires' disease was diagnosed in two patients in a transplant unit, both patients having occupied the same postoperative cubicle shortly before onset of their illnesses. Legionella pneumophila was found in water taken from the cubicle shower bath and from other showers in the unit. To eradicate the legionellae, the water supply was treated with chlorine, but this had only a temporary effect.
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A new type of test used to examine medical students' clinical skills in paediatrics is described. Each student has to circulate round a number of timed stations. At each one he performs a specified clinical procedure--such as history taking, physical examination, urine analysis, and radiological interpretation--and is marked according to his performance. This type of test is objective and can be extended to cover different aspects of clinical methods; it readily informs the student about his progress, and enables the teacher to look critically at his own technique.
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