Circumcision in a National Sample of 4-year-old Children

The radiological picture of acute Friedliinder's pneumonia may resemble that of ordinary pneumonic consolidation, but, as was pointed out by Bullowa et al. (1937), the most striking finding initially is the density of the shadow, which is usually homogeneous and may be suggestive of fluid. A bronchopneumonic phase was described by Kornblum (1928). This was not seen in these cases. After a day or two one notices less-opaque areas due to the formation of abscesses. It is sometimes found that there is bulging or sagging of the interlobar septa, and this is well illustrated in the recent paper by Kirby and Coleman (1951), who reported it in half of their 11 cases. As the chronic stage is reached fibrosis makes its appearance, combined with a honeycomb effect due to small cavities. Keefer et al. (1946), in their clinical trials, found streptomycin effective if given early in lung infections due to Friedlander's bacillus. Chloramphenicol and aureomycin have also produced good results in small series. We found records of 38 cases treated with streptomycin, chloramphenicol, aureomycin, or combinations of these antibiotics. In these the mortality rate was 37%. We were impressed by the rapid downhill course of Case 4, who at 49 years was the youngest of the series. Rapid bacteriological diagnosis is still important in pneumonia. Our routine is to collect sputum at the initial clinical examination. Some of this is stained by Gram's method. If Gramnegative bacilli are found to be the predominant organism, streptomycin, I g. eight-hourly, is given pending the result of sputum culture. No cases have been seen since aureomycin became freely available. We intend to substitute it for streptomycin.