Many studies on prophylactic immunization against pneumococcal pneumonia have been made, using a number of different antigenic preparations. Almost all investigators have concluded that immunization exerts a beneficial effect. In most of the studies, however, certain variables have clouded interpretation of the results. Among the variables, the following appear to be of greatest moment: differences in the composition of the immunized and control groups; uncertainty as to whether the specific pneumococcal types included in the immunizing preparation were the same as those currently causing pneumonia; failure to determine whether the observed decline in cases in the immunized group was due to a decrease in cases caused by the pneumococcal types included in the vaccine; inadequate control of the antigenicity of the preparations used.The subject of antipneumococcal immunization has been reviewed recently by Heffron (1) and references will be made in the present paper to certain aspects only.The studies of Lister and Ordman (2) among native laborers in South Mrican mines between 1930 and 1934 suggest that immunization with a polyvalent pneumococcal vaccine reduces the incidence of pneumonia caused by the same pneumococcal types.

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The corpse of a Late Neolithic individual found in a glacier in Oetztal is unusual because of the intact nature of all body parts that resulted from the characteristics of its mummification process and its protected geographical position with regard to glacier flow. Anthropological data indicate that the man was 25 to 40 years old, was between 156 and 160 centimeters in stature, had a cranial capacity of between 1500 and 1560 cubic centimeters, and likely died of exhaustion.

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We compared the performance deficiencies of airway management captured by three types of self-reports with those identified through video analysis. The three types of self-reports were the anesthesia record (a patient record constructed during the course of treatment), the anesthesia quality assurance (AQA) report (a retrospective report as a part of the trauma center's quality assurance process), and a posttrauma treatment questionnaire (PTQ), which was completed immediately after the case for the purposes of this research. Video analysis of 48 patient encounters identified 28 performance deficiencies related to airway management in 11 cases (23%). The performance deficiencies took the form of task omissions or practices that lessened the margin of patient safety. In comparison, AQA reports identified none of these performance deficiencies, the anesthesia records identified 2 (of 28), and the PTQs suggested contributory factors and corrective measures for 5 deficiencies. Furthermore, video analysis provided information about the context of and factors contributing to the identified performance deficiencies, such as failures in adherence to standard operating procedures and in communications.

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Exactly twenty years ago, David Cogan of Harvard University, Department of Ophthalmology, reported four cases of "Nonsyphilitic Interstitial Keratitis Associated with Vestibulo-auditory Symptoms." All four cases came to him within a year, all from the environs of Boston. In his cases the corneal changes progressed rela tively little but the vestibular condition incapacitated the patients for several weeks or months and the auditory state led to profound deafness.Cogan discussed the differences between this disease and syphilitic keratitis, noting that in the latter condition, only 4% of the cases developed deafness and the deafness did not occur until months or years after the keratitis. Dr. Cogan and his associates have continued to report on these cases of non-syphilitic keratitis with vestibular and cochlear symptoms, as in 1949 when the case load had risen to 13, 1959 when two deaths but no autopsies were reported and 1963 when a limited autopsy on a 14 year-old boy was obtained.Reports of approximately 36 of these cases have come to our attention. They mostly concern relatively young people, although the age range is now ΐΥζ years to 60. Only one Negro and one Cuban are in the list. Reports have been in the Italian and Swiss literature. The disease was not listed on the program of a recent symposium in Philadelphia on vestibular diseases, October, 1964.