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An analysis was made of the severity of over 8000 cases of whooping cough notified from October 1974 to March 1975. Ten per cent of these patients were admitted to hospital and there were 10 deaths. Severity was directly related to age, the disease being most severe in children under 1 year, especially those under 6 months. There was some evidence that previous vaccination reduced the severity of the disease, but the vaccination programme does not cover very young children, and for them whooping cough is a dangerous disease.

During the years 1963-72 33 patients with systemic lupus erythematosus (S.L.E.) died. Of these 30 case records were available for analysis. For the same period 167 patients with S.L.E. were admitted. It was ascertained that of the 30 deaths 22 were directly attributable to the disease itself and 8 were related to complications of therapy. The three commonest causes of death were neurological involvement (11 patients), renal failure (9 patients), and infection (8 patients).

A patient who had received multiple transfusions developed antiglobulin-positive haemolytic anaemia due to a delayed haemolytic transfusion reaction. Many cases of haemolytic anaemia after cardiac surgery could be explained on this basis.

The modes of presentation and the management of acute respiratory failure in 11 infants with severe lower respiratory tract infections (due to respiratory syncytial virus in eight) are described. Progressive respiratory difficulties leading to exhaustion, peripheral circulatory collapse, recurrent apnoeic attacks, or generalized convulsions were the main clinical presentations resulting in severe ventilatory failure. In nine infants preventilation carbon dioxide tensions exceeded 65 mm Hg. It seems likely that the use of intermittent positive-pressure ventilation in these patients contributed to the low mortality rate, less than 0.5%, from such illnesses during the 15-month study period.

During eight weeks of a recent influenza epidemic 29 patients with ketoacidosis were admitted to the General Hospital, Birmingham. This was an exceptionally large number of cases. Of these, 14 had complained of a cough, nine had clinical evidence of respiratory infection, and four extensive bronchopneumonia. Hypokalaemia was present on admission in several instances and caused respiratory failure and death in three patients. Since the dangers of initial hypokalaemia are increased during the treatment of ketoacidosis, especially when sodium bicarbonate is used, serum potassium levels must be estimated initially and, if necessary, potassium chloride given intravenously at more frequent intervals than usual.

Twenty-five cases of severe pneumonitis occurring among children aged 3 to 18 months were observed in Auckland, New Zealand, in 1965. An apparent relationship was established between a uniform disease picture and recovery of adenovirus type 21. Two died, and of the survivors 60% had permanent lung damage, probably resulting from obliterative bronchiolitis. Twenty per cent. were left with proved bronchiectasis. The possible relationships of adenovirus pneumonia to malnutrition or a genetic factor on the one hand and to the development of bronchiectasis on the other are discussed.