Antibiotic resistance in Staphylococcus aureus

cases where the child was restrained and the five cases where the child was not restrained. In the latter group, the major cause of death was a severe comminuted skull fracture with gross underlying brain disruption and most importantly "with a minimum of other injuries" [my italics]. The injury pattern for the restrained children was different. In one case, the child was wearing an adult-type lapsash belt and receivedan abdominal injury (jejunal perforation) with no head injury; in the other three cases, diffuse intracranial injuries occurred without skull fractures but "other major injuries were present in all these children" [my italics]. Hence, the authors' view that the first group of deaths (that is, where the children were not restrained) was preventable. That philosophy has been expressed many times previously; rarely, however, has the effect been substantiated by evidenceof differences in the exact patterns of injury. The third virtue of this article is the extent to which, in company with all good pioneering articles, it offers questions for future research. The questions abound. The first question concerns the age difference. The authors point out that, although deaths in boys predominated, this sex difference only became evident after the age of four years. That finding is consistent with the pattern of total accidental deaths that previously was reported by Mackenzie, whose data covered two decades from 1952-1972. Her data showed a male/female ratio of 1.5 below the age of five years, which rose to a ratio of 2.6 from the age of five years to one of 4.7 from the age of 10 years, and to a ratio of 7.0 from the age of 15 years. " Mackenzie pointed out that the sex difference increased after schooling commences, 10 that is, when children leave the close supervision of their parents and learn more from their peers. Casual inspection of Causes of death shows that, whatever the reason, the phenomenon of male/female ratios increasing with age still persists in the late 1980s. One wonders why and whether improved knowledge would result in improved countermeasures. Next comes the matter of separating children from roads. The conventional wisdom is that pedestrian bridges should be built to span freeways and major arterial roads. But why should young persons, child-minding grandparents, pregnant women, and the disabled have to climb over these traffic streams? Why should the traffic not span pedestrian walkways instead of the other way round? Better still, why should we not prevent the conflict in the first place? There are some useful models. The authors rightly refer to the innovative designs both in Scandinavia and in the Australian Capital Territory where, in several suburbs, children are able because of the design of the suburb to go to school without crossing a main road. The research question is evident: "Did that design work? ". The applied scientific question also is evident if the design did work: "Should we, iJ la seat-belts, make it a mandatory requirement for future town-planning developments? ". The options for improved control are evident. As a final point, it is worth stressing that the authors have understated their case because their data are confined to cases that presented to the Westmead Hospital. Patients who died at the scene of the accident or before they reached hospital were excluded as were burn victims who were not taken to Westmead Hospital but who were admitted instead to the Burns Unit of The Children's Hospital, Camperdown. The options for improved control are greater than are presented here. If we are to reduce the incidence of accidental injury, a necessary preliminary is the removal of the old fault doctrine and the substitution of a conceptual framework which permits a more scientific approach to this major public-health problem. This article by Wheatley and Cass will help some research scientists to conceptualize the problem in a new and more useful way. ERIC C. WIGGLESWORTH Executive Director The Menzies Foundation, Melbourne