An analysis of Medicare claims for patients admitted to hospital with pneumonia in Connecticut shows that outcomes got worse between 1991 and 1997 (Archives of Internal Medicine 2000;160:3385-91). During these six years length of hospital stay went down by four days while death rates after discharge, and readmission rates for pneumonia, went up. Investigators speculate that the trends are linked, although there are several other plausible explanations for the rise in death rates, including the spread of antibiotic resistant Streptococcus pneumoniae.

The Medical Journal of Australia is always a good place to look for novel ways of being poisoned. The Christmas issue carries the first ever report of envenomation by the billy goat plum stinging caterpillar, an attractive green and yellow spiny caterpillar, so called because it eats the leaves of the billy goat plum tree (2000;173:654-5). When one dropped from the sky (or more probably a twig) on to a 26 year old woman from Darwin, pain from the sting radiated from her forearm to her shoulder and resolved only after she was given 5 mg of intravenous morphine. The caterpillar, which was humanely captured for identification purposes, would eventually have turned into a rare moth, Thosea penthima Turner.

Nearly 10% of the 17 150 male doctors in the physicians health …