44 The Philippine Journal of Scvence 1920 
MORTALITY 
Looking over the summary of yearly reports of the Philippine 
Health Service regarding incidence of the disease in Manila 
(Table 1) from 1900 to 1918, we find five hundred four cases 
of which there were one hundred ninety-nine deaths, or 39.4 
per cent. From the sixty-two cases admitted to San Lazaro 
Hospital during 1919 and first two months of 1920 there were 
twenty-three deaths, or 37 per cent. Confining ourselves to 
those cases which were bacteriologically confirmed in this last 
geries we find that out of thirty-one cases bacteriologically 
positive, there were twelve deaths, or 38.7 per cent. 
The mortality is greatest during the first five years of life. 
In the San Lazaro Hospital cases there were seven deaths, or 
36.8 per cent, in nineteen children under 2 years of age; four- 
teen deaths, or 41.1 per cent, in thirty-four children from 2 to 
5 years old; two deaths, or 33 per cent, in six children 6 to 10 
years old; and no death in the three cases more than 15 years 
of age. Among the twenty-seven autopsy cases there were 
thirteen children, or 48:1 per cent, under 2 years of age; ten, 
or 37 per cent, from 2 to 5 years of age; two, or 7.4 per cent, 
from 6 to 10 years; and two, or 7.4 per cent, adults. 
The percentage of mortality is rather high, especially if we 
take into consideration the fact that the cases admitted to San 
Lazaro Hospital were injected at once with antitoxin without 
awaiting the results of bacteriological examination. It cor- 
responds to the mortality in cold countries in the pre-antitoxin 
era but is much higher than that shown by statistics subsequent 
to the introduction of antitoxin, which is only about 14.6 as 
against 9.8 per cent (Osler). 
This high mortality was already remarked upon by Dr. Sal- 
vador V. del Rosario,(2) chief of Manila Sanitation. He sug- 
gests that it might be due to atypical mixed infections or to 
the tardy administration of antitoxin following delayed diag- 
nosis. The last supposition is contradicted by the meager 
information regarding the prevalence in Manila or in the Philip- 
pine Islands of post-diphtheritic paralysis which is so commonly 
observed in recovered cases of genuine diphtheria to follow upon 
the belated administration of the antitoxin. 
In isolating Bacillus diphtherizs we have paid no atten- 
tion to other concomitant bacteria; but we have observed 
streptococci in abundance in at least two cases, one of which 
recovered promptly, and the other proved fatal. If we examine 
the number of days the patients were sick before reporting to 
