1896. SERUM THERAPEUTICS. iii 



these hospitals, to 29 per cent, in 1892, and rose again to 30'3 per 

 cent, in 1893. This diminution is probably due, at least in part, to 

 the fact that at first only a few cases were admitted, and those 

 probably very severe ones with a high fatality. The fatality shows 

 very wide variations, according to the age of the patients: the figures 

 of these hospitals show that in children under five years old it is as 

 high as 53-8 per cent., falling with each quinquennial period, till at 

 the ages of fifteen to twenty it is as low as 3-9 per cent. Washbourne 

 and others give the average hospital fatality in England as 38"9 per 

 cent., and this is probably as accurate an estimate as is possible. 

 The general fatality is, of course, much lower than this, as all the 

 slighter cases which do not come under hospital treatment will be 

 included. According to the figures of the New York Board of 

 Health, the average fatality of diphtheria in that city for the four 

 years preceding the introduction of antitoxin was 34*63 per cent. 

 The average Berlin fatality is given by Baginsky as 41 per cent. ; 

 that of several children's hospitals in Vienna varies on either side of 

 50 per cent., which is about the same as that shown by the Paris 

 hospitals for children. 



When a new remedy such as diphtheria antitoxin is introduced, 

 the temptation is to apply it indiscriminately to each and every case 

 of the disease, however mild and favourable. Hence, in considering 

 the statistics of diphtheria mortality under the antitoxin treatment, 

 some allowance must be made for this fact : the figures may appear 

 a little too good. There can, however, be no doubt that the fatality 

 has been very materially reduced, in some cases to one-half or even 

 less, and this is too striking to be attributable to mere variation in 

 the epidemic constitution of the disease. We have not as yet a 

 sufficient body of statistics from this country, but a few examples 

 may be given. In December, 1894, I^^s. Washbourne, Goodall, and 

 Card reported 72 cases treated with antitoxin, all under 15 years of 

 age, with a fatality of i9'4 per cent. : the previous fatality in similar 

 cases had been 38*8 per cent. In February of last year, Dr. Ruffer 

 reported 274 cases treated with antitoxin in four London hospitals, 

 with a fatality of only 13-5 per cfent. As regards tracheotomy cases, 

 Washbourne, Goodall, and Card report 9, with only 3 deaths, the 

 previous fatality having been 91*7 per cent., while Herringham 

 reports 10 cases with only 3 deaths, the previous fatality having been 

 65 per cent. From the Belvedere hospital in Glasgow, Dr. Johnson 

 reports 105 cases treated with antitoxin, with a fatality of 15*2 per 

 cent, (excluding very mild cases and those who were moribund on 

 admission) : the lowest fatality in the previous five years had been 

 28'6 per cent., and the highest 41-4 per cent. 



From abroad more extensive statistics are available. During 

 the first nine months of the year 1895, the diphtheria fatality in New 

 York has fallen to i9'43 per cent., with only partial antitoxin treat- 

 ment : during the four preceding years it had averaged 34*63 per cent. 



