444 



Br. G. Sims Woodhead 



[Feb. 8, 



not only as a curative or direct therapeutic agent, but also as a pro- 

 phylactic — that is, as a protective agent against possible infection, 

 especially during epidemics of diphtheria. It is almost too soon to 

 consider this prophylactic property of antitoxic serum, as for some 

 time to come the energy of those engaged in the preparation and use 

 of this serum must be directed towards obtaining a sufficient supply 

 for the treatment of cases of developed diphtheria. 



It may be well to consider what have been the results obtained 

 up to the present, and for this purpose the statistical method will 

 probably carry most conviction, especially if it is possible to give 

 full and accurate detail ; and now that these statistics have been 

 criticised not only by those who have used this treatment, but also 

 by those who oppose it because it runs counter to their feelings and 

 ideas, they are every day more and more trustworthy, much fuller, 

 and more valuable. 



It is first necessary to determine the average case mortality in 

 diphtheria for some considerable period before the antitoxic treat- 

 ment was introduced ; then to see what has been the lowest case 

 mortality during an equal and similar period for which we have any 

 statistics ; and lastly, to compare these with the case mortality of the 

 period during which the antitoxic serum has been used. 



In Table I. are given the mean annual death rates from diph- 

 theria per million living in England and Wales and in London, in 

 four periods of three years each. 



Dr. Sykes gives the following statistics: — During the year 1892 

 there were 1962 deaths from diphtheria in London, whilst in 1893 

 there were 3265, or nearly twice as many deaths. 



Now let us see what has been the case mortality. Statistics after 

 correction give the following results. During 1893 there were 

 13,694 cases of diphtheria notified in London. The mortality 

 amongst these cases was 3195 (Lancet statistics corrected), or 23*3 

 per cent. 



Table II. gives further information, and enables us to see what 

 is the diphtheria case mortality in large well-found hospitals. 



In Table III. are given statistics dealing with the diphtheria case 

 mortality where the serum treatment has been used. Wherever 

 possible, the case mortality over a considerable period is given in 

 the last column of the table, for purposes of comparison. 



It is objected, however, that general statistics of this kind are 

 of comparatively little value unless the age of the patient treated 



