24 REPORT—1896. 
and it has during the last two years been extensively tested in practice in 
various parts of the worid, and it has gradually made its way more and 
more into the confidence of the profession. One important piece of evi- 
dence in its favour in this country is derived from the report of the six 
large hospitals under the management of the London Asylums Board. 
The medical officers of these hospitals at first naturally regarded the prac- 
tice with scepticism : but as it appeared to be at least harmless, they 
gave it a trial ; and during the year 1895 it was very generally employed 
upon the 2,182 cases admitted ; and they have all become convinced of 
its great value. In the nature of things, if the theory of the treatment 
is correct, the best results must be obtained when the patients are 
admitted at an early stage of the attack, before there has been time 
for much poisoning of the system : and accordingly we learn from the 
report that, comparing 1895 with 1894, during which latter year the 
ordinary treatment had been used, the percentage of mortality, in all 
the six hospitals combined, among the patients admitted on the first day 
of the disease, which in 1894 was 22:5, was only 4:6 in 1895; and for 
those admitted on the second day the numbers are 27 for 1894 and 14:8 
for 1895. Thus for cases admitted on the first day the mortality was 
only one-fifth of what it was in the previous year, and for those enter- 
ing on the second it was halved. Unfortunately in the low parts of 
London which furnish most of these patients the parents too often delay 
sending in the children till much later: so that on the average no less 
than 67:5 per cent. were admitted on the fourth day of the disease or later. 
Hence the aggregate statistics of all cases are not nearly so striking. 
Nevertheless, taking it altogether, the mortality in 1895 was less than had 
ever before been experienced in those hospitals. I should add that there 
was no reason to think that the disease was of a milder type than usual 
in 1895 ; and no change whatever was made in the treatment except as 
regards the antitoxic injections. 
There is one piece of evidence recorded in the report which, though it 
is not concerned with high numbers, is well worthy of notice. It relates 
to a special institution to which convalescents from scarlet fever are sent 
from all the six hospitals. Such patients occasionally contract diphtheria, 
and when they do so the added disease has generally proved extremely fatal. 
In the five years preceding the introduction of the treatment with anti- 
toxin the mortality from this cause had never been less than 50 per cent., 
and averaged on the whole 61:9 per cent. During 1895, under antitoxin, 
the deaths among the 119 patients of this class were only 7:5 per cent., 
or one-eighth of what had been previously experienced. This very strik- 
ing result seems to be naturally explained by the fact that these patients 
being already in hospital when the diphtheria appeared, an unusually 
early opportunity was afforded for dealing with it. 
There are certain cases of so malignant a character from the first that 
no treatment will probably ever be able to cope with them. But taking 
