DIPHTHERIA 203 



the older statistics of mortality are lower than they should 

 be. On the other hand, a bacteriological examination 

 sometimes enables us to recognise as diphtheria mild cases 

 of angina which in former days would not have been 

 included in the diphtheria statistics. No doubt among 

 hospital patients, at any rate, this class of cases is decidedly 

 less frequent than the former class, consequently the 

 mortality of cases in which the diagnosis has been verified 

 by bacteriological examination should be higher than that 

 of cases in which the examination has been omitted. 

 Another point to consider is the varying severity of the 

 epidemic. It is not common to meet with series of mild or 

 severe cases occurring at irregular intervals. The only way 

 to avoid this fallacy is to take either a large number of 

 cases in each series, or to take a large number of series for 

 comparison. 



The following are the general conclusions drawn from the 

 statistical and clinical observations, as drawn up in the 

 reports by the Medical Superintendents of the Metropolitan 

 Asylums Board, upon the diphtheria antitoxin treatment, 



(1) A great reduction in the mortality of cases brought 

 under treatment on the first and second day of illness. 



(2) The lowering of the combined general mortality to a 

 point below any former year. 



(3) The remarkable reduction in the mortality of the 

 laryngeal cases. 



(4) The uniform improvement in the results of 

 tracheotomy. 



(5) Diminution of the faucial swelling, and the sub- 

 sequent distress. 



(6) Lessening or entire cessation of the irritating and 

 offensive discharge from the nose. 



(7) Uniform improvement produced upon the clinical 

 and general condition of the patients. 



