140 



DIPHTHERIA 



the patients being moribund at the time of their 

 arrival, and beyond the reach of any treatment, no 

 antitoxin was given. No change has taken place 

 during the year in the local treatment of the cases, 

 nor has there been any new factor in the treatment 

 other than the injection of antitoxin. 



"It must be clearly understood that, with the 

 exceptions previously stated, it has been the practice 

 at each of the hospitals to administer serum to 

 those cases only in which the symptoms on admission 

 were sufficiently pronounced to give rise to anxiety, 

 the mild cases not receiving any. 



" No less than 46.4 per cent, of the antitoxin 

 cases were under five years of age, against 32.5 per 

 cent, in the non-antitoxin group ; and only 1 6. 1 per 

 cent, in the former class were over ten years of age, 

 against 33.8 per cent, in the latter. The high 

 fatality of diphtheria in the earlier years of life is 

 notorious. 



"It is obvious, therefore, that to compare the 

 mortality of those treated with antitoxin with that 

 of those which during the same period were not 

 so treated, would be to institute a comparison be- 

 tween the severe cases and those of which a large 

 proportion were mild. This would clearly be 

 misleading. 



" The only method by which an accurate estimate 

 can be obtained as to the merits of any particular 

 form of treatment, is by comparing a series of cases 

 in which the remedy has been employed with 

 another series not so treated, but which are similar, 

 so far as can be, in other respects. This, in the 

 present instance, is impossible ; but, having regard 

 to the fact that 61.8 of the 1895 cases were treated 

 with serum, an approximately accurate conclusion 

 can be drawn by contrasting all cases of diphtheria 



