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It will be seen that the decrease in the number of cases notified during the period of holiday
influence, and the subsequent increase in the following period, is most marked at the school age.
The influence of schools in the dissemination of diphtheria is more fully discussed in an
appendix to this report (see Appendix I).
Diphtheria—Proportion of cases and deaths in hospitals.
Diagram XII. shows the proportion of London cases of diphtheria admitted into the hospitals of
the Metropolitan Asylums Board in 1897, and the proportion of the deaths from this disease which
occurred in these institutions during the year. It will be seen that these proportions were greater in
the year 1897 than in any previous year.
Bacteriology as an aid, to diagnosis.
In my last report I stated that arrangements had been made by the sanitary authorities
of St. Marylebone, St. Pancras, Holborn and St. Olave, by which facilities were afforded to
medical practitioners for the bacteriological examination of material from doubtful cases of
diphtheria. The reports of medical officers of health for the year 1897 now show that similar
arrangements, mostly with the British Institute of Preventive Medicine, have been made by the
authorities of Fulham, Strand and Clerkenwell, and that in Poplar the matter is under consideration
of the district board. The medical officers of health of Paddington, Stoke Newington, Bethnalgreen,
St. George, Southwark, Lambeth, Wandsworth parish, Woolwich and Plumstead express opinions
in favour of the value of such aid. The medical of health of Marylebone states that the opportunities
given by the vestry have not been much utilised, that the number of cases thus examined was 42, and
that of these 12 were considered diphtheritic. In St. Pancras the corresponding numbers during
seven months were 42 and 22 respectively, in Fulham 48 and 30 respectively, in Holborn 37 and 18
respectively, and in St. Olave, a district which had made arrangements with Guy's Hospital, 2
specimens were sent for examination.
Diphtheria—Age and sex distribution.
The age and sex distribution of the cases of diphtheria notified in London during 1897 are
shown in the following table. It will be seen that as in previous years the incidence of attack at
"all ages" was greater on females than males, but the incidence of death at "all ages" was, as before,
greater on males than on females, but to a less extent than in 1896. The fatality (case mortality) of
the disease was greater at "all ages" among males than among females, and it will be seen from
the table that this higher fatality among males is practically confined to ages 5 and upwards.

Diphtheria—Use of anti-toxic serum.
The use of anti-toxic serum and its effect upon the fatality of diphtheria is discussed in
the reports of medical officers of health. The reports relating to Hackney, Eltham and Plumstead
state that the sanitary authorities authorised their medical officers of health to keep a stock of serum
so that it might, on application, be supplied locally to medical practitioners. In December, the
Metropolitan Asylums Board made arrangements by which, in the event of the Managers being unable
to receive cases of diphtheria into their hospitals, the medical officers of health should be able to
supply practitioners, attending such cases, with serum for their immediate treatment. The opening of
the Park Hospital, however, rendered such action unnecessary.

* See footnote, page 31.