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for instance, it clearly appears that the new treatment was
most successful at the hospitals at which the antitoxin serum
was injected in the largest closes; at which the largest number
of doses were given; and at which the largest proportion of
total cases were thus treated. On the other hand, the
mortality was greatest at the hospitals at which the smallest
and the fewest doses were given, and at which the fewest
cases, in proportion to total cases, were thus treated.
As stated already, the treatment was successful in proportion as it was adopted at an early stage of the disease.
This important point is proved by comparing the death-rate
in cases injected on the first day of the disease, viz., 4.6 per
cent., with the rate in cases in which treatment was commenced at later periods; viz, 26.1 per cent.; the rate rising to
35.7 per cent. in cases injected on the fifth day and after. An
even more striking illustration is furnished by a report
(appended to the general report) made by the Medical Superintendent of the Northern (Convalescent Fever) Hospital at
Winchmore Hill. At this hospital 119 cases of post-scarlatinal diphtheria occurred in 1895, of which 58, being the
severer cases, were treated with antitoxin. Twelve cases
were injected on the first day of the disease, and not one of
them proved fatal. Of the 119 cases only four proved fatal;
a mortality rate of 3.3 per cent., compared with a combined
rate of 22 5 per cent. at the Town Hospitals. During the
preceding three years, in pre-antitoxin days, exactly the same
number of cases (119) had occurred at this Hospital, and these
furnished 75 deaths (instead of 4 as in 1895), and a percentage
mortality of 63 instead of 3.3 as in 1895. "The cases of 1895,"
it is stated, "were, in their earliest symptoms, similar to those
of previous years," and they included cases "which, both
from laryngeal obstruction, and severity of constitutional
symptoms, would, in pre-antitoxin days, have been regarded
as hopeless;" and as to laryngeal cases, it appears that the
mortalities in 1894 and 1895 were in striking contrast; for