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that in 1895 the case mortality of males was 22.7 compared with 25.8 in 1894, and that of females
was 19.6 compared with 23.1 in 1894. The difference in the case mortality in the two years at the
early ages has been marked.

Reference to the reports of the medical officers of the Metropolitan Asylums Board contained in
the reports of the Statistical Committee of that Board shows that anti-toxin began to be used by them
in the last few months of 1894.
Diphtheria—Seasonal variations in fatality.
I have already discussed the subject of seasonal variations in the fatality of scarlet fever, and it
will suffice here to state that the additional figures, which the year 1895 supplies, tend to confirm the
view that diphtheria fatality is subject to a like variation. This will be seen from the following tables.
It may be pointed out that, as in the case of scarlet fever, so in the case of diphtheria, the
fatality of the month of August constitutes an interruption to the fall of fatality from the maximum to
the minimum. This, as in the case of scarlet fever, is probably in some degree owing to a difference in
the age incidence of that month compared with that of other months, due to the decrease in the prevalence
of diphtheria at the school age as the result of the August holiday.
*In the preparation of this table, the question whether the persons, who were attacked and who died, belonged to London is
disregarded, the percentage being calculated on the number of cases notified in London, and the number of deaths occurring in London
and the institutions belonging to London. Inasmuch as the age of the patient is not in all cases recorded in the notification certificate,
it has been necessary to distribute such cases among the various ages proportionately.
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