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proportion than males, but at each subsequent age in greater proportion. The incidence of attack at
"all age3" was, as in preceding years, greater on females than on males; the incidence of death at
"all ages" was, however, as in preceding years, greater on males than on females, this result being
due to the greater incidence of death on males as compared with females in the first four years of life.
After this period, the mortality among females was greater than that among males. The fatality
(case mortality) of diphtheria was at "all ages" greater among males than females. When each age
is considered it is seen that during the first two years of life the fatality among males was greater
than that among females, but during the next three years the fatality among females was greater than
that among males.

Diphtheria—Use of anti-toxic serum.
In my last report I referred to the more recent use of antitoxic serum in the treatment of
diphtheria. A valuable report on this subject has been presented to the Metropolitan Asylums Board
by the medical superintendents of the Board's hospitals, showing the results obtained by the use of this
serum during 1896, and it is therefore possible to consider whether the lessening fatality of this disease
in London is attributable, in any degree, to the employment of this remedy.

It is pointed out that the age distribution of the cases in 1896 was less favourable to low fatality
at "all ages" than that of the year 1894, a larger proportion of children at early ages being admitted in
1896 than in 1894, and although between one year and another there are probably differences in the
fatality of infectious disease, independently, there is no reason for thinking that the differences
indicated above are not substantially due to treatment.
If we assume that the whole of this reduction of mortality has been due to this treatment of
patients in the hospital of the Metropolitan Asylums Board, there would have been, without this
treatment, 365 additional deaths* from diphtheria in London during 1896; instead therefore of a
London diphtheria death rate of 059 per 1,000, this death rate would have been 0.68 per 1,000 and
instead of a London case mortality of 19.3 per cent. there would have been a case mortality of 21.9 per
cent. The death rate in 1894 was 0 61 per 1,000, and the case mortality 23.6 per cent. The year
† See footnote *, page 32.
* Referring to the figures for the whole of London, it may be pointed out that. if the case mortality at each age-group in 1896 had
been the same as obtained in 1894, the number of deaths resulting would hare exceeded the number cf deaths which actually occurred
by 754.