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1896 would therefore, if such correction be made, show, as compared with 1894, a higher death rate
and a diminished case mortality. Whether this diminished case mortality may be in part due to the
treatment with anti-toxic serum of cases of diphtheria in their own homes can only be matter for
speculation. It is, however, interesting to observe that at a time when the hospitals of the Metropolitan
Asylums Board were so full as to prevent the admission of applicants, their medical attendants
were furnished by the Metropolitan Asylums Board through the medical officers of health with warrants
authorizing them to receive free of cost anti-toxic serum for the treatment of their patients. Reference
to this matter is made in the reports of the medical officers of health of Fulham, Marylebone,
Shoreditch, Whitechapel, Poplar, Lewisham and Deptford, and the report of the medical officer of
health of Stoke Newington shows that his Vestry continues to authorize him to furnish to medical
practitioners this material at cost price. "The provision," he says, "has been much appreciated,
and a considerable number of tubes have been disposed of during the year."

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.
The subject of seasonal variation in fatality has already been discussed in connection with
scarlet fever (see page 32), and it will be sufficient here to show the results obtained by similar
treatment of the cases of and deaths from diphtheria. The following table shows that the ligures
supplied by diphtheria point in the same direction as those supplied by scarlet fever. The case
mortality has not been corrected for differences of age and sex distribution. It will be observed that
as in scarlet fever the fatality is greatest at the beginning and end of the year, and that it falls to a
minimum in September and October, while there is in the month of August some increase of fatality,
due no doubt to a decrease during the holiday of the proportion of attacks at school ages, at which
ages the case mortality is less, and to the relative increase of attacks at the younger ages, at which
ages the case mortality is greater. Diagram XII. shows the fatality of each month of the years 1891-6
in relation to the mean of that period.