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17
persons at various stages of convalescence. He finds that at no
stage of the peeling process after scarlet fever has he detected
in the cuticle any microbe which could aid in spreading the
disease. He is now engaged on an examination of the discharges
from the ears and noses of patients suffering from
scarlet fever.
Diphtheria.
57 cases of this disease were notified in St. Margaret's
parish and 53 in St. John's, making a total of 110 (compared
with 106 in 1896). 20 deaths occurred altogether from this
disease, as against 22 (including membranous croup) last year.
The Metropolitan Asylums Board report that—
"The decline in the percentage mortality amongst diphtheria
patients was from 40.74 in 1889 to 29.29 in 1894 and 22.85 in 1895
(when the anti-toxic serum treatment was first adopted) and 21.2
in 1896.
"Diphtheria, like scarlet fever, is most fatal to infant children
The maximum mortality occurs in the second year of life, when
it reaches the high percentage of 56.2, subsequently falling with
every additional year of life to the minimum of 3.2 per cent.
amongst persons between 30 and 35 years of age.
"The mortality per cent. of females is less than that of males
by 2.3."
They also report, with regard to the reduction in the death
rate of diphtheria after the use of anti-toxic serum—
"To a small extent, no doubt, this reduction in the death rate
is attributable to the adoption of the bacteriological method of
diagnosis, which has resulted in the inclusion of certain mild
cases which would not have been regarded as diphtheria on
clinical evidence alone. But, even after making allowance for
these cases, the result of the use of the new remedy can only be
regarded as most satisfactory.
"The aetiology of post-scarlatinal diphtheria is by no means yet
fully understood, but, apart from any question of ward hygiene,
the admission of unrecognised cases and the relative prevalence
of diphtheria in the particular district must neither of them be
disregarded as possible factors."
"With regard to the length of time which anti-toxic serum
remains good, I wrote to the Clerk of the Asylums Board, aud
he very kindly informed me, through Dr. Sims Woodhead—
"That there is a slight falling off of anti-toxin going on as soon
as it is placed in the small bottles. Although this is not very
great it comes to be an appreciable factor by the end of two or
b