Results as modified by age of the pa tients: The highest mortality is found to be under two years; but including till cases returned, even those moribund when injected, the death-rate was but 23.3 per cent. After the second year there is a steady decline in mortality up to adult life. Of 359 cases over 15 years old, there were but 15 deaths.
Paralysis: Out of 3384 cases paralytic sequehe appeared in 328 cases (9.7 per cent.). Of the 2934 eases which recov ered, paralysis was present in 276, or 9.4 per cent. Of the 450 cases which died, paralysis was noted in 52, or 11.4 per cent.
Sepsis: This is stated to have been present in 362 out of 3384 eases, or 10.7 per cent. It was present in 145, or 33 per cent., of the fatal cases.
Nephritis: Nephritis was present 350 times, or in 10 per cent. of the eaQes. The statements on this point are not quite satisfactory.
'Whole number of cases of laryngeal diphtheria, 1704; mortality, 21.12 per cent. (360 deaths).
The cases occurred in the practice of 422 physicians in the United States and Canada.
Operations employed:— (a) Intubation in 637 cases; mortal ity, 26.05 per cent. (166 deaths).
(b) Tracheotomy in 20 cases; mortal ity, 45 per cent. (9 deaths).
(c) Intubation and tracheotomy in 11 cases; mortality, 63.63 per cent. (7 deaths).
Number of States represented, twenty one, the District of Columbia, and Can ada.
Non-operated cases, 1036,-60.79 per cent. of all cases; mortality, 17.1S per cent. (173 deaths). (Archives of Pediat rics, July, '96.) In Japan, prior to serum-therapy, the mortality was 56 per cent.; after its use in 353 cases the mortality was 3.73 per cent. Of 110 cases in which injections made within torty-eight hours after in vasion, all ended in recovery. Of 33 cases treated after eighth day of the disease 11 were lost. Kitasato ("Serum Treat. of Diph.," '06).
In 600 cases of diphtheria treated, one-half were given antitoxin, the other half had no antitoxin. The Klebs-Loef fler bacillus was found in all cases. The cases were treated in the same hospital, had exactly the same food, drugs, and stimulants.
In the 300 cases treated with antitoxin there were 129 tracheotomies; 60 died, the death-rate being 20 per cent.
in the 300 cases treated without anti toxin there wore 199 tracheotomies and 153 deaths,—a death-rate of 52.7 per cent. The earlier the serum is used, the
better the results; however, it is of value even when given late. In 20 per cent. of laryngeal cases, even when there is dyspncea, it lessens the necessity for operation. Clubbe (Brit. Med. Jour., vol. xi, p. 1177, '97).
Laryngeal diphtheria, in any epidemic, is never mild, but has always had a mortality of from 90 to 95 per cent., re duced by operation, intubation, or trache otomy, to from 72 to 76 per cent. In tubation without serum shows a mortal ity of 76 per cent.; in conjunction with a serum of 25 per cent., and, eliminating cases of death within twenty-fonr hours of injection, a mortality of 10 per cent. The reduction of mortality from 76 to 10 per cent. is to be credited to anti toxin. Antitoxin should always be ad ministered as early as possible, and in laryngeal cases without waiting for the bacteriologist's report. No child should be allowed to die ot laryngeal stenosis without an operation, preferably intuba tion, and serum should be injected at once, regardless of the stage of the dis ease, as most desperate cases often end in recovery. Halsted (N. Y. Med. Jour., vol. lxv, '97).
Statistics from the Imperial Board of Health in Berlin: The reports, gathered from April, 1395, to March, 1396, were furnished by 258 physicians from 204 institutions. Of 9351 cases of diphtheria treated with antitoxin, 14S9 proved fatal, or 15 7, per cent. After deducting the absolutely hopeless cases, which perished within the first twelve hours after they were seen, the mortality is reduced to 14 7,0 per cent. Adding to these 9351 cases the result of a former report (Jan uary to April, 1835) and 132S cases from March to July, 1896, published later, a total of 13,137 cases, divided over eight een months, furnished a nrortality of 2032, or 158/,„ per cent. Of these, 4085 patients, or 42.6 per cent., presented the laryngeal variety, 2744 of which were operated upon, with a mortality of 32 Vto per cent. The mortality of cases treated on the first day was 6.6 per cent.; that of those treated on the second day, 8.3 per cent.; of those treated on the third day, 12.9 per cent.; of those treated on the fourth day, 17 per cent.; and ot those treated on the fifth day, 23.2 per cent. Dieudonne (Internat. Med. Mag., Dec., '97).