evidence of that discase.

The case of glossitis was sent

diphtheria. The case of meningitis was admitted as diphtheria; there was no clinical evidence of diphtheria in this case, but I am informed that the Loeffler bacilli were found in a culture. On admission there was well marked inflammation of the fauces and some bulging forward of the anterior part of the soft palate, but no exudate was visible. The patient was delirious, and continued so until death occurred, January 10, 1897. Post-mortem examinations showed considerable engorgement of the cerebral blood vessels and well marked inflammation of the meninges at the base of the brain.

The following table shows the number of admissions, the number of deaths, and the death-rates from diphtheria, scarlatina and measles :

* Eleven (11) of this numher died in 1897. In all subsequent tables in this report are included 8 of the deaths which occurred in the hospital from diphtheria in 1897 among the patients remaining January 1, 1897.

The number of admissions from diphtheria in 1896 exceeded that of any previous year, while the ratio of deaths to cases was less. This reduction in the death-rate is believed to be due to the milder character of the disease. The proportion of hemorrhagic and malignant cases was much less than in any previous year in my experience. Very many of the cases presented clinically only the slightest possible evidence of diphtheria, while in a few indeed no such evidence whatever was seen. In all of

these cases, however, the Loeffler bacilli were found. The patient sent to the hospital upon the diagnosis of diphtheria, but in whom the clinical evidence of that disease was not well marked and the bacilli were absent, were classed under the head of pseudo-diphtheria, as may be seen in Table No. III. Where, however, there was well marked evidence of diphtheria, but the Loeffler bacilli were not found, I adhered to my clinical diagnosis of that disease, and classified the cases accordingly, in spite of the negative bacteriological reports. Some of these cases developed

paralysis and other sequelæ of diphtheria.

The table shows that the death rate from diphtheria in 1896 was 22.2 per cent. This ratio of deaths to cases is not only less than during the preceding year, as already stated, but for several years previous. For example, in 1895 the death rate in the hospital was 26.91 per cent.; in 1894, 33.12 per cent.; in 1893, 28.57 per cent., and in 1892, 26.22 per cent.

In the City, in 1896, the total number of cases of diphtheria, including membraneous croup, reported to the Health Office was 3,595, and the deaths amounted to 1,149. Deducting from these numbers the cases and the deaths in the hospital during the year, it may be seen that the death rate among the cases treated at their homes was 35.06 per cent., or 12.86 per cent. higher than among the cases treated in the hospital.

The admissions from scarlet fever were slightly increased over the previous year, but the character of the disease continued mild. The death rate was 7.15 per cent., against 6.74 per cent. the previous year.

The following table shows the cases of diphtheria, scarlet fever, and measles, classified according to the sex and color of the patients-showing the number of admissions, the deaths, and the death rates under each division:

The following table shows the cases of diphtheria, scarlet fever, and measles, classified according to the age of the patients showing the admissions, the deaths and the death rates at the several age periods therein designated : TABLE VI.

This table clearly indicates that diphtheria is most fatal in early life a fact shown in all of my previous annual reports, as well as by the experience of all observers.

The anti-diphtheritic serum was used very extensively, but no attempt was made to subject this agent to a scien

tific test, as in 1895, when it was used almost exclusively in the early stage of the disease, and in a class of cases in which it is said to be most efficacious. It was used not alone, but in conjunction with other remedies generally approved. During the past year antitoxin was administered alike to mild and severe cases on admission, without regard to the duration of illness; the only difference being that the severe cases received repeated injections. The method of procedure was to administer antitoxin as soon as possible after admission, then make a culture, and if the culture was satisfactory and the Loeffler bacilli were not found the patient was not counted as an antitoxin case, but classified as one of pseudo-diphtheria. The antitoxin employed was almost exclusively that prepared by the Bacteriological Division of the Bureau of Health. A limited amount of that prepared by Mulford & Co. was used, and a still less amount of that prepared by the New York Board of Health.

Of the 869 cases of diphtheria, 553 received antitoxin, and of these 142 died, giving a death rate of 25.67 per cent., against 28.14 per cent. the preceding year. Three hundred and sixteen (316) cases did not receive antitoxin, and of these 51 died-a death rate of 13.29 per cent. In the latter class of cases is included three grades of the disease (1) a large number of very mild cases; (2) a number of well pronounced; (3) a few exceedingly grave cases which died so soon after admission that opportunity was not afforded for the administration of antitoxin. antitoxin and non-antitoxin cases were not analogous in any sense, and are not presented for the purpose of comparison.

The

The following table shows the number of cases of diphtheria which received antitoxin during each month of the year, and the number of deaths and the death rates among the same.

* Three deaths which occurred in 1897 are not included in this table.

The above table shows how greatly the mortality from diphtheria may vary from month to month under the same treatment, and even under the so-called specific treatment.

A large number of laryngeal cases of diphtheria were admitted during the year. A few mild cases recovered, as usual, without operative interference. Intubation was performed in 156 cases, and of these 94 died, giving a death rate of 60.25 pe rcent., against 54.91 per cent. in 1895. Of the 156 cases, 132 received antitoxin and of these 74 dieda death rate of 56.06 per cent., against 52.94 per cent. the preceding year. Twenty-four (24) intubation cases did not receive antitoxin, and of these 20 died-a death rate of 83.33 per cent. Among the latter, two or three deaths occurred from membraneous croup following measles, two or three from membraneous croup following scarlatina, and a number (four, at least,) occurred immediately after admission, and before antitoxin could be given. No com