[22] For an exhaustive and wise study of the diphtheritic paralyses, see Dr. Woollacott's essay in the _Lancet_, 26th August 1899: "The use of antitoxic serum in the treatment of diphtheria has, up to the present time, in the London fever hospitals, had two main results--the death-rate has fallen, while the paralysis-rate has risen. In the hospitals of the Metropolitan Asylums Board, the former has been reduced from 29 per cent. to 15.3 per cent., while the latter has risen from 13 per cent. to as high as 21 per cent. in 1896. This increase of paralysis is chiefly due to the fact that many more patients now recover from the primary disease, and live long enough for paralysis to show itself. _During the last two years, however, the occurrence of paralysis has begun to diminish in frequency.... The earlier antitoxin is given in diphtheria, the less likely is paralysis to follow._" It is to be borne in mind that post-diphtheritic paralysis, in the great majority of cases, affects only a very small group of muscles; of Dr. Woollacott's tabulated cases, 377 were of this kind, and 97 were severe. And "the type of paralysis has, on the whole, become less severe, or at all events less dangerous to life." * * * * * The foregoing reports belong to ancient history. Let us leave them, and study the record of the hospitals of the Metropolitan Asylums Board. They serve a city of 121 square miles, and 4-1/2 millions of inhabitants. The use of the antitoxin in the hospitals of the Metropolitan Asylums Board began in 1895. It had been used in 1894 on a few cases only, during the latter part of the year, and had been procured with much difficulty from various sources, chiefly from the Institute of Preventive Medicine. On 9th November 1894, the Board applied to the Laboratories' Committee of the Royal Colleges of Physicians and of Surgeons, asking them to undertake the supply. Arrangements were made for this purpose; and the sum of £1000 was given by the Goldsmiths' Company. Dr. Sims Woodhead, then Director of the Laboratories of the Conjoint Colleges, now Professor of Pathology at Cambridge, was put in charge of the bacteriological work and the preparation of the serum, with a host of expert colleagues: the administration of the treatment was the work of the medical officers of the hospitals of the Metropolitan Asylums Board. The experiences of 1895 are given in the following passages from the joint report to the Board from the medical superintendents:--