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The diminishing birth-rate

unstandardised incidence rates of 4.6 per 100 000 in 1963-74, 7.7/100 000 in 1975-86, and 10.2/100 000 in 1987-98 are comparable to those reported in earlier English studies. 10 16 17 Reported rates have tended to be higher in Scotland, 18 the United States, 19 Germany, and the Scandinavian countries 21 22 than in England, although rates in the Netherlands 23 have been more comparable. Although some studies have reported reductions over time in case fatality rates, a large Finnish study found no decrease from the 1980s onwards. The fact that case fatality in our study has not fallen since the 1970s is no doubt because no major innovations in treatment have been introduced in recent times.