( 2 )
4. The death-rate on persons treated in the hospitals was 132 per mille,
or the same as last year. Excluding cholera, it was 125 as against 127 in 1871.
The table given in paragraph 5, comparing as it does not only the hospital
rates, but the municipal returns of mortality, shows a great improvement in
the public health during the last five years. In 1867 the hospital rate was 191,
or, excluding cholera, 175. In 1868 it rose to 199, or, excluding cholera, 179,
but since then it has steadily fallen to 1.32, as stated above. At the same time
it must be observed that in comparing the different hospitals an element of
uncertainty is introduced into these returns owing to the practice of rejecting
cases believed to be hopeless at some of the principal hospitals, and sending
them to the Pauper Hospital. Dr. Macnamara states that the growth of
this practice is one cause for the diminution of the mortality in the Native
Hospital. The Lieutenant-Governor has called for a special report on this
subject. The municipal registration figures given in the return show that the
death-rates of the last three years for the town generally are lower than
those of the three preceding by a very marked difference, but the rate
which was 22.6 in 1870 was 23.1 in 1871, and 26.4 in 1872 (not much under
the rate of 1867, viz., 27.1). The rise in the rate is apparently to be ascribed
chiefly to cholera.
5. Setting aside the extraordinary epidemic of dengue, which, however,
among 2,292 persons treated, caused only seven deaths, the table of diseases
shows that the prevalent types of maladies were the same as in former years.
Of 2,761 deaths, 306 were from fever, 217 from cholera, 301 from phthisis,
217 from dropsy, 682 from dysentery and diarrhœa, 33 from pneumonia,
270 from ulcers, 195 from debility. Bowel complaints account for the heaviest
mortality, dysentery and diarrhœa being the most fatal form of diseases.
Cholera was more prevalent than in 1871, and the rate of mortality among
cases treated was high, 484.3 per 1,000. Typhoid fever was also very fatal,
93 deaths among 132 persons treated. Phthisis, dropsy, and ulcers come
next in order of fatality. Small-pox has for some years past been almost
unknown—thanks probably to the operations of the Vaccine Department.
6. The remarks made by the Surgeon-General in paragraph 8 as to the
importance of fixing precisely the locality of cholera cases, are much to the
point, and the Chairman of the Justices will be asked to draw the Health
Officer's attention to them.
7. In paragraph 9 it is shown that the healthiest months in the year are
those in which the heat is greatest, while the most unhealthy are the cold
weather months. The influence of season upon disease is a subject of which
very little is accurately known. As the Surgeon-General remarks, the collec-
tion of careful statistics may enable us in time to bring in meteorology to
assist us in arriving at a clearer theory of causation than we now possess.
8.
The Medical College Hospital.— The number of patients relieved
by the Medical College Hospital was, in-door, 5,163, out-door, 42,213, the
total number being slightly (469) below that of last year. The average
daily sick was 266.90. The decrease in the number treated is entirely
in out-door patients, and is said to arise from more careful registry, treating
each person as one case, irrespective of the number of times he may be treated.
The Lieutenant-Governor hopes that this system is followed in all the hospitals
now. It is very misleading to have the returns compiled on two different
systems, and His Honor begs that the Surgeon-General will make sure that
the proper plan is understood and followed.
9. The death-rate of the hospital was 115.8 per thousand, against 126.28
in 1871. In cases treated to a termination it was 121.8 as against 134.1.
Excluding moribunds dying within twenty-four hours of admission, the rates
for 1872 were, on treated, 90.9, and on cases terminated, 95.9. Dr. D. B. Smith
gives in his report a very interesting analysis of the mortality rates of the hospi-
tal for the past ten years. Among Christian patients they have fallen from an
average of about 95 per mille to 56, and among natives from rates ranging
from 255 to 309 down to 168. The relative mortality among native patients