48
REPORT OF THE
Influence of choler
a on the
d e a t h - r a t e .
And the death-rate of the past year has been less than that of the average of the six
preceding years to the extent of 15.24 in the thousand patients treated.
With a view to facilitate a reference to these facts, the ratio per thousand for the seven
years inclusive and exclusive of cholera are herewith submitted in juxta position.
Years.
Ratio per 1,000 of deaths
to treated, inclusive of
cholera.
Ratio per 1,000 of
deaths to treated,
exclusive of cholera.
Difference.
1865
..
..
..
69.93
52.80
17.13
1866
..
..
..
98.50
53.59
44.91
1867
..
..
..
63.94
45.23
18.71
1868
..
..
..
72.27
48.09
24.16
1869 ..
..
..
53.01
37.20
15.81
1870
..
..
..
52.92
39.59
l 3 . 3 3
1871
..
..
..
36.52
30.56
5.96
Cholera has been, and, in a mitigated degree, continues to be, an important disturbing
element in the mortality rate of the hospital. This does not altogether account for the
decrement in the death-rate during the past three years, and particularly during the last of
the series, for it is apparent from these figures that a certain amount of decrease is fairly
sustained even when cholera is excluded from the calculation.
Chief causes of
death.
Importance of early
treatment in
cholera
and in dysentery.
The chief causes of death for the seven years ending 1871 are illustrated below :—
Diseases.
Treated.
Died. Deaths to treated. Ratio per 1,000 of
deat hs t o t ot al deat hs
1. Cholera
..
..
641
375
585.02
339.36
2. Dysentery
..
.. 1,601
123
76.82
111.31
3. Hepatitis
..
..
368
49
l33.15
44.34
4. Typhoid fever ..
..
85
22
258.82
19.90
5. Remittent fever ..
..
238
31
130.25
28.05
6. Phthisis
..
..
382
127
332.46
114.93
7. Pneumonia
..
..
62
22
354.84
19.90
8. Insolatio
..
..
125
11
88.00
9.95
9. Other diseases ..
.. 13,909
345
24.80
312.21
This statement brings out into prominent relief the important share which a few
diseases have taken in swelling the bill of mortality.
(1.) The deaths from cholera have almost invariably occurred in patients who were
admitted either in a state of profound collapse, or in a condition in which they rapidly passed
into collapse, in which they succumbed without re-action, or if re-action did supervene, they
appear to have fallen victims to secondary fever, uræmia, or dysentery. When cases of
cholera are received at an early stage of the malady, success in their management is propor
tionately frequent. If, therefore, the Masters of ships could be prevailed upon to send all cases to
hospital at the earliest possible stage of the disease, the death-rate would doubtless be materially
diminished. The present practice is by no means conducive to the welfare of the sailor.
He would seem to be dosed on board under most unfavorable circumstances, and is only sent
to hospital when he is either verging on, or has actually merged into collapse, when the
circulation and respiration are rapidly failing, and the functions of the more important organs,
such as the lungs, heart, liver, and kidneys, are hopelessly deranged and embarrassed. Yet
notwithstanding these untoward circumstances, the average mortality from cholera has not
been more than 585.02 per thousand. It accounts, however, for 339.36 deaths in 1,000
deaths from all causes.
(2.) Dysentery, which in its earlier stages is almost as manageable by ipecacuanha as
an ordinary intermittent is by quinine, becomes a most appalling disease when extensive
sloughing has taken place, or when, as not unfrequently happens, it becomes complicated
with abscess of the liver. Nearly all the cases which prove mortal have passed into one or
or other of these conditions, or both, long before the patients have sought for admission into