( 4 )
10. In the Howrah Hospital 612 Europeans and East Indians, and 945
natives, were treated, against 594 and 1,176 respectively. Of 56 children treated,
12 died; the rate was thus 214 per mile. The death-rate among adults was 186.
The general rate was thus raised to 188. The death-rate among the European
class was 29 against 53 in 1879, 55 in 1878, and 39 in 1877. Among
natives the death-rate was 292, against 332, 346, and 252 respectively in the
three previous years. More than one-fifth of the deaths among native patients
occurred during the first 24 hours after admission. It is notorious that coolies
from the interior, who have been employed in the mills and workshops at
Howrah, generally go to the hospital only in the last extremity. If cholera
and moribund cases are excluded, the death-rate is reduced to 243 in 1880 and
287 in 1879. Of the 18 Europeans and Eurasians 4 died of cholera, 3 of
phthisis, and 3 of dysentery. Among natives 33 died of fever out of 202, 18
of cholera out of 29, 8 of dropsy out of 22; 53 of dysentery out of 111,
101 of diarrhœa out of 197, and 8 of debility out of 18.
11.
Them death-rate in cases of major operations in the hospitals,
exclusive of eye cases, was 166 against 175 in 1879, 121 in 1878, 204 in
1877, 255 in 1876, and 295 in 1875. Such figures, however, give no reliable
information as to the actual relation between operation and death. The con-
dition of the patient, the idiosyncrasy of the operator, local circumstances
antecedent or subsequent to operation, and a number of influences which cannot
possibly find arithmetical expression, affect the details of any table of
opera-tions and their results. Numbers of cases are entered as deaths in the operation
list, which must have ended fatally whether operation had or had not been
performed. As Dr. Payne remarks, operation is a process of treatment, not a
disease; and the Lieutenant-Governor accepts his view that no detailed examin-
tion of the list as a whole need be undertaken.
12. It is chiefly in its relation to the question of septic disease in the hospi
- t a l s t h a t a n e x a m i n a t i o n o f t h e r e s u l t s o f s o m e o f t h e o p e r a t i o n s i s o f i n t e r e s t .
Dr. Payne gives the details of four classes of operations, surgically simple, but
particularly liable to be followed by septic affections. These are amputations
through the thigh, the leg, the arm, and the forearm :—
T H I G H .
LEG.
ARM.
FOREARM.
O p e r a t i o n s .
D e a t h s .
D e a t h s p e r m i l l e
O p e r a t i o n s .
D e a t h s .
D e a t h s p e r m i l l e .
O p e r a t i o n s .
D e a t h s .
D e a t h s p e r m i l l e .
O p e r a t i o n s .
D e a t h s .
D e a t h s p e r m i l l e .
1873 to 1876
694
500
414
182
1877
16
10
625
13
4
307
9
4
444
26
1878
7
3
428
16
7
437
8
....
.. .
13
3
230
1879 ..
...
...
...
...
12
6
500
20
9
450
8
1
125
15
3
200
1880
16
4
250
13
3
230
12
4
333
7
1
142
From this table it appears that, in the most dangerous of these operations—
amputation of the thigh—the results of the past year were singularly good.
The number of cases was the same as in 1877, while the deaths were less than
half as numerous as in that year. The leg and forearm operations were also very
successful; while in arm amputations there were 4 deaths out of 12
against only 1 out of 16 in the two previous years. In the Medical College
Hospital the results of the thigh operations were particularly striking. Here
only 2 cases out of 10 ended fatally. The year before 2 out of 4
resulted in death, while the average death-rate from 1870 to 1877 was
no less than 667 per mille. In the same hospital death supervened in 2 out of 5
cases of the much simpler operation of amputation of the arm, though
7 cases were operated in the two previous years without a single death.
It may at once be said that 10 cases of thigh amputation could not be con-
ducted with only 2 deaths, if there was anything in the construction of the
building that necessarily fostered septic disease. In cases of scrotal tumour,
a class of operation specially prone to the disease, there was also a reduction in
mortality. Six persons died out of 54 treated, and the death-rate per mille was
111 against 123 in 1879 and 142 the average of the years between 1865 and 1875.
That the general improvement has been the result of a decrease in septic