12
REPORT ON THE
12. I would again point out that this table does not exhibit the relation
in which death stands to surgical operation. It has nothing in common with
tables of medical statistics compiled for the purpose of showing results of
disease. The same operation which in one case is performed with some
certainty of success, is in others adopted only in the last resort. One surgeon
will operate in a case which another would not touch. A young surgeon, full
of incisive impulse, will show a long list of operations and of deaths, which.
latter, following the former in a printed form, are ascribed to them as effects
to causes. An older practitioner withholds his knife unless he sees fair
probability of good results. He shows fewer operations and much fewer deaths ;
yet if the facts were elicited, it would be seen that the disease, or the condition
which was the true cause of death, had been as fatal: in. the hands of one as of
the other. Operation, as I have said, is a process of treatment, not a disease, and
the method of examining the merits of treatment is something very different
from the inspection of tabulated sequences.
13. The above remarks are enough. to show how largely such. tables as
this must be made up of incidental things, and how impossible it is to trace in
them the relation of surgical operation to. death, to obtain. from them. any
information concerning cases in which it may be supposed that operation has
caused death which, without it, would not have occurred, or even to follow the
particular manner or form of death. So much has this been. felt by surgeons
in Europe, who have charged themselves with the investigation of surgical
mortality, that high authority has been driven to select a small group of
operations as a test of comparative practice, to the exclusion of all others.
14. In his resolution on the report for 1879, the Lieutenant-Governor
commented unfavourably on the fact that the figured results of surgical opera
tions for six consecutive years had not been examined, and the increase of
surgical mortality in 1879 over the previous year, shown by the figures,
had not been considered. The foregoing remarks will, I trust, suffice to
show the impossibility of examination when there was no knowledge. besides
that which crude figures afford. If the subject bad been treated in former
years in particular reports with as much detail as is to be found this year
in the reports from the Medical College, I might, by delaying and. greatly
extending my own report, have produced a full technical account of the
course of events. For this I had not the necessary materials, and I regret
now that I did not explain more fully my grounds for rejecting mere figures
as fallacious, and as affording not even so much as material for examination.
15.
So far as it is the object of Government to obtain a measure of
recent progress with special reference to hospitalism, the best contribution
which I can make to its fulfilment will be made if I follow the method of
Sir J . Simpson, and, selecting a few test operations, trace their results through
consecutive. years. This method, adopted for comparison of surgical success
in different countries and institutions, will succeed and fail in similar degrees
when applied to the same institution in different years, in estimation of the
effects of altered practice. Sir J . Simpson chose for his purpose amputations
through the thigh, leg, arm, and forearm, as least beset with confusing incidents,
and particularly liable to be followed by septic affections. The following
figures show the death-rates after these operations through a series of years
in the Calcutta hospitals :—
STATEMENT No. VIII.
THIGH.
LEG.
ARM.
FOREARM.
O p e r a t i o n s
Deat hs
D e a t h s p e r m i l l e .
O P e r a t i o n s .
De 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 .
Deat hs .
D e a t h s p e r m i l l e .
O p e r a t i o n s .
Deat hs.
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
1 6
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