NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
140
16. Seven cases of Bright's disease were admitted. Of those,
four proved fatal. Every year's additional experience convinces
me of the error of advising patients, suffering from this class of
disease, to reside in the tropics or in climates warm enough to
prove relaxing.
17. Catarrh, displacements, and ulceration of the uterus, have
been treated. One case which I have registered non-malignant
tumour, although I have no doubt it will ultimately prove fatal, was
treated in England, according to the patient's account, as cancer
and the anterior lip of the os removed. When unattended to, it
induces profuse menorrhagia and pain in left ovarian region, extend
- i n g d o w n t h e c o r r e s p o n d i n g l i m b , b u t y i e l d s r e a d i l y t o t r e a t m e n t
so far as the urgent symptoms are concerned, and even the mass of
the tumour becomes somewhat diminished. The posterior wall is
that chiefly affected, and presents to my judgment more of the
characteristics of fibrous tumour than of cancer, both as to signs and
symptoms.
18. 103 cases of alcohol were treated—one died of this poison.
20 cases of delirium tremens were admitted—no death from this
disease.
19. A fatal case of fracture of cervical vertebræ is recorded.
The other injuries, as a rule, did well.
20.
Few capital operations were performed. Extirpation of an
eye was rendered necessary, by destructive inflammation of the
organ, which caused intense suffering to the patient, and threatened
to involve the sound eye.
The amputations were rendered necessary by severe injuries from
machinery, &c.
In one of the cases of hysterotomy, very marked and severe
symptoms (vomiting, &c.,) were completely removed by the opera
-tions.
The perineal rupture, was in fact a laceration of old standing, the
operation was but partially successful.
The case in which Wood's operation was performed, has been lost
sight of.
21. The obstetric ward is nearly complete. It will contain six
beds. A ward for warrant officers, and others of that rank, is san
c -
t i o n e d , i n w h i c h t h e a c c o m m o d a t i o n i s t o b e o f a k i n d s u p e r i o r t o
that for the general run of patients.
141
Annual Report of the Jamsetjee Jejeebhoy Hospital for the year
1872-73.
Males.
Females.
T o t a l .
Remained . . .
313
65
378
Admitted . . .
4,702
1,210
5,912
Total . . .
5,015
1,275
6,290
Discharged . . .
3,879
984
4,863
Died . . .
798
217
1,015
Remaining . . .
338
74
412
Total . . .
5,015
1,275
6,290
Percentage of deaths treated
15.7
17.0
16.13
Daily average number of sick
343.6
80.5
424.1
1. The table given above exhibits the number of patients treated in
this institution during the year. This with the sick of the ophthal
-mic hospital gives a gross total of 6,637 in-patients, while those treat
- e d i n t h e d i s p e n s a r y a m o u n t e d t o 3 5 , 5 7 9 . O n e t h o u s a n d a n d f i f t e e n
died yielding a percentage of deaths to treated of 16.13. This is
slightly in excess of last year, and is owing, I believe, to the fact that
the number of in-door sick has been greater by an average of 47 per
diem, and, consequently, the crowding has been more excessive. Con
- s t a n t a t t e n t i o n , h o w e v e r , h a s b e e n p a i d t o t h e h y g i e n i c c o n d i t i o n o f t h e
hospital, and if the percentage of deaths be the indication of its con
- d i t i o n , i t c o n t r a s t s f a v o u r a b l y w i t h t h a t o f f o r m e r y e a r s . I n o r d e r t o
illustrate this and other points I have drawn out a table giving the
results of the past five years.
It will be remembered that in the latter part of 1869 increased ac--
commodation was afforded by the addition of an upper story appro
- p r i a t e d a s a s u r g i c a l w a r d .
2. There has been, as evidenced in this table, a steadily increasing
demand for admission into the hospital, and for treatment at the
dispensaries, which is not due to increase of population and must
therefore, I conclude, depend on a growing faith amongst the people
in the efficacy of the European mode of treatment. 2,088 persons
have been refused admission during the year, a fact which it is hoped
will not repeat itself, in as much as the pressure will be relieved dur--
ing the current year by the opening of the new native hospital on
the Esplanade.
142
3. Reviewing the question of mortality more in detail, I find that
the following diseases have afforded the greatest number of deaths in
the succeeding order. Phthisis taken alone has the most unfortunate
pre-eminence, giving 121 fatal cases, chronic dysentery 107, acute
dysentery 74, diarrhoea 73, pneumonia 64, remittent fever 64,
debility (?) 52, small-pox 37, intermittent fever 30, tetanus 25, and
Bright's disease.
4. Taking the more prominent diseases treated during the year
(generally in the order in which they occur in the annual return)
I find that malarial fevers numbered 824 ; of these intermittent
fever yielded 619 and remittent 205 ; the mortality in the former
was 4.8 per cent while in the latter 31.2—doubtless due to the
serious complications which so often occur in the remittent form of
malarial fever.
Small-pox.— The cases admitted under this head numbered 215
and the death-rate was 17.2. Last year 122 were admitted ; in
1870, 77, and in 1869, 112 ; so great an increase in the present year
would indicate something like an epidemic outbreak amongst the
denizens of the city. It commenced in the month of January when
32 were treated, and lasted through the three following months. The
same months of the previous year were also marked by the prevalence
of this disorder. Of those admitted 17 were protected and 169 unpro
-tected. There were 64 distinct, 33 semi-confluent, 79 confluent, and
10 in which the eruption was suppressed. Fuller details will be
found in the report contained in Appendix B.
Cholera.— Only twenty-eight cases came under treatment. The mor
-tality was 60.7 per cent. The mode of treatment pursued was, with some
exceptions, the usual one of stimulants and astringents. The excep
-tions were six cases treated with hydrate of chloral ; of these, three
survived. There was no epidemic, the admissions being scattered
pretty equally through the year, the greatest number (5) being admitted
in August and October. In four cases the chloride of ammonium
was administered, but further observations are needed before any
conclusion can be formed of its value in cholera.
Dengue.— Seven cases were recognized—no deaths occurred.
Rheumatism.— Eighty-seven acute and 172 chronic cases were
treated with only four deaths, two in each division.
Venereal Affections.— Primary 134, secondary 172. The percen-
tage of deaths in the latter was 1.2.
Leprosy.— 108 deaths, percentage 13.8. This disease is made the
subject of special report by the sub-assistant surgeon in charge of
the hospital for incurables.
Phthisis.— 309 ; of these 121 died or 39.1 per cent. The death
among the female patients reached 50 per cent. of those treated.
Scurvy.— 108 cases, percentage of deaths 5.5
143
Diseases of the Nervous System included paralysis 17, hemiplegia
55, paraplegia 34, locomotor ataxie 8; percentage of deaths 14.
Heart Disease.—Pericarditis 3, disease of valves 29, fatty degen
-eration 1; percentage of deaths 36.3.
Diseases of the Respiratory System.—Bronchitis acute 62, chronic
100. The former yielded a death percentage of 6.4, the latter
of 12. Pleurisy 10, hydrothorax 2, pneumonia 169; deaths 64
or 37.8 per cent. This high death-rate is due to the disease so
often attacking the poverty stricken and degraded inhabitants of the
worst parts of this great city, many of them mere paupers with
wrecked constitutions and depraved habits, whose vital powers are
only sufficient to sustain existence under the ordinary struggle of the
daily life, and who when stricken with severe disease sink almost
immediately.
Diseses of the Intestines.—Acute dysentery 251—death-rate 29.4;
chronic dysentery 213—death-rate 50.02; diarrhœa 223—rate of
mortality 32.7.
Under this head are also included seven cases of disease of a
grave and interesting nature, namely, three of typhilitis, three of
obstruction, and one of intussussception, all of which fortunately
recovered.
Liver Diseases include hepatitis acute 38, chronic 40, and abscess
32, the relative ratio of mortality being 13.20 and 40.0. One case
of the comparatively rare disease of "Acute yellow Atrophy" occurred,
the symptoms of which were well marked and characteristic. The
case ran a rapid course, terminated fatally, and after death the liver
was found diminished in size, yellow in color, and its tissue disorga
- n i z e d .
Splenitis.—32 cases occurred and three deaths.
Disease of Kidney.— Of Bright's disease fifty-four cases were
admitted, thirteen being acute with no deaths, and forty-one chronic
with twenty deaths or 48.7 per cent. This illustrates a fact which is
very apparent in these returns, viz., the relative fatal character of
chronic compared with acute diseases of important organs thus:—
Diseases.
Percentage of Deaths.
Acute.
Chronic.
Bright's Disease . . .
. . .
48.7
Hepatitis . . .
13.1
20.
29.4
50.02
Bronchitis . . .
6.4
12.
In the above brief review I have omitted mention of two grave
diseases, which I now proceed to give in more detail.
144
5. Hydrophobia.— Of this the most fatal and terrible of the
accidents and ills which flesh is heir to, there occurred eight cases,
none of which recovered. No case of this disease has been admitted
since 1870, when 5 cases occurred ; three of which died in hospital
and the remaining two were discharged, which, probably meant, were
taken away by their friends in a hopeless condition.
Certain remedies have from time to time been put forward as
successful in the treatment of this disorder, but they have all alike
proved useless. A new agent has lately been advocated the Notonia
Grandifolia, of which a supply has been obtained from the medical
stores, and should occasion arise for its trial it will be exhibited; but
I have grave doubts of success. The following table gives an analysis
of seven of the cases, the remaining one seems to have been lost. Chlo-
ral hydrate was tried, but though it relieved to some extent the
horrors attending the disorder, did not seem to exercise any curative
effect : nutritive draughts, consisting of brandy, eggs, and beef-tea,
were administered, and in one case vapor baths and ice to the spine,
at my suggestion, were had recourse to but with the usual unsatisfac-
tory result. I regret that we have not in the hospital more efficient
appliances for administering this form of remedy.
[Table.
145
Tabulated Statement of Hydrophobia treated in the Jamsetjee Jejeebhoy Hospital during
the Year 1872-73.
No.
Names.
Cause assigned.
Treatment.
Symptoms
set in.
Termination of
Disease.
1 Dhonda Dham
...... 15 M H Dog bite 1 month. Nutritive Draughts Chlor. Hyd.
8- 7-72. Died 12- 7-72, 4 A. M.
2 Bhimi Hari
...... 16 M H
" 2 "
,,
Enema
......
1- 8-72.
" 4- 8-72, 5 P. M.
3 Hema Zepa
...... 20 M H
" 2 "
" Chlorof. Inhalation.... 30- 9-72.
" 30- 9-72, 4 P. M.
4 Narayen Baloo
...... 13 M H
" 2 "
" Draughts Chlor. Hyd. 19-10-72.
" 23-10-72, 8½P . M .
5 Khetji Ryman
...... 60 M M
" 6 weeks..
" " "
21-11-72.
" 22-11-72, 3½ P. M.
6 Rajih Futteh
...... 11 M M
" 2 months.
C h l o r . H y d . v a p . B a t h s — I c e t o
Spine
...... 26-11-72.
" 30-11-72, 6½ P. M
.
7 Pestonji Bomonji
...... 18 M P
" 2 "
Chloral Hydrate
...... 17- 3-73.
" 18. 3-73, 8-10 A.M.
146
6.
Tetanus .—Eighteen cases of traumatic and twenty-two of idio
- p a t h i c t e t a n u s w e r e t r e a t e d — 6 6 . 1 p e r c e n t . o f t h e f o r m e r a n d 6 3 . 5 o f
the latter died. The previous year gave the relative percentages of
58.8 and 41 ; whilst in the year 1870 a total of 70 per cent.
died. The subjoined tables illustrate the mode of treatment adopt
- e d , t h e d u r a t i o n o f t h e d i s e a s e , a n d t h e r e s u l t s .
7. Two examples of the somewhat rare affection of the muscular
system, viz., progressive muscular atrophy were admitted to treat
- m e n t , o f w h i c h I e n c l o s e t h e p h o t o g r a p h s w h i c h e x h i b i t t h e p e c u l i a r
withered appearance of the muscles affected very graphically. Both
of these patients were young, their respective ages being eighteen
and twenty years. In both cases the muscles of the upper arms and
chest were affected, the forearms being but little wasted. The chest
was contracted and the shoulders bent forward, the breathing being
chiefly diaphragmatic. The symptoms had existed for several months
before the patients applied for treatment.
8. In illustration of what I have stated when speaking of the
death-rate of pneumonia, and of the probable cause of the high
mortality which occurs in this hospital, I may mention that 213 of the
deaths, or 3.3 per cent. on the admissions, took place within the first
24 hours, the patients, indeed, were in a dying condition when admit
- t e d ; f u r t h e r , i n t h e s u c c e e d i n g 2 4 h o u r s 9 4 d i e d ; a n d o n t h e 3 r d
day 60.
9. The general condition of the hospital is decidedly satisfactory.
The institution is a noble one, and should, and I believe does, elicit the
the zealous attention and interest of the staff.
11. There are some improvements, however, in its internal adminis-
tration and in the external conditions, which could be effected and,
indeed, are greatly needed. As regards the latter or external condi
- t i o n s c a p a b l e o f i m p r o v e m e n t , I w o u l d m e n t i o n — 1 s t , t h e i n s u f f i c i e n t
accommodation for hospital servants and the consequent crowding
to excess which exists, a condition which is far from creditable, and
which may at any time prove a focus for the evolution and spread of
epidemic disease.
11. Secondly, the wretched quarters provided for the resident
house surgeon and apothecary, which are below the level of the
ground, are shut out from the breeze by their close contiguity to the
hospital, and flanked on the one side by the hospital necessary and
on the other by the dead-house. The hygienic condition of these
buildings are the worst possible and demand amelioration.
12. Thirdly, the dead-house which is badly placed, abutting on
the public thoroughfare, below the level of the surrounding ground,
and, consequently, flooded in the monsoons, most insufficiently light
- e d , d e f i c i e n t i n s p a c e , a n d i n s u f f e r a b l y c l o s e a n d i l l - v e n t i l a t e d .
147
The first two subjects have been repeatedly brought forward previ
-ously, and the last I have had the honor to point out to the Deputy
Inspector General of Hospitals personally, and with his approval and
thoughtful co-operation I have great hopes that the sanction of Gov
-ernment will speedily be obtained to the needful improvement being
carried out.
13. With regard to the internal administration, the points which, I
think, most demand attention are—1st, the need of a better paid, more
responsible, and more efficient steward or purveyor, or, in default of
this, the desirability of the personal superintendence of some intelli
-gent and experienced subordinate (medical) officer who might be
able to devote his whole time and energies to the matter of the provi
-sioning of this great institution, and affecting economy in the general
expenditure. The interests involved are very large, and I am persuad
-ed such an officer would more than save his cost to Government and
secure efficiency and thoroughness in the work, which it is impossible
for the First Physician completely to oversee.
13a. Secondly, the introduction of some efficient system of clini
-
cal registration of medical cases in other wards besides the clinical,
in order that the great and valuable mass of data annually accruing
may be rendered more available for reference and more fruitful of
scientific results than is now the case. Many of the great hospitals
of Europe have a recognized registrar who collates and digests the
mass of cases and by evoking order out of confusion render them
available for scientific analysis and capable of yielding up some of the
fruits of experience and experiment they contain. It may not be
practicable to do this at once, but I have attempted a beginning by
enforcing a more systematic form of case taking in the other wards,
and a form of registering eases in every ward, which I hope may form
the basis of the improvement I desire. I subjoin the directions issued
in the Appendix at the close of this report.
20 M D
148
IDIOPATHIC
Nu mb e r . Acute,
Sub-Acute,
Chronic.
Amount of
Dysphagia.
Muscles
affected.
Frequency
and nature
of spasms.
Average
Pulse.
Tempera
ture.
1 Acute.
Considerable. Back and Jaw. Very frequent.
1 6 0
Not stated.
2 Sub-Acute. Moderate. Neck and Jaw. Moderate.
35
100.4
3 Acute.
Considerable. General.
Not noted.
Not noted.
4
Do.
Do.
Do.
Very frequent.
138
100
5
Do.
Moderate.
Do.
Moderate.
144
103
6 Chronic.
Do.
Do.
Do.
116
100
7 Sub-Acute.
Do.
Neck and Jaw.
Do.
90
99
8
Do.
Do.
Do.
F r e q u e n t .
78
99
9
Do.
Do.
Do.
Moderate.
Not noted
10 Chronic.
Do.
General.
Do.
Ditto
11 Acute.
Do.
Do.
Frequent.
90 Not noted.
12 Chronic.
Do.
Neck and Jaw. 'Moderate.
85
96
13
Do.
Do.
Back.
Do.
8 0
not Noted.
14
Do.
Do.
Do. Jaw.
Do.
84
98
15
Do.
Do.
Abdomen.
Do.
120
103
16 Acute.
Do.
Upper Extrem
ity
Do.
72
105
17
Do.
Do.
Neck and Jaw.
Do.
102
100.2
18
Do.
Do.
Back and Neck.
Do.
8 4
92
19
Do.
Do.
Back.
Do.
120
101
20
Do.
Do.
Abdomen.
Do.
96
90
21 Sub-Acute.
Do.
General.
Do.
108
103
22
Do.
Do.
Do.
D o .
72 Not noted.
149
TETANUS.
Cases treated . . . 22
Deaths . . . 14
P. C. of deaths to treated . . . 63.5
Duration
of disease
before ad-
mittance
into Hospl.
Treatment.
Duration
of
Disease.
Result.
Remarks.
3 days.
Chlor. Hyd. Mist. S. V. Gall.
6 days.
Died.
8 "
Ditto.
10 "
Discharged at request.
. . .
Bellad. and Quiniœ.
15 "
Do.
at request.
6 "
Chlor Hyd. Mist. S. V. Gall
7 "
Died.
8 "
Do. Physostigma.
10 "
Do.
2 "
Chlor. Hyd. Physostig. Cannab Qui-
niœ Mist. S. V. Gall Bellad.
2 months. Discharged
5 "
Chlor. Hyd. Mist. S. V. Gall.
11 days.
Do.
at request.
2 "
Physostigma Cannab. Jalap. Calomel 3 "
Died.
3 "
Quiniœ Cannab. Camph. Mist. S.
V. Gallici.
6 "
Do.
9 "
Chlor. Hyd. Cannab. Quiniœ Tonic. 7 weeks. Discharged
12 "
Chlor. Hyd. Mist. S. V. Gall.
2 "
Died.
10 "
Ditto.
5 "
Discharged
15 "
Purgatives Mist. S. V. Gall.
7 "
Do.
8 "
Cannab. Quiniœ Ergot.
5 "
Do.
1 month. Chlor. Hyd.
6 "
Died.
2 days.
Chlor. Hyd. Mist. S. V. Gall.
4 days.
Do.
6 "
Cannab Quiniœ Physostig.
11"
Do.
1 day.
Cannab. Camph. Mist. S. V. Gall. 1 days.
Do.
4 days. Chlor. Hyd. Mist. S. V. Gall.
5 days.
Do.
3 "
Chlor. Hyd. Cannab Quiniœ.
6 "
Do.
7 "
Chlor. Hyd. Ice to spine, Hot air bath,
Purgative Enima.
6 weeks.
Do.
4 "
Chlor. Hyd. Cannab Quiniœ San
-tonine.
14 days.
D o .
TRAUMATIC
N u m b e r .
Acute,
Sub-Acute,
Chronic.
Amount of
Dysphagia.
Muscles
affected.
Frequency
and nature of
spasms.
Average
Pulse.
Tempera
-
t ure.
1 Acute.
Considerable. General.
Very frequent.
128
102.5
2
Do.
None.
Body and legs.
Do.
112
100
3 Sub-Acute. Moderate.
Neck and trunk Moderate.
120
101.4
4 Acute.
Considerable.
Do.
Considerable.
96
98
5 Sub-Acute.
Do.
General.
Moderate.
120
103
6
Do.
Slight.
Neck and ab-
domen.
Slight.
120 Not noted.
7 Acute.
Very consider-
able.
General.
Very frequent.
188
100.3
8
Do.
Do.
Do.
Do.
140 Not noted.
9 Sub-Acute. Slight.
Partial.
Slight.
Not noted.
10 Acute.
Considerable. General.
Frequent.
150 Not noted.
11
Do.
Do.
Do.
Do.
120
Do.
12
Do.
Do.
Do.
Do.
120
Do.
13
Do.
Do.
Do.
Do.
Not noted.
14
Do.
Do.
Do.
Do.
D i t
to.
15
Do.
Do.
Do.
Do.
155 Not noted.
16
Do.
Do.
Do.
Do.
100
Do.
17
Do.
Do.
Do.
Do.
100
Do.
18
D o .
Do.
Neck and jaw.
Do.
128
Do.
151
TETANUS.
Cases treated . . .18
Deaths . . . 11
P. C. of deaths to treated . . . 66.1
Duration
of disease
before ad-
mission
into Hospi
-
tal.
Treatment.
Duration
of
Disease.
Result.
Remarks.
3 days.
Chlor. Hyd. Ergot Mist. S. V. Gall. 4 days.
Died.
3 hours.
Do. Mist. Draught Mist. S. V.
Gall. Artif. Resp.
2 "
Do.
5 days.
Chlor. Hyd. Cannab.
9 "
Do.
16 hours. Chlor. Hyd. Morph hypsd.
1 "
Do.
12 days.
Chlor. Hyd. Mist. S. V. Gall.
C h o l o r o f I n k .
14 "
Discharged
1 "
Assafœtid and Castorium.
1 "
Taken
away.
1 "
Physostig. Ice to spin Art: Resp.
1 "
Died.
7 "
Chlor. Hyd. Mist. S. V. Gall.
7 "
Taken
away.
6 "
Mist. S. V. Gall.
13 "
Discharged
Set in inHos. Mist. S. V. Gall and Chlor. Hyd. 30 "
Do.
Do.
Ditto.
3 "
Died.
3 days.
Ditto.
5 "
Do.
5 "
Ditto.
7 "
Discharged
1 "
Chlor. Hyd. and Brandy.
1 "
Died.
1 "
Chlor. of Inh. Calomel Castor-oil
Enema.
1 "
Do.
2 "
Chlor. Hyd. Mist. S. V. Gall.
4 "
Do.
2 "
Ditto.
5 "
Do.
Set in
in Hospital
Ditto.
1 "
Discharged
152
The following report on the poisoning cases received into the hos
- p i t a l d u r i n g t h e p a s t y e a r h a s b e e n d r a w n u p b y M r . A n d e r s o n , t h e
H o u s e S u r g e o n .
14. The number of cases of poisoning shown in the returns for
1872-73 are as follows:—
P o i s o n s .
A d m i t t e d .
D i s c h a r g e d .
D i e d .
A c c i d e n t a l .
S u i c i d a l .
H o m i c i d a l .
P e r c e n t a g e o f d e a t h s t o a d m i t t e d o f a l l c l a s s e s .
P e r c e n t a g e o f d e a t h s t o t r e a t e d i n e a c h c l a s s .
15
to
24
Alcohol . . . 184 177
7
. . .
. . .
. . .
2.5
3.80
Opium . . .
5
20
32 27
5
. . . 1.81
15.62
29 29
. . .
. . . . . .
. . .
. . .
. . .
Datura . . .
Arsenic . . . 7
6
1
. . .
6
1 0.36
14.28
Cannab. Ind. . . . 11 11
. . .
. . .
. . .
. . .
. . . . . .
Mercury . . . 3
3
. . .
. . .
. . .
. . . . . .
. . .
Copper . . . 3
3
. . .
. . .
. . . . . . . . .
. . .
Poisonous Fish . . . 4
4
. . .
. . .
. . .
. . . . . .
. . .
Diseased grain . . . 1
1
. . . . . . . . .
. . .
. . .
. . .
Pounded glass . . . 1
1
. . .
. . . . . .
. . . . . .
. . .
Total . . . 275 262 13
5 26
1 4.72
5.30
15. Alcohol.—Under this class 184 have been treated, of which
7 died, showing a mortality of 3.80 per cent. to the number treated
and a percentage 2.55 to the total number of poisoning cases.
Many of the cases of alcoholic poisoning treated are brought
to hospital in most extreme states of insensibility and coma, and it
is astonishing to find that so many recover: those cases that have
proved fatal were probably from apoplexy induced by excessive
drinking. This statement is borne out by the post-mortem examina
-
tions which were permitted by relatives or friends—in all there was
a strong alcoholic odour on opening the stomach; the mucus mem
-
branes were reddened, while the membranes of the brain were found
highly congested, the substance of the membranes and brain show
-
ing bloody points with an abnormal quantity of fluid, found either in
the lateral ventricles or at the base of the brain. Two of the fatal
cases were not brought under treatment until 24 hours after liquor
had been taken.