18
REPORT ON THE
The classification is the same as last, year, and there is a diminution of
64 in the total number as compared with 1892. There were 110 deaths,
or 3 . 15 per cent., against 134, or 3 . 78 per cent., in 1892. The mortality cannot
be fairly compared with the rates of previous years, however, since many opera-
tions formerly classed as minor, and which involve little or no danger to life,
are now included in the list. This fact must be kept in mind in comparing the
figures of different hospitals. All operations are in one sense " important."
A man with a cinder in his eye is, till it is removed, as helpless as the victim of
a great surgical injury, but the "operation" required to relieve him requires no
surgical skill. The opening of an abscess may involve issues of life or death,
but is in itself a very simple proceeding. Classification is necessary to allow
of comparison, and every classification is open to criticism; the point to be
remembered is that until the returns are analysed no comparisons are possible,
and that an institution may show a large number of major operations while
doing very little high surgery. The operations are important in the sense
noted above, yet may require very little diagnostic skill or manual dexterity,
and the man who does them may be no surgeon. The real surgical work of
Calcutta is done at the Medical College, Eden, Shama Charn Law and Mayo
Hospitals, followed longo intervallo by Howrah, the Presidency General Hospital
and Sealdah, while the majority of major operations among out-patients at all
the institutions, and most of those at Sealdah and the Chandney Hospitals are
of comparative unimportance in a surgical sense. A curious feature in the
present classification is the omission of operations for the setting of fractures.
The successful treatment of a bad compound fracture involves as anxious work
as almost any surgical case, and is an excellent test of surgical ability and
resource. Yet it counts for nothing in the surgical record of the year. In this
way Howrah is deprived of credit for much most excellent surgery, 47 fracture
cases having been treated during the year.
25. Minor operations —numbered 19,001 as compared with 19,880, a
decrease of 879, the chief falling off being at the Chandney Hospital, though
all the institutions show a decrease, except the Campbell Hospital, which had an
increase of 317, and the Police Hospital of 11. The Dufferin Hospital, included
for the first time, had 166.
26. The Medical College Hospital —shows 1,938 major operations against
2,021 in 1892, but the diminution is among the less important " major" oper-
ations performed in the out-patient department, and there was an increase of 61
in those performed on in-patients. The year has in fact been one of much
surgical activity, and the number of really great surgical operations has been
very large. The table in the margin shows the more important of these,
1892.
1893.
Extraction of lens for cataract
...
298
316
Lithotomy
. . .
...
4
3
Litholapaxy
...
...
19
16
Herniotomy (simple) ...
...
31
1
Herniotomy, combined with radical
cure.
...
11
Radical cure of Hernia ...
...
28
24
Amputations
...
...
55
57
Delivery by forceps
... ...
67
52
Ditto turnin g ...
...
23
11
Ditto craniotomy
...
1
5
Ditto cephalotripsy
...
1
4
Ditto embryotomy
...
...
4
Ovariotomy
...
...
8
8
Laparotomy (abdominal section) ...
17
38
Colotomy
... ...
1
4
Nephrotomy
...
...
...
1
Cæsarean section
...
...
1
...
Operations for elephantiasis of scro-
tum.
39
49
Operations for vesico and recto-vagi-
nal fistula.
22
6
Perineorraphy
...
...
...
14
Operations for stricture
...
49
50
Removal of tumours
. . .
...
33
48
Total
...
697
722
but the list includes very many more
of the highest importance. The
death-rate per cent. of all major
operations taken together was 4.05
against 4 . 36 in 1892. Excluding
cases among the out-patients, it was
5 . 57 as compared with 6 . 32, and ex-
cluding eye cases it was 7 . 79 against
8.79 in 1892. When regard is had
to the magnitude of many of the
operations, these are very remarkable
results, the more so that the hospital
has such radical faults of construction
that it was at one time pronounced
unfit for the treatment of surgical
disease. Of the 19 stone cases only
one died ; of the 57 amputations only
4 ; 11 amputations of the arm and
forearm and 12 of the leg and foot
were performed without a death
;
11 of the thigh gave three deaths ; the
fourth occurred in an amputation at
the elbow joint. Of 141 amputations of the arm, forearm, thigh and leg