On the mortality of London hospitals : and incidentally on the deaths in the prisons and public institutions of the metropolis / by William A. Guy.

  • Guy, William A. (William Augustus), 1810-1885.
Date:
[1867]
Catalogue details

Licence: Public Domain Mark

Credit: On the mortality of London hospitals : and incidentally on the deaths in the prisons and public institutions of the metropolis / by William A. Guy. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    mended patients to be 184 per 1,000, and among tlie same number of free patients, only 160 per 1,000. Both classes of patients were resident in London and its environs. Tliere is still another cause which may be supposed to affect the death-rate of our hospitals, namely, the mean residence of the patients. But this is rather an index to the class of patients admitted, than a direct and influential cause of mortality. An hospital, for instance, which encourages trivial cases, and keeps its beds full, will have a short mean resi- dence, a low death-rate, and a long list of patients, as necessary results ; but the cause of the low mortality is the trivial character of the diseases treated, not the short stay of the patients in hospital. The encouragement of chronic cases of slight severity, would lead to a low death-rate and long mean residence; but here again, the low mortality would result from the nature of the cases, and not from the sojourn in hospital. On the other hand, the admission of cases of extreme severity would entail a high death-rate, with short mean residence, and many patients. But if the cases were somewhat less severe, then the quick death of the few that must die would be set against the slow recovery and lingering convalescence of the larger number that get well, and the result might be a high death- rate and long mean residence. Again, surgical cases, which entail a comparatively low rate of mortality, may necessitate a longer mean residence in hospital. There is, therefore, no such direct relation of cause and effect between residence and death-rate as there has been shown to be between age, sex, and the proportion of medical and surgical cases and the rate of mortality. These natural suggestions are borne out by the numerical returns. The average of surgical mean residences is 34 days ; of medical 30. And while St. Bartholomew’s and Guy’s Hospitals, with surgical death- rates of 61 and 60 respectively, have minimum mean residences for that class of cases of 28 and 31 days; the Boyal Free Hospital, with a surgical death-rate of 49, has a mean residence of 21 days. So also with the medical cases. St. Bartholomew’s and Guy’s Hospitals, with medical death-rates of 182 and 150, have minimum mean residences of 28 and 33 days; while the Royal Free Hospital, with a death-rate of 141, has for its minimum residence 22 days. I may add that of the five hospitals, St. Bartholomew’s, Guy’s, London, St. George’s, and St. Mary’s, which have furnished com- plete retui’ns for five years, and show a higher rate of mortality, general and surgical, than the Royal Free Hospital; none show a lower mean residence than 24 days for medical, 26 for surgical, and 26 for all cases, while the Royal Free Hospital, which has given returns for four years, has a minimum residence for medical cases of 22, for sui'gical cases of 21, and for all cases of 22 days. The geiicial rule, then, would seem to be, that severe cases and long