Reports for the year 1892 of the statistical committee and the medical superintendents of the infectious hospitals and imbecile asylums, also of the ambulance & training ship "Exmouth" committees (7th year of issue) / Metropolitan Asylums Board.

  • Metropolitan Asylums Board (London, England). Statistical Committee.
Date:
1893
Catalogue details

Licence: Public Domain Mark

Credit: Reports for the year 1892 of the statistical committee and the medical superintendents of the infectious hospitals and imbecile asylums, also of the ambulance & training ship "Exmouth" committees (7th year of issue) / Metropolitan Asylums Board. Source: Wellcome Collection.

    56/216 (page 48)
    The relative death-rate of the undermentioned diseases is as follows, as calculated by the recognised formula:— Diphtheria (with 21 successful tracheotomies) 2D83 per cent. Enteric Fever ... ... ... ... ... 16*86 „ Other diseases ... ... ... ... ... 35*71 „ The consideration of the general and special death-rates of any given hospital is of importance in more senses than one; but when calculated on the mere quantity—apart from the quality—of each particular hospital practice, they are utterly inadmissible, inasmuch as it must be assumed that all the compared hospitals receive cases of equal gravity and danger of life, but this assumption would be grossly inconsistent with facts, the quality of cases received in them for treatment differing not in a trifling degree, but enormously from one another. Caution must therefore be exercised when the object is to use special death-rates for gauging hospital non-success in relation to particular kinds of disease. That caution, however, having been duly observed, such death-rates may become of the utmost value, for in their perfection they are true measures of medical non-success, and may be made instrumental both to advance professional science and also to enlighten the public mind as to the respective merits of hospitals. In illustration, it has been pointed out from time to time that the mortality in the Metropolitan Fever Hospitals is higher than in the homes of those attacked by special febrile disease. This probably is true; but the observations and the facts brought under your notice fortnight after fortnight as to the large number of fatalities occurring within a few hours after admission have not received as yet a similar prominent attention. Thus, in the course of the past year no less than 18 Scarlet Fever patients and 36 suffering from Diphtheria passed away in periods varying from two to 30 hours after their arrival, which, subtracted, would reduce the mortality to 5*63 per cent, and 16*61 per cent, respectively. The conclusion forced upon us is, and the inference must necessarily be, that either sufficient care is not always exercised in regard to the condition of cases for removal, or that the transfer is sometimes postponed until the state of the patient is hopeless. As regards the latter, it is by no means an isolated circumstance to receive a child with a report from the ambulance nurse that the medical man from whose care it has come is of opinion that tracheotomy is imperatively required, which, being done in extremis, goes, as a rule, to add to the already too many failures attendant upon the operation. That these unfortunate events will continue to recur is undoubtedly certain ; nevertheless, they render the death-rates, calculated on mere numbers of so-called patients, utterly worthless as measures of hospital non-success. Diphtheria—which, as an epidemic, was previously almost unknown to