48

REPORT OF THE

        And the death-rate of the past year has been less than that of the average of the six
preceding years to the extent of 15.24 in the thousand patients treated.

Influence of cholera
  on the death-
  rate.

        With a view to facilitate a reference to these facts, the ratio per thousand for the seven
years inclusive and exclusive of cholera are herewith submitted in juxta position.

Years. Ratio per 1,000 of deaths
to treated, inclusive of
cholera.		 Ratio per 1,000 of
deaths to treated,
exclusive of cholera.		 Difference.
1865 69.93 52.80 17.13
1866 98.50 53.59 44.91
1867 63.94 45.23 18.71
1868 72.27 48.09 24.16
1869 53.01 37.20 15.81
1870 52.92 39.59 l3.33
1871 36.52 30.56 5.96

       Cholera has been, and, in a mitigated degree, continues to be, an important disturbing
element in the mortality rate of the hospital. This does not altogether account for the
decrement in the death-rate during the past three years, and particularly during the last of
the series, for it is apparent from these figures that a certain amount of decrease is fairly
sustained even when cholera is excluded from the calculation.

Chief causes of
  death.

       The chief causes of death for the seven years ending 1871 are illustrated below:—

Diseases. Treated. Died. Deaths to treated. Ratio per 1,000 of
deaths to total deaths.
1. Cholera 641 375 585.02 339.36
2. Dysentery 1,601 123 76.82 111.31
3. Hepatitis 368 49 l33.15 44.34
4. Typhoid fever 85 22 258.82 19.90
5. Remittent fever 238 31 130.25 28.05
6. Phthisis 382 127 332.46 114.93
7. Pneumonia 62 22 354.84 19.90
8. Insolatio 125 11 88.00 9.95
9. Other diseases 13,909 345 24.80 312.21

       This statement brings out into prominent relief the important share which a few
diseases have taken in swelling the bill of mortality.

Importance of early
  treatment in
  cholera

        (1.) The deaths from cholera have almost invariably occurred in patients who were
admitted either in a state of profound collapse, or in a condition in which they rapidly passed
into collapse, in which they succumbed without re-action, or if re-action did supervene, they
appear to have fallen victims to secondary fever, uræmia, or dysentery. When cases of
cholera are received at an early stage of the malady, success in their management is propor-
tionately frequent. If, therefore, the Masters of ships could be prevailed upon to send all cases to
hospital at the earliest possible stage of the disease, the death-rate would doubtless be materially
diminished. The present practice is by no means conducive to the welfare of the sailor.
He would seem to be dosed on board under most unfavorable circumstances, and is only sent
to hospital when he is either verging on, or has actually merged into collapse, when the
circulation and respiration are rapidly failing, and the functions of the more important organs,
such as the lungs, heart, liver, and kidneys, are hopelessly deranged and embarrassed. Yet
notwithstanding these untoward circumstances, the average mortality from cholera has not
been more than 585.02 per thousand. It accounts, however, for 339.36 deaths in 1,000
deaths from all causes.

and in dysentery

       (2.) Dysentery, which in its earlier stages is almost as manageable by ipecacuanha as
an ordinary intermittent is by quinine, becomes a most appalling disease when extensive
sloughing has taken place, or when, as not unfrequently happens, it becomes complicated
with abscess of the liver. Nearly all the cases which prove mortal have passed into one or
or other of these conditions, or both, long before the patients have sought for admission into