THE CALCUTTA HOSPITALS.

a

Ik our issue for March 1878 we announced the fact that mixed committee of civilians and medical officers had

appointed by

been

the Lieutenant-Governor of Bengal to

report upon the the province, more especially

medical

take into consideration and

administration of

We offered

of view.

financial

a

from

few remarks

a on

point importance of the inquiry, and the advantages which might be expected to result from it if conducted in a just The committee has now comand benevolent spirit.

the

pleted one portion?and that the most pressing?of their labours, namely tration

review of the economical adminis-

a

situated

hospitals

of the

Calcutta and

in

report has recently been submitted to Government embodying the results of the investigations conducted by the committee, the conclusions deduced therefrom, and the recommendations for the better government of the hospitals founded A resolution (dated 25th January, on the evidence.

its suburbs.

A

in the Calcutta Gazette of 5th

published

February)

has

been issued upon this report which sets forth in some detail the principles upon which the management of these hospitals is to be conducted for the future, the

by which these principles are to be realized, and grounds upon which the enunciation and issue of both principles and rules rest. The object of the present enquiry is again stated in this resolution

rules the

to be

"

the establishment of

hospital management,

a

which

uniform will

economy consistent with full of the sick, the elimination of vicious

greatest care

system

provide regard

of

for the for the

principles

of administration, the selection of the methods found by experience to offer the best results, and the distinct apportionment of the duties and responsibilities of the The object thus defined different classes of officers." and stated cannot fail to command universal and warm assent, and the principles formulated by the committee and

adopt ed by

of future

the Government

as

hospital administration

the groundwork

are

equally

com-

mendable and excellent. "

1. That the

management

of

They are these :? principle which ought to govern

a

hospital

the

dispensary supported from public funds, should be?the greatest possible economy consistent with the liberal provision of all things necessary to the well being and comfort of the or

sick. 2. That all officers should be held

concerned, responsible that

each in his this

forced.

own

principle

3. That within such reasonable limits

as

has shown to be

sphere, is

en-

experience

sufficient, medical officers entrusted with the treatment of the sick should be allowed the utmost freedom of action

as

to

ordering diets,

stimulants and other necessaries for but that at the

same

their

extras,

patients

;

time they should be held person-

March 1, 1879.]

ally responsible

if

THE CALCUTTA HOSPITALS.

they

exceed the limits

allow their

or

subordinates to exceed them. 4. That the system of accounts and returns should be simplified to the utmost, in order that the responsible officer may exercise a real control." No unprejudiced person can peruse this resolution and the

report on which it is founded without arriving the conclusion that the expenditure of some of the Calcutta hospitals has, for some years back, been beyond what was absolutely necessary to accomplish the essential objects of these institutions, and there can be very little doubt that a considerable waste of

at

money has taken It is impossible to

public other

place. explain, for example, how one hospital could supposition,

on any diet its

native sick on less than 3 annas per head, while the same class of patients in another hospital cost 6 annas. Unless the people in the former case were denied what was essentially for their maintenance and recovery, and

suspicion that such is the case, or the conregards the constitution of the patients and nature of the cases were widely different, and there is no reason to believe them so, it necessarily follows that, in the latter case, expenditure was incurred, or pretended to be incurred, which was not absolutely necessary for

there is

ditions

no

as

the welfare and recovery of the patients. There can be that, under a system which reduced check to a mere pretence, " extras" were ordered or charged little doubt

77

close and strict watching than any other, and if there exists any condition or influence of any sort which tends to cripple or thwart supervision and control, it is sure to declare itself in "waste" such as this resolution reveals. The Government of Bengal has acted both delicately and wisely in deciding both as regards persons and policy to " let the dead

past bury its dead" in this

matter.

The

policy

and

enunciated are eminently intelligible and principles reasonable. The experience of the past year has demonstrated that medical officers are both prepared to accept them loyally and competent to reduce them to practice successfully ; and with an administrative medical agency and a scrutinising financial agency now

all its own,

peculiarly to carry out its policy and orders, any tendency to excessive expenditure should be capable of ready detection and specially

and

own

easy

We

repression.

would

venture, however,

to

hospital administration by financial tests and most necessary and useful in

suggest that the success of should not be judged entirely

standards.

These

their way;

but,

are

while it is

right

that the

objects

of

should be achieved at as little cost as possible, it is also necessary to remember that the success of the institution must depend on the extent to which these objects are accomplished?on the number of sick treated, on the severity of the diseases and injuries a

hospital

from which they suffer, and on the amount of benefit culpable extravagance. The committee have suc- actually conferred in the shape of mitigated distress ceeded in demonstrating and exposing waste" in and restored health and usefulness. Judged by these many directions, and though some of the items of the standards, we are glad to observe that the Calcutta indictment may be open to challenge or explanation, medical institutions are not only maintaining their place, there can be no question whatever that waste" and but advancing. The Report for the year 1877, drawn worse than waste has prevailed, and prevailed largely. up by Surgeon-General J. Irving, M.D., shows that It has accordingly been found possible to apply the 25,358 indoor patients and 300,204 out-door were pruning knife freely in respect of establishment, clothing, treated in that year against 22,366 and 287,650 in diet, stimulants, and medicines, and it is certain that 1876?a total of 325,562 against 310,016. The death much saving of public money will be thus accomplished. rate among indoor patients was 133*26 per mille It is not our intention to quote or comment on this against 147-76 in 1866. Different hospitals vary resolution in detail. It might be instructive and use- greatly in this respect according to the class of cases ful to study the causes which have led to the abuses treated. The death rate of the Campbell (Pauper) now exposed ; but they are not easy to discover, and Hospital was 248-23 against 250-45. The Municipal many of them, perhaps the chief, do not appear on the police hospital with a death rate of 22-03 stands at the surface. Expenditure in the cause of charity is pecu- other end of the scale. The cause of this immense liarly liable to abuse. It is difficult in treating the difference is obvious. In the one case admissions take impoverished or sick to say where the essential ends place indiscriminately, from the slums and streets of the and the merely luxurious and unnecessary commences. city and its suburbs, of persons living in filth, neglect, Liberality is very elastic, and those who gratuitously poverty and disease ; in the other the admissions are dispense means not their own to others, are very exclusively from a picked body of men, subjected apt to be more prodigal than they would be, were certainly in the performance of their duties to all the the dole paid for by themselves, while subordinate insanitary influence of the town, but young and healthy agents in such cases are prone to divert the stream to start with, and well clothed, fed and housed. The of free relief to their own personal benefit. Chari- intermediate variations in other hospitals depend entable outlay in vhe nature of things needs more tirely on the sort of persons and cases admitted ; and

with

"

"

THE INDIAN MEDICAL GAZETTE.

78

[March 1,

1879.

can be no fair comparison between different from others of equally objectionable construction ; and the rates of the same hospital from year to it is quite certain that with neglect of hygiene " hospiyear do admit of comparison, and it is satisfactory talism" will prevail in the very best hospitals, or even to find them on the whole more favourable. The in open sheds. North Suburban Hospital has, we are glad to observe,

while there

hospitals,

opened

an

out-door

department, "which will be a great Chitpore and that popu-

boon to the native poor of

lous

neighbourhood.

The

proportions of males, females, and children and of the various classes of the population treated, were much the same as in previous years. The percentages were, males 61*8, females 15*5, and children 227 ; Europeans 2*41, Eurasians 11*80, Mahomedans " others" 2-63. The 33-23, Hindus 49*93, and diseases under which the largest number of addeaths took

missions and

place were malarious fever, dysentery, diarrhoea, spleen disease, injuries, diseases of the respiratory organs and syphilitic affections. Of cholera 574

treated and

294 (51-2 p. c.) of typhoid fever treated is not specified. This is to be regretted. It is curious to notice that while most other diseases are more fatal to natives, cholera is more fatal among Europeans. The higher rate of deaths among natives from fever, cases were

The number of

died.

cases

and diarrhoea, as compared with Europeans, is striking. The number of surgical operations

dysentery most

amounted

to

916, with 77

performed

in these

deaths

8*4 per cent., against 669 and 77 or 11*06 The results of 1877 therefore indicate great-

or

in 1876. er

activity

and

hospitals

The detailed list includes 185

success.

of extraction of the lens,

operations for cent.), 24 (with cases of lithotomy (with 5 deaths?20*8 per cent.), 26 amputations of the forearm, with no deaths, 16 of the thigh (with 10 deaths?62*5 per cent.), 13 of the leg (with 4 deaths?30*7 per cent.), and 10 excisions cases

scrotal tumour

of

8 deaths

joints

with

These

figures,

no

Medical College,

or

death. which

are

mainly contributed by

and General

Mayo

and successful surgery. " to note that hospitalism" was not

important ture in

69

11*5 per

the

indicate

Hospitals, It is satisfactory

so prominent a feaCollege Hospital in 1877 as in

the Medical

previous years. It is shown that for much of its hospitalism" the hospital is indebted to importation.

some "

The

question pitalism" the

of how far in any case or cases of " hosdisease is due to constitutional infirmity,

or inside a hospital, is a very delidifficult one, requiring very careful study of individual cases and outbreaks. The Medical College Hospital cannot be pronounced,

to

causes

outside

cate and

theoretical grounds,

on

with strict attention to use

of

antiseptics

surgery, there is can

a good surgical hospital, but sanitary details, the diligent

and

no reason

the

be banished from this

of

practice

to doubt that

hospital,

"

as

antiseptic hospitalism" it has been