Colonial hospital returns.
Besides this statistical inquiry into the condition of schools, I had forms prepared for colonial hospitals into which natives are received for treatment, in order to compare the school diseases with those prevailing among the adult population. They were sent to the colonies, also by the great kindness of the Duke of Newcastle. And returns have been received from the following hospitals:—Free Town, Sierra Leone, Cape Coast, Natal, Mauritius, Colombo and Malabar, King William’s Town, Kaffraria, and from two native hospitals in Canada.
pp. [40] to 53.
These returns were applied for as affording the only means of arriving at a knowledge of the prevailing classes of diseases among natives and of the relative mortality from each class. Abstracts of the returns, showing the mortality on the admissions for different sexes and ages, and the relative per-centages of mortality from each disease, are appended. (Forms I. to Y.) Of course the results can be relied on only so far as they represent the proportions admitted and dead from each disease, taken on numbers often hardly sufficiently large for statistical purposes. On account of the smallness of these numbers, I consider the results as only approximations, which I give because there is nothing better to be had. The tables do not enable us to ascertain directly the state of health or rate of mortality of the native population; but they afford us in an indirect manner a considerable amount of important information as to the diseases from which natives suffer. The hospital statistics appear to be very much in the same unsatisfactory condition as they are in many of our home hospitals. With these reservations the mortality statistics of these hospitals show a very high death rate upon the numbers treated.
Table L, p. [41].
Thus, in Free Town Hospital, the mortality to admissions among males is upwards of 20 per cent., and among females 18·6 per cent. of the admissions.[†]
[†] The admissions are obtained by adding the deaths to the recoveries, in the absence of more definite information.
Table T, p. [48].
At the Civil Hospital, Port Louis, Mauritius, the mortality is 21·3 per cent. for males, and 38·8 per cent. for females. {10}
Table V, p. [50].
In the Ceylon hospitals it is 20·7 per cent. for males, and 18·1 per cent. for females.
Table P, p. [44].
At Natal the mortality is much lower, being 12·8 per cent. for males and 6·6 per cent. for females.
Table N, p. [43].
In Kaffraria the mortality for males and females is 21·8 per cent.
Table X, p. [52].
In the Canadian hospitals it is 12·3 per cent. for males and 14 per cent. for females.
These high death rates can be attributed only to one or more of the following causes:—Defective stamina in the population, delay in applying for medical relief, bad and insufficient hospital accommodation, or defective medical treatment and management of the sick. The exact influence of each of these elements could hardly be appreciated without local inquiry. But the tables enable us to obtain some insight into the matter.
Table M, p. [42].
We find, e. g., that in the tropical districts the miasmatic class of diseases occasions a large proportion of the mortality, e. g., at Sierra Leone 20·4 per cent. of the total mortality among males and 6·8 per cent. of that among females is due to small-pox; that 34 per cent. of the mortality among females is due to dysentery; and that 19 per cent. of the mortality among males is due to periodic fevers. The mortality from miasmatic disease in this hospital is no less than 43·9 per cent. of the total mortality among men, and 43·1 per cent. of the total mortality among women.
Table K, p.[40].
At Cape Coast Hospital the admissions from miasmatic diseases, at least those recorded, amounted only to 9 1⁄2 per cent. of the total admissions, and no deaths are attributed to this class of diseases. This is quite sufficient to show the imperfection of the hospital records at this station.
Table U, p. [49].
At Port Louis Hospital, Mauritius, the miasmatic deaths from dysentery, diarrhœa, cholera, continued fevers, and rheumatism amounted to 54·9 per cent. of the total mortality for men, and 47·9 per cent. of the total female mortality.
Table W, p. [51].
Dysentery appears to be particularly severe and fatal amongst the natives in Ceylon, for the returns show that 43·6 per cent. of the men’s mortality and 30·1 per cent. of the women’s were due to this one disease. The miasmatic class generally gave rise in these hospitals to 64·3 per cent. of the total deaths of men, and 60·1 per cent. of those of women. {11}
Table Q, p. [45].
In D’Urban Hospital and Grey’s Hospital, Natal, 41·1 per cent. of the men’s mortality arose from continued fever, and 6 per cent. from dysentery. This latter disease occasioned all the deaths in hospital among women. These two diseases are the only ones of the miasmatic class which proved fatal.
Table O, p. [43].
Miasmatic diseases appear to be rare among the native patients at King William’s Town, Kaffraria. Only one of them, dysentery, produced a fatal result, and it gave rise to no more than 6 per cent. of the total deaths of men and women conjointly.
Table Y, p. [53].
The same diseases appear to be rare also in the Canadian hospitals, where they occasioned 12·3 per cent. of the men’s mortality and 17·3 per cent. of the women’s. The prevailing types were diarrhœa, periodic fevers, and rheumatism.
Table M.
If we take the other points of comparison, supplied by tubercular diseases, we find a remarkable difference in the proportion of mortality in different colonies. Thus, the death rate from scrofula, phthisis, and hæmoptysis, at Free Town, Sierra Leone, amounts to 3·2 per cent. of the total deaths from all causes among men, and 2·3 per cent. among women. In this hospital other chest diseases give rise to a mortality of 2·4 per cent. for men.
Table K.
At Cape Coast Hospital no deaths are registered from any class of tubercular or chest affections.
Table Q.
At D’Urban Hospital and Grey’s Hospital, Natal, there was a similar absence of mortality from these diseases.
Table W, p. [51].
The Ceylon hospitals afforded also only a small mortality, 0·7 per cent. for men, and 1·1 per cent. for women. There was, however, a mortality of 1·3 per cent. for other chest diseases, among men, and 1·7 per cent. among women. In striking contrast with this comparative exemption from a class of diseases to which the disappearance of the native races has been to a large extent attributed, we find a very considerable increase in the other hospitals.
Table U.
At Mauritius the mortality from scrofula, phthisis, and hæmoptysis, was 8·7 per cent. of the total mortality among men, and 3·7 per cent. among women. Other chest diseases furnish a mortality of 3·6 and 1·8 per cent. among men and women respectively.
Table O.
At King William’s Town Hospital, Kaffraria, the mortality from tubercular diseases, for men and women {12} conjointly, was no less than 70·6 per cent. of the total deaths, and from chest diseases 11·7 per cent.
Table Y.
Both classes of disease afford a high death rate in the Canadian hospitals. For the tubercular forms this amounts to 44·9 per cent. for men, and 41·3 per cent. for women. The other chest diseases give rise to 30·6 per cent. of the total hospital mortality for men, and 24·4 per cent. for women. Three-fourths of the whole hospital mortality among men, and two-thirds among women, were thus due to some form or other of chest disease.
Much has been said and written on the pernicious effects of the use of intoxicating liquors by uncivilized races. Diseases of the brain and nervous system, and liver diseases, are those which, at home, are generally supposed to indicate the greater or less prevalence of habits of intoxication among the people. Let us inquire to what extent admissions and deaths from these classes prevail in the various colonies.
Table M.
At Sierra Leone brain and nervous diseases occasion 5·7 per cent. of the total admissions, and 12·7 per cent. of the total deaths among men, and 9·2 per cent. of the admissions, with 21·6 per cent. of the deaths, among women. Liver diseases afford only 0·1 per cent. of the admissions, and no deaths.
Table K.
Cape Coast Hospital affords an extraordinary contrast to this, for there we find that, although brain and nervous diseases and liver diseases occasion no more than 4·8 per cent., and 2·4 per cent., respectively, of the admissions, all the deaths arose from them.
Table Q.
The Natal hospitals show a proportion of admissions from brain and nervous diseases, of 5·7 per cent. of men, and 8·3 per cent. of women. But no deaths and no admissions from liver disease.
Table O.
The King William’s Town Hospitals, Kaffraria, show no admissions from either class.
Table U.
At Mauritius the admissions from brain and nervous diseases were 3·5 per cent. for men, and 2·7 per cent. for women, and the deaths 6·1 per cent. for men, and 1·9 per cent. for women. Liver disease is so rare as to be scarcely appreciable.
Table W.
A similar remark applies to the infrequency of liver disease in the Ceylon hospitals. In these hospitals, the admissions from brain and nervous diseases are 1·6 per cent. for men, and 3·2 per cent. for women. And the deaths 1·5 per cent. and 3·1 per cent. respectively. {13}
Table Y.
No liver diseases were admitted into the Canadian hospitals. And the brain and nervous diseases afforded 6·5 per cent. admissions, and 2 per cent. deaths for men, with 5·2 per cent. admissions and no deaths for women.