TABLE NO. 1.

YEAR.Number
of
cases.		Number
of
recoveries.		Number
of
deaths.		Number
of deaths
within
48 hours
of
admission.		Average
stay in
cases
ending in
recovery.		Average
stay in
fatal
cases.		Percentage
of deaths.		Percentage
of deaths
after
deducting
cases fatal
within
48 hours of
admission.
18628968217541/3823.617.7
1863363332321/531/38.32.9
1864433581381/2818.616.3
1865363151381/251/213.911.4
1866231760452/3926.0
1867242040371/361/216.6
1868272340443/41014.8
1869211651351/21423.820.0
1870241951471/21120.817.4
1871322661373/4131/218.815.0
1872211653371/241/223.811.1
18731284234933.320.0
1874161240541/293/425.0
18752018214841/210.05.3
1876302192451/21130.025.0
18774834144481/2121/229.222.7
187885304952/337.5
1879171520531/3811.8
188040355247101/212.58.0
Totals,62150012128431/283/419.515.7

Out of the 621 cases admitted, 121 were fatal. This gives a death-rate of 19.5 per cent.; but if we deduct the 28 cases in which the patients died within forty-eight hours of their admission, it falls to 15.68 per cent., or about the same ratio as Murchison found to exist among the cases treated at the London Fever Hospital. Other observers have obtained slightly different results. Thus, the mortality was 11.16 per cent. in 197 cases analyzed by Dr. Hale, and 13.5 per cent. in 303 cases collected by Dr. James Jackson. Dr. Cayley93 found the death-rate of the several hospitals in London to be 17.8 per cent., and Geissler94 that it was in all the German hospitals 12.8 per cent. in 1877, and 13.5 per cent. in 1878. Flint had 18 deaths in 73 cases, or 24.4 per cent. According to Liebermeister, the ratio of mortality at the hospital at Basle during the twenty-two years from 1843 to 1864, or before the introduction of a systematic anti-pyretic treatment, was 27.3 per cent., and only 8.2 per cent. during the six years immediately following its adoption. As the results obtained at the Pennsylvania Hospital are apparently not so favorable as those reported at some of the continental hospitals, it is only proper to state that a large proportion of the cases were severe, that many of them were far advanced in the disease when admitted, and that very few of the patients were under twenty-one years of age. These are all circumstances which influence very decidedly the prognosis in typhoid fever. In no other city are the laboring classes able to surround themselves with so many comforts as in Philadelphia. This fact, fortunate as it is in the main, often operates to the disadvantage of the patient by enabling his family to indulge for a time the reluctance which it naturally feels to part with a member when sick. In the case of the young this reluctance is so hard to overcome that children with acute affections are rarely brought to hospitals for treatment. There were also special causes for the large mortality in certain years. This was particularly the case in 1862, when a large number of soldiers fresh from the battlefields of Virginia, and suffering from the typho-malarial form of the disease, were admitted into the hospital. Many of them were moribund upon admission, and others, exhausted by the fatigue incident to transportation here and by previous hardships, soon succumbed to the disease.

93 Med. Times and Gaz., 1880.

94 Schmidt's Jahrbuch.

Table 2 gives the number of cases, with the number of deaths occurring in each season, at the Pennsylvania Hospital during the last twenty years:

TABLE NO. 2.

Spring.Summer.Autumn.Winter.
Number of cases8925918291
Recoveries7319116373
Deaths16681918
Percentage of mortality18.026.210.419.8

It will be seen from this table that the highest death-rate occurred in the summer and the lowest in autumn, while there was only a slight difference between the death-rate of spring and that of winter. Murchison's experience, based on a much larger number of cases, has led him to conclude that while the disease is a little less fatal in autumn, the difference in the mortality at different seasons is very inconsiderable. Chomel believed that the percentage of deaths was highest in France during the winter months, and Bartlett held the same opinion as regards America. Epidemics of great severity have undoubtedly prevailed in winter, as the in Lowell, Mass., referred to by Bartlett, but there can be little doubt that the death-rate is highest in this country during the warm months of the year. Dr. Cleemann95 found that the monthly average mortality in Philadelphia for the ten years from 1866 to 1875 was highest in August, and next highest in September, confessedly the two months of the year when the heat in this city is most exhausting. I feel very sure I have lost patients with typhoid fever in these months and in July who would probably have recovered if the weather had been cooler. With a temperature often rising above 90° F. at midday, and sometimes for several days at a time never falling below 80°, all radiation of heat from the surface of the body is arrested, and death frequently occurs as the result of hyperpyrexia.

95 Transactions of the College of Physicians of Philadelphia, 3d S., vols. ii. and iii.