"In regard to this fact I received the following communication from Drs. Stillé and Pepper: "In explanation of this apparently unaccountable excess of mortality among the black men, various circumstances may be advanced. In the first place, a very large proportion of the patients of this class were admitted in a dying state, and in more than one case death actually occurred before the patient could be placed in the bed. In very few instances, indeed, did they seek admission until a stage of the disease had been reached when the chances for successful treatment were greatly diminished. Again, it is a positive fact that relapsing fever, as occurring, presented a degree of gravity (indicated by intense jaundice, passive hemorrhages, suppression of urine, etc.) not met with in any other class of patients. We must call attention to the fact that the black men's medical ward, in common with other medical wards, and probably to even a greater degree, was overcrowded with these grave cases, and that ample space and most free ventilation are very important in the treatment of all zymotic diseases.'” Typhoid Fever.-In 1876, during the centennial exhibition, typhoid fever was rife in Philadelphia, and the Philadelphia Hospital had many cases, but far less than might have been supposed, as the disease did not so generally affect the poor, but those in better circumstances, who did not, as a rule, seek the hospitals. Over 50 cases, however, were treated. Puerperal Fever.-More or less of this disease has been present during many years. In the Annual Statement of board of guardians for year ending December 31, 1865, appears the following report, by Dr. R. M. Girvin, recording clerk: "During the last quarter of the year, puerperal peritonitis made its appearance in the obstetrical department, threatening to be epidemic. The lying-in ward was immediately vacated, thoroughly scrubbed and whitewashed, and disinfectants employed. The physician in charge of the cases attended no confinement for two weeks. At the end of one month patients were again admitted to the ward, no return of the disease following. The prompt hygienic measures adopted seem to have arrested the spread of the disease, but three cases occurring, all of which were attacked within seventy-two hours of each other. 666 Dr. J. S. Parry carefully examined such records as could be obtained of this ward, and reports as follows: "Cases of puerperal peritonitis occurred in the house every year from 1841 to 1858, except during 1844 and 1845. In January and February, 1849, the disease prevailed as an epidemic, at the end of which time the ward was vacated for four weeks. It appeared again as an epidemic about the middle of December, 1855. From this time to the 27th of February, the year following, twenty cases occurred, of which thirteen died and seven recovered.'" Dr. W. H. Parish, December 10, 1879, before the Philadelphia county medical society, read a paper on "Puerperal Septicæmia, chiefly as observed at the Philadelphia Hospital," from which we make the following quotations, which cover the history of about ten years. "The following paper is based chiefly on cases occurring in the Philadelphia Hospital between January 1, 1870, and December 1, 1879, a period of about ten years. They are arranged in the books of the white obstetric wards, under the headings of puerperal fever, septicemia, pyæmia, general peritonitis, pelvic peritonitis, pelvic cellulitis, metritis, phlegmasia dolens, and erysipelas. The sum total of these cases is 181, of which there have been 88 cases of puerperal fever, 8 cases of septicemia, 2 of pyæmia, 35 of general peritonitis, 5 of pelvic peritonitis, 28 of pelvic cellulitis, 6 of metritis, 6 of phlegmasia dolens, and 3 of erysipelas. I have studied all recorded cases of these diseases, because I believe that nearly all such conditions occurring in lying-in women, either originate in septicemia, or are modified in some part of their progress by septic influences." 66 The record shows that in January, February and March of 1874, pelvic cellulitis and pelvic peritonitis were of unusual frequency, 12 cases of the former and 5 of the latter being so registered on the ward books, and a number of milder cases were not recorded." "The most serious epidemic occurred during March, April and May of 1877. During these months there occured 35 cases with the recorded diagnosis of puerperal fever. Most of them were successive cases of delivery, and in not one of them is there recorded an instance of interference or of abnormality during labor. The poison in these cases was transferred in various ways from patient to patient. They were all normal deliveries, but were preceded in the wards by cases of erysipelas, and by one case of fatal traumatic peritonitis, the result of dystocia. This epidemic corresponded in its general manifestations with endemics of so-called puerperal fever seen by various practitioners in practice, and often noticed in lying-in hospitals ever since the establishment of such institutions." The following extract from a report made to the board of guardians April 26, 1886, is of great interest in connection with the subject of the mortality in the obstetrical wards, both at the time of epidemics or endemics, and at other periods. It also shows in a striking manner the great good accomplished by the trainingschool for nurses. "Drs. W. H. Parish and Theophilus Parvin, of the obstetrical staff, submit the following summary, giving the total inmates, women confined, deaths of mothers, deaths of children, total deaths, percentage of total mortality, and mortality of mothers, from January 1, 1875 to April 1, 1886. "It will be seen that this summary does not tally with the 'summaries' in the published Annual Statements for most of the years referred to. By reason of striking errors in the method of arriving at the rate of mortality, the summary of each published annual statement, excepting those prepared under the care of the resident physician-in-chief, has almost invariably overestimated the rate of mortality in the obstetrical wards. As an illustration of the divergence between the summary here1 Philadelphia Medical Times, February 14, 1880, with submitted and the summaries of the printed annual statements, it may be seen that the printed official annual statement for the year 1877 gives the total mortality in the white obstetrical ward at 41.75 per cent., and that of the colored obstetrical ward at 50 per cent., whereas in this summary, the total mortality, i. e., the mortality among the mothers and infants for 1877, in the two obstetrical wards combined, is given as 11.74 per cent. The latter is as nearly correct as can be arrived at. The error referred to was the result of including the children along with the mothers in the number of inmates, and in determining mortality." Obstetrical Wards, Colored and White, Philadelphia Hospital. "The training-school for nurses took entire charge of the maternity wards in April, 1885. It will be seen that the number of deaths among mothers and children combined has been since the introduction of the trained nurses, 4.14 per cent., to be contrasted with the former mortality over a period of eight (8) years, of 9.45 per cent.; and the number of deaths among mothers, after labor, since the introduction of the new nurses, has been 0.80 per cent., to be contrasted with the former mortality of 5.37 per cent. over a period of nine (9) years. The mortality during the twelve (12) months ending April 1, 1886, was less than during any year referred to in the above table." "The new maternity buildings were occupied in January, 1885." "The errors referred to as existing in the figures pertaining to the obstetrical wards affect, also, the total percentage of mortality from all diseases, but to a less degree than might, at first thought, be expected, because these figures merge with those representing the other departments. The printed figures indicating the average total mortality are, therefore, not so far astray as the printed figures indicating the mortality in the obstetrical departments, but for the sake of accuracy, we have substituted the correct ones. In this manner we ascertain the average mortality in the entire hospital, except in the insane department, to be:— For the year 1875... 8.63 per cent., against 9.53 per cent. in the printed report. "It will be seen that no such striking diminution in the mortality of the entire hospital can be claimed for the obstetrical department in the past year. In fact the mortality for 1885 (11.86 per cent.) is 1.59 per cent. greater than that of the previous year, which was 10.27 per cent., which was, however, low as compared with the year before it. This may be partly explained by the fact that the burning of the insane department which occurred February 12, 1885, so crowded the wards of the hospital that hygienic conditions were correspondingly impaired, and this state of affairs continued late into the spring. "In fairness, too, it should be stated, that generalizations dealing with so short a time as that during which our present system of nursing has been in operation, cannot have as much stress laid upon them as if they had been based upon a longer period. "There are other points of view than the statistical whence our present system of nursing ought to be judged. By general acknowledgment of those in a position to know, our hospital from being the worst nursed in the city has come to be considered among the best, and other hospitals far more favorably placed as regards advantages of construction, the nature of diseases treated and social position of their patients, now look upon it as a model worthy of imitation. In one hospital, at least, a great revolution in its entire executive management is about to be inaugurated, which would not have been thought of for many years, at least, if the system at the Philadelphia Hospital had not attracted the attention of those in charge and secured their approval. Further, one of our graduate nurses has recently been appointed chief nurse of the Pennsylvania Hospital. "Finally, our present system of nursing has produced results in a direction which was scarcely contemplated in its conception. Not only are our patients better cared for and more comfortable, but a refining influence is also exerted upon them of which at first thought they seem hardly susceptible, and a degree of self respect is engendered which contributes to the better discipline which characterizes the wards throughout. "Respectfully submitted by order of the medical board, W. H. Parish, M.D., E. T. Bruen, M. D., Influenza.-This pandemic which swept over the world in 188990, was the cause of over three hundred severe cases being treated in the Philadelphia Hospital. The poor consumptives were very unfortunate, forty-five in the medical wards being hurried off during three months, from the middle of December, 1889, to the middle of March, 1890. During this period, sixteen deaths occurred from pneumonia, all largely due to the epidemic. The mortality was so great among the phthisis cases in the fall of 1890, that these wards presented to those familiar with their usual appearance a very noticeable diminution of the array of chronic cases. There were fourteen resident physicians and twenty-five nurses sick with the disease, thus damaging the service of the hospital. In the insane department fifty cases occurred among the patients. |