136 EEPOB.T — 1866. 



After analyzing the ahove Tables, wliicli referred especially to the medical sta- 

 tistics of the hospital, another Table was added, which bore more particularly upon 

 the subject of hospital economics and management. This Table extended over a 

 period of thirty-five years, from 1831 to the present time, and showed, in the first 

 place, the number annually admitted into the hospital, and of those attended to as 

 out-patients. Both these bore a proportion to the rapidly increasing popidation of 

 the town, and the latter was also somewhat afl'ected by the state of trade, which 

 in times of activity caused a number of accidents of a comparatively trifling kind 

 to swell the number of out-patients. It was noticed as a remarkable fact that, in 

 a population whose occupation brings them constantly into contact with weighty 

 and complicated machinery, the vast majority of injuries received by those engaged 

 in the lace and hosiery manufactures were of so slight a kind as to render admis- 

 sion into the hospital unnecessary. The number of more serious accidents occur- 

 ring amongst the large manufacturing population of the town and suburbs was far 

 outweighed by those from the colliery and agiicultural districts of the county. 



The 3rd colimm (the average number of patients in the house) of course varied 

 nearly in a direct ratio with the numbers admitted, but not absolutely so, as it was 

 influenced by the mmiber of days during which each remained in the hospital, the 

 average of which was shown in the 4th column. The latter return had always 

 been considered a most important point in the economy of the hospital. Various 

 causes tended to prolong the stay of some of the patients beyond the time which 

 might be considered absolutely desirable ; and for this reason it had been the 

 practice in the Nottingham Hospital to have, on the first Tuesday in each alternate 

 month, a general inspection by the whole of the medical stafi" of such patients as 

 might have been in the house upwards of eight weeks. Those patients whose 

 cases required further treatment in hospital were then recommended to be retained, 

 whilst those who would be equally benefitted as out-patients, or those who were 

 not likely to be further relieved by remaining in the wards, were recommended to 

 be removed as soon as possible. By the careful carrying out of this arrangement a 

 gi'eat saving to the hospital was eflected, and room was thus made for the ad- 

 mission of those urgent cases which were generally waiting for beds. By these 

 and other means the average number of days during which the patients have 

 remained in the hospital had fallen in thirty years from 50 to 35'7. 



The 5th column showed the total cost of the Matron's department (i. e. pro- 

 visions, coals, gas, water, &c.) in each year, and as this was of course influenced by 

 the varying price of provisions, the contract price of meat and bread, a fair index 

 of that of other articles of consumption was given in the two following columns, 

 6 and 7. 



The 8th column gave the annual cost of wines, spirits, and porter ; and the 9th 

 that of medicines, instruments, and appliances. 



There was one item under the latter head which had in a few years undergone 

 so remarkable a change that it was thought deserving of a separate column. This 

 was the cost of leeches, which in 1835, with an admission list of 750 in-patients 

 and 1650 out-patients, amounted to the sum of £90 ; whilst ten years later, in 

 1845, with 1214 in-patients and 3069 out-patients, the same item of expenditure 

 had fallen to £53 10s. Qd. Since that time, with a rapidly-increasing number of 

 patients, there had been a rapidly decreasing cost of leeches, so that in 1857, with 

 1379 admissions into the hospital, and an out-patient list of 7620, the cost was 

 only 12s. lOd., and in the following year, with 1361 in-patients and 7724 out- 

 patients, the cost was stUl only 13s. Id. Since that time the sum paid for leeches 

 had been so small that its notice as a separate item of expenditure had been dis- 

 continued. 



The 11th column gave the average cost of each in-patient in each of the thirty- 

 five years, which varied from £4 12s. in 1836 to £2 8s. 2|f7. in 1845 ; but as the 

 comparison of those years was rendered difiicult by the varying time during which 

 each patient remained in hospital, the 12th column had been added to show the 

 cost per day of each patient during that period. It thus appeared that the highest 

 cost was 2s. 2^d. per day in 1834, the lowest Is. 3f d. in 1848 and 1850. 



The last column gave the average cost of each out-patient, which had varied 

 from 5s. lOd in 1836 to Is, id, in 1859, a diflerence which had, it was believed, 



