Volume 1

The science and art of surgery : a treatise on surgical injuries, diseases, and operations / by John Eric Erichsen.

  • Erichsen, John
Date:
1888
Catalogue details

Licence: Public Domain Mark

Credit: The science and art of surgery : a treatise on surgical injuries, diseases, and operations / by John Eric Erichsen. Source: Wellcome Collection.

    42/1244 (page 12)
    septicfemia, common iu fowls, knowa as chicken cholera, lose considerably in virnlence if the organisms which form their essential part are cultivated under ■conditions which are not suited to their growth. The converse, although not proved, is possibly true also,—that the virus increases in intensity if cultivated in a medium suited to its growth and development. Such a medium for the growth of pathogenic organisms is found in the feeble tissues and unhealthy sores of patients weakened by breathing the impure atmosphere of an over- crowded ward, and it is thus that infective processes of intense virulence may be developed. Our knowledge of the conditions under which the virus is developed in hospital gangrene and pyjemia is still very far from perfect: but this much is certain, that they are essentially filth-diseases, and may, if the term be allowable, be manufactured in any hospital or house, however clean or well situated, by the accumulation within it of too large a number of patients suffering from wounds the discharges of which are in a state of decomposi- tion. It is probable that the contagia of some of these diseases are destroyed by oxidation ; but, be this as it may, it is evident that a want of free ventila- tion must lead to a concentration of such poisons as are disseminated by the air, and at the same time the patient's body will be rendered more susceptiljle to their influence as its vitality becomes lowered. In the prevention of the elfects of over-crowding we have to consider first the vitiation of the air by the patient by the natural processes of respiration .and excretion ; and, secondly, fouling of the atmosphere by the emanations from wounds and sores. The first of these causes of impurity is unavoidable, and it is only by providing sufiicient air for each patient and changing it with sufiicient frequency that its evil effects can be prevented. In determining the condition of the air of a room or ward the carbonic acid present is taken as the index of the degree of impmity, as it is easily estimated, while the determination of the organic matter is almost impossible. Parkes and De Chaumont give -6 per 1000 volumes of total carbonic acid in the air as the limit of impurity allowable. Of this about -2 is derived fi-om respiration and the remainder is the normal quantity present in the atmosphere. In order to maintain the air at this standard an ordinary man requires to be supplied with 3000 cubic feet per hour. This is the minimum quantity of air that -will suffice for the purpose, and it would evidently be unwise to trust to this. The rule, therefore, laid down is that at least 4000 cubic feet per hour must be provided. In order that this amount of air may be obtained without exposing the patient to draughts, a sufficient cubic s])ace must be allowed for each patient, so that if the air be changed from three to four times per hour the requisite amount may be supplied. Under exceptional circumstances 1000 cubic feet per head might thus, with good ventilation, be made sufficient; but no surgeon would be content with this if he could obtain more ; as in civil practice he always can. The rule, therefore, laid down in the construction of hospitals is that each patient shall be allotted from 1500 to 2000 cubic feet of ■space, the larger space being required for infectious, or surgical cases. In ■order to maintain a proper degree of separation of the patients each must be allotted from 100 to 120 square feet of floor. The effective height of a ward for the purposes of ventilation does not exceed 12 feet. Not only, however, is space required, but change of air, by proper ventilation, is equally needful. Military experience has shown conclusively that churches form the worst possible hospitals, for in these buildings, although the cubic space per head