Volume 1

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

  • John Eric Erichsen
Date:
1895
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.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

    41/1274 (page 9)
    counting these the number of organisms that have been deposited can be ascertained, and their nature may be determined by subsequent microscopic examination. The general results of these observations have been to show that the number of micro-organisms in the pure air of a mountain top is very small, in fact they may be absent. In the air of an ordinary country - place they are scarce, but always present; in the air of a city they become numerous, and the atmosphere of a surgical ward is often loaded with them. Thus, in the Observatory of Montsouris, which is situated in a park on the outskirts of Paris, the daily average was 75 organisms per cubic metre ; in the Rue de Eivoli it was 750 ; in the low parts of Paris 850, and in a ward in the hospital of La Pitie it amounted to 11,100. In the wards of the hospital the number rapidly increased, when, owing to cold weather, the windows were closed. It may therefore be taken as proved that the air of hospitals, and inhabited houses generally, contains floating in it numerous organisms which are capable of growing- ia the discharges of wounds, and of establishing in them various fermentative changes, the products of which are more or less detrimental to the patient both locally and constitutionally. It is by no means necessary that the fermentative process thus induced should \)Q the ordinary foetid putrefaction ; in fact the organisms which cause this are scarce in the air, being much more abundant in water ; still, although there may be no smell, the fermentation set up in the discharges is not always innocuous. The air of a surgical ward or sick room is vitiated by the patient, first, by the normal products of respiration and excretion from the lungs and skin ; and secondly, in many cases by the emanations from wounds or sores. The first is unavoidable, the second is to a great extent under the control of the Surgeon. An average adult man gives ofi' per hour about '6 cubic feet of carbonic acid gas, from 1 to 1| ounces of water, and an undetermined quantity of organic matter. This organic matter is partly solid, consisting of epithelium and fatty matter from the skin and mouth, and partly a vapour given off from the lungs, the nature of which is somewhat uncertain. It is extremely offensive, and is so imperfectly diffusible that it is probably in great part molecular ; it is nitrogenous and oxidisable, although but slowly. It is readily absorbed by damp walls or bedding, the most hygroscopic substances taking it up most readily. It is this substance that gives the fusty smell to an ill- ventilated room. Experiments have shown that it is highly poisonous, and this explains the fact that air fouled by respiration is much more deleterious than that vitiated by combustion or by the addition of pure carbonic acid gas. Parkes states that allowing the fullesD effect to all other agencies, there is no doubt that the breathing the vitiated atmosphere of respiration has a most injurious effect on the health. Persons soon become pale, and partially lose their appetite, and after a time decline in muscular strength and spirits. The aeration and nutrition of the blood seem to be interfered with, and the general tone of the system falls below par. Under such circum- stances convalescence is ])rolonged ; the reparative power is less, wounds tend to slough, and the patient is more readily affected by any local or general infective process to the poison of which he may be exposed. The special contamination of a surgical ward may arise, first, from the presence in the atmosphere of the gaseous products of decomposition ; secondly, from a great abundance of the organic particles which act as the