Report on the charitable institutions of Melbourne / by Dr. Gresswell.
- Gresswell, D. Astley (Dan Astley), 1853-1904.
- Date:
- 1893
Licence: Public Domain Mark
Credit: Report on the charitable institutions of Melbourne / by Dr. Gresswell. Source: Wellcome Collection.
Provider: This material has been provided by London School of Hygiene & Tropical Medicine Library & Archives Service. The original may be consulted at London School of Hygiene & Tropical Medicine Library & Archives Service.
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![only 1*26 per cent.—is attributed by Professor Pippingskokl to wholesomeness of the conditions in and about the hospital and to general cleanliness of habits of the people. The contrast pointed out long ago by Sir James Simpson—that, whereas 30 per cent, of the jjersons died who underwent certain forms of amputation in eighteen large hospitals during a certain period, the mortality from such o])erations for the same period in country practice was only 10 per cent.—was attributed to difference, not so much of treatment, but of conditions to which the patients were subjected, the conditions of country life being of a more wholesome character than those obtaining at that time in most hospitals ; and this explanation is confirmed by many experiences. Of the latter there may be mentioned the fact that the mortality from compound fracture of the extremities in the Bostoii City Hospital was reduced by more than one- half after the wholesomeness of the ljuildings had 1)een improved, though the method of treatment was continued as before; and again the fact tliat with an army engaged in war septic disease is largely avoided if tlie men be treated in the open air, whereas that disease is but too common when the men are treated as they were during the siege of Paris in ordinary city l)uildings. No doubt the lowness of the mortality among Avomen in childbirth generally throughout England, only 08 per cent. (Duncan), and that among the 11,000 women who were delivered in 1867 in 40 English work-houses, only 0*7 per cent., are similarly to be explained ; as is also the contrast observed l)y M. le Fort in the mortality among women delivered in Paris in 1873-5, according as those women were delivered—either, on the one hand, at their several homes by official midwives or in the licensed homes of midwives; or, on the other hand, in special maternities or in ol)stetric wards of general hospitals, the percentage mortality in these four sets of cases having severally been as follows, viz. :—0-18, 0-5, 3-1, and 4-1. The necessity for excluding from the hospital all conditions favorable to Necessity for retention, cultivation, and distribution of infective micro-organisms nuist then be uueTuonT admitted. No ju.stification can l)e advanced for tolerance of conditions nnder which wound-infections are facilitated. The same holds also of conditions which facilitate other forms of infection, such as granular conjunctivitis, tuberculosis, and ordinary infectious diseases. But, over and above all this, there is the necessity for preventing unwhole-Necessity aiso someness of the atmosphere arising from other conditions than the presence in it of chcm'cai'aiid disease-producing micro-organisms. In the ordinary process of respiration part of propenL of tue the vitalizing agent of the air that is breathed is withdrawn, and the vitalizing influence 'P''- of the remaining portion of tliat agent is ]n'ol)ably reduced, while at the same time the atmosphere becomes charged with matters possessed of poisonous properties. Some of the injurious effects of overcrowding and of insufficiency of ventilation are thus explained. Overcrowding and insufficiency of ventilation directly aid the transmission of infection ; but they also, independently of such infection, render the air of rooms in some instances actually poisonous, and in others of such a kind as to lower the vitality and reduce the power of resistance to processes of disease. There is much evidence to support these statements. Improvement of the ventilation of factories has been followed generally and almost at once by improvement of appetite, of colour, and of energy among the employes, and by a great reduction of the previous rate of sickness among them. There can be but little doubt that the overcrowding of the Hotel Dieu of the last century—where at times 30 square feet only were allotted to a patient, and two, three, four, five, or even six patients in all stages of illness had to share one bed—was in large part the cause of the frightful mortality recorded against it, and at least in some part independently of the facilities afforded iDy such over- crowding for contracting specific infection. The fall of mortality among the French cavalry horses to one-ninth of what it had previously Ijeen, which years ago followed the increase of cubic space allotted to them, was no doul)t the result, not solely of the reduction of opportunity for contraction of infection, ])ut in part at least of a more vitalizing condition of the atmosphere. Prior to 1836 the yearly mortality among those horses was over 18 per cent., l)ut on increasing the ration of air it fell in the next ten years to 6 per cent., and in 1862-6 it was only 2 per cent. A similar fall of mortality accompanied a similar change in connexion with the English cavalry horses. The reduction, also, of deaths from phthisis in the European and English armies and in the royal and merchant navies is no doul)t not explained solely by reduction of the opportunities for transmission of micro-organisms from one person to another. C—No. 6.](https://iiif.wellcomecollection.org/image/b24398305_0005.jp2/full/800%2C/0/default.jpg)
