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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![To all this add the fact that the excretions in cases of illness may be increased, perverted and rendered more dangerous—and the importance of securing a thoroughly wholesome atmosphere in and about hospitals, as a cardinal guide in hospital-location, -planning, -construction, and -management, will be admitted. Guides towards Souic experimentally determined data, affording guidance in the accomplish- who'esome mcut of this object, may now be briefly referred to. First, it may be observed that hospitai air. ozouo—a peculiarly active form of the vitalizing element of the atmosphere—is found in special abundance in sea- and in mountain-air, and, though present over the suburbs of large towns, may be, and often is, almost or wholly absent towards the centres of them. Similarly, also, the amount of carbonic acid in the air—which may be taken as a rough criterion of the amount of combustion and decomposition going on—is found to increase from the suburbs towards the centres of large towns. Dr. Smith found in Manchester that in usual weather the air of the suburbs contained 0*029 per cent, of carbonic acid, while that of the central streets contained 0*04 per cent.; and almost precisely the same increase was found by Carnelly, Haldane, and Anderson at Dundee. Then, too, it has been shown that the composition of the atmosphere is largely dependent upon that of the soil. The soil of cities and of manured lands is an active scene of decom- position of dead organic matter in process of being resolved by countless minute organisms into simple inorganic bodies. The soil of city streets, as might be expected, is foun d to be more or to be less charged with micro-organisms, with organic matter, and with products of decomposition of organic matter according as the street from which it is taken is more or is less subjected to business-traffic. The dust of the most busy streets of Naples has been found to contain as many as a thousand million micro- organisms to the gramme, whereas the sand of the seaside may be almost bereft of such organisms. Dust from the streets of Na])le8 was inoculated somewhat recently by Dr. Manfredi into guinea pigs. Disease followed in 73 per cent, of the animals inoculated ; and among 42 of the animals thus diseased the micro-organism of pus, that of malignant oedema, of tetanus, of tuberculosis, or of septicaemia was found in as many as seventeen, these micro-organisms having apparently therefore existed in the dust used in the inoculations. To the same order of facts doubtless belongs also the special incidence of infantile diarrhoea on communities dwelling on soils that are moist, pervious, and polluted. It may be observed, too, in this connexion that, while no micro-organisms have been discovered in sea air and only 0*001 per litre on high mountains, 3'9 have been found per litre in the Rue de Eivoli (Paris), and 7*0 in St. Paul's Churchyard (London); and that the raising of dust into the atmosphere may, so to say, indefinitely increase the numljer and probably the kinds of them in the air —not merely of those concerned in decomposition and in putrefaction, but of those also that are concerned in the production of specific disease. It will, then, be evident that these and like matters demand consideration when determining upon the measures to be taken for securing wholesomeness of atmo- sphere in and about hospitals. In the first place, accordingly, the site needs to be selected with due regard to cleanliness and dryness of soil, as also to wholesomeness of atmosphere dependent upon other conditions in the locality. Next, the buildings must be so related one to another, as also to elevations of surface and to erections at the time or likely in the near future to be constructed in the neighbourhood, that the sun's rays may fall directly upon the several compartments of the buildings and upon the several parts of the grounds; and that at all times there may be as complete perflation as possible of the grounds, particularly between the buildings. Thirdly, the buildings must be so constructed that indoor perflation may be readily and thoroughly supplied at any time, and be under complete control. Then, too, the cubic space allowed and the mode of ventilation must be such that only outdoor wholesome air will be supplied to each patient, and that such air, when once contaminated with any unwholesome exhalation or emanation, will be removed—not merely diluted—so as not to come within the respiration- or the wound-sphere of any inmate a second time. Means must be supplied also for readily removing, and for preventing as far as possible the lodgment of, all infecting agents, all material subservient to their develop- ment, and all fermentable matter. Regard should also be had to quietude of locality, and to cheerfidness of prospect. In other words, the hospital-atmosphere must be as free as practicable from products of decomposition of organic matter, and must approach in composition, probably also in electrical reaction, as nearly as may be to the atmosphere over seas and elevated lands, the ward-air being maintained, however, as nearly as practicable](https://iiif.wellcomecollection.org/image/b24398305_0006.jp2/full/800%2C/0/default.jpg)
