UPON SALUBRITY OF A SURGICAL HOSPITAL 135 



evolution of noxious effluvia ; and even the foul gases from the open pits were 

 perpetually diluted by the air with which they mingled, so that but a small 

 })roportion of them would enter the wards ; and accordingly, when the patients 

 were cleared out for the purpose of the annual cleaning, there was nothing in 

 the wards to offend the nose. But the emanations from sores are poured 

 directly into the confined atmosphere in which the patients are ; and any one 

 familiar with the faint sickly smell commonly perceptible in surgical wards 

 under ordinary treatment, and still more with the stench which prevails at the 

 time of the daily dressing, will readily understand that putrid exhalations from 

 the patients may be a source of mischief, compared with which the other 

 circumstances alluded to may be of comparatively trifling consequence. 



With the object of getting rid of this great evil as much as possible, I have 

 used antiseptic means, not only where they are of essential importance for the 

 treatment of the individual case concerned, as in recent wounds and abscesses, 

 but also in superficial sores. For though granulating surfaces will commonly 

 heal well enough under a putrid dressing (for such the cleanly water dressing 

 becomes within a few hours of its application), every case so treated furnishes 

 its quota to the vitiation of the general atmosphere of the ward. Hence, for 

 the sake of the inmates generally, it is obviously desirable that healing sores 

 should be dressed with some application which, while permitting, or, if possible, 

 favouring cicatrization, should prevent odour. For this purpose some dressing 

 unstimulating, but at the same time persistent in antiseptic action, is requisite, 

 — a combination which I have sought in various different forms to obtain, and, 

 of late more especially, with very satisfactory results, so that w^hile the healing 

 of superficial sores proceeded with greater rapidity than under water dressing, 

 all my sixty patients might sometimes be dressed without the odour of putre- 

 faction being perceptible in one of them. 



The result of this great change has been such as to demonstrate conclusively 

 that the exhalations from foul discharges are the essential source of the insalu- 

 brity of surgical wards ; and that when this is effectually suppressed, other 

 conditions, which we are accustomed to regard as most pernicious, become 

 powerless to produce serious evil. 



It is obvious that the facts recorded in this paper are of extreme importance 

 with reference to the vexed question of hospital construction. With the view 

 of assimilating the atmospheric condition of our large hospitals to that of a 

 private dwelling, it has been lately proposed to do away with them altogether 

 in their present form, and to substitute for them congeries of cast-iron cottages, 

 capable of being occasionally taken down, cleansed, and reconstructed — a plan 

 wliich, besides involving enormous expense, would interfere most seriously 



