Volume 1

A system of medicine / edited by J. Russell Reynolds.

Date:
1866-1879
Catalogue details

Licence: Public Domain Mark

Credit: A system of medicine / edited by J. Russell Reynolds. Source: Wellcome Collection.

    241/976 (page 221)
    22 same remarks apply to the treatment which should he adopted in the case of compound fractures and other injuries. And in regard to cases of deep-seated suppurations, acute necrosis, carbuncle and diffuse cellular inflammation, there is no doubt that free and early incisions are especially important in preventing the supervention of Pyaemia. In hospitals, or other places, where many sick are accumulated, the precautionary measures above insisted on become doubly important, especially those of ventilation and cleanliness. In discussing these two measures we open up the whole subject of hospital construction and hygiene—a subject which, even if in many respects appropriate to the present article, is far too extensive to be considered even briefly here. It may however be stated generally, that there should be abundant cubical space to each bed, abundant space between the beds, plenty of ventilation by means of open windows, aided by open fire- places ; that the walls, the floors, the ceilings, should be kept scrupu- lously clean ; that the wards should be periodically emptied ; that water-closets should be so arranged as in no degree to infect the ward ; that sponges should never be used in the cleansing of wounds—nor anything absorbent in fact which might be used on a second occasion or in the treatment of another case. But the danger of Pyaemia, incidental to wards or places in which many sick are accumulated, is less due to mere accumulation of sick than to undue accumulation of such as are suffering from certain forms of sickness, such namely as are suffering from open wounds, whether arising from accident or disease or design. The presence of what has been termed a “ traumatic katmosphere ” would seem to have quite a special influence over the development of Pyaemia, and for that reason the creation of a traumatic atmosphere should be as much as possible avoided. This may be effected partly by the means just adverted to, viz. free ventilation, and avoidance of overcrowding ; but especially by so distributing- traumatic cases as to allow of no undue accumulation of them in any one ward of a hospital, or generally in any one spot. The presence of erysipelas, diffuse cellular inflammation, phagedsena, or any other unhealthy inflammation, and especially the presence or recent occurrence of Pyaemia in a ward, should be the signal for redoubled vigilance in securing that all sanitary regulations are as far as possible systematically carried out. Then, especially, all danger of