While it is important for every hospital to know something of the quality of the food and water supplied to its inmates, it is of still greater importance to know that in every department of the hospital there is provision for the entrance of pure air and the exit of impure air. We may live without food for days or weeks, but the breath of life is the first great essential of existence. Deprived of it and death results. Poison it and deterioration in health results. “Bountiful nature has supplied an inexhaustible supply of this essential, and the means for its purification. Only when man’s ingenuity or stupidity thwarts her efforts, confines the air, prevents its free circulation, does it retain the poison he has contributed to it.”
A large part of the science of sanitation can be summed up in one word: cleanliness; clean air, clean food, clean water, clean rooms, clean beds and bed linen, clean occupants of the beds, and clean appliances.
Dirt
Dirt has been defined as “matter out of place.” To have the ability to recognize when matter becomes dirt, and get it into its proper place and proper form, is to have the key to hospital sanitation. It means a strict attention to what elsewhere might be considered small details. It is said that under the microscope the dust of an ordinary house resolves itself into soot, minute particles of cotton and wool fibres, spores of bacteria, starch grains, pulverized straw, epithelial and epidermic debris, and fragments of food. It consists to a great extent of organic substance, capable of decomposition. When added to this we have some of the constituents of dust common to a hospital, such as shreds of linen or wool from soiled bedding, pieces of hair, dried particles of pus, blood, and human tissue, crystals of urine, etc., the consideration of how to get dust into its proper place and form, how to deal with it, so that it is not a menace to both the healthy and sick inmates, is no small or unimportant part of hospital management.
Flies
Flies—the common, innocent-looking house flies, that formerly were regarded simply as annoyances to be endured, have been found to be among the most active agents in the spread of disease. Now that the germ theory is so well understood, it is not difficult to see how this takes place. Victor Vaughan, a member of the Army Medical Commission during the Spanish-American war, states as follows his observations regarding the fly as an agent in spreading typhoid fever in the camps: “They swarmed over fecal matter in the latrines. They visited and fed on food prepared for soldiers in the mess tents. In some instances when lime had been spread over the contents of latrines, flies, with their feet white with lime, were seen walking over the food. Officers whose mess tents were protected by means of screens suffered less proportionately than those whose tents were not so protected.”
Dr. M. J. Rosenau, in his valuable book on “Disinfection and Disinfectants,” expresses his opinion with no uncertain sound on the fly question when he says: “In fact, as our knowledge of the subject increases we find that domestic animals and vermin are playing a very conspicuous role in the transmission of disease. So dangerous do we now know that the fly and mosquito may be, that when the matter is more generally understood, it should be a greater reproach to the housewife to have these dangerous vermin in the household than to have bedbugs.”
Where dressings soiled with pus and excreta have constantly to be handled, as in a hospital, the presence of flies is a real source of danger that no careful housekeeper will ignore. To keep them out of the building, and manage so that no substance about the exterior may be left to attract them, means that a systematic inspection of the premises must be made, to see that fruit peelings or scraps of food are not thrown from the windows, that careful and prompt disposal of all refuse is accomplished, that scrupulous cleanliness in and about the institution is practiced, and that properly fitting screen windows and doors are in place early in the season, and left till cold weather has caused the fly to leave for parts unknown.
Garbage
The disposal of garbage and the waste accumulation from the wards forms one of the most serious problems that confronts the hospital housekeeper. There is but one safe method of disposal and that is by cremation, prompt and swift and sure. The too common method of storing garbage in large cans, and allowing it to vitiate the air with its obnoxious odors, and attract to itself flies an other vermin, till the city garbage collector gets around to remove it, is a practice that ought to be abandoned as speedily as possible by every institution. Much responsibility rests upon the superintendent in such matters. She alone cannot effect desired improvements, but she realizes the need as no member of the board can, and she ought to tactfully educate the board and urge the necessity of proper appliances for this purpose. Recently twenty letters were sent out to twenty various sized hospitals inquiring as to the methods used in disposing of soiled dressings and refuse from the wards. Answers were received from almost if not all, and there was a general agreement that cremation was the only proper method of disposal. However, in only three or four of the twenty had any provision been made in the plans of the hospital for this very important work. Some hospitals burnt them in the furnace, some in the laundry stove in the basement, some covered them up and carried them to the laundry stove in an outbuilding, some had them carted away to the city dumping ground. From one Chicago hospital of whom inquiry was made we had the following report: We have a water heater and garbage burner which runs day and night, and into this burner we put all of our soiled dressings and garbage of every description at any hour, day or night. They are consumed without causing us any trouble whatever. We certainly find it a great comfort not to have any garbage, not even a garbage box or barrel on the premises. Our pails and baskets are brought down to the boiler room twice daily, and there immediately emptied into the burner. The pails are scalded and cleansed, so that we keep everything sweet and clean.”