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sion was sabsiding, and in a day the course of the day extended or two the wound began to gra- up to the groin. It was more ex. nulate ; and on the 4th of August, tensive on the following day,it being entirely healed, she was the mind was wandering, the discharged well.
pulse feeble and rapid, the tongue A medical patient who had parched, and the skin hot and dry. been laboring for a long time un- All his symptoms had gradually der ascites and general anasarca become worse till the 7th, when to such an extent as to render her vesications appeared on the limb, case hopeless, but who was in a and he continued to sink till the much more comfortable state than 10th, when he died. This pashe had been for a length of time, tient's system was much impaired was suddenly attacked on the 21st by intemperance. of July with erysipelatous inflam 9. A medical patient, who was mation on one of the lower ex- convalescent, was attacked with tremities. It spread with great erysipelas about the right ear on rapidity, and assumed a violent the 26th of October. , It extendcharacter, and proved fatal on ed to the side of the face and the 230.
temple, down the neck, and to It may be proper here to re- the scalp, with considerable redmark, that the first case was the ness and swelling, and some vesionly one that had hitherto occur- cation. In a day or two the disred in the ward in which the dis- ease subsided in some measure ease originally appeared, though on this side, and appeared in a all the cases mentioned had been much milder form on the other. confined to that side of the house. It never assumed a very serious
7. On the 9th of September, aspect, and entirely subsided by however, a man was admitted the 31st, and he was discharged with a scrofulous disease of the well on the 11th of December. testis, into the room in which the 10. A girl, of about 15 years first patient died, and on the 17th of age, with scrofulous ophthalhe was attacked with erysipela- mia, was affected with erysipelas tous inflammation about the ankle on the face about the last of Ocof the right leg. This extended tober. The disease in her case to the thigh, and afterwards ap- was comparatively mild, and nopeared on the head and face. It thing unusual occurred in the began to subside on the 23d, was course of it. It continued four very slight by the 26th, and on or five days only, without any viothe 30th he was entirely well. lent constitutional symptoms, and
8. On the 29th of September, at the end of this period, she was a man, of a bad habit of body, as well as usual. with an ulcer of long standing 11. A healthy girl, 18 years about the tendo Achillis, was ad- old, who had been in the hospital mitted into the upper ward of the a few weeks with an ulcer on the other side of the house, as remote leg, was attacked with erysipelas as possible from the place in about the head, on the 7th of Nowhich the disease had hitherto vember. It extended over the appeared. On the 3d of Octo- whole face in the course of two ber, erysipelas was discovered on or three days, so as to close the the leg about the ankle, and in eyes, and produced an enormous
swelling of the head, attended the left eye, and openings were with deafness. In this case how- made in them, by which a consiever the symptoms were not of derable quantity of pus was disthe worst character; the mind was charged. An abscess also formed not in the least affected, and in a on the head behind the right ear, fortnight from the attack, the pa- which was opened; the original tient had recovered her health one, on account of which he came entirely.
to the hospital, was on the left 12. The next case of this dis- side. After all the symptoms of ease occurred in an unhealthy the erysipelas had disappeared, man, of a scrofulous habit, 34 and the patient was about taking years of age, who had his left his discharge, he was attacked in testicle removed on the 23d of the night with an epileptic fit, to December For a few days af- which he had been subject. He ter the operation, everything ap- stated in the morning that he had peared to be going on well, and had a slight one the preceding the wound was rapidly healing ; night ; he seemed as well as usbut on the night of the 31st he ual ; a light diet and a cathartic was seized with a violent rigor, were ordered for him, and he infollowed by a hot fit, and pain in tended to go home the next day. the right arm, though there was In the night following he was neither swelling nor redness. On seized with another fit, and exthe morning of January 1st, the pired in a few moments, before arm was considerably swollen and any one in the ward could get to discolored, the color however was him. much darker than is usual in ery 14. On the night of the 6th of sipelas. The pulse was very ra- January, four days after the atpid and feeble, the tongue parch- tack of the last patient, a man in ed, and the skin hot. In the the same ward, laboring under course of the day he became de- chronic diarrhea, in a state of lirious, and died in the afternoon. extreme debility, without the
13. A man 32 years of age, slightest prospect of recovery, who had been in the hospital was seized with a chill, followed about three weeks for an abscess by heat, with soreness about the on the head, of which he was ear. He soon became delirious, nearly well, in the same ward and continued to sink, till the afwith the last patient, was attack- ternoon of the 8th, when he died. ed in the night of the day on 15. A healthy man, on whom which the other died, with a chill the operation of tying the external followed by great heat. In the iliac artery had been performed morning the disease appeared on the 25th of November, was about the head and face, which the next subject of this disease. were much swollen, and almost All his symptoms after the operacovered with vesications. The tion had been favorable till the disease began to subside on the 25th of December, when a swellsixth day, and by the tenth was ing appeared between the spine nearly gone. During its progress, of the ilium and the wound; this suppuration took place in the up- suppurated and was opened on per and lower eyelid of the right the 31st. In a few days after, eye, and in the lower eyelid of erysipelatous inflammation made
its appearance in the neighborhood parts of the house. This was a of the opening, extending for a very large number, when comfew inches on to the abdomen; it pared with the number of patients yielded however soon to the re- in the institution, as it constituted. medies employed, though the onetenth of the whole. Hitherto wound was slow to heal, and the the disease had excited but little patient was not discharged well alarm, as there had rarely been till the 16th of February. This more than one or two cases at the patient was in a part of the house most at a time, and usually a very very remote from the three last. considerable interval elapsed be
16. A medical patient, in a tween them, so that not a suspi. ward adjoining the one in which cion had been excited that it was the disease first appeared, was owing to any peculiar state of atattacked on the 7th of January mosphere in the hospital. The with swelling and redness of a aspect of things was now however deep color of the left eyelids. In entirely changed, and the medical the course of the day the redness attendants recommended to the and swelling did not increase, trustees that no more patients though he complained of great should be admitted at present ; soreness of the face. The erysi- that all who were in the house pelas in this case never assumed should be discharged as soon as it a very threatening or severe cha. could be done with safety and racter, but subsided almost en- convenience ; and that, if necestirely in the course of three or sary, a house should be provided four days. The patient was a in the neighborhood, to receive man of regular habits and good for a time those who could not constitution, and not much debili- be otherwise disposed of. These tated by his previous disease. recommendations were promptly
17. About the time that the attended to, and on the 15th of last patient was attacked, a fe- January only twelve persons remale, in whom the brachial arte- mained, all of whom were on that ry had been tied, was affected day removed to a house in Vine with erysipelas. It appeared Street, in the immediate neighparticularly about the arm, though borhood of the hospital. it extended somewhat up the The first inquiry then, was, in neck, and there were some slight what way this erysipelatous inappearances of it on the body. flammation had been kept in exShe recovered in the course of istence in the house for so long a three or four days. It should be time, or to what peculiar circumobserved, perhaps, that she had stance was this singular fact owbeen in the house several months, ing? The situation of the Masand during this period had had se- sachusetts General Hospital is veral attacks of the disease, all of remarkable for its salubrity and which however were mild. adaptation to the wants of such
Thus it appears that no less an establishment ; and it will not, than six cases of this disease oc- I am confident, be thought hazeurred within a week, three in arding too much, by those who the ward in which the first pa- have been coversant with its intient died, one in the adjoining ternal arrangement, to say, that one, and the other two in remote in point of cleanliness it may chal
lenge a comparison with the best there was not a single case of this regulated hospitals in Europe or disease. It is not improbable this country. There was one that there may have been one or circumstance however in which two solitary instances at other it differed from other institutions times,-- it would be remarkable of the kind; I refer to the manner if it were otherwise ; but that it of warming and ventilating it. All never prevailed there to any exthe wards, with two or three ex- tent, I am absolutely certain. ceptions, were warmed by fur- The reason of this exemption I naces placed in the cellar. The conceive to be the fact, that the hot air, which was external air rooms, in which the patients were heated by the furnace, was ad- kept, were spacious, well ventimitted at the upper part of the lated, and had large open fireward, and at the bottom there places. was an outlet for the escape of In the house of industry at the foul air. This was consider- South Boston, on the other hand, ed better than to admit the air which, besides having every adfrom below, both for the purposes vantage of situation, is far cleaner of warmth and ventilation, and it than the old almshouse, and is inanswered the first purpose per- tended only for the reception of fectly at all times, and the other paupers, erysipelatous inflamma. in a great measure so long as fire tion, of the same character prewas kept in the furnaces. But cisely as that which appeared in when this was extinguished, the the hospital, has already occurred patients, to prevent the wards several times. The rooms, apfrom becoming cold, shut the propriated to the sick in this ventilators, and there being no house, are small, have but one fireplaces in the rooms, there window, communicate with an was consequently little or no cir- entry warmed by a furnace, and culation of air during the night. a part of them are not provided
The following fact may be with fireplaces. mentioned in corroboration of the It seems to me to be no objecopinion, that the disease was pro- tion to this opinion, that several bably owing to a want of com- of the cases in the hospital occurplete ventilation. The alms- red during the summer ; for the house in Leverett Street was, till windows in the patients' rooms the erection of the hospital, the being all closed at night, and only public receptacle for the there being of course no fire in sick poor, as well as the paupers the furnaces, there was conseof the town, and though it was far quently but little change of air. from being clean, I cannot learn It is a fact also, and certainly a that any case of erysipelas occur- striking one, that not a single case red there from the time of its appeared in any room in which erection till its removal in 1825. there was a fireplace; and it is For several years I was well ac- not less remarkable, that not a quainted with the state of this case has occurred in the house house, part of the time as a stu- since the patients have been redent of medicine, and a part of admitted, though nearly five the time as the physician, and months have elapsed since it was during the whole of this period reopened, a period of exemption
more than double in length of throughout was ready to receive what has existed since the occur patients, and they were accordrence of the first case,—and dur- ingly readmitted on the 3d of ing this very period the disease February, it having been closed has been unusually prevalent in nearly three weeks. As was revarious parts of the city. This marked above, almost five months must be attributed cheifly, I have elapsed since their return, think, to the more complete ven- without the occurrence of a sintilation of the wards; for the hos- gle case. The furnaces are still pital, though perfectly clean, is used to warm the building, and not more so than formerly, and small fires are lighted in the firethe number of patients is as great places sufficient only to promote as it has frequently been before. a free circulation of air. The
So soon as the patients were state of the atmosphere is cerremoved from the hospital, the tainly more agreeable in the following means were employed wards than before the alteration ; by the advice of the medical at- it has lost all that closeness, tendants to purify it, and to pre- which, at times when the heat vent the recurrence of the dis- was great, was extremely unease. All the mattresses were pleasant, if not unsalutary. ripped open, the tickings washed, Nothing occurred in the progthe hair picked and baked, having ress of this disease at this time to been first exposed five days and warrant a belief, that it was pronights to the air, during which pagated by contagion. The seperiod the thermometer was most cond patient was not admitted inof the time below zero, all the to the hospital for more than a windows in the house were kept month after the death of the first, open for the same length of time. and in no instance were any of the After this, the wards were first nurses or attendants attacked with fumigated with sulphur, then with it, nor did it seem possible in any the gas of chlorine ; all of them case to trace it from one patient were whitewashed, and part of to another. An atmosphere, cathem were painted; the wood pable of producing erysipelas in work, in those that were not those predisposed to it, seems to painted, was washed with lime- have been generated by the first water. Fireplaces were then patient ; and this was never enmade in all the wards, with two tirely removed, from the want of or three exceptions only, and sufficient ventilation, till after all these were rooms of a very small the patients were discharged from size. Fortunately this could be the house. I am not disposed to done without much difficulty, as deny, in opposition to the opinion Alues were left in the walls origi- of the late Dr. Wells of London, nally from an apprehension, that as given in his Observations on the furnaces might not warm the Erysipelas,' in the second volume building sufficiently. The bed- of the Transactions of a Society steads were left out doors, ex- for the improvement of Medical posed to the weather which was and Chirurgical Knowledge, ‘may, intensely cold for several days, sometimes at least, be communiand then carefully washed. The cated from one person to another,' house having
having been scoured though I must confess that nothing