THE NUMBER AND DISTRIBUTION
              OF
iceo-Organisms in the Air of
 The Boston City Hospital,
             WITH SOME
CARBONIC  ACID DETERMINATIONS.
By GREENLEAF R. TUCKER, S. B. 
WA T892n 1889
63051150R


NLM  051312m  7
    NATIONAL LIBRARY OF MEDICINE
NLM051312097 
 
 
          THE NUMBER AND DISTRIBUTION
                           or

MICRO-ORGANISMS IN  THE  AIR  OF  THE BOSTON
                  CITY  HOSPITAL,
                      WITH SOME

      CARBONIC  ACID DETERMINATIONS.
By GREENLEAF R. TUCKER, S. B.
   The  object of this .investigation  was to determine  the
number and  distribution of the  micro-organisms in the air
of the Boston City Hospital; to ascertain the causes affect-
ing their number and distribution ;  and to examine, as far as
possible, the character of the  organisms present.  A study
of the germs themselves was soon found to be impracticable,
and it was thought advisable to reserve this part of the subject
for future investigation.   Transfers of colonies from the air
of the wards, to the number  of about  two hundred, have
been made and  preserved for this purpose.  It is  believed
that these cultures will represent most of the forms habitually
present in the air of these buildings.
   The experiments to be described began in November, 1888,
and  were continued uninterruptedly for a  period of three
months.   Some  regret  is  felt  that  a portion of the work at
least could not be conducted under the conditions of weather
to be expected at that time of year.   The winter was excep-
tionally mild, and the ground practically free from snow.
   The  investigation of indoor air began by taking samples
in the afternoon, between  two and three o'clock;  the time
being so chosen because the wards are then in their normal
condition, only such work being done as the necessities of 

 162        STATE  BOARD OF  HEALTH.       [Jan.

 the sick demand.  On Monday,  Tuesday, Thursday and
 Saturday  of  each week, friends  of patients are  admitted
 from  two to  three p.m., usually  to the number of two to
 three  hundred, and  distribute themselves throughout  the
 various wards,  the number of visitors in  each  ward  being
 often  equal to the number of  patients ; this afforded  oppor-
 tunity to observe the effect upon the air of increased numbers
 of people, over those habitually present.   It was found nec-
 essary to limit the number of  experiments  each day to five,
 including the outside air.  The total number of  wards being
 eighteen, four or five days elapsed  before a return  could  be
 made  to a given point; and the entire month was necessary
 to accumulate sufficient data for  each ward, from which  to
 draw  conclusions.
  During December,  samples were taken mornings, gen-
 erally between eight and ten o'clock, the wards  at that time
 being in a more or less disturbed condition, — beds are made,
 floors swept, surgical dressings  changed, and  the general
comfort of the patients attended to.  By following this plan,
two series of results were obtained, showing the condition
of the air under quiet and disturbing influences.  The  month
of January and part of February  were devoted to special
investigation, which  the previous  work  had shown  to be
necessary.

Methods  employed in the Quantitative Determination
           or  Micro-organisms in the  Air.
  The introduction by Koch in 1881 of a  solid-culture me-
dium  for the study of micro-organisms has resulted in methods
by which we can determine with facility, and approximately,
if not with accuracy, the number of micro-organisms  in  the
air.   Koch himself exposed plates coated with a solid nutri-
ent gelatine,  upon which aerial microbes settled, and  could
be counted after  development.  Hesse, however,  was  the
first to  apply this principle quantitatively to investigations
of the air, and in 1883 published the well-known method
bearing his name.  Petrie, in Germany, and Frankland,  in
 England, have proposed methods, which, while retaining the
solid-culture  medium  of Koch, differ essentially from  the
 method of Hesse  and from each  other, in detail.   In this
ARMLD FORCES MEDICAL LIBRARY
      WASHINGTON, D. C.  .^- 
 1889.]      PUBLIC  DOCUMENT —No.  34.         163

 country, also, some new methods of culture have been prac-
 tised by the writer, in conjunction with Professor Sedgwick,
 in a series of investigations conducted at the Massachusetts
 Institute of Technology^

                      Hesse's Method.
   Hesse makes use of the fact previously ascertained,—that
 micro-organisms  rapidly  settle out in  a quiet atmosphere.
 He employs a long glass tube of large bore, coated inside
 with sterilized nutrient gelatine.  The tube is fastened to a
 photographic  tripod  in  a horizontal  position,  and, by a
 suitable connection with  two aspirator-bottles, a slow cur-
 rent of air  (one litre in three minutes)  is drawn through the
 tube.   The germs  are all supposed to settle out during the
 passage of the air through  the tube, and remain fixed  by
 the moist,  solid  gelatine, where they  become visible  after
 several days as  isolated  colonies.

                   FranManoVs Method.
   This method consists in aspirating a known volume of  air
 through a glass  tube  containing two sterile plugs of glass-
 wool alone, or glass-wool and fine sugar-powder ; after which
 the germ-laden filter is transferred to a flask containing melted
 sterilized nutrient  gelatine,  the two thoroughly shaken  to-
 gether, and solidified upon the sides of the flask by cooling,
 where the colonies  which develop can be counted.

                      Petrie's  Method.
   Petrie uses fine sand as a filter, packed in  a small glass
 tube, and held in place by disks of wire gauze.  After draw-
 in^- through sufficient air by means of an air pump, the sand,
 with its occluded gernn, is poured into several small double
 dishes of glass, containing nutrient gelatine, the object being
 to distribute the sand and germs over a considerable surface,
 so that the colonies may be more readily counted.

  The method employed  in the present  investigation was
first used by the writer, in association with Professor Sedg-
* See foot-note on page 164. 
164         STATE  BOARD OF HEALTH.       [Jan.

wick,*  in  a  series of  experiments in  1887, and will be
described somewhat  in  detail.
  The  actual requirements of a  quantitative  method for
the bacteriological examination  of air,  briefly  stated, are
as follows : —
  First.—A means of collecting and accurately  measuring the
volume of air  to be examined.
  Second.—A suitable filtering medium for holding back the
micro-organisms contained in the air.
  Third. — A solid-culture medium, in which the germ-laden filter
can be diffused, and where, on cooling and incubating for a suffi-
cient length  of time, the  germs may develop and  be counted as
isolated colonies.

  The apparatus  consists essentially of three parts :  (1) A
glass  tube of special form, to which the name of aerohioscope
has been given (see Fig. 1) ; (2)  a stout copper cylinder of
about  sixteen litres  capacity,  provided  with  a  vacuum
gauge (see  Fig.  2) ; (3)  an air  pump.   The aerohioscope
through which the air is aspirated is six inches long, and one
and three-quarters inches in diameter at its expanded part;
the upper end of it is  narrowed somewhat to a  neck one inch
in diameter  and one inch long.  To the lower end is fused a
piece of glass tubing six inches long and three-sixteenths of
an inch in bore, in which to place the filtering material.
  Preparation of the  aerohioscope:  Upon the narrow part
of the tube, two inches from the lower end, a slight mark is
made with a file, and a little roll of brass gauze  is inserted,
which serves as a stop for  the  filter to be placed above it.
Beneath the gauze stop is placed a  small plug of cotton wool,
and the open  ends are then plugged with cotton wool ; the
tube is  now placed in  a  sterilizer, and subjected  to a heat of
at least 150° C. for one or two hours.  When cool, the non-
sterilized cotton-wool plug is carefully removed  from the
neck, and sterilized No. 50 granulated sugar  is poured in,
until it just fills  the  four inches of narrow  tube above the
gauze stop.   This column  of sugar weighs one gramme and
is the filtering material  employed  to engage and retain the
  * The complete paper was  presented to the National Academy of Sciences at
"Washington, April 18, 1888, under the title "A new Method for the Biological Ex-
amination of Air: with a description of an Aerohioscope." 
1889.]    PUBLIC DOCUMENT —No. 34.     165
^..'^m i-
I C iiiiiiiili^#
■:Kwn
"COI
x-
Fig. 1. 
166
STATE  BOAKD  OF  HEALTH.
[Jan.
micro-organisms.  The cotton-wool plug being replaced, the
tube is again placed in the sterilizer,  and re-sterilized for
several hours at 120° C.
   Taking the air sample :   In order to  measure the amount
of air used, the value of each degree on  the vacuum gauge is
determined in terms of air, by means of an air meter, or by
calculation from the known capacity of the cylinder.  This fact
ascertained, the negative pressure indicated by the needle on
exhausting the cylinder shows the volume of air which must
pass into it to fill the vacuum.   By means of  the air pump,
one exhausts the cylinder  until the needle reaches the mark
corresponding to the amount of air required.  A sterilized
aerohioscope is attached to  the cylinder, in an upright posi-
tion, by means of a clamp ;  and, to establish communication
between  the two, they are joined together  by means of a
rubber tube attached to the lower end of the  aerohioscope
and to a stop-cock on the cylinder.   For removing  and pro-
tecting the sterilized cotton-wool plug while the air is being
drawn  through the tube, a very simple device is used.   A
glass shield with a neck slightly larger than the neck of the
aerohioscope, and  bearing  a  rubber finger-cot, is pushed
down over the cotton-wool plug; when, by compressing the
rubber, the plug can be removed  (inside the shield), and
remains suspended  there.   The plug removed, the cock is
opened, when air will pass through  the aerohioscope, leaving
its germs in the sterilized sugar filter.
  Cultivation  of the germs :   The aerohioscope, after the
air has been drawn through, is taken to  the culture room for
further treatment.   The tube being held in a nearly horizon-
tal position, the sugar  (with  the contained germs)  is made
to run into  the  body  of the  tube, by a gentle  tapping.
Melted sterilized nutrient gelatine  (25  cc.)  is  now added,
under proper precautions, and the neck closed with a perfo-
rated sterilized rubber stopper, plugged with cotton wool.
On rotating the tube, the sugar all dissolves in the gelatine,
leaving the germs uniformly  distributed  through  it.   The
gelatine is now congealed in an even film upon the  inside of
the tube,  where, after  four or five  days, the  colonies will
develop, and can be  counted by the aid  of squares engraved
upon the glass. 
1889.]
PUBLIC  DOCUMENT —No. 34.
167
  The following  cut shows  the apparatus set up  ready for
use : —
■A- Aerobiojcope
•E>  Air-Cylinder
• C • Vacuu it? <jcsk.\<&
•T>- AiriWp-  ,,°
■"E-<ila?7 Shield-
  • App^duj ofer-fccu&ptiW7ve delerroination •

  ^/Aicro-orcJ(\Dij!77/-- in-Air-
                           Pig. 2.

  This method has several advantages  not to be found in
other methods.  In the first place, the use of a vacuous cylin-
der permits a. known volume of air to be aspirated with great
ease, and the rate of flow through the filter is controlled to
a nicety.   The advantage of a soluble filter (sterilized gran-
ulated  sugar),  leaving  only  the  germs imbedded  in  the
gelatine,  cannot be overestimated ; for any insoluble sub-
stances seriously  interfere with the counting.  Again, the 
168        STATE  BOARD OF  HEALTH.       [Jan.

aerohioscope,  quite apart from the filter, constitutes an im-
portant advance, since it obviates the necessity of transferring
the filter (and contained germs), thereby avoiding accidental
loss or gain of germs.  The whole apparatus is portable, and
the method, as compared with others, is  exceedingly rapid
of execution.
                      Outside  Air.
   In order to  have data  for comparison with the work done
indoors, the outside air was examined nearly every day during
this investigation.  The results are of  some value in them-
selves, as showing the condition of the air of Boston in a rather
secluded place, but in  the immediate vicinity of its traffic.
   The samples were  all taken at the same place, at the foot
of the surgical steps,  four  feet  from the ground, on the
north side of the  hospital, except on rainy days,  when the
apparatus was  moved  under the steps, to avoid annoyance
from the rain.  The  direction and strength of the wind, tem-
perature, time  of day, and any disturbing influences likely
to affect  the results, were observed.  The ground was free
from snow and the weather was  mild throughout, while the
prevailing winds were strong.  The general averages for the
months of November and December,  1888, and  January,
1889, are shown in the following table : —
Date.	Number of Experiments.	Average number of Bacteria.	Average number of Moulds.	Ratio of Bacteria to Moulds.
November, 1888, . December, 1888, . January, 1889,	19 22 15	10.4 14.5 13.2	6.8 5.6 3.5	1.5 • 2.6 3.8
All figures representing bacteria and moulds are for 10 litres of air.
  The average number of bacteria are thus seen to be about
the same for the three months, and representing, as they do,
less  than  two per litre of  air,  must be considered small.
Carnelly (Phil. Trans, of the Royal Society of London, vol.
178) found recently in the town of Dundee, in quiet places,
as a mean of  fourteen experiments, less  than one bacterium
per litre of air;  while, in certain  streets where  the ratio of 
1889.]     PUBLIC DOCUMENT —No.  34.        169
bacteria to moulds was very high, the total number of organ-
isms was 17.5 per litre of air.
  A comparison  between the numbers of organisms found
on clear and on rainy days is  shown in the next table : —
	November.			December.			January.		
of Weather.	a| S >5 " ~	o H 0	0) <*-> »° « S « o a = k. a o	•*- i O OS c u a *> *-< ~ go,.	to . « » -r « a "s ^ * ~	0) tg w° 18 S B « a 3 J» 3 O <j » s	Number of Determina-tions.	Average Number of Bacteria.	<3 3 on
Rain, . 5 Clear, . j 14		7.6 11.4	7.8 6.4	3 18	9.3 15.0	6.3 5.4	2 9	2.5 19.0	3 3.5
  The number  of bacteria present in the air on clear days
is greater than on  rainy days, but the number of moulds
remains the same ;  i. e., rain washes  out  bacteria  from  the
air, but does not remove moulds.  Both bacteria and moulds
were more numerous on rainy days than was expected ; and
this is perhaps accounted for by the fact that the experiments
were made under some  stone  steps,  near a basement door
frequently opened by employees.
  No  deductions could  be  drawn  from  the  effect of  the
direction of the wind upon  the micro-organisms, owing to
the position of  the buildings.   The quarter from which  the
wind  blew was taken from a neighboring weather-vane;  but
the direction, as felt by the  observer,  seldom coincided,
being generally either easterly or westerly.   The  effect of
the strength  of the wind is,  however,  worthy of notice,
being to  increase the numbers of bacteria.
November.		
		
o -		
z =	e:	
— ~- 0	u	f2
		
~-.2	«	£
fc	"	r*.
2	2.5	18.0
15	11.0	4.3
 6

15
12

15
9.3
4.4
<*•		
\ O d		
		
		
v a	.<3	
! flSS	Z	1
		
		
		
55	*~	<!
2	4.5	3
!0	17.0	4
 
170         STATE  BOARD OF HEALTH.       [Jan.

  The following table  gives  the full data for all determina-
tions made upon outside air during the month of December,
1888.   It shows considerable variation from day to day, not
readily  accounted  for by the surrounding  conditions.  The
disturbing influences incident to a great city are so many,
that  causes affecting the numbers  of micro-organisms in
outside  air  are  generally beyond the eye of the observer.
Outside Air.  December, 1888.
Date.	Time.	Bacteria.	Moulds.	Remarks.
1	12.45 p.m.	1	5	Wind W., and moderate; almost raining.
3	11.15 A.M.	8	2	Wind W.: clear and cool.
5	10.00 "	0	7	Wind S. \V., and gentle; sky overcast; ground damp.
6	11.00 "	75	5	Wind N". W., and strong; cloudy, cool; two teams drove by; considerable 'walking about.
7	11.25 "	57	8	Wind W.; strong and puffy; clear and cool.
8	11.30 "	1	2	WindS.W.; moderate.
10	10.35 "	8	33	Wind S. E., and moderate; ground wet.
11	11.10 "	4	3	Wind E., and strong; raining hard.
13	11.45 "	19	3	Wind W., and strong; cold and quiet.
14	9.15 "	17	1	Wind W., and strong; cold and quiet.
15	11.00 "	12	6	Wind W., moderate; cold and quiet.
17	11.30 "	21	13	Wind S., and gentle; raining hard.
18	12.00 M.	3	3	Wind N. \V.,and strong; snowinga little; ground wet.
20	10.00 A.M.	7	3	Wind N. W., and moderate; cold.
21	-	24	10	Wind S. W., and gentle; sky overcast; quiet.
22	11.35 "	1	2	Wind N. W., and strong; cold; quiet.
24	11.40 "	14	14	Wind S. W., and gentle; very quiet.
25	1.00 P.M.	10	3	Wind S. W., and gentle.
26	11.30 A.M.	3	17	Wind S., and gentle; ground moist; warm.
27	9 50 "	14	6	Wind N. W., and gentle; ground wet.
29	10.15 "	2	1	Wind S. W., and strong; cool and quiet.
31	11.25 "	13	6	Wind S. W., and moderate but puffy; ground moist.
Ave	rage, .	14.5	5.6	
General Description of the Hospital (with Plates).*
  The group of buildings which constitute the Boston City
Hospital are thirteen in number, nine of which  are exclu-
sively devoted  to  the sick.   The hospital is on  Harrison
Avenue (see plate), and occupies about 292,000 square feet
of land.   Buildings to the right of the administration build-
ing are devoted to the treatment of  medical cases,  while
those to the left are wholly devoted to surgical cases.  The
two pavilions, medical and surgical, nearest the street (see
cut of  hospital), are  substantially  alike  in  construction.
The  upper and  lower floors are occupied  by male  patients,
 * The descriptions of the hospital appearing in this paper have been taken from the
medical and surgical reports of the Boston City Hospital, second series. 
Wards B. C.  D.
Wards  M. N. O.
ADMINISTRATION
Wards F. G. H.
BOSTON  CITY  HOSPITAL.
HELIOTYPE PRINTING CO., BOSTON. 
PLATE N?I
ALBANY   ST.   wfkt
 
AJ.Boyden JJel
HARRISON  AVENUE.+54-85 feet. 
 
1889.]      PUBLIC  DOCUMENT —No.  34.        171

the middle floor by females.   The pavilions  immediately in
the rear of the above are also medical and surgical.   (Plans
of other buildings, not seen in the cut, may be seen in plate
No.  I.)  Pavilions 3 and 4 are one-story buildings.  These
wards  are for male patients  only, and contain twenty-eight
beds.  A two-story brick pavilion  contains the  male and
female isolating: wards.  There are ten rooms on each floor,
opening from a hall or passage way, and designed to accom-
modate one  or more patients.   The vacant  space between
the isolating wards and male medical ward 4 (plate No. I.)
is now occupied  by two  new  buildings for  contagious dis-
eases.   They are totally  different  from all  others of  the
group, but are themselves essentially alike.   Diphtheria and
scarlet-fever are at present treated in these wards.
   The hospital receives mainly acute cases, with only such
chronic cases as  the  authorities believe can  be  benefited
by a short  residence  in  the hospital.   The hospital report
for the year 1888 shows the  number of patients admitted
during the year  to be 5,875 ; of this number, 3,665  were
males, 2,210 females ; 2,445 were born in the United States,
the nativity of the remaining number being divided between
thirty-five  countries, representing  all parts of  the  globe.
The character of the diseases treated in the wards  of this
hospital, in the course of  a year, embraces nearly all known
to medical science.
   The first two buildings  to  be described are shown in plate
No. I.,  where they  are  designated  surgical and medical
pavilions.   A plan of the second and third  floors  is shown
in  plates Nos. II. and III.  Each pavilion is 148  feet in
length, 48  feet in width, and three stories high.  On the
first, second and  third floors are wards, each  80 feet  long,
27^- feet wide, the two lower  being 16  feet, and  the upper
103feet high.  Each ward  is  lighted  by fourteen  windows,
seven  on a°side, and is arranged  for twenty-eight beds.   By
considering the data of the two buildings together, we shall
have not only a comparison of the wards of each pavilion,
but of the two buildings themselves, devoted to two distinct
classes of patients, — medical and surgical.   In every other
way the  conditions  found  in these  buildings  are   identi-
cal.   The  following tables give   the  average  number  of 
172        STATE  BOARD OF  HEALTH.       [J;in-

micro-organisms, of five  or more  determinations  in each
ward : —
Medical Pavilion.
							
Afternoons, November, 1S88.				Forenoon	s, December, 1888.		
	Wards.				Wards.		
	F.	G.	H.		F.	G.	H.
Bacteria, . . Moulds, . .	15.8 9.2	13.0 9.0	33.3 13.2	Bacteria, . . Moulds, . .	15.2 1.5	49.7 1.3	62.5 5.2
Surgical Pavilion.
Afternoons, November, 18S8.				Forenoons, December, 1888.			
	Wards.				Wards.		
	B.	c.	»■		B.	c.	D.
Bacteria, . . Moulds, . .	6.8 6.6	5.6 2.8	13.0 | 8.2 I	Bacteria, . . Moulds, . .	24.7 13.5	15.8 20.0	16.5 26.5
   The table shows the following results : —

   /. — Bacteria are more abundant in the medical than in the
surgical pavilion.
   This appears to me to  be a very important and significant
fact.  Here are two  buildings exactly  alike, all the condi-
tions within being the same, except that in one are medical,
in the other surgical, patients.  If the organisms come entirely
from the outside air,  there is no reason  why both buildings
should not contain practically the same numbers.  It seems
probable,  therefore,  that a  portion  at least  of the  bacteria
found in  the  medical wards  is due to  the class of  diseases
assigned to them.

   II.—Bacteria in  both medical and surgical  wards are
more abundant mornings than afternoons.
   This is due  to the  conditions of the wards at the time of
experiments.  In the morning the disturbing influences are
many, —bed-making, sweeping, dusting, changing of suro-i-
cal dressings, toilet  and general care  of patients.   Such 
PLATE N° 2.
 
 
PLATE N? 3
BASEMENT CORRIDOR
KITCHEN. BAKERV AND STORE ROOMS
SCALE OF F EET
A CHILDREN'S WARDS.             O  PAYING PATIENTS' ROOM.
D SKYLIGHT OVER OPERATING THEATRE.    P  CHAMBER3.
G OPERATING ROOM.              Q  CLA2ED ROOT OF VENT. CHAMBER
H WARUS AND ROOMS FOR DISEASES OF WOMEN. R  VENTILATORS.

          FOR  OTHER  REFERENCES  SEE PLATE N? I
EBS ?CnI°J
   PLAN  OF
THIRD  FLOOR 
 
1889.]     PUBLIC DOCUMENT —Xo.  34.        173

work occupies  the time between  seven and  ten  a.m.,  at
which time morning samples were taken.   This general dis-
turbance of the morning distributes the organisms throughout
the air,  where we find them in increased numbers ; while in
the afternoon a sufficient time has elapsed for many of them
to settle out again.

   III. — In the afternoon micro-organisms are most abundant
in the upper ivards, Hand D, of each pavilion.
   Ward H in the medical  and D in the surgical pavilion are
seen to  be higher in micro-organisms in the  afternoon  than
the other wards.  There  are  two  reasons for this :  First,
cubic space ;  second, unusual disturbance  by patients.  The
cubic space per bed for the lower ward is 1,265 cubic feet;
for the  upper ward, 790  cubic  feet.   This  comes from the
difference in height, — 16 feet for the lower wards, against 10
feet for the upper wards.  The unusual disturbance alluded
to in these ward's  consists. in  a  greater amount  of walking
about.  There are fewer helpless cases, and consequently a
larger proportion  are up  and about  the  wards.   So much
movement in a ward keeps the  micro-organisms more com-
pletely  in  suspension, so  that large numbers are more uni-
formly  found throughout the afternoon  than in more quiet
wards with greater cubic space.

   IV.__Female wards C and G contain less micro-organ-
isms than the male wards.
   There is far less commotion in a female than in a male
ward, women being much more quiet than  men.   Such pa-
tients as are able to be  up, remain, as a rule, sitting  quietly
by their bedsides, so that  the fewer number  of micro-organ-
isms in  the air of a female ward  is quite what we  should
expect.

    Medical and Surgical Pavilions, Nos. 1  and 2.
   The next buildings to be considered, taking them in order
of plan  (plate No. I.), are the medical and surgical buildings,
numbered 1 and 2. Their general dimensions are 24  feet by
94 feet, the height being the same as those just described.  A
projection from the rear wall of the medical  pavilion  gives a 
174        STATE BOARD  OF HEALTH.       [-J{in-

small ward of eleven beds on each floor, the remaining space
being divided into rooms of various  sizes, opening from a
central corridor, and devoted principally to paying patients,
both male and female.  The open  wards are devoted exclu-
sively  to  women,  the lower ward being  for convalescent
patients.  The lower ward, M, of the surgical  pavilion, con-
tains the operating amphitheatre and the accident rooms, and
is entirely devoted to the demands of  operative surgery.
The middle floor, ward N, is exclusively  a  private ward, for
both men and women.  The  upper floor, ward  O,  is the
children's ward, and, in addition to three small wards, it has
a number of private rooms for adults.
  Owing to the distribution of floor space, and the purposes
to which these buildings are devoted, the results obtained in
them  are  not comparable with those in the  two buildings
just described.  The wards  (Q, R, S)  on  each floor  of the
medical building correspond closely with each other, but not
with the wards (M, N, O) of the surgical building.
  Below are the tables of  averages for each ward, all results
being  the  mean of five  determinations.   Morning samples
were  taken  between  ten  and  eleven a.m. ; afternoon sam-
ples, between two and four p.m.
Medical Pavilion.
Afternoons, November, 18S8.			Forenoons, December, 1888.			
	Fkmale Warps.			Female Wards.		
	Q. ! R.	s.		Q.	R.	s.
Bacteria, . . Moulds, . .	8.6 9.8 8.2 ■ 9.8	8.8 13.0	Bacteria, . . Moulds, . .	9.6 7.4	13.5 9.8	5.4 19.6
Surgical Pavilion.
AFTERNOONS, NOVEMBER, 1888.				Forenoons, December, 1888.			
	Wards.				Wards.		
	M.	N.	0.		M.	N. 18.2 7.0	o.
Bacteria, . . Moulds, . .	13.3 9.3	2.5 11.0	13.5 19.0	Bacteria, . . Moulds, . .	14.6 15.0		15.3 26.5
 
 
PLATE N? 4..  Q
s^a^Eggag^^assad   m
SIDE  ELEVATION
     FIG . I.
   SITZ BATH.
   STEAM BATH
   SHOWER BATH
   [VENT SHAFT.
D.  JSLOP SINK.
   lURINAL.
E.  LOBBY.
          FIG.3    «

PLAN OF BATH  ROOM AND WCLOSETS.


              JO. 30 FT
.SECTION ON LINE A B
VENT. OF W CLOSETS
jDOORS TO
|DAY ROOM.
LAVATORY.
jCASING OF
'radiator
steam pipes
FIG 5
PARTIAL SECTION
THROUGH WINDOW
PARTIAL  TRANSVERSE
SECTION BETWEEN WINDOWS.
DETAIL OF HEATING AND VENTILATING. 
 1889.]      PUBLIC DOCUMENT —No. 34.        175

  These tables do not show the  striking  differences seen in
 the larger medical and surgical buildings.
  Medical Pavilion.—In  this building  the numbers found
 are very small, and  are practically alike  for bacteria  and
 moulds.  The  determinations made in the morning do not
 materially  differ  from those made in the  afternoon.   The
 finding  of small numbers of micro-organisms in the air of a
 ward during the forenoon is the best  proof we can have of
 the absence of germs from  the room itself.
  Surgical Pavilion. — In the afternoon the  wards of the
 surgical building agree in the number of bacteria found, ex-
 cepting in ward N.   Ward O was more abundant in moulds,
 both forenoon and afternoon, than the other wards ; and  this
 is true  of ward S, the corresponding  ward of the medical
 building.   During the month of November,  ward N  was
 closed,  and the samples were all taken with  the ward empty,
 and very quiet. The average number of bacteria found at this
 time was 2.5 per 10 litres of air; but in December, with two pa-
 tients and one nurse present, the number of bacteria was 18.2.

     One-story  Medical and  Surgical  Pavilions,
                    Wards  T and P.
  The one-story buildings are shown in plan in plate No. I.,
 where they are numbered 3 and 4; and a section and eleva-
 tion of the surgical pavilion are shown in plate No. IV.  The
 two buildings are alike in form and arrangement.  The ward
 is 94  feet long, by  26^  feet wide, and has seven opposite
 windows and fourteen beds on a side ;  the  windows, having
 double  sashes,  are 9  feet high by 4 feet wide.  The height
 of the ward, from the floor to the centre of the arched ceiling,
 is 22 feet, or an average of about 19 feet.   The  floor  area
 for each bed is 89 square feet, and the air space about 1,700
 cubic  feet.  The basement is an open and free  air space,
 containing  only heating apparatus.   The floor is  made hard
 and impenetrable to moisture by concrete  and cement, and
 is on a level with the ground outside. Its numerous windows
can  be  left open  many months in the  year; and, its doors
being locked, it is cleanly and free from any intrusion.
  The  method of heating and ventilating these buildings is 
176        STAPH  BOARD OF  HEALTH.        [J«
shown in plate No. IV, fig. 5.  The air enters the ward only
through inlets under each window, fourteen in all.   The
foul air escapes through five large openings along the centre
of the arched ceiling, each 3 feet  by  6  feet, into a ridge
chamber,  and thence either through  the free  openings in
the sides  of the chamber above the  roof, or through  five
ventilators,  each 2   feet  in diameter, on  the  top  of the
ridge.
  It  has  been  found,  by air-meter  tests, that the  whole
volume of air in  the wards, about 47,600 cubic feet, or 1,700
cubic feet per patient, is changed between  three  and four
times hourly.
  A consideration of the  number of micro-organisms found
in these wards is particularly interesting, as they represent
the modern ideas of  hospital construction.  The  system of
heating and ventilation is regarded as excellent, and they are
considered model wards, in all respects.  The following table
shows the average number of micro-organisms found in both
wards, forenoon and afternoon : —
Ward P (Surgical, Male).  Samples taken Afternoons, November. 1888.
Date.	Time.	Tempera- <. ture, Degrees.	o ^ o a PS	« a M	2 ~3 o	Remarks.
Nov. 3, " 9, " 15, " 20, " 30,	4.25 3.10 2.10 3.00	69 70 70 64 65	27 28 25 31	23 25 9 12 12	12 35 2 15 6	Some walking about. Close smell. Fifteen visitors present. Twenty-two visitors present; ward quiet. Considerable walking about.
Average, ....				16.2	14	
Ward P (Surgical, Male).  Samples taken Mornings, December, ls88.
Dec. 3, 11.00	70	31	6	0	Ward quiet.
» 7, 10.45	66	28	21	7	Surgeon's visit, with fourteen students.
" 24, 11.15	72	25	5	14	Ward quiet.
Average,			10.6	7	
 
1889.]      PUBLIC DOCUMENT —No.  34.         177
Ward 1 (Medical, Male).  Samples taken Afternoons, November, 1888.
Date.	Time.	Tempera-ture, Degrees. Number of Patients.		.2 £ 2 Remarks. 1 |		
Nov. 3, " 9, " 15, « 20, " 30,	4.15 3.00 2.30 3.00 2.40	68 70 70 65 63	25 16 25	13 11 9 6 19	0 20 4 7	Windows closed. End door open; some walking about. Fourteen visitors present; ward quiet. Sixteen visitors present. Changed some bedding.
Average, ....				11.6	7.6	
Ward 1 (Medical, Male).  Samples taken Mornings, December, 1888.
                    and January, 1889.
Dec. 8, 11.15	69	25	22	9	Mopping floor.
" 13, 11.25	64	26	29	4	Ward quiet.
" 24, 11.10	68	24	8	1	Mopping floor.
Jan. 2,	-	-	26	15	
Average, ....			21.3	9.5	
  No high numbers  appear in any of the determinations,
either forenoon or afternoon.  In ward T the bacteria found
in the forenoon are about twice the number found in the
afternoon, while the moulds are about  the same.   In ward
P, on the contrary, both bacteria and moulds are highest in
the afternoon.   This is perhaps due to the  fact that the
determinations that were made  in the morning occurred too
late  to  be affected by the general disturbance of  ward
work.
  During the morning of December 7, ward P was visited
by the surgeon and fourteen students, all moving about from
bed  to  bed.   The number of  bacteria found was but 21.
Ao-ain, on the four afternoons when visitors were present, in
both wards P and T, the number of bacteria was less than it
was on  other days.  With wards in good order, it seems to
be true  for all, that the presence of visitors does not as a rule
increase the number of  micro-organisms.   The large cubic 
 17s        STATE  BOARD  OF  HEALTH.       [J'>m.

 space, excellent ventilation, and perfect cleanliness of these
 buildings,  is sufficient  to  account for  their freedom from
 micro-organisms.

              Isolating Wards, K and  L.
   A  two-story  brick  building, located near  the  southern
 corner of the grounds, contains the male and female isolating
 wards, which are shown in plates I. and II.  The building is
 1011 feet long, and 46| feet wide, with a basement or cellar
 underneath, which brings the first floor to  a height of about
 two feet above the ground  level.  There is  a  ventilating
 chamber on the roof, 10 feet wide, extending the whole length
 of the building.  A hall or passage way, 10  feet wide, divides
 each story, with rooms on  either side, and windows at each
 end, excepting at the entrance door on the first floor.  There
 are ten rooms on each floor, 14 feet by 15 feet in size, and
 designed to accommodate from one to four patients in each.
 The rooms on the first floor, for male  patients, are 14 feet
 high; and those on the second  floor, for females,  are 18 feet
 high.  The fresh-air supply is admitted through openings in
 the outer wall under the windows, and near the floor in each.
 A steam radiator is  placed in  front of these openings, and
 surrounded by  a casing of wood lined with  tin, having a
 register in front.  A simple arrangement  of  sliding valves
 within the casing controls the temperature and volume of the
 entering air.  The air of these rooms is believed to be changed
 from three to four times hourly.
  The service of these wards is the most arduous of any con-
nected with the  hospital.   For many years they furnished
the only available place for the  treatment  of  contagious
diseases, as well as a class of cases which,  by reason of un-
cleanliness, delirium, etc., were not fit to remain  in an open
ward.  During the summer of 1888 they were vacated, and
thoroughly renovated.  The opening  of the new wards for
contagious  diseases has removed the necessity of  treating
such cases here.   At present there are treated in these wards,
alcoholismus, alcoholic pneumonia, erysipelas,  rheumatism,
typhoid fever, and many unclean medical and surgical cases. 
1889.]     PUBLIC DOCUMENT —No. 34.        179

  The above  facts are mentioned because it was thought that
these wards would furnish a larger number of  micro-organ-
isms than other parts of the hospital.
  Of the tables of determinations representing the work done
in this building, the  following show the  average  results for
morning and  afternoon,  in the corridor of each ward ; while
the  others show the condition of the rooms themselves.  All
determinations made in  the rooms of each ward  were made
on the same day, each determination following the other in
succession.   The number of micro-organisms found in ward
K corridor in the afternoon is surprisingly small;  and even
in the morning, when there was considerable walking about
by nurses and patients, the numbers found were  also small.
Moulds appear from the table to abound in ward L.   The
bacteria were few in  number both forenoon and afternoon.
Ward E (Male), Isolating Ward. Samples taken Afternoons.
Date.	Tempera-ture, Degrees. Bacteria.			o	Remarks.
Nov. 2, " 10, " 16, " 21,	2.25 2.50 3.00	71 66 68 65	3 11 0 1	6 5 17 4	End door and window open; considerable draught; floor unclean; some walking about. End window open; draught; considerable walking about. End door and window open; considerable draught. End window open; some walking about.
Average,			3.6	6.2	
Ward K (Male,) Isolating Ward.  Samples taken Mornings.
Dec. 1,	12.00	59	10	8	Corridor door open; cool draught; patients walk-ing about; floor unclean.
" H,	11.30	64	13	28	End door and window open; draught; some walking about.
" 17,	10.25	66	7	1	End door and window open; considerable walking about.
" 26,	12.00	64	18	6	Floor just previously swept; end door and window open.
Avera	ge, .		12	10.8	
 
180        STATE  BOARD OF  HEALTH.

   Ward L (Female), Isolating Ward.  Samples taken Aftenv
Date.	Time.	%i\	M <	2 "3 O	Remarks.
Nov. 2,	-	72	10	8	End window open; considerable draught.
" 10,	2.10	67	23	s	Visitors' day; ward previously swept.
" 16,	2.35	70	5	G7	End window open a little; windows in room open
" 21,	2.45	63	2 10	13	End window open; cool draught.
Average,				24	
Ward L (Female), Isolating Ward.  Samples taken Mornings.
Dec. 11, 11.15	65	4	99	Pretty quiet; some walking about.
" 17, j 10.40	-	5	12	Quiet.
" 26, ; 12.00	-	19 9.3	11 40.7	End window open; quiet.
Average,				
  Patients'  Booms.—As before stated, these  rooms are 14
feet by 15 feet, with a cubic space in ward K of 2,940 cubic
feet, and in ward L, 3,780 cubic feet.   With  two or three
patients in a room, the cubic space is ample ;  but in ward K,
with four  patients in a room,  which the demands upon the
ward frequently necessitate, the cubic space is  rather small.
  The  following tables show the results  of  one determina-
tion  in each  room, the rooms  being numbered from 1 to 12
in each ward : —
       Ward K (Male),  Medical and Surgical.  (February 4.)
Time.	c		<4H • o 3	tj	4	Remarks.
	o o	Z — <a	yA	rt	s <5	
10.30 A.M.	1	80	i	6	2	Strong draught.
2.05 p.m.	2	7.">	2	10	7	Porter's room; strong draught; 2 occupants; 1 asleep.
10.45 a.m.	3	82	1	15	6	Strong draught.
1.50 p.m.	4	28	4	11	9	Three medical; 1 surgical; swept l'j hours before; slight warm draught.
11.00 A.M.	5	74	3	37	3	Three medical; strong draught; 2 patients up; bad odor.
1.30 P.M.	6	73	4	22	6	Four surgical patients; swept T.% hours before; transfer made and erysipelas patient brought in.
 
1889.]     PUBLIC  DOCUMENT —No. 34.          181
Ward K (Male), Medical and Surgical.  (February 4.) — Concluded.
Time.	3 p	3 a o S35i	^ 0	c a	2 "3 o	Remarks.
11.10 A.M.	7	61	-	9	6	Strong draught; no patients.
1.15 P.M.	8	75	4	18	1	Two medical; 2 surgical; strong draught; swept 1 hour before; 2 patients up.
12.45 "	9	70	4	11	4	Four surgical; slight draught; 1 patient up; swept after dinner.
1.00 "	10	72	4	-	-	Three surgical; 1 medical; draught strong; swept 3,'4 hours before; 2 patients up.
1.25 "	11	79	6	15	5	Private room; cool draught through radiator.
2.40 "	12	65	-	11	4	Kitchen.
Avera	ee, .			15	4.4	
Open	lir,.			3	2	
Weird L (Female), Medical and Surgical.  (February 4.)
Time.	i	Tempera-ture, Degrees.	o ^	|	2	Remarks.
10.20 a.m.	1	70	3	4	9	All medical; 2 patients up; quiet; slight draught.
10.40 "	3	72	4	-	-	
10.55 "	4	72	3	0	9	All medical; quiet; slight warm draught.
11.05 "	5	72	3	3	7	All medical; quiet; strong warm draught.
1.15 P.M.	6	72	4	3	7	Two medical; 2 surgical; swept 1 hour before; 1 patient up; strong draught.
1.45 "	7	69	3	10	10	All medical; swept 1% hours previous; strong draught; quiet; floor not clean.
1.30 "	S	72	3	10	11	Bad smell; swept 1 hour previous; strong draught; floor not, clean.
2.00 "	9	69	2	6	3	One medical; 1 surgical; swept 1)4 hours previous; floor clean.
2.15 "	10	72	4	14	5	One medical; 3 surgical; floor swept 1 hour previous; strong draught.
2.30 "	11	68	2	-	-	Floor swept 2 hours previous; 1 medical; 1 surgical.
2.45 "	12	68	2	4	17	One medical; 1 surgical; quiet; floor swept 2 hours previous.
Avera	je, •			5	8.7	
Open i	lir, 9	.55 A.M.		19	3	
 
182        STATE BOARD  OF HEALTH.        [Jan.

  These tables show a most excellent condition of the air of
these  rooms as regards micro-organisms.  The  number of
bacteria found in ward K, although  three times  as many as
in ward  L, compares favorably with other parts  of  the
hospital.   The writer  is of the opinion that the differences
between wards K and L are more apparent  than real, and
that more organisms  are present in the  rooms  in  ward L
than the determinations of  air  indicate, although  perhaps
not so many as in ward K.   No  other wards of the  hospital
furnish  similar  rooms for comparison;  but  the rooms  of
certain employees (women)  on the third  floor of the admin-
istration building (see table, p. 190) are  not unlike them, in
that they contain from two to four beds.  Here  were found
an  average of 20 bacteria against 15 for the rooms in ward
K,  and 5 for rooms in ward  L.   There was nothing in  the
condition of the  rooms that would indicate whether the num-
bers of micro-organisms would be high or low.  Most of the
windows were closed, but the doors opening  into the corri-
dor were open.   A strong, draught of warm air came from
the radiator, indicating an abundance of fresh air.  In room
5, ward K, giving the highest number of bacteria,  a disa-
greeable odor was noticed ; but this was the only room where
any offensive  odor was  detected.   These rooms certainly
show a freedom from micro-organisms  scarcely to be  ex-
pected from the  class  of cases assigned to them.

             Contagious Wards, A  and E.
  The two  new wards for infectious diseases are practically
alike.  They occupy the space shown in plate No. I., between
the isolating wards and the medical ward numbered 4.  They
are connected with each other and the rest of the  hospital
group by two-story corridors, the upper story being open
and the lower one enclosed.
  Each building may be  considered  as divided  into  five
sections.   The  centre section contains the service  rooms ;
on  either side is an  open ward, and in the end sections are
placed the isolating rooms.  A  second story over each  end
section  furnishes  room  for more  complete  isolation  of
patients, when  necessary.   The open  wards are 25 feet 8
inches, by 35 feet 4 inches, and are 16  feet  high ; <nv- 
1889.]      PUBLIC  DOCUMENT —No. 34.         183

ing to each bed, eight in  number,  1,200  cubic  feet  of
air.
  In  the  centre of each ward is a square ventilating shaft,
5 feet by 4 feet, and on two  sides  are  fireplaces.  None
of the basement rooms are  intended for  occupancy.  The
space under the wards has  concrete floors, and is white-
washed.   Air is  admitted by direct inlets, placed at proper
intervals in the basement walls, and by means of a diaphragm
may be made to pass over coils  in galvanized iron boxes, or
may pass  directly to the wards without going over the coils.
The system will  supply 48,000  cubic feet  of warm  air per
hour, or 6,000^ cubic feet per patient.  The upper portions
of the wards are ventilated through register faces in the
walls and ceilings, and  thence upwards to a ventilating ridge
chamber.   The lower portions  of  the ward  are  ventilated
downwards through registers in  the floors,  and thence to the
aspirating shaft in the centre of  each ward.  The capacity of
each ward is 24  beds,  or, including  the chambers, a  total
capacity for both wards of 72 beds.  Ward A is devoted to
the treatment of scarlet-fever, ward E to diphtheria.
                 Contagious  AVards.
Ward A (Scarlet-fever).  Samples taken Afternoons, November, 1888.
Date.	B Tempera- i ture, Decrees. ! Number of Patients. Bacteria.		o	Remarks.
Nov. 10, " 15, " 21,	-	72 4 j 1 i 2 .73 7 ; 12 j 2 64 1 7 0 2		Sample taken in A, North. Ward quiet. Sample taken in A, South. Three visitors pres-ent. Ward quiet. Sample taken in A, North. Ward quiet.
Average,
Ward E (Diphtheria).  Samples taken Afternoons, November, 1888.
Nov. 1,	3.00 p.m.	73	5	4	5	Sample taken in E, South.
" 10,	2.15 "	72	4	7	6	Sample taken in E, North. Ward quiet.
" 15, " 21,	2.45 " 3.15 "	73 74	7 7	17 1	0 5 _	Sample taken in E, South. Three visitors. Nurse caring for patients. Ward quiet.
Aver					4	
 
1?<4
STATE  BOARD OF  HEALTH.
[Jan.
Ward E (Diphtheria).  Samples taken Mornings, December, 1888.
Date.
Time.

cq  a
Dec. 1, 12.00 a.m.	68	4	0	7	Sample taken in E, South.	End window open.
" 5, 11.35 "	69	6	0	0	Sample taken in E, North.	Ward quiet.
" 10, 11.35 "	74	7	4	7	Sample taken in E, South.	One visitor.
" 14, 10.35 "	65	-	8	4	Sample taken in E, North.	Making beds.
" 26, 11.40 "	-	6	5 5 8	17 6,4		
						
  The above tables,  representing the determinations made
in the contagious wards, show a freedom from micro-organ-
isms not to be found in any other wards  of the hospital, the
nearest approach  to  them  being the  three female medical
wards, Q, R and S (see table, p. 174).
  These buildings,  being  divided  into  sections, although
communicating, furnish wards about the size of Q, R and S,
but with fewer beds; and the results obtained in wards of
this  character  show  that they are less likely  to become
contaminated with micro-organisms  than  the larger wards.
  All  the conditions which are unfavorable to  a vitiated
atmosphere, except  the patients  themselves, are found in
these wards.  The buildings are new,  sanitary  conditions
perfect, ventilation good, cubic space large, great cleanliness
of rooms and furniture, and an intelligent and abundant use
of disinfectants.   Nevertheless, in spite of the greatest pre-
cautions, the opportunity of infectious material being set free
in the room exists in the treatment and care  of patients.
Diphtheritic patients especially  receive  a vast  amount of
spraying, douching  and  painting  of throats.   Discharges
from the mouth and  nose are very profuse, and offensive in
odor.  Cloths,  bits of rag and feathers are used in removing
such  discharges;  but,  with all precautions,  bedding  and
clothing  of  patients, especially children, must become more
or less contaminated, and from these infectious  material is
transmitted  to the air.
  The duties of the nurses in these wards are very laborious ; 
1889.]     PUBLIC DOCUMENT —No.  34.         185

but, the  separate wards being small, the work is carried out
in a quiet manner, and the commotion of the larger wards is
never seen in them.
  Up to the present point, it has been the object  of this
paper to show the number and distribution  of micro-organ-
isms in the wards of the hospital; it now remains to consider
some other facts brought out by these experiments.  It has
been shown that the micro-organisms present in the air of a
room in the forenoon exceed  those found in the  afternoon,
and  that this  is due to the disturbances which always occur
in the morning.   We  should therefore think of them as
associated with the room itself, rather than with the air;  for
the air of a room, if left undisturbed, soon becomes practi-
cally free from organisms.   That  there are micro-organisms
at all in the air  of rooms,  depends upon whether they are
occupied or not, or upon the degree of commotion in them.
With a view to finding out  how nearly the air of the wards
became  free from micro-organisms under the most favorable
conditions, the following  experiments were  carried out be-
tween eleven and twelve o'clock at night: —
                                   ©
Xight Work.
Date.	Ward.	Time.	Bacteria.	Moulds.
Dec. 27, .	B	11.20 p.m.	1	4
" 27, .	C	11.45 "	2	1
"■ 27	D	12.10 A.M.	0	2
" 2s,	F	11.15 P.M.	1	0
" 28, ....	G	11.35 "	0	1
" 28, ....	H	11.52 "	13	3
  Between seven and eight o'clock p.m. helpless patients are
made comfortable for the night, others prepare for bed, and
at eight o'clock the lights are turned out.   One person is on
duty in each ward during the night.   Usually a few very
sick patients require attention ; but, with this exception, the
wards remain quiet until morning.
  It will be noticed, from the table  of night work, that  the
wards in which these determinations  were made  are those
belono-ino-  to  the  large  three-storv medical and surgical
     ©  ©            ^            "            #
buildings, where all our greatest numbers of micro-organ- 
186        STATE  HOARD  OF HEALTH.        [J«n.

isms were found.  These experiments show conclusively that
the air of a room vitiated  by bacteria will in three  or four
hours become practically free from them, if disturbing influ-
ences  are removed.  The  determination in ward II gave 13
bacteria  and  3 moulds, — numbers nearly as large as we
should obtain  under ordinary  conditions.   Unusual  results
of this kind cannot be anticipated, and, as  four or five days
are required  to complete a determination, the  cause can
seldom be traced.  The moulds are a  trifle higher than the
bacteria, in numbers ; which is what we should  expect, for
we know that moulds  are relatively lighter  than bacteria,
and of course remain suspended longer.

      Experiments  Before and After  Sweeping.
   The following  experiments were  undertaken to bring out
more  clearly the effects of unusual disturbances in increasing
the numbers of micro-organisms in the air  of a ward.  The
greatest amount of commotion occurs between 7.30 and 9.30
a.m.,  and the  greatest  amount of dust is caused  by the first
sweeping of the  morning.  There is a good deal of dust,
lint, etc., upon the floor of these large wards in  the morn-
ing; and, as dust and micro-organisms go hand in hand, we
should expect  to find micro-organisms more  abundant just
after sweeping than at any other time.  The following table
of determinations, made  just  before and after  sweeping,
shows this to be the case :  —
Before Sweeping.  I  After S\ i eping.
Ward.			
	Bacteria.	Moulds.	Bacteria.
F	56	1	: 99
B	23	3	104 w
C	32	22	
D	31	32	30
F	104	2	160
G	45	2	, 38
II	43	s	81
P	40	12	10
T	20	15	24
B	20	6	7
Dec	18
"	27
"	27
»	27
«	28
"	2X
t<	2*
Jan.	2
"	2
"	3
Average,
42     10.3      70.8    17.s 
1889.]      PUBLIC  DOCUMENT —No. 34.        187

  The average number of bacteria found after sweeping  is
seen to be nearly twice the  number found before sweeping.
The ratio of bacteria to moulds in these wards is in the pro-
portion of 4 to 1, under both conditions.
  The table not only shows the effect of sweeping, but the
whole general effect attending the opening of a large general
ward in  increasing  the number of micro-organisms.  We
have  seen  by the previous table of determinations,  made
about midnight, that the micro-organisms of a ward practi-
cally, all settle out in three or  four hours.  It follows, then,
that the  air remains free from them throughout the  night,
and is free at the time of opening the ward.   The number
of bacteria present in ten litres of air at  any time after mid-
night is  one or less than  one.   If, then, we  consider the
number present at the  beginning of the hospital day as one,
the  increase in  numbers due to  disturbances  caused by
routine work  of  the morning, other than sweeping, Avould
be  as 42 to 1 ;  and,  including sweeping,  as 71 to 1.
  Probably the greatest factor, next to sweeping, in increas-
ing the number of micro-organisms in the air of a room, is
bed-making.   The hospital bed, made up, measures about 8
feet 3 inches, by  2 feet 6 inches ; which  gives, in  a ward  of
28 beds,  577 square feet of surface area, — a little more than
one-fourth the total floor area.   These beds, of course, cover
an  amount of floor  space equal to their size ;  so that,  in
reality, the surface which they present to falling organisms
is about one-third the whole surface exposed.   In the  proc-
ess  of bed-making, many of the organisms which have pre-
viously settled out upon the clothes are again wafted into the
air,  as of  course would be any  bacterial  discharges  with
which the  bed linen might be  contaminated.   I refer par-
ticularly to very  slight discharges ; for, in case of noticeable
discharges, the soiled  linen is  immediately removed, with
proper piecautions.

                  Ventilating Ridges.
  Each hospital  building  is  surmounted by a  ventilating
ridge, into  which the foul air of the ward passes, either by
means of flues  in the  wall or through large openings along
the centre of the ceiling.  From  thence it passes directly 
188
STATE  BOARD OF  HEALTH.
[Jan.
to the outer air through large ventilators, placed at equal
distances  along the top  of the ridge.    These  chambers
extend along the roof over that portion covering each ward ;
they are  about 5  feet  wide, and  of more  than sufficient
height to permit an upright position.   The roof of each
chamber is peaked,  and made of glass.  They can be heated
by steam if necessary, but this is seldom, if ever, resorted
to.
   It was  thought to be a question of considerable impor-
tance to determine  the  relation between the air of these
chambers and  that of the wards; for such knowledge leads
directly to the important question, whether or not there is
elimination of micro-organisms in a mechanically ventilated
building.
   Ridges designated H  and D  discharge  the  air from the
large three-story medical  and surgical buildings, containing
wards F, G and H, and B,  C and  D respectively; while
ridges P and T discharge for the one-story buildings, wards
P and T.
                      Ventilating  Ridges.
		rE.	0 5 — s		O	21	Hi q << a	
Da								Remarks.
Dec		7,	P	57	9		7	Strong upward draught.
	'	12, 18, 19,	I) D II	2 2 3	8 1 1	9 10 106	5 2 6	Ventilators drawing well; no currents felt in the chamber. Ventilators drawing well; no currents felt in the chamber. Ventilators drawing well.
	'	-4, 24, 27,	T P D	1,149 6 6	0 5 22	8 5 31	1 14 32	Good upward currents from ward below; not much i'himj wall outlets. Good upward currents from ward below; not much from wall outlets." Ventilators drawing gently.
	'	2S,	n	17	7	81	1	Ventilators drawing well.
Jan.		-■	T P	12 4	3 10	26 40	15 12	Strong draught from ward below; slight from wall outlets. Strong draught from ward below; slight from wall outlets.
  The tables give, in addition to the micro-organisms found
in the air of the ventilating chambers, the number of bacteria
and moulds in the air of the wards just beneath, about fifteen
minutes before.    The  table  shows, for the most part,  ex-
tremely small numbers of micro-organisms, — so small as to 
 1889.]      PUBLIC DOCUMENT —No.  34.        189

 lead at once to the conclusion that the air, in passing from
 the wards  below, does not carry with  it micro-organisms to
 any considerable extent.
   It is safe to say that, in  wards without special means  of
 air outlets, and  with only ordinary means of ventilation,
 micro-organisms  do not  escape; but  in  wards like P and
 T,  with  exceptionally  good  ventilation,  they do  escape,
 and the  total number in the ward is  thereby much  dimin-
 ished.
   From the fact that micro-organisms settle out so rapidly,
 probably floor ventilation, such as exists  in the contagious
 wards, aids materially in the elimination of micro-organisms ;
 but  the  most efficient  means  for  ordinary  rooms, after
 sweeping or any  unusual disturbance, is a good current of
 outdoor air, by means of open windows and doors.

         Administkation and Other  Buildings.
   So far as I am aware, no standard has been proposed for
 the number of micro-organisms  habitually present in the air
 .of hospital wards.  The terms large and small, as applied to
 the number of organisms found in this investigation, have
 therefore been used entirely in a relative sense.  The deter-
 minations that have been made upon outside  air, while  use-
 ful as a comparison, cannot properly be taken as a standard
 of the purity of the air of rooms ; for individual experiments
 made on  outside air and the air of wards at about the same
 time show no relation whatever, and it is quite possible for
 rooms of the better class  to contain far less organisms  than
 outside air.  In the absence, then, of  a proper standard  of
purity for  hospital air,  it  seemed to the writer that an
investigation of the air of certain  hospital  buildings not
occupied by the sick  would afford a  useful means of com-
parison.   With this object in view, the air of the following
buildings was examined : —
  First. —Administration building.
  Second. —Nurses' home.
  Third. — Laundry, with rooms of the laundry employees. 
190
STATE  BOARD OF  HEALTH.
[Jan.
                Adm in ist ration  B i' ih I ing •
  The number of micro-organisms found in various places on
each floor  of the administration building is  shown by the
following table: —

                Administration Building.
                        First Floor.
Second Floor.
Average,
Place of Experiment.	Date.	Bacteria.	Moulds.
Reception-room,..... Hall,....... Dining-room, ..... Private office, .....	Jan. 5, : 64 " 5, 48 " 5, 18 " 5, 12		2 6 7 2
		35.5	4.3
Sleeping-room,.....	Jan. 5,	1	1
Library, ......	" 5,	1	2
Parlor,......	" 5,	5	5
Hall,.......	" 5,	1	7
Sleeping-room,.....	" 5,	2	5
Third Floor. — Domestics'' Rooms.
Room 1,
  "  3,
  "  4,
  "  5,
  "  6,
  u  7
Jan. 12,
 "  12,
 "  12,
     5,
     5,
 "   5,
 5
 0
 4
20
Average,
9.7
  First Floor.—This  floor (plate I.)  contains, besides a
spacious hall,'  the superintendent's  office,  matron's  room,
family dining-room, and a large reception-room.  This,  be-
ing the executive department, is visited each day by many
hundred people,  representing all classes of society.   Such
is the neatness and the order of this floor, however, that no 
 1889.]      PUBLIC  DOCUMENT —No.  34.        191

 indication is ever seen of the immense amount of business
 transacted.   The  largest number of bacteria was  found  in
 the reception-room and hall, where the greatest amount  of
 activity exists.  In the dining-room and office the  numbers
 were  much less.  That bacteria are here present in the num-
 bers  found  in the reception-room  and hall, shows plainly
 how these organisms are transported by people coming from
 outside air into a room, by dirt on their feet  and clothing.
   Second Floor. — A plan of this floor is shown by plate II.
 Here  are the living-rooms of the superintendent and a few
 of his officers.   It corresponds  to a  private house  of the
 first class.  The  table of data shows the air of this floor to
 be almost free from bacteria, as  might be expected from the
 cleanliness and quiet which prevail.
   Third Floor. —The third floor (plate III.) is divided into
 chambers for the  use of domestics ;  the rooms are small, low
 studded, and the  ventilation is poor, being only by transom
 windows.   Consequently, a larger  number of bacteria  is
 found in the air  of these rooms.   The rooms are  vacant
 most  of the day,  and were vacant at the time of the experi-
 ment.
                     Nurses' Home.
  This building differs  from any that  has been considered;
 it is new, outside the hospital grounds, and is reached by a
 short  walk  in the open air.   It is  four stories  in height,
 each  floor having a central corridor  extending its whole
 length, from which nurses' rooms open on either side.  It is
 essentially what  its name  implies, — "a  nurses'  home,"
 where quiet and comfort are found by the nurses after their
 duties at the hospital are over.  The nurses leave the build-
 ing at about 6 30 a.m., and return for the  night at 8 p.m.
 The samples of air were all taken at about the centre of each
 corridor.  The table below shows for the air  of this building
 very  small  numbers  of bacteria.  Even in the  morning,
 with housework going on, the average number of only nine
 bacteria were found;  while in the evening, after  so many
 nurses, fifty or sixty,  had entered the  building, and distrib-
 uted themselves throughout its various parts, the air showed
an average of but three bacteria.  These results show that
bacteria are not transported from the  hospital wards to the 
192
STATE  BOARD  OF  HEALTH.
[Jan.
" home," at least in any appreciable  numbers, and that they
are not accumulated by any cause.
  The very moderate number of bacteria found in this build-
ing is evidence  enough that the air of even a large  building
may be kept comparatively free from bacteria, under proper
hygienic  conditions.   It  is noticeable that the  number  of
bacteria found is less than we  should expect to find by the
same number of determinations on outside air.

                      Nurses'  Home.
           Samples taken Jem. 4, 1889, 9 to 10 A.M.
CORRIDOR.	Bacteria. | Moulds. Remarks. 1 I	
Basement, First floor, Second floor, . Tliird floor, . Fourth floor, .	; i 7 20 ; Strong draught. 18 59 Before sweeping; floor dirty. 3 j 7 Very quiet; floor clean. 10 11 Floor partly swept. 9 16 Sweeping finished before experiment.	
Average,	9.4	22.6
Samples taken Jan. 4, 1889, 8 to 9 P.M.
Basement,
First floor,
Second floor,
Third floor,
Fourth floor,

  Average,
0
2
3
5
7

3.4
20
 4
 8
17
16
Very hot;  no one present.
Quiet.
Very little walking.
Very quiet; some draught.
Very quiet.
13
                        Laundry.

  In this building  we have a  wash-room  and  an ironing-
room on the first floor, and the sleeping-rooms of the laun-
dresses on the second floor.  Every morning the soiled ward
linen is taken to the wash-room,  and assorted  into special
lots preparatory to  washing.   The handling of such a large
amount of soiled ward  linen should be a prolific source of
air infection in this room ;  but, as will be seen from  the
table of  determinations, the number of bacteria, although
large, is not extraordinary.   The  day, however, on which
the  samples were  taken, was  very windy; and, the door
being  open, a  very  strong current  of  air  was blowing
through, which  may have  carried off a  large  number of 
1889.]      PUBLIC  DOCUMENT —No. 34.        193

micro-organisms.  Still, a  larger number of  bacteria was
present in the wash-room than in the ironing-room, which
connects directly by  an open door.  The rinse-house is a
small out-building, in which  the preliminary  cleansing  is
given to especially foul clothing.  Here, again, a  pretty
large number of bacteria was found, in the presence of very
free air currents.
  Up a narrow  staircase  one passes  to a corridor  out  of
which lead  the  laundresses' rooms.  They are small, low
studded, badly ventilated, but quite  cleanly, owing  to the
strictness  of  the  hospital rules.   There  is an  extremely
offensive odor in most of these rooms, which is attributed by
the  administration to the uncleanly habits of women of this
class.   In the morning the determinations were  made after
the rooms had been vacated several hours, but in the evening
the women were  sitting quietly in their rooms.  The number
of bacteria found  shows undoubted evidence of vitiation  of
the  air, due to personal uncleanliness; for the rooms them-
selves are clean, and it is noticeable that in the evening, with
the women present, although not stirring about, the numbers
increased.  This is in direct contrast with the results found
in the nurses' home, where, under similar  conditions  of ex-
periment,  the  numbers found in  the evening were less than
in the morning.
  According to the class of inhabitants, then, the number of
bacteria was found to increase : for instance, in the dwelling
apartments of the superintendent there  was an average  of
2 bacteria; in the nurses' home we have  an  average of 9.4
bacteria;  in   the  domestics'  sleeping apartments  in the
administration building were 20.3 bacteria; and worst  of
all the  laundry  employees' rooms, where there  were 36.7
bacteria.
                        Laundry.
Place of Experiment.	Date.	Bacteria.	Moulds.
Ironing-room,..... Rinse-house,..... W ash-room,..... Wash-room,.....	Jan. 7, 8, 8, 8, Average,	23 43 33 84	17 5 7 6
		45.7	8.9
 
194
STATE  BOARD  OF HEALTH.
[Jan.
Rooms of Laundry Employees.
Morning.					EVKNINO.		
Dnte.	1 Koom. ' Bacteria.		Moulds.	Date.	1 1 Room, j Bacteria. 1		Moulds.
Jan. 7, 1		38	2 j Jan. 7,		1 ' 57		1
"7, 2		5,440*	0 1	7,	2 ! 44		2
7, 3		14	2 !	7,	3 50		13
7, 4		27	4	7,	4	6	1
7, 6		31	2	7,	5	82	1
7, 6		40	3	' 7,	6	1	2
7, 7		28	1	7,	7	72	0
7, | 8		18	9	7,	8	14	3
7, ' 9		24	10	7,	9	13	0
7, 1 10		33	6	7,	10	28	6
Average,		28	4.7	Averng		36.7	3
                  * Omitted from average.

                    Basements.
As a matter of general  information, determinations of the
air  in the basements were made.
in the following:  table
The results are embodied
	Date.	Basement under Ward.	Bacteria.	Moulds.	Remarks.
1888.					
De	C. 7, 14,	P Q	0 7	101 10	One window on each side open; closed during experiment.
	17, 1*, V.K	K B F	0 4 0	7 13 8	Cool and damp ; strong smell.
	24, 24, ' 27, 28, 31,	T P B F Q	3 1 0 2 4	10 36 69 3 6	End window open ; slight draught. One window open.
1889.					
Jan. 2,		T	0	6	
	Avera'		2	16.3	
  These basements  are  used to some extent for the storage
of furniture and other hospital property;  aside from this,
they serve only as open  air spaces, the windows being open 
1889.]      PUBLIC  DOCUMENT —No. 34.        195

in favorable weather.  The walls are of solid masonry, and
the floors are of concrete.  Doors for the most part are kept
locked, and with occasional white washing; the basements are
always clean and wholesome.  It is evident from the table
that bacteria do not find a congenial climate in these base-
ments, for they are notably absent.   On  the  other  hand,
moulds abound in considerable numbers ; but lack of damp-
ness and  darkness  keeps the numbers far below  what we
should find in an ordinary cellar.  The presence of moulds
in  an  atmosphere  disturbed  only by the leakage  of air
through windows, or at the most through open windows, in
favorable weather, makes evident their relative lightness.

The  Bacterial Examination  of Air after  the Fumi-
      gation of Infectious Clothing by Sulphur.
   It is not within the  scope of this paper to investigate the
efficiency of sulphur as a fumigating agent, and no attempt
has been made to do so.  The experiments presented were
suggested by the fact that bed-making  in the wards furnished
a means of air-infection.  The bringing together of large
quantities  of bed linen for fumigation, from the infectious
wards, it  was thought, would vitiate  the air unmistakably,
and become  manifest, with  a few determinations of air, in
the small confined space of the fumigating vault.  The ex-
periments  were, however, extended, so that in  reality they
became a measure, not of the efficacy  of sulphur as a fumi-
gating agent, but of the method of fumigating employed in
this hospital.   The fumigation of infectious clothing under-
takes to kill not alone  the bacteria that may be present, but
also the more refractory spores ; and any method which fails
to kill every germ and every spore, is  worthless.
   A description of the fumigating vault and the method of
fumigation employed is as follows.  The vaults are of brick
masonry in the corner of a  basement room, one under the
contagious ward A,  the other under contagious ward E. They
are 16 feet long, by 9 feet wide and 9  feet high.  Racks are
built upon two sides, on which to deposit clothing.   Tightly
fitting double  doors prevent the escape of sulphur  fumes
during fumigation,  and a flue connecting with a  chimney re-
moves the fumes after fumigation is completed.  All  soiled 
  19(3        STATE  BOARD  OF  HEALTH.       [Jan.

  clothing from the contagious wards is sent down shutes  into
  the basement, and  on certain  days of  the week is removed
  to the  vault and immediately fumigated.   This is  accom-
  plished by  burning in an iron  pot about  ten pounds of  sul-
  phur, the heat from the pot placed in a pan of water furnishing
  a certain amount of moisture.   The  exposure given is usually
  from six to eight hours.
   In the  experiments to be described, the following  pro-
  cedure was carried out: —
   First. — A determination of the  air of the room outside
  the fumis;atinsr vault.
   Second. — A determination of the air within the fumijnit-
 ing vault, empty.
   Third. — A determination of the air within the  vault, with
 clothing distributed, and ready  for fumigation.
   Fourth. — A determination  of the air within the vault,
 after fumigation, and in the presence of sulphur fumes.
   Fifth. — A determination of the air within  the vault, after
 the escape of the sulphur fumes.
   Sixth. —A determination of the air within the vault, after
 the clothing  had  been  fumigated and violently shaken.
   Seventh.—A  determination  of the air  within the vault,
 after the clothes had been removed.
   Eighth.—A determination  of the air within the vault,
 after a period of repose.
   Ninth.—Between determinations one and eight, frequent
 determinations were made of the  air outside the  vault, as a
 control.
   Two series of experiments were carried out, one in vault
 A, the other  in vault E, that one might serve as a  control
 upon the other.  Of course no agreement is to  be expected
 between the  actual number of micro-organisms  found  in
 corresponding experiments of  the two  series, because  the
 conditions which  influence the numbers  necessarily differ at
 different times; for  example, the gross  amount  of  clothes
 operated upon varies  at each fumigation, the clothes them-
 selves present different degrees of infection, and the amount
 of disturbance to which they are subjected will differ.  Only
 a general agreement, therefore, must be looked for at  certain
critical points. 
1889.]
PUBLIC  DOCUMENT —No.  34.
197
   The  following  tables  represent  the  results  of  the two
series of  experiments : —

                      Table A.  Experiment 1.
a *
Placb of Experiment. — Remarks.
	1888.			
1,	Dec. 9,	0	34	9.45
2,	" 9,	4	19	10.09
3,	'• y,	0	29	10.50
4,	" 9,	3	98	11.04
5,	" 9,	2	13	5.50
6,	" 9,	0	U	6.U5
 9,
10,
11,
" 10,	3	3
" 10,	49	28
" 10,	1	31
" 10,	25	28
" 10,	5	50
8.45 a.m.
9.00
 9.15
10.00
 2.20
Room outside of vault.
Inside of vault;  doors open.
Inside of vault;  clothes on  racks
  ready for fumigation.
Outside of vault.
Outside of vault.
Inside  of  vault, in  presence  of
  sulphur fumes
Inside  of  vault,  after  discharge
  of sulphur fumes;  doors closed
  during the night.
Inside  of  vault;  doors  closed;
  clothes  well shaken.
Outside of vault.
Inside of vault;  clothes all out.
Inside of A~ault;  after repose.
Table E.  Experiment 2.
Time of Day.
Place of Exf-ekimest.— Remarks.
	1888.
1,	Dec. 15
2,	" 15
3,	" 15
4,	" 15
5,	" 15
6,	" 15
9,	" ]
10,	" ]
11,	" 1
12,	" ]
13,	" ]
16,
16,

16,

16,

16,
16,
16,
36	21
19	12
50	11
23	13
9	4
0	2
2	5
3	11
10	4
7	16
3	19
0	7
0	2
9.00
9.15
 3.45 p.m.


 8.30 a.m.
 8.45   "

 9.20   "

10.10   "

11.15   "
 2.00 p.m.
 4.10   "
Outside of vault.
Inside of vault; empty.
Inside of vault; clothes on  racks
  ready for fumigation.
Outside of vault.
Outside of vault.
Inside of  vault, in presence  of
  sulphur fumes.
Outside of vault
Inside of vault, free from sulphur
  fumes.
Inside of vault, after clothes had
  been shaken ;  doors closed.
Inside of  vault, after removal  of
  clothes.
Inside of vault, after repose. 
 198        STATE BOARD  OF HEALTH.        [Jan.


                Description of the Tables.
   The determinations to be  particularly noticed are Xos. 3
 and 8, in table A, and Nos. 3 and 9, in table E.  Determi-
 nation 3 represents the air of the vault after an  enormous
 quantity of infectious clothes had been shaken  and thrown
 upon the racks.   Determinations 8  and  9 show the  same
 thing, after the clothes had been fumigated for several hours.
 Determination 3, in table  A, for some  reason difficult to
 see, gave  negative  results;  but determination  8 of the
 same table  shows that the organisms were there,  and  re-
 tained their vitality  throughout  the  exposure to  sulphur
 fumes.   In determination  3, table" E, the numbers of bac-
 teria were distinctly increased by handling  the clothes, and
 the same treatment after fumigation (determination 9) still
 furnished some germs,  although in diminished  numbers.
 In  both  cases, with the vault undisturbed but  filled with
 sulphur  fumes, the  result  was negative,  as was  to be ex-
 pected.   The subsidence  of  the germs  is shown  in both
 tables, more especially in  table  E, where the experiments
 were extended with that object in view.  The control exper-
 iments on the air  outside the vaults  show  that the results
 obtained within the vaults  were not  due to causes existing
 without.
   It was evident  to  the writer, that, by throwing such a
 large quantity of bed linen upon the racks of the vault,
 much of it  escaped the action of the sulphur fumes ; for,
 with doors and ventilators closed, the atmosphere is " dead,"
 and it would  be impossible for sulphur fumes to  penetrate
 and expel the confined air  between the folds of such heaps
 of materials.  In addition  to  bed linen, a certain amount of
infected patients' clothing, done up in " emigrant  bundles,"
 and tied up in sheets, is fumigated  at each operation.  A
 large  portion  of these bundles is perhaps  not infected with
 the germs of contagion, but is filled with vermin.  A careful
 examination of many of them outside the vault after fumiga-
tion, showed not the slightest smell of sulphur fumes beneath
 the outer layers.   This fact suggested the following experi-
 ments.   Vault E, with closed doors, was  swept vigorously,
 racks dusted, and then subjected to fumigation in the regular 
1889.]     PUBLIC DOCUMENT —No. 34.         199

way; after which the dust was again disturbed, and a deter-
mination of the air made.
  No. 1. — Before  fumigation, floor  swept,  racks  dusted,
vault filled with dust.  Found : bacteria, 33 ;  moulds, 77.
  No. 2. — After  fumigation, sulphur fumes  all out,  vault
quiet.   Found:  bacteria, 0; moulds, 1.
  No.  3.—Floors swept,  racks dusted, vault filled with
dust.  Found: bacteria, 1; moulds, 1.
  The above experiments  demonstrate one of the  practical
applications to which the bacterial determinations of air may
be put.   A determination of the  actual efficiency of a  fumi-
gating agent must be shown by the  more refined methods of
bacteriological investigation; i. e.,  the inoculation  of mate-
rial with known species  or their spores, subjecting the in-
fected  material to  the action of the  fumigating agent, and
subsequent culture  for negative or positive results.  Conclu-
sions are evident: whether sulphur is or is not an efficient
fumigating agent, the method, as carried out here, is worth-
less.

  In the foregoing discussion of the number of micro-organ-
isms in  the various  wards of the  hospital,  we  are  left in
doubt whether the averages presented represent the condi-
tions of the  air from day to day, during the two months
occupied in collecting the data, or whether individual deter-
minations  are true only for the days on which they were
made.   Nor can  we  tell  whether  a single  determination
made at a given time of the morning and afternoon, as in
the experiments, represents a fair average for the day itself.
  Circumstances connected with  a hospital ward, which may
increase or decrease the number of micro-organisms in the
ward itself, do not, we think, materially change from day to
day.  A certain standard of cleanliness is maintained, rou-
tine nursing  is  thoroughly systematized,  the  number of
patients and classes of  diseases vary but  slightly ; so that
each ward becomes  endowed with a character of its own,
to  which  a pretty  constant  number of  micro-organisms
undoubtedly belong.   The  numbers fluctuate  considerably
at  different periods of a single  day, according to  the local
disturbances in the ward ; which throws some doubt on single 
200         STATE  HOARD  OF  HEALTH.       [Jan.

determinations if given  to express the condition of the air
other than at the time of experiment.  I have endeavored to
trace these  variations by  a  series of  hourly experiments,
conducted throughout the hospital day.

                 Hourly Experiments.
  These hourly experiments  were made in the six wards of
the two  three-story buildings, in the two one-story build-
ings, and in one contagious  ward.   Hourly determinations
of carbonic  acid were  also conducted at the same time, to
see what relation, if any, exists between carbonic acid  and
micro-organisms in  the air of these wards.  The experiments
were all made in the centre of the ward, at about the breath-
ing  line.  In  all  previous work the  determinations were
made with the wards in  the  exact condition  in which they
were found ; but in the  hourly experiments  it was  deemed
advisable to keep windows and doors closed  throughout the
day, thus making the wards depend entirely on the mechani-
cal ventilation.  The tables are  of  especial  value  on  this
account, because they represent  the wards  in  their most
unfavorable condition.   All the wards are thoroughly aired
in the morning by open doors and windows, and, according
to the weather, are  open more or less during the day.   This
keeps the air free from disagreeable odors, and the tempera-
ture is to some extent regulated in this way.   The following
sketch of daily routine work  of the hospital ward is given,
as upon this depends  largely the variation  in  numbers of
organisms found at different periods  of the  day.   To  this
must be  added a  considerable  amount of  movement  by
patients.
                 Routine of Daily Ward Work.
7-7.30 a.m. : —
    Breakfast served.
7.30-9 a.m. : —
    Beds made.
    Wards swept.
    Pulses and temperatures taken.
    Sputa cups emptied and cleaned.
    Typhoid fever patients bathed and cared for.
9-9.30 a.m. : —
   Bathing and caring for very sick patients continued.
   Poultices made and applied. 
1889.]      PUBLIC DOCUMENT —No.  34.          201

9-9.30 a.m. : — Concluded.
    Lotions, liniments, etc., applied.
    Nutrient and cathartic enemata given,
    Convalescent patients dressed.
    Physicians1 visit.
9.30-12 m. : —
    Milk, eggnog, etc., given.
    Wards dusted, floors mopped.
    Physicians1 visit.
    Hourly medicines given.
12-2 p.m. : —
    Dinner served.
    Medicines given, floors swept.
    Tables dusted; general care of patients.
    Poultices and dressings reapplied.
2-3 p.m. : —
    Milk, eggnog, etc., given.
    Wednesday and Friday, general bath days.
    Monday, Tuesday, Thursday and Saturday, visiting days.
    Medicines given.
3-4 p.m. : —
    Temperatures taken.
    General care of patients.
4-8 p.m. : —
    Supper served.
    Poultices reapplied.
    Back of patients rubbed with alcohol or starch.
    Milk or other drinks given.
    House physicians1 visit.
    Medicines given.
    Changes of beds requiring it, and other preparations for the night.

   One  of the most interesting facts brought out by  these
hourly  experiments is the  period of high numbers due to the
excessive commotion of the morning, previously alluded to.
This period unmistakably begins at the time of opening the
ward, about 7 a.m., and continues until the ward is in order,
which varies from 9.30  to  10.30 a.m.  The number of bac-
teria in the air varies greatly for this period, in the  different
wards,  for of course both duration and amount of commotion
are variable conditions.  The object sought for by the nurses
is that the chamber-work, so to speak, shall be done as soon
as possible, in order that  the  sick may be attended to, and
the ward made presentable for the morning visit of the physi-
cian or surgeon.   It  seems unfortunate, that, in doing this,
patients should be subjected to bacteria-laden  dust, which is 
202        STATE BOARD  OF  HEALTH.       [Jan.

for a time settling on their beds and person.   This stirring
up of the dust could probably be diminished by  sprinkling
the floor  with some suitable material, wet with a proper dis-
infectant.  It is now  customary,  in some of the wards, to
use sawdust moistened with water;  but it is used so spar-
ingly as to  be of little value.
  This is a question  of removing mechanically the  micro-
organisms,  not  of the air, but  of the room itself; and the
time is never so favorable  as when they are in repose on the
floor and  furniture.  Every accumulation  of a  sweeping
means the elimination of a certain number of organisms ; and
if by any means the dust which  is now scattered through the
air at the period mentioned  could be added to that already
collected by the broom, the  micro-organisms  present  would
soon be reduced to  a minimum.   The tables of hourly work
to follow show that, at the second and third sweeping, which
occurs at 12.30 p.m. and 4.30 p.m., very little dust is  raised,
for the number of micro-organisms in the air are only slightly
increased,  if at all, at those times.   Of the  considerable
number  of organisms present  in the air, in the  morning,
many fall on the beds, some on the  floor, and some  remain
suspended.   Those which settle upon the floor are in part
removed by  the  mopping,  which always follows the first
sweeping, so that very few  remain  to  be  disturbed  by any
cause.   The point at  which commotion ceases  and bacteria
begin to settle out is  clearly shown by the tables.   In the
medical wards F, G, H, the drop in  numbers occurs at 10.30
a.m., and is quite marked.   The time varies in the surgical
wards, being 9.30  a.m. in  B,  10.30 a.m.  in  C,  and 11.30
a.m. in D ;  while in  the medical  and surgical pavilions, wards
T and P, it occurs still earlier, — 8.30 a.m. in both wards.
  There  are  several periods after  9 or  10 o'clock when
slightly increased numbers of bacteria might  be  expected:
namely, at 11.30 a.m., when dinner is served, followed by a
second sweeping; at 4.30 p.m., the supper hour; and again
at 7.30 p.m., when the beds are arranged and patients made
comfortable for the  night.   These occasions give rise  to dis-
turbances  slightly  greater than  those  which  immediately
preceded them.  In wards F,  H, D and T, the  number of
bacteria  were slightly increased at the time of second sweep- 
1889.]     PUBLIC DOCUMENT —No. 34.        203

ing; but wards B, C, G  and P were  not  so  affected.  The
third sweeping does not  appear to  increase the organisms;
but all the wards except F and G showed a slight increase of
bacteria at 7.30 p.m., falling again when the ward was closed
at 8 p.m.  It appears from  the  hourly experiments  that in
general the air from about 10 o'clock assumes practically a
normal condition.   The  figures  seldom quite agree, but a
certain amount of variation must  always be expected in
bacterial examinations of air.
   The number of «iicro-organisms  found by hourly experi-
ments, taken as a standard,  furnishes the means of  demon-
strating the  truth of the  determinations made morning and
afternoon,  but on  different days, during November  and
December.  In the  table below, the  two series are given
for all wards in which hourly experiments were conducted : —
Average of Hourly Experiments, from 6.30 A.M. to 8.30 P.M., January,
                          1889.
	F.	G.	H.	B.	c.	D.	p.	T.	E.
Bacteria,	64	21	43	13	19	19	12	13	7
Moulds,	36	2	12	19	7	10	5	7	6
Average of One Determination, Morning and Afternoon, November and
                      December, 1888.
Bacteria,	■ 41	47	48	16	27	15	14	17	7
Moulds,	. i 5	6	9	10	12	17	11	9	5
  With the exception of the bacteria and the moulds in ward
F, and the bacteria in ward G, the above  figures, consider-
ing the manner in which the data were obtained, correspond
in a manner scarcely to  be expected, and  strengthen  the
opinion previously given, that the bacteria present  in  the
various wards are practically constant from day to day.   By
referring to the figures  below, taken  from the tables which
furnish the above averages, it becomes  at once evident why
the two series for wards F and G do not agree. 
204        STATE  BOARD OF  HEALTH.       [Jan.
Ward F.
Determinations Made during December.		Hourly Detekmixat	OSS.
Time. Bacteria.		Time.	Bacteria.
-	-	6.30 A.M., .	477
7.55 a.m., . . . 104		7.30 "...	106
8.55 "...	77	8.30 "...	162
10.00 "...	56	9.30 " : .	51
10.30 "...	24	10.30 "...	28
Ward G.
8.20 A.M, .	45	8.30 a.m., .	59
9.10 "	56	9.30 "...	56
10.50 "	48	10.30 "...	15
10.35 "	176 i		
  In ward F, the determination at 6.30 a.m. gave 477 bacteria,
a number considerably greater than all others throughout the
day combined ; and in ward G, on December 8, at 10.35 a.m.,
the number of bacteria was 176.   Both these numbers are ex-
ceptional and accidental;  they are due to what Tyndall has so
aptly called "bacterial clouds."  Later, such  " clouds " or
aggregates of  bacteria are probably  uniformly distributed
throughout the air.   By eliminating these two numbers, the
average number of bacteria for ward F becomes 34, in place
of 64 ;  and for ward G, 25, in place of 47.  By this change,
the table of comparative results  for the two series agree in
every case.  Although 477  bacteria for ward F, at  6.30 a.m.,
must be regarded as accidental, moderately high  numbers are
always present at this hour in the male wards, where patients
are stirring about; while in the female wards bacteria are not
stirred up and distributed through the air until the regular
opening up of the ward.
  The  column on the left gives the number of bacteria found
on different days at different hours; that on the right, num- 
1889.]     PUBLIC  DOCUMENT —No. 34.         205
bers found in the same wards at nearly corresponding hours
to the former, but  on the same  day.   The  agreement is
remarkable, and  shows that on any day, at a given time,
the number of bacteria in the air will be  about the same in
these wards.
  The fact that the bacteria take such a sudden drop at about
10.30 o'clock a.m., and then remain practically constant for
the rest of the day,  permits a sharp dividing  line between
bacterial determinations of the morning and afternoon ;  and
shows that, in bacterial determinations of the  air of rooms,
particular attention  must  be given to their condition, the
amount,  duration and character of any disturbing influences,
and the  time and  number  of the  determinations made
accordingly.
  The two tables below represent  the hourly determinations
treated in two ways : First, by making the division at 10.30
a.m.; second, by making the  division at 12.30  p.m.,  and
taking the mean of the two parts in each case.  They require
no special comment.

   Average of Hourly Determinations, from 6.30 A.M. to 8.30 P.M.
					Wards.				
	F.	G.	H.	B.	C.	D.	p.	T.	E.
Bacteria,	64	21	43	13	19	19	12	13	7
Moulds,	. 36	2	12	19	7	10	5	7	6
Carbonic acid,	. .7.10	6.30	8.02	-	5.53	7.05	5.68	5.72	5.62
Average of Hourly Determinations, from 6.30 A.M. to 12.30 P.M.
Bacteria,
Moulds,
121

 47
27

 1
56
16
17
19
16
 4
28
11
20

 4
15

 3
Average of Hourly Determinations, from 130 to 8.30 P.M.
Bacteria,

Moulds,
19
21
15
 3
29

 7
 9
20
21
 9
10
10
 3
11 
206         STATE  BOARD  OF  HEALTH.       [Jan.


   Average of Hourly Determinations, from 6.30 to 10.30 A.M.
Wards.
	F.		H.	B.	c.	D.	Y.	T.	E.
Bacteria,	165	34	63	21	15	24	25	15	7
Moulds,	51	1	21	20	5	11	3	3	4
Average of Hourly Determinations, from 11.30 A.M. to 8.30 P.M.
Bacteria,	11	14	31	9	20	16	6	12	9
Moulds,	28	3	6	19	7	10	5	9	8
  The statement previously made,  that  bacteria  are more
abundant in medical than surgical wards, is also shown to be
true by hourly experiments.   In the  table  below, the aver-
ages of hourly determinations are placed in a manner to show
this, the results for each surgical ward being placed beneath
the medical ward corresponding to it in situation.
Wakd.                    Bacteria.      Moulds.
71	36
13	19
21	2
19	7
43	12
19	10
13	7
12	5
F — Medical, .

B — Surgical,

G— Medical, .

C — Surgical,

H —Medical, .

D — Surgical,

T —Medical, .

P — Surgical. 
1889.]     PUBLIC  DOCUMENT —No.  34.        207

  The following  tables give  the  full data of  the hourly
observations  made  in the various wards  throughout  the
hospital day,  from 7.30 a.m. to 8.30 p.m.
  The charts  were drawn from the data furnished by these
tables and show graphically the fluctuation of carbonic acid,
bacteria, moulds  and temperature in Fahrenheit degrees
from hour to  hour.
  One fact shown by the charts is  worthy of mention here :
the proper time to mop a hospital ward is  about  one hour
after  the general  sweeping;  for the  maximum number of
bacteria appears to be reached just after sweeping and the
minimum at about one hour later. 
208
STATE BOARD  OF HEALTH.
[Jan.

CARBONIC ACID.   PARTS IN 10.000
:i: i  o






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	o BAC7	ERIA.	*	0	8		8	6.	o TEMP.	°.
?

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1889.]     PUBLIC DOCUMENT —No. 34.        209
    Tables of Hourly Determinations.
Ward F (Medical Ward, Male).  Jan. 15, 1889.
Time.	Tempera-ture, Degrees.	1 a S < Q	03	2 3 o	Remarks.	
A.M. 6.30 1 64		5.51 '477		0		
7.30 63		6.17	106	2	Sweeping almost finished.	
8.30 63		7.22	162	2	Bed-making from 7.30 to 8.30; walking about.	"much
9.30 64		6.81	51	25	Second sweeping nearly finished.	
10.30 64		6.40	28	227	Ward in order, and quiet.	
11.30 64		6.13	3	81	Ward quiet.	
P.M. 12.30 64		6.18	19	2	Ward quiet.	
1.30 65		6.50	11	4	Ward quiet.	
2.30 67		6.63	5	31	Thirteen visitors present.	
3.30 65		7.50	20	54	Taking temperatures.	
4.30 63		7.48 10		4	Quiet.	
5.30 66		8.46: 7		1	Quiet.	
6.30 66		8.40	15	42	Quiet.	
7.30 70		11.20 j 8		30	Quiet.	
8.30 66		7.36 j -		-	Quiet.	
Average, .		7.10 63.7		36		
Outs	ideair,	4.99	-			
 
210
STATE BOARD OF HEALTH.
[Jan.
CARBONIC ACID  PARTS IN IO.OOO.
©PS"

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	0	8	$		&		6	—*-5	o	
B	ACTE	RIA						TE	"r	
0 fc	? i	. 0	a		0					
 
1889.]     PUBLIC  DOCUMENT —No. 34.        211
Ward G (Medical Ward, Female). Jan. 24, 1889.
Time.	; = u	a <	~	2 3	Remakes.
A.M.					
6.30	72	8.44	10	0	
7.30	70	6.83	28	0	
8.30	08	7.22	59	4	
9.30	68	5.21	56	1	
10.30 68		4.20	15	0	
11.30 68		5.43	7	1	
P.M.					
12.30 i 68		7.18	14	0	
1.30 69		7.33	11	2	
2.30 68		5.46	30	2	
3.30 : 68		6.15	16	6	
4.30 66		6.55	15	0	
5.30 ! 66		5.09	14	5	
6.30 66		6.94	12	1	
7.30	66	6.63	14	8	
8.30	66	5.92	6	0	
Average, .		6.30	20.5	2	
Outside air,		4.74	-	-	
 
212
STATE BOARD  OF HEALTH.
[Jan.
 1 c
. ™ . p
CARBONIC ACID.  PART5 IN 10
OOO.
 
1889.]     PUBLIC DOCUMENT —No. 34.        213
Ward H (Medical Ward, Male). Jan. 25, 1889.
Tempera-ture, Degrees.		o 2	a	T3	Remarks.
A.51.					
6.30	74	6.58	47	3	Several beds made; patients walking about.
7.30	72	9.39	90	1	Breakfast served ; making beds.
8.30	68	6.91	96	2	Floor swept.
9.30	74	9.48	40	35	Physicians' visit, with twenty-nine students.
10.30	68	6.49	43	63	Mopping floor.
11.30	08	7.62	30	5	Quiet.
p.m.					
12.30	68	7.85	45	3	Sweeping floor.
1.30	68	6.24	13	2	Quiet.
2.30	68	6.85	73	3	Considerable walking about.
3.30	08	7.23	24	10	Quiet.
4.30	68	8.71	-	-	Quiet.
5.30	74	9.37	33	-	Gas burning,
6.30	74	9.24	19	16	Some walking about.
7.30	75	9.47	24	5	Some walking about.
8.30	72	8.89	19	3	Lights out.
Average, .		8.02	43.3	11.6	
Outside air,		-	-	-	
 
214       STATE BOARD OF HEALTH.     [Jan.
			CARBONl'C ACID PART5 IN						10,000		
Pi	In O* «J tt >£ 5 - >*										
0					N						
m 0					; i						
0>					i						
q				/	1						
o				------ <■							
5					\						
8					T i i i I						
i3				/ / /	/						
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-				\							
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(	5	!■	* •!	0	^ c	» ;					
i
0 
1889.]     PUBLIC DOCUMENT—No. 34.         215
Ward B (Surgical Ward, Male). Jan.  3, 1889.
Time.	pr u u S 3 be £ *" O	1 s a <	<s	2 o 3	Remarks.
A.M.					
7.45	63	-	20	6	End window open; making beds.
8.25	-	-	7	30	Making beds ; floor swept.
9.12	-		68	25	End window closed.
9.30	-	-	6	15	Mopping floor.
10.30	-		4	23	Floor swept at 10; a few dressings changed.
11.30	65	-	5	25	Surgeon's visit; ward in order, quiet.
P.M.					
12.30	68	-	8	7	Ward swept before experiment.
1.30	-	-	2	17	Quiet.
2.30	67	-	8	65	Quiet.
3.30	67 .	-	12	44	Quiet.
4.30	67	-	13	6	Supper brought in.
5.30	-	-	4	, 8	Gas lighted; quiet.
6.30 70		_ 2		10	Quiet.
7.30	73	-	34	1	Quiet.
8.30	-	-	2	4	Quiet.
9.30	-	-	2	3	Quiet.
Aver	age, .		13.1	19.3	
 
216
STATE  BOARD  OF  HEALTH.
[Jan.
CARBONIC ACID  PART5 IN IO.OOO.
        o»   >   Q»   o>_____^
 
1889.]     PUBLIC  DOCUMENT —No.  34.
217
Ward C (Surgical Ward, Female).  Jan. 22, 1889.
	a	o	OS		
Time.	!■ £ £	§ s	S	■a	Remarks.
		« <			
					
	h a		B	3	
A.M.

6.30
67  : 4.74!   5
7.30   67  !  4.17 ; 22
8.30	66
9.30	65
10.30	08
11.30	66
P.M.	
12.30	69
1.30	72
2.30	72
3.30	72
4.30	08
5.30	68
6.30	08
7.30	66
8.30	68
4.69

4.19


5.50

5.59



5.48

6.13

6.74

7.29

5.11


6.33


6.78

6.33

3.91
 2

17


31

18



16

 3

19

28

 6


17


16

17

63
Average, .   5.53

Outside air,  4.18
19
 7

 4

 7


 4

 0



 1

 2

10

28

11
6.5
Disagreeable  smell;  close;   patients
  quiet.

Breakfast served.
Floor swept at 8.45 ;  surgical dressings ;
  making beds.

Mopping floor; ward quiet.
Ward swept.
Eleven visitors present.
Transom over  door open during  last
  hour.

Gas lighted at 5 10, twelve  burners;
  patient died, and was removed.
Four patients preparing for bed.

Lights out;  nurse attending to duties. 
218
STATE BOARD OF  HEALTH.
[Jan.
5-5 I I o 30i a o O 00 o o 2°?° N		CARBONIC ACID PARTS IN lO.OOO. +. ' ui Ok >l 9 <©								
		\	\ \ \ \				/		I f 1 /	
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0 ° Tl			i \ \ \ I						I \	
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0 In			I l l i						\ \ \ \	
L* O 0>			\ \						/ 1	
8			i i i i i						I 1 1 1	
0 05			i i i i i	MOUL	D5		o	-vj	00	
8		0 BAC	O TEFU	* ^	8		6	0	o TEMP	
c	> fe	i 4 C	' 8	- 0 C	> 8					
 
1889.]     PUBLIC  DOCUMENT —Xo. 34.
219
Ward D (Surgical Ward, Male).  Jan. 23,1889.
a 3 a
74   7.63

72   6.74
21

26
72   8.3H   18
4 88

8.31

8.32

6.24


6.49
Average, .

Outside air,
 2

 7

13

18
1 /,	u.uu	/.o
68		19
70	9.00	30
68	8.90	72
70	6.38	3
70	5.01	9
70	5.70	13
 3

19

10


17
15

31

 4

 8

 6

 6

15

 6
10.4
Ward in disorder;  making beds; floor
  dirty; very close ; opened end window.

Ward swept about 9.
Surgeon's  visit between  10 and 11; all
  dressings changed.
Patients eating dinner.



End door closed.

End door open.

Supper brought in.

Gas lighted.

Dressed amputation.

Much walking about; patients prepar-
  ing for bed.

Lights turned down at 7.45.
ARMED FORCES MEDICAL LIBRARY
       WASHINGTON. D. C. 
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 &30   930  10.30  1130  12.30

—— BACTERIA PEA IO LITRES OF AJR

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— CARBONIC ACID  PER 10,000 PAfVTS

—TlMPtRAIVRE  0T*M**NH"T)
1.30   2.30   3.30  +30

 TIME  OP DAY.
3.30  6.30   730   0.3O 
1889.]
PUBLIC  DOCUMENT —No. 34.
221
Ward P (Surgical Ward, Male).  Feb. 1, 1889.
Time.	c. £ % a = a a? ■*■* o	a u	a	o	Rkmarks.	
A.M.						
6.30	75	7.54	21	0	Several patients up.	
7.30	74	6.09	26	2	Breakfast served.	
8.30	72	5.63	67	17	Sweeping floor; cold-air inlets a little.	opened
9.30	70	5.39	0	5	Ward in good order. •	
10.30	72	5.95	12	2	Ward in good order.	
11.30	70	5.49	8	2	Some draught.	
P.M. 12.30	70	6.12	5	1	Second sweeping finished.	
1.30	68	5.47	1	3	Quiet.	
2.30	66	5.51	9	6	Fifteen visitors present.	
3.30	63	5.01	2	2		
4.30	65	4.98	4	13	Very quiet.	
5.30	65	6.04	9	13	Fifteen gas jets burning.	
6.30	66	5.56	3	2	Very quiet.	
7.30	66	6.21	11	2	Very quiet.	
8 30	68	4.19	3	2	Lights out.	
Average, .   5.68



Outside air,  4.45
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                                 TIME  OF   DAY.
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UfrHT SOLID LINE:---BACTERIA PER (O LITRES OF AIR,.
  •r  BROKEN " ---MOULDS
HEAVY SOLID LINE——CARBONIC ACIO PER l&OOO PARTS
  •■  BROKEN « —TEMPERATURE (FAHRENHEIT) 
1889.]     PUBLIC  DOCUMENT —No.  34.          223
Ward T (Medical Ward, Male).  Feb. 2, 1889.
Time.		1 3 a <	a	■3 3 O	KEMARK8.
A.M. 6.30	70	7.67	3	2	
7.30	69	5.63	35	2	Making beds.
8.30	70	5.77	27	6	Making beds.
9.30	72	6.16	5	6	Felt close; ventilators in ceiling closed.
10.30	70	5.49	7	1	Felt fresher; quiet.
11.30	70	5.21	3	4	Quiet.
P.M. 12.30	69	5.39	25	3	Some walking about.
1.30	68	5.35	5	28	Some walking about.
2.30	-	5.36	17	12	Some walking about.
3.30	63	5.56	13	4	Taking temperature ; cold ; closed two ventilators in ceiling.
4.30	61	5.44	14	16	Supper brought; closed all ceiling ven-tilators but one.
5.30	68	-	11	15	Fifteen gas jets burning; some work.
6.30	69	-	9	2	Pretty quiet.
7.30	72	-	18	6	Quiet.
8.30	70	-	3	4	Quiet.
Average, .  5 72 j  13   7.4 
224        STATE BOARD OF  HEALTH.      [Jan.
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   H
CAR.BONIC ACID.  PARTS IN  lO.OOO
         +■   Ol   O*.   VI    03
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1889.]      PUBLIC DOCUMENT —No. 34.        225
Ward E (Contagious Ward, Diphtheria).  Jan. 26,1889.
Time.	i OS 00 9 V V m	■e »	s pa	s 3 O	Remarks.	
A.M. 6.30	68	5.38	no	count	E, South.	
7.30	68	4.28	13	5	Making beds ; ward swept;	E, North.
8.30	66	5.00	7	0	E, South.	
9.30	68	6.25	3	6	E, North.	
10.30	68	5.12	4	5	Mopping floor; E, South.	
11.30	66	5.44	17	6	Mopping floor; E, North.	
P.M. 12.30	_	6.58	6	3	E, South.	
1.30	68	5.83	26	17	E, North.	
2.30	-	5.17	12	11		
3.30	70	5.04	10	11		
4.30	-	5.02	7	14		
5.30	72	7.65	9	5		
6.30	70	6.67	3	3		
7.30	-77	5.91	0	5		
8.30	77	4.97	1	4 6.4		
Average, .		5.06	7.2			
Open air,.		3.89				
 
226        STATE  BOARD OF  HEALTH.       [Jan.

         Carbonic Acid and  Micro-organisms.
  Hourly determinations of carbonic acid in the nine wards
examined show a most satisfactory condition. *  According to
the standard usually adopted, the ventilation in all the wards
examined is good, and in most of them perfect.
  Although no relation exists between the amount of carbonic
acid and the number of micro-organisms found in individual
experiments,   the  wards  which showed  the  best average
results in carbonic acid are also freest from micro-organisms.

                        Moulds.
  Heretofore, but little has  been said concerning moulds,
bacteria being, from a sanitary point of view, of much more
importance.   There are fewer moulds present in the air of
the wards than bacteria, and they fail to  fall into line with
them  in their distribution  throughout the  day.  On  the
whole, they fluctuate more than bacteria, and the cause of a
sudden increase  or decrease in numbers   is not  so  easily
traced to causes  within the room.   The stirring up  of  the
dust by sweeping and bed-making does not appear to materi-
ally increase their number, for where an increase  in bacteria
from such causes is most marked, the moulds  are conspic-
uously absent; when an increase does appear to be due to
sweeping, etc., the rise in numbers'always follows later than
the bacteria.   The fact  that these large disturbances do  not
increase the  number  of moulds,  shows that they have  not
subsided, and illustrates the well-known fact  that moulds
are relatively lighter than bacteria, and consequently do not
settle out so readily.   The great buoyancy of moulds is also
shown by the determinations  made in the basements, where
disturbiDg  influences  seldom enter,  and yet comparatively
large  numbers were always found suspended in the air.
  While the  bacteria are distinctly greater in numbers  dur-
ing the morning, moulds, on the other hand,  show a ten-
dency to increase  in the afternoon;  thus, in  the  nine wards
examined by hourly  experiments,  the moulds in  six  pre-
dominate in the afternoon.  It is probable  that the moulds,
being so light, are kept suspended longer  in the  upper por-
   • Pettenkoffer's method was employed in all determinations of carbonic acid. 
 1889.]      PUBLIC DOCUMENT —No. 34.        227

 tions of the room by the commotion  of the  morning.   This
 condition being removed, the tendency is to fall;  but if met
 by air currents of sufficient force, they again take an upward
 course,  and thus cause  the  fluctuations so frequently met
 with.
                       Conclusions.
   The results obtained from  buildings of the hospital group
 occupied by employees,  investigated for the sake of com-
 parison with the wards, taken  together with the results fur-
 nished  by outside air, furnish abundant proof that the air
 of the  hospital  is remarkably free from micro-organisms.
 Whether the numbers found are greater or less than would
 be found in similar institutions, is not known.   So far as I
 am familiar with the work of other investigators in this field,
 the  results show that hospitals of this class, as compared
 with other buildings,  will take first rank in the freedom  of
 their air from micro-organisms.
   This  is  as it should be :  bacteria, in a way, represent  so
 much dirt.  In a well-managed hospital, one has an approach
 to an ideal degree of cleanliness, and in no class of buildings
 is the same care taken to secure freedom from dirt as is taken
 in such a hospital.  Undoubtedly, the systematic, thorough
 renovation which is going on continually in the hospital, is  of
 great importance in removing accumulations of germs, which
 must inevitably  occur in  the wear and tear of a building.
 This hospital is particularly fortunate  in  this respect; with
 its large tent service, wards in turn can be vacated  during the
 summer months, and put in thorough repair, to an extent
 not otherwise possible.
   In this connection, it will be interesting to reproduce some
 valuable tables prepared  by Prof. Thos.  Carnelly  and his
 colleagues,* showing  the  number  of micro-organisms in the
 air of clean and unclean buildings  in Dundee.
                                                  Bacteria in
                                                 10 litres of air.
    One-roomed houses, clean.......180
                    dirty,......410
                    dirtier,......490
         «      "   very dirty,   .....   930
  * I take great pleasure in referring the reader interested in this subject to  the
work of Carnelly, it being the first  attempt, so far as I am aware, to systematically
determine the number of micro-organisms in the air of buildings. 
228
STATE  BOARD OF  HEALTH.
[Jan.
Naturally ventilated schools, cleaner,
   "       "       "   average cleanliness,.
   "       "       "   dirtier,
Mechanically ventilated schools, cleanest,
     "         "      "   clean, .
     "         "      "   less clean, .
 Uncti-ria in
10 litres of air.
   910
 1,250
 1,980
    30
   160
   300
  These results leave no doubt that the cleanliness of rooms
and of persons also is of the greatest importance in prevent-
ing accumulations of micro-organisms.   It  will be  noticed
that the numbers found in mechanically ventilated schools are
far less than for those ventilated  naturally ;  but the results.
as a whole, both in schools and dwelling-houses, are  enor-
mous,  as compared with those obtained in this hospital. On
the other  hand, Carnelly found in the wards of the Dundee
Royal  Infirmary, between 4 and  5 o'clock p.m., from  ten  to
twenty bacteria.   Neumann (Vierteljahrsschrift f.  gerich-
liche   Medicin,  1886.    B. 14,  p.  30) made  thirty-five
experiments by Hesse's method.   At different elevations,
from   1.40  to  3.20 metres,  about  the same  number  of
organisms were found.  In the morning,  after sweeping,  10
litres of air gave from 80 to  140  bacteria, while four con-
secutive determinations at the same  height showed a  gradual
decrease;  the last examination, at 8 p.m., giving  from 4
to 10 bacteria.
   The results obtained in both  the above  hospitals are  in
perfect  accord  with   those obtained  in  this investiga-
tion.
   The  extent of vitiation which the air  of  dwelling-houses
may reach  is  further shown  by determinations  made  by
Carnelly, on one, two and four roomed houses,  between
12.30  and 4.30 a.m.
One-roomed houses,

Two-roomed houses,

Four-roomed houses, and more, .
	Bacteria.	Moulds.
580		12
430		22
	160	10
 
1889.]     PUBLIC DOCUMENT —No.  34.         229

  When it is remembered that the air of the Boston City
Hospital is practically  free  from bacteria  at the  hour of
midnight, the above results, representing the condition of
the air breathed by human beings, is certainly startling, and
goes far to show  the value of the information furnished by
such determinations.  The atmosphere of a building vitiated
by micro-organisms can be  so readily brought at least to a
moderate state  of purity, by a proper  degree of cleanliness
and oversight, that there is no legitimate reason why the air
of public buildings should reach the condition  of vitiation
shown by  Carnelly's experiments, in certain buildings in
Dundee.
   In  any comparison of the  number of micro-organisms
found in the  air of a hospital with those of other buildings,
allowance must of course be made  for the fact that a very
small number of organisms found in hospital air, if patho-
genic, might be  more  dangerous  than large  numbers of
non-pathogenic forms found elsewhere.  The great majority
of micro-organisms found in air  are probably harmless ; but
their functions  as yet are so  imperfectly understood, that it
would  seem unwise to consider them entirely harmless.
Many of them evince a power in the  decomposition of the
various culture media,  which is suggestive of what  might
happen in or upon the human system, should they find  there
a suitable nidus for development.  Although no attempt was
made in this investigation, except in a very general  way,
to  determine the character  of the germs  present, it was
found  that the same species which occurred in the outside
air were met with in the hospital; but certain  species were
met with in the hospital that were not found in  outside air.
In  the  ward devoted to diphtheria,  species were always
fewer in number than elsewhere, and the  colonies were not
unlike those obtained from  the material furnished by the
patients themselves, although no proof of their identity was
obtained.  The  presence  of pathogenic bacteria  has fre-
quently  been demonstrated in the air of hospital wards ; for
example, Cornet,  of Koch's Hygienic Institute, found bacilli
tuberculosis  in fifteen  out of twenty-one  wards in  seven
hospitals in  Berlin, and out of ninety-four animals inocu-
lated, twenty died of tuberculosis.  Von Eiselsberg (Langen- 
230        STATE  BOARD OF  HEALTH.    [Jan.'89.

beck's Archiv. B. 35, heft. 1), in an erysipelas room  of the
hospital, found erysipelas cocci; also, in  a  surgical ward,
where wounds  were treated  under  aseptic precautions, the
presence of Staphylococcus  Pyogenes Aureus was  demon- •
strated.   Emmerich  (Deutsch. Med. Wochenschrift, 1887,
No. 3) not only found erysipelas cocci in the air of an old
dissecting  room, but also in the plastering and  walls  and
ceiling.
  In this connection, it  should  be  stated  that the ordinary
methods employed in the cultivation of the germs  of the air
would  fail to  reveal  the presence of  certain  pathogenic
bacteria, as, for example, bacilli tuberculosis; such  forms,
however, are not difficult to determine by  special  means.
Pathogenic bacteria are as likely to  exist in this hospital as
in any other, and probably  do exist;  but it is worthy of
note that the general health of employees  is excellent, that
contagious diseases are seldom contracted by them, or by pa-
tients themselves, although isolated cases occasionally occur.
  The  importance of obtaining definite information regard-
ing the dangerous or innocuous character of micro-organisms
found in the atmosphere  is evident;  but, until methods are
so amplified  that species can be identified with  a greater
degree of certainty and far less expenditure of time than at
present,  we must be content with  a  determination  of the
number and distribution  of bacteria in the air of buildings.
  Carnelly has proposed a standard for the air of dwellings
and  schools; i.e., twenty micro-organisms per litre,  or  two
hundred per ten litres (excess over outside air), — numbers
so greatly in  excess  of all results obtained in this hospital
as to make evident  the  necessity of a standard  for various
classes of buildings.
  The air of  this hospital  compares favorably with the
external air.   In the absence, then, of a standard of purity
for hospital air, it would not be  unreasonable to require that
the number of micro-organisms in  the  air of a ward should
but slightly exceed the numbers found in outside air.
  In conclusion,  the  writer wishes to  express his gratitude
to the trustees of the hospital  for  aid in carrying on this
work, and to the superintendent, Dr. Rowe, for encourage-
ment in the undertaking. 
 
 
 

 
 
WA T892n 1889




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