USA > Massachusetts > Middlesex County > Newton > Town of Newton annual report 1891 > Part 11
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It will be seen that the results obtained in the male ward were similar to those in the "Georgia Leeson." Upon examina- tion it was found that the ventilating flue of the chimney had steam heat inside, with an upward current, the velocity of which was 775 feet per minute. But the air which sped along upward at such a great velocity was taken from the cellar or basement, and not from the ward where it should have been. There were two causes for this : 1st, a large opening in the brickwork of the flue around the ventilating boxes, and 2d, the open joints and right- angled changes of directions in the wooden flues or boxes. The air of the basement was very warm and stifling and this was being delivered into the ward and into the ventilating flue. My recom- mendations here are the following: To change the wooden ventilating boxes to galvanized iron ones with elbows and curved bends as before recommended for the other ward ; to introduce a "Bunsen " gas burner for the summer heating of the ventilating flue, and to make tight all brickwork around the ventilating boxes as they enter the chimney flue.
I feel that the rooms which contain the water-closets, slop- sinks, and bath-tubs ought not to have a direct entrance from the wards, as the air in these rooms cannot be as pure as that which
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the patients ought to have. I therefore recommend that the en- trances marked DW in my sketches (pp. 23 and 25), be walled up. This would necessitate the opening of new corridors to con- nect the wards with the bath-rooms, which can be easily done by giving up the use of a private room in each case.
As there is no ventilation provided for any of these rooms except the bath-room for the male ward, I would recommend that a separate ventilating shaft be put in, having the same ap- pliances for creating a circulation as I have already recommended. The rooms opposite the matron's I would recommend to be ventilated in a similar manner.
There is a ventilating flue in the chimney of the nurses' dormitory, or former female ward, which I recommend to be put into proper condition and utilized. Also, that the indirect radiation from the registers be put into proper working order.
I would also recommend that the ventilation of the "chil- dren's" ward be extended and put into good working order.
I also recommend the placing of mixing dampers so that the temperature of the warm air brought into the various wards and dormitories can be regulated by the nurse or attendant in charge of the ward ; also that a larger amount of fresh cold air be supplied the heating radiators.
I also recommend that some guard or device be placed near the monitor roof ventilation to prevent the driving storms from entering the garrets and spoiling the ceilings or leaking into the wards.
In order to insure the working of all ventilation, I recom- mend the purchase of an Anemometer and also of a " Wolpert " air-tester, and that the nurses be instructed in the use thereof. Under the present arrangements an immense volume of heat is being poured into the cellar and basements and lost for any useful purpose.
DISINFECTANTS.
As typhoid is the only disease classed among contagious diseases that is admitted into the hospital, I will consider this question more particularly from this one stand-point. For the disinfection of the stools etc., I recommend the use of chloride of lime in its pure state, which is only obtainable when it is fresh.
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REPORT OF BOARD OF HEALTH.
There should be as nearly 30 per cent. of chlorine as possible in the article used and this standard deteriorates very rapidly when exposed to air and heat. With a little instruction and ingenuity I think the hospital would be able to provide its own chloride of lime, and thus insure its strength.
Some of the lime should be placed in the vessels before receiving the stools, and afterwards the stools should be covered with the lime and allowed to stand two or three hours before being sent to the cesspool.
For the clothing, I would recommend that it be soaked in a solution of bi-chloride of mercury (1 to 500) and after soaking for an hour, thoroughly boiled.
At least once a month I recommend the disinfection of the cesspools by the use of copperas and bi-chloride of mercury.
Once in two weeks I recommend the cleansing of all waste pipes by crude-potash flushed down by hot water, followed by copperas dissolved by boiling hot water for disinfecting purposes.
The use of bi-chloride of mercury is to be carefully looked after on account of the danger of cating away the iron waste pipes.
: For cleaning of bath-tubs, all marbles, enamelled iron, and general crockery-ware of plumbing etc. I recommend the use of dry table salt.
I would also recommend the use of permanganate of potash for deodorizing the water-closet bowls, slop-sinks etc.
OUTSIDE INFLUENCES.
To the north of the Hospital are several stables, most of them being controlled by Mr. Thompson. The stables used for his horses are in generally good condition and no fault can be found with them at the present time. There is also a cow-barn which is not as clean as it might be when I visited there. The manure is dropped underneath the barn, and to the eastward is open and exposed to the air. The manure from the other stables is piled on the ground to the north of the cow-barn. Every rain and thaw of snow carries liquid from this pile of manure over the surface of the surrounding land, and under the right conditions of weather I should suppose might create considerable odor.
Near this cow-barn, on the hospital grounds is a shed which is also used for stabling purposes, with the manure thrown out on
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the ground towards the hospital. I would suggest that the hospital stable be moved to a more suitable place with proper manure pit provided.
To the west of the hospital on the opposite side of Washing- ton street, Mr. Gleason[has been keeping six pigs. The Board of Health have notified him that"after the spring killing, the keeping of pigs will be regulated by them, so that no further re- commendation is necessary.
I have recently learned that the contents of cesspool wagons have been used for fertilizing purposes on the fields north-west of the hospital. I have no doubt that the Board of Health will see that this is prevented in the future.
In conclusion I desire to thank Mr. Coon, Miss" Peters and all who have aided me so materially in these investigations, and for the many_kind acts and courtesies received.
Respectfully submitted, W. S. FRENCH, Agent of Board of Health.
This report was approved by us and forwarded to the Executive Committee of the Hospital for their consideration. Many of the changes and recommendations contained therein have been carried out, and had it not been for financial troubles and lack of means, it is to be presumed that the others would have been.
The most important change inside the buildings has undoubtedly been the improvements made in the ventilation of the "Georgia Leeson " Ward, and the construction of a typhoid disinfecting closet for the same ward.
This Board was requested to allow its Agent to super- intend the work of changes, etc., but this could not be done. He was, however, authorized to give any assistance that he could towards securing the desired results. Upon farther examination, our Agent recommended the introduction of a mechanical system of ventilation instead of what was recom- mended in the report. This also met the views of the State Inspector more fully. A contract was therefore made by the
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Hospital with Mr. Gosline for alterations in the ventilating system. A large 24-inch Blackman fan-wheel was placed at the foot of the ventilating chimney. The foul air ducts leading from the ward to this chimney were all reconstructed, being made of galvanized iron graded in size, and as much friction as possible done away with. The fresh air boxes were also reconstructed and mixing dampers put in. To operate the wheel a small "Otto" gas engine was placed in the basement. The foul air is drawn out of the ward from underneath the beds through the ducts to the chimney by means of the wheel, and is then forced out of the chimney by the same power. The experiments which have been made show that this is done so that no draught is made at any place and yet all the air in the ward is operated upon. Before the absolutely final results can be definitely reported upon, another series of experiments must be made under similar conditions as to temperature, etc., as those existing at the time the defects were discovered.
A new passageway to the bath-room was constructed by giving up one of the private rooms. In this corridor was partitioned off a closet, extending to the open air at the top, lined with tin and all the joints soldered. A large Bunsen burner was placed inside so as to insure an upward draught, the air supply being taken from below. All typhoid dejecta is brought here and thoroughly disinfected before being sent to the cesspool.
The results obtained in the Georgia Leeson Ward serve to emphasize the imperative necessity of similar changes in the other wards and the nurses' dormitories, and now that the Hospital is reported to be out of debt, it is to be hoped that the money will be forthcoming for these much needed improvements.
A new and large cesspool was constructed for the drain- age from the " Leeson " Ward and the new private patients building, which greatly relieves the old ones. An overflow
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drain was also constructed from the old cesspool "C." It is hoped that these measures will obviate any farther trouble with the cesspools until the public sewer is built.
Hospital for Contagious Diseases.
The buildings for the care of diphtheria, scarlet fever, and small-pox, which were in process of construction at the time of our last report, have been completed and put into use. All cases have been cheerfully taken care of by the staff and nurses of the Cottage Hospital.
In the early part of the preceding year the ground plans had been submitted to this Board and received its approval. No detail plans or specifications were ever shown to us, and so far as we know, to no representative of the City Govern- ment. No person having been designated by the City Council to see that the buildings were completed in a manner suited to the use for which they were to be put, this Board felt justified, as the parties directly interested, in trying to carry out the latest ideas and methods of hospital construc- tion.
In order that our own observations with reference to ventilation might be reinforced by expert testimony, Mr. J. H. L. Coon, State Inspector, was requested to give his opinion upon the heating and ventilating of these buildings. He unhesitatingly pronounced them inadequate if at any time in cold weather, the wards should be full. With only one or two persons in a ward at a time, they would probably be sufficient, as also in warm weather when windows can be opened.
Our Agent, after receiving instructions from us, made a careful examination of the buildings to be used for conta- gious diseases, and presented the following report, which was approved and forwarded to the Building Committee of the Hospital.
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REPORT OF BOARD OF HEALTH.
To the Building Committee of the Newton Cottage Hospital.
GENTLEMEN :
As the buildings for the care of contagious diseases are not yet completed, and as the Board of Health of the City of Newton feel that you are desirous of obtaining the best results possible, after visiting the premises and considering the results to be reached, they have instructed me to prepare a report in their be- half, under the general supervision of Dr. Baker, suggesting such changes and improvements as are desirable to insure their suc- cessful operation.
In accordance with these instructions I have examined these buildings and would submit the following for your consideration :
SMALLPOX WARD.
It seems to me that due consideration has not been given to the fact that whenever this ward is put into use it has got to be- come the home of the nurses and patients therein, and that they are cut off from all intercourse with those outside. For that reason probably there will be more suggestions with reference to this ward than for the others.
As will be seen by reference to my report on the original buildings, I object decidedly to the rooms containing the water- closets, opening directly out of the wards. I therefore recom- mend that the present entrances to those rooms be walled up ; new ones made where it was formerly proposed to have windows ; additions made on each side to the ell containing the water- closets with entrances from the wards through into the closets. I would also recommend that a swing door be placed in the partition between the two closet rooms, and that one of the water- closets be changed to a slop sink of the same pattern as used in the diphtheria and scarlet-fever wards. I also recommend the
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putting in of a sink similar to those used in the dietaries, in the room used for the slop sink.
No provision has been made for a diet kitchen. As the nurses will be obliged to cook their own meals as well as those of their patients, this is very essential. I would recommend that an addition be put on the front of the building to contain a kitchen and an additional passageway wherein a linen press (similar to the one just built for the male ward of the main building) can be placed, also closets for patients clothing. As accessories of the kitchen, I would recommend a good sized range with a water- front and an ordinary house boiler connected therewith. I would then recommend the supplying of the slop-sink. the ward sink in the same room, and the dietary with both hot and cold water.
No provision was made for a laundry. I would therefore recommend the putting in of a laundry in the basement of the ell, below the water-closet and slop-sink rooms, and that the same be connected by means of stairs and a trap-door. I understand that a suggestion has been made to place a laundry under the diet kitchen. There are quite serious objections to this and I hope that it will not be longer considered.
There should also be some small room or tight closet pro- vided for the proper disinfection of the patients clothing, etc. This can be done in connection with the laundry, I should think, with the entrance to the closet from the outside.
The only method that has been provided for heating and ventilating this whole building is by the fireplaces in each ward. This disease is one of the worst that we have for foul emanations and everyone will admit that this is one of the most vital ques- tions in a hospital ; I would therefore recommend that this subject be referred to a committee, consisting of the architect, some mem- ber of the Board of Health, and one other whom you may select, with full power to put in such a system as will meet the require- ments of the State Inspector.
I most unhesitatingly condemn the present scuttle openings in the ceilings of the wards as I have previously done in the other contagious wards.
DIPHTHERIA AND SCARLET FEVER WARDS.
The system of ventilation as designed for these buildings has
REPORT OF BOARD OF HEALTH. , 35
been pronounced inadequate by the State Inspector. No ventila- tion whatever is provided for any of the rooms adjacent to the wards or for the rooms in the central building. The rooms in the central building will probably be in constant use night and day if both scarlet fever and diphtheria are being treated at the same time. Ventilation should therefore be provided for these rooms if possible, and also a room or place provided for the proper airing of the bedding, etc. of the nurses.
I would therefore recommend that the subject of heating and ventilating in these buildings be referred to the same committee as before, with a recommendation that the indirect system be used, as upon investigation this seems to be feasible.
The plumbing is undoubtedly as good as can possibly be obtained and meets with hearty approval.
The drainage of the buildings if finished in accordance with the system at present designed, will undoubtedly be ample and sufficient for all purposes.
There should also be provided a good sized brick vault or chamber properly fitted up for the disinfection of articles by steam, or dry heat at a high temperature. I would recommend that this be placed under the scarlet fever ward, as that disease needs it as much as any.
MORGUE.
The proper and successful conducting of an autopsy requires an over-head light both day and night. I would therefore re- commend that this be introduced. It will also need some pro- vision for drainage.
In conclusion, while you may consider that many of these recommendations are unnecessary, we must remember that every nurse who enters upon the duty of caring for patients having con- tagious diseases, exposes her life and health. It is therefore in- cumbent on us to see that every convenience or safeguard possible is provided for the welfare of those who are unfortunate enough to be obliged to use these wards, and I trust that they will all meet your cordial approval.
Respectfully submitted,
W. S. FRENCH, Agent of Board of Health.
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REPORT OF BOARD OF HEALTH.
Some of the changes recommended in this report have been cheerfully made. No change, however, has been made in the heating and ventilating. The method adopted for the disposal of the sewage from these buildings, contemplated the introduction of a system similar to that which has been in successful operation at the Prospect School, Upper Falls. The receiving and settling tanks are now used as tight cess- pools, and must of necessity be frequently opened and emp- tied. It was intended, however, that they should be inter- mittent and automatic in their action, discharging by means of siphonage into porous tile drain pipes branching in various directions, and running off into the field below. It is to be hoped that the system will be completed and the remaining changes made at an early date, for these buildings supply a necessity that was long felt and that cannot be procured at a moment's notice. We would especially recommend also the introduction of disinfecting closets.
These buildings will prove to be of inestimable benefit, the more that our citizens realize that here they can secure treatment and care far better than can be given in any pri- vate house, especially in severe cases where steam is required, or tracheotomy is to be performed.
Disinfection.
The same policy with reference to the care of infectious diseases has been pursued as in former years. The houses have been placarded, and upon receiving notice from the physician that the premises were ready, they have been thoroughly fumigated. So far this work has proved very efficient. No better evidence could be asked for than the results obtained in the Barnard, and later on, in the Mason and Rice Schools. In the Barnard School, scholars in the process of desquamation were sent home by their teachers. It could not be told how much infection existed there, nor where. Every scholar was threatened, through the use of
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REPORT OF BOARD OF HEALTH.
books handled by infected scholars. Immediately upon clos- ing the school, such books as were known to have been in the hands of the infected were burned. All of the others were spread open as much as possible, on top of the desks, all the inner doors thrown open and the building fumigated from cellar to garret, about four hundred pounds of brimstone being used. In about 18 hours the building was thrown open and aired. Then a force of nine or ten individuals was put to work and every inch of the building was washed in a solution of corrosive sublimate. The pens, rulers, etc., were dipped in a similar solution, and the books were thor- oughly dusted and brushed. When through, the teachers were proud of the cleanliness of their building, as were also the teachers at the Rice and Mason schools which were treated in the same manner. No cases were developed in these schools after this disinfection and the threatened epidemic of scarlet fever averted. Could a private house be handled in the same manner, the results that could be ob- tained in preventing disease would be wonderful. The ex- perience in these schools points us to the great danger that exists in the interchange of books and other school property which comes from the city's ownership of the same. While we do not wish to advocate the repeal of the present law be- cause of any danger of infection that may come from such interchanges, yet it would seem advisable to reduce this danger to its minimum, and in some way have each scholar use the same set of books, etc., during the year.
No housekeeper would feel satisfied with having her house cleaned in the manner that our school-houses are cleaned in the summer. As carried on at the present time, the summer cleaning, done just before the re-opening of the schools, is an optical delusion-an attempt without the reality. As long as the schools have been clearly shown by not only our own experience but that of other places, to be the starting point of a great many cases of infectious disease,
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it is especially recommended that every school-house in the city be put through the same thorough disinfection each year in the summer vacation as has been herein described, with the addition of a coat of whitewash to all the cellar walls.
Ashes.
The removal of ashes is in charge of the Highway De- partment and under the immediate supervision of the Super- intendent of Streets. Many of our citizens are of the opinion however, that it is conducted by this Board, as the receipt of occasional letters relative thereto have shown. At the proper time it may be deemed advisable to unite this work with others, bringing it all into the Health Department. The work has been done in its usual satisfactory manner.
Dumps.
The condition of the dumps in the city had been the cause of much complaint and a great deal of criticism. The Board accordingly put a man to work in the spring levelling them off, and burying all objectionable matter. He has been kept steadily at work and the improvement and benefit which has accrued have shown the wisdom of this proceeding. The Board accordingly asked for and obtained an appropriation to continue the work during the coming year.
Drainage.
During the year but one petition under what is known as the "wet land act," has been presented to this Board. It was that of P. Cox et al., for the abatement of an alleged nuisance on the south side of Prospect street, Ward 3. The Board upon' examination did not feel called upon to proceed any farther under this act, but have been abating the trouble through other means and the work is now very nearly ac- complished.
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REPORT OF BOARD OF HEALTH.
In December 1890, this Board received an appropriation and passed the necessary orders for the drainage of what is known as the Mague Meadows and adjacent district. As it was too late to do the work that year, the City Government of 1891 re-appropriated the money and the work has been nearly completed. When finished, it will form no small part in the surface drainage of this vicinity.
The Bullough's Pond district needs a systematic plan of drainage and cleaning, not only as a matter of development for the city, but as an actual necessity for the benefit of the people in that neighborhood.
As the surface drainage of the city has got to be con- sidered entirely independent of the sewerage system, this Board will undoubtedly receive petitions from time to time under the provisions of the "wet land act." The Board would therefore renew its recommendation for the establish- ment of a loan to be drawn upon in a proper manner through your honorable body.
Glanders.
Evidence is rapidly accumulating that this disease is far more prevalent in the state than has been admitted. As a rule all possible efforts are made to conceal the existence of the disease and to quietly dispose of the animal. If the animal is immediately killed and the stable is properly dis- infected all public ends are satisfied, as far as trying to pre- vent the spread of the disease is concerned. But the Board of Health should be promptly notified and enabled to pro- nounce upon the thoroughness of the disinfection. This disease is altogether too dangerous not only to animals but to the human race to allow financial consideration to prevent the carrying out of measures to stop the spread of the disease.
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REPORT OF BOARD OF HEALTH.
No absolute rules for the guidance of Boards of Health, or of individuals, relative to disinfection, have been prepared by the State Cattle Commission, but we are informed that this defect will be remedied at an early date.
The Board will aid all proper endeavors to keep the knowledge of any case from becoming public, but it intends to do its whole duty and enforce compliance with all regula- tions relative to notification and isolation, even to prosecution, if found necessary.
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