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The fourth chapter, “Innovations,” discusses the environmental challenges in a rapidly urbanizing London, the capital of the largest empire of the modern period. It explores the early innovations in dealing with excreta disposal, including the creation of an underground sewer system and efforts to use the highly dilute sewer effluvia as fertilizer. The direct health benefits of modern sewerage alone were modest. Many smaller and less wealthy cities and towns opted for other methods of human waste disposal, including the tub-and-pail system. Much infectious intestinal disease was the result of pathogen-laden flies alighting on food and the contamination of the urban milk supply. The major reductions in mortality and morbidity from intestinal pathogens came about as a result of the filtration and chemical treatment of drinking water with chlorine or ozonation.
Chapter three, “Diffusion and Amplification,” discusses the long era in which pathogens and parasites were extended to new regions. As human communities became more complex, networks of trade expanded and became denser, allowing for the rapid, long-distance transmission of intestinal pathogens. Over the first millennium and a half of the Common Era, the disease pool of Eurasia and northern Africa became increasingly integrated. In the late fifteenth century, some Old World intestinal pathogens crossed the Atlantic and became established in the Americas. By the early nineteenth century, the integration had become global. Rapid urbanization in the industrializing North Atlantic states created a crisis of urban fecal pollution. In response, the first public health reform movements emerged. Beginning in the first half of the nineteenth century, cholera pandemics spread along global trade routes and infected all the inhabited continents. This provoked the first efforts at the international control of disease.
The purpose of this paper has been to investigate the vulnerability of staff in an Irish district lunatic asylum (1869–1950) to infection and injury as exemplified by the records of Monaghan District Asylum (renamed Monaghan Mental Hospital in 1924 and St Davnet’s Hospital in 1954). Some comparisons with other Irish district asylums are included.
The Minutebooks of Monaghan District Asylum, located in St Davnet’s Complex, Monaghan, were sampled in December of each year from 1869 to 1950 with the sampling extended outwards as required. In addition, the reports on the District, Criminal and Lunatic Asylums in Ireland (1869–1921) and the annual reports of the Inspector of Mental Hospitals (1923–2013) were surveyed for comparisons.
Staff in Monaghan District Asylum were vulnerable to infection from contagious diseases including typhoid, tuberculosis and Spanish influenza. As with other Irish district asylums, overcrowding was the norm and isolation facilities were either absent or inadequate. The close proximity of staff to patients in an overcrowded and frequently insanitary institution placed them at increased risk of contracting disease. Moreover, staff at all levels, from resident medical superintendent to attendant, were, on occasion, at risk of injury from patients. The Monaghan experience would seem to indicate that any consideration of staff patient relationships within asylums should be nuanced by a consideration of the risks posed to staff due to their occupation.
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