Added to the many other gratifying signs of a rapidly increasing interest
in the all-important subject of the proper supply of pure air to our
houses, is the awarding of the grand prize of the Paris Exhibition to
Dr. Evans, for an American sanitary collection.
The Sanitary Commission, during our late war, acted upon the principle
since expressed by the report of the Board of Health of New York. They
say: "And viewing only the causes of preventable diseases and their
fatal results, we unhesitatingly state that the very first sanitary want
in New York and Brooklyn is VENTILATION--ventilation supplied in all
existing tenant-houses, work-rooms, school-rooms and places of
assemblage--and in all that shall hereafter be constructed."
The early recognition during the late war, both by the Sanitary Commission
and the government officials, of the important fact that many more men are
killed by breathing foul air than are killed by the enemies' bullets, led
them to use very active exertions to secure good ventilation in hospitals
and camps, and to teach the men themselves the value thereof. The result
has been highly satisfactory. The fact that we must make some positive
provision for a constant supply of fresh air to every occupied room,
and not rely on accidental cracks and openings, is now very generally
felt. The simple, practical and efficient means used by the government
has done much towards creating this wholesome public opinion.
The annexed plan (excepting a stove and twelve beds, omitted from
centre of plan, indicated by the space) is a copy of one I furnished
the Committee; and which was faithfully executed in preparing one of
the models of hospitals, the arrangements of which have been so highly
appreciated, and has shared one of the grand prizes at the Paris
Exhibition.
It is a representative plan, showing the general arrangements of wards
in a large number of the hospitals.
[Illustration: Fig. 1.]
The special arrangements of flues, V, for winter ventilation, and the
introduction of the fresh air around the stove, were not introduced into
the hospitals in Philadelphia, built at the commencement of the war. And
the subsequent orders of the Surgeon General and Quarter Master General
for the introduction thereof were protested against by the Surgeons of
Philadelphia, owing probably partially to their proverbial objection to
changes of any kind, and partially to that dread of "ventilation" made
but too popular by the many erroneous theories which propose to introduce
the fresh air directly into the room, and at times, too, when it is even
below the freezing point, without first warming it. These arrangements,
shown in the accompanying plan and section, were thoroughly tested,
however, in many of the hospitals subsequently built in many of the
Western cities.
The plan of ridge ventilation, shown in the accompanying section, I
applied first in St. Louis, in the summer of 1863. It is the principle
of the Emerson ventilator applied to ridge ventilation. Much trouble
had been experienced with other forms on account of their allowing the
storms to beat in, and the difficulty of opening and closing them with
the various changes of wind; this form fully remedies those objections,
and can be left open without inconvenience at all times while snowing
or raining. It uses the force of the wind, whenever there is a current
passing over the top of the building, for sucking the air out of the ward,
because the air in passing across the top of the building is deflected
from the straight line by the angle of the roof-board, which creates a
partial vacuum in the space below, which, with the friction of the passing
current with that coming out of the ward, makes an outward draught,
varying in proportion to the velocity of the external current. This is
often very useful, especially in summer, when there is not sufficient
difference between the external air and that in the ward to create a
current. There is often a considerable force in the passing current at
the top of the building when there is much less below.
[Illustration: Fig. 2.]
But of course these openings had to be closed in winter to prevent all
the heat from escaping. It then became necessary in wards that had no
fireplaces, to make something as substitutes therefor. Wooden shafts or
flues were made to answer this purpose.
I at first made large wooden boxes, placing them in the centre of the
wards, and allowing them to extend down to within twelve or eighteen
inches of the floor. This was of great advantage, but as the true principle
of ventilation is to have an opening for the exit of the contaminated
air at the feet of each occupant of a room, or at the head of the bed
of each patient in a hospital, it was soon observed that these shafts
were too few and far between to make a very perfect arrangement.
The necessity for providing for the escape of the foul air from the
level of the floor in winter, so as to utilize the heat, was, after
much opposition, finally established and officially acknowledged by the
government officers. Then arrangements were made for its introduction
into the government hospitals in a more perfect manner.
I believe in no case, however, was it so fully carried out as to place
a ventilating flue between each bed, but in some they were arranged, as
shown (marked V) in the accompanying plans between every other two beds.
These flues were carried together and extended through the ridge of the
roof and capped as an Emerson ventilator; the opening into the large
flue, extending to just below the ceiling, was closed in winter at all
times, excepting when the room was too warm. This was for the exhaust,
but of no less importance was the supply.
The popular dread of ventilation arises in a great measure from the
supposition that good ventilation implies a strong draught of cold air
upon your back or feet or some other unfortunately exposed place. Such an
unfortunate occurrence must be fully remedied in any system of ventilation
before it can become popular.
As the simplest way of getting at this, all the fresh air required to
supply the partial vacuum created by the exhausting shafts was brought in
around the stoves, and partially warmed before entering. At the first the
stoves were entirely encased, and the fresh air allowed to encircle them
completely, but experience soon demonstrated the desirableness of having a
portion of the hot stove exposed for direct radiation, so that the feeble
and chilly ones might come near to it and warm themselves. There should
always be a considerable amount of direct radiation in every hospital;
that from an open fire is the best, but that from a stove or steam-pipe
is very good.
Arrangements were also made for the evaporation of a large amount of
water.
As the first winter approached after the commencement of the war, the
idea seemed almost shocking to me of putting the sick and wounded men
in such open barracks, generally without plastering, and made, as many
of them were, with rough boards and very open.
But experience soon taught me the very great superiority of these light
and airy buildings over many of the elaborately finished, dark, air-tight
structures, such as hotels, colleges, new-fashioned asylums, &c., which
the government was compelled to take for hospital purposes.
In fact, when completed with the ventilation as above described, with the
abundant sunlight on both sides, without any obstructing partitions and
abundantly warmed in winter, and with the proper supply of moisture, they
made undoubtedly the most comfortable and wholesome class of buildings,
as a whole, that have ever been erected for hospital purposes, not
excepting even many of the recent elaborately finished buildings, where
not unfrequently too much dependence has been placed on the very meagre
and insufficient effect produced by attempts at artificial ventilation,
instead of relying more upon the great natural means of ventilation--an
abundance of large open windows, open fires and good ventilating stoves.
The ventilation of the latrines or water-closets of a hospital, as well
as any other place, is a matter of great importance.
In the spring of 1863, I had put up in a hospital in Washington a
ventilating shaft for the latrine room, similar to the one shown on the
plans. This was an experiment, but it proved so satisfactory that it
was subsequently ordered to be applied in all the principal hospitals.
The difficulty in the isolated wards was, that it required a separate
fire in each shaft in the summer. Where it is possible to get it near
the kitchen or bake-oven fire, that answers a splendid purpose; but
in the single wards it is not necessary to keep up a constant fire; a
few sticks of wood every morning answer the purpose of keeping the air
in the shaft warmer than the surrounding atmosphere, which, of course,
creates the proper draught.
These shafts were made very large--never less than thirty inches square
and sometimes three feet by six feet. The popular plan of opening the
water-closet windows and allowing much of the fresh air to enter the
building that way was strenuously avoided; the windows in the closet were
fastened shut, and then the air to supply this large exhaust shaft was
drawn from the adjoining ward or room, which ventilated that ward and
prevented any unpleasant odor from the closets returning into the ward.
Wherever it was possible, a sheet iron or cast iron pipe was carried up
into the centre of this shaft from the kitchen, laundry, bakery or any
other constant fire, and where no heat from a permanent fire or from a
steam coil could be obtained, a small stove for the purpose was provided.
LEWIS W. LEEDS,
_Germantown, Pa._
7th mo. 26th, 1867.
_The subjoined are a few of the Letters received from prominent
Sanitarians and others._
Office of the Superintendent of Health,
Providence, August 5, 1867.
Friend Leeds.
Your Lectures on Ventilation have been received. I am much
interested in them, and think the views given are correct. I
hope they will be widely circulated. Too much cannot be said to
the people upon the subject.
Ventilation is all-important. Indeed, I think that if the air
could be constantly kept in motion, the worst sources of impure
air in our cities would be rendered almost free from danger.
In seasons of epidemic cholera, the most oppressive feature of
danger is the stagnation which exists in the atmosphere. There
was good sense and true philosophy in the old custom of burning
bonfires to keep off disease. I must close, wishing you much
success in your efforts to awaken the people to the importance
of this subject.
Truly yours,
EDWIN M. SNOW, M. D.,
Superintendent of Health.
* * * * *
Bangor, Maine, August 23, 1867.
My Dear Leeds.
Your pamphlet was duly received. I have read it with much interest,
and believe it to be worthy of extended circulation. It is the
clearest paper on the subject I have yet read.
Yours, in haste, A. C. HAMLIN, M. D.
* * * * *