CHAPTER XII.

THE PREVENTION AND CORRECTION OF VITIATED AIR.

The important part which vitiated air enacts in the production of many forms of disease, has been already fully shewn; and it must be admitted, that whatever has for its objects the prevention and correction of that principle, is deserving of attention.

By preventing the production, and by removing vitiated air when already formed, a vast amount of disease may be arrested, and much of that benefit will actually be accomplished, which it was boldly but fallaciously pronounced would revert from many absurd measures which were adopted, and which are still recommended for the avoidance of contagion, and would realize almost all the advantages which Quarantine Regulations, and the most efficient systems of Contagion Police can or propose to afford; and that, too, at no inconvenience to individuals, no restraint upon communication, after certain processes of purification have been undergone, and no ruinous hindrance of commercial transactions.

The various sources of vitiated air have been already noted. Some of them are beyond any present remedy, as the unwholesome condition of the surface of the earth in many regions, within the tropics, for whose correction or improvement, time, capital, enterprise, labour, and perhaps new climates, are essential. To that source of vitiated air, draining, cutting down superabundant wood, embanking rivers, reclaiming partially inundated land, and cultivation, must be applied before the emanations which infest these situations can be prevented from arising.

Another source of vitiated air is, men being crowded together in close and confined apartments, where no attention is paid to the preservation of cleanliness and the removal of impurities, as in some jails and other places for the confinement of criminals.

That source of vitiated air is particularly worthy of notice here, because a very common form of disease which it induces is what is well known as Jail or Contagious Fever.

The means for the prevention of this form of vitiated air are obvious. Large, airy, well ventilated and lofty apartments are essential, if many persons must be put together; and, where that is not necessary, it is advisable to have them separated in several different chambers, where due ventilation is strictly maintained, by retaining the windows more or less open through the day, or by other equally effective means.

By the sleeping of many persons in one apartment, the atmosphere is deprived to a great extent of its more vital fluid, and becomes unfit to support respiration in its integrity; and the health of the inmates is not unfrequently injured in consequence. The sleeping of many persons in one bed-room, therefore, should be avoided, where it is possible; but, where that is not practicable, it becomes necessary to lessen the evil consequences, and this may be done by keeping a door or window partially open during the night, when the weather is not too inclement to forbid that procedure.

At all times, exhalations to a great extent are proceeding from the bodies of men; and, where individuals are much confined to one apartment, and where that is small, close, and ill ventilated, they fasten or adhere to the furniture, curtains, carpets, and the very walls. During sleep, the amount of these exhalations, it would appear, is increased. It is then that the pores of the entire system, as well upon the internal as the external surfaces, are most freely laid open, and that they pour forth their respective fluids most abundantly. The quantity of watery vapour which issues during sleep from the lungs is prodigious; and the large quantity of water which is sometimes seen collected on the panes of windows in the morning, and which is condensed vapour, affords some idea of the vast quantity of fluid which is exhaled during sleep. With this watery vapour, other ingredients of a hurtful nature are conjoined, and, like it, adhere to the furniture and clothes. When these exhalations are permitted to remain, they impart to the room a disagreeable odour, cause the bed-clothes to be damp and unwholesome, which, with the progress of fermentation, at length emit offensive effluvia. In order to avoid these hurtful consequences, the following measures should be adopted. When the bed-room is left in the morning, the window or windows should be opened, and the bed-clothes freely exposed to the air for some time: the constant passing of fresh air over the clothes and through the apartment, will shortly carry off the greater part of the exhalations which may have adhered.

The window should be left open during a part of the day, if the atmosphere without is not particularly damp, as the removal of impurities, when they have adhered to solid bodies, is not effected at once, or so immediately as is generally believed.

Exhalations of a very hurtful nature proceed also from excretions, which should be removed immediately, certainly before fermentation can have proceeded to any considerable length.

The furniture of bed-rooms requires special care. The various processes of rubbing, washing, and scouring, should be frequently repeated; and articles, such as bed and window curtains, should be oftener in the washing-tub than is dreamt of by many very careful housekeepers, and when they are composed of fabrics of a nature to forbid contact with soap and water, the necessary purification may be effected, at least in a partial manner, by occasional exposure to the wind in the open air.

In those apartments in which the sick are contained, the atmosphere is particularly liable to become vitiated from the exhalations of the body, and from the excretions being in general more disposed to be virulent than those of persons in health.

The necessity for a constant supply of pure air is, if possible, increased, and the utmost care and attention is demanded, in order that this may be duly provided. In large hospitals for the reception of sick, ventilation becomes a point of the most important nature; and, when efficiently established, is entitled to be considered one of the most powerful remedies which can be obtained to check the progress of disease, and to promote recovery, when that is once established.

Various methods have been devised to promote ventilation in hospitals, which it is unnecessary to describe here; for this reason, as well as others, that the importance of ventilation is too well understood by medical men, for them not to enforce it in establishments of which they have the management.

During sickness in private houses, ventilation cannot be too much enforced. When the weather will permit, one window at least should be partially opened, pulled down, if possible, during the summer. In winter, the door of the apartment should be left open for a short time occasionally; and, if the chamber is not very small, a fire may be used, which will not only remove the cutting dullness of the air, but will also ensure a constant change of the atmosphere, from the ventilation which it causes.

In some forms of disease, as in the “Sweating Sickness of England,”—the typhus fever, the skin is wont to become covered with perspiration, which is particularly prone to undergo putrefaction. To obviate that putrefaction, and to prevent the formation of effluvia, it is proper to wash the skin of the patient, in almost every form of disease, with soap and warm water, which will purify that important organ, and assist in rectifying its functions. Where the character of the disease is putrid, sponging the skin with vinegar and water, either warm or cold, should be adopted, and is often of the greatest use.

All impurities should be removed from the sick-room, as they are liable to vitiate the atmosphere; and all clothes and utensils which have been used by the patient should be immediately put among warm water, and left there till a convenient season occur for their being thoroughly cleansed.

When the patient is in a state to bear the fatigue of being removed for part of the day to another chamber, advantage should be taken of his absence from his bed-room, to ventilate the apartment, by throwing open the doors and windows, to expose his bed and body clothes to the free action of the air, and to cover the sickly smell frequently present in sick chambers, by the burning or dissemination of some fragrant substance in the atmosphere.

CORRECTION OF VITIATED AIR.

The effluvia which are wont to arise in sick-rooms, are sometimes so very strong, especially where little attention is paid to cleanliness and ventilation, as to fasten most tenaciously to the contents of the apartments, and to impart to them a most disagreeable and sickly odour, not immediately removeable upon the establishment of currents of air obtained by opening the doors and windows.

These effluvia, for the most part, are cognizable to the organ of smell, and they have long been, and are still, vaguely designated “Contagion,” “Infection,” and the like.

Where effluvia are not recognised by the organ of smell, there are many good reasons for believing, notwithstanding that circumstance, that they may be present in rooms which contain, and which have lately contained, sick persons.

Well authenticated cases are on record, where persons in health have inhabited apartments which, at a former period, contained sick persons, and have been attacked with disease in such a manner as to leave little doubt of the presence of unwholesome effluvia, and of their having been the efficient agency in the production of the evil. These instances have occurred, where it is impossible to suppose that the effluvia could have been commingled with the atmosphere during the whole interval, often amounting to years, from the period of the removal of the sick, to that of the taking up of their abode there by those who have suffered.

The period during which the apartment has been uninhabited has, on many occasions, been too long to admit of the opinion that the atmosphere has not been again and again changed. It would therefore appear, that not only the atmosphere becomes infested, on those occasions, with effluvia, but that the walls, the furniture, and the floors may likewise become impregnated with them.

It is consonant with experience to admit, that solid bodies occasionally combine with, or imbibe, or attract gasiform products, or that aeriform or vaporic agents adhere to solid substances.

The opinion may be entertained, that the effluvia of sick rooms may fasten to the furniture, &c., and in that situation, even where ventilation is maintained, form centres from whence they may be disengaged, either constantly, for a long period, or only on occasions which are particularly favourable for their redissemination in the atmosphere.

It is common to designate these effluvia primarily disseminated in the atmosphere, and the vitiated air which is formed in old fever and plague wards, and to which reference has just been made, Contagion, without any other term to mark the distinction between these principles and those which are legitimately so called. In a previous part of this work, the distinction has been carefully made, and it was shewn that the effluvia under discussion do not form, strictly speaking, a contagious, but only a vitiated atmosphere.

As it appears that effluvia which arise from the bodies, and the excretions of the sick, do not only mingle with the atmosphere, but also adhere to furniture, walls, &c., when concentrated and long exhaled, it becomes necessary not only to remove that atmosphere in which they are disseminated, but also to adopt means for the purification of all those bodies to which they may adhere, in order that the atmosphere may not become again and again loaded with them, arising, as they may, from the places to which they are adhering.

The means best calculated to obtain that end, are those processes to which reference was made above, viz. rubbing, scouring, washing, and exposing to the free action of the air.

But besides these means of purification, there are others, as fumigations, which are calculated to be highly useful, and which should be used on all occasions of severe general disease.

Fumigations are vapours of an elastic nature, permanent and non-permanent. They are diffused through the atmosphere, and impart to it their peculiar odours.

They are highly useful. In the _first_ place, there is reason to believe that they, especially the more active, may decompose the effluvia which are mingled with the atmosphere, and which are adhering to solid bodies, all of which they can be made to reach and act upon, and even to penetrate where the scrubbing-brush and hot water cannot be applied; in the _second_ place, they insure a change of atmosphere; and, in the _third_ place, they effectually cover or hide the smell of the sick-room, which is at all times highly disagreeable, and which is often regarded with great terror and apprehension, being ever associated with ideas of contagion and disease;—and in this way, fumigations are found of very great value, giving, at the same time confidence to the timid, and affording something different from what contagion is commonly thought to be, on which the organ of smell may be safely exercised.

Some fumigations are produced by the volatilization of solid bodies, as camphor and carbonate of ammonia, or sal volatile;—some by the volatilization of liquids, such as vinegar, pyroligneous acid, and the various essential oils, as cinnamon, rose, thyme, mint, pennyroyal, carraway, and turpentine, while others are permanently elastic fluids or gases, as muriatic acid gas, chlorine, and ammonia.

The first-mentioned substances, viz. camphor and ammonia, are not very strong, and may be disseminated through the apartment of the patient, even when he is present, without giving him any uneasiness. Carried about with those who visit the sick, and who are apprehensive of contagion, they are useful by affording a grateful odour, which hides disagreeable taints, and perhaps it is in that way chiefly that they are useful.

The liquids which have been named above, have been long used for the purposes of fumigation, and in general, they may be employed even in the presence of the patient. A few of them may possibly decompose effluvia, but there is much reason to think that they are useful, for the most part, by hiding ungrateful odours, and imparting to the atmosphere, which is liable to be suspected as unwholesome, a delightful fragrance.

Vinegar is much used for the purpose, and with very considerable benefit, and is therefore to be employed.

The essential oils are capable of being diffused throughout the air, and with the assistance of heat, are often made available for the purpose of covering odours. When they are to be used, the oils should be poured upon a piece of live coal, held in the middle of the apartment; they are then immediately converted into vapour. In like manner, vinegar and the other volatile liquids may be disseminated through the atmosphere.

The oils, the vegetable substances in which they are contained, tar and the like, are occasionally burnt with the same intention, and sometimes with advantage.

The incense so much used by the ancients, was procured for the most part by the burning of the vegetable substances in which these essential and fragrant oils resided, by which part of them is diffused in vapour.

The ostensible and pretended object of the priests, in offering up incense, while that and other religious rites were performing over the bodies of deceased persons, was the conciliation and propitiation of the Deity. But while this was the sole ostensible object of the priests, and that which was held by the people, as the only and exclusive purpose proposed, there is good reason to believe that the offering up of incense, like many other observances of religion, had its temporal, and worldly, as well as spiritual ends; and that the sweet smelling odours, which were thought would be so grateful to Heaven, were, on those occasions, used in no small degree, as so many fumigations, to defend the pious and resigned priests from the effluvia of the dead body, and the consequent corruption of the atmosphere.

The use of fumigations, in a disguised form, was perhaps rendered necessary, as the purpose of purifying the atmosphere, might have seemed to cast reflections or imputations on the dead, which the vile, barbarous, and superstitious people, especially relatives, might have resented with acts of violence, or which might have thrown priest-craft into contempt and abhorrence.

Perhaps it was in reference to this matter, as it was in many others of graver import, that the ignorant and superstitious condition of the people on the one hand, and the cunning, subtlety, despotism, and superior knowledge of the ministers of religion on the other, in early times, made it convenient that certain ends, thought to be desirable, should be accomplished without reasons, explanations, or intentions being given.

There is, then, reason to believe, that the burning of oils and other fragrant substances, was used in very early times to purify the atmosphere from the effluvia of dead bodies.

The products of the combustion of essential oils, tar, pitch, and the like, are carbonic acid gas and watery vapour, which, there is reason to think, cannot be useful in purifying the air, or in neutralizing hurtful effluvia.

The permanently elastic gases which are used as fumigations, are the most potent agents of the kind, and they are generally used, and with much propriety and advantage, in all cases where disease is of a putrid character, and where, in short, the atmosphere is likely to be vitiated to a great extent. They form also the most useful fumigations for the purpose of purifying the atmosphere, and the walls and furniture of apartments lately inhabited by the sick, and their employment, in such cases, should never be neglected, even when there is no great reason to apprehend vitiation of the atmosphere, for when advantage is doubtful, there can exist no possibility of detriment. The agent now most commonly employed, is chlorine gas, and it is perhaps the most efficient in the list of fumigations.

Chlorine gas has a greenish colour, and a most disagreeable and suffocating odour. Water impregnated with it, has the property of destroying colours, and chlorine is, on that account, much employed in bleaching, in the forms of “Bleaching Powder” and “Tennant’s Powder.”

When chlorine gas is disseminated through an apartment, any stench, however strong and intolerable, which may have been present there, is no longer perceptible, the odour of the chlorine taking its place, or so completely covering it, as to render it no longer cognisable to the senses.

Chlorine gas is employed both alone, and in combination with other bodies, as lime and soda.

In combination with these alkalis, chlorine forms the chlorides of lime and soda. The former is well known in this country, and the latter, when dissolved in water, forms the “Liqueur disinfectante” of Monsieur Labarraque, which is much celebrated on the Continent.

The solutions of these salts in water, are sprinkled occasionally through the apartments which are to be purified.

When these solutions are sprinkled about, and exposed to the action of the air, the chlorine escapes in its gaseous form and mingles with the atmosphere, while the lime and soda, which are now uncombined, attract and unite with any carbonic acid which may have arisen from the patient, his clothes, or excretions.

The solution of chloride or chloruret of lime, answers sufficiently well, but as it is to be obtained in all drug shops, it is unnecessary to add here a formula for its preparation.

FORMULA FOR THE PREPARATION OF CHLORINE GAS.

Take three parts of common salt, one of black oxide of manganese, and three of strong oil of vitriol. Mix the salt and the oxide together in a stoppered retort, pour in the oil of vitriol and apply a gentle heat. The gas is immediately evolved, and rapidly diffuses itself throughout the atmosphere. Muriatic acid gas, a combination of chlorine and hydrogen gases, though considered as inferior to chlorine as a fumigation, is frequently employed for the purpose of decomposing effluvia, as the materials for its preparation are almost ever at hand.

FORMULA FOR OBTAINING MURIATIC ACID GAS.

Put a handful of common salt previously made very hot into a saucer, and pour over it an ounce of strong oil of vitriol. The gas is immediately extricated.

It has been already said that the fumigations just noticed are on many occasions highly useful, and their employment is much recommended in all situations where the atmosphere is liable to be contaminated by effluvia from sick persons or from dead bodies; but it is not therefore to be understood that, because the use of these agents has been advocated, it is for the purpose of destroying atmospheric contagion, of decomposing the specific animal poisons which have been supposed to be present, and dissolved in the atmosphere, which is the object, or one of the objects, held in view by the generality of those who advise the use of fumigations. These fumigations have been recommended with the view of correcting what has been treated of as vitiated air, which is distinct from, but which has long been erroneously regarded as, Atmospheric Contagion. On some occasions, great fires of wood, coal, pitch, gunpowder, and the like, have been recommended for the purpose of destroying contagion and purifying the atmosphere. During the prevalence of the plague in London, great fires were kindled in the streets, and, according to some historians, with considerable benefit.

Such great fires produce great agitation of the atmosphere, and it is possible that in this way they may prove useful in improving the condition of that fluid, particularly when, as happened occasionally during the visitations of plague in London, the weather is sultry and close, and when the atmosphere is confined and little agitated, and allowed almost to stagnate.

There is much reason to think that the agitation of the ocean, by its waves and tides, is not more favourable to the preservation of the purity of its waters, than the movement of the atmosphere, by winds and currents, is to the maintenance of its wholesome condition, and when this is lost, to restore it; and in the absence of winds, and when pestilence is raging, the use of combustion on a large scale may with advantage be adopted; but in this climate, where the weather is seldom long calm, the occasions for the employment of that agency can be very rare indeed.

Heat is much used for the purpose of dissipating effluvia, and purifying goods, clothes, letters, &c., which are supposed to be impregnated with contagious matter, or other unwholesome impurities; and there is good evidence to shew that this agent is perhaps the most powerful instrument which is ever employed for the purpose in question.

Heat when applied to an atmosphere containing effluvia will rarefy it, cause it to become lighter, and dissipate it, amid the atmosphere above, where any opportunity is afforded for its egress; and when the heat is employed in the sick chamber, much good is effected by the dissipation of the damp and condensed vapour which cannot fail to be frequently present in that situation.

In the sick chamber, the presence of a fire for even an hour daily is highly useful where there is little opportunity for ventilation, and when the external atmosphere is damp and motionless, for the heat issuing from it, will dislodge and dissipate any effluvia which may have become condensed, and have fastened on the furniture of the apartment.

The condensation of effluvia, &c., is thus depicted in the “Mussulman.” The apartment is that of a prison. —— The pestiferous breath of the surviving was mingled with the effluvia from the dead, and the empoisoned exhalation was condensed on the damp walls, and was seen trickling down in drops of poison to the ground.[10]

Footnote 10:

The Mussulman by Madden.

Heat, when applied to clothes which are impregnated with specific contagious matter, or merely impurities or condensed effluvia, is calculated to be highly useful, and where washing cannot be adopted, should never be neglected. Clothes which are thus tainted will be deprived in a great measure of their power of doing mischief, by placing them before a fire for a considerable time, for there is good reason to think that specific contagious poisons will be decomposed, and it is ascertained that condensed effluvia may be dissipated by the application of a smart heat.

The following experiment will at once illustrate the property which some bodies possess of absorbing effluvia from the atmosphere, and prove the influence of heat in again expelling and dissipating them. Pure sand, exposed to a red heat to drive off impurities, was put amidst tainted air. Put into a glass tube and exposed to a spirit lamp, it yielded ammonia or hartshorn,—a product of putrefaction which the sand had undoubtedly absorbed from the tainted atmosphere. Ammonia is a compound of nitrogen and hydrogen, gases which are evolved during the putrefaction of animal materials.

The investigation of the means by which persons, merchandize, clothes, letters, &c., may be most speedily and most effectually freed from effluvia, contagion, and other unwholesome impurities, is a most important point, for it relates to the most vital interests of society, commerce, freedom of intercourse, personal liberty, and the safety and health of the community. But from the very important considerations with which the investigation is connected, the merits of the respective means employed for the purpose will not be treated of here, as they deserve a more extended consideration than can be given. In the mean time it would be highly dangerous and impolitic, to adopt any great and rash change in a system so important as quarantine, until the most full and sound inquiry has been made upon the subject. Public safety demands the utmost caution.

There may exist great diversity of opinion respecting the nature of the impurities with which merchandize and clothes are sometimes impregnated, on the period during which they retain their activity, and on the means of purification; but it has been often clearly demonstrated, that specific contagious matter, or virus, and effluvia, may be conveyed by these bodies, may be retained for a considerable time, and, on a favourable opportunity, produce very hurtful effects.

The impurities may be variously designated, yet their unwholesome tendency is much the same, and it is necessary to adopt provisions to counteract it.