The Construction of Hospitals for the Insane
PART I.
Chapters 1 - 10- Chapter I
- PRELIMINARY REMARKS
- Chapter II
- DEFINITIONS OF INSANITY
- Chapter III
- FREQUENCY OF INSANITY
- Chapter IV
- CURABILITY OF INSANITY
- Chapter V
- ECONOMY OF CURING INSANITY
- Chapter VI
- HOSPITALS THE BEST PLACES FOR TREATMENT
- Chapter VII
- DIFFERENT CLASSES OF HOSPITALS FOR THE INSANE
- Chapter VIII
- STATE PROVISION TO BE FOR ALL CLASSES
- Chapter IX
- THE ASSOCIATION OF MEDICAL SUPERINTENDENTS OF AMERICAN INSTITUTIONS FOR THE INSANE
- Chapter X
- FIRST STEPS TO SECURE A HOSPITAL
- Chapter XI
- FORM OF LAW FOR ESTABLISHING A HOSPITAL
- Chapter XII
- BUILDING COMMISSIONS
- Chapter XIII
- SELECTION OF A SITE
- Chapter XIV
- AMOUNT OF LAND
- Chapter XV
- SUPPLY OF WATER
- Chapter XVI
- DRAINAGE
- Chapter XVII
- ENCLOSURES
- Chapter XVIII
- PATIENTS' YARDS
- Chapter XIX
- IMPORTANCE OF ARCHITECTURAL ARRANGEMENTS
- Chapter XX
- CHARACTER OF PROPOSED PLANS
- Chapter XXI
- SIZE OF BUILDINGS AND NUMBER OF PATIENTS
- Chapter XXII
- POSITION, AND GENERAL ARRANGEMENTS OF THE BUILDING
- Chapter XXIII
- FORM OF BUILDING
- Chapter XXIV
- HEIGHT OF HOSPITALS
- Chapter XXV
- TEMPORARY OR WOODEN STRUCTURES
- Chapter XXVI
- NUMBER OF PATIENTS IN A WARD
- Chapter XXVII
- NATURAL VENTILATION
- Chapter XXVIII
- CELLARS
- Chapter XXIX
- MATERIALS OF WALLS
- Chapter XXX
- PLASTERING
- Chapter XXXI
- SECURITY FROM FIRE IN CONSTRUCTION
- Chapter XXXII
- ROOFS
- Chapter XXXIII
- SIZE OF ROOMS AND HEIGHT OF CEILINGS
- Chapter XXXIV
- FLOORS
- Chapter XXXV
- DOORS
- Chapter XXXVI
- LOCKS
- Chapter XXXVII
- WINDOWS AND WINDOW GUARDS
- Chapter XXXVIII
- INSIDE WINDOW SCREENS
- Chapter XXXIX
- STAIRS
- Chapter XL
- ASSOCIATED DORMITORIES
- Chapter XLI
- INFIRMARY WARDS
- Chapter XLII
- BATH ROOMS
- Chapter XLIII
- WATER CLOSETS
- Chapter XLIV
- WARD DRYING ROOMS
- Chapter XLV
- WATER PIPES
- Chapter XLVI
- DUST FLUES AND SOILED CLOTHES HOPPERS
- Chapter XLVII
- KITCHENS AND SCULLERIES
- Chapter XLVIII
- DUMB WAITERS AND DISTRIBUTION OF FOOD
- Chapter XLIX
- RAILROAD
- Chapter L
- HEATING AND VENTILATION
- Chapter LI
- AXIOMS ON HEATING AND VENTILATION
- Chapter LII
- HOT AIR AND VENTILATING FLUES
- Chapter LIII
- LIGHTING
- Chapter LIV
- PATIENTS' WORK ROOMS
- Chapter LV
- GENERAL COLLECTION ROOM
- Chapter LVI
- WASHING, DRYING, IRONING, AND BAKING
- Chapter LVII
- FARM BUILDINGS
- Chapter LVIII
- COST OF HOSPITALS FOR THE INSANE
- Chapter LIX
- DESCRIPTION OF THE PLATES
- Chapter LX
- DESCRIPTION OF THE FRONTISPIECE AND ITS GROUND PLAN
More to come...
CHAPTER LII
HOT AIR AND VENTILATING FLUES.
IT is to be remembered, that fresh air heated by steam or hot water on the plan suggested, can never attain a very high temperature, and of course it must be introduced in much larger quantities than if from common hot air furnaces, and as a consequence, the flues must be large and pass as directly upwards as possible from the air chambers. All lateral or sloping flues should, if possible, be avoided. The flues frequently put into public buildings are not one-fourth as large as is desirable. They should always be made perfectly smooth on the inside, and the maount of air passing through them should be controlled by appropriate registers. The first should be effected either by very careful plastering, smooth brick with struck joints, or by terra cotta or by tin boxes built in the walls. All the main steam pipes should be very carefully protected by some of the various preparations now in use, to prevent loss of heat.
Although the heat from a hot water apparatus is entirely unexceptionable, and for private dwellings or small establishments, perhaps even preferable to steam, unless it is under very low pressure, still for a large institution like that under notice, steam is on many accounts more desirable. With high steam, less radiating surface is required, because the temperature of the inside of the pipes throughout is nearly uniform, and never below 212 degrees Fahrenheit; smaller pipes may be used; the heat is distributed and controlled with much greater facility and rapidity, and besides the steam is required for various other purposes about the institution. The steam, too, may be generated at almost whatever point may be considered most desirable, even at a distance of several hundred feet from the building, and yet by proper arrangements, be conveyed to it promptly and with little loss of heat. Such a location for the boilers as proposed, allows a proper site to be selected for the wash-house, gas works, pumps, etc., which should always be together, so that they may be superintended by the same engineer. It also protects the institution from one of the most common and dangerous sources of fire, and at the same time saves the inmates from all danger from explosions, and from the annoyance of the dust, dirt, and gas connected with the fuel and ashes, and which, if in the building, are pretty sure some time or other, to escape into the rooms above. If hot water is used, it will be much more difficult to keep large fires, with all the inconveniences incident to them, at a distance from the building, and large fires in a hospital are always dangerous. By using steam as proposed, the only fires really necessary in the whole establishment, are those in the kitchens.
It is best that all these flues for the admission of hot air and for ventilation should be direct, and carried up in the interior or corridor walls, which being eighteen inshes thick, will allow each flue to be about nine by twelve inches in the clear. In most of the wards it is proposed to introduce the heated air near the floor, and to have one of the ventilator registers open near the ceiling, and the other near the floor. One or both these openings can be used at pleasure, and when it is desired to economize heat, as may be expedient in very cold weather, or when there is a deficient supply of heat, those near the ceiling are to be closed, but at all other times both may be open. In some of the wards for the most careless and uncleanly patients, it will be well to reverse this arrangement, admitting the warm air near the floor. When the warm air is admitted near the floor, especially when the patients are likely to interfere with the openings, a cntrivance should be put up which will allow the air to escape freely, and yet prevent anything being thrown into the air chambers below.
The ventilating flues should terminate in the attic, in gradually ascending trunks of a size more than equal to the aggregate of the flues entering them, and leading to the different main shafts which rise above the roof of the building. The upward current in these shafts, if a fan is not used, is to be increased by means of coils of steam-pipe placed in them, or by heated iron pipe carrying off the gas from the kitchen or other fires that may be used; but with a fan, nothing more is required, if it is used as it should be, night and day, summer and winter. The practice adopted in some buildings makes it necessary to say, that fans are of no value unless they are used, and unless regularly and steadily used, their value is not likely to be appreciated or understood. Steam jets, fires in the attic, or gas burners in the flues, have some objections in a hospital for the insane, and as steam is required for so many other purposes, its use, as suggested, will be found most desirable.
In addition to the several openings for both purposes, in the corridors, which should be numerous enough to secure the free diffusion of air, there should be at least one for heat and another for ventilation in every room in the building.
Whenever a steady driving power can be obtained, fans are of all means the most reliable and effective for forcing ventilation. With a fan, there can be no question as to the forcible displacement of air from every corner of an apartment, and a steam engine should be brought into use for this most important purpose. Even fans driven by hand are often very useful in some of the wards in securing a rapid exchange of air, and for drying any rooms that have been soiled or scrubbed.
The great amount of ventilation required in hospitals for the ordinary sick or insane, renders it important that there should be a considerable excess, rather than any deficiency of radiating surface. About one superficial foot of radiating surface, the temperature of which is 212 degrees Fahrenheit, will be required for every hundred cubic feet of space to be warmed, in the latitude of Philadelphia. In some of the colder sections of the United States, it will require one foot of radiating surface to every seventy-five or even fifty feet of space to be heated, while in the South the ratio will be proportionably diminished.
The radiating pipe or the cast-iron radiators, as may be preferred, should be placed directly under the openings to the flues, and near them, so that all air passing upwards must come in contact with them.
To secure each story and to every class of patients their due proportion of heat, it has been proposed to have a distinct arrangement for each story, and this cannot fail to effect the desired object; or the point in the air chamber, at which the flue commences, will also regulate the supply of air to the apartment to which it leads. Without attention to these points, it is quite possible for the upper story to be over-heated, while the patients in the lower one may be suffering from cold.
Although it is entirely inadmissable to warm a hospital by direct radiation from steam pipes, still, rooms that are not regularly used or only for short periods, as, for example, dining rooms, work rooms, halls or apartments that are particularly exposed to the admission of cold air, may have some steam pipe distributed in them to keep up the proper temperature, while the fresh warm air that is also admitted from the flues is relied on for ventilation. So, in exceptionally cold situations, a certain amount of direct radiation is a great comfort in extremely severe and windy weather. As already said, bath rooms should always have radiating pipes in them, to secure a high temperature, when hot baths are given. Great care, however, must be taken that this mode of heating is not so much extended, as to interfere with the general ventilation of the house. In crowded wards, or in any part particularly exposed to impurity of the air, it should be entirely avoided.
Where the heated air is admitted near the ceiling and the foul-air flues open near the floor, it is particularly important that the windows should be tight and kept closed, to secure a regular circulation. There should also be registeres in the foul-air flues, near the ceiling, for use in summer weather or when the rooms have become accidentally over-heated. This mode of admitting warm air has peculiar advantages for the class of patients for whom it is recommended, for it not only prevents their congregating around the hot-air openings and using the flues as spittoons, but effectually secures the wards from all the offensive odors with which they are frequently filled from articles thrown through the registers. At the same time it must be acknowledged, that for those who are not addicted to these careless habits, there is great comfort, when coming in cold and chilly, in being able to approach the heated air, and in regulating their distance from it afterwards, at will.
There is really nothing so pleasant or probably so healthful in the way of heating, as the warm air derived from an open wood or coal fire, with which there is never any deficiency of ventilation. If besides this, a reasonable amount of pure and slightly heated air is admitted into the halls of a private dwelling to moderate the general temperature, and to prevent currents of cold air when the room doors are opened, we have the most comfortable of all modes of heating. Open fires would not be less pleasant in the parlors of a hospital for the insane, but the risks attending them, at times, even in the least excited wards, are so numerous as to render it prudent to dispense with them in every part of the building regularly occupied by patients.