THERMAL VENTILATION,
AND OTHER
    APPLICABLE TO PUBLIC BUILDING-S,





              AND RECENTLY






ADOPTED AT THE NEW-YORK HOSPITAL







        A DISCOURSE,





 Delivered at the Hospital, February 8tl&, 1851,
JOHN WATSON, M. D.

"'■i!t<f\-1'. "-
PRINTED BY WM. W. ROSE, 17 WALL STREET.




            1851. 
1 
DISCOURSE.
  Those of you, gentlemen^ who have formerly been fa-
miliar with the plan of this edifice, must have observed,
that it has recently undergone extensive alterations.
  The measures which have resulted in these changes
were adopted in the early part of last spring.  The work
was commenced in May, and has been in active progress
ever since.   The new arrangements being now so far
complete as to allow the wards in every part of the house
to be again open for the accommodation of the sick, it
has been thought  advisable to invite the attention of the
public towards them in their present state of renova-
tion, and to solicit a careful inspection of them from the
members of the medical profession, from the guardians
and directors of other public institutions in the city, and
from such other  enlightened individuals as may  deem
the condition and management of the  New York Hospi-
tal  worthy of a special examination.
  With this view, gentlemen, the Executive Committee
of the Board of Governors, who have been more  im-
mediately instrumental  in bringing about the present
changes, and the  Physicians and Surgeons of the Insti-
tution,  at whose advice  and recommendation they were
commenced, have solicited the favor of your attendance
on the present occasion, and have instructed  me to pre-
sent to  you a summary account of their improvements,
and of the reasons and circumstances which have led to
them.

  The health and comfort of domestic life are intimately
connected with the abundant and unfailing supply of
                                     2 
4
pure and genial air.  To furnish this, as free as possi-
ble from accompanying annoyances, is a problem, which,
of late, has excited much thought and ingenuity.  The
means hitherto employed for the purpose, or at least the
most of them, have long been^n requisition ; but the ne-
cessity for the more constant employment of these, and
for their unremitting and energetic action, is hardly yet
sufficiently understood.
  It would here be out of place to dwell upon the con-
stituent elements of the atmosphere, its sensible and in-
sensible changes, or the various sources from which it
may become deteriorated, and dangerous to health and
life.   Among the members of the medical profession
these  points are under  daily observation, and in every
well-informed community of the present day, they are
generally understood.
  The great fact developed in the Hyienic relations  of
the atmosphere within the past few years, is, that the
sources of  in-door contamination  are more abundant,
more  difficult of removal, and more deleterious  in vari-
ous ways than  had been previously acknowledged  or
suspected.
  The words of Count Rumford—until recently a name
of great authority—are in proof of this:  " As long," says
he, " as any fire is kept up in the room, there is so con-
siderable a current up the chimney, notwithstanding all
the reduction that can be made in the size of its throat,
that the continual change of air which this current oc-
casions,  will be found quite sufficient  for keeping the
room sweet and wholesome: and even in rooms in which
there is no fire-place, and consequently no current of air
open from the rooms setting up the chimney, as in those
heated by German stoves, and when the windows and
doors are double, and both are closed in the most exact 
5
manner possible, by slips of paper pasted over the cre-
vices, or by strips of list or fur ; yet, when these rooms
are tolerably large, and when they are not very much
crowded with company, nor filled with a great many
burning lamps and candles, the air in them is seldom so
much injured as to become unwholesome." *  It is but
just to observe, as a palliation for some of the erroneous
opinions embodied in these words of Count Rumford,
that he probably never thought it possible to reduce a
chimney throat to such a degree  as is now common in
grates for the  combustion of anthracite  coal.  As  a
comment on the rest of his remarks, I cannot do better
than to adopt the words of Mr. Bernan: " We instinc-
tively shun approach  to the dirty, the squalid and the
diseased; nor use," says he, " a garment that may have
been worn by another.  We open sewers for matters
offensive to the sight  and smell; we carefully remove
impurities from what we eat and drink; we filter turbid
water, and fastidiously avoid drinking from a cup that
may have been pressed to the lips of a friend: yet, on
the other hand, we resort  to places of assembly,  and
draw into our mouths, air loaded with effluvia from the
lungs, and skin, and clothing  of every individual in the
promiscuous  crowd—exhalations  offensive, to a certain
extent, from  the healthy individual; but,  when rising
from a living mass of skin and lung, in all stages of eva-
poration, disease and putridity, and prevented by walls
and ceiling from escaping, in the  highest degree dele-
terious and loathsome." f

  I need not dwell on the character and amount of these
exhalations.  From the lungs alone, it is estimated that
* Essays, vol. l,p.302.
t Warming and Ventilation, vol. 2, p 313. 
6
about 16 feet of carbonic acid gas,  and from 16 to 20
ounces  of aqueous vapor, highly charged with animal
matter, are eliminated every twenty-four hours.  For
the vast amount of combined exhalations from the lungs
and skin, and for some of the evils resulting from them
when allowed to accumulate, and to be reabsorbed into
the circulation, I may refer to the  able report of my
friend and colleague,  Dr. Joseph M. Smith,  presented
to the American Medical Association, at their last annu-
al meeting, and published in the volume of their Trans-
actions  for the present year.
   Estimating the pulmonary and cutaneous exhalations
thrown  off in the form of vapor, at 40 ounces daily for
every healthy individual, and the monthly accumulations
of a family of ten persons, in one of our close and ill-
ventilated city houses, where the inmates are confined
not more than half the time, at about five hundred
pounds, no inconsiderable portion of which consists of
animal matter, which  cannot remain long suspended in
the air,  and which  must, in  consequence, be precipitat-
ed and allowed to decompose in the apartment, and we
have sufficient materials, he conceives,  to account for
the frequent spontaneous generation  of typhus fever.
This, however, is  an  estimate for the badly ventilated
abode of healthy individuals.  Apply the same reason-
ing to the wards of an hospital, the inmates of which
are confined to their  apartments both night and day,
with their exhalations at the time of evolution already
approaching a state of putrefaction, and the quantity of
animal matter contained in these out of all proportion
greater than that in the exhalations of the healthy; re-
membering, also, that the lungs  are organs of absorp-
tion as well as of exhalation, that the whole mass of the
blood passes  through them  about once  in every three 
7
minutes, and while thus passing is continually exposed
to vitiation from any deleterious  agents that  happen
to be retained in them, and we have some data from
which to estimate the agencies continually at work for
the propagation of typhus, and scrobutus, and purulent
cachexia, and dysentery, and gangrene—not to speak of
other innumerable, nameless,  but not unknown peculi-
arities of diseased action, which render the treatment of
hospital patients so difficult, their vital force so languid,
and their chances of recovery from disease, which,  un-
der more favorable circumstances,  would be looked for
as a matter of course, so  deceptive and precarious.

  Like breeds like, is a law in pathology as well as in
animated nature—a law recognizable in all the vegeta-
tive processes taking place within the body, and at least
sometimes  also out of it:  for, though the fact is often
overlooked, it is, nevertheless, an important truth, that
all the changes occurring in what is usually called effete
matter, are not in strict subservience to  the simple laws
of inorganic chemistry.
  The twin-bearing mother and twin-bearing daughter;
the hereditary peculiarity of race  and stock, down to
the minutest family trait,  idiosyncracy  or propensity ;
the spread  and propagation of diseased  actions, univer-
sally acknowledged to be communicable  from individual
to individual,  are, perhaps, not more in strict  subser-
vience to this law than certain changes continually tak-
ing place among the molecules of effete  matter, as well
while retained within the body as after their elimination.
  The class of diseases to  which this law of propaga-
tion is universally admitted to apply, is comparatively
small.   In the philosophical study of Pathology, ten-
dencies in subservience to it in other classes of diseases, 
8
perhaps in all diseases, may possibly be  shown to be
neither limited nor rare.  In the simple process of what
is called healthy inflammation,  we sec this tendency to
propagation from surface to surface, in intertrigo :  we
see it in the contaminating touch of the herpetic lip; in
the diffusion of furunculi;  in the progress of carcino-
ma and of tubercle : we see it in the eroding ulcer, and
in  the multiplication  of carbuncles, as well  as in  the
extension of typhus, of erysipelas, of purulent cachexia,
and of hospital gangrene.
  We see the influences of this  same law in changes oc-
curring in annualized, and even  in vegetable substances,
to all appearances deprived of vitality, and detached
from the living tissue, or free in the open air.   The pu-
rulent deposit, now formed from the living blood in the
midst of comparatively healthy tissues, and  now as  a
free secretion, is also formed  by the disintegration of
the primitive tissues, and even by changes  occurring
among other secretions already thrown out of the body
and resting upon its diseased surfaces.   The effete mat-
ters ceasing to be eliminated from a healthy individual,
excite diseases identical with those which these same
materials give rise to, when reabsorbed with the breath,
and imbibed from the open air.   The fomites of filthy
clothing and of foul rooms, propagate diseases in every
way identical with  such  as  originate  from  internal
causes.   It is not every case of scarlatina, of measles,
or even small pox, in which we can trace the  commu-
nication of virus from  individual to  individual,  much
less so of typhus, of cholera, of yellow fever, of puerpe-
ral fever, and erysipelas.
   The study of this primary law of organic  develope-
ments, is never to be overlooked by the inquirer into
the hidden causes of disease.  Applying it to the exha- 
9
lations from the living body, he is, at least in part, pre-
pared to resolve some of those questions which formerly
confounded, and which still continue to baffle the judg-
ment and sagacity of the  most acute and assiduous ob-
servers. The Hvgienist, above all, is called upon to re-
member it in all his provisions for the health and safety
of his fellow men, collected together in large  assem-
blages, whether in armies or in  fleets, in prisons or in
factories, in schools or crowded individual abodes, in
asylums or in hospitals.   Thus far directed by it,  he
has furnished most  of the suggestions which,  of late
years, have led to so  much improvement in the comforts
and amenities of social life, and  among the rest, to the
creation of what has now become almost a new  science
—Thermal Ventilation.

  The art of purifying the in-door air, as already re-
marked, has been greatly improved within the past few
years—not so much  by new inventions as by the judi-
cious application of such as were formerly in use, and
by the adaptation of these in accordance with the rules
of health, and without regard to the purposes to which
they were originally turned.  There is hardly an appli-
cation now in use for the heating and airing of dwell-
ings, that had not been previously  employed for other
purposes, most of them,  with little  or no essential mo-
dification, for centuries,  and  some of them, since the
earliest times.
  I. The Hypocaust of  the ancient Romans was evi-
dently derived from  the brick kiln.   The primary con-
struction of the one is essentially the same  as  that of
the other—both alike consisting of an immense mass of
mason work,  underlaid with flues  for the diffusion of
heat, with no provision for the withdrawal of smoke or
vapor. 
10
   The Hypocaust was first employed for heating bath-
ing-rooms and sudatoria, but  afterwards for warming
private dwellings.  It was without chimney,  and with-
out flues for the transmission of heat to the apartments
above it—at least during the combustion of fuel.  Its
mouth or entrance was at the outer wall, and through
this the smoke escaped, as from the mouth of an oven.
The heat imparted to its  mass of brick and stone, was
transmitted  by slow  conduction through  the  tyle or
marble pavement, to the  room above.  In some of its
more complicated forms,  there were concealed flues ri-
sing in the wall to the first or second story, but with
no outlet at  the top.   In  others, these flues, after the
fire beneath  them had ceased to glow, could be opened
by the removal of a lid or cover, and thus they allowed
the warm air issuing  through them to enter the upper
apartments.
  These  cumbrous furnaces were, of course, subject to
frequent leakage.  The Emperor Julian, by a defect in
one of them, and the exhalation of vapor through the
walls of his chamber,  was completely overpowered, and
his life was  only saved by speedily removing him into
the open air.  His successor,  Jovian, is said to have
been suffocated by the fumes of a furnace while sleep-
ing in a close apartment.
  The  Hypocaust, for the simple purpose of imparting
heat, has for many centuries been laid aside.  The focus
and brazier, even in ancient times, were usually prefer-
red to  it. Yet it may have early served as the  proto-
type of the  German stove,  as this  latter has, in turn,
served  as the model  upon which the  air-chamber was
engrafted in the original  dry-air furnace.   The Hypo-
caust, with the addition of a smoke-flue, is still retain-
ed in the malt kiln—a furnace with a low room above 
11
it, used by brewers for the drying of grain, after this
has undergone the requisite degree of saccharine fer-
mentation.
  The focus in the centre of the room, or instead of this,
the clibanum or brazier, was the usual  fire-place even
in the most costly residences of the  ancients.  In the
castles of the English Normans, and in other similar
structures of the middle ages, the fire-place was moved
to a deep recess against the wall, and the smoke, as in
more ancient times, found vent at the loop-hole in the
roof, or through the open turret, or the louvre window
in the side of the dwelling.   But on the invention of
chimneys, by the Italians, in the early part of the four-
teenth century, the open fire-place  assumed the form
which, under varying modifications, it has ever since
retained.
   The third essential form of heating apparatus is thei
water stove, now looked upon as one of the most recent
and original, as it is certainly one of the most admira-
ble.  But this identical apparatus, or some contrivance
like it, may have been used by the ancient Egyptians for
the  hatching of eggs;  for it  is well known that they
used some artificial  machine for this  purpose.  But
whether used by them or not, in its present form it was
first'introduced into  France  as  an  apparatus for the
hatching of eggs, under the name of Bonnemain's Chick-
en Stove, in the latter part of the past century.   For the
heating of dwellings, it was first employed in England
by the Marquis of Chabannes, and claimed by him as an
invention of his  own,  as early as 1816.
   The steam apparatus, for the purpose of warming,
was only a special adaptation of the ordinary boiler of
the steam engine ;  and we find that Mr. Watt, the great
improver of the engine, began to turn  his attention to 
12
the use of steam for the heating of houses, and, in fact,
employed it in his own office for this purpose, as early
as in the winter of 1784-5, allowing the steam to es-
cape, and  thus to evolve its latent heat.  Mr. Boulton
soon afterwards applied it successfully for the  heating
of baths, and other domestic purposes; and in the year
1795, introduced it, by means of metallic pipes, into the
house of his friend, Dr. Withering,  of Birmingham.
Before this, however, viz. in 1791, Mr.  Hoyle, of Hali-
fax, (England,) obtained a patent for heating by steam-
pipes  passing to and  from  the boiler,  and distributed
throughout dwelling-apartments, in essentially the same
manner as employed at the present day.  We need not
follow the various modifications and extensive applica-
tions of this  apparatus in the hands of our ingenious
countryman, the late Mr. Perkins, or the improvements
upon his plans,  especially in combining the apparatus
with systems of ventilation, by other artizans and me-
chanics  of England and this country.
   II. Appliances for the tempering of summer heat are,
in some countries, as necessary, and may have been as
long in use as the heating apparatus of other places.
   The Punkah, a  horizontal fan, suspended from the
ceiling,  and made to vibrate over the heads of the com-
pany in some of the spacious abodes of India, belongs
to this class of contrivances.   It is  usually worked by
hand; but some of the Nabobs, we are told, have lately
applied the steam engine to it.
   The Tattie, a kind of mat, saturated with water, and
suspended in the doors and  window spaces, to favor
rapid evaporation,  and thus  to cool the surrounding
air, is another contrivance of the  Southern Asiatics,
for effecting the same object.
   The underground tunnel, now in use as an equalizing 
13
chamber, was long ago employed as a cooking appara-
tus.   The palace of the Trenti,  at Costosa, in Italy,
being in the neighborhood of some deep stone quarries,
the air in which had been noted  for its coolness,  one
of these was fitted up at great expense, and connected
with the various  rooms of the building by means of a
tunnel through the rock.  When  they would have cool
air from this spacious iEolian Grotto, says an old trav-
eller who visited the place in 1663, they shut a gate in
the cave, and open a door at the end of the tunnel, which
lets in the fresco, every rflom having a hole in the wall
or pavement, to admit it.*
  I need hardly allude to the plan of suspending a mass
of ice near the ceiling, which is now in common use, dur-
ing the warm weather, in our own country, for the cool-
ing of milk rooms and other domestic purposes.
  III. After the Louvre,  the open turret, the latticed
window,  the  chimney,  and the  windsail,  the contri-
vances of most repute for producing a change of air,
are the  rotary centrifugal fan, the air pump, and the
ventilating fire, for creating either an upward or  down-
ward current.
  The influence of large fires in  rarifying the air,  and
removing  noxious vapors, was as well understood in
ancient  times as at present.  Acron, the Pythagorian
philosopher and physician, who lived nearly a century
before Hippocrates, is said to have arrested the spread
of an epidemic at Athens, by kindling numerous fires
in different  parts of the  city.f    Celsus alludes  to the
beneficial effects of fire, of the sun's heat, and of an airy
and elevated exposure in purifying the air of sick rooms ;
and Agricola, in  the sixteenth  century, states, that in
Germany it was customary to remove the foul air from
*Bernan, vol. 2, p. 187
tLitirc, OEuvres d'Hippocrates, torn 1, p. 17. 
14
  mines, by suspending a fire  in the middle of the shaft,
  to create an upward current.  The creation of a down-
  ward current, by a fire in the basement, is, I believe, a
  comparatively  recent invention.   The attic  fire-place
  and flue, for the removal of foul air from the dwelling
  apartments beneath, was first applied to the old  Eng-
  lish House of Commons, and with good effect,  more
  than a century ago.
    The rotary, or centrifugal fan working by a crank,
  and an air pump, in the form of an  immense pair  of
  bellows, also appear to have been in use for injecting
  pure air into mines, and thus forcing  out the foul air,
 as early as the sixteenth century, and are still in use for
 the  same, as well as for other purposes.   A triple
 barreled air pump, working with a crank by hand pow-
 er, was invented by Dr. Desaguliers,  in 1727, for the
 removal of impure air from the mines of the Duke  of
 Westmoreland,  and was capable of discharging about
 ten cubic feet of air per minute.  The same ingenious
 philosopher, from causes which he could not  control,
 being  obliged to remove his ventilating fire  from the
 attic of the old House of Commons, placed in its stead,
 over the top of the building, the  rotary centrifugal fan,
 which still  goes by his  name, for drawing  up the foul
 air from beneath.   This instrument was erected over
 the roof of the building  in 1736, was worked by a hand
 crank, and  continued in operation until the year 1820,
 or about 84 years—a sufficient proof of its usefulness.'
 The fan is still employed for ventilating ships and fac-
 tories, sometimes for increasing the draught of furnaces,
worked either by hand, by water, or by steam  power!
It can be worked either as a forcing, or, by a reversed
action, as a sucking pump.  In a portable form it has
occasionally been employed in the wards of this  hospi- 
15
■tal.   The apparatus called the ship's lungs,  invented
by Dr. Hale, of London, during the last century, worked
by a double lever,  and capable of discharging about a
tun of air at a stroke, was somewhat in the form of an
immense pair of bellows, acting also  as an exhausting
pump.
  Mr. Sutton, a brewer, of London, during the last cen-
tury, ventilated the holds of ships by means of the cook-
ing fire on the deck, drawing up the  air through tubes
which were connected with the ash pit of the fire-place;
and  Sir  George Paul, about 1820, ventilated, by the
same means, the wards of an hospital, the foul air from
near the  ceiling of every lower ward being drawn  up-
wards through a flue, and conducted through the fire-
place of the room over head, and so carried off by the
chimney.  Mr. Green, as early as 1793, excited an up-
ward ventilating current in a similar manner,  substitu-
ting a wide metallic pipe for the foul air  flue  or chim-
ney, and  a smaller tube within  this, instead of the fire.
  By the iEolian apparatus of Mr. Deacon, invented in
1813, the air was  forced  from  beneath, by means  of a
fan,  through earthen  or metallic tubes, the sides of
which were kept immersed in boiling water; and when
thus heated,  it was  allowed to rise  upwards into  the
dwelling apartments.   By using cold instead of hot
water, he could temper the air also for summer use.
  The gimlet-hole system of ventilating apertures, first
devised by by  Sir Humphrey Davy, for the equable dif-
fusion of fresh air, and for preventing strong  draughts
in the removal of foul air, and originally introduced by
him in the English House of Lords, has since been car-
ried out by Dr. Reid and others, with the most favora-
ble results.  Davy, however, appears to have  been but
badly  rewarded for his trouble, at least if the epigram 
16
in which  his  experiments  are  recorded,  speaks the
truth.*
  From these facts, (and innumerable others might be
adduced,) it is clear, not only that the instruments and
appliances now in use for Thermal Ventilation, are not
of recent date,  but that they had long ago  been occa-
sionally employed for this purpose.  For mitigating the
summer's heat and winter's cold, and  removing from
around  him such noisome and offensive vapors as are
recognizable by his  senses, and even those more in-
sidious exhalations which issue  from his own body, as
well as those others ''which the sun sucks up from bog,
fen, marsh," and even from the open  field or mountain
side, man must have, in all ages, exerted his ingenuity.
All, then, that can be claimed by modern science, in its
more  efficient protection of health and life in this res-
pect, is, in having demonstrated the importance of con-
tinual attention to the principles upon which the art of
Thermal Ventilation is founded,  and of carrying out its
measures  in accordance with these, to an extent never
before admitted, and for reasons which,  until within the
past half century, could hardly have been understood.
  Let us now return to our own institution.

  The central or main building of this hospital was com-
menced nearly eighty years ago, and has been in con-
stant use  for hospital purposes, now, just sixty years.
It was constructed after plans which had been prepared
under the supervision of Dr. John Jones, a  surgeon of
great reputation in this city about the middle of the last
century, and the author of the first surgical work ever
published in this country.  The original plan  of the
* " For boring twenty thousand holea,
 The Lords paid nothing: d----their souls." 
17
building, for its time, was probably the best that could
have been devised.  But to meet the growing exigen-
cies of the city, to maintain efficient internal sanitary
arrangements,  and provide for the  convenience and
proper treatment of the sick, the house, within the past
fifty years, has  undergone several important changes.
   As originally finished, it was in length, from north to
south, about 124 feet.  Of this length, 66 feet were in-
cluded in the central portion, and 29 feet at either ex-
tremity were occupied by the  wings.   In width, from
east to  west, it measured rather less than 50 feet for
the centre,  and 86 feet for  the wings.   It was  at first
only two stories high:  the third story was added in
1803, giving it  an elevation of 52 feet, of which  10 feet
above the ground were  appropriated to the basement,
and 14 feet to each of the three stories above this.   In
1829, a quadrangular extension of 12 feet from north
to south, and about 40 feet from east to west, was add-
ed to each of the end wings,  making the whole length
148 feet.
  A central hall, or corridor, eight feet wide, extended
through the whole length of the building on every floor,
terminating, for the basement and first story, in end
doors,—for the two upper stories, in wide windows,
since cut down to the  floor.  In  the  wings on either
side of the corridor were the wards, or sick rooms ;  and
in connection with each ward were provided, in the ex-
tension of 1829, two small rooms, the one for the nurse,
the other for a bathing-room and water-closet.  The
wards could be  approached only through the  central
corridor. They were lighted by numerous windows on
three sides, and supplied with fire-places for the  com-
bustion of wood, in the wall immediately facing the hall
doors.   The central portion of the building was, as at 
18
present, mostly taken up  with the spacious vestibule
leading from the front entrance,  with transverse pas-
sages from front to rear, with two flights of stairs, and
with the various offices and other smaller apartments.
  Taking the original plan in connection with the ele-
vated site of the building, on the brow of a hill overlook-
ing the level space of 600 yards, lying between it and the
banks of the Hudson River, and with its rural,  or,  at
least, suburban exposure,  it will be  perceived that  at
the date of its erection, it must have been well provided
with all the requisites for maintaining a  thorough sys-
tem of what is now technically  called Spontaneous,  or
Natural Ventilation.
  Its situation, I have said, was suburban. The five acre
lot, near the centre of which this building stands, for
some time after the commencement of the present cen-
tury, was at considerable distance beyond the northern
limits of the city, the ground to the south of it, as far  as
Murray street,  still lying in open fields.  A gentleman,
now officiating  among our Governors, looking from the
rear of his  own house in  Murray street, remembers  to
have witnessed the attack of the populace  upon the south
wing of this building, during the  memorable riot, known
in the history of the city as the  "Doctors' Mob."
  In the year 1792, Dr. Tillary, after officiating about
a month as one of our attending physicians, gave  as  an
excuse for sending in his resignation, that the Institu-
tion was so far  out of town, that he would be unable to
continue his services without incurring the expenses of
a horse and gig.*
  *it may, perhaps, be worth while to remark, for the information of those who are not famil-
iar with the topography of this city, that the Hospital is about three-fourths of a mile north of
the Battery, or southern limit, and nearly three miles south of the point to which the thickly
settled portion of the city now extends towards the north.  Most of the heavy business is done
in the elder portion of the  city to the south of the Hospital, whilst the great mass of the popu-
lation reside in the northern section. 
19
  For many years after the opening of this building, the
ancient chimney-piece was still in vogue, and the blaz-
ing hearth adorned the rooms in most of our city dwell-
ings.   Stoves were yet unpopular, and anthracite un-
known.   Oak and hickory were  still abundant, and no
one contemplated  the necessity of cheaper fuel, or of
economising heat at the expense of fresh air.   Under
circumstances  such as these,  typhus, and typhoid ery-
sipelas must have been but rarely witnessed.  But with
the open hearth and crackling fire of wood, come smoky
rooms and troublesome currents of cold air.  For these
annoyances, our patience, if not our health, impels us to
seek a remedy.
  But these were days before the fame of Howard.  Ac-
cidents like those at the Oxford Assizes in 1577, or at
the Old Bailey in 1750, had not yet entirely ceased:  the
close air and unwholesome regimen which had decimat-
ed our own people in the British prison ship at Walla-
bout, were still among the scourges of the sea; and the
favorite means of purifying prisons and asylums,  was
still, by  the daily sprinkling of lime water, or of an
acetous  infusion  of  rue, wormwood, sage, lavender,
mint, and rosemary.   In short, the principles of venti-
lation, as  a sanitary measure, were, as yet, habitually
overlooked; and consequently, it could hardly have been
expected, that the governors of this institution, in their
earliest  attempt to find a remedy for smoky rooms
and  draughts  of cold air,  should at first have fallen
upon the best one.  A Franklin, a Rumford fire-place,
a chimney cowl, or turn-cap, might have remedied the
smoke ;  but stoves might prove  a cure for both annoy-
ances ;  and  stoves  were introduced,  one  for each
ward, with its pipe opening into the chimney,  and
the fire-place sealed up with a fire-board.  The rooms,
                                     4 
20
as a matter of course, now became offensive from close
air ; to  relieve which, a four inch circular opening was
next made through the walls of the building, near the
ceiling, in each ward.  But  this defective method of
tempering the winter atmosphere  was  endured only
long enough to lead to a better, namely,  to the down-
ward  system of thermal ventilation, which was devised
about 1820, and which, among other improvements, was
introduced here in 1829.
  This system, said to have formerly been employed by
Evelyn, was first applied to  hospital use by Mr. Win.
Strutt, at the infirmary of Derby, in England.   He in-
troduced the fresh air through an underground culvert
4& feet wide, and about 210  feet long, commencing in
an upright shaft in the open ground near the building  ;
which shaft was mounted by a turn-cap,  the mouth of
which was constantly to the  windward. The air enter-
ing through this tunnel, after being heated by a  fur-
nace,  ascended upward to  the sick  rooms, which it
reached at  openings near the ceiling.  Descending as
it cooled, it was next conducted off, as foul air, by open-
ings near the floor of the rooms, and thence ascending
again through foul air flues,  it was discharged through
a second wide tunnel, which, with its turn-cap contin-
ually directed from the wind, rose to some considerable
elevation above the roof.   For some  time after it  was
first made public, this plan of ventilation was in gene-
ral favor, both in England and this country ;  and  it is
still in use in many of our well regulated  public institu-
tions.  As introduced  into  this building, the under-
ground  tunnel was omitted, and the air received  into
ordinary air chambers,  from the windows of the base-
ment.   The foul air from the rooms, instead of rising
by special flues, was conducted off through the throat 
21
of a narrow anthracite grate near the level of the floor,
passing to the top of the house through the chimneys,
and thus, when  necessary, admitting of  a certain
amount of forced ventilation,  by the small coal fire in
the grate  at the point of the room  most remote from
that at which the air entered.

  With the  occasional aid of a fire tin the grates, and
of lateral  ventilation through the windows, doors, and
special openings over the doors, with frequent purifica-
tion by  whitewashing  and scrubbing; and with strict
attention  to cleanliness in  the  furniture  of the  sick
rooms, as  well as  in the personal habits of the patients ;
the new system  of warming and airing continued for
many years  to  be satisfactory.  But within the  past
three  or four years—owing partly to the failure of the
furnaces,  partly  to essential defects in the downward
ventilation  under any  circumstances ; partly to  the
gradual increase in the number of severe surgical cases,
partly, perhaps mainly, to  the greater prevalence of
ship fever, or the  European typhus, which, since  1847,
has always prevailed in the  city,  and given rise to  a
great share of the medical  cases here; and, perhaps,
owing also to other causes, which  at present  can nei-
ther be  analyzed, nor detected,—it  was observed, that
the atmosphere  of the house had a growing tend-
ency to  deterioration.  The  severer forms  of erysipelas
became more common here than formerly, the convales-
cence of patients  after surgical operations was neither
so rapid nor so certain as might have been expected
under the favoring circumstances of pure and genial
air ; and  at length,  in 1849, hospital  gangrene, one of
the most serious pests of the old and crowded infirma-
ries of Europe, declared itself for the first time among
the inmates of this hospital. 
22
  Under these circumstances, in the early part of Feb-
ruary last,  a committee from the Board of Governors
was  appointed to inquire into the causes of the exist-
ing evils ; and in association with the physicians and
surgeons of the  institution, to submit some plan for
the more efficient ventilation of the main and south
buildings, with special reference to the  arrest or pre-
vention of the prevailing diseases.  In compliance with
the duties imposed upon them, the  committee, on the
2d of March, replied, that mere ventilation, however
well  devised, independent of other measures, offered no
sufficient remedy against the evils in question; and
that, to put an effectual check upon them, would in-
volve a thorough revision of the  whole  internal  ar-
rangement of the two buildings.
  In allusion to  the defects of a downward ventilation
they remark, that this plan, though sufficiently effec-
tive  for temperature merely, and  perhaps  the  best
for the heating of prisons  and other institutions where
economy in fuel  is of primary importance,  is,  at  the
present day, condemned by the most competent autho-
rities as being more specious than correct in its appli-
cation to hospitals.  The exhalations  from the sick
naturally seek the highest level ; but by this mode of
ventilation they are forced reluctantly to descend ; and
in so doing, they are drawn again  and again into the
lungs of the patients ; and the more frequently by such
of them as lie prostrate upon their backs near the level
of the floor, than by the less feeble who are able to walk
about.  The experience of the past winter, they say,
has  sufficiently  demonstrated that  with  the  present
system of drawing off the foul air,  a healthy  atmos-
phere cannot be  maintained without the aid of collate-
ral ventilation, and the  admission of cold  air through 
23
the crevices of the windows.  In the adoption of any
new plan, it may perhaps still be  inexpedient wholly
to prevent the transit of cool air in this way.  But the
cooling effect of windows  moderately tight, is owing
mainly to another cause, namely, to the  direct loss of
heat through the glass by conduction. Most of the heat
thrown into the rooms is lost in this way.   The warm
air impinging on the cool glass, is suddenly condensed
near the top of the windows, and  precipitated down-
wards to the floor, and in its descent it  falls in strong
currents upon  the patients lying near  the windows,
with their heads towards the wall.
   In regard to the actual accommodations of the house,
they remark, that with  the  existing means of ventila-
tion for the winter season, the number of patients ad-
mitted has been greater than a due regard to the wel-
fare  of  the  sick  would sanction.  The  number of
healthy individuals that may be accommodated during
the night, within a given space, with impunity to them-
selves from confined air, is no criterion for determining
hospital accommodations,  where the sick are confined
both  night and day, and  where  unwholesome  exhala-
tions   are  continually rising  from their  bodies and
mingling with the  atmosphere  of their  apartments.
The effluvia  from the bodies of the sick,  the animal
matters from their breath, are in time condensed along
the windows and around the cooler parts of the room,
settling upon,  and  intimately  combining with,  the
walls and fixtures, so  as to be wholly incapable of re-
moval by ventilation ; and when allowed to accumu-
late,  although incapable  of detection by sight or smell,
they  may, nevertheless, serve as a most prolific source
 of disease.  The more crowded these apartments, the
greater the number of offensive patients  under treat- 
24
ment, and the cooler and damper the weather, the more
rapid will be the accumulation of these offensive depo-
sits, and the greater need of attending to every con-
ceivable expedient for their prevention or removal.
  After an exposition of the general condition of the
two houses, they proceed to recommend, that in the
main house the dry air furnaces and downward ventila-
tion be abandoned, and some more approved method of
heating and ventilation be substituted, to apply to every
part of the building as well as to the wards ;  that all
parts  of the house be kept, as nearly  as possible,  at
the same temperature ; and that the ventilation of the
sick-rooms be so devised, as to withdraw the foul  air at
numerous points along the upper as well as lower parts
of the rooms ;  that the beds in the several wards be so
arranged as to stand entirely free from  the walls  ; that
the number of them, unless new accommodations can be
provided, be diminished ;  that every annoyance in con-
nection with bathing-rooms be obviated ;  that all cum-
brous furniture and fixtures, not absolutely necessary,
be removed from the wards ; that a proper eating  room,
and convalescent room, be provided in connection with
each of the large wards ; and that every patient whose
disease renders  him an  object of offence  to others, or
whose case requires seclusion, be provided with a small
room in some portion of the building by himself.
   After submitting these suggestions  in their first re-
port,  the Committee, by order of the Board, were in-
structed  to continue their investigations, and to pre-
pare plans and estimates for carrying their various sug-
gestions into effect.
   In  compliance with this order, three  of  the  Com-
mittee, with some of the medical officers of the Institu-
tion, were deputed to inquire into the  practical  appli- 
•
                         25

cation of such sanitary arrangements as had recently
been introduced into the hospitals and lunatic asylums
of Trenton, Philadelphia and Boston.
  In this tour of observation much attention was given
to the different systems of Thermal Ventilation, by dry
air furnaces, by water furnaces, and by the steam appa-
ratus ; as well as to the different modes of ventilation,
by the ascending and the descending  current.   With
respect to these two movements, the result of a careful
inquiry was, that other things  being equal, the rooms
in which the upward current was  adopted were invari-
ably better aired, and less offensive than those in which
the downward current existed;  and that among the lat-
ter, the more complicated the apparatus, and the more
circuitous the movement, the less efficient it became for
removing the foul smell from the apartments.
   In a second report, presented on the 1st of May last,
the Committe state, that their inquiries had furnished
them with facts sufficient to enable them to appreciate
the worth, and to decide upon the necessity of most of
the measures of improvement which had already been
submitted.  Without entering into a minute account of
the several institutions which they had visited, they re-
mark that the  new arrangements for the heating and
ventilation of these  institutions, and the  alterations
which they have undergone, are on  a  scale of enlight-
ened liberality hitherto unknown in the charitable insti-
tutions of this country; and that in such of them as have
been constructed or remodeled within the past few years,
the old plan of heating by any air furnaces has been en-
tirely abandoned, and the hot water or the steam ap-
paratus introduced.
   Discovering, in the course of their inquiries, that the
new system of heating and ventilating by steam, had 
•
                        26

been received with greater favor than that by  simple
hot water, even in the institutions in which this latter
had already been partially adopted, the committee were
induced to examine the steam apparatus with much at-
tention.  It is capable of being  managed with perfect
safety ; it is more efficient in large buildings than  the
simple hot water apparatus, and it obviates the neces-
sity of numerous furnaces in different parts of the base-
ment.  It can be brought into full operation with much
greater speed than the hot water apparatus ;  it can be
turned to a great variety of uses, as,  in aid of ventila-
tion, in the heating of water for baths, for cooking, and
for the uses  of the laundry.  It can be  worked with
much less labor and expense, after the first outlay for
fixtures  ; and with less risk of vitiating the air, by the
escape of gases from the fires ;  and by having the fur-
naces beyond the walls of the building,  it guards more
effectually against the admission of dust and dirt than
any other apparatus.
   Convinced of the advantages of the steam apparatus,
and satisfied that the suggestions for the  general renc*-
vation of <the hospital, as presented by the physicians
and  surgeons,  and embodied in the first report, were
practical and judicious ;  and that, if carried out, they
could not fail to add greatly to the conveniences of the
institution ; and  having  consulted mechanics, and ob-
tained the necessary drawings  and estimates, the com-
mittee submitted  to the Board of Governors their plan1
of improvements, which,  as adopted by the  Board, and
since carried into effect,  is  essentially as  follows :—

   1. For the  Admission of Pure Air.—For supplying'
the wards with pure air, independent of accessory aid
from windows and doors,  two  perpendicular cool air 
27
shafts, each about fifteen feet high, and four and a half
wide internally,  one in the  open green at  the  north,
the other in the corresponding green at the south of the
building, and each at the distance of thirty feet from it,
have been erected, and made to communicate beneath,
with two underground  air-ducts of the same capacity,
each passing in a direct line from the bottom of the up-
right shaft, towards the centre of the basement  hall,
and beneath it, to within a few feet of the point at which
the respective wings meet the central  portion of the
building.   Each of these underground air-ducts, in its
passage beneath the hall,  gives off four laterally as-
cending branches, which open  into a  corresponding
number of air-chambers in the basement of the wings.
The united capacity of the ascending branches  is still
equal to that of the main air-duct, and each of them
opens into its respective air-chamber through the floor.
   For  supplying pure air to the centre of the  house,
three  apertures are provided near the  basement win-
dows, one on either side of the front entrance, and one
at a corresponding point in the rear,  and the air is in-
troduced through these in  such a way as to become
somewhat  tempered before  reaching  the  three air-
chambers under the central portion of  the house, and
into which it is  received near the floor.
   From  the  eleven air-chambers, four for each  wing
 and three for the centre, the air is conducted upwards
by flues, all terminating near the floor of the respective
 apartments to which they lead.

   2. For the Supply of Heat.—The space to be heated
 within the building is estimated at three hundred and
 thirty thousand (330,000) cubic feet,  and the tempera-
 ture to be  maintained throughout the  house at 68° or
                                      5 
28
70° Fahrenheit,  through the whole of the winter sea-
son.  The heating apparatus consists of two tubular
boilers, with their necessary fixtures and appliances,
and an extensive series of steam pipes for the diffusion
and radiation of heat in different parts of the building.
  Each of the boilers is about twenty feet long.   The
shell in which  its flues are enclosed is about three feet
nine inches in diameter, and twelve feet long.  The front
is three feet eleven inches wide by six feet two inches
in height, having a semi-circular top surmounted with a
safety valve, and branches to connect the steam mains.
The fire-box is three feet seven inches wide by four feet
three  inches long; and the smoke-flue  is twenty-two
inches in diameter.  There are in each boiler one hun-
dred narrow flues, each twelve feet long by two inches
in outside diameter.   These boilers are placed side by
side within a large furnace-room, which has been pro-
vided for the purpose,  in a  building at the low ground
in the west of the premises near Church street, a hun-
dred feet and more west from the north wing of the main
building.  The boilers are connected together by pipes,
and so arranged by valves as to work either conjointly
or separately, as may be required  by the state of the
weather.  They are supplied with water, when needed,
from the Croton main, by a permanent connection;  and
there is also connected with them a water-pipe com-
municating with the sewer, for the discharge of water
when the boilers are to be  emptied.  The fuel for the
furnaces is  deposited in a  new vault in their vicinity.
The branches for the transmission of steam from the
united main at the boilers are three—one for supplying
the small tubes in the air-chambers ; one passing to the
kitchen for culinary purposes, and to the attic for heat-
ing the bathing-water in the tanks, and for rarifying the 
29
foul air in the belfreys—the third, going to the wash-
house, and supplying the engine for working the forcing-
pump in the furnace-room.
  Leading from the furnace-room is  an underground
tunnel about a hundred feet long, following the ascent
of the surface, and terminating at the bottom of the en-
larged chimney, which rises about eighty-eight feet per-
pendicularly in the west wall of the north wing.  This
tunnel is about three feet six inches wide by six feet in
height, and arched above, but narrows to about half
this size before reaching the chimney.  Through it the
smoke and  gases  from the furnaces are conducted to
make their  escape by the  chimney: through it, also,
pass the several steam-pipes and water-pipes from and
to the boilers, most of which are made to rest upon ver-
tical supports secured in the floor, or so contrived as to
move backwards and forwards, and  to accommodate
themselves to the contraction or expansion of the pipes.
  The main steam-pipe  for the  heating of the house,
after passing from the boilers and reaching the base-
ment of the  building,  is conducted along the ceiling of
the basement hall, giving off as it passes a lateral sup-
ply-pipe to each of the eleven air-chambers, and an as-
cending pipe to furnish radiating coil for heating three
small rooms in the centre of the house which could not
be readily reached from the air-chambers.  This main
pipe measures three and a half inches internally, and is
about  two hundred and ninety feet in length.
  The lateral supply pipes  distribute the steam to nests
of radiating pipe which  are arranged in horizontal
shelves in the upper part of the chambers.  These pipes
are of three-quarter inch bore, and when in full opera-
tion,  present a heating surface of wrought iron suffi-
cient to raise the temperature of the air in every part of 
30
the house to 68° or 70° Fahrenheit, during our severest
winter weather.  The temperature of the radiating sur-
faces is usually from 180° to 200° Fahrenheit, and never
sufficiently high to scorch cloth or paper.   The whole
length of radiating pipe throughout the house does not
exceed thirteen thousand nine hundred (13,900) feet.
  The steam pipes for cooking, and those going to the
attic, are of various lengths, and are from two inches to
an inch and a quarter in bore.  They form a separate
circulation of their own, and can at  any time be dis-
connected from those for heating the atmosphere, so as
to be in operation while the others are not in use.   The
heating of water for culinary purposes in the kitchen, is
effected by steam jets.
  The length of iron pipe of every sort throughout the
house, connected directly or indirectly with the boilers
and  heating circulations, is equal to  about seventeen
thousand two hundred and seventy-nine (17,279) feet;
and if all were  reduced to the standard of the radiating
tubes in  the  air-chambers, they would measure  about
twenty-one thousand (21,000) feet  in length, and furnish
a superficial surface of five thousand two hundred and
fifty (5,250) square feet, or about ten times the superficial
measurement of the  boilers.*  The heating capacity of
  * The actual measurement of the different kinds of iron pipe used in the different circula-
tions for supplying the main house, are as follows:
£ inch pipe	78 feet in		length.
£ do	201	do	do
I do	13,771	do	do
1 do	516	do	do
1J do	516	do	do
2 do	375	do	do
2j do	67	do	do
U do	338	do	do
3i do	290	do	do
          16,152
Return bends,  1,127
17,278 
31
the whole apparatus is, of course, in proportion to the
power in the boilers of converting water into steam, and
of forcing the circulation of this through the pipes; but
the relative heating capacity of the apparatus at any
given point  within the building, is in proportion to the
extent of radiating  surface  there collected, and from
which the heat is to be eliminated.
  After the  steam in circulation has become condensed
and converted  into hot water, this  latter is returned
through a lower range of tubes from the different cir-
cuits, and being collected at the main return-pipe, it is
again conducted to the bottom of the boilers.   Thus,
without waste  of steam, or of hot  water,  a continual
series of circulations is kept  up, and an equable distri-
bution of heat maintained in every apartment.
  The temperature,  volume  and velocity of the air for
the different rooms, are regulated by stop-valves in the
air-ducts, by wooden slides at the bottom of the hot air-
flues in the  air-chambers,  by registers for controlling
the too rapid escape of air from the  rooms above, and
by valves in the main steam-pipes as well as in the  la-
teral pipes leading to the air-chambers, and at the junc-
tion of the different shelves of radiating pipe within these
chambers.   The force of the current and volume of air
in the various wards are so arranged  as to be wholly be-
yond  the control of the inmates of these  apartments ;
but the air-flues leading to the offices and small apart-
ments  in the centre of the  house, can  be regulated by
registers which are  of easy access.
  It is estimated that, with the two boilers at present in
operation, a sufficient heat can be produced, not only for
the main building and the  cooking and washing of the
whole establishment, but also for warming one of the
other two buildings  belonging to the Hospital.   But for 
32
the heating of the whole of these by steam—a measure
still in contemplation—an additional boiler will still be
requisite.
  The working pressure of steam in  the boilers for all
purposes to which  they  have, as yet,  been employed, is
about twenty-five pounds to the  square inch.  It is ne-
ver allowed to exceed thirty pounds ;  though a pressure
four times as great as this, might be employed with safety.
  At the first kindling of the  fires in  the furnace-room,
on the 22d of October last, there were one hundred and
ten tons of Lackawanna coal in the vault.   After they
had continued in operation up to  the 1st of February, or
one hundred and one days,  there were still remaining
about fifteen tons : showing an average consumption of
fuel for keeping the house warm, for the heating of ba-
thing-water, and assisting the process of cooking, at ra-
ther less than a ton a-day.
  The skill  requisite for managing the whole heating
apparatus, may be acquired in a few  days by any ordi-
nary laboring man.  The points chiefly calling for atten-
tion are, first, the height of the water in the boilers, es-
pecially before starting them anew in the morning ; se-
condly, the management of the fire to the best advantage;
thirdly, in seeing that the air-cock is open when the steam
is  let  into the main conducting-pipe, and  that all the
heating-tubes are exhausted of air—a circumstance es-
sential to the ready circulation of steam and the return
of hot water to the boilers.  These points being observ-
ed, the waste of water  need not exceed a  few gallons
daily,  except so much as may be withdrawn for work-
ing the engine, and for cooking.  An evaporating trough,
supplied with water from the hydrants, is placed in the
upper part  of each air-chamber:  from each  of these
troughs  several gallons of water  are absorbed daily
bv  the heated air. 
33
  3. Additional Accommodations.—Where no artifi-
cial means are employed  for assisting in ventilation, a
space of from 700 to 800 cubic feet is usually considered
sufficient for each individual.  In the barracks assigned
to the British soldiery in India, each soldier is allowed
about 800 cubic feet of free space,  while  about 1,000
cubic feet are usually allowed to the inmates of well ar-
ranged prisons; the latter being in confinement both
night and day, the former constantly exposed to the open
atmosphere during the day time.  It is estimated that
every healthy individual, breathing about twenty times
in a minute, and inhaling at each breath about twenty
cubic inches  of air, draws  into his  lungs  about three
hundred  and thirty-three  cubic feet of air every twenty-
four hours ;  and that of the air respired at each breath
about one-twentieth part, or what  amounts  the same
thing, about one-fifth of the oxygen is absorbed, and an
equal amount of carbonic acid gas eliminated from the
lungs to replace it. With a knowledge of this continual
process of vitiation, independent of  others  from the ex-
halation of watery vapor and the  elimination of ani-
mal matter,  it is clear that the same air should never
be inhaled a  second time.  In the arrangement of hos-
pital wards these facts are not to be overlooked.   In
the reconstruction of our present wards they have been
carefully considered.
   For increasing as far as possible  the room devoted to
 the sick, and for rendering their apartments more airy
 and salubrious, the whole space within the walls of each
 wing on every floor, including every two of the former
 wards, and the intervening portion  of the hall, has been
 thrown  into one large ward, measuring about twenty-
 three and a half by eighty feet, independent of the ad-
 ditions of 1829, actually occupying not less than twenty- 
34
nine thousand cubic feet of space, and, with the liberal al-
lowance of twelve hundred cubic feet for each of the
inmates, capable of  accommodating not fewer  than
twenty-four patients.   This important change applies
to all the main wards above the basement, excepting on
the third story of the north wing, which is still, as for-
merly, devoted in part to the surgical amphitheatre.
Each of these enlarged wards communicates with the
corridor only by a single door, and is well exposed to
light and air on every  side by numerous large windows.
  In connection with  this improvement, four spacious
piazzas, with sides enclosed, each three  stories high,
now occupy the recesses formerly existing on either side
of the extension of 1829, at the ends of the wings.  In
these new structures,  and communicating with each of
the wards, are  now, first, refectories or eating-rooms,
with the requisite fixtures for cupboards, closets, water
jets and dumb waiters; and secondly, convalescent or
sitting-rooms, with  drawers and  closets  for the  safe
keeping of clothing, bedding, and furniture out of use:
each of these new rooms measuring, internally, about
twelve by twenty feet.
  Between these, in the extension of 1829,  one of the
former nurse's rooms has been converted into  a room
for the seclusion of special patients, and the other has
been so much enlarged by doing away with one of the
former water-closets as to furnish sufficient accommo-
dation for the two nurses now in charge of every ward.
The remaining water-closet, with the washing and bath-
ing apparatus, has also been wholly reconstructed and
rendered in every way more commodious and appropri-
ate than formerly.   Each wing is now also furnished
with  a  perpendicular discharge-shaft communicating
between the  several wards and the basement, for the 
35
removal of soiled clothing and the dust and sweepings
of the  apartments;  and with  another corresponding
shaft for the transit of food by the dumb waiters.
  In connection with  the improvements in the wings,
the central portion of the house has also been renovat-
ed.  The floors in nearly every part of the house have
been relaid, the old plastering of the walls has been re-
placed by a new hard finish,  the  central flight of stairs
has been remodeled  and extended to the  third  story,
the rear flight has been newly planked,  the windows
throughout have been repaired and furnished with new
inside  lattice  shutters,  and  all the chimney-flues  of
the four central chimneys, not  converted  into hot-air
flues, have been provided with registers, and made  to
serve as ventilating, or foul-air shafts.  The offices in the
basement and on the principal floor, have been remodel-
ed, as also several of the small rooms in the second and
third stories ; and those of the  third story arranged
to serve as reserved wards, for special emergencies.

  4. For the Supply of Bathing-water.—In consequence
of the great elevation of the  buildings, and the frequent
failure in the supply of water from the hydrants,  it has
occasionally been necessary to employ a forcing-pump
for supplying the baths  of the upper stories.  To ren-
der the supply of hot and cold water here more reliable,
four large tanks, each holding about seven hundred gal-
lons, two for hot and two for cold water, the former of
iron, the latter of wood lined with lead, have been placed
in the attic, immediately under the central cupola.   The
forcing-pump for supplying  these with water is  plac-
ed in the furnace-room, and worked, when necessary, by
steam power.  The water in the iron tanks is heated
by radiating steam-pipes, arranged in coils at the bottom
                                     6 
36
of each tank.   The water, hot and cold,  is conveyed
from the tanks, by metallic tubes, to every part of the
building above the basement.

  5. Drainage and Sewerage.—The drainage in dif-
ferent parts of the Hospital, having become somewhat
defective, has been newly arranged throughout; and the
underground drains leading from the three main build-
ings, as well as the main sewer as far west as Church-
street, have been entirely rebuilt.

  6.  Ventilation.—The fresh-air  shafts,  and  under-
ground air-ducts,  give each wing of the  building an
equalizing reservoir containing about sixteen hundred
(1600) cubic feet, in which the air is tempered before
reaching the hot-air chambers ;  and thus equalized,
either for winter or summer use.  Every ward receives
fresh air by four  distinct openings—one from each  of
the chambers beneath it.  The average united measure-
ment of these openings for each  ward is  about seven
superficial feet. They are sufficiently large, with a cur-
rent moving at the almost imperceptible velocity of half
a mile an hour, to supply each ward with three hundred
cubic feet of pure air  in a minute, or more than twelve
cubic feet per minute for every patient—a supply thought
to be ample for sanitary purposes.  But as the current,
under ordinary circumstances,  is probably more than
four times that speed, it is believed that  deficiency of
pure air by the new arrangements, independent of any
aid from doors or windows, has been entirely obviated.
   The velocity with which the fresh air is supplied to
the wards must,  of course, vary with  the force of the
wind at the time, the difference between  the out-door
and in-door temperature, and the amount of resistance 
37
from curves and valves, and from the friction of air-
flues.   With the heating apparatus in operation, the
velocity is believed never  to have fallen short of the
highest estimate above  given.  In the  only attempt as
yet made to measure the actual velocity of the current,
the wind at the time being rather fresh from the north-
west, the out-door temperature at 34°, the in-door tem-
perature at 70°, and the openings for the admission and
discharge of air being  about of equal  dimensions, J;he
velocity of the fresh air from the top of tfife air-JJafi*
in the open ground, to the point at which it first reaches
the air-chambers in the basement, was found to be 90
feet in four seconds of time,  or  about  equal to fifteen
miles an hour.
  The foul air from the wards is drawn  off, first, by two
chimneys with open fire-place, sone at either extremity
of each ward, by a small flue opening at a register near
the ceiling in each of the nurses' rooms, and by another
in each of the bathing-rooms, all of which rise perpen-
dicularly to give vent to the  foul air at the top of the
house; and secondly, in addition to these, by nine new
ly constructed ventilating shafts, measuring each about
six by nine inches, arranged at short intervals along the
sides of each ward, some with registers near the floor,
and others near the ceiling,  and all rising perpendicu-
larly to the attic, and there terminating in larger trunks,
which converge towards two upright turrets  or bel-
freys, which in  turn ascend through the roof of either
wing, and give exit to the foul air through their open or
louvre sides over the top of the house.   The united ca-
pacity of these various ventilating channels is as nearly
as possible equal to that of the inlets for fresh air, in
every apartment and throughout their whole course.
  Thus far the ventilation is in accordance with  what 
38
is technically called the natural method, and will pro-
bably at all seasons be sufficient.  But in order to com-
mand a rapid change of air at seasons in which heat is
not supplied to the wards, it is proposed to place coils
of radiating steam  pipe  at the bottom of each of the
four belfreys,  so as to rarify the air rising into these,
and thus facilitate  its escape.   An occasional fire of
wood on the hearth at either end of the ward, will effect
the same purpose.  The smoke-flue from the furnaces,
and from the kitchen ranges, rising in the chimneys at
the west end of the wards, will also rarify the air in the
contiguous foul-air shafts connected with these chim-
neys, and at all seasons of the year assist in ventilation.
   From the velocity of the  air as it enters, and from its
distribution by numerous openings for  exit and admis-
sion, it  must  be sufficiently apparent that while  in
transit through the apartments it can never lodge for a
sufficient length of time to become deleterious to health.
   But perhaps the best proof of the efficiency of the
ventilating apparatus is, that to the senses of the ob-
server the air within  the wards, with every bed occu-
pied both night and day, is  always  fresh and exhilarat-
ing. During the months of December and January last,
there were in the Hospital several patients with pro-
fusely suppurating  sores and foul discharges; but by
placing  these patients in the  beds  nearest to the fire-
places, the foul smell  arising from them being obviated
by the draught towards the chimney, was scarcely per-
ceptible at the distance of three feet beyond their beds,
and was wholly imperceptible in  every other part  of
the ward.
  The ventilating apparatus for the body of the house
is  essentially on the same  plan  as for the  wings, the
chimneys serving part of the way up for fresh air-flues, 
39
and for the rest of the distance as foul-air flues, opening
at the roof.

   7. Night Illumination.—For the saving of labor and
the promotion of cleanliness, and for affording sufficient
light at night throughoutfthe house, hithertoiiomewhat
defective, especially in the surgical amphitheatre, it has
been thought advisable to introduce  gas ^ttlumination.
Every ward and other apartment is at present liglite^
in this manner.                      ju

   Alterations in the Marine or South Building.—In the
Marine House the old plastering of the walls has been
scraped and renovated ; the old ventilating flues have
been  repaired ;  new ventilating registers have  been
opened near the ceiling, and at the level of the  floor,
between each of the larger wards and the adjoining cor-
ridor;  and additional forced ventilation has been se-
cured by means of two large hall stoves in the central
corridor  on every floor.   These  arrangements, how-
ever, are only temporary, and made in contemplation of
other measures hereafter to be carried out, for the im-
provement of this edifice, or for its total reconstruction.

   The Laundry.—In order to adapt the steam appa-
ratus to the washing, drying, and smoothing of clothes,
a one-story stone building, forty-five feet long and thirty-
two feet wide, has  been  erected immediately over the
furnace room, to be, when finished,  divided into three
apartments—a washing-room, a pressing-room, and
a drying-closet.  The latter is to be twelve feet square,
and to be  filled with wooden horses, about six inches
apart; and these to be so suspended from the top as to be
easily drawn outwards or  inwards.  The wet garments 
40
spread upon them being brought into a current of dry
and  heated air from  below,  will readily impart their
moisture to the air, to be carried off as vapor, through
a ventilating turret in the roof.  The washing machi-
nery, and the apparatus for the mangling or smoothing
and pressjflj of clothes, will also, as far as possible, be
effected either by the  use of  steam heat, or by the ac-
tion of the steam  engine.   Much attention has, within
the past few^^ars, been  given to improvements in the
washing machinery of our public institutions, with spe-
cial  reference to  the  saving of labor.  Among the in-
struments now in use for this purpose, the rotary dash-
wheel for cleansing, and the hydrostatic and the centri-
fugal press, for rinsing, may  all be worked by  steam,
and have been received with much  favor.

                 CONCLUSION.

  In the adoption of the  various measures of sanitary
improvement now described, it has been a main object
on the part of the Governors of the Hospital  to intro-
duce every available invention, shown by experience to
be the best of its  kind, for promoting  the usefulness of
the Institution, and facilitating the labors of those who
have in  their immediate charge the care and treatment
of the sick.  These measures were resolved upon only
after much deliberation and full conviction of the bene-
fits to be expected from  them ; and it is gratifying to
know that, so far as  they have yet  been tested, they
have proved eminently successful.
  In conclusion, it is  proper to observe, that the  gen-
tlemen of the Executive Committee, under whose watch-
ful and  enlightened supervision the whole of these im-
provements have  been effected, were Wm. M. Halsted, 
                        41

Esq., John A. Stevens, Esq., Frederick Sheldon, Esq.,
Geo. F. Trimble, Esq., and Benjamin, L. Swan, Esq.,
with whom was also  associated the President of the
Hospital, Geo. Newbold, Esq.  The mason-work, un-
der the immediate care of MrJ^oren jo Moses ; the car-
penter-work under that of Mr. Thowas *G&tdner ; the
plumbing under that of Messrs. J.  aid! S. Plfffbm  ; and
the heating apparatus uncler thatof IKr. Thos. T. Tal-
ker, of the firm of Morris, Tasker  djjMorris, of Phila-
delphia.   The actual expenditure on account of the
heating apparatus, with all the necessary fixtures, has
been $9319.15.   The mason's  an* carjf&R&'s "work'
constitute the principal items of expense; and it is esti-
mated that the whole of the outlay for all the improve-
ments  effected, will not fall far short of fifty thousand
dollars. 
t