Politics of Nature: Ventilation, Ideas of Health, and 18th-century British Military and Naval Hospitals

COVID-19 workplace poster

This post is part of a series on Politics of Nature, edited by Emily Webster, in which contributors explore the diverse and complex relationships of humans and their nonhuman environments, as they are framed by politics, broadly construed. The series showcases the ways in which thinking about, writing about, and acting within nature has affected these relationships.

Throughout the summer of the pandemic, I was increasingly struck by the omnipresent discussion on cable news networks and major U.S. newspapers about ventilation, fresh air, and the health benefits of being out in the open. How, for example, if you absolutely must celebrate a summer long weekend, it would be better to do so outside rather than in; how beaches are a less risk for contracting Covid-19 than being inside a crowded bar; or how if we want grade schools to open, then maybe it is finally time to fix some outdated and ineffective ventilation systems.

Then, one morning in the imperceptible day-after-day monotony of the COVID-19 summer, while drinking my coffee and indulging in my ten-minute free preview of CNN Go, I blurted out to my partner, “this obsession with ventilation is like my hospital regulations.” What I meant, of course, was not that I spend my days regulating hospitals, but that I could not get over the similarities between the concerns over ventilation now and the concerns over ventilation in late-eighteenth century British military and naval hospitals.  

Ventilation, from a historical perspective, is a fairly new idea. Environmental historian Vladimir Jankovic views the eighteenth century as a turning point in the understandings of air, and the process of controlling when and how outside air entered the indoor space. According to Jankovic, it became possible in the mid-eighteenth century for the majority of the British population to live in a comfy indoor world, establishing a firm boundary between what was considered “indoor” and “outdoor,” and a subsequent “dichotomy […] between the medical qualities of indoors and outdoors.”[1] Neither indoor or outdoor spaces were inherently healthy in and of themselves, if you keep the dangers of marshes and miasma outdoors, or the risks of exhalations from sick people indoors in mind. Once a clear boundary was established through architecture, it was possible to control indoor air, to make the domestic space, and the hospital, healthier. This helped to prevent disease from occurring, spreading, or worsening, while promoting healing at the same time. The benefits of ventilation could be achieved by means as simple as opening a window, or as complex as the use of mechanical ventilators, such as the Hales’ ventilator pictured below.[2]

Ventilation bellows
Hales’ Ventilation Bellows (1758), by pushing on the stick flap doors would open and close allowing for air to be exchanged and spaces to be ventilated. Image from the Wellcome Collection Library.
[Image description: Drawing of a large rectangular box with with flap doors on one end and a stick on the other. The side is open, where there are alternating diagonal layers.]

While the concept of ventilation was relatively new in the eighteenth century, the connection between air and health was not—dating back to the work of Hippocrates and Galen.[3] Eighteenth-century military and naval medical officers held the belief that environmental factors influenced the constitution of their patients, and either promoted or hindered recovery. Stagnant, smelly air, they believed, would lead to the build-up of deadly noxious effluvia, while fresh breezes and regular fumigation contributed to rapid recoveries. 

These medical axioms—that bad air could cause or perpetuate disease and that fresh air could create a healthy healing environment—clearly manifested in military and naval hospital regulations. First, all hospitals—whether regimental, general, or naval—needed to be in the best possible environment. For example, regulations for Irish regimental hospitals from 1803 stipulated that “Hospitals should be capacious, and, if possible, placed in an elevated healthy Situation.”[4]  

Second, the interior air of the hospital was to be made as healthy as possible, whether through fumigation, or ventilation as mentioned in the 1800 General Hospital regulations where “the wards must be thoroughly cleansed, ventilated, and fumigated with nitrous gas.”[5] Ventilation was easier to achieve in tented regimental hospitals since the tent walls could be raised and lowed to facilitate the movement of fresh air.[6] 

Finally, patients should, in the parlance of COVID-19, practice social or physical distancing. In 1795, the Comptroller of the Navy Admiral Charles Middleton, wishing to prevent overcrowding wrote, “Haslar Hospital is capable of containing Two thousand one hundred sick, but it ought never to receive more than Eighteen Hundred that a sufficient number of Wards may be empty and aired to receive, and Shift the Sick into—this is of the utmost consequence to the mens [sic] recovery.”[7] Meanwhile, regimental hospital regulations advised, “The Hospital is never to be crowded, every man to have at least the space of five feet allotted to his bed; and every man a bed to himself.”[8] At both military and naval medical institutions, clothing and bedding were to be aired in the fresh air and sun, and convalescent patients were encouraged to spend time in healing outdoor air. To put it simply, fresh air equaled healthy air. 

Types of ventilators
Types of Ventilators (1758). Bellows ventilators, like Fig. XIX required mechanical intervention. The passive ventilators in Fig XX. and Fig XXI relied on the movement of outside air to facilitate ventilation. Image from the Wellcome Collection Library.
[Image description: Drawing of three types of ventilators, from left to right: the same Hales ventilator as described above; a narrow rectangular box with rectangle pop outs inserted from the front and top; a windmill-type structure drawn from the side that consists of a framework with sails. In the right upper corner, a drawing of the sails from the front.]

Our present-day experiences with COVID-19 have often been aptly compared with the influenza pandemic of 1918-1919. Yet the connections between ventilation and health date back farther still. The moving of a curtain in the breeze or the thrum of an air conditioner may be constant and unremarked features of our daily life, but that breeze and fresh air have long been considered a key to health.  

[1] Vladimir Jankovic, Confronting the Climate: British Airs and the Making of Environmental Medicine (New York, NY: Palgrave Macmillan, 2010), 1-2. 

[2] Stephen Hales, A treatise on ventilators. Wherein an account is given of the happy effects of many trials that have been made of them […] in refreshing the noxious air of ships, hospitals and mines, to the better preservation of the health and lives of multitudes. Volume 2 (London: R. Manby, 1758).

[3] D.C. Smith, “Medical Science, Medical Practice, and the Emerging Concept of Typhus in mid-Eighteenth-Century Britain,” in Theories of Fever from Antiquity to the Enlightenment, eds. William Bynum and Vivian Nutton (London: Wellcome Institute for the History of Medicine, 1981), 130; Jacques Jouanna, Greek Medicine from Hippocrates to Galen: Selected Papers (Leiden: Brill, 2012), 128-129. 

[4] Instructions for the Army Medical Board of Ireland, to Regimental Surgeons and Assistant Surgeons Serving on that Establishment (Dublin: George Grierson, 1803), 1.

[5] The British Military Library, Volume 2 (London, 1801), 342. 

[6] War Office, Regulation for Improving the Situation of Regimental Surgeons and Mates and for the Better Management of the Sick in Regimental Hospitals (London: J. Walter, 1796), 15. 

[7] “Haslar Hospital Observations,” no date, likely 1795 NMM,;“Medical: Observations, memoranda and abstract 5 docs. ca. 1778-1805,” MID/7/4; Roger Morriss, “Middleton, Charles, first Baron Barham (1726–1813),” in Oxford Dictionary of National Biography (Oxford, 2004).

[8] Regulation for Improving the Situation of Regimental Surgeons, 16. 

*Cover image: a COVID-19 workplace poster from the Government of Ontario.

[Cover image description: poster with a white background and a black header text that reads “Protect against COVID-19.” Underneath the text two side-by-side circles. Inside the right circle, a drawing of an opened door revealing a shining sun. Inside the left circle, a drawing of a curtained open window. Smaller text underneath the circles that reads “Open doors and windows to let in more fresh air.”