I’ve long felt that plenty of exposure to the elements — plants, soil, water, air — is good for us. Even in winter: I love the cold air filling my lungs; the wind blowing me about as I walk and ride my bike; swimming in cool ocean water. I sometimes find myself laughing at a strong wind — things I do! It sweeps away all the cobwebs, though. And I feel alive. Even in summer, I love riding in the rain and getting drenched. I’m grateful I am feeling everything. I’m not a huge fan of high humidity and what it does to the mind so much, but I like the sweating side of it.
I knew I wasn’t alone. There are communities who have ice baths at dawn in winter and who relish the bracing wind at any time but I wasn’t thinking the more academically-minded would weigh into the narrative. And that there was some history to it. Though most people would probably argue with me about the cold and the wind, these two — researcher Richard Hobday and academic Peter Collignon — in their recent Cureus piece An Old Defence Against New Infections: The Open-Air Factor and COVID-19, confirm that the outdoors are good for us. And for our recovery from illness.
They argue that while environmental factors such as variations in temperature, relative humidity, solar ultraviolet radiation, and dilution are all known to reduce the viability of viruses and other infectious air-borne pathogens, what they call open-air factor or OAF influences both the survival of these pathogens and the course of infections.
They note that “outdoor air was used to treat tuberculosis patients who underwent 'open-air therapy' in sanatoria. There were specially designed open-to-the-air hospital wards to disinfect and heal severe wounds among injured soldiers. Further, in their abstract, they note that open air “was also used on influenza patients during the 1918-1919 pandemic. During the 1960s, OAF briefly returned to prominence when biodefence scientists conducted experiments proving that open air has a potent germicidal effect. When this work ended in the 1970s, interest in OAF again fell away, and it remains largely ignored.”
Perhaps surprisingly, the efficacy of open air isn't new. It’s been known for millennia. To paraphrase Hobday and Collignon: During the last decades of the 19th century, it was thought fresh air, particularly from pine forests, could kill pathogens such as strep, staph, and TB. Much further back, Pliny the Elder (AD 23-79), who recommended breathing it, argued pine trees imparted a property to the air of forests, which was an effective remedy for pulmonary tuberculosis (TB), and could speed up recovery after a long illness.
In 1840, Dr George Bodington (1799-1882) wrote how he’d used fresh rural air, gentle exercise in the open, and a nutritious diet to heal patients with TB. At the time, it was considered incurable in medical circles. Subsequently, Florence Nightingale became an advocate of pure air in sickrooms based on her experiences during the Crimean War (1854-1856). She stipulated that the first canon of nursing was that indoor air be as fresh as outside air, and promoted the 'pavilion plan' hospital: an arrangement of separate wards designed for cross-ventilation — during the daytime and at night — through open windows. These wards were also designed to admit sunlight, as solar radiation was known to be a natural disinfectant — even through glass. The idea was extended to schools; open-air schools were part of the public health campaign against TB and other childhood diseases. Like TB wards, such schools had windows that folded back along one or more walls. These opened onto terraces or verandahs for lessons outside.
In the 1880s, Dr Alfred Loomis, a pioneer of TB therapy in the US, claimed it was an 'acknowledged fact' among the medical profession that pine forests in particular had a beneficial effect on TB. In his view, clinical experience had established this 'beyond question'. It was why the preferred location for TB sanatoria was often among or near pine trees.
There’s plenty of ozone, a germicidal agent, in evergreen forests, although Loomis argued it was the vapour given off by pine trees combined with ozone that produced an airborne disinfectant. Not only was it lethal to germs, it was also beneficial to health. The antiseptic element in forest air was both a stimulant to and tonic for the usual physiological processes within the lung. Loomis concluded it should be possible to make the air inside houses antiseptic by growing evergreen trees nearby. Doctors and hospital architects also placed great value on building sanatoria in areas where there was an abundance of ozone.
During the First World War (1914-1918), many soldiers were nursed outdoors because the smell of their septic and often gangrenous wounds was too offensive to tolerate in hospital wards. British surgeon, H.S. Souttar, found putting patients outside and then leaving their infected wounds open to fresh air greatly improved recovery. He wrote, "The results were almost magical, for in two or three days the wounds lost their odour and began to look clean, while the patients lost all signs of the poisoning that had been so marked before." In 1914, Dr Robert Saunby, a professor of medicine at Birmingham University, asked, 'Why have we been so slow to recognise that fresh air is the best tonic, the best antiseptic?'
So successful was it that special wards were designed for the open-air treatment of infected wounds and for general infections that often accompanied them. Also, during the 1918-1919 influenza pandemic, patients nursed outdoors were reported to have recovered in greater numbers than those in hospital wards.
With this in mind, during the pre-antibiotic era, hospitals and sanatoria were often built to exploit the germicidal and health effects of rural air. The tall ceilings and big windows in schools, hospitals, offices, and domestic buildings of the period were designed for high ventilation, both during the day and night. Hospital patients were encouraged to breathe cold, pure air, as this was thought to help them recover. 'Rural air' was also held to be important in controlling the spread of infections indoors and disinfecting wounds.
Today, however, fresh air is no longer considered to be germicidal or therapeutic for hospital patients or, it would seem anyone else, given our obsession with airconditioning everything! Buildings are no longer designed for free access to fresh air. For example, windows are smaller, ceilings are lower, cross-ventilation can be difficult if not impossible, and balconies and verandahs are not as common as they once were.
My takeaway
Isn’t it past time we thought more seriously about our modern hospitals (and modern schools and just about everywhere else modern, of that matter!) that are almost without exception airconditioned, lacking natural ventilation, locked off from the natural world? Isn’t it time to reinstate the sanatoria model, which valued open windows, fresh air and moderate sun exposure? Modern hospitals are really not the healthiest of environments in which to get well, are they? And don't get me started on the food!
Read the full story here.
TL,DR (too long, didn't read): From the end of the 19th century to the middle of the 20th, there was a widely held belief that outdoor air had disinfecting and therapeutic properties. High volumes of fresh air were thought to be of fundamental importance to indoor health. The tall ceilings and big windows in schools, hospitals, offices, and domestic buildings of the period reflect this. Is it not time to rediscover open-air wards and the open-air regimen, which might benefit patients and staff in hospitals alike? The open air factor will likely also help reduce the transmission of numerous infections in schools, homes, offices, and larger buildings.