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658 Chapter 36 1945 Guide in removing particles of 15 to'20 microns and smaller; besides dusts and smoke85. Although the chief remedial factor in the treatment by conditioned air is the filtration of pollen, a certain amount of cooling and dehumidification appears to be desirable. A comfortable temperature between 70 and 75 F and a relative humidity, well below 50 per cent proved satisfactory86. Direct drafts, overcooling or overheating are apt to initiate or aggravate the symptoms. Limitations of Air Conditioning Methods The. results obtained with air filtration or other air conditioning pro cesses in the control of allergic conditions are fairly comparable to,those obtained by desensitization treatment so long as the patients remain in the pollen free atmosphere. But while specific desensitization is preven tive and in a few instances curative, for all practical purposes filtration gives only temporary relief. In mild cases sleeping in an air conditioned space may make it possible for the individual to pass more comfortable days. With rare exceptions, the symptoms recur on.exposure to pollen laden air. Moreover the usefulness of air conditioning methods is limited because all cases are not caused by air-borne substances. Cases of bacterial asthma do not respond to the treatment with filtered air. Despite these limitations air conditioning methods possess definite advantages in the simplicity of treatment, convenience, and under certain conditions almost immediate relief87. Pollen cases are usually relieved of most of their symptoms within 1 to 3 hr after exposure to properly filtered air. A pollen-free atmosphere is especially valuable in cases where desensitization has given little or no relief, and where desensitization is not advisable owing to intercurrent illness. OXYGEN THERAPY Oxygen therapy is the.principal measure employed for preventing and relieving the distressing symptoms of anoxemia, which is a deficiency in the oxygen content of the blood. Some of the more important conditions in which oxygen treatment is believed to be beneficial are pneumonias, anemia, heart affections, post-operative'pulmonary disturbances, certain mental disturbances, asphyxia, asthma and atelectasis in, new-born infants. The effectiveness of oxygen therapy is not related to the type of administrative device except as the oxygen concentration is- affected; that is, oxygen at 50 per cent concentration is equally effective whether given by any of the three common methods, catheter, face mask or tent88. The necessity of air -conditioning in oxygen therapy arises from the fact that oxygen is too expensive a gas to waste in the ventilation of oxygen tents and oxygen chambers. The oxygen rich atmosphere in these enclosures is therefore reconditioned in a closed circuit by removal of excess heat, moisture, and carbon dioxide given off from the occupants being treated. **Air Cleaning as an Aid in the Treatment of Hay Fever and Bronchial Asthma, by Leo H. Criep and M. A. Green {Jctomal of AUergy, 7:120,'1936). "The Effect of Low Relative Humidity and Constant Temperature on Pollen Asthma, by B. Z. Rappaport. T. Nelson and W. H. Welker {Journal of Allergy, 6:111, 1935). "Hospital Air Conditioning, by C. P. Yaglou (The Environment'and Its Effect upon Man, Harvard School of Public Health, p. 244,1Q39). "Manual of Oxygen Therapy Techniques, by A. H. Andrews, Jr. (The Year Book Publishers, Inc., 1943). Air Conditioning in the Treatment of Disease ._______________________________ . 659 Oxygen Tents In oxygen tents the air enriched with oxygen is usually circulated by ' means of a small motor blower which sends the air over, soda lime' to remove carbon dioxide and then over. ice. to remove excess heat and moisture. The concentration of oxygen in the tent is regulated by means of a pressure reducing valve and flow meter. In an inadequately cooled tent, high temperatures and humidities are inevitable, increasing the discomfort of the patient and imposing an added strain on an already overburdened heart. Oxygen therapy under such conditions may do more harm than- good. An ice melting rate of approximately 10 lb per hour gives satisfactory results in patients with fever in a medium size oxygen tent. Oxygen tents are confining to the patient. They may terrify the rest less and delirious patient. Medical and nursing care is complicated, as the tent must be opened or removed with attendant loss of oxygen. Oxygen concentrations of 50 per cent or more are difficult to maintain, and it is a problem to keep the temperature and humidity low enough in hot weather. However, with attention to details, the patient can be made quite comfortable. Oxygen Chambers The conventional oxygen chamber is an air-tight sheet metal endosure of fire-proof construction, large enough to accommodate one or two patients. Trap doors or curtains are provided for the personnel, food and service, to avoid loss of oxygen. Glass windows in the ceiling and' walls admit light from outside the chamber. The air conditioning system may be of the gravity type, or of the fan type using mechanical refrig eration or air drying agents. The temperature and humidity requirement in oxygen therapy depends primarily upon the physical condition of the patient, and secondarily upon the type of disease. In pneumonias89 prescribed conditions should be an effective temperature of 66 to 68 F, humidity of 50 per cent, air movement of not less than 50 linear feet per minute, oxygen concentra tion of 50 per cent, and carbqn dioxide of less than one per cent. Oxygen in Aviation An important application of the principle of oxygen therapy is in aviation. At the present time all high altitude military airplanes in this country are provided with gaseous oxygen equipment and military personnel are required to utilize oxygen at all times while in flight above 15,000 ft, or between 12,000 to 15,000 ft for longer than two hours, or1 between 10,000 to 12,000 ft for longer than six hours. The use of oxygen in commercial aviation will depend on the height, and duration of the flights as well as the state of health of the passengers. The necessity for portable, comfortable equipment, the possible fire hazards due to smoking, and the use of oxygen on sleeper planes are some of the difficulties facing civil airline operators. The pressure cabin airplane, capable of flights at 15,000 to 20,000 ft may be one of the solutions of the problem40. GENERAL HOSPITAL AIR CONDITIONING Complete conditioning of a large hospital involves a capital investment and running expenses which may.not be justified. Air conditioning has `The Management of Pneumonia, by J. G. M. Bullowa, {Oxford University Press, p. 260, 1937). "Principles and Practice of Aviation Medicine, by H. G. Armstrong (The Williams and WOkina Com* pany, 1939).