The effects of ventilation on indoor air quality and health is a complex issue. It is known that ventilation is necessary to remove indoor generated pollutants from indoor air or dilute their concentration to acceptable levels. But, as the limit values of all pollutants are not known, the exact determination of required ventilation rates based on pollutant concentrations and associated risks is seldom possible. The selection of ventilation rates has to be based also on epidemiological research (e.g. Seppanen et al., 1999), laboratory and field experiments (e.g. CEN 1996, Wargocki et al., 2002a) and experience (e.g. ECA 2003). Ventilation may also have harmful effects on indoor air quality and climate if not properly designed, installed, maintained and operated as summarized by Seppdnen (2003). Ventilation may bring indoors harmful substances that deteriorate the indoor environment. Ventilation also affects air and moisture flow through the building envelope and may lead to moisture problems that deteriorate the structures of the building. Ventilation changes the pressure differences over the structures of building and may cause or prevent the infiltration of pollutants from structures or adjacent spaces. Ventilation is also in many cases used to control the thermal environment or humidity in buildings. Ventilation can be implemented with various methods which may also affect health (e.g. Seppdnen and Fisk, 2002, Wargocki et al., 2002a). In non residential buildings and hot climates, ventilation is often integrated with air-conditioning which makes the operation of ventilation system more complex. As ventilation is used for many purposes its health effects are also various and complex. This paper summarizes the current knowledge on positive and negative effects of ventilation on health and other human responses. The focus of the paper is on office-type working environment and residential buildings. In the industrial premises the problems of air quality are usually more complex and case specific. They are subject to occupational safety legislation and not discussed here.

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Summary of human responses to ventilation

A double-blind study was carried out on 15 premenopausal women under 40 years of age who showed objective evidence of myocardial ischemia or necrosis as demonstrated by electrocardiogram or enzyme studies, or both. In each, selective coronary arteriography was normal. Three women later died with single or multiple subendocardial infarcts. None had disease of the large or small coronary arteries. None had a predisposing cause of premature coronary artery disease, except that 8 smoked cigarettes and 4 were obese. Abnormal hemoglobin-oxygen dissociation was found in 14 of the 15 women with myocardial ischemia or necrosis. Among 3 who discontinued cigarette smoking, the anomalous dissociation returned to normal within one month of cessation of cigarettes. In the other 5 it remained anomalous. Fifteen age-matched control women were also studied by double-blind technic. Abnormal dissociation was found in the 1 control subject who smoked (more than 12 cigarettes daily for more than 15 years). Selective coronary arteriograms were not performed among women in the control group. The strong correlation between the empiric observation of abnormal hemoglobin-oxygen dissociation and the presence of myocardial ischemia and necrosis with normal coronary arteriograms suggests that there may be a relation. This may be true in view of the high oxygen demands of the myocardium (especially the subendocardium). It is possible that inefficient or slow release of oxygen by hemoglobin could contribute to myocardial ischemia or necrosis. Alternatively, the hemoglobin-oxygen affinity changes may be secondary “stress phenomena.” Electrocardiographic abnormalities occurring at rest during forced hyperventilation appear to aid in predicting the laboratory abnormality. Propranolol is often effective in treating this condition.

The paradox of myocardial ischemia and necrosis in young women with normal coronary anteriograms. Relation to abnormal hemoglobin-oxygen dissociation.

One hundred years ago, in November 1845, Sir James Watson sent a test tube of urine obtained from a 45 year old tradesman to Dr. Henry Bence-Jones with an accompanying note inquiring as to the nature of a strange substance present in that urine. This substance, then called "animal matter," has since become known as Bence-Jones protein.1MacIntyre2reported this case in 1850 in theMedico-Chirurgical Transactions. Dalrymple3examined and described pathologically two ribs of an affected patient and reported the condition as mollifies ossium in 1846. However, von Rustizky4is said to have been the first to describe the condition under the title "multiples myelom" in 1873, and Kahler5is credited with having associated this disease with the occurrence of Bence-Jones protein in the urine. Since these early reports additions have been made to the literature steadily and at a somewhat increasing rate as

MULTIPLE MYELOMA: A Review of Eighty-Three Proved Cases

A report was presented of 4 cases of CO poisoning. In one case all were members of the same family found unconscious in their home with an unvented heater. Three other cases, women exposed to CO fumes in an ambulance for 6 hr were also reported. The infant died with carboxyhemoglobin (COHb) of 55%. The 7-yr-old daughter suffered only retinal hemorrhages and transient paresis and EEG abnormalities. The mother showed subendocardial injury and ischemia after 6 days, followed by sharp T-wave inversion and radiating pain. The EKG returned to normal after 1 mo. The father showed subepicardial injury 5 days after exposure and died soon after. His heart showed focal degeneration of myocardium with swollen and necrotic muscle fibers. Of the 3 women, the 68-yr-old with a previous history of heart failure, stroke, and hypertension, responded to O/sub 2/ with only transient ST-segment depression and QT-interval prolongation. The 29-yr-old daughter showed T-wave inversion in the precardial leads persisting for 2.5 mo. The 52-yr-old niece showed slight ST depression and low T wave which returned to normal the following day.

Myocardial Toxicity from Carbon Monoxide Poisoning

The bone marrow on sternal aspiration in multiple myeloma.

Although much has been written on the subject of acute carbon monoxide poisoning, there is a dearth of literature on chronic carbon monoxide poisoning. This may be attributed to the fact that there is no unanimity of opinion as to whether frequent exposures to sublethal amounts of the gas over a considerable period of time causes any clinical phenoma or pathologic changes. Some authoritative textbooks on medicine either do not recognize the existence of chronic carbon monoxide poisoning as a clinical entity or lead one into doubt and pass the matter over with a mere reference to the subject. Because of this prevailing doubt, I have critically studied from the standpoint of symptomatology and clinical manifestations a series of ninety-seven patients who were repeatedly subjected to sublethal doses of carbon monoxide, at varying intervals over prolonged periods. The results of these studies, as well as those which I 1 previously

Slow carbon monoxide asphyxiation: a neglected clinical problem

In the course of study of a large group of patients whose illness could unquestionably be attributed to frequent and prolonged exposure to carbon monoxide gas, we were forcibly impressed with the frequency with which cardiac symptoms appeared. In most instances these symptoms were chiefly functional. However, in some cases the clinical manifestations were predominantly those of organic heart disease. Carbon monoxide chemically considered is nontoxic; that is, it has no direct effect on the tissues of the body. Its injurious action is due indirectly to its extraordinary affinity for hemoglobin, because of which the oxygen of the oxyhemoglobin molecule is replaced by carbon monoxide, thus producing a state of anoxemia. In consequence of this anoxemia, functional disturbances arise. These are due primarily to mere oxygen want and secondarily to the anoxemic lesions produced through oxygen deprivation. Structures endowed with a rich blood supply, such as the myocardium and the

Role of carbon monoxide in the causation of myocardial disease

CLINICAL OBSERVATIONS, BY DR. BECK Owing to the fact that Bence-Jones proteinuria and multiple myeloma are conditions of rare occurrence, one not only should feel justified, but also should feel it a duty to the profession to report individual cases, especially so long as we need more light on the pathologic and clinical features of the disease. The case herewith reported is of special significance since bone marrow plasma cells were found in the circulating blood by one of us, a condition rarely seen. An examination of the literature for the history of cases of multiple myeloma makes it evident that the disease, although rare, has not often been recognized. Thirty-seven years elapsed between the time Bence-Jones discovered the phenomenon in the urine, in 1846, and the report of the second case by Kuhne. Fifty years after the discovery, only four authenticated cases were added to the literature. In the

Multiple myeloma with bone marrow plasma cells in the blood: report of case

CLINICAL STUDY INTRODUCTORY It may appear presumptuous to insert the word "pneumococcic" in the title of a paper which has to deal largely with a disease or condition with local manifestations involving the mucous membrane of the upper air passages and conjunctivae, because recent investigations tend to show that these anatomic situations are a normal habitat of the pneumococcus It is, therefore, with a considerable degree of reserve that this title has been adopted, even after coupling a definite clinical picture with the persistent presence of an overwhelming number of pneumococci characterizing this series of cases It is, of course, impossible to make a numerical division as to what constitutes a normal or an abnormal invasion of pneumococci in the mucous membrane of the eye, nose and throat Therefore, we do not regard the increase in the number of these organisms, even though it be enormous, of sufficient importance to

An epidemic pneumococcic catarrhal disease.clinical study.

In East India and other oriental countries, ipecac has been regarded for a century or more as the great remedy for dysentery. In Europe and America, treatment by ipecac had fallen into disuse until quite recent times, on account, first, of its emetic action, second, of the deterioration and adulteration of the drug, and third, of improper methods of administration. The revival within the past decade of the use of this drug as a remedy for dysentery was largely due to Patrick Manson, whose extensive experience in the tropics thoroughly convinced him that it was an efficient remedy. Besides Manson, a number of other authorities attest the value of ipecac. Notably among these are Woodhull, Major Rhoades, Simon, Dock, Freund, Barker and others. Woodhull 1 refers to it as the one remedy which, if properly used, is as conspicuous in dysentery as quinin is in the malarial fevers, and urges

Harvey G. Beck

Papers

Slow carbon monoxide asphyxiation: a neglected clinical problem

Role of carbon monoxide in the causation of myocardial disease

Multiple myeloma with bone marrow plasma cells in the blood: report of case

An epidemic pneumococcic catarrhal disease.clinical study.

Duodenal medication of ipecac in the treatment of amebic dysentery