The White Plague and the History of Sanatoriums in America
Modern-day tuberculosis, a disease that has been known by many names throughout the ages, has a multifaceted history. From its ancient identification as phthisis in Greece to being termed the white plague in the 1700s, and later consumption in the 19th century, tuberculosis has not only evolved in its medical understanding but has also left a profound impact on societal and cultural narratives worldwide. This article traces the disease's journey, revealing how each era's interpretation and response to tuberculosis may have affected our ancestors.
TB or Not TB, That is Congestion: The History of Consumption
It has been known by many names, but the disease we now call tuberculosis, or TB, a term coined in 1834, has been around for several millennia in every corner of the world. The first writings describing its symptoms date back to India over 3,300 years ago and to China 2,300 years ago, but the disease can be traced back in humans over 9,000 years - the earliest remnants were dated by archaeologists in the bones of a mother and child buried together at the ancient city Atlit Yam, now beneath the Mediterranean Sea.
The ancient Greeks called the disease phthisis and Greek physician Hippocrates (460-375 BCE) accurately defined its symptoms and identified the characteristic lesions or abscesses found on the lungs, describing the disease as fatal, particularly to young adults. During the middle ages, a form of tuberculosis affecting the lymph nodes, called scrofula, came to be referred to as the “king’s evil” because it was widely believed that the touch of a monarch could heal a victim of the disease; the political philosophy “divine right of kings” stated that a monarch’s sovereignty was derived by and answerable only to God, and by acting as God’s emissary they could heal disease. The practice was first adopted in England by Edward the Confessor (1003 - 1066 CE) and in France by Philip I (1143 - 1191 CE), with great ceremony, in which crowds came to court to watch the touching; this practice lasted over 700 years in both countries.
In the 1700s, the disease was dubbed the white plague due to the extensive paleness of suffering patients. By the 1800s it was called consumption, as it was seen to consume its victims as they wasted away. During the same time it was killing one in four people, the disease became part of the cultural zeitgeist as something that was fashionable and romantic. The effects of the disease included extreme weight loss, paleness, and a feverish glow, which were adopted into beauty standards to strive towards. Women powdered their faces and used chemicals such as arsenic to achieve a paler complexion, and adopted voluminous dress skirts which emphasized slender figures. Stereotypical images of the day depicted and described patients as “one of delicate yet desirable youth,” and having “fragile loveliness.” The English poet Lord Byron, popular in the day, is even said to have written, “How pale I look! – I should like, I think, to die of consumption… because then the women would all say, ‘see that poor Byron – how interesting he looks in dying!’”
Because tuberculosis was so rampant and highly infectious, patients were often isolated in shut up rooms and treated with two popular drugs of the day, digitalis and tartar emetic, but none of these were effective methods for treating the fatal disease. In 1840, British physician George Bodington published a new treatment plan which advocated for the exact opposite - fresh air (regardless of season or state of the weather), exercise, a fresh diet of meat and produce, a quantity of wine, and extensive rest so that the patient’s immune system could recover and fight the infection. His work was first dismissed by medical journals and medical establishments, but four years prior he had opened the first sanatorium, a long-term care and treatment facility, which put his treatment course into action with some success. The sanatorium would come to be the cornerstone of treatment of tuberculosis patients in the pre-antibiotic era.
The words sanatorium and sanitarium are relatively interchangeable, with sanatorium derived from the Latin sanare (to cure or heal) and sanitarium derived from the Latin sanitas (health). The facilities were part hospital and part resort, built by great architects of the day to maximize a patient’s exposure to sunlight and fresh air. The first sanatorium in the United States was opened in 1875 by Joseph Gleitsmann in Asheville, North Carolina. The second, called Adirondack Cottage Sanatorium, was opened in 1884 in Saranac, New York by Edward Livingston Trudeau, who himself had tuberculosis and found his symptoms disappeared in the fresh air. Trudeau also opened the first United States laboratory for the study of tuberculosis in 1894.
The most basic remedies for tuberculosis were bed rest and fresh air. Sanatorium patients were expected to spend several hours a day sleeping and several hours out in the air, even in freezing conditions; some even slept outside year-round, dressed in flannel and lying under piles of blankets in the cold months. Between 1900 and 1925, the number of beds in sanatoriums across the country increased from 4,500 to nearly 675,000; even then all tuberculosis patients did not have the financial means to buy entry into a facility. The use of sanatoriums declined drastically in the 1950s with the emergence and mainstreaming of home care, found to be just as, if not more, effective as care in a facility, and new pharmacological drugs for treatment. Tuberculosis has still not been eradicated, but drugs and therapies which have been developed in the last 80 years have greatly improved the outlook for patients of the ancient disease.
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Historical Sanatorium Records
In 1904, inspired by the compelling belief that ordinary citizens held the power to combat the widespread and deadly disease of tuberculosis, Dr. Edward Livingston Trudeau, took a pivotal step. Recognizing the urgent need for widespread awareness and focused research on this public health menace, he established the National Association for the Study and Prevention of Tuberculosis. This pioneering organization, which marked a significant milestone in the fight against respiratory diseases, laid the groundwork for what would eventually evolve into the American Lung Association. Dr. Trudeau's initiative signaled a new era of citizen involvement and scientific inquiry in tackling tuberculosis, a disease that had plagued humanity for centuries. His efforts epitomized the transformative power of dedicated individuals in influencing public health policy and practice. Building upon this foundation, in 1907, the organization, bolstered by a passionate group of volunteers, launched the Christmas Seals® campaign. This initiative marked the first-ever "direct mail" fundraising effort, setting a precedent for future charitable endeavors.
The early 20th century in America saw a significant surge in the establishment of sanatoriums, a response directly correlated to the epidemic levels of tuberculosis and heightened public awareness about the disease's transmission. This awareness was largely driven by the educational and advocacy efforts of the National Association for the Study and Prevention of Tuberculosis. These sanatoriums emerged as critical facilities providing specialized, often long-term care, where patients could undergo treatment for months, or even years. A striking example of this extended care was evident at the State Tuberculosis Sanitarium of Montana, where the average patient stay was approximately 300 days. The treatment regimen in these sanatoriums typically emphasized the therapeutic benefits of clean, fresh air, including practices like sleeping outdoors in all weather conditions.
Moreover, the isolated setting of these sanatoriums inadvertently fostered the development of close-knit, self-sufficient communities. Many of these institutions began publishing their own newspapers and encouraged patient engagement in activities like gardening. Notably, they also focused on rehabilitation and future integration into society by offering vocational training. This approach not only aided in physical recuperation but also prepared patients for a productive life post-recovery, underscoring the comprehensive care philosophy of these establishments.
Most family historians learn of their ancestors being infected with the disease through death certificates or census records. However, there may be much more to learn about the final days, months, or even years of that ancestor's life. This is most common when an ancestor was thought to have lived in a specific location, but their death certificate is found in another part of the state or even in another state from which they are known to have resided, as was often the case. The high incidence of tuberculosis led to numerous and prolonged stays in sanatoriums, resulting in a vast archive of records that still exist today.
For those suspecting an ancestor may have been treated for tuberculosis, a fruitful avenue of research is the exploration of extant sanatorium records in the area where the ancestor passed away. These patient files often contain detailed information, including the individual's name, address, marital status, birth date and place, citizenship, parents' names and birthplaces, religion, admission and discharge dates, and comprehensive medical history, including diagnoses and treatment specifics.
It's important to be aware that access to these records may vary due to state privacy laws. While some records may be restricted, others may not be, and even in cases of restriction, there are often alternative sources. Non-patient records from the sanatorium, for example, can provide valuable context about general patient life and events that may have impacted the ancestor during their stay.
Many collections are extant, such as those for the Westfield State Sanatorium of Massachusetts, the Michigan State Sanatorium, the Wisconsin State Tuberculosis Sanatorium, the Minnesota Sanatorium for Consumptives, and the North Dakota Tuberculosis Sanitarium, to name only a few. There are simply too many record collections to list here; that being said, a simple internet search for “historic sanitarium patient records” is a great place to start. Try different variations to expand the search.
As you delve into these records, you may uncover more than just names and dates; you may find stories of struggle, survival, and the human spirit, enriching your understanding of your family's place in history.
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The Christmas Season is upon us. Learn more about the interesting history of Christmas tree lights in our archive article here.
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