The Religion of Tuberculosis

by: Janey Terry

Towards the end of the nineteenth century, tuberculosis victims, banished from their communities, were sent to places designed to house and treat individuals with tuberculosis. Many health care leaders followed the methods of Edward Livingston Trudeau, a doctor who established the first American sanatorium at Saranac Lake, New York. The main elements of Trudeau's methods were "an invigorating climate, an open-air life, rest, coupled with the careful regulation of the daily habits and an abundant supply of nutritious food". The State of Virginia adopted Trudeau's methods, and in 1909, built the first state sanatorium in the Catawba Valley. Eight years after the Catawba Sanatorium was established, the State started a second sanatorium, Piedmont, in Burkeville. By 1917, tuberculosis was prevalent in the black population. Since Catawba Sanatorium only treated white patients, the State opened Piedmont to treat the black residents of Virginia. Two years later, the State opened its third tuberculosis sanatorium in Charlottesville. The Blue Ridge Sanatorium, also segregated, was another sanatorium for white Virginia residents stricken with the disease. The three sanatoria maintained a strict regimen of abundant rest and food. The resting patients occupied verandas all day. Though the mountainous views at Catawba and Blue Ridge were extraordinary, lying on the verandas became a monotonous task, creating long, boring days (Figure 1). One tuberculosis victim, Elizabeth Mooney, wrote to her family stating, "I do nothing all day but lie here staring at the mountains. I wish they would rearrange them a bit".

Although these elements provided the basis for treatment, the patients, segregated from society, needed an outlet to reclaim a sense of life. Katherine Ott, author of Fevered Lives, explains that one loses his/her autonomy from the resulting isolation of institutionalization. Gerlach-Spriggs, Kaufman, and Warner write in Restorative Gardens: The Healing Landscape, "Being a patient is disorienting and terrifying…patienthood is utterly dislocating. The distortion of perception, sapping of the identity, and loss of connectedness to the external are overwhelming". After months of idleness, the patients, breaking from the strict medical regimen, began to search for the normalcy they had in their original communities. The patients initiated many activities, some with a religious emphasis, turning a state institution into a community. The sanatoria were no exception to the standard government regulations, having to abide by the policy of separation of church and state. The State did not monetarily support any religious actions started by the patients; however, they did allow them to conduct activities and construct religious buildings on the sites, altering the institutional landscape. One Catawba patient, Charles E. Brauer, formed a Sunday school program and later pursued the construction of a chapel through a fundraising campaign. Once the Catawba Chapel was complete, Brauer expanded his efforts, helping Blue Ridge and Piedmont start fundraising campaigns for chapels. The religious activities increased through the use of the chapels and the formation of other organizations. These efforts helped the sanatoria connect with nearby communities, and in some ways, dismantle their isolation. As the patients continued to claim their independence, they changed the regimen of the medical treatment and created three communities.

Charles E. Brauer, a barber from Richmond, Virginia, arrived at Catawba Sanatorium soon after it opened. Before contracting tuberculosis, Brauer was a member of the Union Station Methodist Church in Richmond, where he was a layman, member of the building committee for the new church, and Superintendent of Sunday School. In 1910, while at Catawba, he organized the Sunday school program on the porch of the old hotel, the remains of a former use of the site (Figure 2). He became the Superintendent of Sunday School and in 1914, began the fundraising campaign for the chapel. Within two years Brauer had raised enough money to construct the chapel, and the Tuberculosis Committee of the State Board of Health approved the site location that he selected. The architect for the chapel is unknown, but one can only assume that Brauer, who had been on the building committee of the Union Station Church, was involved with the design and choice of materials.

Benjamin W. Poindexter, a draftsman, and, Charles K. Bryant, a Richmond architect, designed Union Station Church. Bryant ended his practice shortly after the completion of the church in 1893; however, Poindexter remained active through 1917, working with Richmond architect, Marcellus Wright. Union Station Church, located in a Richmond community, is built in Gothic style, with brown stone walls and terra-cotta accents, a slate roof with copper ridges and cornices, and stained glass windows (Figure 3). The Catawba Chapel, fifty-four feet long by thirty-three feet wide, is much smaller and different than Union Station Church; however, similar materials and elements are used. Like Union Station Church, the Catawba Chapel is made of stone, slate roofs, with gothic style windows and doors (Figure 4). The Catawba Chapel also exhibits stone buttresses and stained glass in the circular window on its front façade. Unlike Union Station Church, the stone of the Catawba Chapel, quarried on the grounds of the sanatorium site, is rough cut. The Union Station Church's influence went beyond the appearance of the building; one of its Sunday school classes, known as the Brauer Circle, kept up with Brauer's work at Catawba and made a substantial contribution to the Chapel fund.

On March 29, 1916, the Tuberculosis Committee of the State Board of Health requested the Chapel Committee to name the building the Charles E. Brauer Chapel, "in grateful acknowledgement of its debt of gratitude to him [Brauer] for his faithful and valuable services". The Tuberculosis Committee acknowledged Brauer's numerous improvements to the sanatorium. In addition to the Chapel, he also operated a patient store and established the library. In his honor, the Charles E. Brauer Chapel was dedicated on Easter Sunday, April 23, 1916. The completed cost was $8,000.

After Piedmont and Blue Ridge Sanatoria were established, Brauer expanded his efforts, prompting chapels at both sites. In 1921 at Blue Ridge, Brauer organized the Sunday school and initiated the fundraising campaign for a chapel; he raised $500 through the Catawba Sanatorium Sunday School, and raised $500 through personal efforts. In the same time period the Catawba Sunday School donated $100 to the Piedmont Chapel fund (Sun 4/22).

The Piedmont Sanatorium Welfare Board was a major asset to the campaign. They presented the proposal to the Piedmont Committee of the State Board of Health, guaranteeing to maintain the building after its construction. "Conform[ing] to the general scheme of the sanatorium buildings," the wood-framed chapel, complete with white German siding and a green paper roof was dedicated on April 27, 1924, after three years of fundraising (Figure 5). Eight hundred people attended the ceremony, with an array of speakers and musical entertainment, including remarks from Charles E. Brauer.
Ground was broken for the Blue Ridge Chapel in August 1924, after more than $7000 had been raised. Although Brauer helped both sanatoria build chapels, it is obvious that his influence was stronger at Blue Ridge. The Blue Ridge Chapel, almost identical to the Charles E. Brauer Chapel, is constructed of native stone, obtained from an abandoned quarry on University of Virginia property, and covered with a slate roof (Figure 6). It maintains many of the architectural elements, including gothic style windows and doors, stone buttresses, and a circular window on its front façade. Its main differences draw from changes in the plan: exterior doors were added towards the rear, and a demi-octagonal apse protrudes from the rear façade (Figure 7). The Brauer Chapel maintains symmetry on the side facades, and its rear façade is flat. Four years after the fundraising campaign started, the Blue Ridge Chapel was dedicated on October 4, 1925, with a total cost of $12,000.

The use of materials for the three chapels goes beyond Brauer's dominant influence at Catawba and Blue Ridge. Ian Grandison, Professor of American Studies at the University of Virginia, explains that there is a moral hierarchy associated with building materials: wood structures are morally inferior to brick structures, which are morally inferior to stone structures. An example he gave was a comparison between two American college campuses, one white and the other black. Two sisters donated money to both campuses for the construction of buildings. They specified that the building at the black campus be built of wood, although all major buildings on the campus were intended to be brick. At the white campus, the two sisters allowed the building, a chapel, to be constructed of stone. Brick and stone represent stability and superiority. The blacks were not allowed to share these traits with the whites. The two sisters, along with the majority of society, considered brick to be inappropriate for these second-class citizens. The two sisters claimed that the wood building on the black campus fit into its surrounding context; however, the stone chapel on the white campus became an architectural and civic landmark. The wood building, an eyesore, was eventually moved to the backside of the campus and abandoned. Grandison's study symbolizes the racial prejudice between Piedmont and the white sanatoria, Catawba and Blue Ridge. Piedmont Sanatorium received the morally inferior chapel that fit into its surrounding context; however, Catawba and Blue Ridge Sanatoria constructed stone chapels, exemplifying their superior status. Of the three buildings, Piedmont is the only one that has been demolished. Although the chapels housed different classes of society, they were utilized for the same purposes.

The three chapels, used by patients, staff, and employees of the sanatoria, accommodated many events, including Sunday school, church services, prayer meetings, holiday services, special entertainment, and commencement exercises for graduating nurses. For many years, Blue Ridge had religious services three times a week - Sunday school on Sunday morning at ten o'clock and church services on Friday and Sunday evenings at seven thirty. Catawba had a similar schedule. In 1926, Catawba held its first weeklong revival. Local musicians provided special concerts in the chapels and in the infirmaries throughout the years, allowing the patients who were unable to go to the chapels enjoy special events, too. Each sanatorium, with an established nursing school, held commencement exercises in the chapels (Figure 8). For many years Charles E. Brauer was a part of the ceremony at Catawba, either giving the invocation or benediction. Just upon its completion in May 1925, the Blue Ridge Sanatorium's first graduating class of nurses held its ceremony in the chapel; the last graduating class held its ceremony there, also. The chapels were clearly used in the same way the healthy society uses them. They became the meeting place where people gathered to celebrate life, witness special occasions, and support others in need. In 1922, this was exemplified by the Charles E. Brauer Chapel holding its first wedding ceremony.

The Sunday school classes, which had initiated the chapel campaigns, enhanced the living situation for patients at the sanatoria (Figure 9). There were many accounts of their dedication and contributions to the three communities. Doctor Carter, former Superintendent of Piedmont Sanatorium, wrote about the Sunday school's success on influencing the lower-class tubercular patients. The black patients, many of whom were uneducated, were more skeptical of the institutional environment and treatment of the disease. Dr. Carter stated, "[t]he lower class seldom remains long enough to effect a cure, but look with suspicion upon a treatment not using the vilest and strongest drugs promising immediate relief. A very small percentage can be absorbed by the larger percentage of the educated class, and here is offered an excellent opportunity to the educated of favorably influencing the lives of the others. This opportunity is being taken advantage of in the Sunday school conducted by the patients and in the weekly social gatherings". At Christmas, the Sunday school members went caroling through the infirmaries. The children, also a part of the Sunday school at Blue Ridge, created performances for the patients, including plays, readings, singing, and piano selections.

Besides social contributions, the Sunday schools monetarily improved the sanatoria (Figure 10). Throughout the years at Blue Ridge, they bought two pianos (one in 1922 and another replacing it in 1954), instruments for the children's orchestra, hymnals, and various other items. They also provided money for needy patients; they paid the expenses for patients to go home, and for those not able to go, they paid the expenses for the family to visit them in Charlottesville.

The chapels and Sunday schools were not the only religious undertakings at each of the sanatoria. The patients initiated clubs to create better living environments. Piedmont had glee clubs, quartettes, and a Mother's Club. Another effort, initiated at Catawba, was the Tuberculosis League. Three female patients met in the old Virginia Building on March 8, 1925, "for the purpose of making a humble call to God to check the disease". The official purpose of the organization consisted of two parts: 1) to glorify God; and 2) to use the power of prayer to support scientific research, anti-tuberculosis organizations, and all of those suffering from the disease. Their work expanded internationally, including Canada, England, Wales, Switzerland, Puerto Rico, and the Philippines. Their most influential undertaking for the sanatoria community was the ringing of the prayer bell. Starting in June 1925, every morning at eleven o'clock the prayer bell would ring, "reminding patients of the united appeal to God to help heal those affected with tuberculosis". Piedmont adopted this new component of the patients' daily regimen, and in 1927, the patients wrote about their loyalty in Sunbeams, a patient newsletter. One patient, who had been walking on the grounds with visiting family when the bell rang, represented their dedication. He immediately paused and stood still for two minutes.

Another endeavor started by the Catawba patients was Sunbeams, a monthly newsletter, published by the State Board of Health, the Virginia Tuberculosis Association, and the patients of the state tuberculosis sanatoria (Figure 11). Its purpose was to educate tuberculosis patients and healthy citizens throughout Virginia about the disease. Besides articles about the disease itself, the newsletter included current events from each sanatorium, poems, jokes, religious articles, prayers, and advertisements from local businesses in Roanoke and Charlottesville. Blue Ridge used the newsletter to promote its fundraising campaign for the chapel and provide details of the progress. They also frequently gave updates on the chapel's progress. Sunbeams was not a religious newsletter; however, religion was incorporated and became a significant part of the newsletter. In addition to the religious articles inside the newsletter, many of the back covers were composed of religious poems, prayers, and one was an advertisement for the Blue Ridge Chapel Fund (Figure 12). For over ten years Sunbeams was dispersed throughout the three Sanatoria and mailed to Virginia citizens. Several ex-patients wrote to Catawba, requesting a new subscription because they missed the newsletter after returning home.

Sunbeams and the fundraising campaigns for the chapels allowed the sanatoria to reach out to the surrounding communities. Local businesses funded Sunbeams through their advertisements, and friends, family, and local citizens were major assets to the fundraising campaigns (Figure 13). Some citizens gave large contributions, significantly increasing the funds at one time. This was the beginning of breaking the barrier of isolation, which local religious organizations continued to overcome. The dedication ceremony for the Piedmont Chapel, with eight hundred people in attendance, proved bonds were forming with the local communities. In addition, church groups brought Christmas gifts to the children patients, since they were not allowed to go home during the holidays. Many religious members of the surrounding towns visited patients in the infirmaries who were unable to attend religious services. A member of the Ministerial Union of Roanoke conducted weekly services at Catawba, and the Ministerial Association of Charlottesville and Albermarle County provided weekly services at Blue Ridge. Piedmont also had ministers from the surrounding area conduct church services. Doctor Carter stated that "[t]he Negro ministers … have always supported our work most enthusiastically".

The religious activities were dominating the culture and changing the daily regimen. In 1921, the Annual Report for Catawba stated, "…the usual sanatorium activities … continued: regular lectures to the patients; Sunday school in the chapel; services conducted by more or less regular visitors from city pulpits; motion pictures in the dining hall, and patient-organized parties and bazaars for the free-bed fund" (State Board). The staff at all three sanatoria realized the importance of the religious activities that had formed. In 1953, they discussed the positive effects at the Blue Ridge State Board of Health Board Meeting. They felt there was a need for someone to live at the sanatorium and direct the patients' religious activities. Although local ministers provided weekly services, some patients would stay for months without a minister visiting them. Others would die "without a prayer being offered for them." A Chaplain would be able to frequently visit the patients and provide comfort to those who are preparing for surgery. The State never fulfilled this need since State money could not be used for this purpose; however, in 1922, Piedmont had solved this dilemma by allowing the Superintendent to appoint a Chaplain for these duties and provide his meals in return.

Before the chapels were constructed, each sanatorium held Sunday school in the dining room. It was the introduction to pulling religion into the daily regimen and one of the first steps towards forming a community. Once established, each of the Sunday schools initiated the fundraising campaigns for the chapels. After months of inactivity and dependency on medical professionals, the idea of creating something gave the patients self-worth again. Similar to other communities, the chapels were the central focus - physically, spiritually, and socially. There are many examples of the church as a significant element in the community, no matter if the communities are planned or simply evolve over time, such as the sanatoria. The plan of an English village illustrates the idea of creating a place (Figure 14). A curvilinear road goes through the center of the village, transforming it into a place, "a place with a way in and a way out and not merely an incident along the roadside". Using Blue Ridge as an example for the sanatoria, a visitor or a new patient would ascend a curved road, passing houses on both sides, with the chapel among them (Figure 15). The strong visual presence of the stone chapel completes the community. Many towns and neighborhoods within cities are designed in this way, with residences and businesses surrounding the church. Examples include Annapolis, Maryland; Brunswick, Maine; Upton, Massachusetts; and two neighborhoods in Virginia, one in Richmond, and the other in Stafford County. Annapolis, Maryland has an unusual plan incorporating two circles as its central focus (Figure 16). The two circles, one for the State House and the other for the church, are located on the highest and most prominent sites of the city. The State Circle is the larger circle with six streets radiating from it, and the Church Circle has eight streets emanating from it. Brunswick, Maine features a crescent-shaped central green with roads on either side lined with residences and businesses (Figure 17). The central green slopes upward towards the Congregational Church, terminating the view. Brunswick is an atypical New England town, which probably means that it evolved over time, with the crescent green coming into existence by accident. Upton, Massachusetts was definitely a village that evolved over time (Figure 18). Originally scattered farmsteads whose center consisted of a meetinghouse located on an acre of common land. Eventually, after many generations, merchants began to see the advantage of this central area; therefore, businesses and residences developed around the meetinghouse, creating a town. Residences and members also surrounded Union Station Methodist Church, Charles E. Brauer's original church in Richmond, Virginia (Figure 19). Ferry Farm Baptist Church, in Stafford, Virginia, is another church located in a residential neighborhood, where many of its members originally lived (Figure 20). The neighborhood started in 1952, and within seven years the church was built. From villages to state capitols to towns to neighborhoods - all of these places exemplify the church's physical importance in a community.

In some places, the church was the first building and the town grew around it, or in other places, a church was built into a residential area, forming community ties. The chapels at the sanatoria helped create the sense of place. At the time the chapels were built, the patients were living at the sanatoria for two or more years; establishing the chapels, the patients formed communities. Oliver Sacks states, "that one needs open-air hospitals with gardens, set in country and woods…a hospital like a home, not a fortress or institution, a hospital like a home - perhaps like a village". Even though these communities were established to cure a disease, the patients modified the strict daily regimen of the medical treatment adopted from Trudeau, attempting to function like normal communities within society. The presence of the chapels and religious organizations brought new components to their daily routines. They created organizations to improve their community and others, held concerts and other forms of entertainment, celebrated special occasions together, formed bonds with other communities, and changed rules within the community when deemed necessary. The landscape, both natural and man-made, was used as a tool in healing individuals with tuberculosis. While methods of treatment prescribed the outdoors allowing the body to heal, patients at the sanatoria altered their landscape to heal their souls.

Looking at the sanatoria's architecture and landscape today, one can sense an institutional setting, but its history allows the buildings to lose their antiseptic hardness. The history of the sanatoria includes the architecture, landscape, and the medical and social courses of tuberculosis. Patients, staff, and members of the Virginia State Board of Health used architecture to change their landscapes and mimic society. The chapels were significant elements in the development of the sites. Once completed, they became their sanctuaries; the buildings served as the foundation of renewed strength and the center of the communities. Marilyn J. Chiat, author of America's Religious Architecture, quotes a geographer who describes religious buildings as the "universal element in the American settlement landscape, rural and urban … too rich an ore to be overlooked by cultural geographers or historians." Chiat continues by stating that religious buildings are overlooked even though the United States has a more diverse spiritual architecture than anywhere else in the world. She says that, "all we need to do is pause as we speed along superhighways or hurry through towns and cities on our way to somewhere else and take a moment to look around. We would see places of worship, large and small, elaborate and simple, all with interesting stories to tell about the history of a place and of the people who lived there".

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