The Role of Politics in the Life of Virginia Sanatorium

by: Richard Sidebottom

During the twentieth century the public health community in the State of Virginia focused much of their attention on the eradication of the "white plague," tuberculosis. Initially private organizations led the crusade against tuberculosis. Then, the General Assembly and the Governor assumed a direct role in funding, maintaining, and later abandoning or adapting public sanatoriums throughout Virginia. With politics determining the appointments, rules, and funding of these institutions through the State Board of Health, the sanatoriums reflect changing social and medical ideas in their built forms, siting, and landscaping.

For over fifty years, the State of Virginia operated three sanatoriums concurrently for tuberculosis patients. While these three hospitals, Catawba, Piedmont, and Blue Ridge, were not the only treatment facilities in the state, they were the largest, least expensive and the most modern facilities offered. Numerous private sanatoriums also operated but were not directly under control of the state. During the nineteenth century, treatment of consumption was largely confined to one's home or to various resorts that offered rest and relaxation. The first state institution arose from this resort culture. In 1908, The commonwealth purchased the former Red Sulphur Springs resort in Roanoke County and converted it into a sanatorium; the first public response to the tuberculosis epidemic.

On March 14, 1908 the General Assembly of Virginia passed the so-called Baker Bill to reorganize the State's Board of Health. The bill appropriated $40,000 toward eradicating tuberculosis. The money would pay the salaries for the State Commissioner of Health and his staff, including an assistant, a clerk and a skilled bacteriologist. Their job was to "provide for the treatment by the most advanced methods, of the tuberculosis patients in the state at a minimum expense to the patient." This put the onus on the state to research the disease and to take the initiative, implementing new methods of treatment rather than laying idle while private sanatoriums and individuals attempted to care for the diseased. The majority of the appropriation went to creating sanatoriums, either temporary or permanent structures for medical treatment.

Pavilions and tents were used with the other existing buildings at Catawba when the sanatorium opened July 30, 1909. At this point the prevailing opinion on treatment centered on relaxation of the lungs so that the body might heal itself. To meet these ends, the state acquired the former Red Sulphur Springs resort hoping to take advantage of the buildings already in use and the healing qualities of the landscape. Two pavilions were named for politicians involved in opening the hospital to the public, one for Governor Swanson and one for State Senator William Baker. Four of Baker's six children had died of tuberculosis. Baker's family history and political leadership led the Board of Health to take the unusual step of naming the building after him even though he was both still alive and in office.

Patients quickly filled Catawba's initial 42 beds, and a waiting list for taking "the cure" reached months in length. The Board made many short-term additions over the next decade to Catawba, adding bed space when funds permitted. Despite the successful treatment of many patients and an extensive education campaign by the Virginia Anti-Tuberculosis Association, people still arrived in droves. It was agreed that additional sanatoriums throughout the state should be constructed to help alleviate the waiting list at Catawba and to do more to get tuberculosis care to a preventative stage.
In 1916, the General Assembly passed an act which gave cities and counties the right to start a sanatorium in their locality. It would be up to the local government to raise a tax for the construction. After the facility was completed the state would then lease and maintain the hospital for state use. The act included a section stating that any type of charitable contributions could be used for funding the venture. It appears that the hope of this legislation was to organize a web of small tuberculosis facilities around the state so the patients would find it easier to get to sanatoriums when in need of treatment.

Although this did not actually take place, the law did have some lasting impact on the state subsidy of patient expenses, the role of charity in state facilities, and the importance of local government in creating and supporting sanatoriums.
The legislation of 1916 influenced the push by the Board of Health to establish Virginia's second tuberculosis hospital. The communicable nature of tuberculosis meant that anyone within society could contract, carry, and spread the contagion. The state had realized this in trying to extend treatment to whites without money, but had not yet extended treatment to blacks. By 1918, the importance of curing members of all portions of society had been driven home by the medical community and private tuberculosis efforts. Siting the commonwealth's first sanatorium for blacks was not an easy task. The state initially intended to place the project in Ivor, located in Southampton County fifty miles south and east of Richmond. The local community there made it known that they were not willing to have such an institution in their backyard. After a number of similar instances around the state, property in Burkeville, Nottoway County was secured. Dr. H.G. Carter, first superintendent of the facility and a leader for extending the cure to blacks, said in recounting the opening that there was "a compromise" on the matter of place.

A primary motivation behind creating a sanatorium for blacks was to protect white families from contracting disease from their household servants. Dr. H.G. Carter, the superintendent of the first state sanatorium for blacks, Piedmont, said in 1917:

"The interdependence of the two chief races of the South as shown by the tables of occupation at Piedmont Sanatorium make a fight against disease in both essential in order to get results in either one."

The tables he speaks of showed that a majority of the patients were servants to white families. In order to meet the interest of eradicating the "white plague" amongst whites, the state would also have to take on the case of blacks. The hospitals would have to perform essentially the same functions of cure while at the same time conform to the prevailing belief in white supremacy. Despite the commitment to treating tuberculosis in all Virginia, the built environment at Virginia's sanatoriums show important differences in the sanatorium landscape built for whites and blacks.

By the time Piedmont opened its doors, there were already plans for establishing an additional sanatorium for whites just outside of Charlottesville. Unlike the difficulties encountered by the state in establishing Piedmont, Blue Ridge sanatorium, as it would be known, was accepted and even courted by the City of Charlottesville and Albemarle County. The city raised $15,000 to fund the sanatorium and offered to provide free water for the first five years to the facility. In addition to these efforts the new hospital was to be affiliated with the University of Virginia medical facilities, including their medical school. In January of 1919, Edwin Alderman, the president of the university, pledged the support of his school in a letter to the State Board of Health. Alderman had himself undergone treatment for tuberculosis at Saranac Lake and later served as Vice-President of the Virginia Anti-Tuberculosis Association. This group produced a pamphlet in the same year entitled "Lost: 5,000 men and $25,000,000 in Virginia during 1919" urging the General Assembly to either add to the bed space at Catawba or open a new sanatorium. It included letters from patients at Catawba, editorials from newspapers and private citizens, and even the testimony of Dr. W.A. Lambeth, director of physical education at the University of Virginia, urging the government to add more beds statewide. With all of the pressure and with local support for a Charlottesville sanatorium, the Board of Health quickly moved to start a new facility.

On April 26, 1920 the Blue Ridge sanatorium opened with a front-page headline in the Daily Progress. The paper's article mentions that although there was no public ceremony due to an early opening, the community supported the venture. The 1870's house on the property purchased for Blue Ridge was renamed the Davis building and the new patient areas named the Addison, Thomas, and Strode pavilions. This process follows in the footsteps of the Catawba structures. Westmoreland Davis was governor at the time of Blue Ridge's inception. Known mostly as an advocate of agricultural innovations, Davis was a progressive who found his way into office during a three-way vote by making himself the candidate against prohibition. The "genteel maverick" from Loudon County was himself a non-drinker but was able to secure the office and thus his spot in the history books by defending the side of drinkers. He was able to do very little during his term (1918-22) as neither party claimed him and was thus considered an ineffective leader.

"On the subject of his record of public service Davis was almost paranoid, fearful that posterity would forget him and suspicious that the press was systematically awarding his accomplishments to others."

With his name secured on the most prominent building at the new hospital, the governor visited on August 15, 1921 to inspect the progress and found everything in order.

The three pavilions had also been named for politicians. State Senators Aubrey Strode, A.F. Thomas, and Walter E. Addison all had a hand in writing the bill that raised a "mill tax" for funding Blue Ridge. Strode was a lawyer who pushed for social legislation of all sorts during his terms in the senate (1906-10 and 1916-19). In addition to supporting the tuberculosis movement, Strode was an advocate for a state funded women's college and a leader for prohibition. He also was applauded in his time for authoring Virginia's infamous eugenic sterilization law which forcibly sterilized certain members of the public considered unfit to have children. After his time in the senate, Strode was appointed in 1933 to a judgeship in the Lynchburg Circuit Court. He was joined in name at Blue Ridge by senators A.F. Thomas and Walter E. Addison both of Lynchburg and both newspaper editors. Only Strode and Addison were in the senate when the bill was passed.

Interestingly, Addison and Thomas never served together because they represented the same area. However, it may be inferred that Thomas helped in drafting the bill and as a former senator was included amongst the authors when lauds were distributed. The laurels bestowed these politicians did as much to reinforce the role of the state as provider for the sick as it did to stroke the ego of each individual.

It is hardly surprising to find no mention of politicians amongst the buildings at Piedmont. The Moton pavilion and Carter Building were both in honor of doctors who helped to make Piedmont a viable tuberculosis center. Dr. H.G. Carter was instrumental in treating tubercular blacks in Virginia at a time when he says people questioned, "would the Negro have enough resistance to justify building and conducting a sanatorium?" This quote shows the prevailing view of black inferiority and also shows the levels at which blacks were excluded from the governmental decision making process. Dr. Moton was a prominent member of the Negro Organization society which lobbied the state to provide for treating African-Americans. By naming a patient pavilion for Moton it identified the importance of charity in the role of curing tuberculosis. The Negro Organization Society apparently was involved in the "compromise" surrounding the start of Piedmont by buying the land on which the sanatorium was built and donating it to the state. They then provided the funding for a pavilion and helped with some maintenance costs. These efforts were crucial to the opening of Piedmont just as Charlottesville's contribution was crucial at Blue Ridge. The funds for Piedmont however show a need for private support with the state appropriations just to operate. The first major private charitable gift for medical treatment at Blue Ridge was not until 1926.

On April 26, 1927 a parade starting in downtown Charlottesville wound its way around the city's major streets down Monticello Road and into the entrance of Blue Ridge sanatorium three miles away. The fanfare marked the opening of the state's premier tuberculosis pavilion which was built with contributions from the Masonic lodges throughout the state. It was named for George Wright, a Grand Lecturer for the Masons of Virginia who also served as Director of the Virginia Anti-Tuberculosis Association from 1909-13. At his death, the Masons looked to commemorate him by giving to a cause that he supported. The building did much to help at Blue Ridge as it provided about sixty beds, new office space, and new technology, including an operating room and Alpine lamp room. The Masons were promised in return the priority on filling open beds in the building for themselves or family members. By providing Masons privileged status, the deal shows how private charity can influence public works.

By 1930, it was obvious that political standing had much to do with how treatment for tuberculosis was dispersed. Blue Ridge had received appropriations continuously from the state throughout the twenties, and additional help from the Masons, creating a state of the art complex that provided patients with an ideal setting for healing. To remind the sick and their families of who was helping them and to celebrate public commitment the names of two governors and four state senators received prominent recognition on sanatorium buildings. However, the building boom of the 1920's at Blue Ridge would stop with the Great Depression. No expenditures were made for new buildings at the hospital for over ten years. When new money was finally available in 1939 through a Works Progress Administration grant, the need of the sanatorium had changed. With mostly advanced cases arriving in the thirties, the sanatorium continually called for more infirmary space to be added. The new infirmary, or East Wing, was a streamline, institutional building that looked to house as many patients with as little expenditure as possible. The design did however still incorporate sleeping porches for the treatment and comfort of the patients. A similar WPA building at Piedmont is devoid of porches, has an additional floor, and is made of plain concrete unlike the brick at Blue Ridge. The new buildings at both Piedmont and Blue Ridge were left without political names because there was little that local politicians could claim as achievements with federal help providing funds. The evolving interest in making care more efficient shows in treatment procedures as well.

During the difficult financial years of the 1930's the state started to look more heavily at new procedures for curing tuberculosis. In 1938 the first appropriation was passed by the General Assembly for pneumothoraxis, a surgical procedure for resting the lungs. In the operation a portion of the rib cage would be removed causing the lung to collapse and thus allowing it to rest. This procedure had a moderate amount of success in stopping the development of the tuberculosis, but often left the patient with a collapsed lung for life. Many doctors including the head of Blue Ridge, Dr. W.E. Brown advised against the development realizing patients would think that pneumothoraxis alone was able to cure them. It would be another ten years before the cure they hoped arrived.

The introduction of streptomycin in the 1940's greatly changed the face of tuberculosis treatment and with it sanatorium facilities. The General Assembly first approved the experimental use of antibiotics in 1947 for Blue Ridge. It immediately became evident that tuberculosis could be stopped from advancing and perhaps even eradicated with the new drug. The next year $50,000 was put into spreading the new treatment throughout the state. In 1949 with this new development, a west wing extension was added to the main infirmary with no sleeping porches, as the old treatment of fresh air had passed. After construction of a new nurses building in 1951, no new structures would be erected at Blue Ridge. The state's support of a cure for the people of Virginia no longer included creating a healing environment but rather a less expensive diet of pills.
From the introduction of antibiotics, the state's role at Blue Ridge, Piedmont, and Catawba became one of maintenance. There was no longer much public fanfare or political interest in conquering the wide spread menace. In 1968, in the interest of making the state more accessible to all, the state of Virginia decided to build an interstate to the south of the Charlottesville. The selected route cut off the old entrance to Blue Ridge, erasing the previous picturesque entrance. By the 1970's it was apparent that tuberculosis was on its way to being a controlled contagion. In 1970, the director of Blue Ridge wrote:

"It is anticipated that Catawba will close this decade. Blue Ridge Sanatorium will remain open indefinitely and continue its close relationship to the University of Virginia Medical Center, but how the beds will be utilized in the 1980's is not evident at this time."

That question is one that still has not been answered. Catawba did close, January 1, 1972, even sooner than the director had imagined. All of the patients left at Catawba were transferred to Blue Ridge that year. Catawba and Piedmont were converted into a mental health facility and a geriatric hospital, respectively. Blue Ridge however continued as a hospital of mixed uses. Programs had already begun there in the early 1970's for treating substance abuse. The drastic decline in tuberculosis cases had for the most part relieved the state of its charge from the 1908 legislation. The last order of business for ending the state's involvement in tuberculosis care was to jettison Blue Ridge.

On February 13, 1978 a bill was brought before the state senate of the General Assembly to transfer Blue Ridge Sanatorium to the University of Virginia. The bill transferred the property to the university to do as they needed and provided that they would contract with the state to care for the tuberculosis patients left in the State of Virginia. It states, "Continuity of in-patient care of such patients is to be coordinated with outpatient care as provided by private and public health physicians at both the State and community levels." Thus, the life of Virginia's sanatoriums ended as it began seventy years before, at the pen of the state's legislature.