The Tuberculosis Experience of African-Americans in Virginia

By Lindsey Dene Gertz

The early twentieth century represents a complex social condition, especially for African-Americans. During this time, blacks worked to reconcile a difficult past, change the nature of interaction with whites, and build the foundation for a bright future. In 1918, the Commonwealth of Virginia established Piedmont Sanatorium in Burkeville, Virginia, to treat black tuberculosis patients. The story of Piedmont can illuminate both the positive and negative aspects of this time in history. Piedmont's built environment is diverse; it is inferior and marginalized, yet progressive. In addition, it provides a tangible record of how Piedmont served as a philanthropic aide to society.

Providing medical facilities for the treatment of tubercular blacks was unprecedented in the early twentieth century. In 1915, Miss Agnes D. Randolph used her position as the Executive Secretary of the Virginia Anti-Tuberculosis Association to persuade the Commonwealth of Virginia to build a tuberculosis sanatorium for blacks. By 1916, the legislature granted this request and the Board of Health placed advertisements for a site where the "colored sanatorium" could be built. These ads appeared in newspapers across the state from Richmond to Roanoke.

The first location considered for Piedmont Sanatorium was in Ivor, Virginia. Ivor's citizens detested the idea of building a sanatorium for blacks in their town. The minutes from the meeting of the State Board of Health on August 24, 1916, provide an account of this opposition:

While the negotiations [for the purchase of the property] were in progress, and before any papers were passed, a large number of protests began to come into the health department from citizens of Ivor, objecting seriously to the location of such an institution at that point. The Commissioner went down to Ivor and attempted to allay the feeling, without result. A number of the citizens had employed an attorney and a delegation bringing a large petition entered emphatic protest before the committee.

Ivor failed as a satisfactory location not only because of the citizens' opposition but also because of its geographical characteristics. Thomas Spees Carrington, author of the guidebook on sanatorium construction, said, "a damp or swampy location should be avoided, as such land when selected must be drained." J. Walter Hosier wrote to Governor Stuart relaying a discussion he had had with a black doctor about the unsuitable property. The black doctor felt that the purchase of the site would have been "a great injustice to the Negroes, inasmuch as the land is very low, partly swampy, poorly drained and 'a mosquito incubator.'" Hosier suggested that the committee look for another site somewhere in the foothills near Petersburg.

After rejecting the location in Ivor, the Piedmont Sanatorium committee visited a site in Lynchburg, Virginia. Here again, the committee met opposition from the citizens of Lynchburg and "any idea of such purchase was immediately abandoned." By 1917, a real estate agent named Mr. Barnes was hired to negotiate the purchase of a site in Burkeville. To avoid a situation similar to what had taken place in Ivor and Lynchburg, the committee asked a group of citizens from the Burkeville area to sign a statement which said the sanatorium could be built there. Despite the signed statement, complaints emerged for the third time. The State Board of Health received a letter from an attorney named Mr. H.H. Watson who wrote on behalf of a group of citizens who did not want the sanatorium to be located in Burkeville. This time, the State Board of Health ignored the opposition and continued making plans for the erection of the new Piedmont Sanatorium.
In contrast, Blue Ridge Sanatorium, a tuberculosis sanatorium for whites in Charlottesville, Virginia, did not face the controversy that Piedmont did when it was founded. Rather than protest the location of a sanatorium in the community, the City of Charlottesville paid $15,000 of the $32,000 required for the procurement of the property where Blue Ridge was built. Whereas Piedmont had been objectionable, Blue Ridge was welcomed graciously.

Not only did Charlottesville's citizens initiate efforts to locate Blue Ridge Sanatorium in their community, they also offered to provide water to the location. The city gave an additional $3,000 towards the cost of a new water system and "promised to furnish water free for a period of five years if the new sanatorium should draw water from the city main." The town of Burkeville withheld such generosity. At the Piedmont Sanatorium site, a well had to be drilled in order to create a water supply. The Piedmont Committee called for bids and the work was awarded to the Sydnor Pump and Well Company.
Other points of contrast between Piedmont and Blue Ridge appear in the differences between geographical features and proximity to non-tubercular medical facilities. Burkeville's landscape consists of flat land and pine trees. Blue Ridge Sanatorium, on the other hand, is located in the picturesque foothills of the Blue Ridge Mountains. In the case of any non-tubercular medical emergency, patients at the Blue Ridge facility would have had access to the medical professionals at the University of Virginia. A cooperative partnership between the sanatorium and the university was initiated almost as soon as Blue Ridge opened. In the event that a black patient at Piedmont had a non-tubercular medical emergency which the staff there could not handle, the patient would have to travel more than 50 miles to receive treatment at the St. Phillips Hospital in Richmond.

The circumstances surrounding Piedmont were obviously less advantageous than those surrounding Blue Ridge. One possible reason for this could be that the Commonwealth of Virginia began Piedmont Sanatorium as an experiment. There was fear that blacks might not be receptive to diagnosis and treatment due to differing cultural beliefs. The African American had a long tradition of treating medical problems according to superstition or other folk regimens without the assistance of a physician. One such superstition held that the best way to treat respiratory illness was to sleep in a building that had all of its "cracks chinked." The tuberculosis regimen involving fresh air and the sleeping porch contradicted the idea that staying inside was the best way to treat illness.

The experimental nature of Piedmont Sanatorium is evident in the pavilion architecture at that facility. Initially, only one pavilion was planned for Piedmont Sanatorium. This building, named for Miss Agnes Randolph, was a one-story frame structure that was left open on one side and "screened with heavy curtains." The pavilion cost $8,041.00. When construction began at Blue Ridge Sanatorium, this facility received three wood frame pavilions complete with sleeping porches which have been described as simple and unassuming (Figure 1.) Nevertheless, they were covered in stucco giving Blue Ridge a more permanent and appealing nature than the modest and experimental Piedmont. Also, the Piedmont pavilion provided space for 25 patients, whereas the Blue Ridge pavilions provided space for 120 patients. It seems that the State Board of Health did not want to invest a great deal of capital at Piedmont until they were certain that the facility would succeed.

The notion that Piedmont was an experimental, and therefore less substantial, facility is somewhat contradicted by the architecture of the administration building on the sanatorium site (Figure 2.) The Administration building cost $14,286.00, a good deal more than the cost of the first pavilion. The structure is made of solid brick laid in five-course American bond. It has decorative fenestration with segmental arches supporting the weight of the wall above each window. It also has a two story porch with a decorative railing which somewhat resembles Chinese Chippendale and four square columns with simple capitals at the top. The interior is spacious with relatively high ceilings. The staff dined in an upstairs room that has an elaborately coffered plaster ceiling. Overall, the building resembles the elements found in colonial revival buildings.
In looking at the relationship between the administration building and the patient pavilions at Piedmont, a hierarchy is established which orders not only the built environment but also the regimen of daily life at Piedmont. Brick is normally considered to be more substantial than wood and, in this case, the brick of the administration building communicates that the power of the institution lies with the administration and not in the patient occupied space. Further supporting this message was the administration building's location between the first two patient pavilions (Figure 3.) The two-story structure towered above the small pavilions and created a point from which the patient pavilions could be kept under watch.

Everything at Piedmont was hierarchically ordered and routine. Patients were expected to follow a specific regimen as part of their treatment. A pamphlet given out to all new patients sheds light on what this routine consisted of. Every morning, patients were awakened at 7:15 a.m. They had breakfast and then rest followed by lunch, and more rest. From 1:45 until 4:00 p.m., the quiet hour demanded that noone should speak. Some patients who were further advanced in their treatment exercised at certain times of the day. At 6:00 p.m. the patients ate supper and at 9:30 p.m., they went to bed. This routine is very similar if not identical to the one at Blue Ridge sanatorium.

An important goal of the treatment of tubercular blacks was their eventual re-entry into productive society. In 1919, Miss Helen Morris was hired as the sanatorium's first occupational therapist. She led the patients in handicraft activities. Some patients were taught skills that they would be able to use once returning to the real world. Piedmont patients were also expected to serve as role models for tubercular blacks who could not come to Piedmont. The Piedmont staff taught their patients the proper ways to dispose of sputum and other ways to handle the ills of tuberculosis in hopes that their patients would return to their home communities and teach other African-Americans about tuberculosis.
Educating the black population about tuberculosis took place both on and off the Piedmont site. Patients at the sanatorium were required to attend weekly lectures to learn more about tuberculosis. Field clinics were established to diagnose blacks in other areas of Virginia and to give advice on dealing with the disease. By focusing on the black population as a whole, rather than merely the patients who received treatment at the sanatorium, Piedmont provided widespread benefits to society.

Representing the progressive and philanthropic nature of Piedmont Sanatorium's existence is the institution's relationship to the Negro Organization Society. The Negro Organization Society participated enthusiastically in the public education campaign for tuberculosis and worked fervently to improve living conditions among the black population in Virginia. Founded by a charter in the state laws of Virginia, this group's ultimate purpose was to help the black individual establish "self-supporting citizenship." As an advocacy group, the Negro Organization Society addressed the underlying problems leading to poor health among African-Americans. A pamphlet which enumerated the initiatives of this organization gave reference to seven principles of improvement: "Better Homes, Better Business, Better Farms, Better Jobs, Better Civics, Better Schools, and Better Health."

The Negro Organization Society was intimately involved with the operation of Piedmont Sanatorium. In their promotional brochure, the organization claims that they purchased the land on which Piedmont is located and donated this property to the state of Virginia. However, no reference to this was found in the State Board of Health minutes. The society also claims responsibility for the erection of "permanent buildings" at the site and for providing beds to patients who could not afford treatment on a charitable basis. The building most likely to have been erected with the help of the Negro Organization Society is the second pavilion built at Piedmont. This wood frame pavilion housed male patients and was named for Dr. R. A. Moton, a prominent member of the Negro Organization Society (Figure 4.) The Negro Organization Society also donated funds to furnish the basement of the Carter Building, which housed visitors to the Piedmont facility. The Carter Building was constructed in 1923 with an appropriation from the General Assembly.

There is yet another aspect of Piedmont's history that improved the black population at large. Shortly after the sanatorium opened, a nursing school for black women was established on the Piedmont site. The Nursing School at Piedmont Sanatorium offered a tuberculosis specific curriculum. The program was only for two years and allowed black women to become certified specifically in tuberculosis nursing. If these women wanted to become registered nurses, they had to complete a third year of training at St. Phillips Hospital in Richmond. The ultimate goal of establishing the nursing school for tuberculosis, it may be assumed, was to have these nurses work with the black population at large to fight tuberculosis. However, there is some evidence that suggests the students received a less than optimal education.

In a letter addressed to Miss Josephine McLeod of the Virginia State Board of Examiners of Nurses, Miss Naomi Hatcher illuminated problems that the nursing school faced in 1943. Hatcher claimed that there was a "lack of adequate instruction and guidance furnished the nurses in training." She also said that the lack of satisfactory preparation had negative results, such as lowered morale among the student nurses and a lower quality of care for the patients in the institution. The nursing school suffered from frequent disruptions in administration and acquired a "most unenviable reputation."
In 1950, the nursing school finally received some attention. A new dormitory for the student nurses was constructed and included (Figure 5): a complete teaching unit with ample space for large lecture rooms, laboratory, study hall, library, offices for the instructors, a large recreation room with a kitchen, a laundry room, space for beauty parlor and ample storage space for the nurses' surplus luggage.

In 1951, Blue Ridge received a new nurses' dormitory named Stafford Hall (Figure 6.) This building was more finely appointed than the one at Piedmont and was the beneficiary of services rendered by a professional interior designer. One account of Stafford Hall says:

The building itself cost four hundred thousand dollars and was a model dormitory. Stafford Hall housed 80 student and graduate nurses and also had two apartments, one for the superintendent of nurses and the other for the housemother…Rooms for nurses were furnished and were arranged in suites of two rooms with a bath between. On the first floor was a large living room L-shaped with a fireplace at each end. Other smaller parlors for dating flanked the main living room; these provided more privacy and were dubbed "pet parlors" by the girls. Downstairs there was a large recreation room with a piano and tables for bridge and ping-pong; this room also had a stone fireplace. Pajama rooms furnished with a refrigerator and other kitchen appliances were available to nurses for snacks or preparation for a full meal. Every nurse who lived in Stafford Hall still talks about the good times the people who lived there had.

Eventually, the Piedmont Sanatorium School of Nursing was no longer needed. In addition to serving Virginia natives, the school also catered to black women from Northern states. As nursing schools in the North were integrated, northern blacks no longer needed to come south to receive a segregated education. In 1960, the Piedmont School of Nursing closed. That same year, the School of Nursing at St. Phillips hospital in Richmond also closed.

The nursing school's turmoil in the 1940's took place in the midst of a debate over whether or not an all-black staff should be hired for Piedmont Sanatorium. During that time, hospitals in Virginia were experiencing staffing shortages due to World War II. In June of 1943, Governor Darden proposed having an all-black staff at Piedmont in order to free white personnel to work in white hospitals. This suggestion received both praise and criticism.

John Williams, writing on behalf of the Virginia Commission on Interracial Cooperation, supported the Governor's proposal. He said, "It would help a great deal in preventing race tensions in Virginia if the Negroes in Virginia could realize that the white people are ready to give them responsibility as they show themselves capable of exercising it." On August 3, 1943, the State Board of Health issued a statement saying that they believed hiring an all black staff would decrease the effectiveness of the institution. Many of Piedmont's white patients wrote letters claiming that they would no longer be able to receive treatment at the sanatorium if it were turned over to black personnel. The State Board of Health eventually rejected the proposal.

The year following the debate about personnel, money was obtained for the construction of new employee cottages at the site. Peripherally, Governor Darden was involved in this endeavor. In a letter to the War Production Board, he said, "This institution, devoted to the care of Negroes infected with tuberculosis, will require the dormitories proposed if the help necessary to carry on the institution is to be secured." Theoretically, decision-makers for Piedmont Sanatorium felt that the provision of attractive housing would persuade white personnel to stay on at the institution.

At this time, the Art Commission of Virginia had control over architectural plans for government-funded construction in the state of Virginia. The original plans for the new dormitories included a Jeffersonian portico with round columns and Corinthian capitals. However, the use of classical elements in such a way was deemed ostentatious and inappropriate for the modest institution. In correspondence with the Chairman of the Art Commission Phillip Stern, Fred Saunders, the engineer responsible for the plans said, "The only two buildings at the Piedmont Sanatorium which have columns have square columns which are plain and inexpensive. These two buildings are much larger and cost a great deal more than the two dormitories which are now being built."

Patients at Piedmont Sanatorium reacted to the new employee dormitory as well. Even though a new steel and concrete building had been erected with Works Progress Administration funds in 1940, many patients still occupied the original wooden structures. One patient who resided in the Randolph building expressed her outrage at the dedication of financial resources to the new employee housing when Piedmont required other necessities. In a letter to Governor Darden, Lois Kirkpatrick wrote, "the building we inhabit is a fire trap… they say we cannot have a new one because of the war, but they build a new cottage for the employees. The unfairness and injustice of it all hurts."

The architectural landscape of Piedmont Sanatorium in the middle decades of the twentieth century looked remarkably different than it had at the beginning. In addition to the Carter Building, the Works Progress Administration building, and the new Nurses' Dormitory, a wooden chapel with a south-facing tower had been constructed in 1923 (Figure 7.) Blue Ridge Sanatorium also had a chapel which was completed in 1925 (Figure 8.) This Gothic style building was made of stone and closely resembled the chapel at Catawba Sanatorium in southwestern Virginia. Once again, Blue Ridge's superiority to Piedmont is asserted in the differences in building materials. Furthermore, the inclusion of a polygonal apse at the Blue Ridge chapel makes this building's plan architecturally more significant than the simple rectilinear form used for the Piedmont chapel.

The modern building at Piedmont Sanatorium, which was constructed in 1940, added 79 beds for adults and space for children. It was a modern streamlined building made of concrete with large windows in the central portion of the façade (Figure 9.) Blue Ridge Sanatorium also received a similar building with help from the Works Progress Administration. A conscious effort was made to have the design of Blue Ridge's modern building compliment the other architecture at the site. No such allowance seems to have been made at Piedmont. The Blue Ridge building is brick and has elaborate art-deco ornamentation around the windows and entranceway (Figures 10 and 11.) An examination of the plans for these two buildings shows that the sleeping porch was still used at the time of construction for the Blue Ridge building, but sleeping porches were omitted from the Piedmont building (Figures 12 and 13.)

The provision of space for children at Piedmont marked the fulfillment of a long-awaited need. As early as 1921, Dr. H.G. Carter, the first superintendent of Piedmont Sanatorium, had requested space for children. In his annual report to the State Commissioner of Health that year Dr. Carter writes,

I further recommend the building of a children's pavilion of twenty beds. This is a feature of tuberculosis work that has been neglected. All up-to-date tuberculosis sanatoria have provisions for treating children. We are constantly turning down applications for admission of children and I recommend this pavilion.

Children were admitted at Blue Ridge Sanatorium as early as 1922, when the construction of the new Trinkle building for adult patients made it possible for the Thomas pavilion to become a designated space for youth. In 1926, Blue Ridge received a new pavilion for children, the Garrett building (Figure 14.) The new children's building was "located away from the adult buildings and was designed as a preventorium for treatment of early forms of childhood tuberculosis." This building housed "twenty girls and twenty boys ranging in age from five to fifteen years old."

The African-American tuberculosis experience does not end at Piedmont. African-Americans were also a part of the Blue Ridge Sanatorium community, but in a marginalized way. On the Blue Ridge site, there was a dormitory for black workers and it may be assumed that these employees were not allowed in the area where the white staff lived. Many of the African-Americans at Blue Ridge Sanatorium were convicts who were hired in response to the previously mentioned staffing shortage that had became a problem for many hospitals across the state.

By 1965, Piedmont Sanatorium closed and black patients were admitted to Blue Ridge Sanatorium for the first time. An anonymous history of Blue Ridge Sanatorium provides an account of the integration, The staff in general received the new arrivals as people who were sick and needed care. The [black] patients themselves felt some apprehension at coming to a previously all white institution. One male patient at first wore a heavy leather belt over his bathrobe in case he needed a weapon, but he soon learned that he would be treated with kindness just as all the thousands of patients who had preceded him at Blue Ridge had been.

The closing of Piedmont Sanatorium symbolizes the dawn of a new age. In this age, the previous doctrine of "separate but equal" becomes extinct. An examination of Piedmont Sanatorium has suggested that "separate but equal" never really existed. Yes, the institutions were separate, but it is difficult to argue that Blue Ridge and Piedmont were equal. Piedmont Sanatorium may be remembered for its inferiority, but it may also be remembered for the benefits it brought to society. This is best summarized by a 1939 article published by the Virginia Department of Health, "That Piedmont represents a distinct influence in the lives of thousands of Virginia's citizens there can be no question. Indeed, the direct and indirect services it has rendered through the last decades in need of them literally are incalculable." Overall, the African American tuberculosis experience at Piedmont Sanatorium was as complex and contradictory as the twentieth century.