The Garrett Building: An Architectural Record of the Children’s Preventorium Movement

by: Rebecca Synder

Throughout the nineteenth century, tuberculosis was the most common cause of death among Americans.1 Those that were stricken were often viewed as outcasts. In the words of one victim: Diagnosis: Pulmonary tuberculosis. The door to the future slammed in my face…having tuberculosis was frightening…My morale plunged about as low as it could get.2 Another sufferer reportedly, felt like a leper and wanted to cover her face and cry, ‘unclean, unclean.’3 Tuberculosis was a disease that was feared both by its victims, and by society. Beginning in the late nineteenth century, the medical community attempted to halt the spread of the disease by isolating those infected from the rest of humanity, and housing them in sanatoriums throughout the United States.4

The Blue Ridge Sanatorium, located in Charlottesville, Virginia and founded in 1920, is an example of such an institution. The architectural design of the buildings at Blue Ridge and their placement within the landscape give important insight into the evolution of medical and popular theories of tuberculosis treatment. One building that reveals a clear relationship between architecture and treatment is the Garrett Building. Otherwise known as the Children’s Preventorim, the Garrett Building tells the story of the popularization and eventual decline of the preventorium movement and its role in the history of tuberculosis treatment in America.

Until the discovery of the tubercle bacilli by German scientist Robert Koch in 1882, the cause of tuberculosis was unknown.5 For the majority of the nineteenth century, medical thinking regarding appropriate means of diagnosis and treatment for the disease had not yet reached a consensus. In the words of historian Katherine Ott: The average physician at work practiced a rich mixture of common sense, folklore, popular knowledge, and medical doctrine.6 After Koch’s discovery, this informal attitude towards tuberculosis treatment and diagnosis gave way to a more institutionalized approach with the emergence of the sanatorium.7

Modeled after the European closed institutions, the first American sanatorium was founded in 1884 by Dr. Edward L. Trudeau in Saranac Lake, New York.8 The method of treatment introduced at Saranac Lake was a rapid departure from those popularized in the earlier part of the century. Trudeau believed that once confined to a sanatorium, patients would regain their health through a strict regimen of fresh air, nutritious food, supervised exercise, and large amount of rest.9
The popularization of Saranac Lake had a significant influence on the design of early American Sanatoriums. After visiting Trudeau’s unique institution located in the Adironack Mountains, physicians and organizations alike, became convinced that the sanatorium setting and its strong emphasis on a closely monitored regimen of fresh air, a nutritious diet, and large amounts of rest, could cure tuberculosis. Like Trudeau, they believed that tuberculosis sufferers were victims of poor circumstances, such as bad nutrition and a filthy living environment, and that a stay at a sanatorium would restore health and improve overall quality of life.10

The U.S. government supported the sanatorium approach towards tuberculosis treatment, and viewed it as an effective means to house active cases.11 With the fear of tuberculosis running rampant throughout society, sanatoriums became a way that states could isolate the disease, and instill a heightened level of social order.12 As explained by historian Sheila Rothman:

[It was believed that] confining the tubercular in these facilities would promote not only societal well-being by isolating those with the disease but also individual well-being by implementing a therapeutic regimen. The sanatorium satisfied both the drive to coerce and cure. Inside it, fear met hope.13

By the early twentieth century, a large number of tuberculosis sufferers were placed in state sanatoriums throughout the United States. The Blue Ridge Sanatorium in Charlottesville, Virginia is an example of such an institution. Founded in 1920, Blue Ridge is located two miles from downtown Charlottesville. 14 Like many sanatoriums developed at this time, it was located in a rural area on the outskirts of town. This location settled the nerves of those that feared infection by isolating patients away from healthy society, while at the same time provided a perfect setting for Trudeau’s fresh air treatment.15 Surrounded by mountains and nestled within trees, the site chosen for the Blue Ridge Sanatorium was peaceful and separate from the hustle and bustle of city living. In a 1927 newspaper article in the Richmond Times Dispatch, the Blue Ridge Sanatorium was described as “one of the prettiest spots in all Virginia.”16

Through a careful analysis of the architectural design and the placement of individual buildings within this pristine landscape, a clear insight into the evolution of medical and popular treatments of tuberculosis can be had. One building particularly suitable for this type of analysis is the Garrett Building, otherwise known as the children’s preventorium.
The Blue Ridge Sanatorium opened its doors for service in 1920. However, it was not until 1922 that children were admitted for treatment; discussion for the addition of children began in the spring of this year. It was during this time that Dr. Brown, the director of Blue Ridge, consulted with Dr. Lloyd, the director of the Monroe County Tuberculosis Sanatorium, about the inclusion of children in a sanatorium setting. A letter written to Dr. Brown from Dr. Lloyd in April of 1922 discusses the value of a children’s preventorium, a little-remembered institution that emerged within the larger context of the tuberculosis crusade of the early twentieth century: 17

I believe, just as all the rest of the men in tuberculosis work do, that if we are going to get anywhere in the fight that we must provide not only sanatorium capacity for the curable and advanced cases, but early diagnosis and attention for children so that they might not break down with tuberculosis. I should like to see Virginia have a preventorium in each of the large cities.18

Two scientific findings set the stage for the emergence of the preventorium movement. First, in 1903, research suggested that tuberculosis in adults resulted from the reactivation of an infection acquired during childhood.19 Second, in 1908, it was discovered that the presence of a tuberculosis infection could be determined before the development of outward symptoms. Before this discovery, tuberculosis sufferers were classified into two groups: the sick and the well. After 1908, a third category was added: those infected with the organism that did not yet have an active form of the disease.20
Through its design and method of treatment, the preventorium was intended to protect the health of children who fell into this third category: those infected without manifestations of the disease.21 The preventorium’s method of exposing these children to proper means of treatment, and isolating them from further infection, was viewed by the medical community as a highly effective way to prevent the spread of tuberculosis into future generations.22 In his book, Tuberculosis in Children: Its Diagnosis and Treatment, published in 1921, Dr. Hans Much reflects this idea:

Tuberculosis of the adult develops from an infection in childhood; consequently any attempt at its eradication must begin by providing effective treatment in childhood, as at that period the disease is easily curable and the resulting immunity insures a lasting protection for the balance of that individuals’ life.23

The majority of children admitted to preventoriums were underprivileged and undernourished, and had contracted the disease from family members living together in overcrowded homes. These children were removed from their homes and placed in preventoriums in hopes that outdoor activities, fresh air, and sunshine would increase their resistance to tuberculosis and prevent lifelong debilitation by the disease.24 The preventorium practiced a closely monitored regimen of wholesome food, rest, exercise, sunshine and prolonged exposure to the open air. Education about personal hygiene and healthy living were also an important part of the institution’s program. The typical length of stay for a child at a preventorium ranged from a number of months to years. During this time, visits from parents were permitted on a limited basis.25

Philanthropist Nathan Straus opened the first preventorium in Lakewood, New Jersey in 1909. This new method of treatment became extremely popular in the early twentieth century and by the late 1920s, nearly every state had at least one preventorium.26 Like other states, Virginia was an active participant in the preventorium movement, and opened its own children’s preventorium at the Blue Ridge Sanatorium in 1926. Although repeated recommendations were made to build preventoriums at the other two state sanatoriums, Catawba and Piedmont, it appears that Blue Ridge was the only place to ever house such an institution27 The most important piece of evidence supporting this idea is found in an analysis done by the Virginia Tuberculosis Association in 1944 entitled, “Problems Concerning Tuberculosis Control in the State.” In this evaluation they state: The children’s preventorium at Blue Ridge Sanatorium should be studied to determine whether it is necessary, or an efficient way of preventing T.B. Although numerous facilities at Piedmont and Catawba are evaluated throughout this document, there is no mention of preventoriums at these institutions.28 In continued support of this idea, it is known children were not treated at Piedmont, the state sanatorium for African Americans, until 1940, at which time they were housed in a three-story building that was shared with adults.29

It is clear from first hand accounts that some children with tuberculosis were treated at Blue Ridge Sanatorium in 1920 and 1921, but it was not until 1922 that the idea of establishing a preventorium began to emerge.30 At a Meeting of the State Board of Health Committee for Blue Ridge Sanatorium on April 6th of this year, it was suggested that one of the three existing pavilions at the sanatorium be set aside for the treatment of children.31 On June 29th, 1922, the Thomas Building, which formerly housed adult male patients, was designated as the children’s pavilion. 32 Until this time, there was not an adequate place in the state for the treatment and care of tubercular children.33

An average of 35 children were treated at the Thomas Building at one time, and there was often a small waiting list. Children between the ages of 6 and 15 were admitted for treatment. According to a letter written in 1923 by Dr. Brown, the director of Blue Ridge, to Dr. Ennion, the State Health Commissioner: The majority of children admitted to the Thomas pavilion were only suspect or contact cases, in which positive diagnosis could not be made…These children were given the benefit of the doubt and were considered as suspicious, and treated until their general condition permitted their returning home. In this same letter, Dr. Brown expressed his satisfaction with the function of the Thomas building.34 His statement is a direct reflection of the ideas that served as the foundation for the preventorium movement:

The results that are being obtained in this work are extremely gratifying. Since the prognosis in tuberculosis is, in a great measure, dependent on the state of diagnosis; it would seem that by treating these positive and suspicious childhood cases early, is getting at the very root of the disease; and in this way, is the means of greatly assisting in the eradication of tuberculosis.35

In September of 1922, formal proposals were made for the construction of a pavilion at Blue Ridge specifically designed as a “children’s preventorium.” A statement made on September 30, 1922 at the Meeting of the State Board of Health Committee for Blue Ridge Sanatorium reflects this push for a new pavilion:

The ‘Thomas’ pavilion which we are now using for children is of a type of construction that is not very well adapted for children’s needs. It would be well to have a pavilion built especially for early, ambulant cases among children with an adequate school room attached in order to give them the best possible advantages.36

On March 19, 1926, the Blue Ridge preventorium opened at a cost of $29,843.66 and increased the capacity of the sanatorium to 210 beds.37 It was designed by Eugene Bradbury, a prominent Charlottesville architect, and was named the “Garrett Building,” in honor of William A. Garrett, the oldest state senator in years of service.38 The preventorium was constructed of hollow tile and stucco and was built to house children ranging between the ages of five and fifteen.39 In accordance with the requirements of other state preventoriums, children eligible for treatment at Blue Ridge were those infected without manifestations of the disease; open cases of tuberculosis were not permitted.40 As stated in a 1926 Sunbeams article about the history of Blue Ridge:

These children are not cases of open tuberculosis; but in the main are very early cases; and the principle work of this unit is as a preventorium, the idea being to restore these underdeveloped and under-nourished children to a normal condition in order to prevent them from breaking down with tuberculosis in later life.41

The location of the Garrett Building within the sanatorium landscape provides important insight into the method of tuberculosis treatment practiced by preventoriums in the late 1920s. The Garrett Building was situated a significant distance away from the main sanatorium buildings that housed the adult patients; it was located in the field, which bordered on the Monticello and Scottsville roads.42 The choice to isolate the children’s preventorium away from those patients suffering from advanced forms of tuberculosis reflects a key idea of the preventorium movement: the segregation of the healthy from the sick as an effective means of treatment. Those who founded preventoriums strongly believed that isolating children from tubercular victims would protect them from contracting the disease later in life. As stated by Dr. Hans Much in 1921, We have to consider the human being the chief source and danger of infection.43 In a statement made in the Blue Ridge Sanatorium’s 1926 Annual Report, it is clear that the founders of Blue Ridge’s preventorium shared this belief:
Contracts were let for the construction of a special unit for the children. We had long felt the need of this, as we did not think it was advisable to have the children come in contact with adult patients. I feel that we can accomplish greater good through this unit than we have been able to heretofore.44

The architectural design of the Garrett Building also reflected the theme of isolation. The design of the Blue Ridge preventorium enabled it to function as a self-sufficient community, separate from the sick population of the sanatorium. The best elements of a home, school, and sanatorium were combined into one pediatric institution.45
The preventorium was composed of two parts: a main pavilion and a separate building that contained a dining room and kitchen. The inclusion of a dining room and kitchen in the design ensured that the children were never in contact with adult patients who had more severe cases of tuberculosis.46

The main pavilion had two open wards, containing twenty beds for boys and twenty for girls. Two isolation rooms were located at either side of each ward. These rooms were used to isolate all children when they are first admitted to the preventorium for a period of two weeks. The purpose of this isolation was to decrease the likelihood for the transfer of “acute infectious diseases” to other patients.47

The inclusion of a large screened in sleeping porch, and an outdoor concrete platforms for each of the wards gives insight into some of the methods of treatment practiced in the preventorium. 48 At this time, the exposure to fresh air was perceived as one of the most effective forms of tuberculosis treatment.49 In these early years of tuberculosis treatment, patients spent most of their time on sleeping porches. As described by one of the preventorium’s patients: We slept on the porches in every kind of weather. 50 The inclusion of these large screened in porches in the design of the Garrett Building assured that plenty of crisp mountain air would circulate throughout the preventorium. Like the porches, the concrete platforms were also used to expose patients to the outdoor elements. They were specifically designed for heliotheraphy. 51 Heliotheraphy was a popular method of treatment at this time, and used exposure to direct sunlight to fight the disease.52 According to a 1926 Report of the Superintendent and Medical Director of Blue Ridge Sanatorium, it was believed that children taking heliotheraphy assimilate their food better and make steadier gains in weight then those who do not.53
Other elements included in the first floor design of the main pavilion were an open-air schoolroom located in the center of the building, locker rooms, storage closets, a nurses’ station, and toilet rooms.54 The presence of a schoolroom in the preventorium ensured that children would not fall behind in their education while they underwent treatment at the sanatorium. Education was an important part of the children’s daily regimen. The second floor of the main pavilion contained an apartment to house the preventorium’s teachers that taught in this one room school. 55

The architectural design of the Garrett Building supports the idea of the preventorium as a protective environment. A section of the 1936 Rules and Regulations of Blue Ridge Sanatorium entitled “Visiting Children,” which was written for the parents of preventorium patients reflects this emphasis on protection:

Remember your child is sent to the Sanatorium because it is ill and needs treatment; and if the best results are to be gotten and the child is to recover in the shortest period, it must be left to our care with little or no interruption from parents, relatives and friends.56

This statement exposes a popular medical theory of the early twentieth century. At this time, it was believed by the medical profession that children were infected with tuberculosis through exposure to a tubercular parent, or living environment. This theory had a large impact on the popularization of the preventorium. Through the construction of these institutions, the state assumed the role of “parent” and provided disadvantaged children with an environment that was viewed as superior to that of their homes.57

The activities that took place within the Garrett Builings, as much as its location and architectural design, contributed to the idea that the preventorium existed as a home away from home. Children at Blue Ridge took part in a wide array of activities including Halloween parties, Thanksgiving dinners, Easter Egg hunts, Christmas concerts and performances. The majority of these activities occurred in the preventorium’s schoolroom. Some of the holiday performances, such as Christmas concerts and plays took place in the sanatorium’s chapel. 58 An account in a Sunbeams article written in 1925, reveals the enthusiasm expressed by the children who participated in these events:

After supper Saturday we went to find the eggs which the Easter Bunny had brought to the nurses’ grounds….On our way to the Chapel we stopped by the infirmary and sang an Easter anthem for those that would not be present at the services. The Chapel was crowded Easter Sunday and the service was fine. We opened with “Ring the Bells of Easter,” and then sang “Jesus Christ is Risen To-Day.”…We had some more egg hunts on the Strode grounds Monday and had lots of fun. We are now back at our old games, such as horse-shoes, etc.59

The vibrant life of the Blue Ridge preventorium came to an end with the publication of the Lymanhurst studies in the late 1940s. In 1921, Dr. Arthur Meyer and his colleagues at the Lymanhurst School began a groundbreaking medical study. They traced the treatment of 136 children sick with the first infection type of tuberculosis. These children were divided into three groups, which enabled them to observe the effects of different types of treatment upon the first infection type of the disease. The first group was sent to sanatoriums, the second group was sent to the Lymanhurst school, which bore close resemblance to an American preventorium, (Lymanhurst), and the third remained at home with no treatment, except that every effort was made to isolate the children from open cases of the disease.60 Among those traced, Meyer and his colleagues were unable to see any difference in the course of the disease, regardless of what environment the children the children were treated in. The Lymanhurst studies proved to the medical community that there was no real need for the preventorium; the children treated at these institutions could benefit equally as much from home treatment. In the words of Arthur Meyer:

The failure of treatment to influence the course of the first infection type of tuberculosis is being recognized by a good many tuberculosis workers with the result that already in this country some buildings constructed for children on sanatorium grounds have been closed and later re-opened for the isolation of patients with pulmonary tuberculosis in communicable form.61

Like other states, Virginia also recognized the value of the Lymanhurst studies. Discussion concerning the closure of Blue Ridge Sanatorium began in the mid 1940s. The 1946 Blue Ridge Annual Report recognizes the huge impact that the Lymanhurst studies had on the fall of the preventorium movement:

The “Garrett Building,” now used as a Preventorium for children, has, for some time, been a source of concern to us. Whether the purpose for which it is used will justify continuing with it is the point involved…Dr. Meyers, who ran the Lyman-Hurst School of Tuberculous Children in Minneapolis, Minnesota, from his work, felt it was not usually necessary to hospitalize children with primary tuberculous infections….He maintained that removing from the home the source of infection of the child, or breaking the contact, was all that was necessary. Since the publication of Myer’s work, many Preventoria for children throughout the country have been closed. There have been some who thought that our Building was no longer needed for the purpose for which we are using it, but should also be closed and the facilities used for the treatment of adult reinfection types of cases…. With the urgent need for treatment of ill adult patients, and considering the difficulty of getting suitable help to properly operate the Sanatorium, it is believed by us advisable to close the Garrett Building and use the personnel on other Buildings to help relieve the acute shortage.62

On June 1st, 1950, the Garrett Building ceased its role as Virginia’s only public preventorium. Upon its closing, the building was used to house the white male employees of the sanatorium that had formerly been located in the Trinkle Building.63 The building was eventually demolished sometime later.

The discontinued use of the Garrett Building as a children’s preventorium, and its eventual erasure from the sanatorium landscape, symbolize the end of an era in the history of tuberculosis treatment in the United States. However, even though its physical form no longer exists, the surviving architectural plans, pictures, and first hand accounts of the Garrett Building enable it to serve as an important architectural record of the preventorium movement.

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