History of Tubeculosis

The History of the Tuberculosis:

(as written by Margaret Tulloch and edited by Richard Sucre)

Prior to the discovery of the tubercle bacillus, consumption, as tuberculosis was then known, was treated primarily in the home, though some consumptives traveled to salubrious climates in places such as the Adirondacks or the Rockies to recover. Consumption in the early 1800s, for instance, was regarded as a wasting disease which produced in its victims a refinement of the body, heightened artistic sensibilities and ennoblement of the soul. At this time, notions regarding diagnosis and treatment varied widely. According to the historian Katherine Ott in her work entitled Fevered Lives: Tuberculosis in American Culture since 1870, "The illness itself was characterized by a fluid group of behaviors, signs, and symptoms, with shifting connotations. Diagnosis depended largely upon a patient's temperament, which could be sanguinous, lymphatic, bilious, or nervous. However, as in other areas of medicine, there was no consensus upon what each signified." Doctors in the 1870s and 1880s offered often conflicting diagnoses and cures, prescribing all manner of "snake oil" patent remedies. One physician even espoused the belief that by wearing a beard, a man could effectively ward off consumption. The Romantic perception of consumptives as the tragically beautiful victims of a wasting disease was replaced with a stigmatized view of "lungers" as the infectious carriers of a devastating illness, as fear of contagion spread in the late 1800s with the emergence of new theories regarding bacteriology.
Towards the turn of the century this escalating terror, coupled with optimism regarding the institutionalized treatments first pioneered at the German "closed institutions" run by Drs. Hermann Brehmer and Peter Detweiler, led to the construction of tuberculosis sanatoria across the United States. According to Sheila M. Rothman, author of Living in the Shadow of Death: Tuberculosis and the Social Experience of Illness in American History, "A generation of physicians, social reformers, and philanthropists were convinced that confining the tubercular in these facilities would promote not only societal well-being by isolation those with the disease but also individual well-being by implementing a therapeutic regimen. The sanatorium satisfied both the drive to coerce and cure." As concepts of bacteriology gained acceptance, the idea of caring for patients in a setting removed from the general populace was considered wise and necessary for preventing the spread of the disease. Not only would such a location ensure the public welfare, but the siting of sanatoria in the countryside was also considered to aid the patients in their recovery. At the time, cities were considered by many to be pestilential and insalubrious places so the notion of patients taking in the fresh air and sunshine of healthful and preferably mountainous, rural settings was persuasive. Even in the early 1800s when notions regarding diagnosis and treatment were far from standardized, fresh air, along with nourishing sustenance, was one of the few antidotes upon which most physicians and patients agreed, especially given society's reluctance to embrace urban life and pandemic fears regarding immigrants, tenements and the physical and moral "evils" of the city. It is not surprising, then, that pastoral settings, often former farms, were viewed as the ideal locations for sanatoria and that many maintained their own agricultural operations, particularly dairies, in order to supply the patients with fresh and healthful alimentation.
Nonetheless as treatments progressed and the responsibility for recovery was subtly shifted away from the patients themselves to their doctors, these sanatoria with their agrarian healing landscapes were closed and converted to geriatric, psychiatric or other such facilities. Their dairy herds were sold at auction, as their fields and pastures were often parcelized and sold for development. According to historian Katherine Ott, today "therapy relies completely upon chemotherapy. There is no need for a change in lifestyle, personal habit or mental adjustment." Tuberculosis today is treated in clinical, modern settings where efficiency and technology are of primary importance and the mantra of "fresh air, rest and good food" is accepted as intuitively, rather programmatically, important. The outpatient clinics and hospitals of today are often found in urban settings, as tuberculosis has increasingly become a disease of AIDS patients and the homeless - ironically, the very settings which in the early part of this century were believed to cause the disease. As Ott astutely observes, "The history of tuberculosis chronicles how a romantic, ambiguous affliction became first a dreaded and mighty social truncheon, and finally an entity bound up in the public health and civic order." Thus, the evolution of medical and popular notions regarding tuberculosis is reflected in the changes of the settings in which the disease was treated, ranging from the early sanatoria with their pastoral healing landscapes and agricultural operations to the more antiseptic and clinical, from both a physical and metaphorical standpoint, modern hospitals of today.
It is in this larger context that the history of tuberculosis sanatoria in Virginia unfolds and is best understood. Blue Ridge Sanatorium, for instance, is representative of many of the early sanatoria in Virginia and beautifully embodies this complex evolution of theories regarding tuberculosis. By examining its current physical form and looking back through its archives to see how the site has changed over time, as well as by researching the institution's shifting attitudes toward the treatment of tuberculosis and resultant transformations in the way of life at Blue Ridge, we can begin to comprehend this history. As we have seen, agriculture and nutrition played an important interrelated role in the treatment of tuberculosis at such institutions and it is through this particular lens that we will regard the history of the disease at Virginia sanatoria such as Blue Ridge Sanatorium.

The History of the Tuberculosis (photos):


Dr. Edward Trudeau	Pneumothoraxix Procedure