August 6, 2015

Tuberculosis Sanitariums: Reminders of the White Plague

  • By: National Trust for Historic Preservation

For centuries, the white plague -- also known as tuberculosis (TB) or consumption -- was considered an ailment of the poor. The rich often escaped the embarrassment of the disease by retreating to European health spas, while the poor continued to suffer with no relief. As the Industrial Revolution brought more workers into crowded urban centers, the plague spread and no one was immune.

Written by Anya Grahn

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Left: Consumptives playing in front of an open-air cottage at the Wisconsin State Sanitarium (circa 1940). Right: Mae Panzenhagen Strong in front of the Wisconsin State Sanitarium where she had been a patient (circa 1945).

Bacteriologist Robert Koch’s germ theory in 1882 provided better insight into the disease, and lent itself to explaining the spread of tuberculosis. State and local anti-tuberculosis organizations led social movements to improve sanitary conditions through anti-spitting laws and health regulations; encouraged consumptives to seek medical treatment; and persuaded state and local governments to create a network of state and county hospitals that isolated consumptives.

These sanitariums mark the beginning of government-funded campaigns to address tuberculosis. At these sites, consumptives spent years seeking a cure through prescribed regimens of fresh air and sunlight. Located away from local urban populations, these self-sufficient medical complexes became isolated communities containing a series of buildings that provided housing for patients and staff, medical and administrative offices, utility plants, and other uses. While many of these structures have been lost, others have found new uses as housing developments, medical facilities, and even museums.

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Dr. Edward Trudeau's open-air cottage, "Little Red," in Saranac Lake, New York inspired the design of a number of sanitariums throughout the country.

In 1884, Dr. Edward Trudeau, a consumptive himself, opened the first public tuberculosis sanitarium in Saranac Lake, New York. His first open-air cottage, “Little Red,” inspired the design of a number of institutions throughout the country that prescribed fresh air and sunlight as a cure for tuberculosis.

These initial open-air shacks progressed into well-designed pavilions and cottages, often consisting of two- or three-bedroom dormitories with private screened porches. In the 1920s and '30s, states began passing laws that required state hospitals to provide beds equal to the number of tuberculosis-related deaths in each region. Soon these simple cottages grew into expansive medical complexes.

The first government-funded sanitariums were large institutions that borrowed design elements from previously developed government institutions, such as radial prisons and Thomas Kirkbride asylums. Popular architectural styles, familiar and soothing, characterized the exterior of these buildings, while the interiors had plain decorating that was easy to clean and prevent contagious tubercle bacilli and dust from collecting.

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The local historical society in Louisville provides ghost tours and ghost hunts at the The Waverly Hills Tuberculosis Sanitarium.

Tuberculosis sanitariums also organized patients into three distinct classes based on the progression of their disease: hospital, semi-ambulant, and ambulant.

  • Upon entering the sanitarium, physicians prescribed round-the-clock bed rest to their patients in hospital wards.
  • Semi-ambulant patients, permitted to leave their beds several times a day, were often housed in separate hospital wards or pavilions that allowed them greater freedoms.
  • Finally, ambulant patients, who were closest to being cured, were assigned to open-air cottages and shacks constructed away from the main hospital buildings.

Additional wings and buildings were constructed for dining, medical and administrative offices, communal gathering spaces, and housing for sanitarium staff.

The need to create sanitary environments that complemented the fresh-air treatment, in part, contributed to the Modernist movement. Modern architecture design reflected the core principles of tuberculosis treatment -- fresh air, sunlight, and hygiene.

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Alvar Aalto’s 1929 Paimio Sanitarium in Finland.

Indeed, sanitariums designed in the Modern style served as an instrument of healing, and new materials such as steel, sheet glass, and reinforced concrete allowed architects to produce well-lit and ventilated structures that aided in the overall healing process. The strong horizontality of these first modern sanitariums created cantilevered balconies and overhangs for those taking the fresh-air cure.

Alvar Aalto’s 1929 Paimio Sanitarium in Finland is one of the best examples from this era, and features custom-designed splash-proof sinks, lighting fixtures, and door knobs that contribute to the cure.

The development and use of streptomycin in the treatment of tuberculosis during World War II brought an end to the White Plague and the sanitarium movement. In the decades following a drug cure, many of these large complexes were abandoned and fell into ruin. In other cases, these structures found new uses -- for example, the Wisconsin State Sanitarium in Whales was converted Ethan Allen School for Boys in 1959 after the sanitarium closed.

For the few sanitariums that remain, rehabilitation has required creativity. The 1940 Silvercrest Tuberculosis Sanitarium in New Albany, Indiana, was designed in the Art Deco and Art Moderne styles and closed in 1972. It recently underwent an extensive renovation to create a senior housing community, the Villages at Silvercrest. The layout and design of these sites lend themselves for reuse as medical facilities.

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The Waverly Hills Tuberculosis Sanitarium outside of Louisville, Kentucky has gained a reputation for its paranormal activity.

Others -- whether in ruinous condition or rehabilitated -- have gained reputation for their paranormal activity. The Waverly Hills Tuberculosis Sanitarium outside of Louisville, Kentucky, has become a tourist attraction, with the local historical society leading ghost tours and ghost hunts. The site has been featured on television programs and documentaries as well. The funds raised by these activities contribute to the site’s ongoing maintenance and preservation.

In some cases, these sites are successfully interpreted as museums. The Arkansas Tuberculosis Sanatorium Museum in Booneville continues to tell the story of tuberculosis, utilizing the extant Art Deco and Craftsman-styled structures on its site. In Magee, Mississippi, the Mississippi State Sanatorium Museum is housed in one of the original buildings; the site and its buildings have been listed on the National Register of Historic Places and designated Mississippi Landmarks by the state’s Department of Archives and History.

These stately institutions contribute to our understanding of private and public efforts to combat the White Plague in the early twentieth century through World War II. They speak to health, design, and community, and while many of these sites have been abandoned or largely forgotten, the ones that remain can teach us about a fascinating chapter in medical history.

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