Tuberculosis Epidemic Spurs Chronic Care Facilities

State Tuberculosis Sanitarium, Terra Alta, WV, 1918.
Library of Congress American Memories: Taking the Long View Panoramic Photographs, 1851-1991

Around the turn of the century, tuberculosis or "consumption", the "White Plague" of the eighteenth and nineteenth centuries, became epidemic. Tuberculosis was highly contagious, and spread rapidly in the newly-urban society because so many people were living crowed together in cities. Since the disease was so contagious, patients to be separated from the general population, preferably out in the country where they could get plenty of fresh air, which was believed to be a necessary part of curing the disease.

The spread of tuberculosis was instrumental in spurring the development of public institutions designed to provide chronic care, since patients needed to be maintained for a fairly long period of recuperation. To effectively control the disease, even those who could not pay for their care had to be removed from the general population and cared for at the expense of governments or charities. A large percentage of these patients were indigent. For instance, it was estimated that 85% of those stricken with tuberculosis in Michigan were unable to pay for their own care. (Medical History of Michigan, 1930)

New buildings were built for this purpose by state or local governments, preferably with an attached farm to help provide for the cost of caring for the indigents. Some counties found a perfect spot for these buildings on land they already owned -- their poor farms, which already had working farms and were generally located far outside the city walls. Over time, conditions improved in the sanitariums as laws were changed and the government and medical community learned how to provide chronic medical care in institutional settings. 

"The [Michigan] county sanatorium law of 1925... insures high standards and adequate financial support. The standards require that a sanatorium have a minimum capacity of fifty patients, thus eliminating the old, small tuberculosis hospital that was often nothing more than a boarding-home or retreat for consumptives on county poor farms, where doors and windows were shut, and where medical treatment occasionally consisted of self-administered cough medicine. The institution must employ a full-time physician, provide modern X-ray equipment, have a graduate nurse as supervisor of the nursing staff, and must furnish patients with occupational therapy work." (Medical History of Michigan, 1930)