A Historical Lesson in Disease Containment

Another physician, this one unnamed, noted that regular motion appeared to help. “Dr. Rush,” he wrote, “informs us that he saw three persons who had been cured of consumption by the hardships of military life in the Revolutionary War.” The writer himself advised slightly less strenuous activities: horseback riding, hunting, and “muscular training” that could be done indoors. Sanatoriums were designed to allow patients to go out into the open air, with the aim of strengthening their bodies enough to withstand the disease’s assault. In a 1966 poem, David Cheshire described “white beds placed out, neatly in the sun” and “the delicate, antiseptic scrape of the surf / over the beach” at a French sanatorium—an idyllic scene for a medical facility.

When they weren’t outdoors, patients at some facilities were able to listen to the radio, watch movies, or even attend live talks from visiting lecturers. Contained within a community of fellow tuberculosis sufferers, they could also socialize inside the facilities—a feature shared now by the emergency hospitals in Wuhan. “My friends,” Ruth Reed wrote of her fellow patients, “know how to make the days easier.”

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But the facilities were not resorts. The sanatorium, Cheshire wrote, was “a place / unplagued by uncertainties.” Patients lived by strict routines intended to help manage their disease, until they grew well enough to return to the wider world. Despite that “red tape and reliance on rules,” William Garrott Brown, another tuberculosis patient, wrote in 1914, “for the mass of us, a sanitarium is best.” But, he asserted, “the real sanitariums are far too few.”

Once begun, the movement developed quickly; between 1900 and 1925, the number of beds in sanatoriums across the United States increased from roughly 4,500 to almost 675,0000. But, Mooney, the Johns Hopkins professor, said, “these places never catered toward the vast majority of cases … although provision increased a lot in the early 20th century, it was never really enough to cope with the demand.”

And, he notes, many ailing people lacked the money they needed to buy themselves entry into facilities, or support them and their families while they were there.

“It was more imaginable for a person of resources and wealth to contemplate [going into a sanatorium] than it would be for somebody who was a working-class poor breadwinner,” Mooney said. “Just taking months off work wasn’t a possibility for everyone.”

Questions of disease and civic duty, he said, were complicated by the weight of patients’ other responsibilities: jobs, families, homes that could not easily be left behind.

Even after scientists realized the importance of containment, Western nations failed to build a health infrastructure that could effectively combat the infectious diseases of the 19th and 20th centuries. Tuberculosis killed hundreds of thousands of people living in Europe and the United States in the 1800s, but as the century turned and a new one began, most people who contracted the disease continued to live at home and go to work.

“I think if you’re going to ask people to do these things”—to enter sanatoriums and isolation hospitals, or even to self-quarantine in their homes for extended periods of time—“you’re going to have to have social-support networks in place,” Mooney said. Spaces can only contain a disease, after all, if the people carrying it have the motivation, and the means, to use them.

Annika Neklason is an assistant editor at The Atlantic.