During the mid-eighteenth to early nineteenth century, pulmonary tuberculosis (TB) became one of the leading causes of death. At the beginning, it was believed that the disease was caused by hereditary as well as social factors. TB was not recognised as infectious until 1865, and there was no way of effectively treating it. After Hermann Brehmer suggested that the condition could be cured with a regime of fresh air, exercise (which was later changed to rest) and good nutrition, he built the first sanatorium in Germany as a treatment centre. The name, sanatorium, was derived from the Latin verb ‘sanare’ meaning to heal.
This idea was initially rejected by the majority of the medical society, but eventually began to gain steady popularity. Many sanatoria opened, first in Europe and then in the United States. The recovery process consisted of isolation, fresh air, good nutrition and rest. As many of those infected were still not expected to recover, these facilities began to be referred to as ‘waiting rooms for death.’
Each sanatorium had strict regulations, which were designed to help with recovery and prevent the further spread of the disease. The buildings were mostly located in less populated areas, or the open countryside. The main emphasis was placed on resting in the open air, and patients were provided with beds or sleeping pouches in well-ventilated rooms. They were also instructed not to spit on the floor, cough in public and control any bodily fluids emitted from the lungs, mouth or throat.
The medical community believed that ‘improper’ exercise speeded up death, and the instructions included to avoid getting out of breath, exercising when the temperature was high or if phlegm was streaked, avoiding fast walking or running, and to never get tired. Patients’ activities were scheduled each day and consisted mainly of reading, or rest. Individuals were encouraged to follow the sanatorium’s rules to assist in their recovery.
The patients’ social lives were also regulated, and talking about their illness was forbidden. They were encouraged to keep a positive frame of mind, as this would speed up recovery. Even though the need for sanatoria acknowledged a high possibility of dying, great pains were taken to limit the appearance of death in the environment. After a friend or family member had passed, those close to them were discouraged from going through the bereavement process, as it was not helpful during their own recovery.
Patients would mourn quietly, and often secretly, but staff members had to maintain composure even though they were faced with frequent deaths. They were banned from telling other patients when somebody had died, and nurses became the mediums between the living and the dead as they were required to inform the family members left behind. The sanatoria remained quiet, controlled environments until an antibiotic was developed to treat TB in the 1940s. As their need declined, many were turned into regular hospitals or abandoned by 1950.