As cyclists ride through the Catawba valley west of Roanoke, they observe two strikingly different examples of how twentieth century Americans have thought about the relationships between health, physical activity, and the natural environment. Immediately to the south of the Transamerican Bicycle Route is McAfee Knob, one of the most famous landmarks along the Appalachian Trail, which extends for more than two thousand miles along the eastern United States. Established in the mid twentieth century with the goal of providing an increasingly urbanized population with opportunities to spend time in nature, the Appalachian Trail is experienced by hundreds of thousands of people, including through-hikers, who travel the length of the trail, as well as many more day hikers and backpackers covering shorter distances. This trail, like thousands of other miles of hiking trails in the United States, illustrate how physical activity in a natural environment has become associated with mental and physical well-being. Immediately to the north of route 76 in the same valley is the location of the Catawba Tuberculosis Sanatorium, opened in 1909 to fulfill a very different vision of the relationship between health, exercise, and nature. In the early twentieth century, these facilities were intended to remove sick individuals from unhealthy conditions in cities by bringing them into the fresh air of a rural location. In addition to fresh air and a good diet, Catawba Tuberculosis Sanatorium mandated complete rest for patients as the only way to recover from disease and build a foundation for improved health. This episode explores this vision of physical well-being in a location that is adjacent to two of the major routes for strenuous physical activity: the Appalachian Trail and the Transamerican Bicycle Route.<\/p>\n\n\n\n
Welcome to episode 20 of the Virginia Bikecentennial Route 76 Podcast. This episode is connected to the community of Catawba, located just over 330 miles from Yorktown, the starting point for the westbound route, and about 220 miles from the Kentucky border, where eastbound rides enter Virginia. This podcast is a production of Virginia Tech, a public land grant university located in Blacksburg, just three miles from Route 76 in southwest Virginia. I am your host, Tom Ewing, and this podcast is produced by the digital humanities program in Virginia Tech University Libraries, under the direction of media manager Joe Forte.<\/p>\n\n\n\n
In late nineteenth century America, tuberculosis caused more deaths than any other disease. Often called \u201cconsumption,\u201d because of the way that the disease seemed to consume the body from within, this disease was initially regarded as an affliction of the well-to-do, including artists, writers, and intellectuals. By the end of the nineteenth century, however, the disease was increasingly recognized as a disease of the poorer classes, which included immigrants from Europe, African Americans in the South, and residents of crowded urban tenements. The perception of tuberculosis as a chronic and deadly disease for individuals coincided with an emerging concern about the health of communities that posed a broader threat to society. This desire to address public health concerns coincided with research on so-called microbes that transmitted infectious diseases, which led to recommendations for improved sanitation of living conditions, isolation of the sick, and the search for an effective vaccine. The Catawba sanatorium had its origins in these emerging perception in the late nineteenth for a public health response to infectious disease.<\/p>\n\n\n\n
Catawba was also a product of a unique effort to address tuberculosis by treating patients in remote locations with ideal environmental conditions where they would be expected, even required, to do as little as possible. The movement to create tuberculosis sanatoria began in Europe, where alpine and coastal resorts began to attract prosperous clients seeking cures, and then spread to the United States. The first American sanatoria was created in the 1880s in the Adirondacks (hence the name of the popular chair, designed to ensure that people sat in the most restful position). By the early twentieth century, this approach to tuberculosis cures was being adopted by state governments as a response to tuberculosis as a public health problem. In 1909, the Virginia government created Catawba as the first sanatorium in the south established and administered by a state government.<\/p>\n\n\n\n
The location of Catawba was consistent with the origins of the public health movement. Red Sulphur Springs, located about twenty miles west of Roanoke, was first established as a resort in the nineteenth century, and eventually expanded to feature a hotel for 300 guests and a grand ballroom. The main attraction of the resort, however, were promises of fresh air and clean water with alleged healing properties. In 1909, when the Virginia Department of Health decided to create the first state-run sanatorium facility for tuberculosis patients, the site of the former Red Sulphur Springs Resort was selected as the ideal location. Already known for its good climate and clean water, and with existing facilities that could be renovated, thus saving the costs of construction, Catawba offered another advantage desired for a tuberculosis sanatorium: it was some distance from the cities where dense populations were regarded as a contributing factor to the spread of this disease. <\/p>\n\n\n\n
Catawba began admitting patients in 1909, and quickly expanded to accommodate more residential patients. Eventually the facility would expand to care for hundreds of patients at a time. During the almost forty years that Catawba provided medical care for tuberculosis, thousands of patients spent days, weeks, or even months in this facility located in this valley.<\/p>\n\n\n\n
The method of treating patients at Catawba involved five principles advocated by the sanatorium movement: fresh air, rest, good food, proper living, and care by a physician. The primary goal was to provide, and even require, patients to rest as much as possible. <\/p>\n\n\n\n
Fresh air treatment meant that patients spent as much time as possible outside, in all seasons and conditions. The design of the building facilitated this treatment, with covered porches that allowed patients to rest and even sleep outside. In cold weather, patients remained outside as much as possible, wearing layers and adding blankets when sleeping in the open air. A list of rules published in 1930 declared that patients should remain in the open air all of the time, except during meals, using the toilet, or before going to bed in the evening.<\/p>\n\n\n\n
The sanatorium followed strict guidelines prescribing the amount of time each patient should spend resting. One patient wrote in a letter that he was expected to remain in bed for 22 of the 24 hours in the day. <\/p>\n\n\n\n
The sanatorium diligently monitored the weight of patients. Once a week, patients lined up to have their weight checked: those who gained weight were celebrated for this evidence of improving health–and often bragged about their gains in letters to friends and families. Guidelines for patients included this short reminder: \u201cIf at once you don\u2019t grow fat, keep it up.\u201d<\/p>\n\n\n\n
The treatment regime limited exercise to a considerable extent. Only the healthiest patients, whose illness was deemed to be receding, were allowed just short periods to walk around the grounds. Patients with more advanced conditions were prohibited from any kind of exertion as part of their treatment regime.<\/p>\n\n\n\n
The rules of the sanatorium also discouraged patients from conversation with other patients or visitors. Patients were prohibited from talking for more than two hours every afternoon, as part of the enforced rest time. Extended visits by family members were also discouraged. Elaborate rules were also imposed to keep men and women apart — yet the evidence from letters, diaries, and even photo albums confirmed that flirting, courting and even marriages were common occurrences in the Catawba community. A 1930 marriage between Wadie Jane Weaver, a nurse in training, and William Hart, a patient, suggests that courtship was possible even with these strict rules. <\/p>\n\n\n\n
The sanatorium guidelines declared that discipline was essential for the successful treatment of tuberculosis. Patients were prohibited from many activities such as drinking, smoking, gambling, flirting, and complaining. Yet Catawba also sponsored social activities, including holiday parties with costumes, food, and celebratory (non-alcoholic) drinks. The Catawba Sanatorium Church was the center for religious as well as social life for decades — and remains one of the existing buildings on the grounds of the current state hospital.<\/p>\n\n\n\n
A positive and even cheerful attitude was deemed necessary to achieve the desired cure, even as they faced months of forced idleness. A letter from a former patient praised the institution for stimulating influence, cohesive power, inspiring ideals, and spirit of cooperation and unity. A scrapbook kept by patient Ruie Fitzpatrick in the late 1920s includes numerous inscriptions from friends testifying to shared memories and strong bonds of friendship. Patients at Catawba built their own sense of community through everyday practices, social events, and even a weekly newspaper, with the title, Sunbeams. Photographs, diaries, and letters from the 1920s particularly illustrate how patients shared experiences and built community around treatment programs. Photographs of ten or more patients gathered for outdoor activities suggests that community was an important part of the sanatorium experience.<\/p>\n\n\n\n
The medical staff at Catawba included a physician director as well as physicians and nurses specializing in tuberculosis care. Catawba, like other state sanatoria, trained nurses for its own facility as well as other kinds of tuberculosis care. Initially, only patients who had recovered from tuberculosis could enter the Catawba nurse training program, which ensured that they had direct experience with the disease. More than 250 women completed the Catawba nurse training program in the forty years until it closed in 1954. The current state hospital includes many photographs of the nurses who received their training at Catawba. <\/p>\n\n\n\n
Treatment in the first decades after Catawba opened included tuberculin, which researchers hoped would prevent the further development of tuberculosis, as well as homeopathic and herbal remedies. Physicians experimented with more interventionist measures, including deliberately collapsing a lung in a procedure known as pneumothorax with the goal of allowing the lung to rest and heal itself. Other more drastic measures included removing ribs, to ease pressure on lungs, or removing one infected lung. X Rays were increasingly used to diagnose tuberculosis in the lungs of patients.<\/p>\n\n\n\n
The open air treatment could not cure tuberculosis, but it could slow the progress of the disease and patients could recover their strength to the point of resuming many aspects of their lives. Healthy good, prescribed rest periods, and isolation from everyday life certainly contributed to these recoveries, thus promoting the idea that the sanatorium could cure patients and allow them to return to their homes, their families, and their regular lives.<\/p>\n\n\n\n
Recovery was the goal, but not all patients saw improvement. Catawba patients died while receiving treatment as tuberculosis remained an incurable disease. Some patients discharged from Catawba were unable to sustain their recovery and either returned to the facility or died at home or in another hospital. And some patients remained at Catawba for months or even years, as the treatment was enough to keep them alive but not enough to make them healthy again. <\/p>\n\n\n\n
Patients had to pay to stay at Catawba, which meant that only people from relatively well off social classes could afford this treatment. In the early years, the cost was $7 a week for lodging, food, and treatment. Some patients received discounted or even free treatment, subsidized by the state or by charitable contributions. Even if patients received free or discounted charges, however, patients are bore the cost of lost income during the weeks, days, or even months that they spent at this sanatorium, away from their families. <\/p>\n\n\n\n
Catawba only admitted white patients. The color line was implicit when the sanatorium was established, but was made explicit in the admission forms, which required certification that the applicant was a white citizen. In 1918, a separate facility, Piedmont Tuberculosis Sanatorium, was established by the state of Virginia to treat African American patients. These two institutions functioned in parallel for decades, with the color line enforced to maintain separate treatment for African American and white patients. Death rates for African Americans declined as did death rates for white patients, yet the rate was always higher for African Americans due to structural inequalities in unequal access to health care, environmental conditions, and related medical conditions. <\/p>\n\n\n\n
Treating the disease of tuberculosis was only part of the purpose of this facility. Catawba, like other tuberculosis sanatoria, also had a mission of educating patients and the public more generally about the danger of tuberculosis and promoting practices and policies to prevent the further spread of this disease. Patients were frequently reminded not to spit in public and to cover their cough, which were daily practices that they were expected to model for others in public spaces. The institution preached the gospel of good health within and beyond its walls. <\/p>\n\n\n\n
The Virginia State Department of Health tracked the outcomes of patients admitted to Catawba for treatment. It is important to realize that the facility did not admit patients with advanced cases of tuberculosis, because they would derive no benefit from the open air cure, rest, good food, or care by a physician. Catawba sought to admit patients with moderate or mild cases of tuberculosis, because they were most likely to benefit from the treatment and leave the hospital with arrested disease. Only a tiny fraction of tuberculosis patients in Virginia could be treated at Catawba, and the illness remained incurable for most of the population during the first half of the twentieth century.<\/p>\n\n\n\n
New medical procedures brought an end to the tuberculosis sanatorium at Catawba and elsewhere in the country. The discovery of the antibiotic streptomycin in 1943 allowed physicians to kill the tuberculosis bacteria, thus providing the first real preventive measure for this deadly disease. Outpatient diagnosis with x-rays and treatment with antibiotics replaced sanatoria as the preferred methods for dealing with tuberculosis. The Catawba Sanatorium stopped admitting tuberculosis patients in the 1960s, and then became the current state hospital serving patients with mental health needs.<\/p>\n\n\n\n
Several historical sites on the grounds of Catawba hospital illustrate the legacies of this early approach to public health and well-being. A gazebo with a marble fountain marks the spring that inspired the original Red Sulphur Springs Resort. The Brauer chapel completed in 1916 with donations from patients and community organizations overlooks the current hospital building, which was built after most of the sanatorium buildings were torn down. Some of the existing outbuildings were designed during the sanatorium era, as illustrated by their wide porches designed for outdoor resting. A historical marker on Route 311, less than a mile from where Route 76 turns in the direction of Catawba road, provides motorists with a brief history of this remarkable institution. The Catawba sustainability center, with a parking lot on Route 76, has a connecting trail up the hillside that that allows visitors to reach McAfee Knob and other sites along the Appalachian trail, thus providing a very different experience of the long-standing and complex relationship between health, nature, and well-being in rural America in the twentieth century. <\/p>\n\n\n\n
You have been listening to episode 20 of the Virginia Bikecentennial Route 76 Podcast. This episode is connected to the community of Catawba, located just over 330 miles from Yorktown, the starting point for the westbound route, and about 220 miles from the Kentucky border, where eastbound rides enter Virginia. This podcast is a production of Virginia Tech, a public land grant university located in Blacksburg, just three miles from Route 76 in southwest Virginia. I am your host, Tom Ewing, and this podcast is produced by the digital humanities program in Virginia Tech University Libraries, under the direction of media manager Joe Forte. To learn more about the stories in this episode, visit our website or follow us on social media, all accessible for the homepage for this podcast.<\/p>\n","protected":false},"excerpt":{"rendered":"
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