Four

Into the Mountains

HERMANN Brehmer was studying medicine in Berlin in 1853 when a twenty-year-old theory about the cause of tuberculosis came to his attention. Several German and Austrian doctors had suggested that consumption was caused by a weak heart. The blood of a TB patient, they believed, wasn’t being pumped through the body with enough force to flush out the disease.

None of these doctors bothered to test this theory in a scientific manner. And neither did Brehmer. Instead, in his doctoral paper, Brehmer simply proclaimed the theory to be absolutely true. He backed up the claim by stating that he’d observed many weak hearts in postmortem examinations of victims of consumption (though in truth he’d participated in very few autopsies).

 

Hermann Brehmer created his sanatorium cure based on very little scientific research  

 

He then invented a course of treatment. Consumption was curable in its early stages, he boldly stated—again, without any scientific backing. His answer was largely scientific double talk: Get the patient quickly into the pure air of the mountains, he directed, where “the reduced atmospheric pressure [at higher elevations] would ease the pumping action of the heart muscle.” This, in turn, would improve the overall condition of the body and help it fight off the disease. He supported his theory by quoting world-famous explorer Alexander von Humboldt, who claimed that TB did not exist in any of the world’s mountainous countries. This was absolutely untrue.

Brehmer was so taken by his own theory that the following year he established the first institution specifically designed to treat tuberculosis of the lungs. He called this medical facility for longterm illness a sanatorium (from the Latin word sanatorius, which means “health giving”). In fact, when his TB sanatorium opened in the Bavarian mountain village of Görbersdorf, it was little more than several hastily nailed-together shacks. But Brehmer’s steadfast promise of a cure made Görbersdorf an instant success.

There was more to Brehmer’s treatment than simply hanging around in the fresh mountain air to improve the flow of blood. He rejected the traditional, often harsh, methods of treatment, such as bloodletting and the use of drugs to cause vomiting and diarrhea. Instead, he intended to help patients strengthen themselves physically from head to toe so that the body could ward off TB. To accomplish this, he proposed a regimen of carefully supervised walks through the forest, bed rest, and a nutritious diet. He or one of his assistants would always be present to monitor the patients.

None of Brehmer’s ideas was particularly new. The notion that the body was its own best healer was the foundation of the ancient Greek theory of humors. Brehmer was, however, a great self-promoter. Not only did Görbersdorf continue to expand over the years, but other tuberculosis sanatoriums began springing up throughout Europe.

One of the most famous was founded in Germany by a cured expatient of Brehmer, Dr. Peter Dettweiler. Dettweiler made what he considered several improvements on Brehmer’s cure, but his real claim to fame was something quite simple. He was the first doctor to keep detailed records of his treatment of each patient’s illness and publish these findings in important medical journals. Over a ten-year period, he wrote, he’d treated 1,022 victims of consumption and been able to cure 542 of them. While modern physicians dispute his cure claim as wildly exaggerated, it was an impressive-sounding success rate. It captured the attention and imagination of doctors and sufferers of consumption around the world.

 

Brehmer built his sanatorium in Görbersdorf into the very large institution pictured here in the 1870s.  

 

Many other sanatoriums also claimed a degree of success that rivaled the Brehmer/Dettweiler treatments, often adding their own unique twists to the original regimen. Dr. Otto Walther created a special diet to strengthen his patients’ bodies that required them to eat massive amounts of milk, cheese, meat, potatoes, butter, fruit, and sweets every day. Whether it worked or not will never be known, because Walther never allowed his records to be published. But his patients seemed to love the diet. One consumptive from England reported happily, “It is amazing the amount one can eat when forced to.”

 

(Top) A class of tuberculosis sufferers raking hay in Dr. Rollier’s Sun School in Switzerland.  

 

(Bottom) An early-twentieth-century panoramic view of children with tuberculosis on the front lawn of a TB sanatorium in Liverpool, England.  

 

Some sanatoriums used soothing music to keep patients calm and relaxed, while others tried to forbid excess mental stimulation (such as the reading of books). They believed that a tired brain was just as dangerous as a tired body. What was common among all these emerging institutions was that a patient’s life was carefully and, in some cases, severely regulated. Patients weren’t allowed to leave the sanatorium without permission, and they woke up, ate, took their temperature, exercised, and went to sleep under strict supervision.

While popular in Europe, the idea of sanatoriums didn’t catch on in the United States for some time. The credit for its eventually happening rests entirely on the frail but determined shoulders of a consumptive doctor named Dr. Edward Livingston Trudeau.

In the spring of 1873 Trudeau believed he was dying. As a teenager he had nursed his older brother, who had died from TB. He’d also come in contact with the disease while treating it in his medical practice in crowded New York City. Now, suffering from advanced TB, Trudeau decided to retreat to the wilderness of the Adirondack Mountains, not to seek a cure but to spend his last remaining days in a place he loved.

At the time, the Adirondacks was a vast area of untouched forests in upstate New York, “visited,” Trudeau recalled, “only by hunters and fishermen.” While the Adirondack landscape was beautiful, with its many lakes and rugged mountains, “it was looked upon as a rough, inaccessible region” with a “most inclement and trying climate” that included fiercely cold and snowy winters. Trudeau’s out-of-the-way destination was forty miles from the nearest train station, and the wagon trip over rocky, rutted roads so exhausted him that he had to be carried into the sportsmen’s hotel where he was staying.

In the weeks to follow, Trudeau spent his days being rowed across pristine mountain lakes, strolling along forest paths, and napping under towering pines. Remarkably, his fever disappeared, then his night sweats vanished. By the end of the summer, instead of wasting away and dying in his beloved mountains, Trudeau had gained fifteen pounds and was completely cough-free. When his return to New York City quickly brought back his symptoms, Trudeau, along with his wife and their young child, moved permanently to the town of Saranac Lake.

The idea of setting up a sanatorium of his own came to Trudeau in 1882 after he read about the Brehmer/Dettweiler cure regimens. They sounded remarkably like his own daily routine in the mountains, so Trudeau decided to test the theory out on some of his own patients. Trudeau’s innovation was to establish a sanatorium so that “poor, sick people in cities could ... have the chance of improvement I had had by coming to the Adirondacks.”

Two years later, he opened the Adirondack Cottage Sanatorium and received its first two patients. At the time the sanatorium consisted of one tiny red cottage fourteen feet wide by eighteen feet long with “a little porch so small that only one patient could sit out at a time, and with difficulty.”

 

When Dr. Edward Trudeau arrived in the Adirondack Mountains, he was so weak, he could barely stand up. But in a photo taken after three months of fresh air, good food, and exercise, he appears remarkably healthy.  

 

A replica of "Little Red," the first cure cottage at Trudeau's Saranac Lake sanatorium.  

 

From this humble beginning, Trudeau’s sanatorium would grow bigger and more influential every year. Eventually, the Adirondack Cottage Sanatorium would have fifty-eight buildings on a rolling landscape of eighty-five acres. The single one-room cottage would give way to larger cottages that accommodated a number of patients at the same time. In addition to the patient cottages, the campus would include a large administrative building, an infirmary for bedridden patients, a training school for nurses, a research laboratory, a chapel, and even its own post office.

The village of Saranac Lake also changed. While many other towns and cities shunned TB patients, the inhabitants of Saranac Lake embraced them as if they were long-lost friends. The people of Saranac Lake didn’t seem to fear TB, perhaps because the idea that tuberculosis was a contagious disease was not universally accepted. Additionally, because locals firmly believed that their climate was unusually healthy, they may have thought it would protect them from the disease. After all, what could they possibly fear if the very air they breathed was the cure?

Whatever the reason, local adults eagerly signed up to help care for the waves of arriving patients, while children brought the sanatorium guests magazines and ran their errands for a few pennies. Requests for admission to Trudeau’s sanatorium far outnumbered the available beds, and local residents gladly picked up the slack. They began building houses that included open-air porches where sick individuals could sleep or sit in the sun year round. In time, the hunting- and fishing-guide business that had sustained the village for decades was replaced by what came to be called the curing industry.

The success of Trudeau’s sanatorium prompted demands for similar institutions in other areas of the country. From that single red cottage in the New York wilderness, the American tuberculosis sanatorium system eventually grew to number 536 facilities taking care of more than 673,000 men, women, and children at a time.

These institutions created a unique lifestyle that many patients hated, some tolerated, a few even enjoyed, and all endured because it offered something no hospital could—the hope of a cure.

 

A patient poses with her husband and children in front of a private cure cottage in Saranac Lake, New York.