Sanatoria


Figure 1.--Here we see the children at an unidentified Swiss sanatorium, probably in the early-20th century. Notice the snow covered mountain in the background. The whole idea of a sanatoria was to expose the patients to as much fresh air and sunshine as possible. And the German doctors promotig the idea saw pure unpoluted, cold mountaiun air as especially healthful and beneficial.

Two German doctors in the 1880s began promoting sun light and fresh air as beneficial for patients aflicted with tuberculosis. This came Dr. German Robert Koch had identified the cause of tuberculosis. Soon special care facilities called sanatoria were being built in many European mountainous regions, especially in the Alpine region (Austria, southern Germany and Switzerland. They were designed to maximize exposure to fresh air and sunshine. Puropse built facilities featured large balconies on which patients could lie in their beds without clothes or with minimal clothes. Here they could be exposed to fresh air and sunshine. Many German and eventually foreign patients went to these establishments. We are just beginning to collect information about these santioria. While the initial concern was tuberculosis, the beneficial affects of fresh air, sunshine, and good food was useful in treating other disorders as well. They are essentially hospitals devoted to the care of individuals with chronic diseases such as tuberculosis or mental disorders. The concept was expanded during the late-19th century to include facilities caring for people that were not really sick, but persuing a variety of "cures" to improve one's health. I am not sure if there were sanitoria specializing in caring for children, but suspect there may have been. Children were involved in these sanitoria both for treatment, but also because their parents needed treatment. In some cases the entire family might join the patient, often stating in near by homes. The staff of the sanitoria also had children and given the isolated areas in which the facilities were located, these children often had to be accomodated in various ways. We also notice schools adopting some of the same efforts to expose children to fresh air and sunshine.

Comsumption

Tuberculosis was known as consumption through much of the 19th century. It was a disease known for cebnturies. Because diseases were not fully understood until modern times, it is often difficult to be sure as to what diseases are being described in historical accounts. Historins have identified accoiunts of consumption going bck more thn a milenium. It was aiseasec thst was primarily treated at home through the mid-19th century. It was a disease that had a range of symptoms. One historian writes, "The illness itself was characterized by a fluid group of behaviors, signs, and symptoms, with shifting connotations. Diagnosis depended largely upon a patient's temperament, which could be sanguinous, lymphatic, bilious, or nervous. However, as in other areas of medicine, there was no consensus upon what each signified." [Ott] The Western medical establishment focused primarily on epedemic infectous disease. Less attention was gicen to less dramatic diseases despite the death toll could be even higher. Tuberculosis is the outstanhding hitorical example of such a disease. And there was during the 19th and early-20th century centuries the deth toll ws very high. [Bryder] Doctors had no idea what caused the disease or how to treat it. Tuburculosis in the 19th and early-20th centuyry was a huge medical problem aflicting large numbers of children and adults. Both doctors and conmen offered conflicting diagnoses and cures and prescribed a perplexing variety of patent remedies that had not foundation in actul science. One chrlatan even claimed tht by growing a beard, a man could prevent consumption. Women and children apparently were on their own.

Dicovery of the Tubercle Bacillus (1882)

The German doctor, Robert Koch (1843-1910), discovered the tubercle bacillus (1882). The identicication of the bacillus was one of the pivotal moments in medical science. The pproblem was that unlike many bacilli, it divided very slowly so culture was difficult. Also it didn't take up the stains used to identify other bacteria, on account of it had a lipid coat. Special techniques had to be devised. A controversy emerged regrding the human and bovine types. Tuberculin was introduced as a cure, but proved to be ineffective, but did become a diagnostic tool. Koch's discovery was one of the great turning ponts in the development bof modern medecine. And was the beginning pooint in the nastery of a disease which had plagued man. Doctors had debated the nfectious nature of tuberculosis for centurie. Koch proved that the cause infection by a specific micro-organism which he suceeded in isolating. This was essentially the launch of the modern science of bacteriology.

Closed Institution Approch (1880s)

Once Dr. Koch finally suceeded in identifting the cause of tuberculosis, the question emerged as to how to best treat the disease. Two German doctors, Drs. Hermann Brehmer and Peter Detweiler, began in the 1880s promoting sun light and fresh air as beneficial for patients aflicted with tuberculosis. This led to pioneering the German 'closed institutions' approach which becamne popularly called snatoria.

Opening Sanitoria in Mountaneous Ares

Soon special care facilities similar to hospitals called sanatoria were being built in many European mountainous regions, especially in the Alpine region (Austria, southern Germany and Switzerland. Thgese xwere resideb=ntiual care facilities for extended stays. They were designed to maximize exposure to fresh air and sunshine. Puropse built facilities featured large balconies on which patients could lie in their beds without clothes or with minimal clothes. Here they could be exposed to fresh air and sunshine. Many German and eventually foreign patients went to these establishments. We are just beginning to collect information about these santioria. .

Thomas Mann (1875-1955)

Thomas Mann, the great German Author and Nobel Laureate, wrote The Magic Mountain, after his wife's stay in a Sanatorium at Davos, Switzerland. It was his master work and one of the great novels of all times. Mann was born in Lubek (1875). He wrote not only novels, but short stories and essays become aespected social critic, philanthropist, and essayist. He was awarded the Nobel Prize for literature (1929). He is especually respected foir his attemps to assess the European and German soul. His older brother was the radical writer Heinrich Mann, and three of his six children (Erika Mann, Klaus Mann and Golo Mann) became important German writers. After the NAZIs emerged as a major German political power, Mann spoke out against them anhd becmeca prominant critic. When Hitler came to power (1933), Mann was vacatoning in Swtzerland. His son Klus advised him not to return. His works were mot immediately banned anhd burned, perhaps because he was a Nobel Laureate. His works were banned after the NAZIs becamne cmore entrenched (1936). He sprnt the war in the United States and made poropaganda brioadcasts for the Allies.

Treatments

While the initial concern was tuberculosis, the beneficial affects of fresh air, sunshine, and good food ws useful in treating other disorders as well. They are essentially hospitals devoted to the care of individuals with chronic diseases such as tuberculosis or mental disorders. The concept was expanded during the early-20th century to include facilities caring for people that were not really sick, but persuing a variety of "cures" to improve one's health. Interetingly, some onservers believe that some of the earliest facilities were better than the more modern. One American doctor believes that early primitive tent facilitie were better interms of cure rates than the luxurious, elequently equipped santoria subsuequently built becaue they exposed the patient better to freh air and sunshine. [King, p. 271.]

Sponsors

The individuals and groups opening santoria varied from country to country. We note government agencies, including municipalities opening sanatiri. We alo notice indicuals, usually doctors, opening private sanatoria. Some of the doctors wre tuberculosis specialists interested in goods works and research. Si And we note chrity groups, in some case assocation organized to oromote the care pg=f tuberculpsis patients. Religious groups were also active, supporting a variety of charitable work. Huucters and connen were nited from an early point. The unscruollous were aided by the fact that snatoria quickly became a fad. A doctor writes, "umerous medical men, unhampered by special training, are establishing institutions everywhere, and are appeling to their bretheren for patiebnts to fill them. The apotheis of the sanatorium has also been taken advatage of by gentlemen whose commercial instincts ar keen but are deficientin ethical culture." [King, p. 271.]

Age Trends

We are not sure if there were sanitoria specializing in caring for children, but suspect there may have been. Children were involved in these sanitoria both for treatment, but also because their parents needed treatment. In some cases the entire family might join the patient, often stating in near by homes. The staff of the sanitoria also had children and given the isolated areas in which the facilities were located, these children often had to be accomodated in various ways.

Schools

We also notice schools adopting some of the same efforts to expose children to fresh air and sunshine. Many schools were set up, as it was perceived that the pure air and sunshine was beneficial to all, not just those with any illness. We notice an unidentified Swiss school in 1929 which placed a great emphasis on fresh air and sunshine.

Country Trends

Sufferers of comsumption or tuberculosis as it is now called for centuries were treated at hime. Only after a German doctor isolated the tubercle bacillus did treatment begin in health facilities. Other German doctors proposed the closed institution on sanatorium approach. They proposed facilities that woukd expose patients to healthy diers along with fresh air and sunshine. TheGermans considered cold mountain air especially healthful. As a result, snatirium were opened in Alpine sutes in both southern Germny and neigboring Switzerland. Swiss sanitorium were especially popular because of the many beautiful mountain sites that were developed. Doctors in other countries followed the German/Swiss developments with inteest. Sanitorium were also opened in America, but rather than in the distant Western montains, the pristine area north of New York city with forests and lakes were developed. Similar sites were developed in Finland. Subsequently, desert sites in American Southwest with dry warm air became popular. We notice Canadian sanatorium in the western mountains. We do not notice many sanatoria in Britain. Rather suferers who could afford itcwentvto Switzerland. Sanatoria were opened in Russia and later the Soviet Union, but they did not have the focus on tuberculosis that the western sanatoria had.

Antibiotics

Albert Schatz, a graduate student at Rutgers University, discovered streptomycin during World War II (1943). It ws an antibiotic and the first real cure for tuberculosis. With the development of streptomycin and othetr antibiotics, sanatoria were made obsolete. A dose of anbtibiotics could achieve in a few days and with greater surity than what might take a year in a sanitorium. And at only a small fraction of the cost. This quickly ended tuberclosis as aajor medical oproblem. Sadly the disease is now becoming more resistant to 'modern' treatments and there has been a resurgence of the resistant form. Antibiotic resistant strains are appreaing in certain parts of the world, especially Southeast Asia. And they are being imported to America and Europe others by immigration and tourism. As a result, increasing numbers of people are catching tunburculosis once again. A British reader writes, "Immigrants from Africa and the Indian subcontinent have brought the disease to Britain and the samne seems ti be occuring elsewhare in Europe. All dairy products have now to be Pasteurised, which is a good think, except the 'organic' lobby doen't like it! The wife of our Rector who married our daughter succumbed to it following a visit to India, and eventually died despite having an early diagnosis and the best available treatment."

Modern Usage

Manu sanatoria closed adter the appearance of anti-biotics. The sanatoria that survived changed their purpose. Many are sports hotels, Old peoples Homes, or in quite a number of instances derelict. A British reader tells us, "Some 30 years ago, we swapped houses with the Director of a Swiss Sanatorium. His wife had trained as a nurse with my wife. His sanatorium had few tuberculosis patients. Most were Italian workers, employed drilling tunnels though the mountains. They had developed silicosis from the stone dust. We were told that to comply with Swiss Health Regulations a Sanatorium had to be built at a height of over 2,000 meters. This was not the case of the earlier buildings. Many were at locations under 1,000 meters. Davos was the highest at 1,600 meters."

Sanatoria Clothing

Sanatoria clothing varied among institutions and over time. The iniitial imopetus from German doctors was toi exposed patients to as much fresh air and sunshine as possible. Thus we see patients laying in beds on verandas, without any clothing or minimal clothing. Of course, people, especially children, can not lay around all day long. And we see boys wearing a varirty of brief pants-like garmnents. Some look like rompers. Others look rather like diapers. And we see some that look like brief underwear, covering the front and back with a connectig band. Some girls today wear this style of underpants. We see the romper-style pants also being worn at schools, including Swiss schools set in sites like those selected for sanatoria. We are usure why such unique, specialized garments were adopted by the sanatoria and wondered why the boys just did not wear short pants. A British doctor writes, "I was also puzzled by this. The only thought I had was that they might be suffering from renal and bladder tuberclosis, but it was not a disease I encountered when I was doing paediatrics. I only came across this variety of tuberculosis in adults, but then I was post anti-biotics. My patients would have contracted the disease in pre-antibiotic days." As far as we can tell, these destinctive pants seems to be a general approach st the sans, rather than focused on specific individuals and conditions. The only reason we can think of is that the sans pants were generally more 'airy;' as opposed to wearing short pants and underwear. But some san pants whilke short lokk to be rather thick and closed which would be les 'airy' than light-weight short pants. And in the late-19th and early-20th centuries when many sanatoiria were opened, knee pants were very long and worn with underwear. We suspect that these san pants were adopted during this period and becanme an accepted tradition even whenlighter-weiht anbd shortre pahnts became more common after World War I. And of course short pants were worn ith underwear, unlike the various types of san pants.

Popular Attitudes

It is difficult to assess prescisely, but surely medical endorsement of fresh air and sunshine must have affected public attitudes and in turn this would have affected attitudes toward children's clothing. The general approach to drressing children in the 19th century, after the early Napoleonic era, was to bundlke them up from head to toe. Here modesty was a major factor, but protecice cothing and warmth was also important. The idea essentially was to block out fresh air and sunshine. Of course many children went barefoot, but this was largely a poverty indicator. Dresses and pants were commonly long and when they began to be cut shorter, pantalettes and long stocking covered bare limbs. Short sleeved shirts did not exist. Interestingly after the sanatorium movement we begin to see a decline in the popularity of long stockings, This trend is much more noticeable in Europe than America. We notice knee pants becoming incresily poopular and in Europe were commonly worn with socks rather than long stockings. We also notice shorter-cut knee pahts and older boys wearing them. the same trend occurred for girls, We begin to see long stockings disappear as beachwear. Vacations to ocean beaches becamne very popular with doctors endorsing the beneficial affect of not only fresh air and sunshine, but also sea water and air. This was made poossible for the general public by rising wages and the railroads--all products of the expanding capitalist industrial economy. This was not just for the well to do, but workers as well. And the summer camp movement devloped in America to get kids out of the often polluted cities into the fresh air and sunshine The camps were usually located in undeveloed forested locations with beautiful, unpolluted lakes. Many of the camps adopted uniforms of short sleeved shirts and kneepanhts/short pats without long stockings. After the turn of the century we also notice the appearance of Barefoot Sandals. Another trend was toward casual wear, but this seems to be most pronounced after World War I. The fresh air and sunshine movenent began in the early-20th century Edwardian Era when formality in dress was still pronounced. And after World War I, short pants began to replace knee pants. Here America was an outlier. American boys did not like short pants and more commonly wore knickers. We even notie madvertisements incouraging mothers to cover up knees, especially in cold winter weather. The general trend was, however, was to dress children in clothing that exposed them to fresh air and sunshine. And the sanatorium movement must have been a factor here.

Sources

Bryder, Lind. Below the Magic Mountain: A Social History of Tuberculosis in Twentieth Century Britain (Oxford: Oxford University Press, 1988), 298p,

King, John C. "Observtions upon sanatori for pulmonary tuberculosis," California State Journal of Medicine (September 1904) Vol. II, No. 9, pp. 27172.

Ott, Katherine. Fevered Lives: Tuberculosis in American Culture since 1870.






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