Sanatoria

When I’m sick I always find myself thinking about our society’s attitudes towards illness and the treatment thereof. Much has changed over the past century.

The 1920s and early 1930s were an interesting time for medicine. The snake-oil ideas of the 19th century were mostly outmoded, replaced by a scientific understanding of the germ theory of disease. However, in a time before antibiotics, treatment lagged behind knowledge. Prevention and healthy living were the only ways of stopping disease, and they were taken very seriously. Schools taught children the importance of hygiene; an emphasis on hospital cleanliness prevented countless deaths from infection.

For those who did catch an infectious disease, especially the dreaded tuberculosis, there was not much medical providers could do except provide palliative care and prevent the patient from infecting others and an important tool for both was that quintessentially 1930s institution, the sanatorium.

Nowadays sanatoria are mostly associated with creepy abandoned buildings in horror games or with grotesque torture hospitals (the latter in part because of conflation with mental asylums, which many sanatoria were later converted into). But in their heyday, they were a sort of vacation resort for sick people, located in popular destinations like Arizona and Switzerland, where patients could rest and receive skilled nursing care while also enjoying plenty of fresh air and sunshine.

It’s necessary to note that sanitaria were always limited to the wealthy and socially elite. The best institutions were extremely expensive, and then there was the cost of travel. Many were whites-only. And anyway, most people didn’t have the luxury of spending months or years convalescing. But at any rate, rest and healthful conditions were understood as a prudent and effective treatment, even by those for whom they were out of reach.

In 1943 streptomycin, the first effective antibiotic for treating tuberculosis, was discovered, and the sanatorium industry collapsed practically overnight. Antibiotics became the silver bullet for the treatment of infectious disease, and the role of healthy living in disease treatment fell by the wayside. Even hygiene became less important, as hospitals found it easier to routinely administer antibiotics than to devote doctors’ and nurses’ valuable time to a lot of hand-washing.

This has come back to bite us in a major way in the form of drug-resistant bacteria. Hospitals are now hotbeds of secondary infection; early wonder drugs like penicillin and sulfa nearly useless; multidrug-resistant tuberculosis is making an aggressive comeback. We risk returning to a time when infections made even routine operations like dialysis into deadly risks.

This is not a tirade against antibiotics—I like not dying of pneumonia—but a reflection of what our modern attitude towards illness has caused us to forget. Today science has proven more strongly than ever the health risks of stress and the importance of relaxation and self-care, yet our society provides less room for it than ever.

In today’s society, overworking is a virtue. A third of workers get no sick leave, and those who do may still be penalized as raises and promotions go to colleagues who took fewer sick days. The growing gig economy stingily metes out payment only as tasks are completed, penalizing any moment of downtime. In the midst of a flu pandemic claiming 4000 lives a week, we can’t even accomplish basic public health objectives like preventing food prep employees from working while sick. The prevailing attitude, and often the only option available to regular people, is to medicate the symptoms and tough it out.

Today, our society would see a month-long stay in the mountains for one’s health as not only prohibitive, but a frivolous indulgence rather than a legitimate health benefit. We wouldn’t accept the idea that anyone needs a long vacation for any reason, and indeed, do not accept any person who can’t keep up a schedule of constant work.

Sanatoria may not be poised to make a comeback anytime soon. But it’s nice to remember that there was a time when we recognized that checking out of society for long stretches of time could be good for you. Let’s hope that we find our way back to that place someday—and maybe this time we’ll recognize that it’s true for everyone, not just those who can afford it.