When sun, air, water and food treated TB

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Let’s begin this story in 1906. This is the year of first ever postage stamp on tuberculosis (TB). On 21st December, Netherlands issued a postage stamp. This was a semi-postal Christmas charity, where postal authorities sold 1c, 3c, 5c stamps at double the price. One half went to postage. They gave the other to Amsterdam Tuberculosis Society as a charity. It was a limited success, and by 3rd January 1907, the official last day of sale, it raised about 22000 guilders (about 12000 Euros).

The above stamp depicts four symbols, for four treatments of tuberculosis. Sun for light, fountain for water, a bird for air, and wheat for nutrition. This was a standard regimen for TB, and patients paid for it in “sanatoria”.

A Backstory to sunshine

Three leaps led to first TB treatments. First, In 1882, Robert Koch discovered TB bug. He also showed that these bugs spread through aerosols. Many perceived that “air” had something to do with it. We needed good-air, for a better cure.

Second, a few years later, in 1895-96, Roentgen discovered X-rays. Now we could see deeper tissues, including lungs. By early 1900s, we could look at TB-lesions in chest X-rays. This was the next leap in diagnosis of Tuberculosis.

Third, in 1903 Nobel committee awarded Nobel prize for medicine to Niels Ryberg Finsen for his invention of light therapy for skin tuberculosis. Certain wavelengths of light killed bacteria, including those that caused TB.

Thus, air and sunshine became necessary components of TB treatment. We need nutrition to gain weight. Central and Southern Europe had a spa-culture. These spas were based on a concept of “healthy-water”. Since all these “treatments” are special, and tuberculosis “infectious”, we had to give them at “special centres.”

The first Sanatoria

Much before Robert Koch discovered tuberculosis bug in 1882, and proved that it is infectious, sporadic attempts were made to treat the disease in specialised centres or “sanatoria”. The name in Latin meant “healing places”. The first sanatorium, established in 1836 in England, had a life span of only four year. The next one came up in Poland in 1863. Credit for this one goes to Hermann Brehmer, who as a botanist cured himself of TB by staying in the Himalayas. His self-cure led him to study medicine, become a physician, and establish a “healing-place” with clean high-altitude air.

Sanatorium movement gained after the bug was discovered. Many local, regional and some national TB associations were set-up. These associations launched a crusade against TB, and chose a Lorraine cross as its symbol. This symbol from the “medieval crusades” had found a modern use. With no definitive cure at hand, TB associations promoted setting up of sanatoria, in places of high altitude, away from the cities, with lots of sunshine. These became exclusive TB-resorts, often in scenic locations.

Indian Sanatoria

First Sanatorium in India was inaugurated in 1911, by then Viceroy Hardinge. This was at a place Dharampur, now in Himachal Pradesh. This was a 100-bed facility and had expanded from one to five buildings over next thirty years. It had cottages for the rich, and wards for the less rich The next ones came up in Shimla in 1914, and Tambram in Tamil Nadu in 1928.

Getting a berth

Getting a berth at a sanatorium was not easy. A set of pre-printed postcards from Dharampur sanatorium sets a procedure.

One had to approach the sanatorium with an application. If this was suitable, one had to fill up a set of admission forms and wait for approval. If approved, money was to be deposited, and one could travel to the sanatorium. This process, and sanatorium routine is spelt out in detail in a patient’s diary. While this diary is from a TB patient in England, the procedure was similar. (Read these diary extracts here)

Patients spent months at the sanatorium, and followed a regimen of sunshine, air, food and water. Surgical management (of putting some air in the chest cavity) came later. Obviously, only a few could afford this treatment. It was expensive, and berths were few. Further, only the “mild” and “early” cases were admitted to the sanatorium – so as to maximise its success rate. Historians estimate that less than 4% of all patients with TB were actually treated at these facilities.

Life in a sanatorium

When sun, air, water and food were medicines, health-workers administered them with precision. This welcome trust picture library details the regimens (See here). Nurses counted hours spent in sunlight, and we had contraptions to maximise their use. The prescriptions of food and rest gradually changed over the days. Doctors monitored progress, by serial chest X-rays.

Since treatments were long, we had various activities for the inmates. Some sanatoria became small-scale industries. Some produced toys, while others had cards, cups, clothes and apparel. These sales, helped raise more funds for the facilities, and helped them grow.

End of an era

Streptomycin was the first medicine that drastically improved cure rates. (See a previous blog). In 1947-48, scientists conducted first trials of this drug, amongst sanatorium inmates. For some years, TB-medicines were given only after admission to these sanatoria. Gradually, these became TB-hospitals. Later, as confidence in treating TB grew, these buildings were put to different uses. While a few became spa-resorts, some were taken over by the armed forces, and others by researchers.