Roanoke Red Sulphur Springs and its successor Catawba Sanatorium as historic havens for treatment of tuberculosis having been discussed here not long ago, that sparked additional inquiry.
Q: Edward A. Turpin, my husband, was a tuberculosis patient at Catawba Sanatorium in 1956 when he was 6 years old. Is there a list of doctors or other information about the hospital during that era?
A: Hospital records from 1910-1972, when it operated as a state-run facility to treat TB (since then, it has been a state mental health hospital), are hard to come by. Tisha Parrott of the current hospital’s administrative staff said finding such information, if such were even available, would take time.
Given that it’s been nearly a half-century since the last sanatorium patient was discharged and the institution’s mission has changed entirely since then, difficulty in accessing records from the previous era is easy to understand.
The Library of Virginia, a repository of sundry state archives, holds no Catawba Sanatorium records either. The retention period for state hospital and mental health facility records is six years, state librarian Sandy Treadway wrote in an email.
“After that time, patient medical records for adult patients who have been discharged may be confidentially destroyed,” she wrote.
For discharged minors such as the questioner’s husband, the retention period is 24 years after the individual’s birth date. If the current hospital has nothing on file, it is likely because the records have been destroyed, the librarian wrote.
What we are then left with is an interesting heap of conflicting information about a facility that began in the 1850s as a retreat for well-to-do health seekers some of whom were TB sufferers. Lacking a cure (TB was not really under control until almost 100 years later with the advent of anti-bacterial drugs), fresh air, good nutrition, and rest were considered the most viable treatments.
Catawba offered all three, a practice that was refined when the state assumed operation of the former resort in 1912. The effectiveness of such an approach was questionable, but self-promotion, exaggerated though it may have been, was a useful strategy when time came for always contentious budgetary debates in the General Assembly.
The positive messaging persisted long after the sanatorium closed.
Recalling the program for the hospital’s 75th anniversary celebration in 1984, Chris Gladden of the then Roanoke Times & World-News wrote in 1992 about the glowing analysis of the hospital’s historic impact in its anniversary literature.
“The drop in mortality in Virginia from 200 per 100,000 in 1900 to three per 100,000 in 1970 is, along with the eradication of smallpox and polio, one of the spectacular success stories in medical history, of which Catawba Sanatorium was an integral part.”
The “spectacular success” claim, at least in the early years, was open to debate, as suggested by Grace Hemmingson in a 2017 essay for the Smithfield Review entitled “Catawba Sanatorium: Its Founding and Early History.”
Her research indicated hospital officials were not averse to cooking the outcome books by basing success claims for annual reporting on sketchy data. For instance, the hospital gave itself an opportunity for a higher success rate in its first decades — lacking a cure, success was defined as a patient’s return to more or less normal life — by barring the sickest patients from admission.
The state Board of Health was reported in newspaper accounts of the opening of the facility to have given the directive the new hospital would not be a “resort of hopeless consumptives” but instead sought to admit only those “whose cases are deemed curable.”
In other instances, reported descriptions of patient outcomes were at best confusing based on the reporting criteria. In one report, a high rate of positive outcomes for 50 patients was indicated by the breakdown of one patient “cured” (a clear misnomer), six more “arrested,” 40 “improved,” only three “unimproved,” with zero fatalities.
The problem was, none of the recovery categories was defined thus “leaving room for doubt about what the categories described,” Hemmingson wrote.
Another reason to dispute high success claims was that TB death rates were already in decline before the hospital opened. A better understanding of the role of contagions and hygiene and an improved middle class standard of living were more likely factors in the decline.
The death rate would probably have “continued dropping without the state sanatorium,” she wrote.
Also contradicting the notion that the sanatorium had a major impact on the TB epidemic was the relatively small number of patients actually treated at Catawba in comparison to the large numbers of the untreated statewide.
A substantial portion of the untreated were either poor white or Black. The poor could not afford the $20 per month patient cost; Blacks could not get a bed at any cost. Catawba was segregated and Black TB sufferers were not treated much at all in Jim Crow Virginia, the only way being “if he or she were insane or criminal,” according to Hemmingson.
Not until the Piedmont Sanatorium for the exclusive treatment of the state’s Black population opened in 1917 was there a public hospital for that community. In other words, the “separate but equal” ideology upheld by Plessy v. Ferguson in Hemmingson’s analysis “was put into practice in the treatment of tuberculosis.”
Any good that derived from a stay in the hospital prior to the use of antibacterials was thought to be due to little more than the availability of non-polluted mountain air, good nutrition, and the care of doctors and nurses. Also, it was believed that removing the TB-afflicted from society reduced spread of the disease from their families and the public at large.
Hemmingson argued that any claims that such exiles had a lasting impact on control of the disease were rendered moot because of the typically short amount of time patients were actually in the hospital. Eager to return to work (families were often left with the heavy loss of a primary breadwinner) and reunite with their loved ones, many patients sought discharge as soon as allowed. Relapses were likely if not inevitable.
Unlike the first sanatorium patients, the good news for the last generation of Catawba’s guests and TB sufferers elsewhere was the availability of the antibiotic streptomysin to treat the disease.
As far as the poor were concerned, affordability no doubt continued to be a major piece of the treatment puzzle.
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