Asheville: Paradise of Pestilence

by Mike

A hundred years ago Asheville, North Carolina contained possibly the biggest concentration of sanitariums* and other tuberculosis facilities in America, including resorts, hospitals and boarding houses catering mostly to sufferers of the consumptive disease. The known healthful ozonic properties of mountain air, the nearby hot springs (in Hot Springs, 30 miles north), the coming of the railroad in the early 1880s, the city’s comfortable position between the climatic nightmares of North and South, and the enthusiasm of wealthy families like the Vanderbilts and the Groves made this small city the trendiest place to try and reverse the wasting effects of phthisis.

The National Register of Historic Places’ booklet about Asheville has a brief, very good section about Asheville’s role as resort and health destination. From the link:

Dr. Joseph Gleitsmann, a German born and trained doctor, arrived in Asheville to establish the Mountain Sanitarium for Pulmonary Diseases. … Gleitsmann systematically studied the United States and “selected Asheville as having an optimum combination of barometric pressure, temperature, humidity and sunlight” which he believed to be conducive to healing tuberculosis. Gleitsmann is credited with helping to establish Asheville as a center for tuberculosis treatment, not because of his sanitarium, but because of the many articles he wrote and talks he gave at medical gatherings promoting the benefits of the Asheville climate

from Knopf's 1899 "Pulmonary Tuberculosis"

from Knopf’s 1899 “Pulmonary Tuberculosis”

A typical assessment of Asheville’s charms is found in an 1899 book called Pulmonary Tuberculosis: Its Modern Prophylaxis and the Treatment in Special Institutions and at Home. In this work, Dr. Sigard Adolphus Knopf goes through all aspects of the disease, including history, symptoms, contagion, prevention, sanitary laws, and all kinds of ideas for treatment, along with a list of good sanitariums and details on how the best ones function.

Knopf sez (pp. 173-175):

The view from the sanatorium is one of surprising loveliness – a panorama of city, rivers, valleys, forests, and distant mountains. The building is a substantial and ornamental structure, of three stories and basement, designed for sanatorium purposes, and contains eighty rooms. The appointments are modern, with elevator, electric lights, etc. The basement, which is on the level of the ground, is devoted to the bath establishment and gymnasium, including a swimming-pool. The house is provided above and below with numerous sunny, sheltered verandas and porches.

The grounds consist of fifteen acres of park land covered with an open growth of handsome oaks, interspersed with pines. The adjacent territory is especially suited for exercise on foot or horse-back, mountain-climbing, etc.

The treatment in the sanatorium is, of course, the hygienic and dietetic, with all its various adjuncts (hydrotherapy, massage, etc.). The sanatorium is bountifully supplied with remarkably pure water for drinking and all other purposes, from its own spring, the large stream from which does not vary perceptibly in quality or quantity during wet or dry weather. In addition, the perfect system of sewerage will be flushed with water form the city water-works, and all sewage, after having been disinfected, will be discharged into the French Broad River, one mile away.

Sounds pretty nice. And yet, Dr. George D. Barney takes a rather more cynical approach in an essay for the July 15, 1899 issue of the weekly New York Medical Journal, volume 70 (pp. 86-90).


“Phthisis” isn’t exactly a synonym for “tuberculosis”. It refers to the progressive wasting and weakening that happens late in infection. If you get infected by tuberculosis and manage to nip it in the bud, you can avoid phthisis. Also I don’t think it refers to complications outside the lungs, like osteomyelitis. But I’m no medical historian. (Well, I am an amateur historian, I guess. I’m no expert.)

Anyway, Dr. Barney’s piece first goes through the best ways of treating tuberculosis, and then starts denigrating lazy doctors and charlatans who provide false hope and recommend unnecessary therapy. Here’s an excerpt:

It is a mistaken idea to send patients that are advanced into the second and third stages of the disease off on a globe trot when rest and home comforts are in greater demand. I do not believe in the specific curative quality of any climate, but do believe very strongly that it is essential to the majority of phthisical patients to be treated and cured in the same climate that they have to live and work in after their restoration to health.

The features of “consumptive resorts” are greatly overestimated and dangerous. Asheville, North Carolina is no exception. … Asheville, North Carolina, is a city where thousands of phthisical patients gather from all over the country, the majority being in the second and third stages of the disease. These poor, misled patients are advised to go to Asheville, because “a change of climate will cure them,” and so they make every effort possible to reach that haven; and the home physician draws a sigh of relief when they have gone.

And so the patient arrives in Asheville to find thousands there for the same purpose–i.e., “to be cured without physician’s aid, as climate will do it all.” Here we find thousands without a medical adviser, going about the city streets, depositing expectoration that contains millions of tubercle bacilli upon the sidewalks every few feet, which, being exposed to the sun’s rays, dry and pass off into the atmosphere, to be inhaled into the air-passages of the inhabitants. Flies alight upon these deposits of expectoration and then go from dinner table to dinner table, drop into the milk, alight upon prepared food, and so infect the masses. Such a state of affairs is most dangerous, and the profession should know the condition, that they may govern themselves accordingly.

The concerns about dust and flies are overblown, but still, this does not sound so great. Those who can afford a sanitarium enjoy clean sheets, nourishing provisions, clean floors, and so on. But then there are the boarding houses, and people who rent out a room, and surely some desperate people camping outdoors, all drawn to the promise of wholesome climatic healthfulness.

At some point both nature parks and fine restaurants, when they get too crowded and noisy, go from alleviating your workaday stress to aggravating it. This would be even more true with a health resort, even though you supposedly benefit just by spending time in the place, rather than by pursuing any particular course of healthful activities.

T.E. Linn, a doctor who lived and practiced in Asheville, is aware of these concerns. But in a piece for the February 1901 Medical Century (volume IX, issue 2, pp. 46-48) he pooh-poohs the horrors of contagious flies or dust or food miasmas:

Asheville has well deserved its reputation as a mecca for the consumptive: as thousands of them have been restored to health here, some of whom had been well advanced in this disastrous disease. The objection is raised by some that there being so many consumptives here, it would be dangerous for the pleasure-seeker or tourist to visit here. This is greatly exaggerated, as I for one can not believe that this disease is so contagious or infectious as that would indicate. I base my opinions upon this fact, that there are hundreds of families here who have had dozens of the most advanced cases of phthisis in their homes, as boarders, year after year for ten or twenty years, and not one member of those families, to my knowledge, has contracted phthisis.

On the other hand, he seems somewhat doubtful of the germ theory of disease in the first place.

If phthisis be on the increase, I would certainly look for other causes than contagion. … As long as people neglect the most ordinary laws of healthy and hygienic dressing, so long will this disease develop. So long as our tenements are crowded, poorly lghted by the sun’s rays and poorly ventilated; so long as people are ill-fed and bolt their food; so long as the house is so improperly heated in cold weather, and so long as the climate shall be so changeable,– just so long will there be thousands dying each year from phthisis.

How seldom, comparatively, do we find this disease among the farming element, and when we do, it can almost invariably be traced directly to neglected colds. Another factor which may be a cause is the prevalance of indigestion among the country people, owing to coarse food and the habit of cramming the stomach with such food in five minutes or less.

Farmers and their families, as a rule, have enormous appetites from working in the fields, and then sit down to their meals greatly fatigued and eat rapidly great quantities of pork, cabbage, radishes, cucumbers, corn and pie, drink several glasses of cold water to hasten the food to the stomack without masticating it sufficiently, and then getting up from the table, being as they so often say “full up to the neck,” are in a few moments hard at work. No wonder that the great boon of the quack and patent medicine man is the farming element.

Yeah! Farmers, stop stuffing your faces with cucumbers and pies, and you won’t end up poisoning yourself by swilling Father Nazarian’s Rheumatic Cure or Mayr’s Wonderful Stomach Remedy. But at least you don’t have to worry about phthisis.

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In the end, it’s really the judgment of the marketplace that determines whether a town becomes more livable by being filled with consumptives. Revealed preference will dictate whether the concentration of such people becomes a nuisance that outweighs the salubrious air, elevation, barometric pressure, breezes and so forth. And for that sort of data, we turn to The Survey, a “Journal of Constructive Philanthropy” published by the Charity Organization Society of New York.

“Charity Organization Societies” were founded in many cities in the late 19th century, as part of an effort to use economic principles to stop wasting the money and effort of well-wishers. Modern enlightened charities would direct charitable resources to people who could potentially be pulled out of poverty rather than hopeless cases and moral degenerates, and also try to get able-bodied people to work for their handout without establishing Dickensian workhouses of enslavement. In the June 12, 1909 issue of The Survey (volume XXII, issue 11, page 422), an unknown writer points out that in Asheville and other cities, real estate convenient to sanitariums has gone way up in value in the years since the cities became known hotbeds of tuberculosis treatment.


At Aiken, S.C., property in the neighborhood of the local sanatorium has increased 400 per cent since the institution was built. At Hebron, Me., surrounding property has increased twenty per cent as a direct result of the presence of a tuberculosis sanatorium. The effect upon land values has been similar in Luzerne, Pa.**; Liberty, N.Y.; Saranac Lake, N.Y.; Pittsford, Vt.; Mt. Vernon, Mo.; and Silver City, N.M. At Asheville, N.C., vacant lots near one of the sanatoriums sell at four times their price in 1900, and others farther from the institution but nearer the city are less valuable.

There you have it. There was probably a burst in this property bubble, but I don’t know where to look for evidence. Asheville did try to shift its economy from “medical tourism” to “tourism in general”, with the pivot point probably being the July 1913 founding of the palatial Grove Park Inn. Here’s a good article by Jason Sandford of the Asheville Citizen-Times, from July 2013.

…before he pulled up his St. Louis stakes and moved to Asheville to build his grand hotel, the Grove Park Inn, wealthy pharmaceutical-maker Edwin Wiley Grove began working to turn city leaders away from that idea and toward better serving tourists.

“Grove was one of the individuals who recognized what a mistake that would be, that Asheville could literally become a leper colony for tuberculosis,” said Bruce Johnson, author of two books about the history of Grove Park Inn, which opened 100 years ago this month.

Asheville was one of the hardest-hit cities by the Depression, as voluntary tourism was not as recession-proof as medically prescribed tourism. But it continued to be a city!

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* “sanitorium”, “sanitarium”, “sanatorium” are all the same word. I can’t stand ambiguous spellings, and there aren’t many in English, but this is one.

** A note to those who, like me, grew up five miles from Luzerne, Pa., and recognize it as a small town on the edge of Wilkes-Barre’s suburbs, with no particular bucolic attributes or beauty of setting, currently containing nothing of note but Hops & Barleys and a lumberyard. You’re probably right in doubting it was once a health resort. I can find no evidence of a “Luzerne” sanitarium other than the one in White Haven, a far more picturesque and out-of-the-way location in Luzerne County, which may not technically be in the Poconos but is close enough.