Rural TB Retreat

Consumption patients could find fresh air, sunlight, and a dreadful isolation at the Montefiore Home for Chronic Individuals

By Marissa Miley 

Home for Chronic Invalids. (Image: Montefiore Medical Center)

The original Montefiore Home for Chronic Invalids. (Image: Montefiore Medical Center)

Tuberculosis once ravaged New York City. At the turn of the 20th century, the deadly airborne disease afflicted thousands of New Yorkers, most of them recent immigrants squeezed into tenement housing with poor ventilation and overcrowding—conditions ripe for spreading infection. The tuberculosis bacterium was discovered in 1882 and, in a pre-antibiotic era, the best treatment was believed to be fresh air and sunlight. A sanitarium provided just that.

The concept for an isolated medical treatment facility for chronic illness was imported from Germany in the 1870s, and gained traction in the late 19th century. By the 1890s, there were 40 sanitaria across the country.

Thanks to Jewish philanthropy, the 25-bed Montefiore Home for Chronic Invalids—a private sanitarium once located on 84th Street and York Avenue—opened its doors to tuberculosis patients in 1884. Here, isolated from their families, patients fought the symptoms of tuberculosis—fever, weight loss and chronic cough—in a bucolic setting.

While being in quarantine limited the spread of the illness, it devastated families dependent on ill family members, many of whom eventually died. And not everyone could seek refuge there. It’s impossible to determine what percent of tuberculosis sufferers spent time in Montefiore or sanitaria like it, but Alan Kraut, author of Silent Travelers and contributor to Hives of Sickness: Public Health and Epidemics in New York City, says most did not. The sanitarium “was considered to be state-of-the-art in the late 19th and early 20th century,” he said. “The problem was finding the money to send people to these institutions.”

Montefiore Home for Chronic Invalids in the Bronx, New York; this evolved into the present-day Montefiore Medical Center. (Illustration from Brockhaus and Efron Jewish Encyclopedia (1906—1913).

Montefiore Home for Chronic Invalids in the Bronx. This evolved into the present-day Montefiore Medical Center. (Illustration from Brockhaus and Efron Jewish Encyclopedia)

When antibiotic treatment for tuberculosis was discovered after World War II, tuberculosis all but disappeared. Sanitaria were shuttered or converted into hospitals. Many Americans may today consider tuberculosis a remote disease akin to cholera, typhoid and plague—diseases from a different era. Yet the New York City Department of Health and Mental Hygiene recorded 656 cases of tuberculosis in 2013. This figure is a far cry from 1890, when nearly 400 in every 100,000 people had the disease, and in the early 1990s, when there was a spike spurred by poor housing conditions, continued immigration from countries where tuberculosis was prevalent, and AIDS. But the figure also shows how even in contemporary society disease can still lurk in the corners.

“To me, tuberculosis is a social disease with medical manifestations,” said Neil Schluger, a professor of medicine, epidemiology and environmental health sciences at Columbia University. Why do we have TB? Because we have malnutrition, overcrowding, lack of medicine.”

While sanitaria may be a thing of the past, quarantine is still used, although sparingly. In the early 1990s, two locked hospital wards to treat tuberculosis patients cropped up in New York City, at Bellevue Hospital and Coler-Goldwater Hospital on Roosevelt Island. And a sanitarium-inspired method for treatment called “Directly Observed Therapy” emerged then to ensure that all tuberculosis patients take the full course of treatment. Today, it is the standard of care in New York City.

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