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For six decades, the Catawba Sanatorium treated patients ravaged by tuberculosis.
Courtesy of Collection of the Historical Society of Western Virginia
Patients slept on open verandas, regardless of temperature, due to the perceived benefit of inhaling fresh air.
It would often begin as fatigue occasionally accompanied by night sweats and persistent coughing. Once blood appeared in the mouth from a cough, the diagnosis was certain — tuberculosis. Originally called consumption, tuberculosis was the leading cause of death in the US in the 19th and early 20th century, with an estimated death rate of 450 Americans per day.
With no known cure, patients literally wasted away. The skin went pale due to the impact of the disease on the blood and organs, causing tuberculosis to be known as the “white death.” Even if one survived the disease, debilitating symptoms would reoccur throughout one’s lifetime. Physicians initially tried bleedings and purgings with no success and eventually settled on a treatment regimen of bed rest, a healthy diet and fresh air. The latter was deemed critically important as tuberculosis commonly affected the lungs.
Courtesy of Collection of the Historical Society of Western Virginia
Patients are being weighed in this 1930s image. Weight gain was believed to be a sign of recovery.
By the 1880s, researchers discovered that tuberculosis was not only contagious, as opposed to hereditary, but spread by coughing and sneezing. Urban centers, factories and the homes were Petri dishes, and the message to tuberculosis sufferers was clear — stay away! — giving rise to tuberculosis sanatoriums.
Virginia established its first tuberculosis sanatorium in 1908 at Catawba in Roanoke County by converting the Roanoke Red Sulphur Springs resort, purchasing the 30-room hotel, ten cottages and 600-acre campus for $19,000. Most of the cottages and farm buildings were in total disrepair.
Patients were initially housed in wooden pavilions with long verandas where they could be subjected to mountain air, regardless of temperature, and diets of farm fresh fruits, vegetables and meats to stave off weight loss. While rest was encouraged, patients also walked the grounds usually with the assistance of canes to enjoy the rural environment. The “healing waters” of the former resort were deemed an asset to treatment. Doctors and nurses lodged on site in separate quarters and over time the sanatorium gained a post office, amusement hall, crafts center and even a chapel.
The sanatorium had its limitations, however. At first it only admitted patients whose cases were deemed curable and remained limited to whites usually from middle class backgrounds. In 1917, the state opened the Piedmont Sanatorium for Blacks. Catawba grew to a 163-bed capacity, yet there were thousands of tuberculosis cases. Patients and supplies had to be hauled from Salem, 12 miles away, over the poorly maintained roads that crossed Catawba Mountain.
Robert Williams resigned as the sanatorium’s first resident physician because he believed the sanatorium was under-funded. Treatment cost patients $5 per week, an amount equivalent to one-third of a typical family’s monthly household income.
To address the reluctance of nurses to both treat tuberculosis patients due to contagion and move to Catawba, the sanatorium created its own nurses’ training school and employed the graduates, many of whom had been former patients.
Courtesy of Collection of the Historical Society of Western Virginia
This 1930s image shows one of the many pavilions with wide verandas that housed Catawba’s tuberculosis patients.
Stays at the sanatorium were limited to four months. Although short, the time was sufficient enough for the patients and staff to form close ties. The Catawba Alumni Association was created allowing survivors to contribute to the facility’s ongoing mission. Within a few years of opening, patients had formed a Sunday School, a library and clothes closet and orchestrated game nights. The alumni association began publishing a small magazine “Sunbeams” to provide encouragement to patients and an outlet for them to record their experiences.
The daily schedule began with a “rising bell” at 7:15 a.m. followed by breakfast at 8 and then two hours of either rest or walking. The rising bell sounded again at noon with lunch at 1 p.m. Quiet hours, strictly enforced, were from 2 to 4, then rest or exercise, with supper at 6. All patients were put to bed in the pavilions at 9 with lights out 30 minutes later.
For all the yeoman efforts at Catawba, true recovery was slight. Lack of knowledge about the disease and no known cure caused physicians to try experimental procedures that had little effect. One included suppressing the lungs so the organ could rest. Many physicians considered weight gain a sign of recovery and thus cause for discharge. Fresh air and good diets were not curative, however, and those that were discharged typically relapsed. Further, homesickness caused many patients to leave early contributing to tuberculosis’ spread in their homes. By the 1920s, the four-month limit was abolished so that patients could stay longer and many did, sometimes for years.
It was not until World War II that bacilli were determined to be the cause of tuberculosis and with that discovery was the development of streptomycin. For three more decades, Catawba Sanatorium continued to treat tuberculosis patients as well as those suffering from other ailments. Catawba closed its tuberculosis ward in 1972 and transitioned to a center for the care of geriatric and psychiatric patients.
From its beginning until 1972, it was estimated that Catawba Sanatorium treated an estimated 25,000 tuberculosis patients and was the forerunner for several other sanatoriums that opened in Virginia in an attempt to stem the white death.
The story above is from our July/August 2025 issue. For more stories like it, Subscribe Today. Thank you!