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The medical historian Flurin Condrau on tuberculosis sanatoria

11. November 2019 | Esther Peter | Keine Kommentare |

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Prof. Dr. Flurin Condrau is a medical historian at the University of Zurich. He wrote his dissertation on the social history of tuberculosis sanatoriums and has since published on various aspects of the history of tuberculosis.

Prof. Dr. Flurin Condrau was interviewed by Ursula Reis, subject specialist for medical history at the Main Library – Medicine Careum.


You have already dealt with tuberculosis sanatoria for your dissertation. How did you come up with the topic?

I was first interested in tuberculosis as a disease of poverty, as a topic in social and health policy. Then I came across the fact that from 1880 onwards, much hope was placed in the treatment of broad sections of the population in people’s sanatoria. I wondered how this idea came about and who came up for the costs. Why were poor patients suddenly treated in health resorts that had previously been reserved for the upper classes?

The spa collection at our library contains many richly illustrated advertising brochures from private sanatoria, mainly from Davos and Arosa. From popular sanatoria aimed at the public, the library holds rather cure regulations and similar documents. One gets the impression that these were very different institutions. Rather hotels in the case of the private sanatoria and already nearly correction houses with the popular sanatoria. Were these really two separate worlds?

Basically yes. In Davos, however, the two worlds met. Here there were popular sanatoria and luxury sanatoria at the same time. Rich patients cared about the doctors’ reputation, the entertainment on offer and the food served in the dining room. They chose the destinations, the sanatoria and made decisions on their therapy. The situation was different for poorer people. Therapy was prescribed to and paid for by early health insurance companies or welfare offices. The patients had to follow instructions and keep to a strictly regulated daily routine.

Hygienic disciplining played a major role here. After all, there was no drug for healing. The purpose of the stay in the sanatorium was to activate self-healing powers, through good nutrition, the climate and the correct, hygienic daily routine. Patients were encouraged to heal themselves by adapting their behavior. This demand of course indirectly accused patients that they had potentially made themselves with ill by their wrong behavior. The city in particular was perceived as a place of illness. Not only because of the living conditions or the air pollution, but also morally, for instance in the bars or the so-called nightlife. The sanatoria were thus closely linked to the moral concepts of the time.

In our collection, there are brochures from private institutions that also offer high altitudes therapy, but according to the brochure did not admit patients with pulmonary tuberculosis. Was this type of therapy also used for other diseases? Or how is this to be understood?

The idea behind high altitude therapy was that long periods of breathing in the fresh mountain air strengthen the patient’s self-healing powers. The therapy was invented for the treatment of tuberculosis, but could also be used for other diseases.

The question of who should be admitted was central to every institution. When a resort admitted tuberculosis patients, no other guests would come. Even the tuberculosis sanatoria had to deal with this question. Highly contagious or even dying patients were also not desirable for them. There was always a tension, which patients should be admitted, how were the beds filled? It could even be more attractive for a sanatorium to mostly admit people considered at risk of developing tuberculosis. Since those at risk were probably never ill, they could later be discharged as cured, which was good for the success statistics.

What significance did the tuberculosis sanatoria have for Switzerland, for example for Davos and the surrounding area?

Davos as we know it today, with its infrastructure, tourism and international appeal, was first created by the tuberculosis sanatoria. When Spengler began with high altitude treatment in Davos in the 1850s, it was a small mountain village. However, this changed relatively quickly when patients began to stay for winter therapy in the 1860s.

From around 1900 the Davos combination of sport, tourism and health was almost unique. There were also other important resorts for tuberculosis treatment in Switzerland and abroad, but the Davos combination of very different infrastructures remained largely unattained. In addition to the booming sanatorium sector, Davos also hosted international sporting events, the natural ice rink achieved legendary status in Europe, and mountain and ski sports were established.

After the Second World War, Davos added congresses to its range of activities. Research institutions were founded in Davos at an early stage. This is another unique selling point of Davos: tuberculosis sanatoria were not particularly highly regarded locations for medicine, but Davos succeeded in raising the status of the area through its connection to research.

The idea of going to a resort or sanatorium for several weeks is rather distant to us today. What has remained of these health resorts and their therapy concepts?

On the one hand, there are the wellness destinations. Today, they are mostly not part of medical therapy but aimed at paying customers who use them as part of a sporting lifestyle. Some tuberculosis sanatoria were converted into rehabilitation clinics. The history of rehab is poorly researched, but there is evidence that good rehab today often contributes to medical success.

The health resorts were based on a hygienic understanding of health. Scientific hygiene was an important medical discipline that combined social challenges such as drinking water supply and sanitation with aspects of individual lifestyles. The specialization of medicine was much less developed around 1900 than it is today. Much of what medicine offered or thought about can be summarized under the concept of hygiene. Sanatoria played their part in this hygienisation of everyday life by helping to shape individual lifestyles on a scientific, i.e. hygienic basis. This was more or less new at the time.

Selected Publications:

Flurin Condrau and Janina Kehr. Recurring revolutions? Tuberculosis treatment in the era of antibiotics. In: Jeremy A. Greene, Flurin Condrau and Elizabeth Siegel Watkins (eds.). Therapeutic revolutions. Chicago: The University of Chicago Press, 2016, S. 126-149.

Flurin Condrau and Michael Worboys (eds.). Tuberculosis then and now : perspectives on the history of an infectious disease. Montreal: McGill-Queen’s University Press, 2010.

Flurin Condrau. Urban tuberculosis patients and sanatorium treatment in the early twentieth century. In: Anne Borsay and Peter Shapely (eds.). Medicine, charity and mutual aid. Aldershot: Ashgate, 2007, S. 183-205.

Flurin Condrau. Frauen in Lungenheilanstalten zu Beginn des 20. Jahrhunderts in Deutschland und England. In: Merith Niehuss und Ulrike Lindner (Hg.). Ärtzinnen – Patientinnen. Köln: Böhlau, 2002, S. 199-214.

Flurin Condrau. “Who is the captain of all these men of death?” : the social structure of a tuberculosis sanatorium in postwar Germany. In: Journal of interdisciplinary history 32 (2001), S. 243-262.

Flurin Condrau. Behandlung ohne Heilung: zur sozialen Konstruktion des Behandlungserfolgs bei Tuberkulose im frühen 20. Jahrhundert. In: Medizin, Gesellschaft und Geschichte 19 (2000), S. 71-94.

Flurin Condrau. Lungenheilanstalt und Patientenschicksal: Sozialgeschichte der Tuberkulose in Deutschland und England im spätern 19. und frühen 20. Jahrhundert. Göttingen: Vandenhoeck & Ruprecht, 2000.

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