A Trip to the San: TB Patient Experiences in Newfoundland in the 20th Century

Tuberculosis was one of the most common infectious diseases of the 20th century, and thousands of people became TB patients. Newfoundland had especially high rates of TB, and from the early 1900s to the 1970s, many people suffered and died from the disease. Some of these were treated at home or in hospitals, but most were sent to one of the sanatoria in St. John's and Corner Brook, where they often endured very long stays. Sanatoria were hospitals designed to isolate and treat people suffering from TB, and were meant to be places where patients could rest, undergo treatment, and heal. However, the experiences of TB patients were not entirely positive.

Sanatoria, Tuberculosis, and Treatment

TB patients were sent to a sanatorium for two reasons. The first was to isolate or quarantine a contagious TB patient from his or her community to prevent the spread of TB. The second reason was to obtain treatment. Originally this was a “rest cure,” which meant the patient would be given good food, plenty of rest, and most importantly fresh air. Doctors believed this was necessary for a TB patient to heal, and good food and rest did in fact greatly improve a person's chances of fighting off the infection.

Sanatorium treatments usually included long spells in the open air. Pictures of sanatoria often show patients in their beds on the building's balconies, sometimes bundled up against the cold. Windows were often kept open to provide fresh air, and it was not uncommon for patients to wake in the morning to find snow on their beds from a nearby open window.

Sanatorium stays could be very stressful. Although treatments differed according to the programs and beliefs of individual sanatoria and their doctors, they usually involved severe limitations on physical and mental activity. Visits by friends and relatives were limited or prohibited outright. Isolation and boredom were therefore two of the biggest challenges faced by TB patients – and many of them stayed in a sanatorium for a year or more.

Surgical treatments for tuberculosis were common by the 1930s (approximately 35 percent of TB patients in Canada underwent surgical procedures in the 1940s, for example). These procedures varied, but usually involved the insertion of air or some inert material into the chest to collapse a lung and allow it to rest and heal lesions and cavities. More drastic and invasive was the removal of ribs to collapse a lung. These procedures, while sometimes successful, were often painful and disfiguring. A patient with ribs removed, for example, could become humpbacked or have uneven shoulders. Patients often required several surgeries to remove ribs. Recovery could be very painful, and sometimes the surgery itself could kill the patient.

Tuberculosis could also be quite debilitating if the disease attacked the bones and/or joints. The spine is the most frequent site of TB bone infection, and when this happens TB can destroy the spine's structure and leave patients humpbacked or otherwise deformed. It can also attack the hips and knees, and severely limit a person's ability to move and walk. People with tubercular spines or joints often required surgery to limit the damage, which could further reduce the joint's range of motion. They sometimes spent time in a Stryker frame, a bed designed to immobilize part of the body. TB sufferers often needed braces or crutches to walk.

Although the effects of surgical treatment were often severe, the surgical era of TB treatment was relatively short, lasting only 20 years or so. By the 1950s, surgical treatments were largely replaced with pharmaceutical regimes. Drugs revolutionized the treatment of tuberculosis, and led to the end of the sanatorium era.

Sanatorium Life 1940 – 1970

By the 1940s, sanatoria were no longer simply places where patients were quarantined and given rest. They were more elaborate treatment centres where doctors performed surgery and supervised diets and activities. Food was wholesome and plentiful, although patients did complain about lack of variety. Bed rest was emphasized and patients were discouraged from performing physical activity. Pharmaceutical treatments became possible in the 1940s, and drug regimens began to replace surgical intervention.

Yet patients still faced long sanatoria stays. To deal with the isolation and boredom, sanatoria became places where patients could take art classes, get involved in theatre or radio, and contribute to publications about living with TB. Patients took up hobbies such as ship modeling and radio building. Writing letters to newspapers and radio stations was a common pastime, as was composing poems and songs. In the 1940s and 1950s, Dominion Ale sponsored a weekly jingle writing contest (the winner received a box of Ganong chocolates), and patients in the San contributed such ditties as:

There once was a guy from Oderin
Whose home-brew was everyone's minion
But Dominion's great fame
Put his home-brew to shame
At least, that's my humble opinion!

Some of the more entrepreneurial patients found creative ways to keep busy and make themselves a little pocket money as well. One patient ran a hockey lottery, selling tickets betting on the scores of Maple Leaf games. This broke the St. John's Sanatorium's rules against both gambling and having the radio on past 10:00pm, but staff apparently turned a blind eye. Other patients operated canteens, selling items like cigarettes and razor blades, or worked as barbers.

Separation from friends and family was one of the greatest challenges of being a TB patient. Many sanatorium patients were young and single without families, but in many cases they were men and women who had spouses and children, who were doing their best to manage without them. The standard Newfoundland family unit of mother, father, and children depended upon both parents, and with one or the other in a sanatorium times could be very tough.

Letter-writing was common, and health authorities encouraged friends and family to write to the patients frequently. Visits were sometimes permitted, but were kept to a minimum to avoid spreading the disease and causing additional stress to the patient. At Christmastime in the 1940s and 1950s, the radio station VONF aired the holiday special “Christmas at the Sanatorium.” This gave TB patients the chance to read holiday messages to their friends and family over the air, mixed with musical entertainment.

While these activities helped alleviate loneliness, they could not replace regular contact with family and friends. Many patients became good friends with each other, and socialized by playing cards, checkers, or chess. Perhaps unsurprisingly, several people met their spouses while they were patients at the San.

Occupational Therapy and Rehabilitation

The idea of occupational therapy had been present in Newfoundland since the early 1900s, largely because of Wilfred Grenfell and his attempts to provide training and work experience to patients and residents of northern Newfoundland and Labrador who lived with severe poverty. By the 1950s, TB treatment had grown to include this idea of occupational therapy and retraining. Patients who had been in a sanatorium for a year or more would rarely have a job waiting for them when released. They would have difficulty establishing careers if TB or treatment had left them with permanent disabilities or limitations, or if they were advised to do only light work by their doctors. Most jobs in Newfoundland involved heavy manual labour in the fishing, mining, or logging industries, and ex-TB patients were unlikely to be able to find suitable work.

To overcome this problem, the St. John's Sanatorium established an Occupational Therapy Program in 1948, and cooperated with the Adult Education Department to provide training to patients in areas such as bookkeeping, typing, radio repair and watch-making. This program was later expanded to include a loan fund to allow ex-patients to purchase tools and equipment. Training programs for patients grew to include programs at vocational and technical schools. From 1950-1970, approximately 2,000 ex-patients from both the St. John's and Corner Brook sanatoria received training that allowed them to pursue jobs and careers.

TB associations and sanatoria also helped patients start businesses. The Newfoundland Tuberculosis Association, for example, provided money and support for sanatorium patients upon their release. One beneficiary of this program was Luke Foote from Lamaline. He had held various jobs before being admitted to the St. John's sanatorium in 1950 at the age of 24. He spent 23 months there, undergoing thoracoplasty and treatment with streptomycin. On his release, he was advised not to work for six months. But Foote had a young family to care for, and soon began his business career by opening a small convenience store in his home. In 1957 he approached the Newfoundland Tuberculosis Association for help in setting up a dry cleaning business in Fortune. Edgar House, the Association's Director, arranged for Foote and his business partner (another ex-San patient) to spend three months working in a dry cleaners in St. John's to learn the trade, and loaned the money to purchase equipment. Foote operated the business successfully until 1975, and hired many other sanatorium patients over the years.

The lengthy, drawn-out nature of tuberculosis treatment in the 20th century meant that many patients spent long periods of time undergoing treatment and recuperating in sanatoria. These treatments usually lasted from one to two years, but it was not uncommon for patients to spend five or more years in a sanatorium. Sometimes they would leave after a long period of time, apparently on the road to recovery, only to have a relapse and be readmitted for another lengthy stay.

Many of these patients were young, and it was not uncommon for a young man or woman to spend a large portion of their teens or twenties as a sanatorium patient. While support from family, friends or groups like the Newfoundland Tuberculosis Association might improve their chances of securing employment, many of these people had difficulty once they were released. Although sanatoria were the primary sites of care for TB patients throughout the 20th century, the many months spent reading, playing games, or simply taking the “rest cure” were no guarantee that the patient would be able to live a normal life once their stay at the San was done.

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