When a country is in the throes of an epidemic, it’s almost instinctual for its inhabitants to retreat. They scatter, clusters of populations diffusing across the countryside, hiding in cloisters of healthy bodies and fresh air. Chaucer’s The Canterbury Tales, in fact, is told from the perspective of one such group, grasping desperately to each other’s company and well-being in the midst of the Black Plague. In other cases, it’s those suffering from illness who are assembled away from civilization, sent to live together in hoards of suffering and sickness, like the lepers who were banished to colonies on remote islands, left heedlessly to their deaths.

Asheville’s cool nights and dry air drew tuberculosis patients from across the country

In the late nineteenth century, as tuberculosis spread through America and neared the proportions of an epidemic, doctors and citizens alike took measures to avoid the hysteria that can accompany the height of such an incurable illness. As with the plagues and pestilences of the past, the population agreed on swift and strict removal of the infected as a course of action; but this time, they relied on the referral of physicians, rather than forceful expulsion, as the impetus for the exile. Physicians prescribed their patients with recuperative itineraries that included a restful atmosphere and “an abundance of clean air” far removed from the pollution and population of big cities. An environment with low humidity, cool nights, warm sunshine, and fresh air. And no environment was better defined by those parameters than western North Carolina.

For centuries, people had been fleeing to Appalachia for the healing airs and waters of the cool, quiet mountains. Native Americans had long designated the lands surrounding western North Carolina’s hot springs (around which the town of Hot Springs arose) as “neutral,” meaning ailing members of various tribes could gather there to convalesce. As early as 1795 European settlers began to realize the healing benefits of the region. And in the 1880’s, as tuberculosis began its steady rise through the ranks of Americans, physicians began sending their patients to the hills of Appalachia in hopes that the airs could heal what their hands could not.

The newly constructed railroads brought ailing Americans to Asheville en masse, forcing the city and her local community to respond, react, and adjust. The sudden migration of tuberculosis patients to the mountains didn’t just necessitate an increase in lodgings and facilities in which to house them, but a plan of action to keep the existing population healthy—and unpanicked. Local Ashevillians, as one might expect, were certainly not thrilled at the prospect of an incursion of citizens with a virulent disease; their reactions were often of alarm and trepidation. In 1912, a bulletin from the local health department required that the infected population control themselves around the healthy so as not to put them at risk. Spitting on the sidewalks was banned, and every local business was required to provide a spittoon for the ill. The fear of infection gripped the town and forced those with tuberculosis into exile.

Though the town initially rejected the influx of the ill, it eventually came to flourish under the economic advantages of the sanitariums.

But, unlike other diseases of history, those with tuberculosis were not forsaken and left to a life of suffering and solitude. Since TB was a disease that spread, regardless of status or wealth, through all classes of Americans, many of the facilities built to house them were advertised as pleasant and invigorating retreats, rather than hospices where the sickly and miserable retreated to die. Dozens (and by some estimates, well over 100) of these centers, or sanitariums, were constructed around the epicenter of Asheville. The sanitariums boasted amenities like privacy, fresh air, kindly caretakers, and a curative climate, and the afflicted flocked to them in droves. These were luxurious facilities, not sterile hospitals, where the wealthy and well-off could feel they were at a resort rather than an infirmary.

Dozens and dozens of sanitariums arose in and around Asheville, including Halthenon.

Many of these buildings still stand today, reminders of Asheville’s long history with the White Plague. In Montford, just outside downtown, a grand Victorian house still stands, now converted into apartments. The porches and balconies which enwrap the house are a testament to the structure’s former life; they were once used to provide patients with purportedly curative mountain air and sunshine.

St. Joseph’s was originally a sanitarium before becoming Asheville’s primary hospital

A larger sanitarium on Biltmore Avenue, St. Joseph’s, which would eventually morph into the site of St. Joseph’s hospital, was operated by Asheville’s Sisters of Mercy (as was the house on Montford). Included among St. Joseph’s advertised luxuries were a “fireproof” structure with steam heat and private bathrooms and sleeping porches for each of its ninety-five rooms. In the 1930’s, not long before tuberculosis began its retreat at the hands of antibiotics, the state constructed a 1,000-bed sanitarium for infected war veterans. The structure still stands, abandoned, across from the modern VA Hospital just east of Asheville.

Constructed in the 1930’s, shortly before antibiotics were introduced to the fight against TB, the state built this sanitarium for infected veterans. It now sits abandoned across the street from the modern VA Hospital (photo courtesy of Amy C. Ridenour).

At its height, tuberculosis was incurable; despite the positive affirmations of the physicians who sent them to the cool, dry air of the mountains, over 75% of patients who entered Asheville’s sanitariums in the late nineteenth and early twentieth centuries passed away within five years. In spite of the haunting statistics—and the town’s initial abnegation of its unhealthy visitors—the influx of TB patients to the area did have a positive outcome on the fate of the town. In the 1920’s, when Asheville was in the vicious grip of the Great Depression, many of the townsfolk relied on the business of the sanitariums to stay afloat. And some of the greatest icons of Asheville’s history were brought here by her curative airs: both Edwin Grove and George Vanderbilt followed the physician Dr. Westray Battle to Asheville (Grove for his hiccups, Vanderbilt for his mother’s illness). Grove and Vanderbilt each fell in love with Asheville and designed two of the grandest and most iconic edifices in the region, the Grove Park Inn and Biltmore Estate.

In 1900, tuberculosis was the second leading cause of death in the United States, second only to pneumonia. Just as local tribes had designated the lands at the crest of the mountains as neutral centuries before, so did the physicians of the era, sending the weak and ill of different cultures and background to gather in the medicinal auras of Appalachia. In Asheville they found, if not a cure, a soothing backdrop in which to spend their final days—surrounded by the soft winds, gentle rains, and soul-stirring views of the Appalachian Mountains.

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Constructed in the 1930’s, shortly before antibiotics were introduced to the fight against TB, the state built this sanitarium for infected veterans. It now sits abandoned across the street from the modern VA Hospital (photo courtesy of Amy C. Ridenour).