Women and the White Plague

Nurse treating bed-ridden patient at sanatoriumNurse treating bed-ridden patient at sanatorium (Photo: Library of Congress)

February is designated as “Go Red For Women” month, a time to raise awareness about heart disease in women who die of heart attacks at higher rates than men. Many people don’t know that the symptoms of heart disease are different in women and men, an ignorance that illustrates a continuing disparity between women and men in the prevention and treatment of many illnesses. But this was old news to a San Francisco physician over one hundred years ago. Dr. Philip King Brown took on one of the most frightening diseases of his time and made sure that women got the best care and treatment when they were struck down. That disease was tuberculosis, and his solution for women was the Arequipa Sanatorium.

Tuberculosis is an infectious disease that can affect any part of the body, but its pulmonary form is the most common, and most well known in popular culture; from Greta Garbo in “Camille” to Mimi in “La Bohème.” Sufferers inhale the tuberculosis bacillus, and if the body’s immune system is not strong enough, the bacilli multiply, eventually causing cavities in the lungs and destroying their ability to transmit oxygen. Sufferers cough incessantly, making them dangerously contagious. Eventually, the patient wastes away, one of the reasons the archaic word for TB was “consumption.”

From the 1880s until after World War II, the only way to beat TB was to spend time in a sanatorium. The first American sanatorium was conceived by New York physician Edward Livingston Trudeau. When he contracted TB in 1873, he went on a last tramp through the Adirondacks and was surprised to find that his health improved. He studied this phenomenon through his own illness, and the result was the Adirondack Cottage Sanitarium, built in 1884 in Saranac Lake, New York. (The traditional name for this kind of institution became “sanatorium” in later decades).

Patients stayed in bed on porches or in screened wards, and prayed that The Rest Cure would fulfill its name. Here’s how it worked: when patients were at rest, ate good food, and breathed fresh air, cells called “macrophages” would wall off the bacilli in the lungs, and within weeks or months the active phase of the disease would be halted. Once at this stage, people could live with inactive TB for decades with no serious problems. No one was “cured” of pulmonary TB, though. It could come back years later if the immune system weakened or another disease compromised a patient’s health. Then, the wall of macrophages could break open, releasing the bacilli into the body yet again. When you got TB, you were on probation for life.

By 1910 there were more than six hundred sanatoria all over the United States, of which only three or four treated women exclusively. Dr. Philip Brown wanted to change that. He had a unique upbringing, which explains his unusual concern about women’s health. Born in Napa, California in 1869, Brown was the son of Dr. Charlotte Brown, one of San Francisco’s first female surgeons. In 1872, Charlotte left her husband and three toddlers to study at the Woman’s Medical College of Pennsylvania. When she came home with her M.D. in 1874, she moved her family to San Francisco to open her practice.

Her focus was women and children, and she co-founded the city’s Children’s Hospital and nurses’ training school. She was a living example of female empowerment in an age when male doctors looked upon their female counterparts with eye-rolling resignation. Charlotte’s commitment to her profession and to women’s health deeply affected her son Philip and daughter Adelaide, both of whom became physicians. They grew up knowing that women were entitled to equality in the doctor’s office.

After the 1906 earthquake and fire in San Francisco, Dr. Philip Brown saw more women than men coming into his practice with TB. Many of them were wage-earners: shop attendants, teachers, telephone operators, office workers. Stuck inside as San Francisco’s men worked outdoors to rebuild the city, these women were easy prey for the TB bacillus. His mother’s life of service inspired Dr. Brown to open a women-only sanatorium where women could take the cure at little cost.

He was wealthy and socially connected and tapped into his circle for help. Philanthropist Henry Bothin donated some lovely wooded land in Fairfax, in Marin County. Architect John Bakewell designed a brown-shingled building with the screened porches and open wards he knew would be the most effective. Arequipa (a Peruvian word meaning “Place of Rest”) opened in September of 1911.

Dr. Brown believed in the curative powers of personal agency, and from 1912 until after World War I, patients made pottery and tile as occupational therapy. They sold their pieces in high-end stores and the money helped pay their sanatorium fees. Dr. Brown hired famed ceramists Frederick Rhead, Albert Solon, and Fred Wilde to teach clay work and run the operation. On nice days, the women decorated their pieces outside among the bay and eucalyptus trees. After the pottery closed (the prices for clay and other raw materials were too high after World War I), women could learn typing and laboratory skills if they chose. But they could also just lie in bed, follow doctors’ orders, and read. Sanatoria had many rigid rules, but following them meant going home sooner.

Medical treatments at a sanatorium were essentially the same for both men and women. But Dr. Brown knew how hard it was on families when a wife, mother, or daughter had to go away for months or years. He believed that recovering from TB was harder for women because of the cost, the pressures of leaving children with relatives, or the financial hardship because a working daughter wasn’t bringing her wages home. Arequipa was his response to an intolerable social and medical problem. Men were never admitted to his sanatorium, even when admissions were down. Dr. Brown’s vision of female care was absolute.

Cabot Brown, his son and also a physician, eventually took over as Medical Director, and Dr. Philip Brown died in 1940. When streptomycin was discovered in 1943, doctors realized they now had a drug that would kill the TB bacillus. Patients could now be treated at home, and the days of the sanatorium were numbered. Arequipa closed in 1957, leaving behind a forty-five year legacy of whole and healthy women.

The Girl Scouts acquired the property in 1960, and when the transfer was official, Corena Green, a reporter for the Marin County Independent Journal, wrote this about Arequipa’s place in history:

So 50 years later the profile of Arequipa changes but
not the heart or the intent. The early pioneers and patients
returning now surely would see only progress in the program
about to be launched at the site – a program designed to
produce happy, healthy young women, ready to take their
place in the American Scene.

In a 1910 pamphlet, in which he explained why women needed their own TB sanatorium, Dr. Brown wrote, “The opportunities that are open to women are distinctly against them, not only being conducive to the acquiring of tuberculosis, but offering a minimum of opportunity for recovery under the present conditions.”

These twin themes – disease and its unique effect on women – still pose challenges to today’s physicians. A look backward to success stories like the Arequipa Sanatorium can make solutions easier to find.

About the Author

Lynn Downey

Lynn Downey writes on topics ranging from the history of jeans, the treatment of tuberculosis in California, American art pottery, and the history and culture of Arizona dude ranch towns. She was the Levi Strauss & Co. Historian from 1989 to 2014 and her biography of Levi Strauss will be published by the University of Massachusetts Press in the fall of 2016. She is currently working on a history of the Arequipa Sanatorium through the lens of her grandmother’s experience there.

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  1. Downey writes with verve and compassion about a disease virtually forgotten today. Anti-biotics 75 years ago killed a killer. How often one reads nineteenth century letters describing continuing grief as a family member wastes away.
    As a California Civil War journalism historian, I early realized that printers seemed especially susceptible to consumption. Work in cramped, smelly, and poorly ventilated job and newspaper offices did not foster health.
    Hurrah for Dr. Brown! He used the great 1906 San Francisco calamity to observe that women, who comprised more than half of his TB patients, had less than 1 percent of the facilities in the nation to aid them. He not only observed, but he did: Arequipa Sanatorium. That Downey’s grandmother, then a young mother, thrived under Dr. Brown’s regimented care is a story worth reading. Write On! Ms. Downey.

  2. Dr Phillip King Brown was my great uncle and I’m so pleased to read your article about him. I’m doubly pleased your mother recovered under his care and without that, you might not of been here to tell this wonderful historical narrative. Many thanks to you!

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