Western North Carolina has been long well known for its climate, luring for many years a continuous stream of sick, infirm, and hypochondriac migrants into the region. During the late nineteenth century, as the tuberculosis epidemic was at its height, it was dubbed the «Land of the Sky» and then «Switzerland of America» by renowned travel writers and newsmen, slogans that were taken up and reprinted in brochures and on billboards. Visiting physicians waxed about the salubrious effects of exposure to the area’s cool and dry «aseptic» climate, widely thought to hamper the growth of bacteria. Pseudoscientific studies on ozone levels, high-altitude barometric pressure, and the healthful aura of balsam spruce, among other things, bolstered the claims. Annual summer visitors traveling up from Florida were soon joined by flocks of winter people, consumptive and healthy alike, fleeing the cold and dark of northern cities.
Perhaps the country’s first sanatorium, The Villa, was built in Asheville around 1870. The local Veteran’s Affairs hospital began in 1930 as the country’s largest sanatorium, boasting over 1000 beds. In the early twentieth century, Western North Carolina had one of the highest concentrations of sanatoria in the United States. With the exception of the aforementioned Circle Terrace, all were segregated, and most were prohibitively expensive. These sanatoria sprang up alongside numerous in-patient preventoria, something in-between a sanatorium and summer camp, and scores of more modest boarding houses. The most famous example of the latter is Thomas Wolfe’s mother’s Old Kentucky Home in Asheville, thinly fictionalized in his novel ‹Look Homeward Angel› (1929). In it, Wolfe mourns the rapid changes to the region occurring during the first decades of the twentieth century, as Asheville (Altamont, in the book) became a health-retreat boomtown. The grim specter of tuberculosis inflects his nostalgia. Wolfe himself was terrified of the disease, referring in the novel to tubercular visitors as «lungers» and even at one point to a local doctor as a «lung shark». He himself died from advanced tuberculosis at the age of 37, after a latent infection made its way to his brain. It’s entirely possible that he contracted a virulent strain of the bacteria at his mother’s boarding house, which he visited for the last time just months before his death.
Those with expendable capital – members of the nouveau riche, titans of American industry and their descendants – were the first to embrace a return to those areas of rural America that were deemed to provide relief, medically and sensuously, from life in cities. In the late nineteenth century, enterprising capitalist Edwin Grove and railroad heir George Vanderbilt followed the same doctor to Western North Carolina, seeking the cure (though not for consumption: hiccups, in Grove’s case, and «mother’s illness», in Vanderbilt’s). Grove, the «father of modern Asheville», brought with him a fortune made from his quinine tonic, which in the 1890s, as malaria achieved its global spread, sold more bottles than Coca-Cola. Vanderbilt was an aesthete who inherited his wealth, along with his nebulous illness, from his mother. Both men, taken by the mountainous landscape and ostensibly curative climate, decided to stay. In 1889, Vanderbilt began construction on the Biltmore Estate, its centerpiece a massive chateau, listed in the record books of then and now as America’s largest home and featuring an eclectic range of architectural elements and furnishings acquired by Vanderbilt during his travels throughout Europe. Reflecting the era’s grave concern with the importance of exposure to sunlight and fresh air, Vanderbilt, in consultation with his chief architects Richard Hunt and Frederick Law Olmstead, decided to construct a long open colonnade into the western face of the structure, a direct importation from the architecture of Swiss and German sanatoria; it is one of the few structural features not in keeping with the building’s traditional French and English manorial style, and a more opulent manifestation, in pink granite, of the cure porches of area boardinghouses. A large and beautiful solarium sparkles at one end of the loggia, bronze cupid raising out of a mess of exotic ferns and flowering plants.
Grove’s hotel, a «cool room high in the old rough pile of rocks», as described in Cormac McCarthy’s novel ‹Suttree› (1979), became one of the most well-known luxury hotels in the United States. Ford, Firestone and Rockefeller were guests. So were Taft, Wilson and Roosevelt. F. Scott Fitzgerald made the inn his home for two summers in 1935 and 1936, languishing in alcohol and misery, as his wife, writer and painter Zelda, received electroshock therapy across the valley at Highland Hospital. Inspired by the naturalism of the Arts and Crafts movement and the lodge-architecture of the hulking Grand Canyon Hotel in Yellowstone, the Grove Park Inn was constructed from massive uncut boulders of native granite laid atop a concrete frame, many still covered in moss. Apart from the looming twin granite chimneys, one of which contains a still-functioning crank elevator, the most prominent feature of the inn is still its palatial Sunset Terrace, opening to a startling view of the city and the west-facing slope of Sunset mountain; much like the Biltmore loggia, the terrace was considered a necessary addition in order to allow the building, and those inside of it, to freely take in the mountain air.
These two mega-projects, both monumental examples, in their own right, of the architecture of tuberculosis, solidified Asheville’s reputation as a place to take the cure. Many of the architects and artisans imported to the area to work for Vanderbilt or Grove remained in the area after their estates were complete, influencing the form and style of much of the construction taking place during the first real estate boom, concurrent with Asheville’s rise as a treatment center for TB. The mountainous landscape provided a perfect backdrop for multiple trends in late-nineteenth and early-twentieth century architecture, including French, Tudor, and other Romantic styles, as well as the naturalistic directives of the Arts and Crafts movement. These architectural and aesthetic preferences were, during the tuberculosis epidemic and associated wellness-boom, articulated with the forceful imperatives of health and fashion: buildings should complement the mountainous setting and emphasize cleanliness, order and simplicity. Most of all, they should be open to sunlight and promote the free cycling of fresh air, i.e., they should breathe.
The mountain air promised rest and respite from a nation in the throes of industrialization and urbanization, as gilded-age writers and politicians openly celebrated the untrammeled progress of American industry, while at the same time bemoaning the rapid growth of cities and associated social problems. The climactic theory of medicine emerged at a time when such changing social conditions and urbanization led many to view life in cities with a marked pessimism. In the late nineteenth century, popular ideologies of social progress began to gradually give way to rising fears of social degeneration, and the swelling of cities and accompanying growths in industrial production provoked increasing paranoia about diseases identified with the poor, immoral and non-white (tuberculosis, syphilis, alcoholism, mental illness), which led in turn to increasingly eugenic and segregationist approaches to care.
In the 1850s, it is estimated that between seventy-five and ninety percent of the entire world’s population were infected with mycobacterium tuberculosis. In most cases the disease remained latent, buffeted by protective phalanxes of immune cells, though it would emerge in some twenty percent of all cases. By the late-nineteenth and early twentieth-century, tuberculosis was the leading cause of death in the United States, killing one out of every seven people between 1870 and 1910. It was especially bad in the cities, more or less lethal according to the neighborhood in which you lived, your income and the color of your skin. Eventually, tuberculosis was discovered to be contagious. Racial and class panics erupted throughout the country, with health departments paying cash rewards for those willing to report neighbors suspected of having TB. White families fired their black domestic workers out of fear that their children would be infected.
Consumption eventually lost a bit of its romance, but not all of it. Wealthy whites were able to escape the pressures and potential contaminants of urban life by retreating up mountains to high altitudes, clean air and mineral springs. Those who were immunocompromised through overwork, undernutrition or poor ventilation obviously had it much worse. The disparity in death rates of those with access to the climate cure – majority white and upper class – with those who suffered and died disproportionality from the disease – the non-white and lower class – were especially stark in the Jim Crow South. In the southern states, medical care was not available to most blacks, especially in smaller, more isolated towns like Asheville. But even those with privileged access to the cure died at alarming rates because the cure was often ineffective. Before the discovery of streptomycin in 1943, after which virtually all of the nation’s sanatoria were shuttered, about 1 in 5 of those who had traveled to the area for relief eventually perished from the disease.
Asheville remains today a destination for a booming wellness culture, tempting health-minded visitors with its salt caves, sensory-deprivation tanks and crystal merchants, its myriad yoga studios, acupuncture clinics and herbal schools, activated charcoal, tea-toxes and the techniques of the body. The Grove Park Inn (renamed Omni Grove Park Inn after its purchase by a luxury hotel conglomerate) now boasts of one of the region’s best spas, built into the hill sloping down beneath the famous Sunset Terrace. The Biltmore Estate draws thousands of tourists to Asheville every year with its grounds, restaurants, winery and hotel. The architecture of tuberculosis remains, however, if you look closely enough. Sanatoria became the sanitaria of another sort, or they were converted into handsome event-spaces or summer camps. Corpse-shoots and dumbwaiters are now elevators. Former boarding houses are now bed & breakfasts or lovely single-family homes, all featuring uncommonly impressive wrap-around porches. Many of Asheville’s most historic neighborhoods still have the look.