Update This post has been corrected to account for my understandable confusion between sanitarium and sanitorium, thanks to one of my commenters

A sanitorium is not an asylum. Before I went to medical school, I the word sanitorium had connotations of mental illness, wards of the state and people living in the fringes of society. Now I understand why the confusion…see comments below But a sanitorium is not an “insane asylum” as my simple pre-medical mind had thought, using only my skills of word-association.

If they still existed, I would actually enjoy a visit to a sanitorium for a getaway vacation. A sanitorium was usually a lodge located out in the countryside our in the mountains. They had lots of windows for sunlight, plenty of fresh air, screened porches, sunning areas, lots of lounge chairs…and you weren’t expected to do anything but lay in the sun and rest, breathing fresh, crystal clear mountain air, while all of your needs were taken care of. Who wouldn’t want to take a vacation at a sanitorium ? The only prerequisite is that you had to have tuburculosis, “the consumption.”…at that time the number one cause of death in the world, and the number one cause of infectious death in the united states. With the discovery of antibiotics, the need for sanitoriums went by the wayside, and many were closed, torn down, or converted for use as another type of health care facility. A great shame, isn’t it?

Most people reading this probably know of older relatives, aunts, uncles, grandparents, who died from “the consumption”. there was no cure for it, it ate away your lungs from the inside out as your body tried unsuccesfully to kill the bacterium causing the disease. For some reason, your body cannot kill TB, but instead, it forms fibrous walls around the bacteria, walling off large groups of infectious particles into small spheres, or “tubercules”, hence the name, tuberculosis. If you successfully fought off the infection, the bacterium remained dormant in your lungs until at a later date, when you were old, infermed, weak and ill, your body finally lost the lifelong battle to keep the bacterium at bay. The TB reactivated, resulting in cough, fever, chills, bloody sputum, weight loss, night sweats and evenutally, “death”…sometimes from uncontrolled bleeding into your lungs from the holes left by the lifelong battle.

Tonight I had a patient, an “elderly” man, who came to the emergency department for 3 weeks of increasing shortness of breath, and left calf pain. If you have every known someone with, or experienced yourself, these similar symptoms, you probalby can guess that he was referred to teh emergency department to evaluate for a pulmonary embolism…a potentially deadly clot in the lungs. We did the whole workup…his chest x-ray looked awful, filled with scar tissue and a lopsided diaphragm. We returned to his bedside to get additional history. “Half of my family died of TB when I was young.” he told us. “I spent several months in a sanitorium in Small City, USA”

For some reason I am fascinated by these stories. Here is an actual person, sitting in front of me who not only survived TB (remember, at that time, it was the NUMBER ONE cause of death in the world…with no reliable cure), but recovered from it while living in a sanitorium as a teenager! I wonder what that sanitarium is now, if it’s still standing? I was additionally intrigued because the sanitorium was located in the city where I grew up…I had never known that one was there.

Well, it turned out that there was NO pulmonary embolism. We had no good explation for his difficulty breathing. No evidence of heart failure, pneumonia or even an elevated white blood cell count showing non-specific evidence for infection. I would not be surprised if he is experiencing a reactivation of his tuberculosis. He still wasn’t coughing up any stuff from his lungs that we could even collect for culture, but I bet that he’ll be back, and that we’ll all be getting PPD skin tests for TB in about 6 months.

Cool, cool case!