Tuberculosis and top sport in Davos: an unexpected combination
Willem Saris and Arie Berghout
Through the centuries Tuberculosis (TB) has been a disease that was feared because there was no remedy for it. In the 19th century this disease was the leading cause of death in the US; around 1900 per day 450 people died by TB. In the big cities in Europe it was similar but even in isolated villages the death rate due to TB increased from 1/6 around 1750 to 1/ 4 in 1900.
The Frenchman, Jean Antoine Villemin, showed in 1868 that TB was not hereditary but contagious.
The Frenchman, Jean Antoine Villemin, showed in 1868 that TB was not hereditary but contagious.
A German physician, Hermann Brehmer who was affected by this disease, went to the Himalayas for his studies and came back cured of TB. He wrote a thesis entitled “Tuberculosis a curable disease” and in 1854 he started in Görbersdorf a hospital for TB patients. This town was at an altitude of 650m above sea.
One of his patients, Peter Dettweiler, founded in 1877 also a hospital in Falkenberg (Germany). The idea behind this approach was the same: the patients should be exposed at high altitude to fresh air and good nutrition.
One of his patients, Peter Dettweiler, founded in 1877 also a hospital in Falkenberg (Germany). The idea behind this approach was the same: the patients should be exposed at high altitude to fresh air and good nutrition.
In 1882 the German, Robert Koch, demonstrated that the disease was caused by a bacteria that could be found in the sputum of the patients. It became also clear that the disease was spread in the population by sneezing and coughing. This resulted in the reaction that TB patients became “untouchables” in the society: Patients had to be isolated. The poor patients were locked up in Sanatoria of a rather low quality while for the middle class and upper class sanatoria were created with a lot of luxury and facilities. One of the first was founded in 1884 by Dr. Edward Livingston Trudeau, the Adirondacks Cottage Sanatorium at the Saranac Lake where he himself also was cured of this disease.
His patients had to follow a strict regime of diet and exercises. They were given three meals each day and every 4 hours a glass of milk. The patients were encouraged to spend as much time as possible outdoors, first on the veranda of the sanatorium and later walking outside in the garden. Similar sanatoria appeared close to the cities isolating the TB patients from the rest of the population to prevent contagion.
His patients had to follow a strict regime of diet and exercises. They were given three meals each day and every 4 hours a glass of milk. The patients were encouraged to spend as much time as possible outdoors, first on the veranda of the sanatorium and later walking outside in the garden. Similar sanatoria appeared close to the cities isolating the TB patients from the rest of the population to prevent contagion.
Two important findings followed in the 20th century. First of all it was determined that the TB bacteria of the animals (cows) was the same as the one that infected humans. It follows that the milk could also be a transmitter of the disease. As a consequence the milk had to be pasteurized or one had to drink only milk that came from cows without the disease. A second important development was that in 1944 the antibiotic that could cure TB was found which meant that from that moment onwards the disease could be cured easily without isolating the patients in sanatoria.
Apart from these important discoveries the morbidity and mortality due to TB declined long before the availability of antibiotics probably thanks to improveved nution and hygiene in the populations in the 20th century.
Apart from these important discoveries the morbidity and mortality due to TB declined long before the availability of antibiotics probably thanks to improveved nution and hygiene in the populations in the 20th century.
The TB treatment in Davos
Dr. Alexander Spengler had observed that in the Davos region no TB occurred but also that strong people who went down the hills for work sometimes came back with TB. They recovered quickly when they remained in the mountains. He therefore believed that the fresh air at high altitude was a very important factor. Besides that he thought that another important factor was good nutrition. When he decided that it would make sense to treat patients with TB in Davos he made a trip along different health centers in German called “Kurorte” where people were treated for different diseases. In that trip in 1862 he took notice of the procedures in the different centers and the effects of the treatments. When he developed the treatment of the TB patients in Davos he followed more or less the procedures he had seen during his voyage in the other Kurorte. The most important aspects were that the patients had to be as much as possible in the fresh air and had to do exercises and should get good food. Important was especially that they had to drink fresh milk, warm from the cow eventually enriched with cognac and Veltliner wine. Furthermore he emphasized the beneficial effect of cold showers.
Dr. Alexander Spengler had observed that in the Davos region no TB occurred but also that strong people who went down the hills for work sometimes came back with TB. They recovered quickly when they remained in the mountains. He therefore believed that the fresh air at high altitude was a very important factor. Besides that he thought that another important factor was good nutrition. When he decided that it would make sense to treat patients with TB in Davos he made a trip along different health centers in German called “Kurorte” where people were treated for different diseases. In that trip in 1862 he took notice of the procedures in the different centers and the effects of the treatments. When he developed the treatment of the TB patients in Davos he followed more or less the procedures he had seen during his voyage in the other Kurorte. The most important aspects were that the patients had to be as much as possible in the fresh air and had to do exercises and should get good food. Important was especially that they had to drink fresh milk, warm from the cow eventually enriched with cognac and Veltliner wine. Furthermore he emphasized the beneficial effect of cold showers.
The big difference with the standard Sanatorium was that the patients were free to move and could have contact within and outside the hospital with other people. In the beginning of the development of Davos as health center there were even not enough hospitals and the patients were staying with local people in their villas.
With the arrival of Dr. Turban (1889) the process changed, at least in his hospital. He obliged the patients to stay in the hospital and to lay down on the beds at the balconies and move very little. He introduced the regime of a sanatorium in his hospital and did not allow his patients to have contact outside.
With the arrival of Dr. Turban (1889) the process changed, at least in his hospital. He obliged the patients to stay in the hospital and to lay down on the beds at the balconies and move very little. He introduced the regime of a sanatorium in his hospital and did not allow his patients to have contact outside.
The visit in 1922 of the Medical doctor I.Snapper
In 1922 a famous Dutch doctor, Isidore Snapper, was invited to guide a group of 30 medical doctors from the Netherlands along the medical centers in Switzerland.
Snapper reported that he arrived by train in Davos Platz where he was welcomed by several well-known colleagues and received bouquets of flowers of the Alps. They were brought to the Kurhaus where they would stay and had a lunch. Then they visited a laboratory for control of the milk. This was important in order to prevent that the guests would get tuberculosis from the cows. After that they made a trip through the town along the different sanatoriums. Snapper mentions that it surprised the Dutch visitors that the patients were walking in the street, many were staying in hospitals but others were just staying in villas even with a bad position with respect to the sun. They were going for a drink outside the hospital and walking on the mountain paths. Several sanatoria were open institutions. The visitors were also surprised about the fact that the sanatoria were built next to the road and close together. In the Netherlands the sanatoria were built in parks with lots of trees to keep the air clean and were also closed institutions to prevent contagion.
The next stop was the famous Turban Sanatorium. In contrast with the other sanatoria dr.Turban had created a closed hospital with very strict rules.
Later there was also a contact with Professor Jessen about the complaints of the Dutch visitors. He did not see these problems. He suggested that the most important issue was the thin air for the patients and did not see the negative aspects mentioned as such important. This did not mean that in his sanatorium these negative aspects were ignored.
In 1922 a famous Dutch doctor, Isidore Snapper, was invited to guide a group of 30 medical doctors from the Netherlands along the medical centers in Switzerland.
Snapper reported that he arrived by train in Davos Platz where he was welcomed by several well-known colleagues and received bouquets of flowers of the Alps. They were brought to the Kurhaus where they would stay and had a lunch. Then they visited a laboratory for control of the milk. This was important in order to prevent that the guests would get tuberculosis from the cows. After that they made a trip through the town along the different sanatoriums. Snapper mentions that it surprised the Dutch visitors that the patients were walking in the street, many were staying in hospitals but others were just staying in villas even with a bad position with respect to the sun. They were going for a drink outside the hospital and walking on the mountain paths. Several sanatoria were open institutions. The visitors were also surprised about the fact that the sanatoria were built next to the road and close together. In the Netherlands the sanatoria were built in parks with lots of trees to keep the air clean and were also closed institutions to prevent contagion.
The next stop was the famous Turban Sanatorium. In contrast with the other sanatoria dr.Turban had created a closed hospital with very strict rules.
Later there was also a contact with Professor Jessen about the complaints of the Dutch visitors. He did not see these problems. He suggested that the most important issue was the thin air for the patients and did not see the negative aspects mentioned as such important. This did not mean that in his sanatorium these negative aspects were ignored.
TB and top sport?
As we have shown above, from 1890 till 1950 Davos was a center for TB patients. The doctors visiting Davos in 1922 were surprised that TB patients were for a large part not treated in isolated sanatoria but were free to walk in the city. In the same time period top speed skaters came 14 times to Davos for the European and World championships. In fact many skaters were visiting Davos also when there were no championships, just for training. Only during the World wars they were not going there. This is surprising if one realizes how afraid people were of TB and with reason. A nurse, Hella Fredman, who worked all her life in the hospitals in Davos suggests that likely the whole population of Davos had TB due to the contagion even though they did not know that.
When we came to Davos for the first time in 1973 this problem did not exist anymore but till 1950 the risk of getting TB should have been a serious issue.
As we have shown above, from 1890 till 1950 Davos was a center for TB patients. The doctors visiting Davos in 1922 were surprised that TB patients were for a large part not treated in isolated sanatoria but were free to walk in the city. In the same time period top speed skaters came 14 times to Davos for the European and World championships. In fact many skaters were visiting Davos also when there were no championships, just for training. Only during the World wars they were not going there. This is surprising if one realizes how afraid people were of TB and with reason. A nurse, Hella Fredman, who worked all her life in the hospitals in Davos suggests that likely the whole population of Davos had TB due to the contagion even though they did not know that.
When we came to Davos for the first time in 1973 this problem did not exist anymore but till 1950 the risk of getting TB should have been a serious issue.