Four nurses pose for smiling candid photos outdoors.

Fresh Air and the White Plague

Circulating Now welcomes guest blogger Cynthia Connolly. Dr. Connolly is Associate Professor of Nursing at the Barbara Bates Center for the Study of the History of Nursing, University of Pennsylvania School of Nursing. She is a pediatric nurse and historian. She studies the history of children’s health and social welfare policy and practice in the United States. Her book Saving Sickly Children: The Tuberculosis Preventorium in American Life (Rutgers University Press, 2008) was awarded the Lavinia Dock Award from the American Association for the History of Nursing. She provides this commentary on TB Sanitorium and Preventorium, ca. 1926.

It’s 1926. The camera is shaky and the images blurry, but we can see a forested hillside and a crop of buildings. Then more acreage, more structures. Eventually, row upon row of people sunbathing; nurses in white uniforms; fresh milk poured into tin cups; children playing and yes, even boxing. We’re looking at the South Mountain Restoration Center, a sanatorium for tuberculosis (TB) patients, but also a “preventorium” for those who did not yet have the disease but might, authorities feared, be susceptible to it.

Institutions such as South Mountain (also known by the name of the nearest town, Mont Alto) were, by the time this film was made, common across the United States. Mont Alto opened in 1907 in rural south-central Pennsylvania, where land was cheap and plentiful. It was the state’s first publicly-funded sanatorium and quickly became one of the nation’s largest. By 1926, the institution housed almost 900 patients. Sanatoria represented one component of a nationwide public health campaign aimed at addressing tuberculosis, a leading cause of ill health and death in the U.S. Popular monikers for TB, such as the White Plague or the Great Killer, signified Americans’ fears regarding the disease.

These institutions were common and mostly unremarkable, so why film the buildings, patients, and staff? Was it to record for posterity the state-of-the art treatment Mont Alto provided? Probably not, since the research laboratories, operating rooms, and other medical features of the institution were not depicted.

Children sit outside in the grass with no shirts on.In fact, though the images may appear random, it is likely that physician Harry A. Wilmer and his colleague Lois Parker had a clear vision of what they wanted to convey. They emphasize state-of-the art ideas about tuberculosis prevention, especially in children. With no cure on the horizon, most of the public health energy in this era focused on preventing the disease from taking hold. Each frame of the movie reveals an important component of the early twentieth century anti-tuberculosis campaign with its emphasis on fresh air, ample nutrition, programmed exercise, and sunlight (heliotherapy). The frames are filled as well with smiling, industrious, specially-trained nurses, many drawn from the (recovered) adult population at Mont Alto.

South Mountain administrators donated the film to the National Library of Medicine (NLM) in 1988. (The institution still operates as a long-term care facility.) Soon after, Walter Zeigler, a former patient and later, employee, narrated the film, recalling his experiences at Mont Alto and answering questions from NLM’s then-curator of historical films, Sarah Richards.  Both the 1926 silent version and the version that includes Zeigler’s 1988 recollections are available in NLM’s Digital Collections.

To read the full essay, including a discussion of contemporary economic considerations, legislation, and understandings of tuberculosis, and to see the film go to NLM’s Medical Movies on the Web, a curated portal including original research on selected films from NLM’s collection.


  1. I have often wondered why it was called the white plague or simply the white disease. I suspect it is because tuberculosis is such a chronic wasting malady that it causes anemia , hence pallor or whiteness . Do you know if this reasoning is correct ?

    1. Thanks for your question. Yes, this is exactly right. Its older names were descriptive. “Consumption” reflected the fact that people got so thin as the infection ravaged them and they appeared to be consumed by it, while “white plague” reflected the extreme pallor from the problems with air exchange in the lungs and the weight loss.

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