When Josiah Gregg and a company headed southwest on the Santa Fe trail in 1831, the young man was confined to lie prone in the bed of a Dearborn wagon. He suffered from chronic dyspepsia and tuberculosis, and western travel was prescribed for his condition. This therapy proved to be highly successful. Two weeks into the journey Gregg was riding a pony and within eight weeks he had recovered completely. When his book, Commerce of the Prairies was published in 1844, it became one of the most influential books of its time. The legend of the West as a place where health was restored became firmly embedded in America and beyond.
The healthseeker, health migrant, old lunger, or one “chasing the cure” were all names given to people who took to the road in search of healthier places. Where today when one becomes seriously ill they check into a hospital, the same could not be said of the earlier era. Finding better health was a search for a place where the person felt better. This idea of travel for health was an ancient tradition. Since the sixth century, when Greek and Roman physicians proscribed a sea voyage across the Mediterranean to North Africa for their patients with cardio-pulmonary conditions, the travel therapy remained one of the few options for invalids.
America of the 19th and early 20th centuries was a sickly place. Gastrointestinal ailments caused by bad food and bad water afflicted nearly everyone. Season fevers persisted, especially in humid, riverine locales; precisely the places where most Americans lived. The medical theory that fog and mist was miasma (bad air) persisted well into the 1900s. The major killer, however, was tuberculosis. The disease thrived in most places, especially in conditions of overcrowding, humidity and contaminated air. Mortality rates for TB ran ten to twenty percent overall, and as high as forty percent in urban areas.
Together with Josiah Gregg, two other notable personalities at the end of the century, Teddy Roosevelt and Mark Twain, expressed their own siren calls to “rough it”; that is obtain a tent to live in and pitch it in the forests, prairies and deserts of the American West. Billy Jones in his 1967 book, Healthseekers in the Southwest concluded that “the search for health was a factor second only to the desire for land in attracting permanent settlers to the Southwest; easily 20 percent of those who migrated to the region between 1870 and 1900 were hopeful invalids.” As late as 1904, the International Conference on Tuberculosis issued a declaration stating, “in the failure of any medication and therapy, travel remains the most effective method for combating the disease.”
Two schools of medical thought emerged to channel the healthseekers to certain locales. The heliotherapists, taking their lead from Swiss physician Auguste Rollier, sought places where the solar rays were superior and might be employed to kill bacteria. High mountain retreats offered in Switzerland and the U.S. Rockies competed with the low valley desert communities of southern Arizona and California. U.S. climatologists headquartered in Colorado Springs sought to match patient needs to climate conditions. Individuals in the incipient stage of disease might be directed to high altitudes where heart and lung function would be taxed with the beneficial result of white blood cell creation. Those in the acute stage were directed to low altitudes where weather conditions provided warmer days without extended periods of precipitation.
Both the heliotherapists and the climatologists took a page from the work of Dr. Edward Trudeau at his wilderness sanitarium in the Adirondack Mountains. Trudeau housed his patients in tents, affording them maximum exposure to clean, fresh air. Plenty of good food and absolute rest rounded out the therapy regimen.
Regardless of the intent of the medical practitioners, individual patients often took matters into their own hands and engaged in seasonal migration. Finding the heat of the deserts in summer as oppressive as snow in the highlands during winter, they moved about as need be, always in search of the illusive “maximum level of comfort.” In the absence of a mechanism that might cure their condition, they traveled in search of that place where they seemed to alleviate their ailments. Financial status was not a limiting factor among the minions traveling the west in search of better health. For those with financial means, an industry was rapidly growing throughout the West to compete for their dollars. Hotels, convalescent homes, sanatoria, rest camps, boarding houses; all were sprouting up in towns and villages along the railroad routes. For the indigent healthseeker shanty towns and tent cities had to make due.
This phenomenon was never more evident than in the aftermath of World War I when the federal government faced the daunting task of caring for some 300,000 veterans with a variety of conditions. Among these were victims of poison gas, survivors of the Spanish influenza who had developed secondary conditions, wounded soldiers from the war, and tuberculars. In the name of efficiency, the government concluded that regional treatment centers were the answer.
The veterans had other ideas. In the instance of the southwest regional center located at Livermore, California, some found the proximity to the Pacific Ocean’s damp and the salt air irritating. Levels of precipitation might be disagreeable along with a number of other factors. While technically assigned to the post, men took the initiative to move to more agreeable environs. Hence places like Tucson and Phoenix became inundated with gas victims and tuberculars. The search for comfort paralleled the impulse for survival.
However, not all local populations embraced the healthseekers who sought convalescence in their communities. In the early years, healthseekers that brought investment capital were welcome citizens. The legions of poor and working classes who followed were not. Healthseekers were soon ostracized by those fearful of the highly contagious diseases they carried. Denver, Colorado was an excellent example. Touting its climate as therapeutic, four tuberculosis hospitals opened in the city by the early 1890s. Within a decade, locals were incurring TB in dangerous numbers. Suddenly, the invalids were not longer as welcome. Those already in the Queen City were shunted off to isolated areas.
Some places sought to dissuade the arrival of tuberculars through quarantine or outright prohibition. States on the southern tier appealed to the Federal government to take action. They argued that they suffered an excessive financial burden in being forced to care for the large number of indigent invalids. In 1914, the Shafroth-Calloway Bill was proposed in Congress by nine Southwestern states. Among the bills provisions were the use of abandoned military reservations and other government property as tuberculosis sanitariums specifically for indigent patients. Western cities and states would receive financial aid for providing welfare to those arriving from the eastern part of the country without the assistance of their home state. Critics contended that the legislation included no provisions to prevent physicians and other welfare agencies from sending their indigent consumptives West, an argument that helped convince Congress to reject the bill.
Others took a different tact to convince invalids to remain in their home communities; they wrote reports and editorial comments that appeared in magazines and major eastern newspapers. Journalist Samuel Hopkins Adams, contributed several articles, including an influential piece that appeared in McClure’s Magazine in January 1905 in which he lambasted the western health movement, promoting instead the principal element of Dr. Trudeau’s therapy: fresh air. Adams pointed out that fresh air and building ventilation was not the sole purview of the West and argued that, “where a tent is unavailable, a roof or porch will do. . . . Climate, while it may be an aid in some cases, has much less influence on tuberculosis, except in the later stages, than is generally supposed.” Adams and others offered as an alternative to moving west; move out onto your porch. Thus was created the “porch cure.”
Writers in the West also contributed missives about migrating for health. Warner Watkins, a Phoenix physician contributed an article, “Ignorance or Malpractice,” to a 1909 issue of the Journal of the American Medical Association. Watkins blasted Eastern doctors who sent “patients of meager means with advanced cases of consumption” to Arizona. He pointed out that “each winter the Associated Charities of this city [Phoenix] is swamped with such a class of patients and the county hospital is filled with them and our potter’s field is a veritable monument to the guilt of all practitioners who are guilty of such malpractice.” Consumption was a term used to describe the withering away of the body and the difficulty in maintaining weight that was common among tuberculars. However, given the limitations of medical diagnostics of the time, consumption was also used to describe a range of respiratory ailments including lung cancer, emphysema, asthma, chronic bronchitis and sinusitis.
Journalist and historian Sharlot Hall in her article, “The Burden of the Southwest” appearing in Out West (January1908), spoke of “a strangely careless disregard of details, an iridescent illusion” created about Arizona. She wrote of an all too familiar situation for the healthseeker. “He goes out, too often, with a light pocket to a strange place, to seek work which he is not able to do for the sake of a climate about which he knows nothing.” Hall was one of the very few to point out that conditions in the west were especially difficult for females. She advised women that bringing sufficient financial resources was a must to insure a good place to live and adequate fresh food. The most likely employment available to women was of the domestic variety, which was not likely to provide the rest necessary to recovery and recuperation.
As the 1920s commenced, many western communities sought to attract other migrants, just not indigent healthseekers. Thus Western writers re-inscribed their locales. Instead of being the place of last resort when a person had one foot in the grave, the West became a site of youthful vim and vigor. Instead of going out West to regain health, one traveled there to retain good health. The new marketing approach targeted the healthy tourist, rather than the sickly immigrant. The tourist and retiree took over as the seasonal migrants. The snowbirds had arrived.
Why did the healthseeker movement last so long and, by some accounts, continues on today? Science prior to the mid-twentieth century offered only personal observation to support the travel therapy, and the individual in most cases engaged in multiple relocations. In fact, a hard science discovery inadvertently led to greater dislocation of invalids. In 1882 when German physician Robert Koch discovered the tubercle bacteria as the cause of tuberculosis, he disproved the conventional wisdom that the disease was passed through heredity. Where a family might keep a loved one who suffered the disease as “God’s will,” they were more likely to evict one who incurred the disease through moral failings. Overwhelmingly, one started down the road to health and traveled to a specific location because they read a testimonial touting the life saving aspects of that place.
And what of today? The U.S. West is still attractive as a location for retirees and seasonal migration. The climate, particularly during winter, has not changed. Some desire to live close to the Mexican border so as to access cheaper drugs, medical services, and therapies unavailable in the U.S. Some travel to places where folk remedies are more accessible (and less scrutinized). The medical industry has reached new heights in diagnostics, drug and physical therapies, new technology, and health maintenance mechanisms. At the same time, diseases like tuberculosis have mutated into drug resistant varieties, particularly among the HIV/AIDS community. The cost of conventional care is rising and some individuals are increasingly resistant to institutional and regulatory dictates. Are we merely connecting health and place in a newer, more technological fashion in the telecommunications era, or are we preparing for a return to the physically wandering healthseeker?