Sanatoriums, a relic of the past, or not?

During the 19th century and first half of the 20th century before the appearance of antibiotics, respiratory diseases were a major cause of mortality and morbidity. In the absence of effective treatments, physicians heuristically recommended the use of sanatoriums or mountain resorts to treat respiratory illnesses. 

This practice has been often portrayed in famous books or films, such as “The Magic Mountain” from Thomas Mann, a novel set in a sanatorium in Davos, Switzerland or “The Painted Veil” by W. Somerset Maugham, another novel set in a colonial-era sanatorium in Hong Kong.  

So, what benefits were expected from recommending long stages in expensive sanatoriums? Maybe it was just the absence of anything else, or was there some practical evidence of recovery? Doctors believed pure air to have disinfection capabilities that could aid in the recovery of patients. But what were the probable reasons behind its effectiveness, other than escaping from filthy polluted industrial cities?

The Open-Air Factor approach was developed during a time when tuberculosis was widespread, and no effective treatments were available. The approach was based on the belief that the fresh air and sunlight in mountain resorts or sanatoriums could help patients recover from respiratory illnesses. Physicians believed that the clean air would help clear the lungs of disease-causing bacteria and promote healing. The Open-Air Factor was widely adopted in Europe and the United States, where many sanatoriums and mountain resorts were established to treat respiratory diseases. These institutions were often located in isolated areas, away from polluted cities, and surrounded by natural beauty. Patients would spend months or even years in these facilities, undergoing various treatments and taking advantage of the clean air and outdoor activities.

The Open-Air Factor approach was highly effective in treating respiratory diseases, especially tuberculosis. The reasons behind its effectiveness were only hinted at the time, but recent studies have shed light on the probable reasons. One theory is that the high altitude and low humidity in mountain resorts reduce the viability of bacteria and viruses, thus slowing the spread of respiratory illnesses. Additionally, the high concentration of ozone in mountain air can help to kill bacteria and viruses. Another theory is that the fresh air and sunlight provide the body with vitamin D, which is essential for a healthy immune system. Moreover, doctors also emphasized the importance of rest, healthy diet, and exercise, which are critical for maintaining good health and supporting the body’s immune system, something not much in hype at the time. Patients in sanatoriums or mountain resorts received a well-balanced diet, and their physical activities were carefully monitored to ensure that they did not overexert themselves.

During those centuries the exact Open-Air Factor chemical process was completely unknown. Although the reasons behind its effectiveness were not fully understood then, recent studies have provided some insight into the probable reasons: These studies have shown that this disinfection process is likely due to the Advanced Oxidation Process (AOP) that occurs in the atmosphere, specifically the creation of hydroxyl radicals. The AOP is a process that occurs naturally in the upper layers of the atmosphere, where hydroxyl radicals are produced by the reaction of oxygen and water vapor with sunlight. These hydroxyl radicals are highly reactive and can quickly react with and break down organic compounds, including viruses and bacteria. They are called the natural detergent. This process is believed to be responsible for the disinfection capabilities of the Open-Air Factor approach to treating respiratory diseases.

Several studies have supported this theory, including one study conducted in a tuberculosis sanatorium in Switzerland, which found that the air in the sanatorium contained a high concentration of hydroxyl radicals. Another study conducted in a hospital in Taiwan found that exposure to outdoor air significantly reduced the airborne concentration of bacteria in hospital wards.

So, really doctors were heuristically correct despite they did not know about the capabilities of the AOP occurring in the atmosphere, nor the existence of hydroxyl radicals being the ones to blame for the breakdown of viruses and bacteria in the air, thus aiding in the recovery of patients.

The Open-Air Factor approach remains an important part of the history of medicine and a reminder of the value of natural remedies in the treatment of diseases.