Elsevier

Health & Place

Volume 17, Issue 1, January 2011, Pages 94-102
Health & Place

Landscape and children’s health: Old natures and new challenges for the preventorium

https://doi.org/10.1016/j.healthplace.2010.08.018Get rights and content

Abstract

Preventoria were established in the early part of the twentieth century at fresh air sites away from cities for the purposes of rest cures for children, usually for those who were at risk of contracting tuberculosis. This paper discusses preventoria in relation to their general landscapes, and outlines the types of landscapes in which preventoria are found, namely woods and forests, ocean, rivers and lakes, and agricultural settings. The preventorium movement is placed in historical landscape context, with urban planning, national parks, and other nineteenth century trends. Fresh air was the driving force of both treatment and locations of preventoria and sanatoria. Current movements in child health to combat obesity and ‘nature-deficit-disorder’ also call for greater engagement with fresh air, and stress the therapeutic value of natural landscape.

Australia’s oldest preventorium is examined as a case study of preventoria and the challenges which old preventoria are facing today to re-invent themselves in predominantly rural landscapes.

Introduction

A Preventorium is an establishment where persons who are at risk of developing infectious diseases, in particular children, receive preventive care and treatment. The word comes from the Latin praevenire – to intervene on behalf of a person, to give help and support and praeverto – to prevent, and to anticipate. Preventoria were established in the early part of the twentieth century, generally for tuberculosis prevention in children. This paper explores the concept of preventoria as therapeutic landscapes (Gesler, 1992), and discusses the oldest preventorium in Australia, in the Wheatbelt town of Kellerberrin in Western Australia, as a case study of a therapeutic landscape for children. Kellerberrin, 250 km east of the State capital of Perth, was settled in 1907 and the Kellerberrin Preventorium, also known as St. Joseph’s Preventorium, was built in 1929 on the northern edge of the town. The site is typical of preventoria, which were usually placed in rural, wooded, mountain, or seaside locations. This paper addresses the location and type of landscape in which preventoria were built, as little work has addressed the nature of these physical places.

The Kellerberrin Preventorium no longer functions as a preventorium, and it appears that many preventoria now lie empty, have been demolished, or suffered serious damage through World War II—such as the preventorium in rural Stoumont, Belgium (Dechamps, 2005), now restored. Joseph et al. (2009) discussed the ‘re-cycling’ of mental institutions in New Zealand. The issue of ‘re-cycling’ is pertinent to preventoria in rural and remote areas, as their role was often important to the life of the local rural community. However, re-cycling in often resource-poor communities can be problematic. Kellerberrin’s preventorium is hoping to re-define itself using those same landscape features of clear dry air and wide spaces that inspired a preventorium to be built at this place last century. Issues for re-cycling using the nature of the landscape appear to be universal but remain largely undescribed.

Section snippets

Tuberculosis and the landscape seen to be required for health

Tuberculosis, often referred to as consumption or ‘white death’, was a major cause of death in the nineteenth century and was responsible for about half of all deaths due to disease in the Western World prior to the 1940s (Daniels et al., 1948). Tuberculosis was associated with poor levels of hygiene and living in close proximity, with intra-familial spread common (Wunderly, 1950), and thus was associated with urban living. Tuberculosis was “considered latent in thousands of children in every

The preventoria

Despite their popularity in the northern hemisphere, only two preventoria were ever built in Australia, perhaps reflecting Australia’s smaller population and less crowded cities. Neither was for tuberculosis patients. Kellerberrin’s Preventorium was the first, and was opened on November 17, 1929, for “delicate” children (Eastern Recorder, 22/11/1932, p. 5). Stewart House Preventorium, at Curl Curl, one of Sydney’s northern beach suburbs, was opened in 1931. The Sydney preventorium was founded

The significance of landscape in the site of the preventorium

Preventoria were built in landscapes seen to be fundamentally opposite to the dense urban conditions believed to encourage the spread of tuberculosis. All preventoria had access to natural landscape features, and many had a large acreage. Landscape was the basis of the preventorium and sanatorium movement. However, no studies have specifically addressed preventoria landscapes, and work on sanatoria and other hospital types have been driven by architectural discourse (e.g. Campbell, 2005, Adams,

Architecture assisting the landscape

Fresh air was the basis of the therapeutic nature of the preventorium and thus landscape, not architectural form, is the basis of the success of preventoria as an idea of child health. Dunglison (1844, pp. 14–22) noted the importance of the “density” of the air, and the improvement in nutrition power in the country (p. 125), while Sir James Clark recommended “to change … the deteriorating air of London, for the more pure and invigorating air of the country” (Clark, 1841, p. 3). Architectural

The significance of landscape to the Kellerberrin Preventorium

The preventorium at Kellerberrin has all of the elements of a restorative and preventive landscape. Kellerberrin, with its hot Mediterranean summers and cool winters, provided dry air seen as therapeutic. There are more than 8 h of sunshine per day as an annual average (Commonwealth of Australia, 2005), and 6 h per day in the winter months. Summers are very hot, with very dry air, with humidity between 20% and 30% in summer and 50–60% in winter. There are high annual levels of solar exposure,

The history of the Kellerberrin Preventorium

As in the first preventorium in the USA, the preventorium at Kellerberrin grew out of the philanthropy of one person, Mr. Stuart Patterson, a successful farmer and businessman who had originally come from New South Wales to settle in Kellerberrin in about 1905. Patterson “quickly built a handsome two-storey hotel, opened up a general store, purchased twelve building lots in the town and farmed on a number of blocks nearby” (Spence, 2001). Patterson and his wife had visited the USA where they

Inside the Kellerberrin Preventorium

While this discussion does not concern itself with the history of the design of preventoria, or how it arose, some comments will be made of its general form. The plan of the Kellerberrin Preventorium (Fig. 2) follows the pattern of existing preventoria overseas, with wings of accommodation for boys and girls around a central administrative and communal area, with dining room, a classroom, and external verandahs for fresh air and sun. The preventorium at Kellerberrin consists of a group of

The future: re-using and re-imagining the preventorium

New uses are being put forward for old sanatoria and preventoria. Stewart House in Sydney changed its name from that of a preventorium in 2009; it is now a company limited by guarantee with a formalised memorandum of understanding with the New South Wales (NSW) Department of Health and the NSW Department of Education and Training. It continues to provide health care, assessment, and short-term respite for children aged between 6 and 16 years who are in need of medical and preventative rest and

All that is old is new again

Increasingly, in a world concerned with rising urbanism and its stresses, old preventoria in rural, mountain, and seaside locations appear to be using the therapeutic nature of their landscapes as selling points for modern ideas related to landscape and health. For example, former preventoria in Russia are now catering for ‘stress’ associated with modern living, where modern ideas of stress relief are based on ideas of recuperative care and the psychological healing values of closeness to

Acknowledgments

I thank Pauline and James Scott of The Preventorium, Kellerberrin, for their excellent hospitality, Dr. Cindy Connolly of the School of Nursing, Yale University, for information about preventoria in the USA, Sister Joan Luff of the Archives of the Sisters of St. Joseph of the Sacred Heart, Mary MacKillop House, South Perth, and permission by the Sisters for the copying of Fig. 3. I also thank Marc Doigny of the Preventorium marin de Clemskerke-sur-mer in Belgium for information about that

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