Home & Design
by Charles Bonenti


  A historic look of Saranac Lake. Photos courtesy of Historic Saranac Lake Collection.

Saranac Lake, NY—this North Country vacation destination known for hiking, fishing and skiing, was actually built upon a deadly disease. Between the 1880s and 1950s, Saranac Lake was a world center for the rest cure treatment of tuberculosis, a bacterial lung infection spread by coughing and sneezing. Symptoms were fever, fatigue and a wrenching, often bloody cough. At the time, it was a leading cause of death worldwide.

The development of streptomycin in 1944 and a later combination of drugs made TB curable and put rest treatments out of business. Yet Saranac’s medical legacy lives on in public health research and in architectural modifications that promoted outdoor living. “Cure Cottages,” as they were called, featured multiple porches, balconies and sunrooms fitted with sliding glass windows where patients on cots and hammocks could spend their days breathing fresh air.

Many can be seen today in local National Historic Register neighborhoods, among them the Highland Park Historic District, where many wealthy families lived, and the Helen Hill Historic District of more modest Queen Anne, Colonial Revival and Arts & Crafts style dwellings. There is also a scattered theme district of individual buildings that fit the criteria.

The districts were established by Historic Saranac Lake, an organization founded in 1980 by local women to spotlight the town’s history as a TB treatment center and preserve its architectural legacy. Executive Director Amy Catania told me more than 700 local homes were initially identified as Cure Cottages. That number was winnowed down and some commercial and institutional properties added to arrive at 140 eligible for listing.

National Register status does not prevent listed buildings from being demolished, but calls for a review if federal funding or licensing is involved. It also makes listed structures eligible for government grants or loans and can be a source of civic pride.

Beyond establishing historic districts, Historic Saranac Lake went on in 1998 to acquire the Saranac Laboratory, built in 1894 by tuberculosis treatment pioneer Dr. Edward Livingston Trudeau. It was restored and opened in 2009 as the Saranac Laboratory Museum, featuring exhibits on medical research, patient care and local history.

Last year, the organization purchased Dr. Trudeau’s former home and medical office in what will be a $3.9 million project to expand museum space. His 64-acre Adirondack Cottage Sanatorium site—renamed the Trudeau Sanatorium after his death in 1915—was purchased last year by a development group that envisions multiple adaptive uses to preserve its buildings.

A medical doctor and tuberculosis sufferer himself, Dr. Trudeau (the great-grandfather of “Doonesbury” comic strip creator Gary Trudeau) left New York City to stay in the Adirondacks in the prevalent belief that rest and mountain air could help him recover. As his health improved, he established a small medical practice in Saranac Lake in 1876 and eight years later opened the Adirondack Cottage Sanatorium, the first of its kind in the United States.

A gentleman who seeks a cure for TB in an Adirondack Recliner.

At its height, Saranac Lake housed up to 2,000 tuberculosis patients who paid to be treated in a variety of settings, depending on the severity of their condition and what they could afford.

Rest cure meant just that. Patients spent their days relaxing, reading, writing letters, playing board games and socializing. Time outdoors (at least eight hours a day), a nutritious diet and a positive attitude were part of the strict regimen. Some were well enough to move about, others rested on wheeled day beds called “Adirondack Recliners” that had adjustable backs and wide armrests that functioned as side tables.

Dr. Trudeau’s belief that exposure to fresh air and maximum sanitation were better achieved in small-scale, cottage-style rather than large hospital environments, led many local residents to adapt their homes to take in ailing borders and the families of patients to relocate or build second homes in Saranac Lake. As a result, the town’s population grew from 533 in 1880, to 1,582 in 1890, to a peak of more than 6,000 by 1920.

Many today wonder, Catania observed, how the community could welcome so many TB cases. The numerous health professionals in residence and very strict sanitation and disposal procedures were said to contain transmission effectively. Moreover, patient care brought needed jobs and income that sustained the local economy for decades. That economy has since shifted to tourism, but some public health research continues at the Trudeau Institute.  
TB’s stamp on the architecture of Saranac Lake extended far beyond the Adirondacks.

“Whether it was subconscious or not, that kind of architecture had a big influence on residential architecture throughout the 20th century,” Paul Whalen, a partner in Robert A.M. Stern Architects, told The New York Times in a May 24 article on ways the coronavirus pandemic may change future home design.
Among the predictions based on experiences of sheltering at home:

  • More open layouts that serve multiple purposes rather than separate rooms for dining, working or study
  • More storage space for long-term stocking of food and cleaning supplies 
  • More cross-ventilation through open windows rather than closed-circuit HVAC
  • Smart technology that eliminates touching potentially contaminated surfaces such as buttons, dials and door handles

    Such continuing adaptation illustrates how architecture is a living art form shaped by vision, the ways it’s used, and, sometimes, by disease.