Ōtautahi/Christchurch
Ōtautahi/Christchurch and the wider area have a long history of Māori occupation. The vast network of wetlands and plains of Kā Pakihi Whakatekateka o Waitaha/Canterbury Plains is inherently important to Ngāi Tahu. A major waterway running through Ōtautahi is the Ōpāwaho (Heathcote River). Kā Huru Manu (Ngāi Tahu Cultural Atlas) summarises information about the river as follows:
Ōpāwaho (Heathcote River) is a spring-fed river that meanders its way through Christchurch into Te Ihutai (the Avon-Heathcote Estuary). The modern-day suburb of Opawa takes its name from Ōpāwaho. More specifically, Ōpāwaho was a pā on the river banks between what is now Judge Street and Vincent Place in Christchurch that was also used as a resting place for Ngāi Tahu travelling between Kaiapoi and Horomaka/Te Pātaka-a-Rākaihautū (Banks Peninsula). The river was part of the interconnected network of ara tawhito (traditional travel routes) that crossed the once-widespread wetland system of greater Christchurch. The river, and its immediate area, was an important kāinga mahinga kai (food-gathering place) where native fish such as tuna (eels), inaka (whitebait), mata (juvenile whitebait), kōkopu (native trout), koukoupara (giant kōkopu), and kanakana (lampreys) were gathered. Ducks such as pārera (grey duck), pūtakitaki (paradise duck), raipo (New Zealand scaup), tataa (brown duck), and pāteke (brown teal) were also harvested from the river. Taura, pora (‘Māori turnip’), tutu, and aruhe (bracken fernroot) were all gathered from the river banks.
Ōpāwaho meanders around the base of Ngā Kohatu Whakarakaraka o Tamatea Pōkai Whenua (Port Hills). The Huntsbury spur was one of the routes taken by Māori when crossing between the Port Hills and the plains.
From 1849-1850 the Canterbury Association oversaw the systematic European settlement of Canterbury and surveyed the town of Christchurch and rural sections outside of the town boundary. Much of the city was built on a wetland site. Despite it being an important mahinga kai area for Ngāi Tāhu, the Pākehā settlers’ poor habits of discarding waste directly onto the land and waterways meant that, by the 1870s, Christchurch had gained a reputation as New Zealand’s unhealthiest town or city. Hospitals were established but they were far less important than public health measures in improving the health of residents and managing contagious diseases such as bubonic plague, influenza and tuberculosis.
Tuberculosis
Tuberculosis (TB) is a contagious, infectious disease, due to Mycobacterium tuberculosis (MT) that has been a permanent challenge over the course of human history. Tuberculosis of the lungs – pulmonary tuberculosis, commonly known as TB – is the bacterial destruction of lung tissue. Bacteria is transmitted from person to person via droplets and in the form of coughing. Patients were described as ‘consumptive’, as it was considered that the body was somehow consuming itself, and for a long time there was no actual cure for tuberculosis. In the eighteenth century, the infectious origin of tuberculosis was conjectured by English physician Benjamin Marten, and the first successful treatments were introduced in the form of sanatorium care. Treatment sought to arrest lung destruction through rest and exposure to sunlight and fresh air.
In the second half of the nineteenth century, dedicated tuberculosis sanatoria were established, some of the earliest being in Poland (then Prussia), Germany and United States of America. They were often set up outside of cities, in natural surroundings, ideally in the dry air of an unspoilt mountain region. By the turn of the twentieth century, the Lancet opened with a series of articles espousing that sanatoria were crucial for the management of the disease and by 1904 there were 135 sanatoria in existence for this purpose.
In New Zealand, as in other parts of the world, tuberculosis was a major cause of death in the late nineteenth century. In 1903 the first dedicated open-air treatment places were set up. In mid-1903 the Department of Public Health established Te Waikato, a sanatorium near Cambridge in the North Island for the treatment of tuberculosis through fresh air, sunlight, exercise and good food. In the South Island, District Nurse Sibylla Maude established a consumptive camp in December 1903, housing and caring for patients in tents in the sand hills near New Brighton, on the outskirts of Christchurch. Although insufficient donations meant both this and her later Wainoni camp petered out after a few years, Nurse Maude’s work in this sphere was very important for raising awareness of both the tragedy of pulmonary tuberculosis and ways to care for those with it.
Cashmere Sanatorium
Following on from Nurse Maude’s good early work, in 1906 the North Canterbury Hospital and Charitable Aid Board decided to build a sanatorium for consumptive patients in the Port Hills of Christchurch. Being out of the smog and with pleasant views, the hills in Christchurch were considered to provide a healthy atmosphere for the sanatorium, and a site was donated for the purpose by the Cracroft Wilson estate. There was some resistance to the location by residents in the wider area, raising concerns about potential health risks or the impact of property values. Nevertheless, planning continued. The architectural partnership of Samuel Hurst Seager, Cecil Wood and Joseph Munnings was engaged to draw up sketch plans and by June 1906 they were advertising for ‘tenders for road formation and excavating on the Cashmere Hills for the Consumption Sanatorium Committee’. Around mid-1906, Seager also designed a specimen shelter for Nurse Maude’s camp, with the view that it inform the medical members of the Cashmere Sanatorium plans committee.
A ceremonial laying of the foundation stone of the ‘Canterbury Sanatorium for Consumptives’ by Acting Premier, William Hall-Jones, took place on 20 March 1907 but progress on building works was slow. In 1908-1909, a central brick administration and dining building was constructed, and nearby was a disinfecting laundry and morgue. Slightly further up the hill, a brick Nurses’ Home was constructed to accommodate the specialist team of nurses required to live and work at the site. The portable patient shelters were the last to be worked on. While Seager, Wood and Munnings had developed early shelter designs, the architects Collins and Harman were also involved at the site from mid-1909. Designs for open-air shelters were being prepared ‘by the North Canterbury Hospital Board Architect’ in mid-1909 and the successful tenderer for the contract was W.F. Maher. The first group of shelters was under construction in October 1909 when a severe storm badly damaged a retaining wall and the in-progress shelters were destroyed. This sparked another round of debate about the suitability of the hillside for the sanatorium. The North Canterbury Hospital Board’s architect was on the ground at the height of the storm which damaged the shelters under construction. It was clear further work was required to stabilise the shelters when re-erected.
Funds were tight and much consideration was given to economy. It took several years of fundraising efforts and a subsidy from the government before the first phase, with some patient shelters, was finally completed in early 1910. The sanatorium was reached by a half-mile (800 metres) of winding road from Ōpāwaho/Heathcote River and plains. Flat terraces were excavated for the shelters on the hillside to the north and west below the main block, and to the east towards a large gully. To stabilise the excavated clay walls, tar seal was used on the gentler slopes while the steeper walls were covered in concrete. Pine trees were planted for shelter along the boundaries and the road. Initially the plan was to have 50 ‘shelters’ – those for the men were below the plateau on the western end and those for the women were in the valley on the eastern side of the main brick buildings – and ranging in sizes to accommodate either one, two or three patients.
The first of the sanatorium’s open-air shelters were built in late 1909 and more were added in October 1910 and throughout the course of the decade. Women’s shelters were on terraces to the east of the central brick building and, separately, the men’s shelters were below the central brick building to the west. The first patients were accepted in March 1910. They housed patients with early stages of tuberculosis of the lungs in the expectation that they would benefit from the treatment of regular mild exercise, rest, ample diet and plenty of fresh air. Where possible the doors and windows were kept open and some of the huts could be rotated to catch the sun. Fresh air was a-plenty, but sometimes the winds were so strong that bedding blew from the beds and the occupants had to close their doors. Furniture was sparse and comprised an iron-framed hospital bed, locker, simple wardrobe and chair.
King George V Coronation Memorial Hospital
Whereas the open-air shelters were for patients with a degree of self-sufficiency in the earlier stages of the disease, another facility was required for those with advanced cases of tuberculosis and needing prolonged bed-rest and active nursing care. King George V Coronation Memorial Hospital (‘Coronation Hospital’), designed by architects Collins and Harman, opened further down on the hillside site in 1914 and had accommodation for 37 beds for the so-called ‘incurables’. The North Canterbury Hospital Board took over the running of the hospital before it opened, as private fundraising failed to raise the money necessary to complete the buildings and fit them out. The Coronation Hospital was a north-facing two-storeyed brick structure, with verandahs and plenty of window space for open air exposure. To the west and south-west of the hospital building were other buildings, the smaller of which was a single open-air shelter of the exact same design as many of those higher up on the sanatorium terraces. Until the late 1920s, the hospital was seen as separate from the sanatorium further up the hill and it wasn’t until 1932 that the two were fully amalgamated.
As patient numbers increased, so did the need for more nursing staff. The original brick nurses’ accommodation at the sanatorium soon proved inadequate and a new Nurses’ Home was built in 1917 a little further up the slope above the original Nurses’ Home. A long timber building with deep north-facing verandahs, the new Nurses’ Home was originally of two storeys. Another floor was added in 1924 and it was extended again in 1931.
Patients in the open-air treatment shelters were expected to look after their own shelter accommodation and walk to and from the main service areas. A regimen of regulated rest, an ample dairy-rich diet, and eventually graded exercise was a key part of the treatment as well as clinical examination, which involved measuring a patient’s temperature, body weight and phlegm. The development of chest x-rays in the 1920s improved diagnosis and assessment of progress but horizontal rest remained the mainstay for patients.
In 1932 the site of the original sanatorium was renamed Middle Sanatorium, as a reflection of further developments higher up the hill.
Military Sanatorium
Between 1914 and 1918, Cashmere Sanatorium felt the impact of World War One through staff change and difficulty in procuring medications. In November 1918, the global influenza epidemic (with the misnomer ‘Spanish flu’) also began affecting sanatorium patients and staff alike. Towards the end of the war, in 1918-1919, a new set of buildings were constructed higher up on the hillside (approximately 180 metres above sea level, 60 metres above the civilian tuberculosis institution), to cater for the large number of returned servicemen with tuberculosis. Modelled on the existing sanatorium below, it had shelters for patients below an administration and services block, and a staff hostel above.
This Military Sanatorium (‘the Soldiers San’) opened in July 1919 with shelters containing 50 beds, and this was later expanded to 100 beds. Initially administered by the Defence Department, the military sanatorium was subsequently taken over by the Hospital Board. By 1925, the demand from ex-service patients was decreasing and civilian male tuberculosis patients became the main users. In 1932, the original Military Sanatorium closed and the site was cleared.
However, World War Two saw renewed demand for the sanatorium as part of war emergency measures. Once again, returning servicemen with tuberculosis required a place for treatment and convalescence. A new complex, named the Upper Sanatorium, was built about 45 metres above the site of the earlier military sanatorium, high up on the hill. It began admitting patients in November 1942. From this time, the process of patient admission changed, with all being admitted through the Coronation Hospital then being transferred ‘up the hill’ to the Upper Sanatorium. A move then to the Middle Sanatorium signalled optimism towards discharge. The Sanatorium was exempt from wartime food rationing as good quality and quantity food was considered an essential part of the patient’s road to recovery. Later, the Upper Sanatorium became known as the Annex, as part of Coronation Hospital facilities.
Fresh Air Home for Children, and its associated Open-Air School
In 1923, a Fresh Air Home or ‘Preventorium’ for children was opened high up on the site (eastward and slightly higher than the military sanatorium). This spacious two-storeyed timber building was designed to take children whose parents had tuberculosis or who were otherwise at risk of the disease and provide them with healthy living conditions. A masonry open-air school building was opened alongside the children’s home in August 1926. As well as having balconies for open-air lessons, the roof was flat so that the children could have further lessons and exercise in the sun. Both the home and school were administered and run by the Hospital Board and provided a model for the Health Department’s homes and open-air schools. Of the 600 children who lived in the home over its 33 years, only six were diagnosed with tuberculosis.