In an attempt to address the tuberculosis (TB) pandemic in the early 20th century, which killed an estimated 450 Americans each day, a U.S. engineer proposed a more creative solution: quarantining the sick in floating hospitals dubbed “Aerial Sanatoria.” Though the idea was technologically far-fetched at the time, it is worth reconsidering today.

Known as the White Plague for its victims’ sickly white pallor, TB, a respiratory disease, was a leading cause of death in the United States from the country’s founding to well into the 20th century. During the height of the pandemic, and especially after scientists determined in 1882 that TB was caused by a contagious pathogen and had no cure, the sick were encouraged to attend and often forced into sanatoria, medical facilities built to isolate people with long-term illness. The sanatorium movement was driven by public health officials who wanted to contain the contagion and by progressive public health reformers who sought a controlled medical research setting in which experimental cures could be administered and patient recovery monitored. According to Mayo Clinic Proceedings, the first American sanatorium, built in the Adirondacks in 1885, promoted isolation in a “salutary environment” and became a model for others to follow. By 1925, the United States had 536 sanatoria with nearly 700,000 beds — from which, according to a 2006 report published in the journal Respiratory Medicine, the majority never returned.

In the October 1920 edition of Science and Invention, Flavius Earl Loudy, a University of Michigan graduate who holds the distinction of earning the world’s very first bachelor of science degree in aeronautical engineering, described a solution that was both humane and, just as importantly, mobile. “Instead of transporting tuberculosis patients to the sanatorium, we should bring the sanatorium to the patients,” Loudy wrote in his piece, titled “An Aerial Sanitorium.” He delivered elaborate schematics and detailed descriptions of “great Zeppelins” that could be outfitted as aerial hospitals: “The patients’ cabin is located on the top of the airship so as to get as much sunshine as possible, while the airship crew… and hospitals corps” occupy lower cabins. In Loudy’s vision, “Food supplies, as well as people, are conveyed to and from the airship by means of an electric hoist in the forward car or cabin. Patients who cannot stand the trip up to the airship can be carried up by an airplane ambulance… the airplane landing on or hopping off from the giant upper deck easily.”

Loudy’s idea was meant to address both economic and medical imperatives. Most people could not afford the expense of traveling to rural sanatoria, yet doctors believed that the dry, high-altitude mountain air and sunshine improved chances of recovery. An aerial hospital solved both. While the cost and ease of transportation and the quality of medical care have advanced significantly since Loudy’s day, so has the frequency, velocity, and scale of our disasters. The need to rapidly deploy supplementary, state-of-the-art medical care — including the ability to properly quarantine — to regions of the world where existing medical infrastructure has been overwhelmed by contagion or crippled by catastrophe has never been greater.

“Instead of transporting tuberculosis patients to the sanatorium, we should bring the sanatorium to the patients.”

All this might have seemed a bit fantastical in 1920. After all, the first zeppelin flight had taken place in just 1900, and only Germany had managed to fly the airships commercially by the 1910s. Even so, zeppelin fever captivated the world. The same year Loudy published his paper, an article in Popular Science proposed outfitting airships as floating science laboratories and sending them to the poles in lieu of whaling vessels, and Scientific American ran a cover image of a zeppelin and airplane dominating New York City’s rising skyline. The famous giant airships, Graf Zeppelin (1928) and Hindenburg (1936), eventually made hundreds of transatlantic crossings and could carry as many as 100 passengers per flight. The great zeppelins only lost their appeal after the Hindenburg disaster in 1937 and the destruction of German airship facilities during World War II.

But today, airships are poised to make a significant comeback, and their technology has advanced considerably. Now, they can transport tens of thousands of tons of cargo, are incredibly fuel-efficient, and, when taking advantage of trade winds, can travel halfway across the globe in less than a week. They no longer require mooring ropes to land or remain anchored, using compressors instead. In other words, airships check off many of the boxes required to quickly deliver surge medical capacity just about anywhere in the world. Equipped as hospitals, they could offer all of the resources — staff and equipment — to extract, quarantine, and treat patients. And a fleet could deliver at scale.

Lockheed Martin is one of several companies betting big on the reemergence of airships for a range of human needs. “Lockheed Martin believes the Hybrid Airship has the potential to revolutionize remote cargo transportation as well as support the important work of humanitarian relief,” a representative told OneZero in an email. As Starre Julia Vartan reported in OneZero, the carbon efficiency of giant airships compared to conventional aircraft has attracted new entrants to the market, including Canada-based Buoyant Aircraft Systems International and France-based Varialift and Flying Whales.

The coronavirus pandemic makes clear that we need new strategies to contain contagious illnesses. Although temporary hospitals tend to have a much better track record restoring their patients to good health than 19th-century sanatoria, the infrastructure we apply to address these outbreaks remains stubbornly rudimentary — from building makeshift structures to buying motels and everything in between. In some cases, like natural disasters, where roads may be impassable or existing facilities devastated, building and buying are not even options. In an email to OneZero, the American Red Cross explained that “during Hurricane Florence, the National Guard used high water vehicles to deliver Red Cross meals and supplies, and the U.S. Army used their helicopters to transport Red Cross disaster workers into inaccessible areas to set up shelters.” As global afflictions continue to intensify, there must be better ways to respond. Remember the sorry aftermath of Hurricane Maria in Puerto Rico, when the USNS Comfort, confined to its harbor, admitted only a handful of patients while thousands perished across the island? Or, more recently, the human and animal evacuees requiring acute medical attention in the wake of Australia’s devastating fires? Perhaps the time has come to consider more radical ideas to deliver relief, even those first proposed nearly a century ago.

Airships can reach just about anywhere — even deep inland where there are no roads — and dock or hover for extended periods of time because they don’t require runways or harbors. If called on to serve a devastated community, they would be neither a permanent fixture nor a disruptive one, requiring no land to be cleared, no influx of workers, and no mountain of construction materials. What’s more, they could be equipped and designed to handle situations requiring mass quarantine and medical attention at scale. What if a fleet of aerial hospitals had been available to China from the outset?

It may have taken 100 years for Loudy’s dream to become realizable, but its time may finally be at hand. Whenever the next specter arises, and whatever form it takes — epidemic, natural catastrophe, fallout from war and conflict — instead of time-lapse videos of thousands of workers building tear-down facilities at a breakneck pace, or footage of people forcibly removed from their homes and dragged to hastily converted stadiums, perhaps those of us fortunate enough to be unaffected will watch as a fleet of hospital airships makes its way across the world with slow but steady precision to serve those most in need.