Tuesday, July 10, 2012

1800-1900: The birth of the TB sanatorium

La Miseria by Cristóbal Rojas (1886) depicts TB late 19th century
By the mid 19th century it was well known that if you were diagnosed with tuberculosis, there was an 80 percent chance you were going to die.  So the outlook for those infested was bleak.

To make matters worse, tuberculosis was a serious threat to society at this time, making it a well known malady and a well known killer.  People had a very pessimistic view of it, and often became submissive to it thinking it was the will of God.

From about the mid 19th century to the turn of the 20th century it was the leading cause of death.  Most every family had either a family member or knew of someone who had the disease or had died from it.

By the end of the industrialized revolution, or by the end of the 19th century, over seven million people had been inflicted by the disease, and at least 50 percent of the populace in America and Europe had been directly impacted by it.  The hardest hit areas were highly populated areas like New York and London.  At the turn of the century it was estimated that over seven million people were dying from the diease yearly.  (12, page 14)

It was a common killer yet people knew so little about it.  They had no idea that overcrowding and poor sanitation was a significant reason for it's spread.  They had little knowledge that it was spread by droplets in the air breathed.  Humid and poorly ventilated rooms created great breeding grounds for Micobacterium Tuberculosis.

Carl von Rokitansky of Vienna (1804-1878) performed many autopsies on tuberculosis victims, and studied the tissue of organs of many who survived.  He learned that of those who survived up to 90 percent had "tuberculous lesions within the normal tissue of the lung."  (1)

Hermann Brehmer (1826-1889) was diagnosed with the condition while he was a botany student in the late 1840s, and he was told my his doctor that he might benefit from the clean air of the Himalayas.  So journeyed there to study plants, and by 1854 her returned to Germany with a new mission to study medicine and ultimately learn more about consumption.

He aimed to add on to the works of Rokitansky.  He described that not all people die from the disease, that many develop "healing of the tubercles in the form of scar formation, calcification, and adhesions, before disintegration and destruction of the lung tissue with its accompanying harmful effect on the whole organism had set in," according to Hugh M. Kinghorn in his paper aptly titled "Hermann Brehmer." (1) 

He wrote a paper "Tuberculosis is a curable disease," in which he was adamant that consumption was a curable disease.  He recommended those inflicted with the condition eat well, get plenty of rest, and exercise.  He was also the first to recommend isolation of those infected both so the victims could receive the proper treatment he recommended, but also to prevent contamination of healthy people.

While he would fight his entire life to convince the medical community that his ideas and treatment for consumption were on the right track, he was the only one to have any success in treating the Great White Plague in Europe during the 19th century.

Yet it took a little luck and some hard work to get his project going.  In 1849 the eldest sister of Brehmer's first wife, Marie V. Colomb, established a hydrotherapy institution in Gorbesdorf, which is a village in Silesia, Germany.  Yet her venture failed, and Brehmer took advantage of this and set up his sanatorium to prove he was right about tuberculosis.

Originally he ran into many problems.  He initially had only a few patients, one cow, and "and a lean horse to fetch coal from a distant place and patients from the station."  Yet after a few years he started to show success, and other physicians started sending him patients. 

Because he houses were private and he was having problems with the natives, he decided to build a "kurhaus" of forty rooms, an entertainment room and several kitchens.  This project was finished in 1862, and ultimately more rooms were added so it could house 60 patients. 

His project proved so successful that soon sanatoriums were being build in mountainous areas all over Europe and the United States.  One famous one in the United States was built in Denver, Colorado in 1899 by the Jewish Community. (Post on the opening of NJH to be published on 10/7/14) (See references 5 and 6 for more information on this)

In 1895 a German by the name of Wilhelm Konrad von Roentgen discovered the x-ray that allowed doctors to see the disease in its early as well as it's late stages.  This marked the first time that the disease could be diagnosed in its early stages instead of having to wait to see the late signs.  It also allowed doctors to see the tubercles in those who had survived the disease.  It showed both active and inactive tuberculosis.

The bacillus that causes consumption was first seen by Robert Koch under the keen eye of the microscope in 1882.  Koch attempted to find a cure and at one point thought he found it, yet he ended up being wrong and was ridiculed for his mistake.  He continued his work for a while, yet later gave it up to work in other areas.  (3) Yet he was so close, and may have succeeded if he just continued a little longer.

Yet another mistake made by Koch was that he joined forced with the German Government to market what he said was a cure.  Many TB patients rushed to Germany to receive his new treatment, and over two thousand TB patients received his remedy.  Yet many of these patients got worse, and faster.  Koch later admitted his remedy was only an extract of the tubercle bacilli. (7, page 17)

In 1907 Clemons von Pirquet proved a tiny scratch of tuberculin was enough to prove a sensitivity to it.  It was from this work, and the work of Koch, that in 1907 Charles Mantoux discovered the first technique to test for tuberculosis.  It became known as the Mantoux test, or the TB test.  It was modified in the 1930s so that it was able to be mass produced, and since then the test has been available.  Most people in the western world have had this little prick more than once.  (3)

However, by the end of the 19th century and the early 20th century sanatoriums for tuberculosis victims were popping up all over the place.

In 1900 tuberculosis was the leading killer in the United States, yet soon thereafter deaths from TB started to decline.  Success in battling TB is often attributed to improved living conditions, reduced crowding, improved sanitation, proper nutrition and isolation.  The sanatoriums probably helped in this regard, yet they also allowed those infected to get proper treatment. (4)

Cases of Tuberculosis have consistently declined in the United States and Europe so that the disease was actually believed to be extinguished in in western societies during the 1980s.  Yet recently some cases have been reported, and these were probably cases contracted while someone was traveling abroad to a third world nation.  TB continues to be a problem in many nations, particularly where sanitation and crowding continue to be a problem.

To make sure the disease remains rare in technologically advanced nations like the U.S., Europe and Australia, most people are tested yearly for the disease.  Most hospitals, mine included, make the test mandatory.

References: 
  1. Kinghorn, Hugh M, "Hermann Brehmer," Trans Am Climatol Clin Assoc., 1921; 37: 193–210.
  2. Warren, Peter, "The Evoluiton of the Sanitorium: The First Half-Century, 1854-1904
  3. Shashidhara, A.N., K. Chaudhuri, "The Tuberculin Skin Test," The National Tuberculosis Institute, 1990, vol. 26, 1&2, March and June
  4. Vynnycky, E., PEM Fine, "Interpreting the decline of tuberculosis: the role of secular trends in effective contact," International Journal of Epidemiology, 1999; 28; 327-334
  5. Gurock, Jeffrey S., ed., "American Jewish History," 1998, New York, vol. 3, part 3, pages 1095-6
  6. "The History of National Jewish," NationalJewish.org, http://www.nationaljewish.org/about/whynjh/history/
  7. "The Captain of the Men of Death," Ulster Medical Journal, 1989, (Suppl): 7-9
  8. Landau, Elaine, "Tuberculosis," 1995, New York, Chicago, London, Sydney, Franklin Watts, pages 13-32

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