Thursday, May 09, 2013

1930-1950: The rise of the asthmatic institution x

Figure 1 -- NJH patients receiving sunlight exposure treatment
Thanks to better care, improved diets and good hygiene, the number of tuberculosis patients declined significantly during the 1930s. National Jewish Hospital at Denver and National Home for Jewish Children in Denver continued to stay open mainly because the doors to these hospitals were open to people with other diseases besides just tuberculosis, particularly asthmatics having trouble managing their asthma at home.   (1, page 115)

In the 1940s the number of tuberculosis patients was generally higher than those with other diseases, like asthma.  However, the number of asthma patients at the institution was on the rise.  And, for the most part, the goal for people with chronic lung diseases was to seek the cool, dry climate of Colorado for improved breathing.  So both asthmatics and TB patients received open air treatment (see figure 1).

Figure 2 --Children playing on swings at the National Home
 for Jewish Children, 1936 (6)
Likewise, patients who got better were provided the "added bonus of rehabilitation, social and education programs.  The education programs were intended to equip patients, who often came from lives of poverty, to function more effectively, in the world outside of the hospital."

Now, before I get into the rise of asthma patients at these hospitals, you have to understand the common thinking about asthma in this era.  First of all, asthma was a much rarer disease at this time, so it didn't get even close to the type of limelight that a deadly disease like tuberculosis got.

During most of the 19th century the two most prominent theories about asthma were that it was a neurotic disorder that resulted in airway constriction and shortness of breath.  This theory continued to be prevalent until it was disproved in the 1940s, and even then it held sway. So for the most part, if you had asthma, it was because you were a nervous person. This wasn't the only theory, but it was among the more prominent.

Another theory that became prominent around the turn of the 20th century was that asthma was also caused by allergies.  So while asthma was a nervous disorder, it was believed many cases were associated with allergies.  Many asthmatics got allergy testing to show they had allergies, and it was determined that some unknown substance in allergens -- like dust mites -- was causing asthma.  What it was no one knew, but some asthma experts believed this might lead to a cure for asthma.

In the meantime, many parents of severe asthmatics failed to understand the need to remove their children from asthma triggers, and so their asthma never got better.  They also failed to remove their children from their neurotic triggers, so, again, their asthma never got better.  Since asthma was much more rare back then than it is today, there was no push to better educate asthmatics, parents of asthmatic children, nor their doctors.

Regardless, the main theory regarding asthma in the 1940s was that it was a nervous disorder, or, as some called it, a psychosomatic disorder. It was all in your head.  Physicians heard stories by concerned mothers that when their asthmatic child went with the guys to do guy things the wheezing started.  So the logical conclusion made by these doctors was that these children were suffering from separation anxiety.  They were having asthma because they longed for their mothers.  For this reason they needed psychological help to be cured of their asthma.

As an asthmatic myself I can kind of understand this theory.  I remember not being able to do normal things with my brothers and dad, and when I did them I was a major burden on them more so than anything else. I remember my dad driving over an hour from hunting camp just to take me back home to mom because I couldn't breathe.  So ultimately I learned it was better for me just to stay home with my mom, where I became close to her.  So now it looks to others as though I'm overly attached to my mother, and when I go hang out with the guys I have separation anxiety, and this results in asthma.

Of course I really wasn't having separation anxiety, nor were any of these other kids back in the 1940s.  The truth is when they hung out with their dads and brothers they, like me thirty or forty years later, were doing things that made them get close up with their allergens.  Dad would take us deep into the woods to cut down trees, and he'd have us kids haul and stack the wood.  He'd come home and burn the wood, creating chimney smoke.  He'd take us to hunting camp, where allergens were galore.  And then when I was back at home my asthma would miraculously get better.

There were also many experts who believed the birth of a new brother could also result in worsening asthma, and this is exactly what happened to me on January 26, 1971 when my brother David was born.  So I suppose these experts might assume my asthma was a suppressed cry for my mother, who was providing all her attention to my little brother.  My physicians may not have thought this when I was suffering from asthma, yet this was the kind of thinking that persisted in the  1940s and 1950s and 1960s, and I'm sure  -- I'm positive -residue from these theories radiated into the 1970s and 1980s. I'm certain some of it affected me when I was a patient at NJH/NAC in 1985.

At first there weren't many asthmatics at these hospitals, mainly because, as noted, asthma was pretty rare in the 1940s. However, it was around this time Dr. M. Murray Peshkin, medical director for the National home for Jewish Children, observed a trend among asthmatic children at the hospital, and he postulated a theory based on his observation that would cause a spike in asthmatic children admitted to asthma hospitals around the nation.

What he observed was there were about 10 percent of asthmatic children who never got better at home, even when he personally visited their homes to make sure they were perfectly clean and antiseptic with no trace of any known allergen.  (2) He observed that as soon as being admitted to his hospital many of these children became immediately better. He observed that 99 percent of the chidlren treated this way had 'substantial or complete relief' of symptoms, according to his own reports. (3, page 145)

He concluded the reason for this was that once admitted to the hospital those children were away from both the stress of home life and away from the allergens at their homes.  So he proposed the idea of the "Parentectomy."  This basically means that children with severe asthma non-responsive to home treatment are removed from their homes, removed from their parents, and admitted to one of the many asthma hospitals around the nation.

So plucking the asthmatic and placing them in hospitals like National Jewish for one or two years was a growing trend throughout the 1940s and 50s, according to George Travis in his 1976 book, "Chronic Illness in Children."  He described that these hospitals worked on the "assumption that severe, intractable asthma stems from the family environment, and thereby removes the child from the parents from one to two years." (4, page 170)

Travis notes that there were some "interesting studies," and I might add, very credible studies, at very credible institution like National Jewish performed that proved the psychosomatic theory of asthma.  (4, page 170)  So it was only fitting that this theory, that began almost two thousand years earlier on some accounts, continued to reign prominent in the medical community. 

So this began the rise of the asthma institution.  It also resulted in some name changes:  In 1953 National Home for Jewish Children was changed to Jewish National Home for Asthmatic Children at Denver.  In 1957 the name was changed again to Children's Asthma Research Institute & Hospital (CARIH), and in 1973 to National Asthma Center.

References:
  1. Minton, Gregg, "Breathing Space,"
  2. Wamboldt, Fredrick S. "Asthma Theory and Practice: It's Not Too Simple," April 2, 2008,
  3. Jackson, Mark, "Asthma: A Biography,"
  4. Travis, George, "Chronic Illness in Children," 1976, California, Stanford University Press
  5. "Clinical History: The Early Years," NationalJewishHealth.org, http://www.nationaljewish.org/about/whynjh/history/clinical/, accessed 11/7/12
  6. Photo from Penrose Library, http://lib-anubis.cair.du.edu/About/collections/SpecialCollections/NAC/index.cfm, accessed 11/8/12

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