1950s: Asthma at national Jewish Hospital

Figure 1 -- National Jewish Hospital today.  You can see the Goodman bulding
on the right.  It was there, on the 7th floor, where I was a patient in 1985.
The boy's ward looked out in this direction.  On the 7th floor was where kids
12-18 lived, and on the 8th floor was home to younger kids.  I stayed
on 7 Goodman for 3 months, andthen I was a patient of 2-May for 3 months
(another building not seen here).  The treatment greatly helped me.

So by the 1880s about 1 in 4 residents of Denver were patients with lung diseases, and many of them were literally dying in the streets.  It was for this reason the Jewish community came together and donated money to open the doors of National Jewish Hospital for the Treatment of Consumptives.  

It was not the only such sanatorium in the area, nor was it the only one in the United States.  In fact, many had opened both in the U.S. and in Europe, and all had about equal success.  What made National Jewish stand out over time was it's effort in 1914 to open the first building outside of a university with the specific goal of researching a cure for a disease.  

It also became the first such institution to open a ward specifically to treat children with a disease in the 1920s.  So by the 1930s National Jewish had the capacity to take care of hundreds of tuberculosis patients of all ages, plus it was a leader in the attempt to find a better treatment and a possible cure.  

And partially through the efforts of this hospital, the number of people getting tuberculosis saw a steady decline beginning at the turn of the 20th century, and then a steep drop off after the discovery of an effective treatment in the 1940s and 1950s.  So while the goal of the hospital was to treat consumptives, consumptive patients were slowly disappearing.

When the hospital was opened in 1899 the president of the institution said, "that its doors may never close again until the terrible scourge is driven from the earth."  It probably appeared that was exactly what was going to happen.  The disease was never driven from the earth, although it's one that is readily controlled, for the most part, in modernized nations of the world, particularly in the United States and Europe.  

Yet there were other respiratory disease that continued to plague the west, and we must not forget that these patients were also welcome at National Jewish.  So as tuberculosis declined as a leading cause of death, and is now at the bottom of the yearly list, other disease saw a steady rise and deserved the attention of the world's leading lung experts, particularly those at National Jewish Hospital.  

Due the the rise of people smoking cigarettes following WWI the incidence of chronic bronchitis and emphysema was on the rise.  Likewise, with the modernization of the west, asthma was also on the rise.  These folks, mainly adults with COPD and children with asthma, needed a place where they could find help.  And that place was National Jewish.

During the 1940s various centers for asthma were opened in the United States, yet National Jewish was already an option for them.  Yet the 1940s saw a rise in the number of asthma patients at the hospital.  Many asthmatics were taken away from the stress of their home lives, with their parents and doctors that had little knowledge of the disease, and admitting them to these asthma and research centers.  (2, page 29)

During the 1960s various discoveries, such as the IgE antibody and cortisone, allowed for better methods of treating asthmatics.  Although cortisone worked to trmeat asthma, there were some pretty significant side effects to taking it long term.  So this brought about the corticosteroid inhaler, although the fear of side effects prevented physicians from using it as a daily preventative medicine.    This fear persisted until the 1980s when studies proved the benefits far outweighed the side effects.

When I was a child in the 1970s with asthma my physicians treated me only when I was symptomatic with rescue medicine like Alupent solution via a nebulizer or epinephrine or susphrine, both when I was admitted to the emergency room.  I have discharge papers telling me to use my inhaled corticosteroid inhaler (Vanceril) only until I felt better, and then to only use it when I was having trouble.

But this was the normal accepted means of treating asthmatics back then, so it wasn't that my doctors were not good doctors.  Yet the physicians at hospitals like National Jewish were participating in the research, and were privy to the latest techniques in treating the disease.  And it's for this reason kids like me with "high risk" asthma were being admitted for long-term treatment, control, and education to hospitals like National Asthma Center/ National Jewish Hospital.

So as the medical needs of society changed through the years, so to did the name of the hospital.  

• 1899 — National Jewish Hospital for Consumptives
• 1925 — National Jewish Hospital at Denver
• 1965 — National Jewish Hospital and Research Center
• 1978 — National Jewish Hospital / National Asthma Center
• 1985 — National Jewish Center for Immunology and Respiratory Medicine
• 1997 — National Jewish Medical and Research Center
• 2008 — National Jewish Health

I was a patient of the hospital in 1985, and was there when the name was changed.  That was also the year the address was changed from Kolfax Avenue to Jackson Street. I think the main reason for the name change at that time was to show that the hospital wasn't just for asthma and COPD patients.  

In 1990 it was proven that inhaled corticosteroids were safe for asthmatics, or at least the benefits outweighed the side effects.  It was also proven that all asthmatics have a certain degree of inflammation always in their lungs.  This proved that asthma was a chronic disease that should be treated on a daily basis to prevent symptoms, as opposed to treating only acute symptoms.  

By 1997 the children's wards that I lived in were closed mainly because asthma had run its course. Surely there still exists the disease, although back in 1985 regional doctors weren't privy to the latest asthma treatment and the physicians at National Jewish were.  

Today, however, partially thanks to the various asthma guidelines, and even while asthma rates continue to rise, asthma is much easier to control.  Part of the reason is better medicine, but another reason is the efforts of National Jewish Health physicians making an effort to better educate regional physicians.  

Today, under the name National Jewish Health, the hospital's doors are still open.  I would imagine COPD patients are still treated on the 2nd or 3rd floors of the Goodman Building as they were back in 1985.  Yet asthmatics are no longer living there. 

Floors like 7-Goodman, where I stayed for three months, and 2-May, where I stayed for 3 months, and 8 Goodman, where younger kids stayed, are now closed.  Replacing this type of long term treatment are very effective outpatient programs.  
Why did the hospital wards end?  Well, I would imagine homesickness and dealing with teenage boys was a major problem.  Yet I think another main reason was that physicians at National Jewish Health, along with other asthma experts, made a major initiative to educate regional doctors to focus on asthma control and prevention, as opposed to simply treating acute symptoms.  

Another major reason for the change was the initiative to create asthma guidelines in the late 1990s.  These guidelines are created by the worlds most prolific asthma physicians and experts.  The goal is to provide a guide for asthmatics all over the world, and the physicians treating them.  

So the need to use a hospital like National Jewish Health has greatly diminished for both the tuberculosis and asthmatic patient.  However, both those diseases are still present, asthma more so than tuberculosis. 

And, when needed, the hospital is still around, and still looking for better ways of treating, and, perhaps more important, curing these disease.  Plus, when needed, hospitals like National Jewish provide a way to help hardluck asthmatics gain better control of their disease, so that they can live life more like a normal person.  (3)

References:

1. Dobozin, Bruce S, Stuart H. Young, "Allergies: The complete Guide to Diagnosis, Treatment, and Daily Management," 2011
2. Bjorklund, Ruth, "Asthma," 2005, China, Marshall Cavendish Corporation0
3. In 2008 I interviewed the Public Relations Representative for National Jewish Health and she provided me with an interview where I obtained up to date information about the NJH children's asthma program.  

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