1840-1903: Open air treatment for consumption x

Figure 1 -1899, National Jewish Hospital, TB patients treated with sunlight (4)

Around the turn of the 20th century tuberculosis was a common ailment, and a leading cause of death.  Yet it also lead to a general feeling of gloom among the populace, especially considering little was known about it and there was no cure.  Yet if you had it there was hope, thanks to places like sanatoriums and hospitals like National Jewish Hospital for Consumptives in Denver Colorado.  

In the 1840s Hermann Brehmer (1826-1889) was diagnosed with the condition and he told his doctor he might benefit from the open air of the Himalayas.  He also decided there might be benefits from isolating tuberculosis patients from the rest of the community, so he created hydrotherapy institution in Gorbesdorf, which is a village in Silesia, Germany. 

Bre

At first he had trouble convincing the medical community he was on the right track, but ultimately he became so successful that various sanatoriums opened 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. 

Many of the Jewish Community who were struck with tuberculosis were flocking to the Denver area because of it's fresh, dry, mountainous air.  Yet many of these victims were without enough money to be able to afford food or housing.

This was brought to the attention of Frances Wishbart Jacobs who worked hard to raise money to build shelter for these destitute victims of consumption.  She was able to find support from members of the Jewish Community and then to generate enough money to build an institution.  (1)

National Jewish Hospital 1892

In 1892 Jacobs died, and a year later the building was finished.  Yet the country was also mired in a recessions that year prompted by the silver crisis, and this resulted in a lack of funds to open the facility.  The building laid empty until Rabbi William S. Friedman took up a project to complete and open the institution.  (2)

The doors to the National Jewish Hospital for Consumptives opened in 1899 with the motto: "None may enter who can pay -- none can pay who enter." (1)  While it was originally built by the Jewish Community, anyone was allowed to enter who needed help.  (2)

One of the original therapies for tuberculosis patients in Denver was to receive heliotherapy, which was sunlight therapy (See figure 1).  It was believed that sunlight would help them "combat the disease."  (3)  This type of therapy, along with open air therapy altogether, was supported by Thomas Beddoes (1803-49), who performed many tests on respiratory patients, and Herrmann Brehmer (1826-89), who, as noted, opened the first sanitorium.  (3, page 37)

Figure 4 -- Open air therapy for TB patient at his home (3, page 38)

Studies were also done that showed TB patients recover faster in the winter than summer months.  In fact, "Dr. Otto Walther says he not infrequently had an inch of snow on his blankets.  At some localities tents are the only shelter, but whether the patients are housed in cottages or in tents, the free access of air must be absolute and uninterrupted. Drafts are not feared. At night the windows, which should constitute at least one side of the room or ward, are kept open; in some places the sashes are removed altogether; the sides of the tents are rolled up, except in the severest storms. In very cold weather the head and hands may be protected with woolen cap and gloves, and at all times the patients are well provided with blankets. In summer the beds or reclining chairs are moved into the open or into covered porches during the day; for the winter most places are provided with glass porches or sun parlors; where the patients spend their days in bed or reclining in steamer chair." (3, page 38)

(5, page 44)

The benefits of open air therapy as reported were: (3, page 39)

• Reduction of the fever
• Improvement of the appetite,
• Induction of sleep

As noted, "Cough and night-sweats disappear in a short time, and, as a logical consequence, the medicinal treatment is reduced to a minimum. Antipyretic drugs are never used and expectorants are rarely required. Suralimentation (the belief that consumption could be cured by forcing them to eat) is practised in many places, especially in the German resorts, where it is pushed to an almost incredible degree; even bed patients with considerable pyrexia are placed on a full diet of meat and vegetables. Trudeau and Flick * content themselves with giving their patients three full meals a day, allowing them to drink milk between meals if they have a desire for it; when, however, there is anorexia, the patient is given raw eggs beaten up with milk every two or three hours." (3, page 39)

While open air treatment was utilized "judiciously" and based on "individual cases," the therapy could also be recommended for home use as well. (See figure 4) Patients may also benefit from treatment in tents, walks or rides in the open air.  (3, page 39)

Another type of therapy was pulmonary gymnastics, or exercise.  While this was debated as an effective therapy, it was often recommended at the various sanatoriums.

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.

References:

1. Gurock, Jeffrey S., ed., "American Jewish History," 1998, New York, vol. 3, part 3, pages 1095-6
2. "The History of National Jewish," NationalJewish.org, http://www.nationaljewish.org/about/whynjh/history/
3. Tissier, Pneumotherapy
4. Photo compliments of National Jewish Health, Facebook, http://www.facebook.com/photo.php?fbid=10151140094301092&set=a.140185801091.110191.41885201091&type=1&theater, accessed on 10/20/12
5. Picture from the Journal of the Outdoor Life," National Tuberculosis Association, Volume XI, January, 1914, 10 cents an issue or $1.00 a year

1940s: Stories from National Jewish Health x

The 1940s saw a significant drop in the number of tuberculosis victims.  There must have been a fear that both National Jewish Hospital and National Home for Jewish Children would be forced to close.  However, the idea of "parentectomy" gave birth to a new clientele: asthmatic children.

What follows are three true stories sent to me from these patients.  Keep in mind names will be changed to protect the identity of the patients, although they did submit these stories and would probably love that I'm sharing them here.

National Home for Jewish Children in Denver:
National Home for Asthmatic Children:

From a patient from Huntington Beach, CA (1943-1944)

When I was 12.5 I was sent to Denver for my asthma by the Social Services of Beth Israel hospital in New York.  It happened to be in 1943, in July or August.  It was either called the national Home for Jewish Children in Denver, or the Jewish National home for Asthmatic Children in Denver.  I remember it was a large facility opposite Lake Junior high School which I attended when school started.

I came from New York with another girl named Ellie.  My name was Nina.  I was very lonesome and homesick, but I made friends and was aught up in the daily schedule of making my bed, eating in a large dining room, giving my clothes to be washed  (I think the number they gave me for the laundry was 22.)  I have used that lucky number ever since when I go to Las Vegas!

I remember Sunday School, which I had never gone to before.  Since I played piano, I found a piano teacher close by to go to for lessons.  I remember going down town with a lot of kids to see a movie.  I also remember seeing the Brown Palace hotel from a distance.  I remember trudging through high snow banks to Lake Junior high across the street.

Some of my friends were...  I believe Mr. Cohen was the Superintendent at the time.

I was there when VE Day was declared and everyone was happy.  That was the summer of 1944.  I left the next month in July to go back home

I have fond memories of the Home even though I was very homesick.  Though the years, I have been in touch with some of the kids I met there, and they are very special to me.

National Jewish Hospital:

From a wife of a patient from Tarpon Springs, FL (1943-4):   From a wife whose husband was a resident (1945-47) but is too ornery to share sentimental memories!

By the time I met and married my husband, Tim, he was an active, successful, fun-loving man with little evidence of illness.  It took months of dating before I even realized he used an inhaler.  He eventually explained what asthma was and how it had impacted his early years.  he told me how his time (nearly two years) at the National Jewish Hospital altered his life immeasurably.

He said at that Home he learned how to be "normal" and participate fully in life.  It was there that he became an outstanding athlete.  This was a gift that enhanced his life from high school, where he was a star basketball player, through adulthood, which has included years of organized softball, basketball, touch football, and vigorous racquetball along with years of coaching kid's sports.

Although he never really shared many memories of being sickly, my mother-in-law related to me the anguish of having a child so ill she sometimes thought he would never grow up.  She talked about a neighbor's asthmatic child who had died and the impact that had upon her -- the enduring sadness and fear.  She said she was told that the only chance her son had for living a normal and relatively healthy life was to send him to Denver.  She said it was a very difficult decision to make.

Living in the Bronx, New York, they were working people who couldn't afford to move, therefore sending their nine-year-old to the National Jewish Hospital was their only hope for his future.

The thought of sending her child so far away tormented her.  She said that in order to prepare her -- and Tim -- for this ordeal, they visited a psychiatrist several times who focused on the ensuing separation, (Tim has no recollection at all of seeing a psychiatrist or therapist. I surmise that he was so young, that these visits never registered as therapy sessions.)

Tim recalls leaving his mother, father and little brother and boarding a train for a very long ride to Denver.  (And returning two years later to discover a baby sister, born while he was away!)

He recalls arriving at the hospital and at some point being asked to relinquish his inhaler.  He remembers being overwhelmed by the number of inhalers in this particular room -- shelves, filled with hundreds of inhalers in all shapes, colors, and sizes.

Tim has mentioned fondly a room with a piano, the school he attended, and the wonderful times he had there, better than any other times in his life up until then!  He talks of how he learned to deal with his illness, how he was encouraged to do everything, how he was taught to handle emotions and to take care of himself in nearly every situation he would face.

As a rule, Irving speaks very little of his asthma or of his time in Denver.  He prefers to function as a healthy, ordinary man who had an ordinary childhood.

I personally thank the people at National Jewish who made it possible for me to have a healthy, active, loving, supportive husband who was the absolute best father any children could have!

From a patient from Ft. Collins, CO. (1949-51):  Remembering Mr. G., the many friends and fond memories of my time at the National Home for Jewish Children in Denver.  Hello to all:  (She lists names here).  I once had the nickname, Mousey, in those days.  I remember sneaking out at nights to Bears Stadium, swimming at Washington Park, Elitch's, and of course, Sloan's Lake and Lake Jr. High.

From a patient from Ft. Collins, CO (1941-1945):  Some o fmy memories.  I remember vividly the huge amounts of food available, having just arrived from Germany (no mat, no milk there -- mostly cabbage.)  I gained 20 or 30 pounds in the first month!

I was among the first to receive a phrenic crush with pneumoperiteum (note: phrenic crush is where a nerve supplying the diaphragm is cut off.  Pneumoperiteum is gas in the abdominal cavity.  I am not sure the connection here to asthma, although there were some questionable procedures performed to treat asthma).

I fondly remember Dr. Japha, also Dr. Rosenbloom, and Dr. Kaufman, Medical Director.

First I was in the big B'nai B'rith Building, later the Guggenheim Building, and finally, as the sort of caretaker, in the Nurses' Building on the corner of Colorado Blvd. And 14th Ave.

I remember other young patients. (She names three).

References: 

1. "Our Memories," National Jewish Medical and Research Center Patient and Resident Reunion," July 30-August 1, 1999, National Jewish Medical and Research Center, Denver, Colorado, Memories is a packet put together for former patients who visited the institution for the reunion.  Note:  I would be more than happy to send a copy of this little booklet to anyone who requests one.  

1940-1970: The decline and return of TB x

By the 1940s there were a variety of antibiotics that allowed physicians to control most cases of tuberculosis. For patients that seek medical attention and follow the prescription of their physician, tuberculosis can be controlled and even cured. By 1969 it seemed that the disease had been conquered, and attention was diverted from it.

It seems to be normal for human beings to forget that of which they do not see. When we don't have a war for a while, we tend to assume one will never occur again and we cut our military spending. When a war occurs, we usually aren't prepared. The same can be said of disease. When we go years without a plague, we assume the disease is cured. When the plague strikes, we aren't prepared. A perfect example of this is the Spanish Flu of 1918.  

There was a friend of mine who often said that we ought to have a war every ten years so we don't forget that freedom comes with a price. We should have a plague every so often so that we don't take these diseases for granted. Surely we don't want wars or plagues, but my friend had a valid point.

By the 1930s and 40s sulfa drugs and antibiotics were discovered as a means of treating infection. These and other medicines allowed physicians to effectively treat and even cure tuberculosis. This decade saw a rapid decline in the number of tuberculosis patients.  

According to Elaine Landau, in her 1995 book "Tuberculosis:"

As late as 1969, the federal government was still channeling annually more than $20 million in TB project grants to local clinics and hospitals throughout the nation. But the declining TB rate made people feel that the crisis was over. So when the government began giving blocks of aid to states and municipalities to be used at the areas' discretion, the funding generally was not expended for TB controll. 

As time passed,countless successful TB programs were dismantled. In New York City alone, more than one thousand beds formerly reserved for TB patients were eliminated from municipal hospitals. Although outpatient services were supposed to be established to ensure the disease's continued decline, these were never made available. Instead, funding was diverted to meet more immediate needs. As one physician who's treated numerous TB victims described the situation, "We knew how to cure it. We had it in our hands. But we dropped the ball. (1, page 3, 4)

Once the "ball was dropped" it was difficult to pick it up again. Organizations with the ability to provide methods of preventing the spread of such diseases, such as the Centers for Disease Control and Prevention (CDC), were not provided with enough funds to effectively perform this task. (1, page 34)

In 1989 a plan was made to provide the CDC with $30 to $34 million dollars to create a TB control plan. Yet the plan was never made "because each year that it was proposed, the White House eliminated its funding from the budget." A similar plan was proposed in 1993 to offer $484 million for TB prevention, but the budget was cut by the Clinton administration to $124 million before it was sent to Congress. So the return of a disease that once ravaged a nation was greatly ignored by Reagan, Bush and Clinton. (1, page 35)

What may have opened the eyes of the government was the AIDS epidemic that struck during the 1980s. Studies showed that with weakened immune systems, up to 50 percent of AIDS victims were developing tuberculosis, and were unable to fight it off. This is one reason tuberculosis spread through prisons and homeless shelters rather fast, particularly in cities like New York "where nearly one-fifth of prison inmates have TB, but none of the jails have separately ventilated cells for contagious cases." (1, page 35-37)

To make matters worse the TB bacteria has the ability to mutate to create drug resistant strains. This occurs when people who are given antibiotics, which are proven to cure TB if used properly, were not taking the antibiotics once they started feeling better. Effective treatment usually takes 6-9 months, but many would stop taking it within weeks.

Landau also said that "this is actually worse than not taking any medication at all, because over a period of time the illness no longer responds to any form of medication, and they have, in fact, dissipated the drug's effectiveness... Unfortunately, significant numbers of people have misused their medication this way. The tendency to do so appears to cut across racial, class, and economic lines." (1, page 39)

Studies show that up to 50 percent of TB patients do not take their medicine as prescribed, and that 14.1 percent of TB cases responded poorly to TB medicines. Studies also showed that TB resistant strains have a 50 percent mortality rate. (1, page 39-40)

References:

1. Landau, Elaine, "Tuberculosis," 1995, New York, Chicago, London, Toronto and Sydney, Franklin Watts 

1689-1970: The slow death of a killer called Consumption

By 1880 a few physicians suspected tuberculosis to be contagious, but the idea was not rock solid in the medical community.  In fact, the idea had been brought up many times, perhaps the first time as bar back as the ancient Greeks (1, page 16), and once again in 1020 by Avicenna.

Avicenna discovered the disease could spread through soil and water, and created quarantines to prevent the spread of the disease.  Yet despite this early success, progress as far as the disease tuberculosis was concerned was slow.  The disease continued to scare people until well into the 20th century.

The following are some of the major advancements that helped end the tuberculosis scare:

1. 1689 Dr. Richard Morton determined the pulmonary form was associated with tubercles in the lungs
2. 1696 Giorgio Baglivi observed the tuberculosis patients got better after a sword wound to the chest.  This was the first observation that a pneumothorax (collapsed lung) might benefit the progress of the disease and induce healing.
3. 1834:  F.H. Ramadge performed the first successful surgery where the lungs of a patient with TB were intentionally collapsed.  Ramadge did extensive research on TB, and even invented an inhaling pipe to treat the disease.
4. 1839 J.L. Schonlein, noting the tubercle, identified tuberculosis as a single disease
5. 1854 the first tuberculosis sanatorium was opened in Gorbersdorf, Germany (now in Poland) by Hermann Brehmer.
6. 1882 Robert Koch identified Mycobacterium tuberculosis.  He thought his glycerinie extract of the tubercle bacilli would be a remedy, but it wasn't.  However, it was later adapted as a test for TB.
7. In 1895 William Rontgen discovered the x-ray, and this allowed physicians to detect the disease early and monitor its progression
8. 1906 lbert Calmette and Camille Guérin in 1906 had success immunizing against a strain of tuberculosis.  They invented what they called the BCG vaccination and used it first in France.
9. 1930s Plombage Technique was trialed to remove infected part of lung.  The part of lung was forced to collapse, and was thought to heal quicker.  Some of these patients had their chest stuffed with ping pong balls or similar objects to prevent their chest from caving in.  There actually was success between the 30s and 50s until the antibiotic was proven to be more successful
10. 1944 Streptomycin discovered as an effective treatment for tuberculosis
11. 1952 Isoniazid invented as the first effective oral drug to treat TB
12. 1967 Rifampin was another antibiotic discovered to treat the disease, it was introduced to the market in the 1970s

All of these discoveries and inventions helped with the treatment of the disease, although it was studies of tuberculosis patients at sanatoriums like National Jewish Health in Denver, Colorado, that truly helped prove the disease was spread most by places associated with poor hygiene.  

Initial studies showed a high incidence of TB among sweat shops in New York and Chicago and similar occupations where there were crowds of people in places associated with poor hygiene.  Efforts were made to educate people of important positions, and laws were passed by cities, especially the New York legislature, forcing improved hygienic practices in public work places.

Major campaigns were begun to discourage people from spitting in public places.  Hand washing was encouraged.  People were encouraged wash and bathe often.  People were educated about the disease, and this, perhaps even more so than the TB test and the vaccine that was later invented, lead to the demise of the disease.

Another significant improvement was the sanatoriums that opened up all over the United States and Europe.  These allowed for the patients to get state of the art treatment, yet it also provided an opportunity to educate them that their disease is communicable, and easily spread to others.  They were educated to not spit in handkerchiefs that sat around.  Plus these sanatoriums kept the TB patients isolated from society, and this also helped prevent the spread of the disease.

All of this helped decrease the number of tuberculosis patients, and tuberculosis deaths, yet what was the true triumph was the discovery in 1946 of the antibiotic streptomycin.  Now there was an effective cure, or at least treatment, for the disease.  Yet still, to prevent the spread, a focus must remain on good hygiene.  This effort continues to this day. 

1750-1850: Tuberculosis wreaks havoc

The industrial revolution swept across the modern from 1750-1850. New inventions improved agriculture, manufacturing, mining, transportation and technology, and this had a stunning effect on culture and economies.  The world was forever changed for the better, or so people suspected.

Yet while culture and economies improved, a vicious killer spread across this modern world.  No one knew what it was. No one knew where it came from.  No one knew what to do about it.  The killer was generally referred to as consumption, and if you got it you were probably doomed. 

Yet since people were ignorant about what it was, and what caused it, and how it was contacted, they didn't know that by getting together in poorly ventilated areas of mills and factories that they were breathing the contaminated air that was exhaled by people who had the disease.  They didn't know that the bacteria was transported through the air and was inhaled.  

They didn't know the disease was spread by sharing hanker chiefs, and by touching contaminated people.  They didn't know that the disease was prevalent before the industrial revolution, but the disease was more of a random disease that occurred here and there by chance.  Yet with the beginning of the revolution, people gathered in small, poorly ventilated areas.  People moved to cities, right into the grasp of the killer.  They did this because they wanted to create a better life for themselves and their children, and they did this not knowing they were living with a beast.  

There were a variety of names for it.  It was called scrofula (swollen lymph nodes), Pott's disease (TB of the bone, spine), the Great White plague (17th century Europe), consumption or phthisis (TB of the lung),  lupis vulgaris (TB of the skin), Mesenteric disease (TB from non-pasteurized milk), white swelling (TB of bone), and King's Evil (TB of of lymph glands). Or sometimes it's simplty referred to as "captain of the ship of death." (9)  We refer to it as tuberculosis.  

A plague swept through Europe in the 16th century, and during this time what Hippocrates referred to as phthsis was referred to as the Great White Plague.  Yet it was usually described by scientists and physicians as either phthsis or consumption and sometimes even scrofula.

During the next 200 years thousands would be killed.  Little was known about it other than it's symptoms.  Usually, a patient was diagnosed by a physician only after the patient noticed he was coughing up blood.  By this time the disease was near its later stages, and prognosis was grim.

  Franciscus dele Bo Sylvius published a book in 1679 called the Opera Medica in which he made the association between nodules in the lungs with phthisis.  Perhaps as a result, in the 17th and 18th centuries there were many references to the disease being contagious, and many warnings about those infected with it.  (3)  Yet for the most part physicians thought it was hereditary, as Hippocrates thought.

Giovanni Baptista Morgagni, an Italian anatomist who lived 1682-1771, wrote quite a bit about medicine in his later years.  He warned that the condition might be an infection and he warned against doing autopsies on anyone infected with it. (1, page 2)

TB was called white plague from 18th-19th centuries

Right around the turn of the 17th century a health edict in the Republic of Lucca in Italy warned: "Henceforth, human health should no longer be endangered by objects remaining after the death of a consumptive. The names of the deceased should be reported to the authorities, and measures taken for disinfection.”(2)

English Physician Benjamin Martin published a book in 1720 called "A New Theory of Consumption."  He wrote that the disease was caused by "wonderfully minute little creatures."  He believed these "creatures" enter the body and cause the symptoms.

Likewise, Martin believed that those in close proximity to the patient, particularly those talking to the person, should be careful.  He wrote:

"It may be therefore very likely that by an habitual lying in the same bed with a consumptive patient, constantly eating and drinking with him, or by very frequently conversing so nearly as to draw in part of the breath he emits from the lungs, a consumption may be caught by a sound person...I imagine that slightly conversing with consumptive patients is seldom or never sufficient to catch the disease."

In 1793 Dr. Matthew Ballie published a book "Morbid Anatomy of Some of the Most Important Parts of the Human Body." (?check year and book)  He provided a description of the lungs and many lung diseases.  He wrote about consumption, and was among the first to note nodules in other organs other than the lungs.

In 1689 Richard Morton (1637-1698) used the term "tubercle" to describe lesions he saw in organs of those who died of consumption.

Rene Laennec was born in 1787 and contacted tuberculosis as a young adult.  He became rapt in studying this disease during the course of his career as a physician.  He is best known for his invention of the stethoscope.  He was also the first to master its use.  He was also the first to see tubercles in lung tissue of those patients?

In 18? he published "A Treatise on Diseases of the Chest, and of Mediate Auscultation."  He
described how to use the stethoscope in assessing and diagnosing patients.  He also discussed the pathology of many disease processes, including what was used it to describe symptoms during various stages of the condition.

Laennec met his demise by the grips of tuberculosis in 1826 at the young age of 45.

Samuel George Morton  (1637-1698) was a pupil of Laennec.  In 1834 he published his own book titled "Pulmonary Consumption."  This would be the first book on the subject published in the United States. (4, page 10).  He recommended that the age old practice of bleeding patients who are coughing up blood was a "plan that has hurried thousands of patients to their graves by destroying the last remains of strength."

However, if the patient was of good strengh with a good pulse, he recommended "ten or twelve ounces of blood, taken rapidly from a large oriface, may divert the current of the circulation and relieve the pulmonary congestion."  (5, page 120).

This would work because the condition resulted in ulcers which dry and the blood becomes congested around these regions causing the ulcers to burst, and this is why these patients spit up blood.  He beleived bleeding prior to this happening would help prevent the congestion.

Other remedies may may also help "promote absorption of the congested blood" include:

• Spirits of turpentine
• Elixer of vitriole
• Common salt
• Opium
• Sugar of lead
• Rest
• Diet of gum water and farinaceous food

He likewise agreed with a Dr. Beddoes who recommended a ride in the fresh air as treatment.  Morton quotes Beddoes:

 "In haemoptysis and pulmonary hemorrhages, I never observed any bad consequence from traveling in a carriage:  on the contrary, I have known these discharges to stop on a journey, though previously they had, for many days, occurred at least once in twenty-four hours."

Johan Lukas Schönlein (1793-1864) wrote relatively little during his life.  He wrote a doctoral thesis and two papers of 1 and 3 pages respectively, although that was it. Still, despite his lack of enthusiasm for writing, it was Schönlein who introduced the terms hemophilia and tuberculosis (1839). The word "tuberculosis" was derived from "tubercle", a word introduced by Morton in 1689 to describe the characteristic lesions of consumption.

The mid 19th century was a time when many scientists and doctors were experimenting with microbes.  In 1843 Dr. Klencke became the first to cause an animal to develop the condition by innoculating a rabit with "portions of miliary and infiltrating tubercules from a man.  Klencke, after accomplilshing this result, did not continue his investigations, and they were consequently soon forgotten."  (6)

Despite all the research that had been done prior to 1865, many physians believed that each case of tuberculosis "rose spontansously in predisposed people."  (2)  Yet it was in 1865 that a French military physician named Jean Antionne Villemin proved that tuberculosis was caused by an infecting organism.

He innoculated cattle with both human tuberculosis and bovine tuberculosis. (6)  He thus proved that two diseases were of similar origin, and he proved that the disease could be transferred form a human to cattle and from cattle to rabbits.  (2)

Regardless of Villemin's work the idea that tuberculosis was a spontaneous condition was ingrained in the minds of many, and they performed many experiments trying to prove Villemin wrong.  Yet in the end Villemin's ideas won out.  Although it took a few years.

Robert Koch (1843-1910) was the next to perform many experiments on tissue from tuberculosis victims to see if he could learn more about it and come up with a cure.  He invented a staining method that allowed him to see the tubercle bacillus.  And, through "artificial cultivation," he was able to grow the bacillus.  He then proceeded to reproduce the characteristics of tuberculosis in animals.  He also identified different forms of the disease in various animals.

Today paleopathologists (scientists who study ancient diseases) are unable to identify tuberculosis by finding the bacteria because they "disappear" shortly after the victim dies.  (8)  Yet some types of the disease effect bones and joints leaving scars that can be identified.

References:

1. Norris, Charles Camblos, "Gynecological and Obstetrical Tuberculosis," 1921, New York, London
2. Koehler, Christopher W., "Consumption, the great killer," http://pubs.acs.org/subscribe/archive/mdd/v05/i02/html/02timeline.html
3. "History of TB," New Jersey Medical School, Global Tuberculosis Institute, http://www.umdnj.edu/ntbc/tbhistory.htm
4. Klebs, Arnold Carl, "Tuberculosis," 1909, New York
5. Morton, Samuel, "Pulmonary Consumption," 1834, Philadelphia
6. Flenner, Simon, , "Immunity in Tuberculosis," Annual report of the Smithonian Institution, 1907, New York, page 627 
7. "Captain of the Men of Death," Ulster Med J. 1989; 58(Suppl): 7–9.
8. Sigeris, Henry E, "A History of Medicine," volume I, "Primitive and Archaic Medicine," Second Edition, 1955, New York, Oxford University Press, page 53
9. Seth, Vimlesh, SK Kabra, Rachna Seth, "Essentials of Tuberculosis,"  Third ed., Jaypee Brothers Medical Publishing, 2006, page 3-4
10. Jones, Greta, "Ca;ptain of All These Men of Death," 2001, New York
11. Prioreschi, Plinio, "A History of Medicine," 1991, volume I, "Primitive and Ancient Medicine," Edwin Mellen Press, Chapter VII, "biblical Medicine," page 514
12. Landau, Elaine, "Tuberculosis," 1995, New York, Chicago, London, Sydney, Franklin Watts, pages 13-32

Photos:

• 1.  from  http://www.grantvillegazette.com/articles/The_White_Plague

Further reading:

• Essentials of tuberculosisi in children
• Johnson, H.A., "Consumption in the Northwestern States," The Chicago Medical Journal and Examiner, Volume 37, William M. Syford, et al, editors, 1878, pages 133-143

1847 definition: Asthma the opposite of consumption

Consumption (later known as tuberculosis) was the most common lung disease in the mid 19th century.  So one physician defined asthma by comparing it with a disease many people back then knew all too well -- consumption.

The physician was Dr. Samuel Sheldon Fitch, and he defined asthma in his book "Six lectures on the uses of the lungs."  He described it as this: (1)

"It is a disease caused by consumption or consumptive tendency in the lungs, and always arrests the progress of consumption.  It is a vastly lesser disease given in place of a greater, and instead of being a curse, is a greater blessing.  In consumption, the lungs are too small; in asthma they are too larger.  A disease like asthma may be produced by ossification of blood vessels of the heart; but in nearly all cases, it is produced by consumptive irritation of the lungs.  It often takes place suddenly, in earliest childhood, continues until between 12 and 20, then goes off and is never seen again; but the person falls victim to consumption.  Or asthma my reappear and secure the patient from consumption.  If properly treated it is a passport to old age; but when badly treated it may terminate in dropsy of the chest." (1)

Next to this description is a picture of an asthmatic rib cage and a consumptive rib cage. The asthmatic rib cage is large and expanded as thought the patient had his chest puffed out.  The consumptive rib cage is small, narrow and weak.

Thus, Fitch believed since asthma produces a larger rib cage it protects against consumption.  It's strong and mighty while consumption is weak and frail.  While both are diseases that cause discomfort, asthma is minor compared to consumption.  Asthma is temporary and goes away, and consumption is long lasting.

Yet under it all he believes consumption causes asthma in some cases, and this is good because asthma protects against the wasting effects of the underlying consumption. (1)

He wrote:

"Asthma all but always cures consumption, or what is made consumption by very bad treatment.  The asthma leaves the person, and he rapidly is overcome by the consumption that had always been on him whilst he had the asthma, and resumes it's rapid and fatal course, on asthma leaving him.  If asthma is cured without perfectly expanding the lungs, and keeping them so, the person is extremely liable to consumption."

Asthma is a blessing and masks the underlying diseases, and even protects the person from wasting or consumption. He describes a patients who had asthma, didn't take care of it not knowing he had underlying consumption, and died of consumption. (1)

"As in heart disease, woe to the person who is cured of asthma.  Without a free, and perfect, and continued expansion of the chest; as he will, in nearly all cases, sooner or later fall into consumption."

The patient must be brought up well, he proposes.  He must be exposed to outdoor occupations and he must exercise.  This is how to treat asthma and prevent it from going away so consumption doesn't show it's ugly head again, destroy him, and ultimately kill him.

So basically he's saying take care of your asthma if you have it because it's a blessing protecting you from the course of your underlying consumption.

There were other physicians who had similar beliefs about asthma and consumption.  Orville Harry Brown gives us the following quote from two physicians named Hall and Hall (further detail eludes me):  (2, page 33)

"Asthma is a spasmodic contraction of the membranous portion of the windpipe. In consumption the patient dies because there are not lungs enough to receive sufficient air for the wants of the system; that is, they cannot get enough air in; while in asthma they cannot getenough air out; hence asthma and consumption are antagonistic, the former is preventive of the latter and a consumptive is cured on the supervention of asthma."

The idea of asthma as an underlying disease, and of asthma as a blessing, is ironic to say the least.  This was not the first time in history that asthma was considered a blessing.  In Ancient Greece it was considered a blessing to have asthma.

References:

1. Fitch, Samuel Sheldon, "Six lectures on the uses of the lungs," 1847, page 69-71
2. Brown, Orville Harry, "Asthma, presenting an exposition of nonpassive expiration theory," 1917, St. Louis, C.V. Mosby Company
   
   
   

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

5000 B.C.- 1750: TB spreads across the world

The 18-year-old Egyptian prince sat on the edge of the bed.  He was fiercely coughing, often bringing up blood which he spat on the ground.  The physician stood alongside him, gently touching the young man's shoulder, chanting an incantation.

He was concerned for his good friend who's skin was drawn taught over his ribs. He seemed to be slowly wasting away.  What the physician offered was the only known remedy for such a condition 2,400 years before the Birth of Christ. Yet his remedy didn't work, and the young prince was mummified.

The bacteria (mycobacterium tuberculosis) that causes tuberculosis (TB) has been around since the beginning of time, although it has evolved during that time too.  At first it may have been a harmless little bacteria, yet it evolved and started causing tuberculosis symptoms in animals.

Then, as humans started cultivating those animals about 8,000 to 5,000 years before Christ, they became exposed to Mycobacterium Bovis, the oldest known species of what is now Mycobacterium Tuberculosis. Evidence of TB was was found by paleopathologists (scientists who study ancient diseases) on human remains dating as far back as 8,000 B.C. (9)

A disease that sounds like tuberculosis was described in writing, etched in stone in cuneiform, by the Babylonian monarch Hammurabi.  He ruled from 1948-1905 B.C.

Some believe it's mentioned in the Bible, which was written in the 1000 year period before the conquests of Alexander the Great, in 327-6 B.C., as shachepeth in Leviticus 26:16 and Deuteronomy 28:22 may be pthisis, which is pulmonary tuberculosis. (11)

Some believe the Bible referenced the condition when Moses said (Leviticus 26: 16, Deuteronomy 28: 22):

Then I will do this to you: I will bring upon you sudden terror, wasting diseases and fever that will destroy your sight and drain away your life. You will plant seed in vain, because your enemies will eat it.

A similar reference was made by Moses in another Biblical book (Deuteronomy 28:22)

"The LORD will strike you with wasting disease, with fever and inflammation, with scorching heat and drought, with blight and mildew, which will plague you until you perish."

However, its difficult to accurately interpret the diseases described in the Bible as knowledge of diseases were scant, which made it difficult to describe them.  Mostly symptoms were listed, which requires the interpreter often to assume what disease is referred to.  Likewise, some symptoms in the Bible may be exaggerated for emphasis of what might happen if a person is evil. (11)

The victims of the bacteria didn't always show symptoms right away.  Sometimes they never did.  Yet the ones who did often developed a strong, harsh cough that was often productive of blood.  They often lost weight, had chills, night sweat and became extremely fatigued.  While some lived to tell about it, most didn't.

The malady was given a name when the Hippocratic (466-377 B.C.) writers referred to it as phthisis in 460 B.C.  Phthisis means wasting away. They described phymata, or tubercles in the tissue of humans and cattle, sheep and pigs. (9)  This is neat because phthisis and pneumonia are the only two lung diseases that were not categorized under the asthma umbrella.  

Hippocrates, the great Greek physician, was the first to write about it as a medical condition, although he acknowledged it had been around for a long time.  He wrote that it was "The greatest and most dangerous disease and one that proved fatal to the greatest number." (1, page 1)

Yet the Hippocratic writers considered it to be a hereditary as opposed to a contagious disease. Aristotle considered it to be contagious, which opposed general consensus at the time.  It was once described as "captain of all these men and death." (10) 

Isocrates is often considered as the greatest rhetoricians' in Ancient Greece.  His intent was to improve the speech and writings of individuals by instilling virtues.  He was born in 436 BC, seven  years before Plato was born.  Both Isocrates and Aristotle also mentioned that phthisis was contagious.  (1) 

Galen wrote about the malady too, and he believed it was an "ulceration of the lungs, thorax or throat, accompanied by a cough, fever, and consumption of the body by pus."  He considered the treatment for the malady to be living at high altitudes, like the top of a mountain.

From about 1066 to 1485, which are considered to be the Medieval or Middle ages in Europe, the condition was referred to as King's Evil "because newly crowned kings (and queens, in England) were alleged to cure scrofula, glandular swellings in the neck associated with TB, with their touch." (2)

Fracastonius of Verona (1478-1553) was the first to use phthisis exclusively for tuberculosis of the lungs.  Franciseus Sylvius (1614-1672) observed tubercles in the lungs of people with pthsisis and is credited with coining the term tubercle.  The tubercle described by the Hippocratic writers now had a name.

After 1492 Europeans started sailing for America.  In America the disease spread too, killing many.  Some believed it was a European disease and the Europeans brought it to America.  Yet evidence of Native American remains show that the disease had made its way to America long before the Europeans. (12, page 13)

So we have a disease that was not prejudiced who it invaded, as the disease was seen all over the world. Most people on the planet had either been inflicted with it, or had seen someone suffer from one or another forms of the disease.  Little was known about it, and there was no cure.  So, for the most part, people saw it as the will of God.  If you didn't catch it, you were lucky.  If you got it, you dealt with it.  If someone you knew got it, you pitied and doted on him.  

The mummy of a 4,412 year old mummy was discovered in a tomb in Egypt.  It was a young prince, perhaps around 18-years-of age.  The mummy was diagnosed by modern experts as having tuberculosis.  This proved the disease has been around for a long, long time.  

By the 17th century the disease was so rampant that that at least one in five death certificates in the city listed consumption as the cause of death.  Yet those statistics would seem small considering what the disease would do to mankind during the following two centuries. (12, page 13)

References:

1. Norris, Charles Camblos, "Gynecological and Obstetrical Tuberculosis," 1921, New York, London
2. Koehler, Christopher W., "Consumption, the great killer," http://pubs.acs.org/subscribe/archive/mdd/v05/i02/html/02timeline.html
3. "History of TB," New Jersey Medical School, Global Tuberculosis Institute, http://www.umdnj.edu/ntbc/tbhistory.htm
4. Klebs, Arnold Carl, "Tuberculosis," 1909, New York
5. Morton, Samuel, "Pulmonary Consumption," 1834, Philadelphia
6. Flenner, Simon, , "Immunity in Tuberculosis," Annual report of the Smithonian Institution, 1907, New York, page 627 
7. "Captain of the Men of Death," Ulster Med J. 1989; 58(Suppl): 7–9.
8. Sigeris, Henry E, "A History of Medicine," volume I, "Primitive and Archaic Medicine," Second Edition, 1955, New York, Oxford University Press, page 53
9. Seth, Vimlesh, SK Kabra, Rachna Seth, "Essentials of Tuberculosis,"  Third ed., Jaypee Brothers Medical Publishing, 2006, page 3-4
10. Jones, Greta, "Ca;ptain of All These Men of Death," 2001, New York
11. Prioreschi, Plinio, "A History of Medicine," 1991, volume I, "Primitive and Ancient Medicine," Edwin Mellen Press, Chapter VII, "biblical Medicine," page 514
12. Landau, Elaine, "Tuberculosis," 1995, New York, Chicago, London, Sydney, Franklin Watts, pages 13-32

Photos:

• 1.  from  http://www.grantvillegazette.com/articles/The_White_Plague

Further reading:

• essentials of tuberculosisi in children