TUBERCULOSIS: USA: History -- Pottenger Sanatorium Monrovia institution

Jim Wigton : June 19, 2011

Pottenger Sanatorium : This Monrovia institution became world famous in the fight against tuberculosis before it closed just over 50 years ago.



Dr. Frances Pottenger very much looked the role of a nineteenth century physician, as this photo taken prior to 1900 shows. Courtesy of the Monrovia Historical Museum
By the 1880s, scientists had determined that tuberculosis was a contagious disease, and this led to the need to place those suffering from the illness in institutions where they could receive proper care.
Monrovia, with its year-round mild temperatures and dry climate, provided an ideal location to help nineteenth century sufferers of this ailment seek a cure. The story of how Monrovia became world famous as a center for the treatment of tuberculosis is largely the story of one man.
Dr. Frances Marion Pottenger was born and educated in Ohio, receiving his M.D. degree and graduating with the highest honors in his class. It was after Dr. Pottenger’s wife died of tuberculosis in 1898, three years after she developed the disease, that he decided to take up the study of TB as his life’s work.
He returned to Monrovia where he had lived when his wife had first become sick, and on December 5, 1903, he opened the Pottenger Sanitorium for Diseases of the Lungs and Throat, located in the 500-600 blocks of Charlotte Avenue (now Canyon Boulevard) and occupying 40 acres. Originally, the institution housed 11 patients but was expanded to care for 134 patients.
Dr. Pottenger lived on the grounds of the sanatorium, and in the first ten years of the sanatorium’s existence he treated over 1,500 patients. Perhaps the institution’s most famous patient was silent screen actress Mabel Normand, who died of tuberculosis at the sanatorium in 1930 at the age of 37.
Dr. Pottenger eventually became one of the leading lung specialists in Southern California, and one of the world’s leaders and pioneers in the fight against tuberculosis. Because of his commitment to his work, the Pottenger Sanatorium was one of the most famous institutions devoted to the treatment of diseases of the lungs. He believed that isolating the patient from the world outside and giving the patient fresh air with easy access to a physician provided the best chance for combating the disease.
The sanatorium was closed in 1955 when Dr. Pottenger, who was 88 years old at the time, retired. He died in 1967. For about the next 20 years, the land was leased to the Carmelite Order as a convent and retreat. Sometime in the 1970s the land was sold and became the housing development known as Canyon Crest. Today nothing remains of the sanatorium’s buildings. However, the existence of numerous postcards circulated at the time provides images of how the facility appeared.
Approximately one-third of the world’s population today is thought to be infected with mycobacterium tuberculosis, with only 5-10% of the U.S. population testing positive for TB. While most infections in humans are latent, if the disease progresses to an active state, it can kill more that 50% of its victims if not treated. But, in part, because of Dr. Pottenger’s efforts in this area, tuberculosis is not the killer it once was.
http://monrovia.patch.com/articles/the-pottenger-sanatorium

TUBERCULOSIS: History: June 18: 90 Years of Tuberculosis Vaccination

June 16, 2011 by Project Staff
National Library of MedicineJune 18, 2011, marks an important anniversary in the history of infectious disease and vaccines—on June 18, 1921, the tuberculosis vaccine was first given to a human. The vaccine, developed by French scientists Albert Calmette and Camille Guérin, was an oral preparation of Bacillus Calmette-Guérin, or BCG in shorthand. BCG is a weakened form of a tuberculosis bacterium that causes the disease in cows. Benjamin Weill-Hall (1875-1958), French pediatrician and bacteriologist, fed the vaccine to infants in Paris who were at risk for the disease in this first use of the vaccine.



Albert Calmette (1863-1933) had acquired the Mycobacterium bovis strain of tuberculosis, which had been isolated from the milk of an infected cow, in 1904. In 1908, at the Institut Pasteur in Lille, France, he and veterinarian Jean-Marie Camille Guérin (1872-1961) began attenuating M. bovis by passing it through a growth medium they had developed specifically for this purpose. Their immediate goal was to weaken the bacteria to the point where they could no longer kill a guinea pig. In the end, the researchers hoped to produce an attenuated strain of the bacillus that would safely confer immunity to an uninfected human host. It would be 13 years before they saw the fruits of their efforts.

The League of Nations endorsed the oral BCG vaccine in 1928. Intradermal (injected) BCG vaccine began to be used in 1927; this became the most common mode of delivery of the vaccine. Today, BCG vaccine is not routinely used in the United States, but is given to about 100 million children worldwide each year. The vaccine does not prevent primary tuberculosis infection (though it does protect children from certain severe forms of tuberculosis). As the World Health Organization says in its position paper on tuberculosis vaccine, “Despite its shortcomings, BCG vaccination is considered a life-saving and important part of standard TB control measures in most endemic countries.”

More than 9.4 million new cases of tuberculosis are diagnosed each year, and one in three individuals worldwide is infected. An estimated 1.7 million people died from tuberculosis in 2009. Thus the need for new, more effective TB vaccines is clear, and many groups are working toward this goal. One of the concepts being studied is a so-called prime-boost regimen, in which one vaccine is given to ready the immune system to recognize TB and another vaccine follows that stimulates the body’s memory immune cells. (This approach has been applied to HIV vaccines and resulted in encouraging results in one large-scale trial.) The Aeras Global TB Vaccine Foundation, a nonprofit organization devoted to TB prevention, is one of the leading groups in developing and testing TB vaccines.

Further Information
See the tuberculosis entries in our collected disease timeline, and read about a global TB vaccination effort in the wake of World War Two in this blog post.
Sources
Aeras Global TB Foundation. Vaccine Science: TB Vaccine. http://www.aeras.org/about-tb/vaccine-science.php
Plotkin SA, Orenstein WA, Offit PA. Vaccines, 5th ed. Philadelphia: Saunders, 2008.
World Health Organization. Vaccine Position Papers: BCG. http://www.who.int/wer/2004/en/wer7904.pdf
World Health Organization. Tuberculosis. http://www.who.int/mediacentre/factsheets/fs104/en/
http://www.historyofvaccines.org/content/blog/june-18-90-years-tuberculosis-vaccination

TUBERCULOSIS: History

After Villemin and Koch’s discovery that tuberculosis was contagious through the tubercle bacilli in sputum, The National Association for the Study and Prevention of Tuberculosis (NASPT) began their Anti-Spitting Campaign to discourage such behaviors as public spitting. The NASPT, co-founded in 1904 by over 200 of the most prominent medical men in America, was a voluntary organization formed to unify and expand the country’s regional anti-tuberculosis programs. TB was the number one cause of death in the United States during the nineteenth and early twentieth centuries and one of the most feared diseases in the world. In an effort to control this health risk, the campaign encouraged towns to outlaw spitting in the streets and on the floors of shops, theaters, taverns, or any public gathering spots. Women refused to wear long dresses into town for fear they may pick up the disease and bring it home with them. Any handkerchief or piece of belonging that was infected was burned, and spittoons were disinfected with carbolic acid and boiling water. By 1915, the NASPT involved children in the campaign, encouraging the Modern Health Crusade, which developed into the new health education system for elementary schools. [Image Source: University of Virginia]

--------------------------------------------------------------------------------


This pamphlet, distributed in 1927 by the Fascist government was part of a national campaign designed to combat tuberculosis. It begins with a quote by Mussolini, explaining that exposure to sun, fresh air, and daily exercise is necessary in order to prevent and fight the disease. The pamphlet illustrations provide information on the disease, describing it as both a “contagious” and a “social illness” rapidly spreading from one sick person to the next healthy person. The advice illustrated includes such tips as to bathe at the least once a week, try to spend most of the day in open air, and to never spit even in a handkerchief. The pamphlets continue to relay guidance on how to monitor an individual when first signs of listlessness and paleness occur. The disease is curable if treated immediately.
[Image Source: Pamphlet Collection Page 1 ]



With almost two million patients dying from tuberculosis each year, a global movement and partnership to stop the disease is necessary. That is exactly why The Stop TB Partnership was established in 2000 and now works with over 500 international organizations, countries, nongovernmental and governmental organizations, and donors to eliminate the disease. In 2001, the partnership launched the "Global Plan to Stop TB" as an effort to reduce tuberculosis prevalence by 2015 to 50% relative to the levels in 1990. Their ultimate goal is complete elimination by 2050
http://www.hopkinsglobalhealth.org/resources-old/global_health_ads/TBcampaigns.html

TUBERCULOSIS: History: Iceland

Sigurdsson S.
Laeknabladid. 2005 Jan;91(1):69-102.

Because of signs of tuberculous lesions in old skeletons it can be stated with certainty that tuberculosis has occurred in the country shortly after the settlement. From that time and up to the seventeenth century, little or nothing is known about the occurrence of the disease. A few preserved descriptions of diseases and deaths indicate that tuberculosis has existed in the country before the advent of qualified physicians in 1760. On the basis of papers and reports from the first physicians and the first tuberculosis registers the opinions is set forth that the disease has been rare up to the latter part of the nineteenth century. During the two last decades of that century the disease began to spread more rapidly and increased steadily up to the turn of the century. Although reporting of the disease was started in the last decade of the nineteenth century the reporting was first ordered by law with the passage of the first tuberculosis Act in the year 1903. With this legislation official measures for tuberculosis control work really started in the country. The first sanatorium was built in 1910. In 1921 the tuberculosis Act was revised and since then practically all the expenses for the hospitalization and treatment of tuberculous cases has been defrayed by the state. In the year 1935 organized tuberculosis control work was begun and a special physician appointed to direct it. From then on systematic surveys were made, partly in health centers i.e. tuberculosis clinics, which were established in the main towns, and partly by means of transportable X ray units in outlying rural areas of the country. In 1939 the tuberculosis Act was again revised with special reference to the surveys and the activities of the tuberculosis clinics. This act is still in force. Some items of it are described. The procedure of the surveys and the methods of examination are described. The great majority of subjects were tuberculin tested and all positive reactors X rayed. Furthermore, X ray examination was made in all cases where tuberculin examination had not been made or was incomplete. The negative reactors were not X rayed. The tuberculin tests were percutaneous, cutaneous and intracutaneous. The X ray examination during the first years was performed by means of fluoroscopy and roentgenograms were made in all doubtful cases. In 1945 when the survey of the capital city of Reykjavík was made and comprised a total of 43,595 persons photoroentgenograms were made. After 1948 only this method together with tuberculin testing was used in all the larger towns in the country. During the period 1940-1945 such surveys were carried out in 12 medical districts, or parts thereof and included 58,837 persons or 47 percent of the entire population. The attendance in these surveys ranged from 89.3 percent to 100 percent of those considered able to attend. In the capital city, Reykjavík, the attendance was 99.32 percent. The course and prevalence of tuberculosis in Iceland from 1911 to 1970 are traced on the basis of tuberculosis reporting registers, mortality records which were ordered by law in 1911, tuberculin surveys and post mortem examinations. The deficiencies of these sources are pointed out. Since 1939 the morbidity rates are accurate. The number of reported cases of tuberculosis increases steadily up to the year 1935, when 1.6 percent of the population is reported to have active tuberculosis at the end of that year. Thereafter it begins to decline gradually the first years but abruptly in 1939, then without doubt because of the revision of the tuberculosis legislation and more exact reporting regulations. After that year the fall is almost constant with rather small fluctuations as regards new cases, relapses and total number of reported cases remaining on register at the end of each year. In 1950 the new cases are down to 1.6 per thousand and at the end of the year the rate for those remaining on register is 6.9 per thousand. In the year 1954 there is a noteworthy drop both in new cases and the total number reported, doubtless because of the new specific medication which began in 1952. In 1960 the new cases are down to 0.4, relapses 0.2 and the rate for those remaining on register at the end of the year 2.4 per thousand. And in 1970 the rate for the same categories are: new 0.2, relapses 0.06, and remaining at the end of the year 0.5 per thousand. At the beginning of the period, when registration of deaths was initiated, tuberculosis mortality was found to be about 150 per 100,000 population. During the next two decades it increases, irregularly but persistently, to reach a peak of 217 in 1925. It remained high for the next seven years, dropped suddenly to 154 in 1933, and then, apart from a slight temporary increase during the years of the second world war, continued to fall rapidly reaching 20 per 100,000 population in 1950. In the period from 1930-50 the tuberculous death rate thus dropped a little over 90 percent. In the year 1952, when specific tuberculosis medical treatment was initiated (streptomycin, isoniazid and PAS) the death rate dropped to 14 per 100,000 population and the next year further down to 9 and since 1956 it never exceeded 5 per 100,000. From the year 1962 the tuberculosis mortality has never been over 2 per 100,000 population. The mortality rates have been broken down to reveal the role of age and sex specific death rates over some selected five year periods. Also the rates are shown according to different forms of the disease, pulmonary, meningeal and other forms. The highest proportionate mortality (60%) was observed in the 15-19 year age group between 1926 and 1930. From 1911 to 1930 tuberculous meningitis caused a remarkably high number of deaths, fluctuating between 20 and 50 per 100,000 population. Since 1956 not a single death from this form of the disease has occurred. Up to that year the highest meningitis death-rate consistently occurred in infancy and early childhood. Sex-specific tuberculosis death rates indicate that in every age-group the disease is more dangerous to women. Between 1941 and 1945, when the combined mortality-rate began to drop sharply, it was the rate for the males, which was first affected. Due to the very steep decline in tuberculosis mortality especially from 1952 tuberculosis mortality figures can no longer be considered the right criterion for the spread and course of the disease. The infection and morbidity rates are from then on the best measures of the prevalence and course of the disease. Tuberculosis infection-rates obtained through tuberculin testing on a comparatively broad scale, especially in school children 7-13 years of age, show a progressive reduction in tuberculosis infection in the country as a whole. These tuberculin surves on school children were initiated by the district health officers in the second decade of the century and therefore now extend over 60 years. The procedure of the tuberculin surveys and the methods used are mentioned. The shortcomings of these surveys and their importance are discussed. The value of the surveys is considered doubtful as long as the examinations are performed without any guidance or coordination. About the year 1930 the total percentage tuberculin tested in the age group 7-13 years was a little over 10 percent. In the year 1935 the director of tuberculosis control sent all the health officers instructions on how to perform the tuberculin testing together with some encouragement to perform such surveys. That year about 43 percent of the 7-13 years population was tested and in 1945 the percentage was 75. Between 1965 and 1970 the attendance percentage was 85. The tested 7-13 years age group showed in 1935 26.1 percent positive reaction, in 1945 10.1 percent, in 1955 5.3 percent and in 1970 0.7 percent. In 1970 0.2 percent of the 7 years old children reacted positively and 1.1 percent of those 13 years of age. the decline of the infection rate in this age group is remarkable. The very few BCG vaccinated children were excluded from the surveys. In the tuberculosis surveys made in the years 1940-1945, which covered 12 medical districts or parts thereof, extensive tuberculin examinations were performed. The results of these surveys showed that the infection rate was higher among male adults than females. This difference was notable after the age of 15 and especially in isolated and thinly populated rural districts. In urban and more thickly populated rural districts the infection rate was much higher. BCG vaccination was first used in Iceland in 1945. Only few persons were vaccinated in the first two years. In 1948 a systematic vaccination was proposed in the country to supplement the tuberculosis-control plan. The vaccination was particularly meant for the age group 12-29 where the risk of infection appeared to be greatest. However, at the end of the year 1950 a total of only about 6,900 persons had been vaccinated mostly groups of school children, young adults and contacts of tuberculosis cases. Most of the children and adults were born between the years 1929 and 1936 but in none of these years did the vaccination exceed 15 percent of those born in any one of the years concerned. Because of the rapid decline in the tuberculosis infection rate, morbidity and mortality in the country this vaccination plan was abandoned and changed at the end of the year 1950. After that only few groups of people were vaccinated, i.e. tuberculosis contacts, medical students, student nurses, adults studying abroad and persons who asked for vaccination. Between 1950 and 1970 only about 7,000 people have been vaccinated. So the total number of BCG vaccinations up to the end of 1970 has not exceeded 14,000 in the country. Therefore it seems most unlikely that the relatively few BCG vaccinations, given in recent years can be expected to have had much influence in speeding up the downward trend of the disease in the country. (ABSTRACT TRUNCATED)

PMID: 16155306 [PubMed - indexed for MEDLINE]
http://www.ncbi.nlm.nih.gov/pubmed/16155306

TUBERCULOSIS: History: England: Roman York Skeleton Could Be Early TB Victim

May 27, 2011

The skeleton of a man discovered by archaeologists in a shallow grave on the site of the University of York’s campus expansion could be that of one of Britain’s earliest victims of tuberculosis.
Radiocarbon dating suggests that the man died in the fourth century. He was interred in a shallow scoop in a flexed position, on his left side.
The man, aged 26–35 years, suffered from iron deficiency anaemia during childhood and at 162 centimetres (5ft 4in), was a shorter height than average for Roman males.
The first known case of TB in Britain is from the Iron Age (300 BC) but cases in the Roman period are fairly rare, and largely confined to the southern half of England. TB is most frequent from the 12th century AD in England when people were living in urban environments. So the skeleton may provide crucial evidence for the origin and development of the disease in this country.
The remains were discovered during archaeological investigations on the site of the University’s £500 million expansion at Heslington East. Archaeologists unearthed the skeleton close to the perimeter of the remains of a late–Roman masonry building discovered on the site, close to the route of an old Roman road between York and Barton–on–Humber.
The burial site is on part of the campus that will not be built on. The University is developing plans for community archaeology and education visits once the investigations are complete.
Detailed analysis of the skeleton by Malin Holst, of York Osteoarchaeology Ltd, revealed that a likely cause of death was tuberculosis which affected the man’s spine and pelvis. She says that it is possible that he contracted the disease as a child from infected meat or milk from cattle, but equally the infection could have been inhaled into the lungs. The disease then lay dormant until adulthood when the secondary phase of the disease took its toll.
Heslington East Fieldwork Officer Cath Neal, of the University’s Department of Archaeology, said: "This was a remarkable find and detailed study of this skeleton will provide us with important clues about the emergence of tuberculosis in late-Roman Britain, but also information about what life was like in York more than 1,500 years ago.
"A burial such as this, close to living quarters, is unusual for this period when most burials were in formal cemeteries. It is possible that the man was buried here because the tuberculosis infection was so rare at the time, and people were reluctant to transport the body any distance."
Malin Holst added: "There were signs of muscular trauma and strong muscle attachments indicating that the individual undertook repeated physical activity while he was in good health. There was some intensive wear and chipping on his front teeth which may have been the result of repeated or habitual activity. There was evidence for infection of the bone in both lower limbs but this appeared to be healing at death."
Investigation of the remains is continuing — Professor Charlotte Roberts, of Durham University, with Professor Terry Brown at Manchester University, is now studying DNA from the skeleton as part of National Environmental Research Council funded research into the origin, evolution and spread of the bacteria that causes TB in Britain and parts of Europe.
http://archaeologyexcavations.blogspot.com/2011/05/roman-york-skeleton-could-be-early-tb.html

TUBERCULOSIS: Colorado: On History: Digging into roots of Shoenberg Farm

Carol Turner : 05/22/2011

While many of Colorado`s pioneers arrived looking for the legendary potato-sized gold nuggets, a good number of folks came to find a cure for tuberculosis. Around the time of Colorado`s gold rush, a new medical movement was stirring, known as the sanatarium movement. Sanataria (or sanitaria) were popping up all over Europe and the United States, many of them offering hot springs as a cure for every ailment. Patients with tuberculosis were lured to rural spots, where they would be cured by a nutritious diet and a long quiet rest in a high altitude setting. Colorado was a prime location.
One local sanitarium was the famed Jewish Consumptives` Relief Society (JCRS) in Lakewood. Another was Denver`s National Jewish Health. Both of these institutions needed fresh dairy and produce to feed their patients, many of whom were non-paying. JCRS had its own small farm, but National Jewish Health was having problems keeping all its patients fed. In stepped Louis Dudley Shoenberg.
Shoenberg (who later changed his name to Beaumont) got his start with the Manhattan Clothing Co. in Leadville, along with his partner, David May of the famed May Company. As a wealthy philanthropist years later, Shoenberg decided to help National Jewish Health with its problem. He might have been inspired because his own son, Dudley, had recently died of tuberculosis. He purchased 70 acres located southwest of West 73rd Avenue and Sheridan Boulevard in Westminster. He brought in a generous supply of Holstein cows and chickens and set to work building a farm. The complex was completed in 1912 and was soon supplying milk, cream, eggs, poultry and fresh vegetables to the patients in the hospital.
A few years later, Shoenberg considered putting together another farm closer to the hospital, as it was having cost and transportation issues. However, the hospital asked him to build a nurse`s home on campus instead, which he did.
In 1921, the Tepper family took over Shoenberg Farm. Jacob Tepper had previously operated a farm on West Colfax, near JCRS. He was forced to sell that farm in 1920, when his wife left the family. He and his four kids moved to the Shoenberg farm and worked it together. Thirty years later, Jacob Tepper`s Shoenberg Farm was reportedly the largest dairy and poultry farm west of the Mississippi.
In 1941, Jacob`s son, Edward, added a new business line to the farm -- a name that is familiar to anyone who grew up in Colorado: Dolly Madison Ice Cream Stores. They eventually opened 19 stores in the Denver area, where they sold groceries and ice cream and operated traditional soda fountains. Sadly, the last of the Dolly Madison stores closed in 2001.
Many of the original Shoenberg Farm buildings are still standing. Westminster, the State Historical Fund and other organizations are now working on an "adaptive reuse" initiative that will create a community and commercial center at the location. For more information, see ci.westminster.co.us/131_2081.htm.

(Primary sources: City of Westminster and historian Dawn Bunyak.)
Carol Turner is the author of "Notorious Jefferson County: Frontier Murder & Mayhem," published by The History Press. Contact her at broomfieldcat@comcast.net.

http://www.broomfieldenterprise.com/ci_18106895

TUBERCULOSIS: History: Oakdale Hall, Iowa

 In 1930, William Lee Burton, then 20, and Elsie Pavelka, then 16, were diagnosed with tuberculosis and were sent to the Oakdale State Tuberculosis Sanitarium outside Iowa City.The two met, and after several years of experimental treatments that included sleeping in screened porches during the middle of the winter, they married in 1939. "We like to say they read poetry to each at their bedside," said Virginia Melroy, one of their three children.
  Patients gather outside of Oakdale Hall to play cards and relax in the fresh air in this 1927 photo. Demolition is scheduled to begin on Monday on the 104-year-old building, which at one time housed the state's largest tuberculosis sanitarium. (Special to the Press-Citizen)


The Oakdale Tuberculosis Sanitarium closed in 1981 when the unit, which now features outpatient treatment with antibiotics, was transferred to University of Iowa Hospitals and Clinics. The building it was housed in is scheduled to begin coming down Monday, officials said, leaving behind plenty of memories for those who worked at the tuberculosis hospital and later one of the numerous units that were housed there, including the Iowa State Hygienic Laboratory until December 2010.
"We had people working in places you never would have thought, but they did great work there," said Kathy Fait, a librarian and historian with the hygienic lab.
Oakdale Hall's history goes back to 1904, when at the height of a tuberculosis epidemic in the United States, the Legislature appropriated $50,000 to set up an isolation treatment facility on a 280-acre farm seven miles west of Iowa City, according to Mary Fabian on the IAGenWeb Project website.
The building went up in 1908 with eight patients to start and grew to a peak of about 400 beds during the 1940s, according to the Saturday Postcard by Bob Hibbs that was published in the Press-Citizen in May 2003.
The original treatment center featured no antibiotics until they were developed in the 1950s and 1960s, opting instead for fresh air and bed rest. Melroy said her parents talked about sleeping outside, even during the middle of winter.
"They would put people out in screened porches in the winter -- fresh air was supposed to be good for you," she said. "Good food, fresh air, they were seen as a way that people could recover."

http://www.press-citizen.com/article/20110308/NEWS01/103080321/Oakdale-Hall-holds-103-years-of-worker-patient-memories

TUBERCULOSIS: History: U of Iowa to demolish Oakdale Hall, former tuberculosis hospital

Mar 11, 2011
IOWA CITY, Iowa (AP) — The University of Iowa is ready to demolish a nearly 100-year-old building that was originally built by the state as a place to isolate tuberculosis patients.
Officials say Oakdale Hall on the UI Research Park campus will be hit with a wrecking ball Friday morning, weather permitting. The total demolition will take two to three weeks.
The state built Oakdale Hall as a sanatorium for tuberculosis patients in 1917. The university took over the property in 1965 and has used it for a variety of programs.
The building housed the State Hygienic Laboratory until December. University officials say they can save millions in maintenance and energy costs by tearing it down and relocating occupants elsewhere.
http://www.necn.com/03/11/11/U-of-Iowa-to-demolish-former-tuberculosi/landing_health.html?&blockID=3&apID=05e3ab8210c94119bf9a7955583358f6