As mentioned earlier, I uncovered the history of Chicago’s Municipal TB Sanitarium but learned little about the purpose it served. Guest blogger Dr. Gilberto Gonzalez, a retired general surgeon, offered to fill in the blanks for me. Dr. Gonzalez trained at Mercy Hospital in Chicago for three years, the Municipal Tuberculosis Sanitarium for one year (1961-62) and two years at the University of Iowa. He practiced for 31 years in Bismarck, ND, and retired in 1995.
Although I remember getting the TB tests as a child, the disease hasn’t been a major public health issue in my lifetime. In his essay, Dr. Gonzalez reminds us that:
Tuberculosis was the leading cause of death in the western world, and was considered incurable before isolation and therapeutic intervention took place.
This is an edited version of Dr. Gonzalez’s comments and I’d like to thank him for explaining what took place across the street from the house where I grew up.
A Medical Resident’s Life at the Sanitarium
by Gilberto Gonzalez, M.D.
On July 1, 1961, I started a residency in thoracic surgery at the Municipal Tuberculosis Sanitarium of Chicago. The Sanitarium was one of the largest in the nation and one of the largest tuberculosis hospitals in the world. The hospital could provide treatment for about 1,500 patients at a time.
The resident’s quarters were located about one block from the main hospital. A tunnel connected both buildings, and a large cafeteria, that fed hundreds of hospital personnel, was located next to the resident’s quarters. Each resident had his own room, and we all shared a common recreation room, which had a television set and ping pong table. The unmarried residents lived on campus, but those who were married stayed overnight only when being on call.
As a City of Chicago employee, the residents had the privilege of working only eight hours a day, something unthinkable on any other hospital other than a city hospital. We received a monthly salary of $300.00; a small fortune in comparison to what I made at Mercy Hospital. (My salary at Mercy Hospital was $100.00 a month with yearly increments of $50.00 a month for the subsequent three years I spent there).
Safeguards Against a Contagious Disease. All the residents donned the hospital attire in the resident’s quarters and walked the tunnel that connected it to the Sanitarium. Approaching the other end of the tunnel, each one instinctively tied the mask’s strings, for it was mandatory to wear a mask at all time while in the sanitarium. Tuberculosis spreads through airborne droplets from sneezing, coughing or talking, and since we were in direct contact with the patients, the potential for contracting the disease was real.
The operating rooms were equipped with ultraviolet lights, which were on all the time. Ultraviolet light was supposed to kill the tuberculosis bacillus, and its use was a common practice in institutions such as the Sanitarium, although its value was controversial and some institutions did not use it any more. Since the operating room attire covered practically every part of our body except our eyes, we were spared a suntan.
A chest X-ray and a tuberculin skin test was a requisite for every one working at the M.T.S. Contracting the disease became real to one colleague resident in surgery when his skin test converted to positive while working at the M.T.S., and he had to receive prophylactic therapy. Dr. Lees used to say that it was easier to contract the disease in the outside world, than it was to get it at the Sanitarium by saying: “Here you know everybody has it and you take precautions, outside you don’t know if the person you are talking to, or riding the bus next to has it or not.” Although he might have been right saying it, one of our colleagues had proved him wrong, and that was more than a reason never to take any chances.
A positive sputum test for tuberculosis corroborated the diagnosis. In the same manner, a negative sputum test after months or years of treatment was a requisite for the discharged from the Sanitarium. It took a long time for the sputum test to convert from positive to negative, and the discharge hinged upon providing six consecutive monthly negative sputum tests.
Many patients sputum test never reverted to negative and never got out. I recall a patient that had been there since 1931, which is the year I was born.
Treatment. The treatment was very standardized, and it progressed from one regime to the next according to the patient’s response. The results were not spectacular, since we really did not have good drugs to treat the disease at that time, and the ones we had: streptomycin, para amimo salicylic acid, and isoniazid had unpleasant side effects. We used other drugs when the ones I mentioned were no longer effective, but they were not any better and the side effects were more serious.
If we consider that para amino salicylic acid and streptomycin were discovered in the 40s and that isoniazid was discovered in the early 50s, we realize how rudimentary the treatment of tuberculosis was in the past. Tuberculosis was the leading cause of death in the western world, and was considered incurable before isolation and therapeutic intervention took place.
By the early 60s, which is the period I am writing about, the mortality due to tuberculosis markedly diminished. The combination of case finding, isolation, the use of three drugs above mentioned, and better standard of living all contributed to the decline. Yet, tuberculosis was still around and the patient’s population of the M.T.S. proved it.
New Treatments and the End of an Era. In the late 60s, two new drugs came in the market that revolutionized the treatment of tuberculosis; namely, Ethambutal and Rifampin. These two drugs, in combination with isoniazid, were very effective in reverting the patient’s sputum to negative in a short time; therefore, they did not have to be treated in a hospital; instead, they received treatment at home. So successful was the new treatment that the Municipal Tuberculosis Sanitarium and similar institutions around the world closed their doors several years later.
Now, few people may remember what happened there, and tuberculosis is fading from memory at least in developed countries. However, tuberculosis disappearance may be more illusory than real. It has always been prevalent in third world countries, and it is still seen in developed countries, and its rampant return worldwide, in a more virulent form, is not only possible, but it is happening now. With the emergence of AIDS in the mid 80s, tuberculosis became prevalent among an imuno-suppressed population; therefore, a more virulent form of tuberculosis emerged, which is resistant to the drugs available today, and a new public health hazard may be in our midst.
I hope the world will be prepared to fight it aggressively, so scenes recorded in this chapter will not repeat, and I can safely say I was part of the last generation of doctors who saw the terrible toll that tuberculosis inflicted upon humanity. I hope also that its control extends to all parts of the world; something similar to what is happening to polio control nowadays.
Update: I have uploaded the unedited, full-length version of Dr. Gonzalez’s memoir to the Histories tab.
Photo credit: Jennifer Stix