Monday, October 19, 2015

1921: The Children's Ward at National Jewish Hospital

Figure 1 -- Hofheimer Children's Building
National Jewish Hospital for Consumptives got off to a great start. In fact, it got off to such an impressive start that after WWI it was noted a need for expansion.  In 1920 a new ward was completed and designed specifically for children. It was called Hofheimer Children's Building (figure 1).

What this showed was the stunning success of the sanatorium for patients with consumption.  During the 1840s George Bodington opened the first sanatorium in Sutton, England.  After publishing his research his opinions were rejected, and his research abandoned.

In 1854 Herman Brehmer picked up his research and opened a sanatorium in 1859 at Goerbersdorf in Prussian Siselia.  It was his research that proved the value of open air treatment and good hygiene in the treatment of consumption.

In 1884 Edward L. Trudeau tested Brehmer's methods in America.  A small amount of money, a small amount of land, and two small buildings were donated.  The Trudeau sanatorium was a success, and provided an example for many other future sanatoriums opened in the United States, including National Jewish in Denver.

Figure 2 -- Rear view of the Hofheimer Children's Building
In 1899 National Jewish Hospital for Consumptives opened, and the specific goal was to provide help only for those who were unable to pay.  Some of the over 300 patients who submitted applications in the first three years were rejected due to the fact they had family members willing to pay for their medical support.

By 1921 it was considered one of the finest sanatoriums in the United States.  Considering that Consumption was among the leading causes of death at this time, of the 3,613 patients seen at National Jewish since 1900, 50 percent returned to their previous occupations once discharged.

Figure 3 -- Combination diet kitchen, drug station, and chart room
The hospital started out as one building and grew to eleven, and the sanatorium had access to a seventy acre farm to furnish a fresh supply of milk and eggs.  A new Children's building was compliments of Mrs. Nathan Hofheimer of New York.

Previously the care of children was done in various locations in the other buildings, and this new building will therefore create a great advancement for the children.  It will provide better access to preventative treatment of consumptive children whose families have no means of affording treatment for them.  The new building has two stories, a basement, and can hold up to 35 children.

Figure 4 -- The girls dormitory.  Notice the arrangement of chairs
and beds to absorb sun rays.
A detailed description of the building is as follows:
On the.first floor is a reception room, a dining and play room for the children, a diet kitchen, dormitories for sixteen beds, with adjacent dressing rooms, bath rooms, toilets, linen room and pantry, and a large porch, fourteen by twenty-five feet, in which it is contemplated to apply heliotherapy. On the second floor are dormitories for sixteen beds, with adjacent dressing rooms and bath rooms, two private rooms with a private bath
The goal of the new facility is to...
Figure 5 -- A list of states and how many patients came from those states.
"establish a preventorium for children who would otherwise live in an environment that would render them susceptible to tuberculosis. They may be sent here for a variable period to be built up by the natural agents of fresh air, good food, and adequate rest, and made strong enough to hold their own in the social complex of city life. In addition it is intended to care for a certain number of orthopedic  cases in this building. There are ample facilities in the Grabfelder Medical Building of the hospital to offer every diagnostic and therapeutic agent that a case may call for. In this building, which is adjacent to the children's building, there are complete facilities for all laboratory, roentgenological, and fluoroscopic examinations, in addition to special dental and nose and throat clinics."

The daily routine of the children seems to be quite similar to when I attended the hospital in 1985 (although when I attended this building sat across from the main complex empty).  Without the ability to interview the caregivers nor the patients, it's nearly impossible to do justice, although the following is a gallant attempt.

1.  Each child is examined fully, upon admittance, and thereafter at regular periods to determine its progress.

2.  The medical care of the children is under the immediate supervision of specialists in orthopedics, pediatrics, and tuberculosis. 

3.  The diets and routine life of the children are under the supervision of a competent person.

4.  The following is the basis of the routine life of the children: 
  • 6:45-7:30, daily shower and dress;
  • 7:30-8:00, breakfast; 
  • 8:00-8:45, housework; 
  • 8:45-12:00, school; 
  • 12:00-1:00, dinner; 
  • 1:00-3:00, rest hour; 
  • 3:00-5:00, recreation and occupational therapy; 
  • 5:00-5:30, supper; 
  • 5:30-7:15, recreation or study period.
5.  The children attend school three hours every morning and their work is conducted by an approved public school teacher. The program corresponds as nearly as possible to that used in the city grammar schools and it is planned to accomplish one semester of work in a year. 

6.  The department of occupational therapy provides tent specialist. The children are trained to be nimble with their fingers, quick with their eyes, and original in ideas. 

Figure 6: Plan of the 2nd floor of the children's building. On the backside
of the building are the dormatories, women on left, men on right.
7.  The following crafts are chiefly used: 
  • basketry, 
  • leather tooling,
  • painting, 
  • toy making, 
  • elementary book binding, 
  • weaving 
  • and block printing
Perhaps occupational therapy was as essential to the tuberculosis child in 1920 as the asthmatics admitted to the hospital in 1985.  These children grow up with diseases, often have trouble breathing, and are often forced to forgo some of the normal activities of healthy children.  For this reason they generally lag behind in basic skills, and this can erode self confidence.  
Figure 7 -- Layout of 1st floor. Dormitories on back side. There are
plenty of windows so allow in plenty of sunlight.

The following further explains this:
"Children living in an institution are necessarily barred from many of the interests of the normal child, and the tendency is to develop habits of idleness and carelessness. Occupational work to a large extent corrects this evil and is frequently responsible for the development of a latent talent. In many cases these crafts lead directly into vocational training along some original line. Whether or not these crafts are used as a means of livelihood in the future, they at least furnish a possible avocation, and in some measure care for those hours which otherwise may easily undo the years of preventive care. Part of the function of a preventorium is to furnish content of mind through active hands, and thus lay the foundations for a useful, busy life no matter what the physical handicap may be. An appreciation of beauty, and the ability to transform that appreciation into some concrete form is a never failing source of interest and pleasure to a child, and he rapidly becomes skillful enough to make objects of real value."
I think the following sums this service up well:
"In this manner, with the generous aid of our numerous friends, we are the agency that takes little children from the slums and tenement districts where frequently we'find them pale, anemic, undernourished, and undersized, sometimes with a. dulled mentality, and gives them the things that are theirs by birthright, fresh air, wholesome food, adequate rest, and wholesome ideas. In a remarkably short time the pale cheeks take on a rosy color, the dull listless eyes become bright, the child with a backward air begins to laugh heartily, and the undersized child takes on weight. Thus in about a year’s time the child is ready to return to the life of the city, but now he is prepared to survive in the struggle."
So the staff at the facility does more than just get the children healthier.  They also work hard to teach them about their disease and provide them with the skills and confidence tofunction in the real world.

Prior to discharge the homes the patient will be returning to are inspected to assure they will provide for the safe and therapeutic environment the patients are instructed in.  The homes must provide cleanliness, good hygiene, and fresh air.

Plus, I would imagine, the family, particularly the mom and dad, must be educated about the disease and the importance of good hygiene.  They must also provide the necessary care and encouragement, and be able to notice the signs of worsening health.

Based on my own personal experience, I think among the most important therapies provided by such a facility isn't so much educating the child, but the family.  Although this, I think, is the most challenging part

According to, the Hofheimer Preventorium was open until 1941, and in its 23 year history cared for 730 children.  
  1. Prisko, S., Secretary for NJH Hospital for Consumptives, "The New Children's Building of the National Jewish Hospital for Consumptives," The Modern Hospital, Volume XVI, No. 5, January to June, 1921, pages 404-407.  All the material in this post that is not my own comes from this reference.  It was a great article, and provides a great description of life at NJH.

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