1840-1903: Open air treatment for consumption

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

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.  

1920s and 30s: Memories from National Jewish

 B'nai B'rith Building.  This was the east part of the campus on the opposite
side of Colorado Boulevard as the 7-Goodman Building that I was in.  This
building was for the most severe asthmatic kids during the 1930s.  By the
1980s when I was a patient, this building stood empty.  It appears,
however, that it is no longer empty.  I'm surprised it still stands. And, a
part of me is happy it still stands.
1

Between 1899 and 1999 there were thousands of children with a chronic breathing disease, mainly tuberculosis and asthma, who benefited from a prolonged stay at the Jewish Hospital in Denver.  In 1999 they were all invited back for a reunion. I was among them. However, due to my place in life, was unable to attend. 

As part of the reunion we were all asked to tell our stories and mail them in. I did not do this, but many others did. They were since compiled into a little booklet that I was able to get my hands on.

I would like here to share some of these stories.  Even though these stories were submitted for the public, I will not share any names here.  My only goal is to give you an idea of what it was like to live in a sanatorium or asthma institution for several months, or years, away from your family and friends. 

Fannie E. Lorber Breaking Ground at the Denver Sheltering Home for Jewish Children

1920s:  Denver Sheltering Home for Jewish Children

I have a story from a lady who's family members suffered from tuberculosis, and she and her three siblings were staying at the shelter because her family couldn't take care of her for a time.  Her father paid $40 a month "for the keep of us four children in our family."  Her recollection was taking dancing lessons.  She adds:  "In sharing these notes I can say 'Thanks' for the shelter and the care I was given while my mother laid in a bed in the hospital with tuberculosis."  I would imagine the hospital she's referring to was National Jewish Hospital for Consumptives.  

Mending clothes was one of the routine chores preformed by the girls.

1930s:  National home for Jewish Children

It was just a simple name change, although the home was the same as the one mentioned during the 1920s.  One guy talked of he and his group of friends having boxing matches "because we had gloves our dad gave us.  He writes how some of the guys "hitch hiked -- got a ride on a cement truck," and one of the kids fell off and was run over and killed.  He remembered running through the tunnels under the hospital -- "especially to escape from Mr. Cohen!  Or hiding in the engine room or the locker room.  And various of us getting beaten up in the locker room by the Boss.'

1930s:  National Jewish Hospital for Consumptives

An unidentified woman reads a story to a group of children in
the nursery at the National Home for Jewish Children at Denver. 
 On back of photograph: ''Story hour in the nursery National
Home for Jewish Children at Denver 1931 (2)

(Resident August 1934-January 1936)  At the time of my admission to National Jewish I had been living in Colorado Springs.  My family had moved from Ohio because of my father's health.  He was tubercular and eventually was a patient at National Jewish also.

At a very early age I had typhoid fever,which left me in a weakened condition from which I never fully recovered.  As I grew older, I failed to recover satisfactorily.  Because my father was tubercular, our family doctor thought it best that i be admitted to National Jewish.

A friend of a friend arranged to have me driven to Denver.  I arrived and was admitted to National Jewish on the 23rd of August 1934.  I was 12 years old.  I was assigned to the Heinemen building for a short time and then transferred to the Hofheimer Preventorium.  I was discharged in late January 1936.  

Dance Recital (2)

I remember the names of many of my fellow patients.  During the school year we went to one of the other buildings on the grounds for our classes.  Our teacher was Miss Mayme Smith.  She taught eight grades in one classroom.  She was taskmaster and a strict disciplinarian.  However, she was always fair. 

the doctors I recall are Drs Black and Cohen.  the nurses I remember are Miss Gresharn, Mrs. Sharam, Miss Elsie and Miss Nickey.  Miss Nickey was the night nurse.  

In addition to attending class, we went on many field trips.  Mostly we walked to the playground at City Park.  Once we walked to Cheesman park where we waded in the pool and I believe we had picnic supper there.  We also went to Elitch Gardens and rode all the rides and to the Schoenberg Farm where we spent the day roaming around the area and having a picnic lunch  At Christmas time the ladies of the Eastern Star took us around to see some of the houses that were very well decorated and lit up.

A group of children sit on an outside deck at the National Home for 
Jewish Children.Each child has a plate of food and an unidentified woman serves them.
 Most of the children are unidentified, however, Bertha Katzson, Doris
Greenstein and Reuben Levine are part of the group. The children
 are in the care of the National Home for Jewish Children
at Denver in Denver, Colorado. (2)

We had students from Denver university visit one afternoon each week.  We called them Club Ladies, one for the boys arranged a trip for a few of the older boys to attend a football game at DU Stadium.  

We used to get our hair cut at regular intervals.  A stool was set up in the nurses' station upstairs, we all lined up and had our hair cut.  All the boys looked the same and all the girls looked alike when the barber was through.  We each climbed on the stool in our turn and zip zip and you were through.  We left our dime for the barber and went our way.

As I recall, we were given some candy on Thursday and Sunday nights.  In the evening we used the dining room as a study hall.  On Sunday nights, while studying, we listened to Eddie Cantor, Ed Wynn, and Fred Allen's radio programs.  At some time a few of us discovered where the candy was kept.  We used to raid it once in a while.

(Resident 1936-1940) "50 Years Ago, They Gave me Back My Life."  Looking at the National Jewish Center for Immunology and Respiratory Medicine, the observers sees a campus composed of both time-honored and modernistic buildings uniquely set off from the busy intersection of Colorado Blvd. and Colfax Avenue.  In 1936, however, National Jewish was a very different place.  Ruth lived at National Jewish for four years during her struggle with tuberculosis between 1936-1940.

As Ruth looks back on her stay, she reflects, "They gave me back my life."  Ruth continued to tell us more about the Center as it was 50 years ago.  "The campus was divided into two parts by the Colorado Blvd.  I lived on the east side of the campus in the B'nai B'rith Building, and on the west side of Colorado Blvd. was the research building, the Pisko building for ambulatory patients, and a few other buildings.  The B'nai B'rith Building was for very ill patients.  After three-and-a-half years, when my tuberculosis was at last brought under control, I was able to move to the west side of the campus into the Pisko building.  In this new setting there was an air of triumph and a sense of camaraderie for we were able to dress and walk to the communal dining room and share meals together.  Also, we could take part in the activities and entertainment wisely planned for our benefit."

Ruth came to the National Jewish Hospital from Arkansas in 1936 after struggling for six years with tuberculosis while living in an Arkansas sanatorium.  she described the mood she prepared for her trip to Denver.  "My father explained to me that I was so ill, the doctors were not sure I would survive the trip to Denver and perhaps I should just stay in Arkansas."

However, Rush is indeed a fighter, and in her heart she felt that the doctors in Denver could help her.  She was prepared to take the risk.  She traveled by ambulance to the train, by train to Denver, and again by ambulance to National Jewish.  The trip required a total of 36 hours.

After being released from National Jewish in 1940, Ruth decided to make Denver her home.  She married soon after her release.  Her battle with tuberculosis had lasted ten long years, and had robbed her of her twenties, yet added a new dimension of perseverance, patience, and compassion to her life.  With the help of the wonderful staff at National Jewish, in particular, Dr. Gugenheim, she was victorious.  Since the, her health has remained stable, and her life has been fulfilling and productive.

In July of 1986, on the 50th anniversary of her entry into National Jewish, Ruth came back to the Center.  It was indeed a  very emotional visit as she toured a different, yet familiar, campus.  today the National Jewish Medical and Research Center is world renowned for only for work with tuberculosis, but for research in respiratory and immune system disease, model patient care programs, and excellent educational training for doctors and patients nationwide.

Rush acknowledged the fifty year anniversary of her admittance into National Jewish my making a gift to the Center in the form of a National Jewish Gift Annuity.  This very special gift from the heart, given with deep thanksgiving, will help National Jewish to progress and grow during the next 50 years.

Compliments of National Jewish Health Facebook Page. Opened in 1899. 

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.  
2. "Jewish Story at the National Home for Jewish Children at Denver," Penrose Presents, University of Denver, accessed 11/8/12

1940's: Dr. M. Murray Peshkin, Parentectomy, and the rise of the asthma institution

Figure 1 -- NJH patients receiving sunlight exposure treatment

Thanks to better care, improved diets and good hygiene, the number of tuberculosis patients declined significantly during the 1930s. National Jewish Hospital at Denver and National Home for Jewish Children in Denver continued to function mainly because their doors were open to people with other diseases besides just tuberculosis, particularly asthmatics having trouble managing their asthma at home.   (1, page 115)

In the 1940's, the number of tuberculosis patients was generally higher than those with other diseases, like asthma.  However, the number of asthma patients at the institution was on the rise.  And, for the most part, the goal for people with chronic lung diseases was to seek the cool, dry climate of Colorado for improved breathing.  So, both asthmatics and TB patients received open air treatment (see figure 1).

Figure 2 --Children playing on swings at the National Home
 for Jewish Children, 1936 (6)

Likewise, patients who got better were provided the "added bonus of rehabilitation, social and education programs.  The education programs were intended to equip patients, who often came from lives of poverty, to function more effectively, in the world outside of the hospital."  (5)

Now, before I get into the rise of asthma patients at these hospitals, you have to understand the common thinking about asthma in this era. First of all, asthma was a much rarer disease at this time, so it didn't get even close to the type of limelight that a deadly disease like tuberculosis got.

During most of the 19th century the two most prominent theories about asthma were that it was a neurotic disorder that resulted in airway constriction and shortness of breath.  This theory continued to be prevalent in the minds of many physicians, although it sort of took a back seat to other theories, such as the allergic theory. In fact, some researchers were so excited about the new allergic theory that they believed this would lead to a vaccine for asthma.

However, the idea that asthma was nervous was reinvigorated beginning with German and Austrian physicians (like Dr. Alexander) in the 1920's. These physicians described wheezing and asthma as a suppressed cry for the mother. So, the treatment for it, along with controlling asthma triggers, was psychotherapy. Of course it was often noted that most asthmatics were not avoiding triggers nor receiving the therapy they needed to obtain ideal control.

As these physicians migrated to the United States this information migrated with them. Do doctors here, including Dr. Murray Peshkin, medical director for the National Home for Jewish Children, must have been aware of it. This must have inspired him.

So, during the 1930's the number of tuberculosis patients were on the decline and the number of asthma patients were on the rise. Still, at this time, there weren't a lot of asthma patients. This changed after Dr. Peshkin observed a trend among asthmatic children at the hospital. He postulated a theory based on his observations that would cause a spike in the number of asthmatic admissions to National Jewish and all the other asthma hospitals around the nation.

What he observed was there were about 10 percent of asthmatic children who never got better at home, even when he personally visited their homes to make sure they were perfectly clean and antiseptic with no trace of any known allergens.  (2) He observed that as soon as being admitted to his hospital many of these children became immediately better. He observed that 99 percent of the children treated this way had 'substantial or complete relief' of symptoms, according to his own reports. (3, page 145)

He concluded the reason for this was removal from allergens and stress at home. He therefore proposed a strategy that involved abducting (with parental permission of course) these children from their homes and admitting them to asthma hospitals. A slang term for this developed: Parentectomy.

Parentectomy became a popular strategy when physicians observed severe asthma in children despite their best efforts. The children would often stay at these hospitals from 1-2 years. And they weren't like typical hospitals either: they were more like institutions. Sure there were nurses and doctors, but there were also teachers and, most certainly, there was entertainment. We can learn what it was like to live at one of these institutions by reading their stories. (4, page 170)

References:

1. Minton, Gregg, "Breathing Space,"
2. Wamboldt, Fredrick S. "Asthma Theory and Practice: It's Not Too Simple," April 2, 2008,
3. Jackson, Mark, "Asthma: A Biography,"
4. Travis, George, "Chronic Illness in Children," 1976, California, Stanford University Press
5. "Clinical History: The Early Years," NationalJewishHealth.org, http://www.nationaljewish.org/about/whynjh/history/clinical/, accessed 11/7/12
6. Photo from Penrose Library, http://lib-anubis.cair.du.edu/About/collections/SpecialCollections/NAC/index.cfm, accessed 11/8/12

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 NationalJewish.org, the Hofheimer Preventorium was open until 1941, and in its 23 year history cared for 730 children.  

References:

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.

1899: National Jewish Hospital for Consumptives

Figure 1 -- National Jewish Health for Consumptives (5, page 16)

By the 1880's a whopping 25% of Denver's residents were suffering from lung diseases -- mainly tuberculosis, and many were literally dying in the streets.  This inspired the Jewish community to coalesce and donate funds to build a home for them. 

In 1899 the doors to the National Jewish Hospital for Consumptives opened with the motto  (1): 

"None may enter who can pay -- none can pay who enter."  

It was built by the Jewish Community, and it was funded mainly with the financial assistance of the International Order of B'nai B'rith. The hospital "adopted a program that emphasized the benefits of fresh air, good nutrition and rest." (6)

Figure 2 -- Patients at National Jewish Hospital getting sun treatment

Regardless of where the funds came from, anyone was allowed to enter who needed help, so long as they couldn't afford to attend one of other sanatoriums.  (2)

The following rules were listed for those desiring admission: 

"The National Jewish Hospital for Consumptives at Denver is intended for the treatment of tubercular diseases only, among the indigent, in whom the disease is not sufficiently advanced to preclude the possibility of recovery or the arrest of the disease within the time, assigned for the treatment." (3, page 156)

Figure 3 -- National Jewish Hospital circa 1920s

The neat thing about the hospital is the it was under the control of a National Board of Directors consisting of 35 members from principle cities around the United States.  When a patient wanted to be admitted, he'd have to have the endorsement of the local director, plus "be examined by a properly authorized physician of the city in which he lives." (3, page 156)

The examination form and the application were then submitted to the"Denver Board for action. Upon arrival in Denver, he (the patient) is at once admitted to the hospital, and re-examined by the admitting physician." The patients are then examined on a weekly basis. (3, page 156)

Compliments of National Jewish Health Facebook Page. 

322) and accepted both male and female patients of all ages. Patients may be married or single. Patients were generally admitted for six months, and examined every two months by their general physician.  Patients could stay longer than six months per recommendation by the medial advisory board.  No patient could stay longer than one full year.
The hospital had a capacity for up to 65 patients, (4, page

The patients in the first three years admitted were of a variety of occupations, including six school children, many tailors, salesmen, and clerks.  Eight were cigar makers, and many more were laborers or worked in sweat shops in New York and Chicago.  (3, page 157)

Compliments of National Jewish Health Facebook Page. 

Of these patients, 83% were admitted after an exacerbation caused by a cold picked up at work. Thus it was based on these statistics that poor hygiene was blamed for many cases, and hygienic rules for certain occupations, particularly tailors and sweat ships, were recommended to and passed by the New York Legislature.  (3, page 157)

Once a patient is admitted treatment is based on a per patient assessment, with one of the more common treatments being open air treatment.  For this reason many of the rooms are made so that they have windows for absorbing sun rays.  Patients have their sputum assessed upon admission and discharge, and weekly.  Patients are also weighed weekly.  (3, page 156)

Other treatments include:

"The climate, nutritious food, and personal hygiene, were mainly relied upon. Patients are encouraged to keep out of doors as much as possible, and to further this purpose, games are provided for their amusement, upon the porches and grounds surrounding the hospital. The food provided is the best the market affords, and is properly prepared. There are a number of special diets upon which the patients may be placed, as directed by the attending physicians, besides numerous extras, which may be ordered for the patients. It has been the aim of the staff to give particular attention to the quality and preparation of the food provided for the patients, and in this it has found the ready cooperation of the Board of Managers.

"All patients are instructed in the danger that lies in communicating the disease through the sputa, and paper spit-boxes are provided for them, which they are required to carry with them in and around the hospital. They are not allowed to expectorate in or use handkerchiefs. Pieces of cheese-cloth, which can be cremated, are provided for their use. Various other measures to secure personal cleanliness are enforced. In regard to medication, no systematic attempt has as yet been made to use true specific medicines. Patients are treated symptomatically, and the majority of the attending physicians avoid the use of large numbers of drugs." (3, page 158)

When the hospital was first opened any patient with consumption was admitted, but this resulted in a high number of deaths in the first year.  This also  resulted in a tightening up of the admitting rules.  After the initial year, "only those in the early stages of pulmonary tuberculosis, who are likely, in the opinion of the admitting physician, to be improved by hospital treatment, have been admitted." (3, page 156)

Figure 4 -- National Jewish Hospital today

According to the Denver Chamber of Commerce, by 1912, it is reported that about 75 percent of consumptive patients staying at the hospital benefit from the treatment provided. Of that 75 percent, up to 25 percent "regain permanent health." (5, page 16)

The Chamber advertised the hospital as benefiting consumptives due to the...

"high, dry altitude, with the maximum of sunshine, is the great remedial agent goes without saying. Situated one mile above sea level, protected by the Rocky Mountain range from cold winds in a latitude nearly parallel with Washington, D. C, Denver and vicinity offers almost unequalled attractions to the invalid; more specially those suffering from lung and throat trouble. The summers are delightful, hot in midday, but with remarkablv cool nights, and always cool in the shade, even in midday. Sunstroke is a thing never known, because of the dryness of the air. There is no dewfall at night; therefore, one can live out of doors in comfort all through the season from May 15th to October 15th. Indeed many invalids live in tents in winter as well as summer." (5, page 16)

Figure 5--
National Jewish wasn't the only tuberculosis sanatorium in Denver.
There were many others in the area, some of which were tent farms.
Tent farms were preferred by some because they were less expensive.
Plus, many also allowed accommodations for "invalids,"
or those victims in the end stages of disease. (5, page 16)
There were many others located around the U.S. and Europe.
Pictured here is the Nordach Sanatorium,
Austin Bluffs, Colorado in 1906
Compliments of Wikepedia. 

As I sit here typing this up I wonder how helpful these sanatoriums were at treating lung diseases, considering the limitations of the era. However, I would imagine they offered solace to those victims of lung diseases who otherwise had little or no home, and especially those who were weak and disabled and left to the streets.

While it was not the only sanatorium in Denver, let alone the west, what made National Jewish stand out were efforts in 1914 to open the first building outside a university with the specific goal of researching a cure for disease.

It was also special for opening a ward during the 1920's specifically for children suffering from lung diseases. By the 1930's the hospital had the capacity to hold hundreds of children of all ages with a disease called tuberculosis. So, this made it one of the few such institutions to provide a home and hope for people of all ages suffering from tuberculosis. By this time it was also a leader in its attempts to find better treatment and a cure for tuberculosis and other lung diseases that plagued society at the time.

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. Saling, Simon, "Report of Cases Examined for the National Jewish Hospital for Consumptives, at Denver, Colorado," The Philadelphia Medical Journal, July 27, 1901, Volume III, July to December, 1901, Philadelphia, The Philadelphia Medical Publishing Company, page 156
4. Solis-Colon, Solomon, "A system of physiologic therapeutics," volume IV, Book II, 1901, Philadelphia, P. blakiston
5. "Denver and Vicinity as a Health Resort," Denver Today: Denver Chamber of Commerce, 1912, Denver, Colorado, Compiled and Published by the Denver Chamber of Commerce
6. "National Jewish Hospital for Consumptives, University of Denver, Special Collections & Archives (Beck Archives), 
7. another good reference

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. (See references 5 and 6 for more 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