How Was Tuberculosis Medically Defined in the early 1900s?

When affecting the lungs, it was often referred to as pulmonary tuberculosis or consumption and was classified as an infectious and communicable disease. It was common in humans and some animals, especially in cattle. About 1/4th of all deaths occurring in humans during adult life in Western countries were caused by tuberculosis; nearly 1/2 of the entire population, at some point during their lifetimes, would acquire it. The central germ at the root of tuberculosis was believed to be tubercle bacillus; this discovery was first made by Robert Koch in 1882. Tuberculosis can affect any organ in the body but more frequently attacks the lungs first. When tuberculosis affected the skin, it was referred to as lupus. The lymph glands were often diseased, particularly those in the neck, and this was referred to as scrofula. At the time, standard forms of chronic orthopedic ailments such as issues with knee joints, hip joints, and the spine were often the result of tubercular infection. Tuberculosis also affected the throat, gastrointestinal system, the meninges, and organs and tissues within the body. Though tuberculosis could target any part of the body, the root cause or etiology was always the same: tubercle bacillus.

Once tubercle bacillus found its way into the body it would multiply should favorable conditions exist for it to do so it would produce small growths or nodules called tubercles; this is also where the name/term ‘tuberculosis’ was derived from. It was believed that with tubercles, living tubercle bacilli were thriving and could be thrown off from the body (by cough, for example). In the lungs, tubercle bacilli were usually contained within expectoration, often in too high numbers. It was estimated that between 2-3 million tubercle bacilli were discharged in the expectorant from a single case of consumption in 24 hours. Though tubercle bacillus needed a host to thrive and reproduce, it was believed, at the time, that the germ could survive long periods outside of the human body, even when expectorant had dried on the ground.

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Early Roots in Kentucky

The anti-tuberculosis movement in Kentucky found its roots in the early 20th-century, primarily in the Jefferson County region. On June 7, 1905, a group of prominent men from Louisville filed articles of incorporation in Louisville for the Kentucky Anti-Tuberculosis Association. The organization would be tasked with promoting public health awareness and establishing Kentucky’s first tuberculosis hospital. Primarily spearheaded by Mr. William Carrier Nones, the Association took off at a relatively rapid pace. In 1905, Nones was the president of the Kentucky Wagon Manufacturing Co. on Third Street in Louisville. Just a short week later, the group officially met and began discussing their plans for the Association. More specifically, they started looking for areas to purchase where they could build a tuberculosis hospital. They initially set their eyes on the South Park Hotel along with one hundred acres surrounding the property; it was approximately ten miles from Louisville on the L&N Railroad and crowned a high hill. While Louisville began forging ahead with their plans, the rest of Kentucky stayed in a sort of stalwart. A growing number of Kentuckians were starting to push for a state tuberculosis sanitarium, however. The numbers of Kentuckians, and Americans at large, were beginning to increase rapidly.

Though the National Association for the Prevention of Tuberculosis established branches of the Association in every State, many government entities took a passive approach. Nearing the end of 1905, the Board of Health in Lexington noted that it “has no authority at present to enforce the isolation of a tuberculosis patient, no matter how great a source of danger and infection he may be to his family, nor even to enforce house disinfection if the persons dwelling in the house object.” The health office went on to say, however, that he was “willing and anxious” to disinfect houses whenever called upon, and has done this a number of times in the city, but until house disinfection became the rule instead of the exception, there was little they could do. In 1906 Kentucky’s Governor, J. C. W. Beckham signed off on a bill submitted by the Kentucky Anti-Tuberculosis Association to set aside from one-half to two and one-half cents on the $100 in addition to the regular tax levy for the support of a tuberculosis sanatorium. This was only a small step in a more generous plan as the win from Kentucky’s general assembly stipulated that funds from the Fiscal Court were to be provided for support of a tuberculosis hospital and the erection had to be completed at the expense of private individuals or subscriptions. In 1906 the Kentucky Anti-Tuberculosis Association had a total of $9,000 which had been collected for the erection of a tuberculosis hospital. At the time, the Association stated that they believed they could secure $25,000, and their subscription list was growing daily.

By 1907, work on the new tuberculosis hospital near Louisville was well on its way to completion. However, funding was always in short supply. The Kentucky Anti-Tuberculosis Association offered membership in the following classes:

• Associate Member: $1 annual dues
• Regular Member: $5 annual dues
• Sustaining Member: $10 annual dues
• Life Member: $100 annual dues

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The fruits of their labor came to fruition near the end of October 1907 when the Association Sanatorium at Hazelwood (referred to as Hazelwood hereon out). In addition to treating consumptives in Kentucky, it stood as a model for other Kentucky cities and counties to rely upon when additional tuberculosis facilities would open. Hazelwood had one main building at its opening, the Administration Hall, a laundry building, and two “shacks” that housed male and female patients. The shacks initially housed eight patients each, but the Association had already made plans to expand those numbers as quickly as possible. Treatment consisted of the “outdoor cure,” which was a frequently accepted approach at the time. In addition to its “curative” intentions, Hazelwood staff would also educate inmates (patients) and the public. During the opening, seven patients were already admitted in the shacks though none of them had been there for more than six weeks. Within those six weeks, two patients were declared cured and were in the process of leaving Hazelwood and returning to their homes. The “outdoor cure” consisted of leaving patients in the open day and night; plenty of air and sunlight, plenty of food, and idling and growing fat were the Hazelwood staff’s motto.

Patients were not merely laid upon the bare ground, however. The shacks of Hazelwood were open on three sides to promote the free circulation of air. Aside from the dressing room, each shack contained two bedrooms of four beds each. Day or night, rain or shine, the patients remained in the open air. The patients were allowed to lounge around and move leisurely and were at no liberty to do anything they pleased except think of walls. One hour per day was spent indoors, and that is when they gathered in the administration building to eat their meals. It was believed that heat, cold, dampness, or dryness of the air did not affect the influence of tubercular disease. More so, it was thought that close or crowded conditions with unclean air typically caused tuberculosis to worsen significantly.

Use of Dispensary

The focus was often put on the tuberculosis dispensary in treating curable cases in sanatoria throughout the United States during the early 20th-century. At the opening of Hazelwood, it was impressed upon that the dispensary, through its doctors and nurses, would keep closely in touch with cases, cleaned the house, taught them how to protect the other members of the family, supplied food, medicine, and clothing when needed, showed them how to utilize the roof or whatever “primitive” facilities were available for resting in the open air during their leisure house and was often rewarded far beyond its expectations. It was also noted during the opening that there were many instances when, under the guidance of such a dispensary, cases of well-developed tuberculosis managed to regain health without ever having to stop working from their jobs for more than a brief interval or gone outside of the city in which they live. Visits to homes of advanced cases often resulted in the discovery of unsuspected, early curable lesions among the other family members–lesions that would have, otherwise, gone unnoticed until it was too late.

As time progressed, additional private and, eventually, state tuberculosis sanatoria opened throughout Kentucky. Shortly after Hazelwood was built, Waverly Hills Tuberculosis Sanatorium was founded, followed by the rapid growth of other institutions and, unfortunately, the rapid growth of tuberculosis. The anti-tuberculosis movement in Kentucky can be credited with turning awareness and activism into reality; groups of dedicated men and women went door to door to get their neighbors to donate. Local businesses provided giveaways in addition to financial donations, and communities came together to address an issue in which state governments had been mainly passive about managing. The Kentucky Anti-Tuberculosis Association was able to expand throughout the state. They maintained a presence in Kentucky’s legislative sessions to encourage legislation for funding or to address public health needs and laws of Kentucky citizens.

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Tuberculosis Sanatoria in Kentucky

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Contributed by Shawn Logan | contact@kyhi.org

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⁘ Works Cited ⁘

1. The Lexington Leader, 9 December 1949
2. The Lexington Leader, 12 December 1952

1. The Twice-A-Week Messenger (Owensboro, Kentucky), 9 June 1905, p. 7.
2. The Lexington Herald (Lexington, Kentucky), 1 August 1905, p. 2.
3. The Courier-Journal (Louisville, Kentucky), 19 March 1906, p. 4.
4. The Owensboro Messenger (Owensboro, Kentucky), 28 February 1907, p. 3.
5. The Courier-Journal (Louisville, Kentucky), 5 July 1905, p. 5.
6. The Courier-Journal (Louisville, Kentucky), 8 July 1907, p. 4.
7. The Courier-Journal (Louisville, Kentucky), 27 October 1907, p. 4.
8. The Courier-Journal (Louisville, Kentucky), 25 January 1929, p. 13.

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