How the Great TB Sanatorium Craze came to the Rocky Mountain West

Part 2 of my review of John Green's "Everything is Tuberculosis: The History and Persistence of Our Deadliest Infection." Read Part 1 here.

There was a rush in the early part of the 20^th century to isolate humans with TB, an incredibly virulent bacterium. Call it the TB Sanatorium Craze. Colorado jumped on the bandwagon early. So did New Mexico, Arizona, and California.

While I am a Colorado native, I spent 33 years living and working north of the border in Wyoming. The Wyoming State Legislature approved a TB hospital in Basin and it opened in 1927 . This probably was due to the Legislature’s tendency to parcel out important government functions: Cheyenne gets the capitol, Laramie gets the university, Basin gets the patients of a worldwide plague. It was only fair. As the years progressed, TB patients sought out famous hot springs in Saratoga and Thermopolis. The steam, heat, and sunlight were viewed as crucial TB treatments.

The Wyoming Legislature discussed a TB sanatorium as far back as 1909. During that same time, the National Tuberculosis Association sponsored a well-attended “Tuberculosis Exhibit” in Cheyenne and Laramie. The NTA traces its roots to 1904 when concerned citizens formed the National Association for the Study and Prevention of Tuberculosis. This was their advice during the Wyoming tour, as outlined in the 1910 edition of The Journal of the Outdoor Life from the University of Michigan:

“The cure consists of plenty of good, simple food, constant fresh air during the night as well as during the day, constant rest in the fresh air until there is no fever , and then carefully and gradually increased short walks, proper care and washing of your body, and proper clothing  and, finally, a determination to get well and to be cheerful in spite of everything, and only to look on the bright side of things, however hard your circumstances may be.”

Sanatoria offered all of these things with the predictable results: The Wyoming State Archives in Cheyenne shows that in 1910-1912, when most counties in Wyoming had between one and 20 cases of TB per year. Albany, Park, and Carbon counties were on the low end with one to three cases per year (Converse County had zero!) and Sheridan, Sweetwater, and Laramie counties were on the high side with Laramie County showing 18 cases in 1911.

At the beginning of the Great Depression and the Dust Bowl in September 1930, patient census at the Basin Sanatorium in September 1930 showed 15 women and 37 men. When effective TB treatments such as streptomycin emerged in the 1940s, the heady days of sanatoria came to a close. Old Archives photos show the building in Basin where patients struggled to breathe. Sad, isn’t it, that some settlers came West for breathing room but died for lack of breath?

Why is Green’s book important to us in the 21^st century? The U.S. has a 99-percent TB cure rate and about 10,000 patients yearly although that’s going up. Green takes pains to tell the story of Americans with TB and the tough time they had before modern meds. The Rocky Mountain West, especially, was home to a number of sanatoria for TB patients. The Wyoming State Archives has documents tracing the origins of the lone state TB sanitorium in Basin.

Construction began in Basin in 1926 and the Sanitarium was opened in May of 1927. By 1969 all references to tuberculosis were removed at the Wyoming Sanatorium due to the significant decrease in the incidence of tuberculosis in the state. It was replaced by the Wyoming Retirement Center which provides nursing care to residents with mental health, dementia and other medical needs.

Colorado boasted plenty of facilities. Green writes that some cities in the West were founded by TB. Colorado Springs is one of them. National Jewish Hospital in Denver had a treatment center for consumptives. It’s still known as one of the best pulmonary hospitals in the country. Fitzsimons Army Medical Center in Aurora opened in 1918 at the tail end of World War One and its specialty was treating men with TB and those whose lungs were damaged by gas attacks.

The U.S. Army sent my unhorsed cavalry officer grandfather to Fitzsimons as he struggled with a bad case of pneumonia aggravated by chemical weapons used in the war. My grandmother, an army nurse and veteran of a M.A.S.H-style unit in France, treated him there. They married in 1922. Their eldest was my U.S. Army Signals Corps veteran father who in 1950 married a U.S. Navy-trained nurse and here I am.

Lung ailments have figured heavily in my family. My brothers, sisters, and I struggled with asthma in our youth. I almost died after a bad reaction to horses at a Weld County ranch. This pretty much demolished my dreams of replacing The Lone Ranger.  

Movie westerns have featured tubercular characters. In “Tombstone,” Val Kilmer’s Doc Holliday gambles, drinks, shoots people, coughs and sweats, not necessarily in that order. A gambler calls him a “dirty lunger” and pays the price. Gunfighter Johnny Ringo calls him a “lunger” and also pays the price. The message is clear. ”I’m your huckleberry,” Doc says, before or after shooting someone. Not bad for a lunger or consumptive patient. Doc succumbed to consumption in 1887 in Glenwood Springs, Colo. He went there in 1886 when told that the hot springs had curative powers. He apparently was misinformed. Visit his grave at the Doc Holliday Grave and Hiking Trail. Flatlanders beware: it’s located more than a mile high and it’s all uphill. Healthy lungs required.

One of our U.S. presidents, sought out the West’s fresh air and healthy lifestyle in North Dakota. Theodore Roosevelt thrived, returned to politics, declared Wyoming’s Yellowstone a national park and Devils Tower a national monument, and the rest is history and myth-making.

North Dakota’s San Haven Sanatorium in the Turtle Mountains treated TB patients from 1909 until the 1940s. As final plans were made for a 1911 opening, Superintendent of Public Health Dr. J.L. Grassick referred to TB as “The Great White Plague” because physicians marked TB-infected lungs with white arrows and healthy ones with black arrows. and assessed the illness as more a lifestyle choice than a microscopic rod-shaped bacillus with plans of its own.

“Wherever man builds his habitation, depresses his vitality by overwork or by debilitating excesses, lowers his powers of life by using insufficient or improper food, surrounds himself with the expectoration of his fellows and deprives himself of the blessings of God’s free air, there you will find it.”

Sanatoriums such as San Haven offered a higher altitude than the surrounding prairie, plenty of God’s free air, proper food, and all the available treatments. One of the more gruesome ones was puncturing and deflating one sick lung to nurture the other. During its time, more than 50 percent of the patients died.

And then came bacteria-battling antibiotics. San Haven closed. The abandoned building is billed on N.D. tourism sites as a good place for ghost-hunting. No mention of how the ghosts of The Great White Plague feel about this.

To John Green’s credit, the book includes blasts at the healthcare industry (especially – surprise! -- major drugmakers) and global policymakers. He does this surprisingly quickly in 208 pages (hardcover) and 256 in paperback. I read it on my Kindle. He requires more pages to describe faulty stars and why those turtles go all the way down, but fiction is one thing and non-fiction is another.

The story that holds “Everything is Tuberculosis” together is one 13-year-old’s journey. Green is a fine storyteller and the one he tells about Henry keeps the reader hanging on to the end.

Postscript: A big thank you to my son Kevin, a writer and tech guy in Cheyenne, for hands-on research at the Wyoming State Archives. As always, the Archives staff went out of their way to help a researcher.

John Green tells us why "Everything is Tuberculosis"

Did you ever wake up with a nagging cough and wonder “Is this the day I get tuberculosis?” Not bloody likely if you live in England or Germany or Denmark or any other place with an advanced healthcare system (even the U.S., despite its flaws).

If you live in Africa’s Sierra Leone, it might be another story.

That’s the one author John Green tells in his new book, “Everything is Tuberculosis: The History and Persistence of Our Deadliest Infection.” You may know Green from his coming-of-age novels “The Fault is in Our Stars” and “Turtles All the Way Down.” These books for young readers have been made into movie versions you can see in the streaming world.

TB has not been one of Green’s main themes – until now. It grew out of a visit to West Africa with a health organization. There he discovered that poor countries struggle with the affordability and availability of TB medications. Just one of the reasons that 1.25 million people still die annually from the world’s most infectious disease.

Historically, TB patients were described as victims of consumption or labeled “consumptives.” It may sound like a less scary term than Mycobacterium tuberculosis, phthisis, pulmonalis, or the great white plague. But consumption is a quick description of what TB does to the body: it consumes it. When it advances unchecked, it dissolves your lungs, renders you breathless, and then you die.

Readers of classic literature recall poets with consumption such as John Keats and Elizabeth Barrett Browning. Keats is sentimentalized because he wrote his gorgeous poems while being consumed by ravenous but slow-growing TB bacilli. Its slow pace makes it a particular tough disease to treat. It also, alas, gives writers lots of time to chronicle it.

This was captured in Jane Campion’s film “Bright Star” about the infirm Keats and the true love he found during his dying days. This sentimentalization, according to Green, painted male Romantic-era poets as heroic sufferers and stricken white women as pale and beautiful as marble statues. American poet John Ciardi may have said it best in “A Trenta-Sei of the Pleasure We Take in the Early Death of Keats” from his collection "Echoes: Poems Left Behind:"

The species-truth of the matter is we are glad (of what?)/to have a death to munch on. Truth to tell (which truth is what?)/we are also glad to pretend it makes us sad./When it comes to dying, Keats did it so well (how well?)/we thrill to the performance…

The romance of TB faded as it kept killing people in new and ingenious ways, and that many of those victims were not poets but the guy next door and millions in poor countries. Its discovery by Dr. Robert Koch in 1882 as a microscopic bacillus, a highly contagious one, suddenly made TB a dirty word.

Green meets Henry Reider is a poor black youngster in Sierra Leone with Multiple Drug-Resistant Tuberculosis (MDR-TB). He has several strikes against him, as he’s poor and he’s black and he lives in an African country without the medical resources required for long-term treatment. When Green first meets him, the boy is so small and thin that he looks like he’s eight and not thirteen.

Green points out that lack of health care spending is rampant in Africa. If Sierra Leone spent the same percentage of its budget on TB treatment as we do in the U.S., that would be 48 U.S. dollars per patient per year. That is less than what one round of TB prescriptions would cost. These medications are expensive and need to be taken for months if not years. Green writes that the country has its own medical schools, hospitals and doctors. But the drugmakers in the West reap big profits and their attorneys work hard to extend patents. Millions with no insurance are SOL.

Read the second part of my review of "Everything is Tuberculosis" next week.