Clinical and Health Affairs
Cousin Lizzie’s Tuberculosis Tent
By Richard I. Haddy, M.D., and Theresa B. Haddy, M.D.
Abstract
Before the discovery of antibiotics as a cure for tuberculosis in the 1940s, open-air therapy was the standard treatment for the disease. This article describes how families and health care institutions used tents, shacks, balconies, and verandas to expose loved ones and patients to the cold, pure air that was believed to help them fight tubercle bacillus.
At first glance, the photo seems unremarkable. A young woman stands beside a tent on the farm owned by her family near Wabasso, Minnesota. The note beside it in the album reads: “Cousin Lizzie at her rest and sleeping tent, 1916” (Figure 1).
But the image has a certain significance: It tells the story of how tuberculosis was treated in the early 20th century and how families cared for loved ones who had contracted the disease. The woman in the photo, who was about 26 years old at the time, was the cousin of our mother and grandmother.
Cousin Lizzie, the oldest of six children, was the first in her immediate family to be diagnosed with tuberculosis. Most of the family members were eventually afflicted—only her youngest sibling, a brother, did not contract the disease. Many spent time in sanatoriums, and some died.
The outdoor structure, built according to the best information available at that time, was evidence of the family’s affection for Lizzie. She was not banished; rather, she was able to remain at home on the farm in the care of her loved ones while receiving what was considered at the time to be optimal care—fresh, pure, open-air therapy.1,2
Cure in the Cold
The combination of rest and fresh air for people with tuberculosis was first suggested by Dr. Ebenezer Gilchrist in his 1777 book Uses of Sea Voyages in Medicine. Gilchrist advised patients with pulmonary tuberculosis and other diseases to take a sea voyage as therapy.2 G.M. Balboni’s 1935 review of the treatment of pulmonary tuberculosis was illustrated with a drawing of the tent ward at Massachusetts General Hospital (Figure 2). Pneumothorax for tuberculosis was first performed at Massachusetts General by Dr. Samuel Robinson in 1909, with patients benefiting from both lung surgery and the fresh air of the outdoor ward.2 Some believed that if the immune system did not have to fend off airborne contaminants, it could fully attack the tubercle bacillus.
Sleeping outdoors was considered to be so important for patients with tuberculosis that a number of different therapeutic structures—including shacks, tents, verandas, and balconies—were recommended. Even sleeping on the ground was advised. In one elaborate description of a tent for the treatment of tuberculosis, “free passage of air” was to be provided; it was considered essential to keep a gentle current of air moving from the space beneath the floor upward and out of the tent.1 Thus, not only would pure air be added, but impure air would be removed, with “no possibility of its being rebreathed.” Other rather ingenious inventions included window tents that sometimes let the patient’s head protrude outside and half-tents with reclining chairs that could be utilized indoors.3 Cold air was considered salubrious, but caretakers were cautioned to ensure the patient’s comfort and warmth with plenty of blankets, layers of newspaper between the coverings, a hot water bottle for the feet, and a woolen helmet to keep the head warm.
Healthful Destination
Minnesota became a haven for people seeking such treatment. Because the state claimed to have exceptionally pure, dry air (southern and southwestern Minnesota were touted for their rich farmland and unpolluted air; northern Minnesota for its forests and lakes) that would cure consumption, bronchitis, and diseases of the chest, it attracted a large number of immigrants from Europe and settlers from the eastern United States in the 1850s.4 Many of these new residents had tuberculosis. By the end of the century, tuberculosis in combination with other infections was believed to be responsible for almost one-third of Minnesota’s annual deaths.4
As transportation improved, people who were seeking better health bypassed the state and went further west and south. By the early 1900s, Minnesota was no longer a destination for people with tuberculosis. But the disease continued to be a problem in the state.5 Redwood County, which included the village of Wabasso near Lizzie’s family’s farm, recorded 5 deaths from tuberculosis in 1927. In 1928, 2,000 persons in the county tested positive for the disease. Between 1936 and 1940, the death rate in Redwood County from tuberculosis was 20 per 100,000 population.
The Coming Cure
Fresh-air and tent therapy were the standard treatment for tuberculosis in the early 20th century. In the mid-1920s, a number of drugs, among them arsenic and gold, became popular treatments despite their lack of benefit for patients with the disease.6 In November 1944, H. Corwin Hinshaw, M.D., Ph.D., of the Mayo Clinic reported successful treatment with streptomycin, the first antibiotic that proved effective against tuberculosis.7 After this discovery, tent and fresh-air therapy rapidly went out of fashion. By 1947, 2 years after the introduction of streptomycin, Redwood County’s death rate had fallen to 4.8 per 100,000 population and was the lowest in the state.5
Eventually, tuberculosis organisms became resistant to streptomycin, so other antibiotics were developed to treat the disease. Today, standard chemotherapy for active cases involves a 4-antibiotic regimen of isoniazid, ethambutol, pyrazinamide, and rifampin.8 Streptomycin is still sometimes used instead of rifampin. Unfortunately, discovery of the efficacy of streptomycin and other antibiotics came too late for cousin Lizzie, who died of tuberculosis in 1918 at 28 years of age. MM
Richard Haddy is a professor and immediate past vice chair for academic affairs in the department of family and geriatric medicine at the University of Louisville in Kentucky. Theresa Haddy has an academic advisory appointment at the Children’s National Medical Center in Washington, D.C.
References
1. Fisher I. A new tent for the treatment of tuberculosis. JAMA. 1903;41:1576-7.
2. Balboni GM. The development in the treatment of pulmonary tuberculosis from 1696 to the present time. N Engl J Med. 1935;212:1020-7.
3. Knopf SA. Aerotherapy and solar therapy in the home treatment of tuberculosis: with description of a window tent. JAMA. 1907;48:214-8.
4. Myers JA. Masters of Medicine: A Historical Sketch of the College of Medical Sciences University of Minnesota 1888-1966. St. Louis, MO: Warren H. Green, Inc.; 1968, pp. 25, 26.
5. Webb WE. Redwood: The Story of a County. St. Paul, MN: North Central Publishing Co.; 1964, p. 520.
6. Benedeck TG. The history of gold therapy for tuberculosis. J Hist Med Allied Sci. 2004;59:50-89.
7. Hinshaw HC, Felman WH. Streptomycin in treatment of clinical tuberculosis: a preliminary report. Proc Staff Meet Mayo Clin. 1945;20:313-8.
8. Campbell IA, Bah-sow O. Pulmonary tuberculosis: diagnosis and treatment. Brit Med J. 2006;332:
1194-7.