TB Notes, 2000
National Jewish: The 100-Year War Against TB
by Jeff Bradley and
Michael Iseman, MD
Director, National Jewish Medical and Research Center
National Jewish Medical and Research Center,
which celebrated its centennial in 1999, is known today for its expertise in a
wide array of respiratory, immunologic, allergic, and infectious diseases. At
the time of its founding, however, it had a single purpose: the care of
impoverished victims of TB.
The need for a TB hospital became acute in
Denver in the 1880s. In those days, people believed that the dry climate of the
high plains on which Denver is located would cure tuberculars (i.e., persons
with TB disease). Consequently, many TB sufferers spent their last dollars
coming to Colorado. By the 1890s, it was estimated that one out of every three
residents of the state was there for respiratory reasons.
Image 1: Picture of the Old National Jewish Hospital
In Denver, TB patients were literally dying on
the streets. Boarding houses often banned "lungers," as they were
called, and many of them were too sick to support themselves. A woman named
Frances Wisebart Jacobs recognized the need for a TB hospital and, after joining
forces with a young rabbi, the two raised enough money to buy some land and
erect a building, which was ready for patients in 1893. Unfortunately, however,
Denver was hit with the Silver Crisis that year, and there was not enough money
to open and run the hospital.
This setback convinced the organizers that they
should expand their fundraising efforts beyond Colorado. The thinking in Denver
was that, since patients came there from all over the nation, people all over
the United States should help support the hospital. They turned to B'nai B'rith,
a national Jewish service organization, and contributions came in from across
the country. The building finally opened in 1899 as the "National Jewish
Hospital for Consumptives."
National Jewish was the first hospital in the
nation to focus exclusively on indigent TB patients. As expressed in a singular
motto, this philosophy was "None may enter who can pay, none can pay who
enter." From day one, National Jewish was non-profit and non-sectarian.
The hospital opened with a capacity of 60
patients; the goal was to treat 150 patients per year. This was made possible by
putting a 6-month limit on patient stays. Furthermore, National Jewish only
accepted patients in the early stages of TB. At least that was the plan. In
reality, however, several chronic sufferers were admitted, and after a few
months, the 6-month limit was lifted.
The treatment at National Jewish was in line
with the protocols at other turn-of-the-century TB sanatoria: plenty of fresh
air, lots of food, moderate exercise, and close scrutiny of every aspect of
patients' lives. The inhabitants of National Jewish, thus, could expect to
sleep outside � or with their heads outside � every night, and were all but
stuffed with food. In 1911, for instance, the annual report records that
National Jewish spent $3,631 on eggs � roughly equivalent to $62,000 today �
for just 120 patients.
In 1914, National Jewish erected a building for
the study of TB; this was the first place in which research on the disease was
done outside of a medical school setting. Other advances included the nation's
first self-contained facility for treating children with active cases of TB and
work on anti-TB drugs such as isoniazid (INH) in the early 1950s. Later in that
same decade, doctors at National Jewish came up with a new protocol for TB that
included abandonment of bed rest and a substitution of physical activity; use of
microbiological assay measurements to determine the proper dosage of INH; and
combined drug therapy using streptomycin, INH, and para-aminosalicylic acid.
As TB gradually came under control in the
United States, National Jewish expanded its mission to include asthma and other
respiratory diseases, but maintained a strong presence in TB. Research continued
on better drugs, and the institution expanded its education efforts. In 1963,
the 1- to 2-week TB control course was offered for specialists from all over the
world, a course that is still offered today. Indeed, over the past 20 years,
nearly 5,000 physicians and nurses have visited Denver for the course.
Rifampin, the most widely used drug for TB
today, was tested at National Jewish in 1970. Two years later, federal funds
established a state-of-the-art laboratory to study difficult TB cases. This
helped establish National Jewish as a highly specialized center for
drug-resistant TB and atypical mycobacterial infections.
Today, National Jewish continues to be a steady
contributor in the fight against TB. The hospital offers compassionate care to
victims of MDR TB, often providing treatment for the poor at no charge. Leading
pharmaceutical companies collaborate with National Jewish to test new drugs.
Perhaps the greatest contribution of National Jewish is in education. In
addition to the TB course, the hospital maintains a Mycobacterial Consult Line,
a free service whereby physicians anywhere in the world can call up and receive
advice from our specialists. Over the past 5 years this service has responded to
over 2,000 calls annually.
At the opening of National Jewish back in 1899,
the president of the institution, speaking of TB in the exalted rhetoric of that
day, declared that it was his dream for the hospital "that its doors may
never close again until the terrible scourge is driven from the earth."
Now, at the time when the World Health Organization estimates that one out of
every three people in the world is infected with TB, those doors are still open.