By Ascension Muñoz (Article first published in Vol. 19, 2000)
White plague, consumption, TB, tuberculosis. Scientists claim this disease existed in the Cro-Magnon era. References to TB abound in literature and music. In the late 1800s and early 1900s, tuberculosis spread rapidly in the United States. The Southwest, including El Paso, was considered ideal for the treatment of TB because of its dry, warm climate. This deadly disease helped establish El Paso as a health center.
Image caption: Patients enjoyed the sunshine on the porch of the El Paso Sanatorium in 1920. (Photo courtesy of the El Paso Public Library)
Throughout most of the 19th century, pulmonary tuberculosis was thought to be a hereditary disease aggravated by humid air, damp soil, lack of exercise, inadequate diet, and overcrowded and poorly ventilated housing. However, in 1882, German physician Robert Koch described the rod-shaped organism called tubercle bacillus that causes tuberculosis. The microscopic bacteria traveling in tiny droplets of moisture floating in the air were impossible to destroy unless exposed to heat or light. Since most infections came from people with pulmonary TB, such people needed to be isolated to check the spread of the disease.
Early symptoms often went undetected, and not until a person lost weight, contracted a dry cough, a rising afternoon fever and night sweats, was it assured that he or she had “consumption.” Advanced stages would be manifest in severe chest pains and bloody sputum produced by hemorrhages in the lungs. In 1895, Allan Roentgen’s discovery of X-rays and Koch’s fi that skin could be tested helped with detection.
El Paso’s climate, characterized by mild winters, low rainfall and humidity and abundant sunshine attracted TB patients from all over the country. The completion of the Southern Pacific Railroad in 1881 encouraged tuberculars to come West.
Although official statistics do not exist for determining the numbers of nonresidents who came to El Paso for treatment of TB, one doctor examined the death certificates for place of birth of the 2,791 TB victims during the years 1904-1913. Almost a fourth had been born in Mexico, 49 percent in the rest of the country and only 12 percent in Texas.
There was no way to know whether these people had been infected before or after they migrated. However, of these persons, 63 percent had come to El Paso less than two years before. Moreover, of the 1,775 whose bodies were shipped to states outside Texas, most were sent to Illinois, Missouri and Ohio, followed by Tennessee, New York, Kentucky and Arkansas.
Early care of TB patients consisted of sitting in parks to absorb the sun and convalescing in private homes. This method was ineffective and many people died. Invalids in advanced stages of the disease or those with little money became desperate, being refused accommodation at every turn. Eating whatever and sleeping wherever they could, infected travelers stopped at farms, ranches and private homes to ask for shelter, food and work.
The migration of infected persons in search of a climatic cure created a major public health problem for sections of the Southwest from the late 1890s through the 1920s. In El Paso, consumptives who found no shelter in town camped in tents in Highland Park, on the east slope of Mt. Franklin. Conditions at the tent colonies were primitive, and fresh, well-prepared food was scarce.
During this period, many sanatoriums and hospitals opened to treat tuberculars. Partly because of the terrible conditions of TB patients in the tent city, the Daughters of Charity of St. Vincent de Paul opened a hospital on Feb. 3, 1892, in a two-story brick building at the corner of East Overland Avenue and Ochoa Street. A month later, the hospital moved to the more spacious John P. Dieter home at the corner of Upson Drive and Prospect Street in Sunset Heights.
In 1894, the Daughters of Charity opened Hotel Dieu as an 80-bed hospital at the corner of Stanton Street and Arizona Avenue. Realizing the need for professionally trained personnel to care for the sick, the sisters established a school of nursing connected with Hotel Dieu Hospital in 1898. Hotel Dieu continued to build and expand until its closing in 1988.
Dr. J. Shelton Hoseley opened St. Luke’s Hospital at 199 Missouri St. in 1900. He sold it to Dr. Charles B. Hanson in 1903 and then founded another large hospital treating mainly TB patients.
Providence Hospital, a major health-care facility in El Paso today, had its roots in care for tuberculars. Originally an enterprise of Dr. Michael Schuster, a Vienna-born doctor who came to El Paso with his family in 1892, the facility was established to care for the employees of ASARCO (American Smelting and Refining Company). Opening in 1902, the hospital became El Paso’s first major non-denominational hospital.
While the poor lived and died in tent cities and charity wards and the employed found treatment in hospitals, the more affl sought care in sanatoria. Dr. Edward Trudeau from Saranac Lake, N.Y., popularized the concept of the sanatorium in the U.S. In an article in Password, Dr. Werner Spier says that in the first two decades of the 20th century, many tuberculosis sanatoria, known as “sans,” were opened in El Paso.
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Among the first sanatoria was the Albert Baldwin Health Resort built in the Highland Park Addition in 1907. Dr. R. B. Homan purchased it two years later and renamed it the Homan Sanatorium. Also in 1909, Dr. Charles Hendricks organized El Paso’s first tuberculosis clinic, and in 1914, along with R. D. Harvey, he built the Hendricks Sanatorium. Its 53 private rooms featured individual showers, sleeping porches and tile walls
Several other sanatoria treated TB patients, including the El Paso Sanatorium at 1109 North Cotton St. built in 1910, now an apartment house; the Convalescent Home for tuberculars built at 2401 N. Copia St. in 1915 and sold the next year and renamed the Wiley Sanatorium; and the Sunnycrest Sanatorium at 2331 Tremont built in 1915 and vacated in 1925. In 1918, the old Mount Franklin Country Club became the Southern Baptist Sanatorium under the direction of Dr. F. Vermillion. An addition of 11 buildings expanded its capacity from 22 to 100 beds.
Logan Heights Estates, a real estate company, offered to the U.S. government a 12-block site at the base of Mount Franklin, and on July 1, 1921, William Beaumont General Hospital opened, catering principally to TB patients.
By the end of the century, physicians realized that TB was the result of a complex interaction of biological, medical, cultural and socioeconomic factors. The disease would thus have to be countered by the efforts of not only doctors and hospitals but also public health and other governmental officials and educated citizens. A proper balance between education and legislation would be needed.
William McDuffie Brumby, public health pioneer and physician, helped found the Tuberculosis Association in 1909, having written the Texas sanitary code. He was one of the first health officers in the country to test daily groups for TB. He convinced the International Congress on TB in Washington, D.C., to persuade officials in eastern states to establish local TB treatment facilities rather than send their residents to the supposedly healthful climate of West Texas.
Between 1900 and 1910, more than 4,000 deaths a year in Texas occurred from pulmonary tuberculosis. In 1911, the Texas legislature passed a bill creating two colonies dedicated to the treatment and education for people infected with TB. Although plans for the treatment of advanced cases were abandoned, the state purchased 330 acres near San Angelo for the location of the colony to treat early cases. The colony provided rest and clear air for the patients and the isolation to calm the fears of the public. Patients between the ages of six and 60 could stay for six months.
The colony became the State Tuberculosis Sanatorium in 1913, and Joseph B. McKnight became resident superintendent. Under McKnight’s leadership, the sanatorium expanded for the next 35 years. Because attracting employees was difficult, the Sanatorium School for Nurses opened in 1915 to train the needed staff, and the first four graduated in 1917 with a R.T.N. degree (registered TB nurse).
Today, tuberculosis is back with force, and drug- resistant strains make treatment difficult. An estimated 10-15 million Americans are unknowingly infected with TB. Tuberculosis is the worldwide leading infectious killer of adults, with someone being infected every second. Eight million new cases occur annually, and of these, only five million receive any form of treatment, according to current statistics from the Atlanta Center of Disease Control.
Border areas pose special problems. The tuberculosis case rate there is 50 percent higher than the incidence for other large U.S. cities, primarily because rapid migration over the years has surpassed the ability of public health services to keep up with demand. While both sides of the border battle AIDS, the modern “plague,” an old enemy is gathering strength to strike again.
UPDATE 2017
There is good news on treating tuberculosis and the battle to contain outbreaks and improve TB education. Latent and active TB are treated with different antibiotics over a period of six to nine months, and it is crucial to fi the entire course of treatment, according to the Mayo Clinic website. Different medications are required for drug-resistant strains. TB is contagious with close contact with a person actively infected, but it is generally not easy to catch.
According to the Texas Department of State Health Services as of August 2016, the incidence rate of tuberculosis in El Paso County declined from a high of 7.6 cases in 100,000 people (2006-2010) to 4.9 cases (2011-2015). In 2014, the national case rate was 3.0 per 100,000. A third of the cases are found in people born in the U.S., and the top fi countries of origin for non-natives are Mexico, the Philippines, India, Vietnam and China.
In this century, there have been advances in testing including blood tests known as Interferon Gamma Release Assays (IGRAs) that are more accurate than the conventional skin tests and involve just a single visit by the patient. According to the Texas Department of State Health Services, “regional and local tuberculosis programs are adopting the IGRA test as the standard tool to screen for TB.”
In El Paso in the past several years there have been reported TB testing done at an adult day care center in 2017, a halfway house and an elementary school, but no active cases were found.
The incident that received the most coverage was the reporting of over 800 staff and patients, most of whom were newborns, at Providence Memorial Hospital, who were exposed to an employee with active symptoms of TB. No active TB cases were found although 11 infants tested positive, but officials said seven of those were false positives. In April 2015, the Texas Department of State Health Services fined the hospital $34,000, the largest fine incurred by a Texas hospital from April 2015 to April 2016.
The website modernhealthcare.com reports that a $1.5 billion putative class action suit was filed by the families of 3,000 children delivered at Tenet’s Hospitals of Providence Memorial Campus facility. The suit alleges that the employee notified administration of her active status in December 2013, but she still worked with newborns in 12-hour shifts until August 2014.
The El Paso County Department of Health offers screening, treatment and education services. The office is at 5115 El Paso Dr., Suite B, near the University Medical Center. For more information, see their website.
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