Tuberculosis (TB) – also known during the 18th and 19th century as the White Plague or Consumption – was the #1 killer in the world during the early-to-mid 1900’s. Much like COVID-19, TB swept across America at the turn-of-the-century, getting its White Death name from one of its most visible symptoms – a deathly paleness due to the lack of oxygen getting to a person’s lungs.
Unlike COVID – a virus – TB is a bacterial disease, spreads through infected mucas, and once a person has been exposed, TB attacks the lungs — often resulting in a long and painful battle that results in excessive coughing, chest pains, weight loss, fatigue, and sadly, for most people living prior to 1940 – death. Throughout the 19th and early 20th century, the crippling conditions of this lung disease caused immense fear among healthy Americans, who were terrified of a sickness they didn’t understand.
At the end of the 19th century, doctors were beginning to learn more about the disease. American physician Edward Trudeau, for example, in the 1870’s, became infected and believed he was dying. In an attempt to enjoy the remainder of his life, he traveled to the Adirondack Mountains in New York – where he remarkably recovered!
Attributing his cure to the fresh air of the mountains, Trudeau built the first American sanatorium in 1885, and that idea became a model for early building design and treatment across the country. In 1882, German physician Robert Koch finally discovered the bacterial causes of TB, but it wasn’t until 1924 when a team of French researchers finally developed a possible treatment. Which now brings us to Iowa City at the turn-of-the-century…
In 1904, deaths from TB in the U.S. were peaking at 188 per 100,000 people, and the only medical solution rested in creating sanatoriums — an isolated hospital meant to separate the infected patients from the public. Sadly, the healing process was long and agonizing, with the only “cure” for this deadly disease – fresh air, plenty of rest, and a good diet. Bed rest was required for all patients, who found themselves often lying on their backs for 24 hours a day!
But despite the drawbacks, by 1908, on what is now the University of Iowa Oakdale Campus, state workers built Oakdale Hall – Iowa’s largest Tuberculosis Sanatorium – on 280 acres of farmland originally used for cattle-breeding and an orchard. The site – just north of Coralville – was deliberately chosen to be far enough away from populated areas, yet adjacent to an easily-accessed rail line so supplies could be brought in, while doctors could have access to SUI Hospital – which, at the time, was located on Iowa Avenue, just east of Old Capitol. Read more here.
The Cedar Rapids and Iowa City Interurban Railway (CRANDIC) – which opened up rail service between the two cities in 1903 – provided a perfect transportation solution for the sanatorium. Pictured below is the CRANDIC’s Oakdale depot.
The first two TB patients were admitted to Oakdale Hall on February 1, 1908. That number quickly grew to eight, and by year’s end there were 45 patients. Over time, as a partially self-sustaining community, Oakdale Hall and its campus eventually included a power plant, several residential patient and staff buildings, a pharmacy, postal and administrative units, as well as associated facilities to support varied farming operations intended to help sustain the institution, including a large dairy. Additional facilities and more land (220 acres) were added in 1926, expanding Oakdale toward its eventual peak size – during the 1940’s – of 400 beds with over 800 patients.
The treatment philosophy at Oakdale was based on making the patient comfortable while providing a maximum exposure to sunshine and fresh air. Pavilions housed row after row of beds of infected people, with many spending every hour in bed on the screened porches all year round — even during Iowa’s harsh winter weather. As the accompanying image (below) suggests, this even included sleeping in beds with snow on the blankets!
Many staff members lived on the farm in state-provided quarters. Betty Lacina, a former occupational therapist at Oakdale, recalled how her husband took his own precautions. During his short walk from one side of the hospital to his office, he held his breath as he passed patients’ rooms. During the 1940’s, when the hospital was completely full, all departing postcards were actually lacquered to encapsulate – and thus prevent – the supposed spread of the bacteria which causes TB!
According to the National Center for Health Statistics, an estimated three million people died in America from 1900 to 1940 from tuberculosis. In 1944, American microbiologist Selman Waksman isolated a fungus that opened the way to modern antibiotic therapy, and with improving public health standards combined with the development of the first drug treatments, Oakdale usage dramatically declined. Though remaining open through the 1970’s – the last TB patient left Oakdale in 1981 – death rates now declined across the country (1980) to only 1 per 100,000!
In a story from The Daily Iowan – December 17, 2010, Betty Lacina – an occupational therapist at Oakdale from 1951 to 1962 – told her story of helping patients battle their depression.
They were away from their families. There was no way they could go home. Patients were not allowed to visit home until after six months to a year of treatment; they also needed to have some observable healing. Many never left. It was such a contagious disease, and they were endangering their family if they went back home and stayed for a period of time, so I think that’s why many of them were depressed. We had people who, because of the fact that they didn’t have any real cure for tuberculosis, some of them would be there for 15 years.
As an occupational therapist, Lacina’s job was to keep patients busy and their minds off their situation. Patients wrote letters, painted, made leather kits, and read — all on the flat of their backs.
That was the whole idea. Keep their minds occupied with something other than dwelling on their disease.
Bill Hedges, who started working on the Oakdale dairy farm in 1959, milked the 84 cows twice daily and recalled also having at least 450 hogs to care for. Hedges’ wife, Virginia, started the same year as a nursing assistant — she was 18 at the time.
Oakdale was not as much of a hospital but a community. It was just like a little town. You just didn’t ever have to leave. Living and working next to patients formed a bond that is difficult to describe. You came to love the patients, because they couldn’t go home, and then when something happened to them, that was really hard. I remember the patients screaming as they received painful shots of a thick, glue-like medicine, and in some cases, patients would die from the fluid in their lungs, while others coughed up blood from hemorrhages the disease caused. It was pretty traumatic when you’re 18 years old, giving shots and watching people bleed out and die on you.
Working among those infected with TB, strict precautions were made to ensure the staff members remained safe. The nurses wore white, one-piece, short-sleeved dress-like uniforms that were washed daily at the hospital. Cloth masks also helped prevent the spread of the bacteria. Employees at Oakdale also received chest X-rays every six months and tuberculin tests every year, but neither Lacina nor the Hedges can recall a single employee catching the disease.
There wasn’t really time to be afraid of catching the disease anyway. When you’re 18, you don’t fear a lot of things, and I suppose that didn’t even enter our minds. I guess I wasn’t smart enough to be afraid.
As medical cures replaced bed rest and fresh air, the Oakdale Sanatorium neared extinction. In 1965, the University of Iowa took full ownership of the property, using Oakdale Hall to house many different programs, including alcoholic rehabilitation and research labs, and the State Hygienic Laboratory in 1971. In 1968, the full 500 acres of Oakdale land was annexed by the City of Coralville.
The university established its Agricultural Medical Research Facility at Oakdale in 1966 as the first step of a major evolution of this rural satellite campus, which now also houses the State Hygienic Laboratory in a new facility, as well as the university’s 197-acre Oakdale Research Park, where, among many other facilities, the National Advanced Driving Simulator is located.
In 2011, what was once Oakdale Hall – the largest tuberculosis hospital in Iowa history – was torn down, after more than a century of service to the State of Iowa and the University of Iowa.
On a personal note, my wife – Sandy Unrue Boller’s grandmother – Mary Holm – was assigned to the Irene Byron Tuberculosis Sanatorium in Ft. Wayne, Indiana (pictured above) from 1948-1950. She was one of those fortunate souls who experienced the hard life of a TB Sanatorium, but recovered and went on to live a productive life until 1996 – passing into glory at the ripe old age of 96. When I was a little boy, growing up in Wayland, Iowa (1951-1956), I was diagnosed with the TB “germ” in my lungs – but, praise God – it was not alive. The doctor believed I might have picked it up from my Sunday School teacher who was diagnosed with TB.
Kudos to the amazing resources below for the many quotes, photographs, etc. used on this page.
History of tuberculosis, Wikipedia
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