PulmonaryTuberculosisisanairbornediseasethatattacksthelungsthroughapathogen

calledMycobacterium(CDC,Tuberculosis).AlthoughTuberculosiswaspresentduring
ancienttimeswithinareassuchasGermanyandEgypt,itseffectswerenottrulydiscovereduntil
itenteredtheUnitedStateswithinthe19thcentury,whereconditionswerefavorableforits
dispersal(Mullner113).Theseconditionsincludedcrowdedandunsanitaryenvironmentsin
whichpeoplesusceptibletothediseaseresided.Eventsleadinguptotheepidemicresultedinthe
birthoftuberculosissanitariumsthroughouttheUnitedStatesandinternationally,specificallyin
heavilypopulatedcities.TheChicagoMunicipalTuberculosisSanitarium,inauguratedin1915,
effectivelyprovideddirectaidforthoseafflictedwithtuberculosisandpreventeditstransmission
bypromotingawarenessthrougheducatingthepublic.
Regardlessofsusceptibilityorof
socioeconomicstatus
,theSanitariumprovidedaccesstotreatmentinordertoabolish
tuberculosis.TheSanitariumnotonlycontributedtoimprovedpublichealthconditionsinthe
early1900sitalsocontinuedtodeterminehowotherpulmonarydiseaseswereaddressedin
futurehealthcriseswithintheUnitedStates.
Theemergenceoftuberculosisdependedonspecifichistoricalcircumstances.The
AmericanIndustrialRevolutioninthe19thcenturyresultedextensiveunemployment,as
employeeswerereplacedbyasinglemachineabletomanufactureproductsmoreefficiently.
Althoughthedevelopmentofmachinescausedlossofjobs,employmentwasstillavailableto
thosewhocouldoperatethemechanicalinstruments.DuetotheIndustrialRevolution,working
environmentschangeddrasticallyemployeesnowlaboredinenclosed,crowded,andunsanitary
factoriesproducingcommoditiesincontrasttoperformingoutdoorstendingtoagricultureor
simplywithinthecomfortoftheirhomes(Mullner114).Industrialhourswereinterminableand

largefamiliescouldnotsurviveoffoftheadultsminisculeincome(Mullner114).Inorderto
avoidpoverty,childrenbeganworkingtoearnadditionalincomefortheirfamilies.Despitethe
desperateattemptstoavertit,povertystrucknumerousfamiliesasaresult,theyresidedin
unsanitary,crowdedhomeswheremalnourishmentwasunavoidable(Mullner114).Because
tuberculosistargetspeoplewithweakenedimmunesystemsandthoselivinginunsanitary
conditions,thediseasebegantospreadrapidlyincitiessuchasChicago,Peoria,andRockford
(Sachs11).
InadditiontotheIndustrialRevolution,immigrationwasanotherfactorthatcontributed
totheepidemicoftuberculosisintheUnitedStatesandtheprogressionofsanitariums(
The
TuberculosisProbleminChicago
1).Immigrantsfromregionswheretuberculosiswasa
commondisease,asinEurope,transmittedthediseasetovulnerablehosts.Thesemigrantswere
moresusceptibletotuberculosisduetofactorsincludingpoorimmunesystemsorlackofproper
medicalfacilities,lowincomes,andunsuspectingexposuretothedisease(Mullner111).With
thepreconditionsofanovercrowdedpopulationandahighlevelofsusceptibility,tuberculosis
soonbecameanepidemicthatdemandedapublichealthresponse.
Toaddresstheoccurrenceoftuberculosisinheavilypopulatedcities,IllinoisState
SenatorEdwardJ.GlackinpresentedtheCityTuberculosisSanitariumActofIllinoison
February23,1905.Thebillrequestedabudgetof$200,000forthepurchaseoflandand
buildingstoconstructastatesanitariuminordertoaidvictimsoftuberculosis(Sachs9).Both
branchesofthestatelegislatureacceptedtheactafteranadjustmentinbudgetingtoonly
$25,000.However,GovernorCharlesSamuelDeenenstilldidnotsignthebillintolawoutof
preferenceforusingstatefundstoinvestineducationalprograms(NGA).OnJanuary14,1908,

thegeneralassemblyintroducedarevisedstatuteinresponsetothegovernor'sdisapproval.This
ordinancedifferedfromitspredecessorinseveralaspects.First,itproposedsanitariumswithno
financialdemandtoresidentslivinginthecity.Secondly,theordinanceenforcedtaxesthrough
theTuberculosisSanitariumFundforbudgeting.Lastly,citizenswererequiredtovoteinorderto
adopttheact(Sachs12).ThemodifiedbillwasapprovedandbeganonJuly1,1908(Sachs9).In
Aprilof1909,Chicago,thecityinwhichtuberculosiswasmostprevalent,wasfirsttoadoptthe
act.Priortoitsopening,theSanitariumappointedaboardofdirectorswhichincludedapresident
andsecretarytocarryoutdecisions.HarlowN.Higinbothamwaselectedpresidentwhile
TheodoreB.Sachswasappointedsecretaryoftheinstitution(Sachs14).InadditiontotheBoard
ofDirectors,theDispensarySystemwasagroupofnursesequallyresponsibleformaking
decisionsregardingtheselectionofsuitablecasesfortreatmentatthesanitariumandother
institutions(MTS,
TheChicagoMunicipalTuberculosisSanitarium
14).OnMarch8,1915,the
firstChicagoSanitariumofficiallyopenedtoreceivepatients.
Onthedayofitsopening,theSanitariumheldatotalcapacityof950bedsandprovided
segregatedgroundsonwhichmaleandfemaleadults,children,andnewbornswouldreside
(Sachs39).FurtherisolationinanInfirmaryBuildingwasrequiredofpatientswhowere
suspectedofhavingcontractedacontagiousdiseaseinadditiontotuberculosis(Sachs42).This
separationwastoensurethatallpotentialmeansoftransmissiontorecoveringpatientsfrom
newlyadmittedpatientswouldbeprevented.Areasofslumberandhealthymealswerecrucialin
thetreatmentoftheillness.Thiswasduetotheextensiveamountoftimetheaverageclient
stayed,whichwasfourtosixmonths,thoughthisvariedforeachperson(Sachs23).Inaddition
tophysicaltreatment,theSanitariumassistedpatientsbyprovidingresourcesformentalstability

througharrangingsocialandrecreationalevents,religiousservices,andschoolforchildren
(Sachs39).Inadditiontoresidencyprovisions,theinstitutealsostrivedtoimprovethepresent
highstandardsofmedical,surgical,andnursingservicesinallareasoftheMunicipal
TuberculosisSanitarium(Strohl).Toattainthisplan,researchandmedicalexaminationwere
conductedinvariousbuildings.TheseareasconsistedoftheXraydepartment,tolocatethe
extremitiesofpulmonarytuberculosisinpatientsandtheSurgicalDepartment,toeliminate
respiratorycomplications(MTS,
TheChicagoMunicipalTuberculosisSanitarium
11).
Laboratorieswereparticularlyhelpfulinmonitoringbacteriaofindividualcasestodeterminea
solutionformajorandminorversionsofthediseasewithintheSanitarium(Sachs40).These
laboratorieswereessentialresourcesthatventuredtocurepulmonarytuberculosisaswellas
jointandglandularversionsthatalsohadaconsiderableeffectonthecommunity.Laboratories
thusplayedapivotalroleindoctorsworktodiscoveracuretorelieveclientsandaccomplish
theprimarygoalofconqueringtuberculosis.
Supplementarytoaidingthehospitalizedcommunityoncampus,theDispensary
Departmentwasalsoresponsibleforthesupervisionofthelargenumberofcaseswhichhaveto
betreatedathome,eitherbeforeadmissiontoaninstitutionorsubsequenttodischarge,alsoof
casesinwhichinstitutionaltreatmentisimpossibleforvariousreasons(MTS,
TheChicago
MunicipalTuberculosisSanitarium
14).Severalmethods,suchastheimportanceofventilation
toridanareaoftubercularair,werepracticedwithintheinstitution.Thoseunabletoattenda
sanitariumwerenotawareofthesignificanceofthesemannersthatwouldbenefittheirhealth.
Therefore,nursestraveledtohomesandexposedtheiruninformedpatientstotheseeffective
techniques.Themostcommonformofexcellentventilationwasachievedthroughoutdoor

treatmentinhomesofTuberculosispatients,forthepurposeofbenefitingthepatientand
protectingthefamilyfrominfection(Sachs32).Theinexpensiveroomsweredesignedbythe
BureauofSpecialReliefoftheDispensaryDepartment,andtheyrepresentedthefirstmunicipal
undertakingofitskindintheUnitedStates.Thepossibilitiesofthisundertaking,efficientlyand
economicallymanaged,arenodoubtverygreatinthefieldofmunicipalcontrolofTuberculosis
(Sachs32).TheChicagoSanitariumsuseofoutdoorventilationroomsintheUnitedStates
motivatedothersanitariumstoinstalltheseporchesaswellasspreadofthegospeloffreshair
andrightliving(
NursesPapers
25).Indistributingthiswordofrightliving,nursesofthe
DispensaryDepartmentwererequiredtotraveltootherstateswithintheU.SsuchasNewYork
andPennsylvaniatopromotetheutilizationofoutdoorroomsandtheirrelevanceinmanaging
tuberculosis(
NursesPapers
24).
Tofurtherfamiliarizethecivilianswithadequatemethodstoprotectthemselvesandtheir
familiesfromtuberculosis,membersoftheDispensaryDepartmentadvertisedpublichealth
education(Sachs34).Theseinstructionsweredisplayedthroughbulletins,literature,exhibitions,
andthedistributionofsmallleafletsbearinganearlydiagnosisofTuberculosisandgiving
locationandhoursofthetenMunicipalTuberculosisDispensaries(Sachs34).Allofthese
mediumsincludeddifferentadvicehowever,theyallhadthecommonpurposeofspreading
awarenessabouttuberculosis.BulletinscontainedpapersonvariousphasesofTuberculosis
whichmadeaccuratesymptomsofdiagnosisavailabletothepublic(Sachs34).Exhibitionswere
designedtoattractlargeaudiences,whichintheperiodof266exhibitdayswasshowninthe
fieldhousesoffifteensmallparksandinfivepublicschools,theexhibitbeingviewedby
307,500people(Sachs34).Literaturewaswrittenindifferentlanguagestocommunicate

understandingtoforeignerswhichwereavailabletotheminlocationsofexamination(Robertson
5).Regardlessofthemediuminwhichthedatawasdisbursed,alertingthepublicabout
tuberculosisanditscontagiousnessmotivatedpeopletomaintainexceptionalhealth.This
encouragementleadpeopletotakeprecautionaryactiontoavoidtuberculosis.Thepositive
responsetopreventivemeasuresdisplaystheachievementsoftheSanitariumanditsinvolvement
withpublichealtheducation.
Insupplyingpublichealtheducationtogeneralaudiencesandprovidingtreatmentwithin
homesforthoseunabletoaffordsanitariaaid,theChicagoSanitariummadeitsprovisions
accessibletoallpeople,includingunderprivilegedfamilies.Onefinancialprovisionthatthe
ChicagoSanitariumofferedwasemploymenttodischarged,recoveredpatientswithinthe
departmentsoftheinstitution(MTS,
TheChicagoMunicipalTuberculosisSanitarium
14).Such
employmentenablednonresidentstopayfortheirtreatment.Afterthisarrangement,pricesfor
Sanitariumcareinbeds,theplacewheremostpatientsresided,werereducedfornonresidents
duringthe1950s(MTS,
TheTuberculosisProbleminChicago
2).Thisadjustmentinfee
enhancedtheSanitariumsaccessibilitytononresidents.TheSanitariumalsomadeitapriority
tocuretuberculosisineveryaspectoflife,includingforthosewholivedtheirsbehindprison
walls.In1954,achestxrayprogramdesignedtolocatetuberculosiswasavailableforinmatesin
CookCountyprisonswhowerethenfurtherisolatedandtreated(Strohl).Althoughthiswasa
difficultissuetoconfrontduetolocation,departmentsoftheSanitariumwentoutoftheirwayto
ensurethataidwassuppliedtoeveryoneinneedofit.Tofurtheraddressanyotherpotential
cases,foodhandlersinthecitywererequiredbytheChicagoBoardofHealthtobeexamined
withxrays,alsointheyearof1954(Stohl).Administeringinspectiontoemployeeswithin

factoriesthatmanagedfoodwasacrucialdecisioninpreventingthetransmissionoftuberculosis
tothepublic.Theavailabilityofdiagnosis,treatment,andresourceshelpedaccomplishthe
Sanitariumsgoalofsuppressingtuberculosis.
Inadditiontothisimprovement,theadmissionslistforpatients,controlledbythe
DispensaryDepartment,wasremoved(MTS,
TheTuberculosisProbleminChicago
2).Thiswas
aresponsetothepreviouslydelayedentranceofpeopleintotheSanitariumwhichresultedin20
deathspermonth(MTS,
TheTuberculosisProbleminChicago
2).Althoughsomemayviewthe
unfortunatedeathsastheSanitariumsfailuretotreatthedisease,theprocesswascompletely
alteredinordertopreventthedilemmafromoccurringagain.Applicantswereadmittedwithout
unduedelay,therebygivingthemcareandstoppingthespreadofthedisease(MTS,The
TuberculosisProbleminChicago,2).ThischangeofpolicydemonstratestheSanitariums
abilitytoconfrontdifficultissuesandlearnfromtragicexperiencestoimproveitsprovisionof
publichealthservices.Furthermore,therateofdeathattheSanitariumdecreasedfrom29
percentin1946to7percentin1956meanwhile,thedeathrateforpeopleinChicagowith
tuberculosisin1956per100,000peoplewas11.4percent,a4.4percentdifference(MTS,
The
TuberculosisProbleminChicago
2).BecausethedeathratewithintheinstitutionandinChicago
bothsubsidedduringthe1950s,adirectcorrelationstandsbetweensanitariumaidandits
effectiveness.Despitethecircumstancethattranspiredfrompostponementofadmission,the
Sanitariumstillprovedtobeefficientinalleviatingpeoplessymptoms,andwithoutthe
institution,thesedeathrateswouldhavebeenmuchmoredetrimentaltothepopulationwithin
Chicago.

Bytheearly1970s,theChicagoMunicipalTuberculosisSanitariumwasnolongerin
operation(Vieweg,
Tuberculosis
).TheriseofmedicinessuchastheantibioticStreptomycinand
theprocessofChemotherapy,whichwasusedbrieflyandwasbeneficialtosomeindividuals,
wasefficientincuringmajorityofthecases(Strohl1).BeforetheSanitariumwasestablished,75
percentofthediseasewaspresentinChicago(MTS,
TheTuberculosisProbleminChicago
1).
Bythelate20thcentury,fewcasesoftuberculosisremainedinIllinois,soitwasnolonger
necessarytokeepsanitariumsopen(Mullner125).Theepidemicoftuberculosiswas
significantlycontrollednotonlyinthestateofIllinois,butwithintheUnitedStatesasawhole.
TheSanitariumaccomplisheditsvisionofcontainingthetuberculosisepidemic,whichhad
previouslycausedmoredeathsthantyphoidfever,diphtheria,whoopingcough,measles,scarlet
feverandsmallpoxcombined(Mullner115).Withthisvision,theChicagoTuberculosis
Sanitariumgalvanizedmanycountiesandstatestobuildsanitariumsaswellasclinicstoaid
residentsoutsideofIllinois(Sachs13).Throughpublichealtheducation,theSanitariummade
effectivedecisionstoalertcitizensabouttuberculosisanditspreventionwithinIllinoisandoutof
state(
NursesPapers
24).EventhoughtheSanitariumisnolongerinservice,theirlegacy
continuesthroughtheirmoderndayorganization.TheTuberculosisInstitute,theoriginalgroup
thatestablishedtheMunicipalTuberculosisSanitarium,wasrenamedtotheAmericanLung
AssociationorChicagoLungAssociationin1972toreflectitsbroaderscopeofconcernwith
otherlungdiseases(HistoricalSketchoftheChicagoLungAssociation1).Thesepulmonary
diseasesincludeasthma,lungcancer,chronicbronchitis,influenza,andothers(ALA,Lung
Disease).TheMunicipalInstitutedemonstratedleadershipinthepastbyconfrontingthe
epidemicoftuberculosisandcontinuestoaddresstoughmedicalissuesastheChicagoLung

Association.Themoderndayorganizationalsocontinuestopracticepublichealtheducationthat
theSanitariumpreviouslyusedtocommunicatepreventativehealthmeasures.Therefore,the
publichealtheducationandmedicaldedicationoftheChicagoMunicipalTuberculosis
Sanitariumcontinuestoleavealegacy.
TheChicagoMunicipalTuberculosisSanitariumwasabletoapproachandcontrolthe
tuberculosisepidemicwhentheUnitedStateswasindesperateneedofmedicalattention.Their
leadershipandlegacyregardingpublichealthwillcontinuetohaveanimpactthroughouthistory.
Astheauthorsofa1932reportwroteabouttheearlyyearsofthetuberculosisepidemicThese
aresomeoftheproblemsthatconfrontedthisneworganizationinitsearlystruggletocurefor
immediateneeds,improvisesanatoriumcare,surveythefield,analyzeneeds,planprograms,by
givingthemitssupport,butthesestruggleswerethebeginningofprogress(HalfaCenturyof
ProgressintheMovementAgainstTuberculosis34).