Bed Rest And Sputum Tests: Inside Chicago's Municipal Tuberculosis Sanitarium
Today, the fieldhouse in Chicago’s Peterson Park has a game room and offers all kinds of classes for kids and adults, but 100 years ago, it served as the lab and morgue of the Municipal Tuberculosis Sanitarium. Once the nation’s largest facility to treat and quarantine victims of this highly contagious disease, the vast campus housed nearly 250,000 Chicagoans during its nearly 60 years in operation.
Questioner Laurie Nayder knew this building (and several around it) had been part of a tuberculosis sanitarium, but she didn’t know much about what happened inside their walls. So she wrote to Curious City with the question:
Can you tell me what it was like in the old tuberculosis sanitarium on Pulaski and Peterson?
The year before the Municipal Tuberculosis Sanitarium (MTS) opened in 1915, nearly 4,000 Chicagoans had died of TB, an infectious disease that mainly affects the lungs. And when it began accepting patients, there were an estimated 100,000 cases of TB in Chicago.
Covering a 160-acre campus with more than 50 buildings, Chicago’s sanitarium was a state-of-the-art facility, and the first to include a maternity ward. It was also one of the longest running in the country. To understand how the sanitarium operated, how TB patients were treated, and how those treatments evolved, we tracked down public health experts and former patients. They talked about treatments that might seem harsh (and downright primitive) today and the scientific breakthroughs that eventually made the sanitarium obsolete.
Chicagoans vote to open the sanitarium
The MTS was modeled on similar sanitariums that were operating across Europe and the United States. It was established as part of an Illinois state law that made local municipalities responsible for treating and preventing tuberculosis. But the funding to build the sanitarium required voter approval, which happened in 1909 after a long public education campaign.
“There was a traveling roadshow through all of the Chicago Public Library branches,” says Frances Archer, who has documented the history of the MTS on her blog, Me & My Shadow. “They had a display that educated people on what TB is. … The physicians and religious leaders ... all banded together to promote it, because they saw this as a social problem that needed to be addressed by the community. So they were able to prime people to vote for this.”
Tuberculosis was seen as largely a disease of the cities because it was transmitted easily in crowded quarters. If they could afford it, some patients travelled to sanitariums in resort areas. These free municipal facilities, however, were aimed at everyone else. Archer says the MTS’ first wave of patients came mostly from the tenements in Chicago’s Maxwell Street area.
“That was a primarily Jewish immigrant population from Eastern Europe,” she says. “And then later after WWI, there started to be other groups from Eastern Europe like Czechs and Poles. Later, during the peak of the Great Migration in the 1940s, you saw a larger African-American population. And so it often reflected the newest immigrants with often low incomes. But that’s not to say there weren’t a lot of middle-class people who just couldn’t afford this kind of long-term treatment otherwise.”
The sanitarium’s ‘authoritarian’ medical treatments
Contagious patients were sent by doctors’ orders to the sanitarium, and once they arrived there, they were kept separate from those with non “active” tuberculosis. Patients had to learn the rules of living at the sanitarium, which included carrying cards with them at all times that indicated their level of contagiousness by the card’s color. This alone reduced transmission rates on campus dramatically and protected visiting families from the spread of the disease.
“At the time, the thought was that you needed to get people out of crowded conditions and give them good nutrition, plenty of rest, fresh air, and sunshine,” says Dr. Mindy Schwartz, a physician and medical history professor at the University of Chicago.
So the contagious wards in the sanitarium were constructed with enormous, openable windows used all year round. Even the cottages, where patients moved after they were no longer contagious, were built with open-air porches for sleeping. Gloria Traub, who was a patient there in the early ’60s, remembers this was especially brutal in the winter.
“The windows were always open, 24 hours a day that winter, that fall, every day,” she says. “If you were cold, it was just like ‘put another blanket on you.’”
Traub notes that in the contagious ward, patients were also required to stay in bed for long stretches and remain perfectly still. They couldn’t listen to the radio, watch TV, or read.
“We couldn’t even read a book because it was thought it would disturb our TB germs,” says Traub who was a nurse and married mother of eight when she was admitted. “So many of these things just seem crazy when you think about them today.”
Another mandatory procedure for patients was the daily sputum test to determine if patients were still contagious with active tuberculosis. But gathering the sputum involved inserting rubber tubes down your throat. This left long lasting unpleasant memories for many former patients.
“To this day I will not forget that taste,” says Lill Campbell, who was sent to the MTS when she was 12 years old in the late ’50s. “It was like a hot water bottle tube, and they would give you ice water so that the sputum would come up and they could take samples. So it would be almost like you are throwing up or gagging, and then they would pull the tube out right away. To me that was horrible.”
Another sputum collection method Gloria Traub remembers was the monthly “stomach washing,” where the staff would gather sputum by running what she describes as a 3-foot hose into her nose until it reached her stomach.
“And when they were done, they would just rip it out,” she recalls. “It was medieval.”
Medical historian Mindy Schwartz says these practices just reflected the period.
“Unfortunately, at that time, medical care was very authoritarian,” Schwartz says. “But that was just the culture back then. Doctors and nurses ruled with an iron fist, and you were a prisoner at the MTS. There were gates and you were treated in a way we don’t treat people anymore.”
New technologies lead to higher survival rates
By the 1950s, antibiotics improved survival rates and reduced the length of stays in the sanitarium substantially.
“In 1948, we got the first antibiotic that was effective in tuberculosis,” Schwartz says. “It was streptomycin and it had to be given by shot. The first oral medication that was really effective arrived in 1954, and it was called isoniazid. That really revolutionized care because it was an antibiotic that could be given outside the hospital.”
These medicines and comprehensive screenings would change the TB landscape forever.
“Over time, given that we knew how to look for TB and we had chest X-rays and public health campaigns, we saw a huge decline of active pulmonary tuberculosis,” Schwartz says. “We also were able to find people who may have been exposed before they developed full-blown symptoms. So the incidence and prevalence declined dramatically throughout the 20th century.”
So, if TB rates were dropping and people could be treated with antibiotics fairly easily at home by 1954, why were so many Chicagoans still sent to the sanitarium until 1974?
There were a few reasons, including the need to monitor patients even when their TB was no longer active, because recurrence was so common. Plus, not all discharged patients remembered to take their antibiotics regularly and on schedule.
Still, TB cases continued to drop, and by the late ’60s, residents of the sanitarium mostly came from high-risk groups. These included immigrants from countries with high incidences of TB, those dealing with substance abuse, and residents of long-term care settings and homeless shelters.
Cesar Onate, who was born in Ecuador, remembers being admitted to the MTS when he was 14 years old in the early ’70s.
“I was the only kid there,” he remembers. “And I remember they fed us a lot because they wanted to fatten us up, and a lot of the people there were malnourished because they were homeless.”
This smaller population of patients combined with better outpatient plans continued to erode the case for keeping MTS open.
The sanitarium becomes obsolete
As early as 1968, budget-conscious members of the Chicago City Council were calling for the closing of MTS as a way for the city to save money. In March 1971, the Tuberculosis Institute issued a report that recommended shuttering it. The institute report further charged that half of the MTS’ 560 patients could be released immediately if “new liberal regulations were used.”
MTS officials defended the facility and its $10 million budget. They claimed they had reduced their average patient stay to just 120 days, and outpatient care would be impractical for many of their residents because they were alcoholics or homeless. The officials argued that these kinds of patients might not remember to take their medicine or show up for clinic appointments.
Still, even advocates like Dr. William Barclay, the TB committee chair for the Chicago Lung Association, acknowledged the waning need for such a large facility.
“The practice of shuttling TB patients off to a sanitarium or similar institutions for long-term hospitalization is an antiquated outmoded and costly method of TB control and treatment,” Barclay told the Chicago Tribune in 1973. He argued state lawmakers should approve legislation allowing general hospitals to treat TB patients.
So by 1974, when a report by a “blue ribbon panel” of lung doctors called the MTS “obsolete,” not even powerful Mayor Richard J. Daley could ignore it. He ordered the budget slashed and the facility closed later that year. At the time of its closing, the facility had 70 patients and 363 employees.
Looking back today
All the patients we talked to for this story have mixed feelings when they think back on their time at the MTS. They shudder at some of the procedures and rules, but they appreciate the sanitarium’s service to society .
“It was a good and it was a bad thing,” says Lill Campbell. “It protected the public from a very contagious disease, and in retrospect, it saved my life. I have issues with some of the staff and the way they treated us, but I don’t know what would have happened to me if they had not intervened. In the end, I think it was a good thing.”
University of Chicago’s Dr. Mindy Schwartz tries to look at it through the lens of the culture and best practices at the time.
“This was a public health response to a prevalent disease at a time,” Schwartz says. “But we now know that the sanitarium movement was actually a small factor in the overall reduction of TB in the U.S. and that other factors were more important. But they were working with the knowledge they had at the time.”
Today, she says, we take a much different approach to treating disease.
“For a lot of reasons, [such a place] would be inconceivable today,” she says. “We no longer dedicate entire hospitals to one disease and we have deinstitutionalized so many people. We have closed mental health hospitals, and we go out of our way to treat people as outpatients in their homes or in nursing homes. For so many reasons it wouldn’t fly.”
More about our questioner
Laurie Nayder is a Chicago teacher who grew up in the South Shore neighborhood.
“So I never knew anything about the sanitarium here on the North Side while it was operating,” she says. “My first visit was when I took my daughter to a haunted trail in Peterson Park.”
In subsequent years, she’s visited the park and nature center that sit on the old sanitarium land and even use some old MTS buildings. She even got a tour of the old MTS morgue from a park insider.
“But I wanted to know more, like what happened in all of these buildings that are still here?” she says.
As part of the reporting for this story, Laurie came along on a tour of the remaining buildings that have been converted into the Peterson Park fieldhouse, a gymnastics center, the North Park Village Nature Center and senior facilities.
She learned about the history of the buildings from Frances Archer and Wayne Schimpff who have studied the MTS for several years. And she heard about the civic sentiment 100 years ago that led to the founding of a facility built to protect the public and take care of Chicago’s sick. Laurie was especially struck by the provision in the plan that made sure all the care, housing, schooling, and even job training were free to patients.
“It was a miracle is how I look at it,” she says. “If you are sick, poor, and [a] minority [today], you aren’t treated like human beings. ... We had it right. I don’t know why we don’t have it right anymore.”