Saving Sickly Children: The Tuberculosis Preventorium in American Life, 1909-1970

Chapter 3: Founding the Preventorium

The Pirquet test and all that it may mean had taught us many things that most of us would not have believed a decade before. —Allan Krause, 19181 On June 14, 1907, Clemens von Pirquet announced in a dramatic presentation to the Vienna meeting of the Imperial and Royal Society of Physicians that he just discovered a way for physicians to recognize children infected, but not yet sick, with TB. Pirquet was accompanied by a six-month-old baby whom the physician had diagnosed with tuberculosis through what he termed the “allergy test.” Two days before the meeting, and again that morning, the young physician had placed a drop of tuberculin on abraded areas of both of the infant’s forearms. Pirquet concluded that the resulting inflammation, which he demonstrated to his colleagues, signaled a tuberculosis infection. Convinced that tuberculin offered an important clue for unraveling the mystery of tuberculosis, especially when used in healthy-appearing children, Pirquet argued his case for tuberculin’s clinical significance. He believed that sensitivity to tuberculin occurred after exposure to the tubercle bacillus, what we today refer to as an antigen/antibody reaction. Pirquet derived the term “allergic” from the Greek words “allos,” meaning other, and “ergo,” meaning work or action, and concluded from his results that tuberculin could be used 48 Chapter 3 Founding the Preventorium Founding the Preventorium 49 to determine those individuals in whom infection had occurred, even if the substance did not represent the cure that Koch had earlier hoped.2 Within the next few months, Pirquet set out to test his hunch on a large scale, undertaking an experiment in which he administered tuberculin cutaneously to over 1,400 clinically non-tuberculous Viennese children under the age of fourteen. His method in this experiment consisted of scrubbing the child’s forearm with the anesthetic ether, and then using a needle scratch to place two drops of tuberculin about four inches from each other just under the skin. Pirquet examined each child twice, once after twenty-four hours and again after forty-eight hours. In order to be accorded a positive reaction, Pirquet decided that an inflammatory reactive area measuring five millimeters in either location had to result from the procedure. Over eighty percent of the children tested positive.3 While not the first to use tuberculin as a diagnostic agent, Pirquet proposed a novel idea, that a complex relationship between host and bacillus mediated the clinical response to the substance.4 From his experiments, a new category of tuberculosis infection emerged. Previously, physicians classi fied children into two groups, the sick and the well. A third group could now be distinguished, “pretubercular” children, comprising those without active disease but infected with the bacillus and afflicted with general symptoms such as fatigue, weight loss, and pallor. Pirquet hoped that identifying youngsters before they manifested positive symptoms might make it possible to prevent the disease from taking its natural course. Learning of Pirquet’s work, his colleagues throughout Europe and the United States scrambled to confirm his findings in time for the Sixth International Congress on Tuberculosis in September 1908. Because all previous meetings had convened in Europe, the invitation to meet in Washington DC at the new National Museum signaled the acceptance of the United States into the international antituberculosis movement. For almost a week, thousands of physicians, scientists, nurses, social workers, government officials, and lay activists contemplated the latest information related to TB’s biological, economic , and social consequences. When not in session, Americans feted their colleagues from abroad at receptions and proudly ushered them on sanatorium tours. Newspapers in major cities provided detailed coverage of the event and President Theodore Roosevelt gave a rousing speech.5 Abraham Jacobi presided over the papers on childhood TB. In his introduction to the pediatric session he described the challenge faced by antituberculosis forces: “The nature of anthrax, of diphtheria, scarlet fever, and typhoid 50 Saving Sickly Children fever have been recognized. Tuberculosis has proved the deadliest and most obstinate enemy of them all. Its onset is insidious, its course frequently not suspected or watched; its invasion not prevented. . . . its development insured by depressed vitality.”6 In advance of the conference, Jacobi sent key participants a series of issues for their consideration. These included ascertaining the role of impure milk in TB infection; distinguishing the differences, both microscopically and clinically between bovine and human...