Huber the Tuber

Recently, I had an office visit from a lovely 80-year-old woman, born and raised in Providence, R.I., whose past medical history included pulmonary tuberculosis for which she was sent to a sanatorium – 50 years ago.

Her TB had nothing to do with why she had come to see me. By and large, this is a really healthy patient whose only complaint was a 2-month history of right shoulder pain that turned out to be caused by rotator cuff tendonitis. But I lingered with her, and we chatted for awhile. She used to work at Veterans Affairs, processing claims and grievances so she was familiar with medical terminology and was in general a joy to talk with. And I was captivated by the progress in medicine that she represented.

Now, by the time I went to medical school, we were no longer sending patients to sanatoria. The word was as abstract a concept to me as, say, injecting intramuscular gold to treat rheumatic diseases. By the time I was in training, everyone in the developing world got a BCG vaccine, which prevents severe complications from TB but does not prevent infections. As long as I have been a physician, we have understood transmission well, have known about four-drug regimens, and were aware of drug-resistant TB (I am still floored when I read about XDR-TB, with the X being short for "extensively.")

Needless to say I was fascinated by her story.

When she was originally diagnosed more than half a century ago, this woman did not have the usual symptoms that we associate with active pulmonary tuberculosis. She had not had a cough and certainly did not have "wasting." She simply tripped one day and in doing so coughed up some blood. She was found to have disease in both apices and, subsequently, she spent 14 months in a local sanatorium. She remembers being treated with "PAS and streptomycin" (PAS being p-aminosalicylic acid), and "lots of fresh air."

Although tuberculosis is rare in the USA today, it was "so rampant that cautionary visual messages appeared in myriad public places, from offices to restrooms," according to the National Library of Medicine. "Huber the Tuber" was a mascot developed by TB patient and physician Harry Wilmer (1917-2005). In the educational pamphlet, Huber rides respiratory droplets along with his cohort "Nasty von Sputum, Rusty the Bloodyvitch, and Huey the Long Tuber." That final appellation is supposedly a reference to Sen. Huey Long, according to the NLM. (Can we still anthropomorphize bacteria into corrupt government officials?)

The discovery of Mycobacterium tuberculosis by German bacteriologist Dr. Robert Koch in 1882 led to a revolution of isolating patients, which in turn led to a decrease in transmission. In 1905, the American Sanatorium Association was formed – it still exists today as the American Thoracic Society! When the association started, there were 106 sanatoria in the United States, which provided 9,107 beds for patients. At its peak in 1954, there were 108,457 beds worsening (Am. J. Respir. Crit. Care Med. 2004:169;118-6). From a patient’s journal during time spent in a sanatorium in 1944, we know that there were only two rules for sanatorium residents:

1. Absolute and utter rest of mind and body – no bath, no movement except to toilet once a day, no sitting up except propped by pillows and semireclining, no deep breath. Lead the life of a log, in fact. Don’t try, therefore, to sew, knit, or write, except as occasional relief from reading and sleeping.

2. Eat nourishing food and have plenty of fresh air.

Not everyone got antibiotic treatment, unless their chest x-rays showed worsening. Some patients were treated with an induced pneumothorax, according to the women’s journal. Why this would be is not clear to me.

Then, in 1952, isoniazid was developed, and that was the start of the end of the sanatorium.

In our daily lives, we focus on individual patients, but history informs the current practice of medicine. How wonderful that we can now treat many illnesses that were once considered uniformly fatal. How fortunate are we to call this our profession, one that provides an unambiguous good.

Dr. Chan practices rheumatology in Pawtucket, R.I.

Recently, I had an office visit from a lovely 80-year-old woman, born and raised in Providence, R.I., whose past medical history included pulmonary tuberculosis for which she was sent to a sanatorium – 50 years ago.

Her TB had nothing to do with why she had come to see me. By and large, this is a really healthy patient whose only complaint was a 2-month history of right shoulder pain that turned out to be caused by rotator cuff tendonitis. But I lingered with her, and we chatted for awhile. She used to work at Veterans Affairs, processing claims and grievances so she was familiar with medical terminology and was in general a joy to talk with. And I was captivated by the progress in medicine that she represented.

Now, by the time I went to medical school, we were no longer sending patients to sanatoria. The word was as abstract a concept to me as, say, injecting intramuscular gold to treat rheumatic diseases. By the time I was in training, everyone in the developing world got a BCG vaccine, which prevents severe complications from TB but does not prevent infections. As long as I have been a physician, we have understood transmission well, have known about four-drug regimens, and were aware of drug-resistant TB (I am still floored when I read about XDR-TB, with the X being short for "extensively.")

Needless to say I was fascinated by her story.

When she was originally diagnosed more than half a century ago, this woman did not have the usual symptoms that we associate with active pulmonary tuberculosis. She had not had a cough and certainly did not have "wasting." She simply tripped one day and in doing so coughed up some blood. She was found to have disease in both apices and, subsequently, she spent 14 months in a local sanatorium. She remembers being treated with "PAS and streptomycin" (PAS being p-aminosalicylic acid), and "lots of fresh air."

Although tuberculosis is rare in the USA today, it was "so rampant that cautionary visual messages appeared in myriad public places, from offices to restrooms," according to the National Library of Medicine. "Huber the Tuber" was a mascot developed by TB patient and physician Harry Wilmer (1917-2005). In the educational pamphlet, Huber rides respiratory droplets along with his cohort "Nasty von Sputum, Rusty the Bloodyvitch, and Huey the Long Tuber." That final appellation is supposedly a reference to Sen. Huey Long, according to the NLM. (Can we still anthropomorphize bacteria into corrupt government officials?)

The discovery of Mycobacterium tuberculosis by German bacteriologist Dr. Robert Koch in 1882 led to a revolution of isolating patients, which in turn led to a decrease in transmission. In 1905, the American Sanatorium Association was formed – it still exists today as the American Thoracic Society! When the association started, there were 106 sanatoria in the United States, which provided 9,107 beds for patients. At its peak in 1954, there were 108,457 beds worsening (Am. J. Respir. Crit. Care Med. 2004:169;118-6). From a patient’s journal during time spent in a sanatorium in 1944, we know that there were only two rules for sanatorium residents:

1. Absolute and utter rest of mind and body – no bath, no movement except to toilet once a day, no sitting up except propped by pillows and semireclining, no deep breath. Lead the life of a log, in fact. Don’t try, therefore, to sew, knit, or write, except as occasional relief from reading and sleeping.

2. Eat nourishing food and have plenty of fresh air.

Not everyone got antibiotic treatment, unless their chest x-rays showed worsening. Some patients were treated with an induced pneumothorax, according to the women’s journal. Why this would be is not clear to me.

Then, in 1952, isoniazid was developed, and that was the start of the end of the sanatorium.

In our daily lives, we focus on individual patients, but history informs the current practice of medicine. How wonderful that we can now treat many illnesses that were once considered uniformly fatal. How fortunate are we to call this our profession, one that provides an unambiguous good.

Dr. Chan practices rheumatology in Pawtucket, R.I.

Recently, I had an office visit from a lovely 80-year-old woman, born and raised in Providence, R.I., whose past medical history included pulmonary tuberculosis for which she was sent to a sanatorium – 50 years ago.

Her TB had nothing to do with why she had come to see me. By and large, this is a really healthy patient whose only complaint was a 2-month history of right shoulder pain that turned out to be caused by rotator cuff tendonitis. But I lingered with her, and we chatted for awhile. She used to work at Veterans Affairs, processing claims and grievances so she was familiar with medical terminology and was in general a joy to talk with. And I was captivated by the progress in medicine that she represented.

Now, by the time I went to medical school, we were no longer sending patients to sanatoria. The word was as abstract a concept to me as, say, injecting intramuscular gold to treat rheumatic diseases. By the time I was in training, everyone in the developing world got a BCG vaccine, which prevents severe complications from TB but does not prevent infections. As long as I have been a physician, we have understood transmission well, have known about four-drug regimens, and were aware of drug-resistant TB (I am still floored when I read about XDR-TB, with the X being short for "extensively.")

Needless to say I was fascinated by her story.

When she was originally diagnosed more than half a century ago, this woman did not have the usual symptoms that we associate with active pulmonary tuberculosis. She had not had a cough and certainly did not have "wasting." She simply tripped one day and in doing so coughed up some blood. She was found to have disease in both apices and, subsequently, she spent 14 months in a local sanatorium. She remembers being treated with "PAS and streptomycin" (PAS being p-aminosalicylic acid), and "lots of fresh air."

Although tuberculosis is rare in the USA today, it was "so rampant that cautionary visual messages appeared in myriad public places, from offices to restrooms," according to the National Library of Medicine. "Huber the Tuber" was a mascot developed by TB patient and physician Harry Wilmer (1917-2005). In the educational pamphlet, Huber rides respiratory droplets along with his cohort "Nasty von Sputum, Rusty the Bloodyvitch, and Huey the Long Tuber." That final appellation is supposedly a reference to Sen. Huey Long, according to the NLM. (Can we still anthropomorphize bacteria into corrupt government officials?)

The discovery of Mycobacterium tuberculosis by German bacteriologist Dr. Robert Koch in 1882 led to a revolution of isolating patients, which in turn led to a decrease in transmission. In 1905, the American Sanatorium Association was formed – it still exists today as the American Thoracic Society! When the association started, there were 106 sanatoria in the United States, which provided 9,107 beds for patients. At its peak in 1954, there were 108,457 beds worsening (Am. J. Respir. Crit. Care Med. 2004:169;118-6). From a patient’s journal during time spent in a sanatorium in 1944, we know that there were only two rules for sanatorium residents:

1. Absolute and utter rest of mind and body – no bath, no movement except to toilet once a day, no sitting up except propped by pillows and semireclining, no deep breath. Lead the life of a log, in fact. Don’t try, therefore, to sew, knit, or write, except as occasional relief from reading and sleeping.

2. Eat nourishing food and have plenty of fresh air.

Not everyone got antibiotic treatment, unless their chest x-rays showed worsening. Some patients were treated with an induced pneumothorax, according to the women’s journal. Why this would be is not clear to me.

Then, in 1952, isoniazid was developed, and that was the start of the end of the sanatorium.

In our daily lives, we focus on individual patients, but history informs the current practice of medicine. How wonderful that we can now treat many illnesses that were once considered uniformly fatal. How fortunate are we to call this our profession, one that provides an unambiguous good.

Dr. Chan practices rheumatology in Pawtucket, R.I.