Because of an editing error, a report Sept. 23 on increased incidence of tuberculosis said an estimated 10 million to 15 million people are thought to be infected worldwide. It should have said nationwide. (Published 10/2/90)
MINNETONKA, MINN. -- The green sweep of the sanitarium lawn was alive with motion as former tuberculosis patients gathered to remember their deadly struggle with the "white plague" that killed an estimated 4 million Americans in the first half of the century.
Glen Lake Sanitarium, one of the nation's top-rated TB hospitals during those disastrous decades, was closing its doors after 75 years recently with ceremonies and an all-day party. Ironically, the end came even as incidence of tuberculosis in the United States is increasing after six decades of continuous decline.
"This was a wonderful place," said keynote speaker Frederick Feikema Manfred, whose novel "Boy Almighty" was written in the "san" and described his two years there beginning in 1940. "It had wonderful food; wonderful, beautiful nurses; sharp-eyed doctors. But even so, it was a house of pestilence. There was an aura of death."
Tuberculosis killed about three-fourths of its victims in the early part of the century, according to the federal Centers for Disease Control (CDC). Almost 125,000 cases of active and inactive TB were reported in 1930, the first year for which statistics were kept.
About that time, the institutions were founded to treat the "consumptives" and isolate them, said Don Kopanoff of the CDC's Division of Tuberculosis Control. Treatment in that era before antibiotics consisted of good food, bed rest, fresh air and sunshine, a combination that freed natural defense mechanisms to fight the deadly lung infection. The death rate was halved.
"The fact that so many survived really demonstrates how, if you give the body a chance, it can sometimes contain serious infection on its own," Kopanoff said.
With the advent of antibiotics in the 1950s, most patients could be treated at home. In 1961, Glen Lake became Glen Lake San/Oak Terrace Nursing Home as inpatient TB care was phased out. In its heyday, the sanitarium had been rated with National Jewish Hospital in Denver and Saranac Lake sanitarium in New York as the best in the country, said Victor Funk, 90, a Glen Lake physician from 1924 to 1958.
The disease was called "the white plague," Funk explained, because it gave all of its victims, no matter their color, an ashen hue.
Manfred was 28 when he collapsed in a Minneapolis tenement and was taken to Glen Lake. A former reporter at the old Minneapolis Journal, he had been fired for union activities and had no income during the year before his breakdown. He had worked long hours on his first two novels, smoked heavily, ate poorly and ignored a worsening cough and steady weight loss. Glen Lake physicians did not expect him to survive, so ravaged were his lungs and so emaciated his 6-foot-9 frame.
"You're deeper in me than love, and forever, too," Manfred wrote of his raging infection in a 1940 issue of an in-hospital newsletter/literary journal. But after five months of complete bed rest, he began to gain weight. He gained 104 pounds in four months. A few months later, he was allowed to walk to the bathroom. A year and a half later, he was discharged.
Manfred became a live-in student of Sinclair Lewis and twice runner-up for major book awards -- the Pulitzer Prize for fiction in 1948 and the National Book Award in 1955. His 28th book was published recently, and his 29th is completed.
In July, tests showed that Manfred was free of tuberculosis. "That's incredible," Kopanoff said. Usually, the bacillus remains forever, controlled and relatively harmless, but ready to bounce back if the body's defenses drop.
After a decline of about 6 percent annually until 1986, new TB cases in this country have increased each year since, according to the CDC. The lowest annual total in the last 60 years was 22,201 in 1985. Last year, there were 23,495, an increase of 4.7 percent over 1988.
In developing countries, where many people cannot afford treatment, more than 7 million new cases occur each year, killing more than 2.5 million annually, according to the CDC.
The biggest reason for the increase in the United States probably is AIDS, which robs the body of its ability to fight infection, said George Cauthen, a CDC epidemiologist.
People infected with AIDS are far more likely to develop TB, especially strains difficult to treat, said Richard J. O'Brien, chief of the clinical research branch of the CDC's Division of Tuberculosis Control. He reported last week that the only available test for TB is ineffective if a person also is infected with the human immunodeficiency virus that causes AIDS.
Other reasons for the increase of U.S. cases include immigration from Southeast Asia, where tuberculosis is more common, and increasing poverty that results in homelessness, overcrowded living conditions and poor nutrition.
Claudia Miller, director of Minnesota's TB control program, said there is "some question whether we might again need TB beds," spaces reserved specifically to treat tuberculosis.
In 1900, the nation had about 4,500 such beds, but by 1954, the number was 111,715. Today, other than in Denver, where the National Jewish Hospital is doing TB research, and in New York City, there are virtually none, said George Di Ferdinando, director of the TB Control Program of New York state.
In New York City, state and city health officials opened an 85-bed shelter two years ago for homeless people with TB. Such people are particularly difficult to reach for treatment, said Jack Adler, medical director of the city's Bureau of Tuberculosis Control.
The shelter offers a few extra comforts, such as more privacy, to entice people to stay long enough to be cured, he said. "If people take their medication, they can be made non-infectious within weeks and cured in about six months," Di Ferdinando said.
Nationwide, the medical and economic impact of the tuberculosis increase is not yet known, Kopanoff said. An estimated 10 million to 15 million people worldwide are thought to be infected, but not enough money is directed toward TB control, he said.
The cost of getting medicine to transients and people unwilling or unable to take medication regularly is huge, said Donald Ramras, chief medical officer of San Diego County in California, where the effort is being made.
At the Glen Lake reunion, former patients sat at linen-draped tables in the airy dining room and visited. Others moved through the corridors with a look of pained preoccupation, as if listening for lost voices.
Lester Dedrick's eyes filled with tears as he described meeting, and losing, his first wife there. Dedrick was admitted in 1939, bleeding heavily from his lungs. His two brothers and a sister also were admitted. He was discharged five years later, but his wife succumbed.
Fred Sippel of Minneapolis was a soldier in 1951 when he contracted TB. All five of his Glen Lake roommates died, but his wife, whom he met there, survived and returned as a nurse.
"I didn't know how to give this talk," Manfred said after his address. "Sometimes, I see former patients on the streets, and there's a real sad streak in them.
"I'm one of the rare guys that bounced out of here optimistic. There was so much death around, and some people just never could shake that sorrow."