Tuberculosis: The White Plague in Iowa

Boil handkerchiefs for a half hour. Keep carpets, curtains and upholstered furniture out of the room. Shave off beards and mustaches. Open the bedroom window night and day. Spit in a pasteboard cup and burn it afterward.

-Iowa State Board of Health, 1906 

No Spitting Allowed

In 1906 the State Board of Health said these were ways to prevent the spread of tuberculosis (TB). Doctors understood that tuberculosis was spread through coughing up sputum (mucus). TB patients and their caretakers were ordered to confine and destroy spit. They were asked to control exposing others when coughing.

TB was called the "white plague" because people who had it became very pale. TB was a very big problem in America's crowded cities. Poor people living in cities had a hard time fighting the disease. But the poor were not the only ones who got TB.

In the late 19th century, TB killed one of every seven Americans. Sanitation and quarantine had helped wipe out the disease in some urban areas at the end of the century.

Move Away, Please

Early in the 20th century, public health experts fighting TB decided that personal cleanliness would help prevent and cure the disease. Physicians also recommended that "lungers" (the term used for people who had TB) move to states with mountain or desert climates. Fresh air and rest were thought to be weapons to fight the disease.

Direct exposure over a long time was required to catch TB. The germ that caused TB, tubercle bacilli, grew very slowly. The public feared that TB was quite contagious. So many patients were moved out of their communities. A person with TB may be sent to a sanatorium or special hospital. At a sanatorium patients could rest in fresh air, eat good food, and limit activity. The sanatorium was usually located in a place away from the public.

B-r-r-r!

Since fresh air was thought to cure TB, patients were sometimes kept in sleeping porches outside. Snow could drift in and settle on top of the blankets covering the beds.

Iowa's oldest and largest public TB sanatorium was Oakdale. It was built in 1907 on 280 acres near Iowa City. The university's medical college was nearby. By 1910 Oakdale housed 506 patients. The number peaked in 1926 at 814.

In 1906 about 7,000 to 8,000 Iowans had TB. The State Board of Health and the Iowa Tuberculosis Association worked together to spread information about prevention. They pushed for early testing. Later, laws were passed to require that dairy cattle be tested for TB. Cattle that were found to have the disease, had to be destroyed. New laws also required pasteurization of milk.

Relief at Last

Death rates did fall in Iowa. Deaths fell from 2,000 in 1906 to 1,000 in 1925. Only 600 people died in 1934. By 1946-1947 Iowa had the lowest death rate from TB in the nation.

By 1950 TB was no longer considered one of the leading causes of death in Iowa. In 1981 Oakdale Sanatorium closed as a TB treatment center.

Worldwide, however, tuberculosis is still a deadly disese. Over two million people die from it yearly. When compared to the past, it is seldom seen in Iowa. Still the state averages 40 to 60 new cases a year.

Sources:

• Swaim, Ginalie. Iowa Heritage Illustrated 86, No. 2 (Summer 2005).
• Iowa Department of Health. "TB Control Program Home."