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

Saving Sickly Children: The Tuberculosis Preventorium in American Life, 1909–1970
(Critical Issues in Health and Medicine.) By Cynthia A. Connolly. 182 pp., illustrated. New Brunswick, NJ, Rutgers University Press, 2008. $39.95. ISBN: 978-0-8135-4267-6

It is the year 1908. In the United States, more than 150,000 people will die from tuberculosis. If you contract tuberculosis, your best hope is to be shipped off to a sanatorium, where you will live a regimented life and sleep outdoors in subzero temperatures. But German physician Robert Koch has discovered that this scourge is an infection, and Austrian physician Clemens von Pirquet has developed a skin test that can detect tuberculosis infection before the ravages of the disease are manifest. This is the setting for Cynthia Connolly's carefully researched and informative history, Saving Sickly Children.

Connolly accurately describes the response to these developments during the Progressive Era. When it became clear, through use of von Pirquet's test, that infection of many children occurred at a young age but that active tuberculosis did not develop until years later, a movement was initiated to identify infected children who had the highest risk of progressing to active tuberculosis. These children were to receive state-of-the-art care in new institutions that resembled sanatoriums. Called preventoriums, they were designed to enhance the ability of children infected with tuberculosis to ward off incipient tuberculous disease through diet, exercise, and education. Preventoriums had a colorful and tumultuous history. Connolly chronicles their rise and fall in the United States and discusses the fortunes of similar institutions that took root in Europe.

In Saving Sickly Children, Connolly traces the developments that led to the founding of the first preventorium in 1912 — in Farmingdale, New Jersey — and the subsequent spread of the preventorium movement throughout the United States. The tale is one of good intentions, money, fear, and social class, and Connolly provides an excellent overview not only of preventoriums but also of how the preventorium movement evolved naturally as an outgrowth of the ideals of the Progressive Era. The movement to create preventoriums declined when scientific studies failed to support the medical theory that was central to its mission: that a residential experience and regimented life could prevent the development of tuberculosis. With the dawn of the antibiotic era, preventoriums, like sanatoriums, disappeared.

Connolly highlights many important features of tuberculosis, such as the centrality of good nursing to patient care as well as the oppressive stigma of the disease. The story of the preventorium movement also has important social overtones because the children who were taken from their homes and sent off to preventoriums for anywhere from 6 months to 2 years were nearly all poor. Sending them to preventoriums was seen as a way of lifting them out of the sordid conditions in which they lived, as well as a way of removing them from contact with adults who were infected with tuberculosis. The air of cultural superiority that was implicit in this practice was not unique to tuberculosis, nor to the field of health care in general, but was part and parcel of the Progressive Era, a time when belief in the possibility of self-improvement was shared by members of the lower and upper classes.

Today tuberculosis remains a scourge in many parts of the world. We have better tools to combat it than did the preventorium and the sanatorium, but we need to rekindle the energy and optimism of the progressives for the struggle. Saving Sickly Children reminds us of how this can be done.

C. Robert Horsburgh, Jr., M.D.
Boston University School of Public Health, Boston, MA 02118
rhorsbu@bu.edu

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