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The History of Tuberculosis and How Colorado Became the “World’s Sanitarium”

  • Writer: FibonacciMD
    FibonacciMD
  • Jul 22
  • 7 min read

Updated: Jul 27

Sunlight therapy for TB patients in Colorado
Sunlight therapy for TB patients in Colorado

Tuberculosis (TB) is an airborne infectious disease that primarily affects the lungs but can spread to almost any part of the body.  It is thought that about 25% of the world’s population has been infected with TB, with an estimated 10.7 million people developing active TB and 1.2 million dying from it each year.  In most individuals, the immune system contains the infection, typically walling off the bacteria within granulomas so it does not spread.  However, approximately 5 to 10% of those infected will go on to have active TB disease.  


History of Tuberculosis

TB is caused by Mycobacterium tuberculosis  and is thought to have infected humans for more than 70,000 years.  About 15,000 to 20,000 years ago, the modern strain of TB is believed to have first appeared.  The illness was described in Indian texts dating to approximately 3300 BC.  Some Egyptian mummies dating back to 2400 BC have shown evidence of the disease.  TB may have been described in the Bible using the ancient Hebrew word schachepheth.  In Ancient Greece, where it was common and documented by Hippocrates, it was known as phthisis.  After the Roman era, TB was widespread in Europe and Asia.  Evidence of TB has been found in Peruvian mummies, dating to before the arrival of the first European explorers in South America.


During the Middle Ages, physicians first described scrofula, a form of TB affecting the cervical lymph nodes.  In England and France, it was known as the “king’s evil,” and it was commonly believed that it could be cured by the “royal touch.”  People lined up in large numbers to receive this “touch” from the king or queen.  The “royal touch” was practiced in England until 1714 and in France until 1825.


In 1720, the English physician Benjamin Marten first proposed that TB was an infectious disease in his book, A New Theory of Consumptions.  TB was known as consumption or phthisis during the 17th and 18th centuries.


In 1735, the Italian Health Board of the Republic of Lucca ordered the isolation of TB patients, or “consumptives,” as they were known.  They were denied admission to public hospitals and had to be cared for in specialized treatment centers. 


By the 18th century, TB had become epidemic in Europe and was known as the “robber of youth” due to the number of young people who died from it.  It was also known as the “white plague” due to the severe anemia and paleness of its victims.  In the mid-1800s, up to a third of English tradesmen and laborers and up to one-sixth of the British upper class were dying from TB. 


In the late 1700s and early 1800s, TB was increasingly being recognized as a systemic disease that could affect multiple organs, not just the lungs. 


In 1839, German physician Johann Lukas Schönlein coined the term “tuberculosis.”  This came from the tubercles (granulomas), or small, hardened nodules that form in the body as an immune system response to contain the infection.


In the early 1800s, considerable debate surrounded the cause of TB, with infection being the predominant theory in Southern Europe and heredity in Northern Europe.  Some physicians even thought it was a form of cancer.  


In 1865, Jean-Antoine Villemin, a French military surgeon, noted that TB was more common in soldiers living in barracks than among those stationed in the field.  He inoculated rabbits with liquid from a TB cavity and produced TB in the animals, demonstrating the infectious nature of the disease. 


Koch Identifies TB and Develops Tuberculin   

In 1882, Robert Koch, a German physician and microbiologist, isolated the TB bacillus and demonstrated that it caused TB by infecting laboratory animals.  It was a scientific breakthrough that earned him the 1905 Nobel Prize in Physiology or Medicine.  His experiments on TB became one of the classic demonstrations of what later became known as Koch's postulates, a set of principles used to establish that a specific microorganism causes a particular disease.


In 1890, he claimed to have isolated a substance from heated, dead “tubercle bacilli” that could cure patients with TB, which he named tuberculin.  While it failed as a treatment, Koch noticed that injecting small amounts of tuberculin produced a much stronger reaction in patients with TB and very little reaction in healthy individuals.  He concluded that tuberculin could potentially be used as a diagnostic tool.


Further Advances in TB Testing 

In 1907, Viennese pediatrician Clemens von Pirquet developed a cutaneous tuberculin test by applying tuberculin to superficial skin scratches, allowing him to identify latent or asymptomatic TB infection.  In 1908, Charles Mantoux, a French physician, developed an intradermal method of tuberculin testing using a syringe.  In 1934, biochemist Florence Seibert demonstrated that the active component of tuberculin was a protein that caused the reaction when a person had previously been infected with TB.  She isolated the protein and called it purified protein derivative (PPD), which ultimately became the standard in TB skin testing.  Although imperfect, the PPD skin test allowed clinicians to identify individuals with prior exposure and immune sensitization to TB, including those with latent infection.  Once effective antibiotics became available, individuals with latent infection could be treated to reduce their risk of developing active disease.


By 2001, a blood test called the interferon-gamma release assay (IGRA) was developed to detect TB.  Today there are two of these IGRA blood tests, the QuantiFERON-TB Gold Plus and the T-SPOT.TB.  They have higher specificity than skin testing and are not affected by the bacille Calmette-Guérin (BCG) vaccine. 


Colorado, the “World’s Sanitarium” 

In the 1800s, TB was the leading cause of death in the United States.  Physicians of that era believed that sunshine, high altitude, and dry climates could improve TB symptoms.  As a result, Denver, Colorado, became one of the nation's most popular destinations for people with consumption and helped drive Colorado's population growth.  Before becoming a haven for TB patients, Denver was known as a rough frontier town filled with outlaws and miners.  Many TB sufferers arrived in Denver after spending much of their savings on a one-way ticket, contributing to rising homelessness in the city.  There were also some East Coast charitable groups that would give TB sufferers a fruit basket and a one-way ticket to Denver.  At its peak, an estimated one in three Denver residents was infected with TB.


Modern Woodmen of America TB Sanatorium- Colorado Springs early 1900s
Modern Woodmen of America TB Sanatorium- Colorado Springs early 1900s

Denver’s first facility for TB patients was opened in 1860, two years after the city was founded.  TB facilities soon followed in Colorado Springs and Boulder and cities began to develop around the TB treatment centers.  TB treatment became Colorado Springs’ first major industry.  Colorado became known as the “World’s Sanitarium.” There were luxurious resort-like facilities, such as the Hygiene House for the wealthy, while for those less well-off, the sanatoriums sometimes consisted of little more than tent colonies.  Frances Wisebart Jacobs, a wealthy Denver philanthropist, was instrumental in the founding of the National Jewish Hospital for Consumptives, which opened in 1899.  Its motto was “None may enter who can pay—none can pay who enter.”  It still operates today as National Jewish Health.


TB Treatment

In the 1940s, the first treatments for TB were introduced: streptomycin and para-aminosalicylic acid.  This was followed by isoniazid (INH) in 1952.  INH was first studied to treat latent (asymptomatic) TB in 1956 and is still used today for that purpose.


Active TB is generally treated with multidrug regimens to prevent treatment failure and the development of drug resistance.  Standard first-line medications used in various treatment regimens include ethambutol, isoniazid, rifampin, rifapentine, pyrazinamide, and selected fluoroquinolones such as moxifloxacin.  Drug-resistant TB remains a major global challenge that requires specialized, long-term treatment regimens.


Latent TB infection is commonly treated with isoniazid, rifampin, or rifapentine, or combination regimens.  

The bacille Calmette-Guérin (BCG) vaccine is frequently administered to people living in countries where TB is endemic.  It uses a live attenuated strain of Mycobacterium bovis that provides partial protection against Mycobacterium tuberculosis.  The vaccine provides 70%-80% protection against children developing severe forms of TB, including TB meningitis and disseminated TB.  It provides substantially less protection against pulmonary TB.  Because prior BCG vaccination may cause a false-positive TB skin test, interferon-gamma release assay blood testing is generally preferred when screening vaccinated individuals.


Summary

For much of human history, an active TB diagnosis was often considered a death sentence, and the only "cures" available were largely limited to measures such as sunshine, fresh air, and the belief in a king's touch.  Despite major advances in diagnosis, prevention, and treatment, TB remains the world's leading cause of death from a single infectious agent and continues to pose a significant global health challenge. 


If you liked this article, you may also enjoy reading The History of Malaria. 

You may also find these other FibonacciMedicine history of medicine articles interesting:


References

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