Oakdale's TB patients endured Iowa's harsh winters in hospital beds made up "Klondike style."

It was known 100 years ago as the "white plague" -- a highly infectuous disease with no known cure. Those stricken were shunned by neighbors and friends and herded into isolation to either recover or die. It was no wonder: at that time, one in four tuberculosis victims paid the ultimate price. They died.

By 1906, when the 31st Iowa General Assembly appropriated $50,000 to establish a "State Sanitarium for the Treatment of Tuberculosis," TB was the leading cause of death in America.

"In locating said sanitarium," the Iowa law read in part, "take into consideration climate, healthfulness, water supply, drainage, quality of soil, facility of access, timber protection to buildings, and a suitable building site."

Six miles northwest of Iowa City and 21 miles south of Cedar Rapids, the state's medical Board of Control found Elizabeth Bumgardner's 280-acre stock farm, perched atop one of the highest knolls in Johnson County. The farm was linked to both communities by the Cedar Rapids and Iowa City (CRANDIC) interurban railway, and it was close -- but not too close -- to the University of Iowa's College of Medicine.

The state paid $150 an acre for the farm, dubbing the site "Oakdale" in acknowledgment of its timber stand of giant oaks. Using plans modeled after Edward Livingston Trudeau's Adirondack Cottage Sanitorium in New York, which was established in 1884 as the nation's first TB treatment center, construction at Oadkdale began in 1907 with an administration building, a power plant, and two open porch pavilions -- one for men, the other for women.

On February 1, 1908, two men were accepted for treatment at the facility renamed "The State Sanitorium." By June of 1910, the number of patients had grown to 506. Numbers rose steadily throughout the hard years of the Depression, climbing to 814 by 1926. Almost all of the patients were Iowans, referred to the sanatorium by their physicians when they tested positive for TB.

Symptoms included coughing, night sweats, chest pain, exhaustion, fever, weight loss, and the spitting of blood. Untreated, tuberculosis literally consumed its victims. Death often came when a blood vessel burst in the lung and the patient drowned in her own blood. Although it affected people of all ages, TB was largely a disease of young adults.

Nationally, TB hysteria spread as insidiously as the disease itself. One state legislature considered a bill that would require tuberculosis victims -- called lungers -- to wear bells around their necks to warn others that they were contagious. Many barbers, hotel managers, and other service providers refused to cater to consumptive patrons. Children exhibiting symptoms of the disease were sent home from school to protect their classmates, while foreigners who appeared to have TB were not allowed to enter the country.

Doctors knew how the disease is transmitted. When people with active cases of tuberculosis cough, they spray thousands of tiny rod-like bacilli into the air that others ingest simply by breathing. The germs remain dormant in a healthy body, but prey on those with weakened immune systems.

For many years, people who rode the CRANDIC interurban would cover their faces with handkerchiefs when the trains passed through the grounds of the TB sanatorium. They weren't taking any chances, knowing that this disease -- also known as consumption -- could put their lives on hold for a very long time.

Fresh air, bed rest, and a diet long on milk and eggs was the treatment regiment Dr. William Spear discovered at Oakdale when he arrived at the sanatorium in June 1927. A young doctor recently graduated from the medical school at Queens University in Kingston, Ontario, Spear didn't know then that he would stay at Oakdale more than 40 years, nearly 30 as the facility's superintendent.

"When I arrived, they were behind the times in terms of surgical treatment of tuberculosis," Dr. Spear, now 95, recalls from his home in Coralville. "In the early stages, Oakdale was used as a last resort. Most patients came in with advanced disease, and mortality was high then. At first, treatment was largely custodial. Patients were forced to stay in bed in open-air cottages. You froze them in the wintertime, roasted them in the summertime. Patients didn't leave their beds unless it was absolutely necessary."

TB patients endured Iowa's harsh winters in hospital beds made up "Klondike style," Dr. Spear recalls. "They put blankets over and under the mattress and canvas on top of that and did all kinds of things to keep warm. They used a stone jug that was a box-like affair with an electric lightbulb in it, sort of the beginning of the electric blanket. Once they got warm, they stayed warm."

Dr. Spear was instrumental in introducing surgical treatments of tuberculosis, including pneumothorax, in which air was injected through a surgical incision to collapse and rest a diseased lung. A more radical procedure -- thoracoplasty -- involved removing ribs to facilitate lung collapse.

Speaking of the simpler pneumothorax procedure, Dr. Spear says, "At one time, 75 percent of patients underwent this surgery. When we thought the lung had healed, we would reinflate it. In those days, it was very effective, and without it many patients never would have left the sanatorium.

"Surgery was the primary treatment from 1928 until 1942, when we entered the drug phase of treatment. The mortality rate was high in the early days, but with active treatment it declined dramatically, and with drug therapy it improved even more."

Mary Elizabeth Godfrey -- known to many alumni by her married name, Mary Beth Dewey, because she treated patients at the UI Student Health Service from 1958 until her retirement in 1981 -- came to the University of Iowa in 1939. She wanted to become a doctor, a first step toward her goal of serving as a medical missionary in Ethiopia. While she was in medical school, though, one of Godfrey's few female classmates came down with tuberculosis and left school for treatment at Oakdale.

"During my senior year of medical school, there was the option of spending three weeks at Oakdale, and I had this friend who was there as a patient," Dr. Dewey recalls. "Those three weeks were exceedingly useful. I helped do physical examinations, worked with experts on taking and reading chest films, and learned a great deal about the pathogenesis of the disease."

It was a disease she'd been exposed to many times. Childhood friends and family members had fallen victim to tuberculosis years earlier, and when Dewey came to the University of Iowa to enter medical school, her own Mantoux test for TB (when a small amount of tuberculin serum is injected under the skin) showed she probably had an active case of the disease.

But there was little to do about tuberculosis back then and Dewey wasn't showing other symptoms of active infection, so she went to class and clinic and learned to be a doctor.

"During the spring of my last year of school, I had some scary symptoms," she says. "I went out to see Dr. Spear and had a chest x-ray. Four days after I got my degree in September of 1944, I was admitted to Oakdale as a patient and was there a good two years. By then, I was good friends with the people out at Oakdale."

Her treatment included eight months of strict bed rest and pneumothorax surgery.

"I lost lots of muscle in that eight months when the only activity you had was crawling out of bed and into a chair while someone changed your sheets," she says. "It was an interesting experience, being a patient. It taught me a lot of things most doctors never learn in terms of what happens within the doctor-patient relathionship."

One thing she remembers is the rules. Patients at Oakdale and other sanatoria across the country were taught to be responsible for their disease. They learned to cover their mouths when others approached, they learned it was dangerous to spit, how to contain expectorate in tissues and how to safely dispose of those tissues. Many of the rules made good medical sense, but some didn't. For years, men and women who were well enough to leave their beds for meals in Oakdale's dining room weren't allowed to sit together. But on the weekly movie night, sexes could mingle.

After 26 months at Oakdale -- eight in bed, eight on a restricted schedule, and ten working almost full-time as a physician treating other patients -- Dr. Godfrey recovered, and in December 1946 she left the sanatorium to go to Broadlawns Hospital in Des Moines, where she completed an internship at the hospital's TB treatment center. From there she went to Hawaii and worked in a leper colony. In 1951, Dr. Godfrey was back at Oakdale, treating patients and working in a laboratory involved in clinical trials of the new drugs that eventually arrested the TB epidemic.

"During the war, streptomycin was just coming in and it was really the start of chemotherapy for TB," she says. "It made all the difference in the world."

By 1949, Oakdale was discharging 100 more patients than it was admitting each year, and six effective new drugs were being used to overwhelm a disease that had killed thousands of Iowans and millions of others worldwide, among them poets (John Keats and Elizabeth Barrett Browning), playwrights (Eugene O'Neill), and philosophers (Henry David Thoreau).

Dr. George Bedell, now a semi-retired professor of internal medicine at the UI, recalls that by the early 1950s about 400 resident inpatients were being treated with bed rest and drugs at Oakdale. Pneumothorax was out and mortality had declined to less than ten percent, but treatment remained tedious. It often took as long as three months to determine if someone actually had an active case of TB. After that, treatment could continute one to two years.

When they were well enough, Dr. Spear put the patients to work. Some were assigned to take the reading carts around to the rooms, while others worked on the grounds or in the dining room, and a few did research analyses in the labs. Some patients never left Oakdale; they just moved from the wards to the duplex apartments Dr. Spear had built for the staff.

Oakdale had evolved into a self-sufficient community. In addition to 400 resident inpatients, its census included 230 employees and nearly 3,000 outpatients. The facility had its own post office, library, chapel, and newspaper. Oakdale offered vocational training in radio and television repair, woodworking, photography, and secretarial skills. In 1958, women patients received instruction in keeping house, including classes in menu planning, cooking, and furniture arrangement, at a model apartment set up for them.

Over time, Oakdale had grown to 505 acres, with 425 acres in crops that helped sustain a dairy herd that provided 60,000 pounds of milk each month and a beef herd that produced 3,000 pounds of meat. Every week, workers collected 150 dozen eggs in Oakdale's poultry barn. Orchards and gardens provided fruits and vegetables. Good food, couple with bed rest and drug therapy, helped patients regain their health. The incidence of TB was on the decline. In 1964, farming activities at Oakdale ceased, when the cattle herds were sold in an auction and a 200-foot, steam-heated milking barn was abandoned.

When Dr. Spear retired in 1970, the Board of Regents gave the Oakdale Sanatorium to the UI. Doctors in the university's pulmonary division took over the care and treatment of Oakdale's 100 TB patients and the scope of the facility was enlarged to include treatment for other pulmonary diseases.

Although the use of Oakdale as a TB treatment facility ended in November 1981, remnants of its medical legacy remain. A close look at the Oakdale Research Campus building that houses the UI's Technology Innovation Center reveals an enduring relic of an era and an epidemic. Worked into the aging building's red brick facade is a white, two-barred Lorraine Cross, a symbol widely recognized a century ago as the battle flag in a global war against tuberculosis.