Dean Wagner's Genealogy - Ah-Gwah-Ching, Minnesota

Ah-Gwah-Ching

Ah-Gwah-Ching, Cass County, Minnesota, USA

Tuberculosis - Thwarted

from
"A Brief History of the Minnesota State Sanatorium --
Ah-Gwah-Ching Nursing Home
1907 - 1982
In Commemoration of our 75th Diamond Jubilee"
By Skip Oliver
© June 1982
Pages 17-22

Before a program of major surgical procedures could begin, preliminary steps had to be taken to put into place the record keeping necessary for this new stage of the Sanatorium's operation.

Helen DeLury, Medical Records Librarian, submitted her MEDICAL RECORD SYSTEM OF THE MINNESOTA STATE SANATORIUM to the Minnesota Hospital Association at Rochester, Minnesota in 1937. Her record keeping system was established and proved adequate in maintaining the medical records for each patient. The Standard Classified Nomenclature of Diseases was applied.

In additon to establishing a sound medical records system, an OUTLINE OF PROCEDURES AND RECORDS was developed for each staff physician. This outline included the rules governing the conduct of the patient and the duties required of each staff physician. Admission procedure, floor charts, medical records forms, requirements of daily staff conference, discharge of patient, follow-up and the forms necessary for surgical procedures. A uniform procedure was established at the close of the biennium in 1938.

In the next few years medical records indicated an upturn in surgical procedures. During 1939, 30 thoracoplasties were performed; 37 phreniphraxis, 14 pneumonolysis-intrapleural, and 1 rib resection. Also included in the list for 1939 was one amputation of toes!!!!

Extensive pneumothorax therapy and pneumoperitoneum therapy was performed during this period. The Sanatorium function became more and more that of a hospital, prepared to perform any or all medical services regardless of complaints, disease, complications, or surgical, procedures. More than 705 of all admissions in 1941 were advanced cases of tuberculosis, calling for chest surgery of some kind. The State Sanatorium was equipped to handle all forms of chest surgery, AND DID SO!

Many changes were taking place on the medical staff at the State Sanatorium. Dr. H. A. Burns resigned as superintendent in 1942 to accept a post as chief of the tuberculosis control unit for state institutions.

Dr. F. F. Callahan was named as his replacement. Dr. Callahan received his Doctor of Medicine from the University of Maryland. Dr. Callahan brought with him to his new post a wealth of background in tuberculosis. He served as medical director of Pokegama Sanatorium from 1919 until 1942, an institution built and owned by Dr. H. L. Taylor. Pokegama Sanatorium was known to be one of the finest private sanatoriums in America, offering modern medical and surgical procedures to its clients.

The medical staff at the State Sanatorium lost Dr. M. M. Williams in 1942. Dr. Williams resigned to enter the U. S. Army serving as tuberculosis specialist.

In 1943 the Legislature placed the Minnesota State Sanatorium under the Director of the Division of Social Welfare. The per diem rate was fixed at $2.28.

The x-ray equipment was rebuilt in 1943 and conversion from DC to AC current was accomplished, cutting down the expensese of numerous retakes of x-rays. An outstanding group of medical personnel were selected as consultants in surgery, proctology, and roentgenology, to provide service to the patients at the State Sanatorium. A total of 110 persons received some form of surgical treatment during this year, thus speeding their recovery and shortening their stay at the sanatorium.

Dr. T. J. Kinsella, served as surgeon on the staff of the State Sanatorium. Dr. Thomas J. Kinsella performed the first successful pneumonectomy for carcinoma 1937. He was the first doctor in the State of Minnesota to do extrapleural pneumonolysis with paraffin and extrapleural pneumothorax. His experimental work on bilateral thoracoplasty was the first of its kind. His first pneumonectomy for tuberculosis was performed in 1937 and the second one in l94O. Dr. Kinsella received his Doctor of Medicine from the University of Minnesota in 1920. He was a fellow, Mayo Foundation from 1920 to 1922. He served as surgeon and assistant medical director of the Glen Lake Sanatorium from 1925 to 1936. He served as associate clinical professor of surgery, University of Minnesota. Dr. Kinsella's articles on chest disease greatly advanced thoracic surgery everywhere.

Under the able leadership of Dr. F. F. Callahan, a full staff of medical personnel were assembled. Extensive, surgical procedures were performed and Minnesota State Sanatorium came to be known as one of the finest hospitals for the care and treatment of tuberculosis in the state.

In 1944 the Occupational Therapy Department moved from its cramped quarters on the first floor of the D Wing to the third floor, permitting the expansion of this much used department and allowing more of the patient population the use of this equipment. For the year ending June 30, 1945, a total of 191 patients made use of the department, and 4,695 separate articles were sold, of which 1800 articles were sold at the Minnesota State Fair. Because the Occupational Therapy Department was fully accredited under the direction of Martha Emig, a two-month course of internship was offered at the State Sanatorium for therapists.

1944 and 1945 were difficult years in the operation of the Sanatorium. Rationing was in effect, causing hardship in the Dietary Department. Great difficulty was experienced in attempting to serve a variety of foods. Great difficulty was experienced in all departments in the area of recruitment. Many employees were serving in the armed forces. Each monthly issue of the MOCCASIN carried a roster of personnel serving in the armed forces.

Dr. Callahan requested funds to begin replacing the cotton mattresses with innerspring mattresses. He also requested that a garage be built to house the MOBILE X-RAY UNIT, purchased by the Department of Health. His request for Mattresses was granted in the 1946 biennium, and 76 mattresses were purchased (the first innerspring mattresses the institution) at a cost of $1,195.48. The garage was built for the mobile unit in 1946. A new radio system was installed for patients' use.

In 1946 permission was obtained from the Department of Interior to establish quarantine quarters for cases of tuberculosis who were considered public health menaces. The State of Minnesota provided funding for the construction of these quarters and they were put into use during that year. A classroom was built and furnished on E-V and all students began taking their classes there. This new adventure relieved the nurses on the floors as children were absent from their wards during class. More satisfaction was gained also in having several children given instruction at the same time. Miss Florence Lyford was in charge of the Education Department.

Dr. Callahan resigned his position as superintendent in 1946, to enter private practice in St. Paul. In 1947 he accepted the position of chief of the medical unit of the State Division of Social Welfare.

Following Dr. Callahan's resignation, Dr. Earl Crow, who had served on the medical staff since March 1, 1942, and had been appointed Assistant Superintendent, was now appointed to the position of Superindendent. Dr. Crow received his Doctor of Medicine from the University Minnesota. His years of service on the medical staff and his association with Dr. T. J. Kinsella during numerous surgical procedures were to serve him well in his new post.

Following the end of World War II, Dr. M. M. Williams returned to the Minnesota State Sanatorium. In September, 1946, he resumed his duties on the staff and assumed the position of Assistant Superintendent. Dr. Williams assisted Dr. Kinsella in numerous surgeries during the next few years. Miss Mrytle Olson, former Assistant Superintendent of Nurses, was appointed to the position of Superintendent of Nurses in March of 1947.

1947 brought with it the use of Streptomycin, the new antibiotic agent, which was obtained for patients in April of 1947. An increase in major thoracic surgeries was seen to develop at this time and Dr. N. K. Jensen was added to the surgical consulting staff. A total of 131 major surgical procedures were accomplished during the 12 month period ending June 30, 1947.

The Sanatorium experienced the loss of Miss Martha Emig in January of 1947 as Occupational Therapy Director. Miss Emig became seriously ill and had to relinquish her post. Miss Emig served as Occupational Therapy Director at the Sanatorium, for 13 years. Miss Rachel Rothnem, Librarian, continued in her, position as librarian, and circulation of books for the year ending in 1948 17,499. She also continued her lectures at the University of Minnesota and supervised the internship program of hospital librarians.

In addition to the new agent Streptomycin, which was introduced in 1947, -PAS, or para-aminosalicylic acid, which was a synthetic salicylic acid compound, became available for general use in l949. Nineteen patients were placed on this treatment at the Sanatorium.

During 1950 a total of 102 separate thoracoplastic procedures were accomplished. The Sanatorium Census reached and passed 300. Also during 1950, Dr. M. M. Williams, who had been on special assignment in the technique of bronchoscopy, performed 38 such examinations that year. Patients continued to be treated with the new drugs streptomycin and PAS.

The role of the State Sanatorium, was to take on another new dimension in its many faceted services to the patient with the addition of a Social Services Department. In November of 1950, Miss Marion Orava was hired as Medical Social Worker. Her professional skill in the solution of patients' social relationships would continue for many years.

In l952, Dr. E. R. Crow resigned his position. Dr. M. M. Williams was appointed to the position of Superintendent.

The year 1954 arrived. For the first time in its history, Minnesota State Sanatorium noted a decline in the average daily patient load. Dr. Williams, Superintendent, reporting to the Honorable Governor C. Elmer Anderson in his annual report stated: "this lowering in daily census rate has been brought about in many ways. A more effective combination of chemotherapy and resection surgery has caused a reduction in the total number of days patients are required to stay in the sanatorium". During 1954, Dr. Williams and his medical team began to employ a service called "The 3-day Check". Patients who had previously been discharged were re-called for three days of intensive short-term examinations. This permitted the physician to control the disease of tuberculosis by recalling former discharged patients to determine whether their disease remained in an arrested status.

The Department of Public Welfare, acting on the advice of the Leqislative Study Commission on Welfare, arranqed for the admission of 30 senile mentally deteriorated, tuberculous women to be admitted to the Minnesota State Sanatorium in February of 1956. These patients were transferred from the Burns Unit of the Anoka State Hospital. This so-called "Pilot Study" tended to lighten the distressing overcrowding of one institution and utilize the empty beds of the sanatorium. In August of 1956 an additional 30 senile mentally deteriorated tuberculous men were transferred to the State Sanatorium from Anoka State Hospital.

The 3-day check program continued to function in 1956 and proved its worth when statistics for that year indicated only two patients of the 400 checked had reactivated their pulmonary tuberculosis after being treated with the new drugs, Streptomycin, INH, and PAS, for what had been considered an adequate period of time.

In 1957 additional senile mentally deteriorated tuberculous patients were transferred to the State Sanatorium, thus necessitating the use of one entire building unit for this type of patient.

During 1958, the "Pilot Study" program effort to utilize empty beds at the sanatorium became Law and 43% of the sanatorium beds were occupied by committed senile patients, of which one third were tuberculous. In 1960 55% of the total bed capacity of the Sanatorium was being utilized by the committed senile patient.

Statistics taken from the annual report of 1961 indicate a total bed capacity of 350. Of this number, 232 were occupied by senile patients and 56 by tuberculosis patients. Dr. M. M. Williams last Annual Report of the Minnesota State Sanatorium for the year ending June 30, 1961 reads as follows:

"It is with the deepest of mixed feelings that I submit this, the last annual report of the Minnesota State Sanatorium, which was created by an act of the Minnesota Legislature in 1903 and opened its doors to patients in December 1907. The undersigned has helped to "celebrate" twenty four of the sanatorium's fifty three "birthdays" but does not look forward with elation, or inspiration, to witnessing its last birthday on December 28, 1961 only to see it "laid to rest" three days later."

"--the job is not far beyond half done and much of the hardest core of the apple remains to be pared away. Yet, on the brighter side, one must realize that it is because of the unceasing effort of all concerned that we have accomplished this much in what is relatively so short a time. It is with a sense of much concern that we "hand over the torch" hoping that what little flame there remains will yet flicker on in the necessarily endless quest for the ever threatening tuberculosis bacillus in its darkest lairs.

"The tuberculous patient gets better treatment and remains in isolation increasingly shorter periods. This last success accounts partially for the decrease in average daily sanatorium patient population. But our "hidden failure" must also be taken into the summation and held accountable."

"The patients, more often than not infectious to family and friends, who never reach the sanatorium for needed isolation and more expert advice, must certainly account to an even greater degree than we are able to suspect or even disclose for the decrease in occupied sanatorium beds."

"As a public, both professional and lay, we are neglecting our vigilence and, in effect, willing to sacrifice something of what has been achieved in this 'battle of the bug'."

The new miracle drugs Streptomycin, PAS, and IHN, had very nearly extinguished the dread disease, tuberculosis. Were we rid of this disease forever?

Some medical theories presented as early as the 1950's, soon after the initial use of chemotherapy were cautious. In 1952 the American Trudeau Society stated: "Tuberculosis is still a treacherous, slow-healing disease. The American Trudeau Society summarize's the results of the study of the new drugs as follows: "Their demonstrated action, although highly encouraging, appears in no way to alter the basic principles of the treatment of tuberculosis as presently understood. Much more work will need to be done to ascertain the exact place of these drugs in the treatment of the disease."

It was not known whether patients would become sensitive to the drugs, or whether the tubercle bacillus would become resistant to them. Much was unknown, and as with any new medical discovery, it would be years before statistics could be developed from case histories.

Dr. Roger S. Mitchell, Associate Professor of Medicine at the University of Colorado and a Director of the Colorado Foundation for research in Tuberculosis stated that the danger of future outbreaks of tuberculosis is feared because of two reasons:

Drug-treated cases of tuberculosis which relapse almost always are reactivated by tubercle bacilli that have become resistant to drugs.

Immunity caused by non-disease-causing contact with tubercle bacilli will disappear as drugs reduce the incidence of disease. This will leave the popalation without its natural protection against the ravages of the disease.

Dr. Mitchell continued to enlarge on his theory that since the beginning of drug therapy, medical men were concerned over the danger of bacilli which develop resistance to the drugs. Such resistance arises from a mutation in the bacilli populayions.

Because of these new theories, the National Health Service and the Tuberculosis Association called a Conference to consider compulsory hospitalization for persons with active tuberculosis.

Speaking before members of the Minnesota Legislature, Dr. M. M. Williams stated: "We lifted the fear -- nobody's afraid of tuberculosis anymore. But never will we outtreat and extinguish tuberculosis. We have improved our position, but the enemy is still there."

Thus it was that at the end of 1961, Minnesota State Sanatorium closed its doors, after 55 years of service in the battle to thwart the disease, tuberculosis.