Tuberculosis

 

            

          By the mid-1800's, tuberculosis had reached epidemic levels in Europe and the United States, including the rural areas like Ohio County. The disease attacked the lungs and damaged other organs.  Before the advent of antibiotics, its victims slowly wasted away, becoming pale and thin before finally dying of what was then known as "consumption" and sometimes referred to as "flux."

           During that time, consumption was thought to be caused by hereditary susceptibility and miasmas, or “bad airs,” in the environment. Among the upper class, one of the ways people judged a woman’s predisposition to tuberculosis was by her attractiveness.

 

            In 1869 a French physician demonstrated that the disease was indeed contagious, conducting an experiment in which Tuberculosis matter from human cadavers was injected into laboratory rabbits, which then became infected. On 24 March 1882, Dr. Robert Koch, a Prussian physician, revealed the disease was caused by an infectious agent.  Treatment was guesswork and varied, but rest was prescribed by most doctors.  Sanatoriums were used to isolate patients until the mid-twentieth century.

 

            We have all been to Mammoth Cave.  But you might not know that in 1842 Dr. John Groghan opened a treatment facility for tuberculosis patients inside the cave, thinking that the cool and pure air would help the patients recover from the disease. The patients lived in 10 wooden cottages about a mile and a half inside the cave.  The cottages measured 12 x 18 feet and canvas roofs.  Two more cottages were built of stone.  About 15 people became patients but the experiment failed after several deaths and the facility was closed within five months.  See the article below for more details.

 

            Vaccines were developed in Europe as early as 1906 but were not accepted and used widely until after WWII. Some say the true revolution of the war against Tuberculosis started in 1952 with the development of an oral drug and then in the 1980’s a drug called Rifampin hastened recovery time.  It is thought that the decline in mortality from infectious diseases has been caused by an improved standard of living, particularly by better nutrition, and by better hygiene, and less by medical intervention. Tuberculosis still rages throughout the world, including the United States, with about 1.4 million deaths last year.  It is a global pandemic that is transmitted almost exactly like the COVID-19 virus (coughing and sneezing). The difference is that Tuberculosis is bacterial and can be treated with antibiotics. 

 

            It is not known how many people died in Ohio County (or Kentucky) of tuberculosis in the 1800’s as death records are minimal and physicians did not understand the disease.  Death certificates did not start using death certificates statewide until 1911.  Before that counties recorded deaths in the county courthouse in a manner similar to the way marriages and births were recorded, but only if some one (a family member) reported the event to a county official. Ancestry.com has a database of Kentucky deaths from 1852 through 1910.  The county records were microfilmed in the 1980’s by the State government, however some records from Ohio County are missing – probably due to Courthouse fires. Here is the first page from the 1852 microfilm records:

            The next to last column states the cause of death.  On this page the word “Flux” is found four times; the word “Consumption” is found five times; and the word “Fever” is found twenty-three times.  Also, “Cold chills” is used and “Cough” is used.  So you can see that it would be impossible to determine how many of those deaths was actually from Tuberculosis or any other specific disease.

            Age of death is the second column and that is easier to read. Sadly, most were young.  From the top the ages are 1 yr, 13 yrs, 1 year, 4 mos., 23, 35, 18, 15, 18 mos., etc.  On the entire page of fifty-five names there are only nine deaths listed for anyone age 40 or older.

            As you can see below, Tuberculosis remained a big problem during the first half of the 1900’s in Kentucky.

Hidden History: Tuberculosis in Mammoth Cave

Mammoth Cave National Park in central Kentucky is home to the world’s longest known cave system. The system of chambers and subterranean passageways reflects the park’s extensive and varied history. In 1839, Dr. John Croghan of Louisville, Kentucky, who suffered from tuberculosis, purchased the Mammoth Cave property for $10,000. At a time when minimal medical knowledge of or treatments existed for the “white plague,” a leading cause of death in the nineteenth and early twentieth centuries, Dr. Croghan was interested in the cave in part as a possible sanitarium.

Visitors and miners had reported feeling distinctly well after spending time in the cave and Horace Carter Hovey wrote that “the air is slightly exhilarating, and sustains one in a ramble of five or ten hours, so that at its end he is hardly sensible of fatigue.” Further, having observed that timber and animals did not decay within the cave, Dr. Croghan hoped the environment would be restorative and therapeutic for tuberculosis patients and subsequently established an experimental hospital treatment facility within the cave.

Believing the uniform temperature and humidity held curative properties, Dr. Croghan invited 15 patients under his care to take up residence in the cave in the winter of 1842. Patients resided within a series of buildings constructed by enslaved individuals, including two stone cabins and eight simple wooden structures measuring 12 x 18 feet with tongue and groove flooring and canvas roofs.

Away from the rhythms of natural light, patients synced their watches with the outside world and managed their daily underground routines accordingly. Living within the cave, patients initially seemed to improve and Dr. Croghan enthusiastically began to draw up plans for a hotel to be established within the cave to house the anticipated masses that would flock to the cave for healing.

However, as winter progressed, it became clear that the dank, dark conditions worsened the patients’ symptoms. Smoke and ash from lard oil lanterns and a large fire used to light the cave continuously filled the chambers while the dampness of the air further degraded damaged lungs. Cedar trees and bushes brought in to lighten the atmosphere quickly withered. While some cooking was completed within the cave, other meals were prepared off-site by enslaved individuals and brought into the cave. A server named Alfred noted, “I used to stand on that rock and blow the horn to call them to dinner. There were fifteen of them and they looked more like a company of skeletons than anything else.”

A Public Attraction

Tours of Mammoth Cave had begun in 1816. The tourist infrastructure developed over the next several decades, including the expansion and remodeling of the existing hotel and creation of new roads by Dr. Croghan. These improvements and public tours of the cave system continued during the medical experiment. Unsuspecting visitors would occasionally encounter ghastly patients in hospital gowns shuffling along passageways or hear hollow coughing echoing in the distance.

In a letter, patient H.P. Anderson wrote that “There are many things to be done to render this place entirely pleasant and to give its virtues a fair test; we are pioneers under all the disadvantages of such and after generations will reap benefits of our experiments.” As complaints and requests to leave arose, Anderson was the only individual to return to the surface while Dr. Croghan convinced the remaining patients to stay.

As the weeks wore on, five patients ultimately died inside the cave, their bodies laid out on what is now known as corpse rock. Dr. Croghan despondently returned to the surface with the remaining survivors. The experiment was not repeated and the wood frame huts were dismantled, while the two stone cottages remain along Broadway within the Mammoth Cave Historic District.

The experiment lasted no more than five months, from autumn 1842 to early 1843. While the cool cave setting conformed to the treatment standards of the times, the unventilated, damp environment made the disease worse. Like his patients, Dr. Croghan ultimately passed of tuberculosis in 1849.

“Groping for Health in Mammoth Cave,” Filson Club History Quarterly, 20: 4, 302-307, Louisville, Oct., 1946.