It wasn't long into the making of On the Lake: Life and Love in a Distant Place, a film about the tuberculosis (TB) epidemic in 1900s America and globally today, to see the uniquely vital role that nurses played in the era of TB sanatoriums.
Not only did nurses have primary responsibility for patient care, but they also literally risked their lives in the battle against one of the deadliest diseases of all time. Despite the risk, nurses consistently rose to a higher purpose.
In the first half of the 1900s, America had more than 600 sanatoriums from coast to coast. Tens of thousands of consumptives, as people affected by TB were called, were sent to the isolation of these distant hospitals, often for years, in hopes of being cured.
No effective medications existed. Fresh air, bed rest, and healthy food were the best chance to recover, along with various types of surgery. It was known that TB was an airborne disease easily spread by coughs or sneezes, and the nursing staff was unusually vulnerable, given that at most sanatoriums, nurses lived on the grounds.
Nurses' experience at Wallum Lake
At the Rhode Island State Sanatorium (on remote Wallum Lake, on the Massachusetts and Connecticut borders), one of several sanatoriums shown in the movie, the medical staff was well versed in precautions, but the threat of being infected was ever-present.
"Keep up your bodily resistance by having regular meals, keeping regular hours, and getting plenty of rest," wrote the Wallum Lake superintendent to his nursing staff in 1941. "If you feel ill or indisposed or have any signs of a cold, obtain medical advice at once. Never let any illness drag along."
For instance, if a TB nurse prepares a child for a chest X-ray, results would be used to determine if surgery was indicated. Among the surgical options in the 1930s and 1940s was the removal of an entire lung. Despite precautions, many nurses did become infected with TB, but how many exactly is unknown as there is no record of this data.
Some, like many of the patients they cared for, died. But others, including Nita Worthington, a New York City's Bellevue Hospital School of Nursing graduate, the nation's first recovered and went back to TB nursing.
Finding their calling
Other TB nurses had found their vocation as young TB patients; moved by the compassion and care they had received as they returned to health, they joined the cause. Vintage photographs and motion-picture footage of nurses in their old-fashioned white uniforms abound in the final cut of the documentary. The images do not fully capture the passion nurses brought to their care. Nursing, they believed, only began with the physical.
Nurse Katherine J. Densford was on the Wallum Lake staff in the 1940s, and during production, typewritten notes from a lecture she delivered were found at the sanatorium. One passage eloquently captured a TB nurse's dedication to this terrible epidemic.
"Nursing care depends on the spirit of the nursing service. It should be a sort of religion to tuberculosis nurses to give the necessary physical care, to care for the mental requirements of the individual, and to provide an atmosphere and environment meeting adequately the spiritual needs of the patient so that he will be comfortable, contented, and happy," wrote Densford.
The larger role nurses played
Rhode Island staff nurses and students lived on the grounds of many sanatoriums, including Wallum Lake. Could that not serve as a motto for nursing today? This mind-body philosophy, which today is widely recognized as critical to a patient's outcome, was also exemplified in a lecture given by Wallum Lake nurse Leah M. Blaisdell in her lecture.
It speaks to the role nurses played in addressing patients' justifiably profound fears of having a disease that killed so many millions before effective drugs were developed, often through an excruciatingly painful and protracted death.
"Fear can make a person forget an appointment for a diagnostic clinic," Blaisdell told the nursing staff. "Fear of economic strain on family can make a patient condemn a good sanatorium its foods, its beds, even its nurses. ... Any of these fears and others may upset the appetite, slow digestion, hinder assimilation, and cause the person to lose interest in taking the cure necessary to speedy recovery. From beginning to end, from tuberculin tests, which uninformed patients may fear, to a complete cure and the protection of other mental and emotional factors, all concerned should pay equal attention to the physical factor. Only in that way will even a dent be made in the tuberculosis patient."
Today, in the U.S., TB is no longer an epidemic. although it remains a grave public health risk, as recently publicized cases confirm. Globally, tuberculosis is the second deadliest infectious disease (after HIV/AIDS), killing almost 2 million people a year and with 9 million new active cases. Whether here or abroad, nursing was and remains of critical importance in battling this historic condition.
