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CMAJ
CMAJ - May 16, 2000JAMC - le 16 mai 2000

Treating TB in the 1950s

CMAJ 2000;162:1405

CMAJ's recent review of tuberculosis1–13 made me recall the way we used to treat tubercular meningitis, a particularly ugly illness in children. Before 1950, no children survived this dreadful disease — 3 weeks from onset and it was all over.

In 1950, I attended a lecture in Boston given by Dr. Honor Smith of Oxford University. Working with neurosurgeon Sir Hugh Cairns, he had treated children with tubercular meningitis successfully using a combination of purified protein derivative of the tubercle bacillus (PPD) and streptomycin, both intrathecally and intramuscularly.

While a resident in Boston, I had seen a number of children die because of tubercular meningitis. When I returned to Montreal later that year, my proposal to treat children who had tubercular meningitis with PPD for my "investigative year" in preparation for Royal College fellowship was accepted. By the end of 1951, 11 children had been treated, 9 of whom survived. The result was unprecedented, and this was probably the first group of children to have survived the disease in Canada or the United States.

This clinical effort took place at the Alexandra Hospital in Montreal (Fig. 1). Over the next 4 years, 100 children were treated, and 80% survived. During this time, 50 McGill interns provided devoted and enthusiastic care to these children.

Fig. 1: The Alexandra Hospital in Montreal provided treatment for children with tuberculosis in the 1950s.
Photo courtesy of Nick Steinmetz

The successful treatment had 2 results. First, the federal government made a substantial grant to the operation of the unit. Second, Dr. Jonathan Meakins, Sr., then professor of medicine at McGill, invited Quebec Premier Maurice Duplessis to visit the unit. After a sumptuous lunch in the dining room of the Alexandra Hospital — all lunches at the Alexandra were sumptuous and formal, with Dr. E.M. Worden carving — Meakins presented the premier with a 1-page report on the state of tuberculosis in Quebec; he compared it with the situation in Warsaw after WW II. Duplessis was shocked and deeply moved by the report, and the result was the immediate construction throughout Quebec of many hospitals to treat tuberculosis. Their wonderful impact is now history.

Granville Nickerson
Pediatrician (retired)
Cobourg, Ont.

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References
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  10. Menzies D, Tannenbaum TN, FitzGerald JM. Tuberculosis: 10. Prevention. CMAJ 1999;161(6):717-24.
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  13. FitzGerald JM, Wang L, Elwood RK. Tuberculosis: 13. Control of the disease among aboriginal people in Canada. CMAJ 2000;162(3):351-5.

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