7.3.3: *Illustrative Cases*

From Sweany, H. C. “The Municipal Tuberculosis Sanitarium Research Laboratory” City of Chicago Municipal Tuberculosis Sanatarium Monthly Bulletin. 1923, 3 (10). City of Chicago Municipal Tuberculosis Sanitarium. 89-96.

The original plans of the Municipal Tuberculosis Sanitarium included a laboratory, but it was almost a misnomer. It consisted of two small rooms in the corner of the main administration building with two rooms in the basement for animals and storage. In addition a few small rooms in different units over the grounds were used for laboratory purposes.

// the scale of facilities prescribes their value //

This equipment was adequate, however, to care for the clinical work and was in keeping with other institutions of the kind over the country, but it was altogether too small for any extensive research work.

// the scale is associated with the boundaries //

// between practice and research //

One visiting physician wittily remarked that the architects must have confused the words laboratory with lavatory. The greatest drawback of all was its unfavorable location.

// between value for some individual patient //

// and the grand spectre of medical science //

Because unsavory odors are sine quo non of medical research work, it afforded a splendid opportunity, for gassing the executive and office force with bromine and other natural gasses.

// i didn’t know funding quarrels resulted in chemical warfare //

Such opportunity was short-lived however, because the laboratory was soon moved into the farm house on the back of the grounds.

The farm house is a beautiful little cottage of five rooms, with a good basement and attic, but as a laboratory it was still only a beautiful cottage. Nevertheless it was the best that could be had at the time and it sheltered the laboratory for five long years. during which time much creditable work was done under the directorship of Dr. Harry J. Corper.

// corper, a military veteran, would move from chicago //

// to denver to pursue further research //

During this period, Dr. Maximilian Herzog was made Superintendent of Laboratories, which position he held until his death. Under his direction an up-to-date animal house was constructed sufficient in size to contain several hundred laboratory animals and a stable was equipped for the accommodation of larger animals for serum preparation.

// read: cages for hundreds of animals //

// mostly guinea pigs //

// corper’s research was reliant on a continual //

// supply of non-human organisms //

In addition, the laboratory was extended to include several more rooms, one of which was in conjunction with the serum stables.

The prime event, however, was the laying of the plans for the present laboratory building. ‘ Dr. John Dill Robertson, President of the Board of Directors, by a most laudable effort, succeeded in obtaining a suitable appropriation for the building and Dr. Herzog began drawing the plans. Unfortunately his work was of short duration, due to fatal illness.

// rip //

The work was carried on by his assistants and later by a supervising committee including Dr. Ludwig Hektoen, Dr. D. J. Davis and Dr. F. O. Tonney. The building was begun and completed during the war, but because of prohibitive prices the equipment was not installed until a year ago, when the writer was given the directorship of the laboratory and the authority to proceed in the equipping of part of the building with furniture and laboratory supplies. The additional proportionate cost was small and the advantages great, therefore the entire building was furnished and equipped at once. This was made possible by the fact that most of the furniture was constructed by carpenters on the grounds.

The task of installing modern laboratory equipment was not simple. The difficulty was aggravated by the fact that much of the material had to come from abroad. Export taxes, import taxes and shortage of raw material placed many hindrances in the way. By utilizing what we already had and buying only essential new equipment, we have at last practically completed one of the finest research laboratories in the country at a very reasonable cost.

// the quality of research is associated //

// with the expense available //

The people of Chicago have every reason to be proud of this institution and I am sure that it will justify its existence by results produced.

// and the character of the equipment //

// as much as the laborers (the researchers) //

Those who have had a part in this work deserve great credit, for it will, no doubt, prove to be a land-mark in tuberculosis research, which is one of the pressing needs today in public health.

// read: we spent a bunch of money on this //

// and we do not want to look like it was a waste //

Tuberculosis, one of the oldest diseases of mankind,

// why this obsession with age //

// that tracing it back millennia gives it greater weight? //

has the peculiar distinction of being one of a very few for which no effective medicinal treatment is known. Malaria, a scourge of the world for centuries and accredited by many as one of the causes of the fall of the Roman Empire, yields quickly to the proper quinine treatment. Leprosy, the stalking death of Asia and Europe for two thousand years, is now bowing to the effective use of Chaulmoogra oil, until leper colonies are being closed for lack of patients. Syphilis, the disease that was for so long considered incurable, yields to the modern treatment with mercury and arsenic compounds.

// syphilis was a beloved research object //

// for the unwashed masses were blighted with it //

Sleeping sickness, or trypanosomiasis, is now successfully treated. In diphtheria, smallpox and typhoid fever there are therapeutic means of preventing or stopping the disease process. There is no such therapy for tuberculosis.

// e. l. trudeau would like to speak to you //

We do not mean to imply that there is no successful treatment for tuberculosis. Everyone knows better. The fact is, however, that our present methods include only hygienic measures.

// read: preventative, and environmental methods //

// read: the best we can do is sit you outside for a couple months //

// i hope you don’t mind //

Why should tuberculosis be more difficult to treat than leprosy, a similar disease in many respects?

// they are deemed similar because both bacilli //

// react to the dying compounds that koch used //

// to isolate the disease //

Why should malaria and syphilis yield to the science of medicine and tuberculosis withstand every effort? These questions demand careful consideration.

// and funding //

First of all the disease has been side-stepped more or less by medical men, because it is not understood and because it is difficult to obtain results in treatment. No serious attempt has been made to prevent the spread of infection by contact until within the last 40 years. It is no wonder that workers in tuberculosis have turned to the law-makers and police to make and enforce laws against tuberculosis.

// investment in these forms of control //

// is an interlocking hegemony //

// over a certain class of people //

The best way of eradicating tuberculosis is to protect the young from infection. Delinquent physicians, and they are becoming few, have been forcibly aroused to their responsibility and opportunity in stamping out the disease.

// discourses of invasion //

// of war, territorial control //

// are tied to the ideologies of prevention //

It has furthermore been demonstrated that tuberculosis is a preventable disease. The death rate from tuberculosis is already rapidly decreasing.

// then wouldn’t this be a success akin to //

// the list before? //

The decrease will be more noticeable when the children of today have grown up and developed into healthy men and women instead of victims of consumption.

// notions of decades long gestation seems to foreground //

// the child as passive victim //

// but also an actor who must be controlled, disciplined //

// made healthy through intervention //

Another reason, perhaps, why more progress has not been made in finding a cure for tuberculosis is the fact that many diseases are more mutilating in their effects. Its nature is such that the patient is well on the road to destruction before he knows that he is ill. Like a thief in the night, tuberculosis creeps in and has its victim before he is aware of it.

// the invader slips in, and kills the subject //

// making them the walking dead //

In times past, the first signs of the disease that were recognized were the pallor and emaciation of advanced tuberculosis, excessive cough and expectoration, or hemorrhage.

// this invasion metaphor echoes a white supremacist panic //

// an lusion of the body (be it the human or the national) //

// as being an essential, contained entity //

// that the outside actor is necessarily poisonous to it //

This last sign, no doubt, has saved many lives because it frequently comes early and people are more afraid of blood than of any other thing, so they go to the physician immediately. It is gratifying to know, however, that the public are beginning to realize that the chance of recovery is proportional to the earliness of the diagnosis.

// seeing the disease when it is a minor actor //

// rather than a surging calamity //

// fetishizes the ideology of perfect vision //

// that one could look at my body //

// and predict my death //

Clinicians say that it is unusual now-a-days to have a patient come in with massive involvement, as was frequently the case a few years ago. This better condition in Chicago, and, no doubt in other cities, has been brought about by the fact that we have well-organized dispensary systems conducted by well trained physicians.

Still another reason why tuberculosis is hard to treat is that by its nature it is difficult to attack. The germ that causes the disease is well protected by a waxy capsule so that medicinal agents cannot destroy it readily.

// the internal, enclosed, actor //

// which cannot be externalized //

// anatomized //

The germ of leprosy is very much like the germ of tuberculosis and a specific cure for it has been found. Medical men are continually searching for a similar remedy for tuberculosis. Legislation, education and organization are reducing the death rate in tuberculosis but there is still much to be desired and much to be done.

// why is a cure fetishized //

// and not the prevention? //

// why is a cure the dominant discourse //

// and not the attention to how it lingers in the public? //

Scientific men and women are devoting time and effort to the search for a therapeutic agent, but the numbers are far too few and proper working facilities too meager at present.

// read: we need more money //

Much valuable work is being done, but with very few exceptions the efforts are not concerted and the work is on too small a scale.

// read: we need more money //

What wonderful results could be obtained if there should arise organizations devoted to this work, similar to that in which Dr. Paul Ehrlich worked out the now famous remedies for syphilis! Such an institution is now in the process of making at the Municipal Tuberculosis Sanitarium of Chicago and, no doubt, Dr. John Dill Robertson had such results in mind when he caused the present laboratory building to be erected.

A well-equipped research laboratory is the most intricate and the most complex institution in existence. It is a place where anything can be constructed or compounded on a small scale. Every product of our factories

// the idealized institution //

originates in a research laboratory.

// the laboratory as capital generator //

It is, or should be, a hundred little plants in one. It is a cold storage, a hot house, a host of different little power plants, a kitchen, a library, a photographic studio, a museum, a zoological garden, an operating room, a glass factory and a chemical arsenal!

// the laboratory as producer, not researcher //

And these are only the less important details! It is a complete chemical laboratory where physical, biological, organic and general chemical problems can be solved. It is a fairly complete physical laboratory especially pertaining to optical physics. It is a physiological, pathological, serological, bacteriological and clinical laboratory.

// overlapping disciplines is so alien when reading the literature //

// which ascribes value to a single, essential cause //

Almost every scientific process can be performed in such an institution. Each of these groups cannot be described in this brief article, but a few will be explained to give an idea of the work done.

In a medical research laboratory where such a variety of work is carried on, there must be many rooms to accommodate the various departments and each one should be planned and constructed with special care for its particular purpose.

// read: we’d rather not share space //

There must he hot and cold water, live steam, high-pressure steam, drains, electricity, compressed air, vacuum and gas in several different places in each room. /

/ don’t worry about where these materials come from //

// this will, of course, be taken for granted //

This means that the walls of the building must be a veritable net-work of pipes. Each room must also have specially constructed work tables, desks, sinks, wall cases, fume hoods and the like. The cost of such a building and its equipment is necessarily high.

// read: we need money //

The laboratory kitchen where culture media or food for bacteria is prepared is, in most respects, like a household kitchen. There is the cleaning sink where dirty glassware may be washed. Before being washed all glassware must be sterilized to kill the germs.

// the lab is a place of death //

// the extermination of an unwanted element //

There are various types of sterilizers. There is the chemical bath; the gas flame, where material may be burned; the hot-air sterilizer, like the oven of a kitchen range; the live-steam sterilizer, where steam comes in contact with the material; and the steam sterilizer where the steam is held under pressure. Every type of sterilizer is needed and each one requires special fittings and connections in order to be of service.

// every type fits with specific protocols //

// to make death for the sake of isolation //

After the glassware is washed it is placed in a dryer, then plugged with cotton and sterilized in the hot-air sterilizer.

// i cannot separate this term //

// ‘sterilize’ //

It is then ready to be filled with media which is prepared by a special process of cooking and sterilizing,

// from its eugenicist use //

depending on the type of media desired. Some media, for example, must be heated in hot-water sterilizers, called inspissators, where water is kept a few degrees below the boiling point.

// from the way it is used to wound the other //

// with such scientific nonchalance //

This is better food for bacteria than when it is cooked in other ways. Other types of media have different methods of preparation. When the media has been cooked, it must be filtered or have the precipitate separated from it. It is then tubed, sterilized and stored for use.

The laboratory kitchen is described because it is a typical laboratory room. Most people are familiar with a photographic shop, office or library and know in general what they require. The rooms where experimental work is done are much more difficult to arrange because of the variety of equipment which must be placed in the proper relation to electrical, water, gas, steam and other connections.

// he keeps repeating these conditions //

// as if there are not specialized tools //

// even for office clerks //

In addition, the accessibility and convenience of the various instruments and apparatus must be borne in mind. The working of one must not prevent the use of another.

In the Municipal Tuberculosis Sanitarium Research Laboratory the media and the chemical store rooms are located on the first floor. The autopsy and pathological rooms, morgue and all related departments occupy space on the north side of this floor and are accessible one to another.

// just as the object needs to be sealed off //

// staged for observation //

An operating section for horses and other large animals with its attendant bacteriological, serological and storage rooms in close proximity, occupies another portion of this floor.

// so do the rooms, have to be predefined //

// prefigured, and made useful for specific research //

There are also photographic, shop, dressing and a variety of other rooms.

On the second floor are located the offices, library, museum, incubators and

// spaces for books and preserved specimens //

// for books and the ‘book of the body’ //

refrigerators, as well as the physiological, general research and main bacteriological laboratories. In these bacteriological laboratories, the cultures are made, the clinical tests performed and the complement fixation reactions and other related work carried on.

On the third floor are located the various chemical laboratories, metabolism, operating and individual work rooms, animal hospital, ice boxes and incubators. The general chemical room forms a nucleus for the chemical department with biochemical, physical, furnace, balance, metabolism and dark rooms in close proximity. The animal hospital is equipped to take care of animals on which experimental work is being performed and has feed and sterilizing rooms in conjunction with the operating room near at hand. The metabolism room is situated next to that in which gas analyses are made. A house especially constructed for the smaller normal animals, rabbits, guinea-pigs and mice, and the horse and sheep barns are, of necessity, separated from the laboratory building.

In our efforts to establish this institution, we need encouragement and support from all who are interested in the prevention of human suffering. Few realize the role played by research and by the men devoted to it.

// research is tied to the reduction of suffering //

// while at the same time leveraging controls and experimentations //

Human progress is in a large measure dependent upon research.

// on the ill (both human and non-human) //

// with a claim to reduce suffering, so long as they can capitalize //

// on the suffering of those desperate enough to be ingested //

// into the research project //

No better example of the value of research was ever brought forward than that afforded by the late war. The research man was the one who had to devise, overnight, means of meeting the new and varied methods of warfare; he was the pivot on which the fate of nations swung;

// national survival rests on the hands of the medical class? //

it was his versatility that changed the factories of peace into arsenals of war. That which applies to war on man may be applied as well to war on disease.

// this war metaphor is a funding metaphor //

// to throw resources against a wall //

// to spend with the reckless abandon without consideration //

// to win a victory against the vilified other //

// the war on cancer, as mukherjee, has argued //

// was a war for funding as much as a wish for a cure //

The value of certain results of research work may be questioned and indeed at times such results may appear academic and of no practical value. To those who hold such ideas let me cite an example. When Michael Faraday discovered the principle on which the modern dynamo was built, scoffers poked fun at him, and it was suggested that a man who would pack a toy around in his pocket and play with it when the occasion permitted must be a bit out of his mind. At last he was asked, “Of what use is it?” His reply has become immortal: “Of what use is a baby?”

// ideologies of potentiality //

// of latent capital //

This “Faraday baby” has grown until half the machinery of the world is run by it and its value to humanity is estimated to be seventy-five billion dollars!

// again, science is described as a capitalist necessity //

// the actor upon which all economies rest //

Such is a brief description of the Municipal Tuberculosis Sanitarium Research Laboratory and its work. It is one of the finest of its kind. Our hope is that it will become a living institution, in the front rank in the struggle to eradicate the great white plague from the earth.