Object 89: VA Film “You Can Lick TB” (1949)

In 1949, VA produced a 19-minute film titled “You Can Lick TB.”  The film follows a fictional conversation between a bedridden Veteran with tuberculosis and his VA doctor, dramatizing through brief vignettes the different stages of TB treatment and recovery.

Two years earlier, VA released a pamphlet with the same title. Both the film and pamphlet were designed to educate the TB patients under VA’s care and drive home a simple message: tuberculosis was a disease without a cure, but it could be controlled through months of strict bed rest followed by a very gradual return to normal activities, all carried out in a hospital setting. As the doctor explained to his restless patient in the film, this regimen was intended “to help build you up to that day when . . . [you] can go home for good.”

Known as the “white plague” in earlier centuries, tuberculosis has claimed more lives than any other infectious disease in human history. Pulmonary tuberculosis, the most common form of the disease, attacks the lungs and spreads easily through the air, making it highly contagious. Around the turn of the twentieth century, TB became less of a scourge in the western world due to improvements in sanitation, hygiene, and living standards combined with public health measures such as widespread testing and rapid isolation of the infected. Yet, it remained one of the leading causes of death in the United States.

The nation’s entry into World War I led to a resurgence of tuberculosis cases among Americans in uniform. The crowded barracks and mess halls of the stateside Army training camps proved to be an ideal breeding ground for the disease. Over 20,000 service members were diagnosed with tuberculosis and discharged from the military between 1917 and 1919. Thousands more developed active cases after leaving the service.

In the 1920s, the newly established Veterans Bureau provided care for these Veterans at more than a dozen dedicated TB hospitals. At first, it housed patients in hospitals, often makeshift in quality, transferred over from the Army and the U.S. Public Health Service. By the end of the decade, though, most of these facilities had either been renovated or replaced by new construction. The agency also established TB units in its general and neuropsychiatric hospitals. Admissions for tuberculosis surged to a high of 44,000 in 1922 but then dropped off sharply, averaging about 11,000 per year from 1929 through the end of World War II.

Veterans’ hospitals followed the same treatment program as the European-style sanitoriums that opened in the hundreds across the country between 1875 and 1925. Doctors prescribed complete and prolonged bed rest accompanied by nutritious food and fresh air to arrest the progress of the disease and restore the weakened body to health. For the seriously ill, physicians resorted to various risky surgical procedures that involved collapsing the damaged lung to give it time to heal. Hospital stays typically lasted six months to a year and relapses after release were common.

VA’s “You Can Lick TB” film and pamphlet reflected the established medical orthodoxy on how to treat tuberculosis. Yet, even as the agency’s physicians preached patience to those in their care, VA researchers were exploring a promising new form of drug therapy.  In 1944, after decades of fruitless experiments, scientists identified an antibiotic agent called streptomycin that had a suppressive effect on TB bacteria in lab and animal tests. The medical breakthrough came too late to be of value in World War II, but the timing was opportune for VA, as hospital admissions for Veterans with tuberculosis more than doubled after the war.  

As soon as it had a sufficient supply of the drug on hand, VA in 1946 launched the first large-scale clinical trial of streptomycin. Dr. John B. Barnwell, the head of VA’s Tuberculosis Division, directed the investigation. A nationally recognized authority on tuberculosis, Barnwell also had first-hand knowledge of the disease from his own bout with TB earlier in life. During the war, VA had been criticized in the press for the quality of its tuberculosis patient care. VA’s Chief Medical Director, Dr. Paul R. Hawley, recruited Barnwell in 1946 to take charge of tuberculosis treatment and research.

The VA-Armed Forces cooperative study designed by Barnwell and his team tested the drug on select patients at seven VA and two military hospitals. The early results were encouraging and showed that streptomycin could hinder the growth of the tubercle bacillus. In 1948, as the benefits and limitations of the drug became apparent, the group expanded the trial to include more VA hospitals and other experimental antibiotics. By 1949, these drugs administered individually or in combination with one another had been tested on 7,000 patients at 54 hospitals. Other health organizations also initiated a series of TB trials.

By the mid-1950s, doctors finally settled on a regimen that included six months of streptomycin accompanied by 18 to 24 months of two other medicines. This new system of care rendered the treatment protocol described in the “You Can Lick TB” film and pamphlet obsolete. The anti-TB drugs increased survival rates, reduced the length of hospitals stays, and eliminated the need for absolute bed rest in all but the most advanced cases.

Within a few decades, almost all of the sanitariums that catered to TB patients in the United States closed or were put to other uses. At VA, the number of tuberculosis hospitals in its inventory peaked at 21 in 1954 and then gradually declined as they were redesignated general care hospitals and started admitting other patients. The TB hospital in Indianapolis, Indiana, was the last to make the changeover in 1969, ending this era in VA health care history.