The Journal of the Arkansas Medical Society Med Journal Sept 2019 FInal 2 | страница 14

Tuberculosis in Arkansas:
An Interview With Dr. Joseph Bates
Teresa Bau, MD
UAMS (South Central) Family Medicine Residency
A
rkansas has a monumental figure of
our state’s medical history tucked
away on the third floor above the
UAMS Library, and his name is Joseph
Bates, MD. Dr. Bates is a pulmonologist
who has truly lived a life of service and
unrelenting commitment towards his
research. He is one of the founding fathers of
modern tuberculosis epidemiology and treatment.
More importantly, while working together with
Paul Reagan, MD, and William Stead, MD, he
changed the paradigm of how tuberculosis now
can be treated in an outpatient setting.
I had the pleasure of interviewing Dr. Bates
for my family medicine residency senior research
project. I did not realize that my interview with
Dr. Bates would be a history lesson, but I should
have known better. Tuberculosis, in much of the
present-day western world, has largely become
an uncommon disease; however, this was not
Mycobacterium tuberculosis
the case merely 60 years
ago when the incidence of
TB in 1953 was 52.6 per
1,000,000 as compared to
the present value of 2.9. In
the 1940s and before, being
diagnosed with tuberculosis
was a serious death threat.
Those with active disease
had a 50% mortality
rate! In the present-
day
developing
world,
tuberculosis continues to be Dr. Paul Regan (left), Dr. Joseph Bates (center), and Dr.
one of the most widespread William (Bill) Stead (right) at the Arkansas Department of
Health in 1975.
and deadliest diseases,
including one of the leading killers of those medical complexes where patients could
with HIV. My conversation with Dr. Bates started live and be removed from the rest of society.
with some basic statistics followed by some However, these patients also were subjected to
epidemiological facts to put it all in perspective experimental treatments by physicians trying
of Arkansas history. In 1882, the bacillus that to find a cure for this illness. TB was thought
causes TB, Mycobacterium tuberculosis, was by many to result from a failure of will or from
discovered by Robert Koch. In the same decade, “over-intensity.” Many modes of treatment
Louis Pasteur was working on the pasteurization
were tried including collapse of the infected
of milk to prevent the spread of “germs.” The
lung via surgical removal of up to eight ribs
work by Koch and Pasteur reported in the 1880s
on the involved side or inducing lung collapse
led to the understanding that microbes could
by inducing a pneumothorax repeatedly over
infect humans and cause disease—thus the
Germ Theory was established. Of note, Waksman
and Schatz discovered streptomycin in 1944;
A most-unexpected opportunity
Damage and Fox co-discovered isoniazid in
presented itself when Dr. Bates
1947. These two antimicrobials are still part
was asked to help control
of the large number of available drugs for the
treatment of tuberculosis today.
a tuberculosis outbreak at
Dr. Bates’s passion for his research was
quickly evident as he became quite emotional
talking about visiting his uncle at one of the
earliest TB sanatoriums in Booneville, Ark. In
the late 1800s, sanatoria were developed where
patients with tuberculosis were “prescribed
sunshine and fresh air” to treat their disease.
These sanatoria were typically self-sufficient
62 • THE JOURNAL OF THE ARKANSAS MEDICAL SOCIETY
juvenile correctional facility at
Wrightsville, Ark. At the time of
this outbreak, it was thought
that the disease spread via
close contact with a person
who had active disease.
VOLUME 116