The Journal of the Arkansas Medical Society Med Journal Sept 2019 FInal 2 | Page 15

parts of both sides of the room (instead of the
new infections only clustering around the bunk
where the newly diagnosed infectious case was
assigned), he knew that transmissions did not
require close contact but had to have spread by
small airborne droplets as observed by Riley in
the guinea pig experiment.
Results from this outbreak were published
in the New England Journal of Medicine. From
this study, additional work was done evaluating
the effect of chemotherapy on eliminating the
infectiousness of a newly treated patient with
TB. Sentinel work on this was done at Jefferson
Regional Hospital in Pine Bluff.
many months or years. None of these measures
were ever subjected to a proper clinical trial to
measure their effectiveness.
Dr. Bates was determined to find a better
treatment, but before a new approach to
treatment could be developed, more basic
information was needed concerning how the
disease was transmitted from person to person.
Dr. Bates knew of important work done by Dr.
Richard Riley, who worked with guinea pigs
and showed that the infectious unit responsible
for disease transmission in the guinea pig was
a very tiny droplet containing only one or two
bacilli. Of key importance about this observation
was that these tiny units did not settle to the
floor, but remained airborne in any occupied
room. Until this time, it was thought that large
clumps of bacilli as are found in sputum from
TB patients were the ones that transmitted the
bacilli to the next susceptible human. Riley’s
findings could change the basic idea of how TB
is transmitted in people, but how could this be
tested in man?
A most-unexpected opportunity presented
itself when Dr. Bates was asked to help
control a tuberculosis outbreak at 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.
However, when Dr. Bates discovered that the
boys in the facility were: assigned bunk beds
located in a single, large room; separated by
age into two groups by iron bars that essentially
divided the room in half; and exposed to a
disease transmitted at random throughout all
Dr. Bates, working closely with Dr. Reagan
and other members of the hospital clinical staff,
formed a clinical unit at Jefferson Regional
Hospital exclusively for treating TB patients. It was
perhaps the first such unit located in a private,
general hospital in the U.S. After about three
years of the unit’s operation, a careful analysis
of the therapeutic outcome for the patients
and their household contacts showed that a
very short period of hospitalization, followed by
continuing treatment on an ambulatory basis,
gave highly satisfactory outcomes. Also of great
importance, it was observed that the patients
discharged on chemotherapy while still sputum-
culture positive were no more infectious for their
household contacts than were the patients who
were culture negative at time of discharge. This
work led to acceptance that TB patients can be
treated effectively in general hospitals and that
ambulatory treatment rather than prolonged
hospitalization and bed rest are required for
tuberculosis control.
Thereafter, Dr. Bates saw the closure of
tuberculosis sanatoria across the U.S. with the
McRae Sanatorium at Alexander, Ark., closing
This work led to acceptance
that TB patients can be treated
effectively in general hospitals
and that ambulatory treatment
rather than prolonged
hospitalization and bed rest
are required for tuberculosis
control.
in 1965 and the state sanatorium at Booneville
closing in 1972. Within 10 years of these
reports, over 600 TB sanatoria across the U.S.
were closed. Dr. Bates’ story is one of lifelong
dedication that has had an enduring impact on
the epidemiology and infectious disease. My
conversation with Dr. Bates concluded with a
moment of silence as he reflected on these
memories, and he returned my gaze with the
contented smile of someone who has lived a
most-fulfilled life. “Thank you for letting me
relive those memories,” he said to me.
Recommended Literature
Bates JH, Potts WE and Lewis M. The
epidemiology of primary tuberculosis in an
industrial school. New Eng J Med, 1965;272:714.
Gunnels JJ. Bates JH and Swindoll H.
Infectiousness of culture-positive tuberculosis
patients on Chemotherapy. Am Rev Resp
Disease; 1974:109:323. [This work was done
at Jefferson Hospital while Dr. Gunnels was a
pulmonary fellow under Dr Bates’ direction and
Ms. Swindoll was a public health nurse assigned
to Arkansas from the CDC. It was this paper that
provided the basic science that showed how
quickly the infectiousness could be controlled
by proper chemotherapy. This paper got lots of
attention and Dr Gunnels was invited to London,
England, to read the paper at a major medical
meeting.]
Bates JH. The changing scene in
tuberculosis. New Eng J Med.1977;297:610.
 Bates JH, Stead WW. Effect of chemotherapy
on infectiousness of tuberculosis. New Eng J
Med.1974; 290:459.
Patients on a ward at a tuberculosis
sanitorium.
 Bates JH, Ambulatory care for tuberculosis-
an idea whose time has come. Am Rev Resp Dis.
1974;109:317.
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