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Sunday, March 21, 1999 - Page updated at 12:00 AM

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When Firland Was Operating At Peak Capacity, Tb Was A Major Killer Of American Adults. Patients Clung To The Hope That They Could Get Into A Sanitarium. But The Treatment Included ... Days Of Isolation

Special To The Seattle Times

As you walk among the stately brick Tudor-style buildings of the original Firland sanitarium , built in 1914 in North Seattle, little suggests the drama of death and disease that went on here more than 50 years ago. Even on a cold winter afternoon, with the sky a smudge of gray and crows shrieking in the trees, the place doesn't betray its origins - unless you know where to look.

Embedded in the walkway is a large red cross with two horizontal pieces - symbol of today's National Lung Association, which started at the turn of the century as the National Anti-Tuberculosis League. More two-barred crosses adorn brass doorknobs inside the building.

On top of a belfry where bats and pigeons hide stands a single-barred cross that signifies the current occupants, Crista Ministries, a worldwide Christian outreach group that bought the sanitarium when it closed in the late 1940s.

Crosses seem a fitting icon for this place, which for 35 years witnessed so much suffering and death. At one point nearly a third of the discharged patients left in coffins. They were among Seattle's contribution to the estimated one billion humans who have died from tuberculosis over the last two centuries.

Firland is but one small part of the history of a disease that has dogged the human race for at least 6,000 years, and still kills at least 3 million people a year.

In many ways TB is an "invisible" disease in the U.S., with 25,000 new cases reported a year, and 1,000 deaths. But lately it's been gaining a higher profile. After a nearly 40-year decline, the numbers crept upward in the late 1980s, because of TB's greater ability to strike when combined with HIV/AIDS and because of immigrants from countries where TB has a strong foothold.

Back when Firland was operating at peak capacity, in the 1930s and '40s, TB was a major killer of American adults. The disease was feared then as much as AIDS is now. But patients clung to the hope that if they could get into a sanitarium (the waiting lists for public facilities like Firland were long), they had a chance to beat the disease.

The idea of TB sanitariums began after a New York doctor named Edward Livingston Trudeau, diagnosed with TB, decided to spend his final days in the Adirondacks where, to his surprise, he began to recover. Convinced of the curative powers of fresh air, rest and good food, he built the nation's first tuberculosis sanitarium near Saranac Lake, N.Y., in 1884.

Over the next 40 years, more than 600 "sans" sprang up around the country, including Seattle's Firland, at 193rd Street and Fremont Avenue North, in 1914. (In 1947 the sanitarium moved to the former Seattle Naval Hospital at 15th Avenue North East and North East 150th Street.)

Firland was funded by a $125,000 bond issue passed in 1912, with strong support from newspapers, churches and the fledgling King County Anti-Tuberculosis League.

Two of Firland's most notorious patients were Seattleites with much in common.

Hazel Wolf, 101, is an environmental activist and legendary Audubon Society organizer. But back in the 1940s she smoked a pack and a half of unfiltered cigarettes a day and held a low-paying government job.

And she probably wasn't a lot less sassy and uninhibited then than she is now. When asked what kind of cigarettes she smoked, she quickly answered: "I used to smoke OP - that's Other People's cigarettes."

She became one of the lucky ones to get a bed at Firland, where she recalls she spent nine months some time in the '40s. There was room for 150 adults and 25 children; thousands were on the waiting list.

Betty MacDonald, who gained national fame with her book "The Egg and I," also smoked heavily. She worked for the state government before she was confined at Firland for nine months during the late 1930s.

Wolf credited Firland's no-smoking policy - and, ironically, TB itself - for allowing her to live long enough, with luck, to witness three centuries (she was born in 1898). "Do you think I would have been 100 if I'd been smoking? No way. That's why I'm so grateful to have had tuberculosis. It saved my life."

Wolf, during her internment, found ways to have fun and make people laugh.

But MacDonald, who died in 1958 (not from TB), found the place depressing.

A divorced mother of two then living in the University District, MacDonald had yet to write "The Egg and I," which sold a million copies in its first year of publication, 1945. She was admitted to Firland in September, 1938, after contracting TB from a co-worker who for two years had a "dry little hacking cough, much of the time in my face."

She bristled at Firland's rigid policies. Of the medical director, she wrote: "He said taking the cure is going to be difficult for you. You have red hair, lots of energy, you're quick, active, impatient. All bad for TB. The cure of TB is all discipline. . ."

Absolute confinement to bed was mandatory the first few months. Reading and writing were also forbidden for the first month.

After her first day, MacDonald took a dim view of her prospects. One good thing, she later wrote: "It's going to make dying seem like a lot of fun."

MacDonald chronicled her stay in her second novel, "The Plague and I," published in 1948. Its title was meant to reap some of the success of her debut work, but the subject matter, understandably, wasn't as appealing.

Later in the book she observed that Firland was "a very cold place, and that includes the attitude of the staff as well as the temperature of the rooms."

Much of that coldness was a result of a traditional sanitarium policy of keeping the windows open at all hours, year 'round. This was thought to speed recovery; later studies proved it did not - though at least it reduced the exposure of health-care workers to airborne germs.

In fact it turned out that people died at the same rate as they would have at home. But sanitariums did keep infectious TB patients away from other people. In the year that a patient stayed at a sanitarium , up to 20 other people - mostly family members and co-workers - who might otherwise have been infected, remained germ-free. And some patients did get better at sanatariums, although it's not clear why.

Wolf, who lives in a Capitol Hill apartment and retains a graceful agility of wit and movement, remembers Firland in a far warmer light than MacDonald. In fact, she scorned "The Plague and I" - and its author, whom she never met - as mean spirited.

One adaptationWolf had to make at Firland was to the institution's generous farm-style meals. Much of the food, including vegetables, chickens and hogs, was raised on the property. Wolf recalled that because of a lifelong disdain for cooking she was undernourished; before Firland, she used to take care of breakfast by quickly swallowing a raw egg.

Enforced bed rest was another adjustment. But she and her ward mates devised a number of ways to handle the isolation. To circumvent the partitions that separated them, patients tossed paper notes to each other.

Patients were allowed to talk quietly but not laugh. "But we did quite a little of that when the nurses went off duty," Wolf said. "I remember once when everybody was tucked into bed and settled down for the night, and I said to the woman across from me, `Let's have a party!' And she said, `Yeah, let's have one.' I said, `Well, have you got anything to drink,' and she said `Yeah, I've got a bottle over here.' Of course we didn't."

Neither Wolf nor MacDonald had to endure the more bizarre forms of treatment given people with advanced cases, including filling a lung with air, oil, paraffin or even Ping-Pong balls to collapse the organ and deprive TB germs of oxygen.

None of these techniques were ever proven to help. But sanitariums, along with improved sanitation, probably did play a role in the declining TB death rate, which between 1900 and 1935 fell by almost 200 percent.

Both MacDonald and Wolf were able to get on with their lives after Firland. But besides memories, Wolf retains another reminder of that period: TB germs still reside within her body, in a dormant state.

"Here I'm sitting with millions of germs. But they're my germs."

Her face lights up in a joyous, life-affirming laugh.

Copyright (c) 1999 Seattle Times Company, All Rights Reserved.

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