Online Exhibits@Yale

Specialist in Tuberculosis

Arnold Klebs trained in the same general areas as his father, namely bacteriology and the study of tuberculosis. Unlike his father, however, Arnold Klebs was not interested in inventing pharmacological cures for tuberculosis, but rather in preventing tuberculosis through hygienic measures and treating tuberculosis in sanatoria. He directed a sanatorium in Alabama in 1897 and 1898. Later, he was an active participant in the Committee on the Prevention of Tuberculosis of the Visiting Nurse Association in Chicago, which became the Chicago Tuberculosis Institute. On the national level, he was a leading member of the National Association for the Study and Prevention of Tuberculosis, founded in 1904, and chair of its Committee on the Diagnosis of Tuberculosis. Klebs’ career as a tuberculosis specialist reached its apex in 1909 with his editing of a major work, Tuberculosis, with contributions by leaders in the field. From 1897 through 1918, Klebs published some 25 articles on tuberculosis.

Title page from <em>The Necessity of Special Institutions for the Treatment of Pulmonary Tuberculosis</em>

A.C. Klebs, "The Necessity of Special Institutions for the Treatment of Pulmonary Tuberculosis," reprint from the Tri-State Medical Journal and Practitioner, 1897.

Klebs’ Description of Hygeia

In this early professional article, Klebs described both the facilities and the regimen of the Hygeia sanatorium in Citronelle Alabama. The benefits of sanatoria, he argued, were fresh air and the physician’s ability to control the patient’s diet and behavior. Expectoration (spitting), he believed, was the main means of transmitting tuberculosis from one person to another.

Arnold Klebs’ Plan for a Small Open-Air Sanatorium in Chicago

Small open-air sanatorium plan from Arnold C. Klebs, “The Construction and Management of Small Cottage Sanatoria for Consumptives,” reprint from Medical News, August 25, 1900.

Klebs’ Plan for a Small Open-Air Sanatorium in Chicago, 1900

With the assistance of the famous Chicago architect, James Gamble Rogers, Klebs presented for consideration this plan for a 25-patient open-air cottage sanatorium. He writes: “It is often surprising to what extent rest in the open air in our winter climate can be carried out, provided the wind can be kept off by adequate shelters. I have been able to keep patients out-of-doors throughout the winter in Chicago, where the season is not renowned for mildness.” The benefits of sanatoria, Klebs believed, were fresh air and control by the physician of the patient’s diet and hygiene.

Page from the <em>Preliminary Report of the Committee on the Prevention of Tuberculosis of the Visiting Nurse Association</em>

Committee on the Prevention of Tuberculosis of the Visiting Nurse Association. Preliminary Report. Chicago: R.R. Donnelley & Sons Co., 1903.

Chicago Tuberculosis Institute

Klebs was a founding member of the Committee on the Prevention of Tuberculosis of the Visiting Nurse Association of Chicago, established in January 1903. He was appointed one of six members of the Committee on Organization, which also included Jane Addams of Hull House as Secretary. Shown are the pages of the Preliminary Report in which the Organizing Committee defines the work of the larger Committee. The Committee on the Prevention of Tuberculosis later became the Chicago Tuberculosis Institute. Klebs continued as a member of the Board throughout his residence in Chicago. The pamphlet displayed was bound by Klebs with other articles by him on tuberculosis.

Harvey Cushing at Johns Hopkins

Harvey Cushing at Johns Hopkins in 1904

Harvey Cushing About the Time Klebs First Met Him

Klebs visited Baltimore, probably for the first time, in January 1904 to attend a conference and exhibit on tuberculosis. In addition to meeting with William Osler, William Henry Welch, and many other notables at Johns Hopkins School of Medicine, he spent time with Harvey Cushing, then an associate professor of surgery. Klebs and Cushing, near contemporaries, became a lifelong friends through their common interests in book collecting, bibliography, history of medicine, and shared sense enjoyment of humorous wordplay. In Klebs’ 1904 memorandum of this trip, he recalled his enjoyment of discussing Leonardo da Vinci with Cushing.

Arnold Klebs at the tomb of Pierre Charles Alexandre (P.C.A.) Louis

Klebs at Tomb of Pierre Charles Alexandre Louis, 1905

Pierre Charles Alexandre (P.C.A.) Louis, 1787-1872, was a great French clinician who had written a major book on the clinical-pathological correlation in tuberculosis. Louis had taken a special interest in the many Americans and other foreigners who traveled abroad and studied with him. Klebs, too young to have known Louis except by reputation, participated in this act of historical remembrance in conjunction with a tuberculosis congress held in Paris. Klebs is at the left. He identified the other participants including William Osler, at the right of the first group.

Pre-Publication Advertisement for Arnold Klebs’ Edited Volume on Tuberculosis

Pre-Publication Advertisement for Klebs’ Edited Volume on Tuberculosis

By the time the book was published, the title and some of the authors had changed.

Title page of <em>Tuberculosis: A Treatise by American Authors on its Etiology, Pathology, Frequency, Semeiology, Diagnosis, Prognosis, Prevention, and Treatment</em>

Tuberculosis: A Treatise by American Authors on its Etiology, Pathology, Frequency, Semeiology, Diagnosis, Prognosis, Prevention, and Treatment, edited by Arnold C. Klebs. New York and London: D. Appleton and Company, 1909.

Klebs’ Major Work on Tuberculosis, 1909

William Osler had asked Klebs to edit a volume on tuberculosis with chapters by leading authors and covering all aspects of this major cause of death in the early twentieth century. Osler wrote the historical chapter. Klebs wrote chapters on “Frequency of Tuberculosis” and “The Sanatorium, its Construction and Management,” and compiled the lengthy bibliography at the end of the work. Klebs describes his role as editor in the short introduction to the volume.

This is Klebs' personal copy of this book.

Page from the article “The Tuberculosis Problem: One Point of View"

Arnold C. Klebs, "The Tuberculosis Problem: One Point of View," reprint from the Annual Review of Tuberculosis, 2 (1918): 106-109.

Late Klebs Paper on Tuberculosis, 1918

Klebs published occasionally on tuberculosis until 1918. By then, he argued that far too much focus was given to the specific bacterium, infection, and contagion and too little to building up natural resistance to the bacterium through improvements in hygiene and working and living situations. He opposed the “compulsory segregation” of those diagnosed with tuberculosis, or of children exposed to tubercular parents. The point of sanatoria was not to segregate people with advanced cases but for the patient who could be brought to health by being removed for a while from “the strain of life that has lowered his natural resistance.”

Title page and frontispiece from <em>Phthisiologia; or, A treatise of consumptions. Wherein the difference, nature, causes, signs, and cure of all sorts of consumptions are explained</em>

Richard Morton, 1637-1698.  Phthisiologia; or, A treatise of consumptions. Wherein the difference, nature, causes, signs, and cure of all sorts of consumptions are explained… London: Printed for W. and J. Innys, 1720. English edition of the original Latin of 1689.

Klebs’ Collection of Rare Books on Tuberculosis

Klebs recalled in 1939 that after he completed the editing of Tuberculosis: A Treatise by American Authors in 1909, "I started and have been at it since to collect old works on consumption, phthisis, scrophula and other similar ailments which from the earliest times had not only killed but debilitated man." In addition to books, Klebs collected thousands of pamphlets, dissertations, and reprints on tuberculosis.

Richard Morton’s Phthisiologia, shown here, was the first pathological study of pulmonary tuberculosis, then called consumption or phthisis. Morton showed that tubercles were formed as a part of the disease process.

Specialist in Tuberculosis