Bed Rest Does Not Contribute to the Cure of Tuberculosis, and the Shifting Tuberculosis Care Out of Sanatoria

Hirsch, James
Photo by Barchrach

Beginning in the mid-nineteenth century, doctors prescribed long periods of bed rest for patients with tuberculosis. Even into the 1950s, physicians' respect for bed rest as a tuberculosis treatment amounted to "reverence," according to Rockefeller's James G. Hirsch (1922-1987). In the 1940s and 1950s, however, antibiotics became available to treat the disease. Hirsh and others wondered whether bed rest helped or hindered the dramatic benefits of these drugs. In a two-year study of 21 TB patients at the Rockefeller Hospital reported in 1957, Hirsh proved that physical activity did not delay or prevent recovery from TB.

This research utilized the facilities of the Rockefeller Hospital, where patients could live, with close monitoring, for extended periods of time. Hirsch and his colleagues studied women with moderately far advanced or far advanced pulmonary tuberculosis that was not treated previously. All were given the antibiotics streptomycin, isoniazid, and p-aminosalicylic acid (PAS). The patients participating in the study alternated periods of strict bed rest and supervised activity. For six months or more, doctors monitored their temperature, pulse, and respiration, and took cultures of bacteria from sputum samples and chest x-rays. In no instance did physical activity worsen the disease. The researchers concluded, forcefully, that "Bed rest is a potentially harmful treatment; the unnecessary prescription of prolonged inactivity is as dangerous and unjustified as is, for example, the use of a potentially toxic drug…without due cause." In part as a result of the study, care of tuberculosis shifted from sanatoria to home and hospitals.

James G. Hirsh graduated from Yale University in 1942 and received the MD from Columbia University's College of Physicians and Surgeons in 1946. He joined the Rockefeller Institute in 1950 and remained there the rest of his research career, becoming professor in 1960. Much of his research focused on the cell biology of the immune system, and he was well known for his studies of phagocytes, the white blood cells that engulf harmful microbes. After retirement from Rockefeller, Hirsch served as president of the Josiah Macy, Jr. Foundation from 1981 to 1987. Hirsch was elected to the U.S. National Academy of Sciences and to the Institute of Medicine. He served as an editor of the Journal of Experimental Medicine, and as a member of the editorial boards of several other journals.

Waverly Hills Tuberculosis Sanatorium, 1926. Courtesy of the University of Louisville

Selected Publication

Hirsch JG, Schaedler RW, Pierce CH, and Maclean Smith I. A study comparing the effects of bed rest and physical activity on recovery from pulmonary tuberculosis. Am Rev Tuberc, 1957, 75: 359-409

Further Reading

Moberg CL and Steinman RM. James Gerald Hirsch, 1922-1987. A Biographical Memoir. Washington, DC: National Academy of Sciences, volume 84, 2003