“Stalking the Great Killer” Chronicles Arkansas’ Fight Against Tuberculosis

By MAK MILLARD

Six stories high and with 500 hospital beds, the massive Nyberg Building, named after Arkansas Representative Leo E. Nyberg, opened in 1940 and served as the point of admission for tens of thousands of tuberculosis patients at Arkansas Tuberculosis Sanatorium south of Booneville.

(Courtesy of Booneville Historical Preservation Society)

In late 2019 – just months before a global pandemic would turn the world on its head – two men began work on a book about a disease far more insidious than COVID and far more deadly than any true crime tale. The result, published this April from the University of Oklahoma Press, is “Stalking the Great Killer: Arkansas’s Long War on Tuberculosis.” Co-authored by historian Larry Floyd and renowned public health figure Joe Bates, MD, MS, the book traces the history of the world’s deadliest infectious disease through an Arkansan lens, from the establishment of the state sanatorium outside Booneville in 1909 to the pioneering work of Bates and his colleagues to revolutionize TB treatment in the 1960s and 70s.

“People don’t realize how bad tuberculosis was. It kind of reached a peak after the industrial revolution, as people started working and living more closely together,” Floyd said. “Arkansas and many southern states, back in the 19th and early 20th century, were hit very hard. It was as bad as COVID was, year after year, for over 100 years.”

Though the disease dates all the way back to the Stone Age, developed countries have only been able to effectively treat tuberculosis in recent generations. For a long time, tuberculosis was the most common cause of death in Arkansas, and it remained a leading cause of death well into the 1950s. Before the development of effective drug therapies, the only real option was to isolate the infected by sending them to the sanatorium, where the fresh mountain air was thought to be beneficial. The Arkansas State Tuberculosis Sanatorium, once the largest in the nation, only officially closed in 1973.

“Stalking the Great Killer” creates a nuanced and compelling telling of this history by weaving together all of the interests at stake, from the social and political to the medical and personal. The book opens in 1949, with a then-teenaged Bates driving his favorite uncle – not much older than Bates, and more like a brother – to the Booneville sanatorium.

“He lived in a little town called Waldo in southwest Arkansas. I drove down there from Little Rock and met him,” Bates said. “He was married and had three young boys, all less than ten. I remember vividly them waving goodbye.”

This experience piqued Bates’ interest in the disease, and as he was coming through college and then medical school in the 1950s, new drug treatments for tuberculosis were being developed. Bates studied tuberculosis and other infectious diseases in graduate school before beginning his research and clinical career, first at the VA Hospital and then at UAMS, where he still works today as a professor of epidemiology and associate dean in the College of Public Health.

In the 1960s, Bates and colleague Paul Reagan began working together to take on the disease. Having seen studies in other countries suggesting the use of drug therapy to reduce infectiousness, Reagan and Bates proposed an experiment of their own: they would treat tuberculosis patients for just two or three weeks at Pine Bluff’s Jefferson Hospital before sending them back home.

“At the time, I was beginning to achieve national recognition for my research in tuberculosis. I became president of the American Thoracic Society; I was the president of the American Lung Association and got all kinds of awards for my work in tuberculosis,” Bates said. “Even as a young man, I had some national status as a legitimate tuberculosis investigator when we were trying to do this.”

Despite the treatment’s potential to be lifesaving for families and communities, vested political and economic interest in keeping the sanatorium open posed obstacles.

“Paul contrasted me; he liked confrontation. He didn’t mind that the legislature was upset and he had to go before legislative committees,” Bates said. “The medical society officials had their meetings, asked him hard questions and didn’t agree with what we were proposing. But both of us had confidence in what we were doing, that it was a good thing to do.”

The pair successfully proved that tuberculosis sufferers could be treated in general hospitals, often in their own communities, rather than being torn from their families and livelihoods for months or years on end at the sanatorium. This was a radical development in the treatment of TB, and Bates and Reagan gained international attention for their findings.

“We presented our report to the American Thoracic Society, which is the leading chest disease organization in the world, and it was chosen as the best paper at this very big meeting,” Bates said. “We were asked to present it in England. Others tried it, and over a two or three year period, most of the sanatoria in the United States closed. People were treated for tuberculosis at selected general hospitals throughout their state.”

This groundbreaking course of treatment propelled Arkansas to the forefront of the fight against tuberculosis; even today, the state’s case rate remains below the national average.

“There were a number of medical authorities at the Centers for Disease Control that were looking at and actively praising Arkansas,” Floyd said. “Many of them visited the state to talk about the pilot program and the success that Arkansas was having under Dr. Bates and his colleagues’ direction.”

Both Floyd and Bates pointed to the critical role of community involve-

From left, medical researchers and treatment pioneers Paul Reagan, Joe Bates and William Stead reminisce a year or so after Stead’s retirement from the Arkansas Department of Health in 1998.

(Courtesy of Dr. Joseph H. Bates) ment in this history; even in the decades before drug therapies, political, medical and community leaders were coming together to bolster Arkansas’ health infrastructure and educate the public. Throughout “Stalking the Great Killer,” Floyd and Bates highlight the other heroes of this fight, all of whom had a hand in helping the state – and the nation – come out on top against TB.

“I was persuaded to do this, in part, because if I didn’t tell this story, it would never be told. I was the one remaining person that had experience and memory and documentation of how we got it done,” Bates said. “Larry provided the professional historian flavor to it, and I provided the medical knowledge and experience.The two of us together, I think, made a pretty good team.”

Vitally, the book also serves as an important reminder for future generations as the work goes on to eradicate tuberculosis and other diseases worldwide.

“I think in medicine, like many other professions, there are certain traditions. It’s been done that way for a long time, and then some young squirt comes along and introduces a totally different approach,” Bates said. “It takes a long time for fundamental changes in medicine to be broadly adopted. It doesn’t happen overnight. It can take years. A vaccine – if it’s effective – is lifesaving. There’s work going on on HIV, on malaria, on TB. These are the three big killers in infectious diseases, where we need a vaccine. There’s progress, good progress, on all three.”

The Lancet, a prestigious international publication in circulation since 1823, recently reviewed “Stalking the Great Killer” in its respiratory medicine journal. In addition to commenting positively on the book’s “fascinating account” that is “neatly balanced between the local, regional and global,” reviewer Talha Burki remarked, “Bates and Floyd have an astute grasp on the contingency of history. The progress they describe is not presented as inevitable or even irreversible.”

Whether you’re interested in the history, the science or the deeply human moments, “Stalking the Great Killer” is a poignant recounting of a major chapter in the stories of Arkansas and the world.

Floyd and Bates will have their first book signing at the Logan County Public Library, where Floyd spent many hours digging through what he describes as “the finest repository of information about the sanatorium,” in May. There will be another signing at the UAMS Historical Research Center planned for a later date.

To purchase “Stalking the Great Killer” or for more information, visit the University of Oklahoma Press online at oupress.com.