The ground-floor of Oakdale Hall is a maze of dimly lit hallways and corridors. Exposed pipes line the ceiling, and small rooms are cluttered with tiles and debris. The heat is shut off here, making the walls feel as cold as a tomb.

The 103-year-old building sees little activity these days. On Wednesday, some construction workers continued asbestos abatement, while the remaining Iowa Hygienic Laboratory employees conducted research behind closed doors of the few rooms still being heated.

By the end of January, what was once the largest tuberculosis hospital in Iowa history will be torn down, after more than a century of service to the state and the University of Iowa.

Many may see the demolition as simply the end of an old building, but Oakdale Hall means much more to the employees and patients who faced one of the deadliest diseases in the world behind its brick walls.

For them, Oakdale was also their home.

"It was really just a little community there," recalled Betty Lacina, a former occupational therapist at Oakdale. "We all had our own little niches."

‘White Plague’

Tuberculosis, once the No. 1 killer in the world, was at its peak during the early to mid-1900s in America. Infection — spread by mucus — often meant a long and painful battle with the disease, and in many cases, it meant death.

Infected people suffered from painful coughing, chest pains, weight loss, and fatigue.

The crippling conditions of the lung disease caused immense fear among healthy Americans, who were terrified of a disease they didn’t understand, said Allan Lynch, Iowa’s TB/refugee health program manager.

"People have a healthy fear of the unknown — always will, always have," he said, and before scientists determined that the sources of the disease were bacteria, people believed the cause was anything from a lack of rest to heredity and vampires.

An estimated 3 million people died in America from 1900 to 1940 from tuberculosis, according to the National Center for Health Statistics.

"You can imagine what the hysteria must have been …" Lynch said. "There was a reason to be afraid."

The "mass hysteria" caused by the diseaseis comparable withfears about AIDS in the 1980s and more recently about SARS.

The medical answer in the early 1900s was creating a sanatorium — an isolated hospital meant to separate the infected from the public.

On what is now Oakdale Campus, workers built Iowa’s largest TB sanatorium in 1908 on land originally used for a stock farm and orchard. The first two patients were admitted on Feb. 1, 1908.

The number of people treated at the facility peaked at 814 in 1926, and the last patient didn’t leave until 1981, according to the UIHospitals and Clinics.

For many, the healing process was long and agonizing. Before the discovery of streptomycin antibiotics in 1943, the only "cure" for the disease was fresh air, plenty of rest, and a good diet. Bed rest was required for patients, who found themselves lying on their backs for 24 hours a day.

Pavilions housed row after row of beds of infected people. The sick spent every hour in bed on the screened porches all year round — even during the winter.

"The effectiveness of such practices is difficult to measure," Lynch said.

But it is known that before the invention of antibiotics, half of those infected with tuberculosis died.

"All we can say for sure is that the old ways used to have 50 percent mortality, and now, we can cure anybody who has TB as long as we can get to it early enough," he said.

Tuberculosis created fear among many, and passengers on the CRANDIC railroad — which traveled between Iowa City and Cedar Rapids — covered their mouths as they traveled past the hospital, and patients were prohibited from leaving after being admitted.

Lacina, the former occupational therapist at the hospital, recalled how her husband, the now 83-year-old Wayne Lacina, took his own precautions. During his short walk from one side of the hospital to his office, he held his breath as he passed patients’ rooms.

Working among the dying

For the employees of the Oakdale Sanatorium, every day involved caring and providing for patients diagnosed with one of the deadliest diseases of its time. Those admitted found themselves quarantined in a community fighting a disease that didn’t have a cure until those successful antibiotics were developed. More effective medication didn’t come around until the early 1960s.

Betty Lacina started working at Oakdale a year after graduating from the UI in 1951. Sitting in her Iowa City kitchen, she remembered the depression many patients suffered.

"They were away from their families," the 81-year-old said. "There was no way they could go home."

Patients were not allowed to visit home until after six months to a year of treatment; they also needed to have some observable healing.

Many never left.

"It was such a contagious disease, and they were endangering their family if they went back home and stayed for a period of time, so I think that’s why many of them were depressed," Lacina said.

"We had people who, because of the fact that they didn’t have any real cure for tuberculosis, some of them would be there for 15 years."

As an occupational therapist, Lacina’s job was to keep patients busy and their minds off their situation. Patients wrote letters, painted, made leather kits, and read — all on the flat of their backs.

"That was the whole idea," she said. "Keep their minds occupied with something other than dwelling on their disease."

Many patients also found themselves subjects of a surgical attempt to cure the disease known as pneumothorax. After removing a few of the patient’s ribs, doctors forcibly collapsed one lung, working under the impression that keeping it inactive would help it heal.

Lacina’s son, Warren Lacina, 53, recalled seeing several residents and employees — who were former patients — looking gaunt and disfigured, permanently slumped to the side after the surgery.

‘Just like a little town’

Betty Lacina and her son Warren visited Oakdale Hall in late October — what they said would be the last time either will see the building.

He stepped carefully through the orange autumn leaves on the wet grass. His eyes, hidden behind black Nike sunglasses, peered across Oakdale’s courtyard of winding pathways and crimson-colored trees — a picturesque scene. A look of nostalgia passed across his face, his memories of Oakdale a little different from that of many former residents.

"This is where I spent the first 11 years of my life," he said.

With both parents living at Oakdale, Warren Lacina and sister Andrea Lacina, now 51, were born and raised on the sanatorium’s grounds. While they had an unique experience, it was standard for nurses, office workers, and grounds employees to live at Oakdale.

With patients unable to leave after admittance until they were deemed cured, the residents of Oakdale needed to support themselves. So a self-sustaining institution developed with such amenities as a post office, fire department, dairy farm, slaughterhouse, and pasteurizing plant.

Bill Hedges, who started working on the dairy farm in 1959, milked the 84 cows twice daily and recalled also having at least 450 hogs at Oakdale.

Hedges’ wife, Virginia Hedges, started the same year as a nursing assistant — she was 18 at the time. She referred to Oakdale not as a hospital but as a community.

"It was just like a little town," the 70-year-old said. "You just didn’t ever have to leave."

Living and working next to patients formed a bond that was difficult to describe.

"You came to love the patients, because they couldn’t go home," Virginia Hedges said, and she paused, looking down at her fingers folding and unfolding. "And then when something happened to them, that was really hard."

She remembers patients screaming as they received painful shots of a thick, glue-like medicine. She also remembers some cases in which patients died from the fluid in their lungs, while others coughed up blood from hemorrhages the disease caused.

"It was pretty traumatic when you’re 18 years old, giving shots and watching people bleed out and die on you," she said.

Working among those infected with TB, strict precautions were made to ensure the staff members remained safe.

The nurses wore white, one-piece, short-sleeved dress-like uniforms that were washed daily at the hospital, Betty Lacina recalled. Cloth masks also helped prevent the spread of the bacteria.

Employees at Oakdale also received chest X-rays every six months and tuberculin tests every year — neither Lacina nor the Hedges can recall a single employee catching the disease. But Lynch said this is unusual, noting that many nurses and doctors fell ill while caring for the infected.

There wasn’t really time to be afraid of catching the disease anyway, Virginia Hedges said.

"When you’re 18, you don’t fear a lot of things, and I suppose that didn’t even enter our minds," she said in her North Liberty home and laughed. "I guess I wasn’t smart enough to be afraid."

The end of the sanatorium

But as a medical cure replaced bed rest and fresh air, the sanatorium neared extinction. By the 1950s, the "bells started ringing for the end of the sanatorium," Lynch said.

In Oakdale’s case, the end of a hospital led to many other uses, and the UI took control of the facility in 1965. The university used the building to house many different programs, including alcoholic rehabilitation and research labs, and the state Hygienic Laboratory made the building its home in 1971. It moved down the street to a brand-new facility earlier this year.

A short walk from Oakdale Hall, the old nurses’ cottage, which now houses offices, still displays the two-bar Lorraine Cross on the red brick at the northeast corner, symbolizing the fight against the haunting disease.

Now, after 103 years, Oakdale Hall is coming to the end of its long service to Iowans. Sitting in the building’s library, Warren Lacina looked briefly around the room stacked with medical books. He has mixed feelings about the facility’s demise. This was, after all, once a part of his childhood home.

"There’s a fair amount of nostalgia there, but, you know, I think that the thing that’s really gratifying is that one, people who have tuberculosis no longer have to come out to a place like this," he said. "People don’t have to come out here and die or be isolated."