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The origins of CTS began from the Southern California Anti-Tuberculosis League. In 1906, the League combined with its Bay Area counterparts to sponsor a state-wide organization known as the “California Association for the Study and Prevention of Tuberculosis. From 1914 to 1930 marked the era of preventoria and concentration on school health, with most attention being given to metropolitan areas. There was no particular organizational pattern”. (Wardrip)

“In 1930, a dramatic statewide caucus was held in Merced, and a new pattern of Federation was formed.” The disparate groups coalesced to form the California Tuberculosis Association. In 1940, the California Tuberculosis Association became the California Tuberculosis and Health Association and board rotation of volunteers was adopted. Concurrently on the national front, the former American Sanitorium Association was reorganized and became the American Trudeau Society in 1939 and later changed its name to the American Thoracic Society in 1960. The new American Trudeau Society became the medical section of the National Tuberculosis Association. It assumed the responsibility for the clinical sections at the annual meetings. The ATS also took over the responsibility for the American Review of Tuberculosis (now the American Journal of Respiratory and Critical Care Medicine).

During 1939, following the creation of the American Trudeau Society, the Board of the California Tuberculosis Association realized the advantages of formalizing a medical section of the California TB Association. The responsibility for carrying this out was delegated to Dr. Carl Howson and Dr. Chesley Bush. Some bylaws were prepared and adapted from those of the American Trudeau Society.

On April 13, 1940, the California Trudeau Society was formed by a visionary group of leaders: Dr. BH Wardrip, Dr. Emil Bogen, Dr. Carl Howson, and Dr. Sidney Shipman formed the Executive committee with an initial membership of 42 physicians for $1/year annual dues. The purpose of the group was to have a Society of physicians whose primary interest was in tuberculosis. They appointed a Program Committee, Nominating Committee, and a Membership Committee, all of which still exist in today’s CTS committee structure.

According to the minutes of the April 13th, 1940 meeting in Santa Barbara, CA., “It was moved, seconded and carried that a request be sent to the Board of Directors of the California Tuberculosis Association to recognize the California Trudeau Society (CTS) as an affiliated organization, to bear the same relationship to the California Tuberculosis Association as the American Trudeau Society bears to the National Tuberculosis Association” and that “the California Tuberculosis Association be requested to adopt a resolution authorizing the officers of the California Trudeau Society to apply to the American Trudeau Society for recognition as a geographical section of the American Trudeau Society. ”

“Since its first annual meeting in 1941, CTS has taken an active part in medical affairs of the state.” CTS passed a resolution calling upon the government to include x-ray examinations on all selective service inductees and shortly thereafter this was adopted. At that meeting, CTS also voted to support amendments to the State Pharmacy Act and appointed a committee on publications to review the medical literature distributed to the California Tuberculosis Association, to medical professionals, and the lay public.

Between 1942 and 1945, many members of CTS were in the armed services. Meetings during the war were held with some difficulty because of the absence of members and transportation. No meeting was held in 1945; however, the work of the Society continued. Medical education and chest disease had always been of particular concern to CTS. “At that time, most physicians doing chest work were those who had been victims of tuberculosis themselves and had obtained their training on almost a preceptor basis from those who had cared for them during their illness and convalescence. Very few had any training on the topic during their undergraduate years. These were the years before effective chemotherapy and of limited thoracic surgery, so there was little dramatic appeal for the graduate to enter this field.” CTS stimulated the interest in chest disease by publication of hand- books, hosting educational symposia throughout the state, providing training scholarships and by providing a Speakers Bureau that continuously supplied qualified speakers to County medical societies, hospital staffs, and general practice groups.

In 1949, CTS was instrumental in stimulating nation-wide interest in the routine x-raying of hospital admissions. “It was believed that constantly bringing before the physician in practice the possibility that his patient might have hidden chest disease would stimulate an increasing awareness and interest.” (CTS First 20 Years) A resolution presented to the American Trudeau Society (ATS) helped to bring about effective action throughout the country.

“In 1950, CTS urged that Blue Cross and other insurance carriers consider, as a recognized laboratory charge, the cost of a screening examination of the chest by x-ray.” “In 1952 and 1953, a committee was active in securing legislation to require x-ray examination of school personnel as a requirement for certification. Legislation was later enacted requiring periodic x-ray examination or tuberculin skin testing of all school personnel. In 1957, the CTS Standards committee was appointed to study and present an outline for Medical Standards of the Treatment of Tuberculosis, which became widely used in California and throughout the country.

“During the first 20 years of the California Trudeau Society, dramatic changes in the development of “mini- film radiography,” the discovery and application of antituberculosis drugs and other antibiotics, intratracheal (positive pressure) anesthesia, most intrathoracic surgery and many new developments in cardiorespiratory physiology were addressed by the Society.” (Wardrip) CTS’s early organization and efforts helped create widespread interest in all respiratory disease and helped make the field of thoracic disease one of “spectacular appeal “.

The need for keeping members of the Society informed was recognized early in CTS’s history. The original newsletter was called the “Fluorograph”, since at that time images of the chest were frequently conducted with the use of fluoroscope prior to the use of x-rays. The first volume of The Fluorograph appeared on September 4, 1940 and contained reports of the activities of its membership, reports on national meetings of the ATS, the National Tuberculosis Association, and the American Association of Thoracic Surgeons. “The Fluorograph “continued to be published through 1950. No publication was issued between 1950 until June 1957 when a committee on medical education, chaired by Dr. James Kieran, began to published the “Trudeau Times “. This publication became “CTS Inspirations in the 1980s.

In 1962, the California Trudeau Society was officially changed to the California Thoracic Society and served as the medical section of the newly named Tuberculosis and Health Association of California-THAC. In 1970 THAC changed its name to Tuberculosis and Respiratory Disease Association of California (TARDAC). Ms. Elma Plappert was appointed as full-time CTS executive secretary. During this time, a committee on nursing, councils on Smoking and Health, an Inhalational Therapy committee and a Scientific Council were established. A Young Investigator session was added to the annual meeting and a teaching kit on the Office Management of Smoking Problems was created. CTS supported legislation regarding arterial blood gas analysis by unlicensed personnel under physician supervision. In 1974, TARDAC changed its name to the California Lung Association, and in 1979 became the American Lung Association of California (ALAC) as it is known today.

In 1973, the recently formed “Association of Medical Directors of Respiratory Therapy of California” became the Respiratory Care Assembly of CTS. The Respiratory Care Assembly published guidelines for third party providers to follow regarding distribution of respiratory therapy equipment for home use which became widely used by third party providers throughout California. The assembly defined levels of care for respiratory patients, information which was accepted and used by Southern California Blue Cross. A committee also produced statements on licensure and alternatives for respiratory therapy personnel and audit criteria for respiratory therapy services. It also adopted Pulmonary Rehabilitation as a report item. In 1975, a committee was established to create pulmonary function lab standards. The assembly protested State Health Department’s regulations prohibiting respiratory therapists accepting verbal orders for drugs. The regulations were then changed because of the committee’s efforts.

In 1976 a committee developed guidelines for distribution to Blue Cross and Blue Shield in the Bay area advocating reimbursement of pulmonary rehabilitation programs. In the late 1970s, this committee developed guidelines for the California Medical Association on the use of respiratory therapy services in hospitals and produced a Medical Directors handbook. CTS definitions for blood gases were accepted and written into state regulations in 1977. In 1978 this assembly surveyed state hospitals on performance of arterial puncture and blood gas analysis. It conducted a study of ventilator practices and use of IPPB and developed guidelines on Pulmonary Rehabilitation. The Respiratory Care assembly formally became part of the CTS by 1977, when a national organization was formed to deal with these issues. The Respiratory Care Assembly is known as the Clinical Practice Committee of CTS today.

During the 1980s, Ms. Colleen Richardson became the Executive Director of CTS. CTS helped to rescind the Department of Consumer Affairs’ ruling prohibiting respiratory therapists from performing endotracheal intubation. The Pulmonary Nurse Specialists Committee was established, standards of care for patients with chronic respiratory diseases were published, and CTS provided input to the drafting of and supported a CSRT bill for credentialing of respiratory therapists. Topics of assembly meetings ranged from “Exercise Testing ” to “Computers for the Pulmonary Physician”.

In 1999-2000, the ATS and the national American Lung Association separated into two distinct organizations. The California Thoracic Society remained a supported entity of the California ALA (ALAC) until April 2010 when the ATS formally incorporated each state chapter. This marks a new era for CTS as we continue our advocacy, PT program, and endeavors such as tobacco control, air quality, production of a Pediatric Home Ventilator guide, and production of an annual CME conference in Carmel, California. The Strategic Plan outlined by 30 dedicated CTS leaders and volunteers in 2008 serves as a beacon to guide CTS into the next decade with goals to: enhance CTS’ electronic image on the internet, create programming that can be accessed electronically, and continue to foster, nurture, and engage members who are providing Pulmonary, Critical Care and Sleep medicine in the state of California.

2010: This year marks CTS’ 70th year and a momentous one because CTS is now independently incorporated as an affiliated state chapter of the American Thoracic Society (ATS) and is moving to San Francisco.