Through its first 60 years--spanning two wars, a depression and then the Cold War--tiny Barlow Sanatorium in Elysian Park was an institution that never lost sight of its mission.
As Walter Jarvis Barlow intended when he founded the philanthropic hospital in 1902, the sanatorium remained a haven for victims of tuberculosis.
The colony of bungalows secluded in a canyon near downtown Los Angeles dispensed clean air and bed rest, the only known treatment for the world's deadliest and most stigmatized disease.
Although spotlighted by regular and glowing reports in the local newspapers, the hospital began fading from view by the 1960s, when medical science gained the upper hand in the fight against tuberculosis. Advances in detection, chemotherapy and surgical treatment rendered the Barlow mission passe.
As the cottages on the hillside drifted into a quaint backdrop, Barlow built a small acute-care facility and concentrated its resources on the treatment of respiratory disease.
Then came the 1980s and AIDS, a new deadly and stigmatized disease.
And history may be set to repeat itself.
Over the past two years, administrators and the medical staff of the small, nonprofit hospital have been quietly planning a revival of its mission using acquired immune deficiency syndrome in place of tuberculosis.
They have developed a plan that would bring dozens of now vacant buildings on the 20-acre campus back into use in a multi-tiered, integrated program to treat all phases as the up-and-down disease progresses.
"I'd like to see us on the cutting edge," said hospital board member Douglas Elliott, a former tuberculosis patient who was treated at Barlow in the 1950s. "We have the potential of a major worldwide treatment center."
The concept calls for a portion of Barlow's 99-bed acute-care facility to be reserved for AIDS patients needing the most intensive--and expensive--medical care. An old administrative building across the street from the main building would be refurbished and converted into a sub-acute ward to care for more stable patients.
The half-dozen cottages around the new facility would be reopened as residential quarters for homeless AIDS patients and respite care, designed to temporarily take home-bound AIDS patients off the hands of friends or family, said Paul Gatto, a Barlow registered nurse who has been appointed AIDS coordinator.
In the final days of the incurable illness, Gatto said, patients from other parts of the hospital would move to the top of the hill into a 25-room hospice to be built in what is now an abandoned staff dormitory.
Officials at the hospital said they are not expecting their grandiose vision to take shape quickly.
So far, most of the progress has consisted of background work, said Dr. Richard Johnson, president of the medical staff and chairman of the hospital's AIDS committee.
Johnson said the medical and support staff at the hospital have received orientation in the treatment of AIDS and that a few AIDS patients have been successfully introduced into the hospital census.
More patients and services will be added cautiously, Johnson said, as the hospital negotiates the financial and legal unknowns which the new disease presents.
For example, before venturing into the new category of sub-acute care, the hospital must know how much MediCal will reimburse for it, said chief of staff Hans Einstein. Though the service will cost less than more intensive care, inadequate reimbursement could make it a financial drain on the hospital, which has only recently climbed back in the black after several years of losing money.
"We can't afford to take in patients we're going to take a big loss on right now," Einstein said.
In spite of that caution, Barlow officials are confident they will see at least one new AIDS program--the 25-bed hospice--open this year.
That program is being developed on behalf of the hospital by the Los Angeles AIDS Hospice Foundation, a private agency which grew out of the political organizations that formed to defeat Proposition 64, the 1986 statewide initiative that would have required the quarantining of AIDS carriers.
"A number of us decided we wanted to be more positive after that was over," said Michael Weinstein, president of the foundation.
Weinstein has become a man with a mission of his own. Last year he served as chairman of the county's AIDS Hospice Planning Commission, which recommended that the Board of Supervisors open 27 AIDS hospices in the county by 1991.
As president of the AIDS Hospice Foundation, Weinstein then set out to open the first of those. His search for a location ended abruptly when he was invited to tour Barlow Hospital last fall.
"I recognized the minute I came here that this was absolutely the right environment for what we intend to do," Weinstein said. "To be in the city but not of the city. . . ."