by Tim Gilmore, 6/16/2023
The State Board of Health Building looks ill, its abandonment an apt metaphor. What happened in this building helped Floridians live decades longer, forgetting the names of illnesses that worried and killed their forebears. Strangely, historically, being taken for granted is one of the surest markers of success, of progress.
The old building faces inward, its cascade of stairs rising to a portico of fluted columns beneath a square pediment emblazoned “State Board of Health,” and stares into the compound of newer Department of Health structures that enclose it, its back to Pearl Street. The city jail once stood here, and Raspberry Park, where early residents regularly dumped trash in the creek.
Deep in its hollows today, I touch old lights and tanks and scopes and cranks and five pound bottles of “Sand, purified” and books and slides and “Your New Spencer Research Microscope,” and leaflets and papers and photos of physicians and a visitors’ register with a first signature dated March 28, 1919.
The Florida State Board of Health grew directly out of the Jacksonville board and the 1888 Yellow Fever epidemic, the last and worst such plague to hit the city. That catastrophic year, more than a third of Duval County residents fled terrified before quarantine came down and armed guards patrolled the perimeters of town. Nearly 10 percent of Jacksonville residents became infected and nearly 10 percent of those who got sick died.
Local boards of health existed in most sizeable towns, but nothing could have seemed more obvious than the need to centralize, consolidate, and maximize healthcare efforts in a state prone to tropical diseases, monstrous reptiles and swamps that could swallow you alive. Throughout the 20th century, State Board of Health leaders also learned to battle politicians who didn’t believe in the efficacy of their own government. Eventually those politicians would kill it.
When Dr. Joseph Yates Porter moved from Key West to Jacksonville in 1889 to assume his title as the first State Health Officer, the new board met in multiple buildings around town. Porter served until 1917. When the new centralized building opened in 1912, it housed a veterinary division, operating rooms, lab space, a bacteriologist’s office, meeting rooms and a public health library. It soon added educational facilities, services for “crippled children,” as well as the State Sanitation Board and offices for mosquito abatement, tuberculosis control and maternal and child health.
Porter concluded his 1911 annual report by saying the expansion into a centralized space would parallel the board’s growth of responsibility and work. He planned “investigation” of “latent malarial carriers, special work on rabies, infantile diarrhea, latent gonorrhea, the common drinking cup, the bacterial flora of cities and towns,” also “anti-venin work” and the study of “bovine uncinariasis and its relation to hookworm disease in the human.” The task before him and the board was to make life in inhumane Florida livable.
Strange, listening to the empty spaces across the second floor today. I pick up a schedule for free chest x-rays in Jefferson County, “Oct. 21 thru Oct. 30, 1964.” After all, “Do You Know For Sure? Tuberculosis? Lung Cancer? Enlarged Heart?” Three years earlier, on “Saturday, June 17, 1961 – Only! NOTICE DOG OWNERS,” at the following locations, “a veterinarian will inoculate dogs against rabies. The charge for this treatment is $1.50 per dog. All dogs and cats 4 months of age or older should be treated against rabies.”
A 1964 monograph about public health in Florida called “Millstones and Milestones” refers to the years 1917 to 1932 as the “Era of Retarded Growth.” Though these years brought steep cuts in public funding for health services, Florida Public Health Officer Wilson Sowder, who led the board from 1946 until its demise in 1969, called the 1931 County Health Unit Law “the most important piece of public health legislation” since the board’s establishment.
The law “provided a partnership agreement,” Sowder wrote in 1989, “between the state and the 67 counties, with joint but flexible financing and administrative responsibilities, as well as provision for small counties to join together in the operation of multicounty units. The law and the system it authorized worked wonderfully well.”
Sowder learned the art of diplomacy in defending public health service against elected politicians who fought the very idea of an effective government. He wrote of the struggle in a series of articles published in The Journal of the Florida Medical Association in 1989 called “Recollections of the 100 Year Struggle for Better Health in Florida.”
Above the cold fireplaces upstairs today, I look into the eyes of bland oil paintings of tuberculosis board administrators from 90 years ago and the photo of a long bearded Gulf Coast quarantine officer from 1890, turn the pages in an old Manual of Clinical Microbiology and sheets of “Inspections of Vessels Arriving,” run my fingers across the edges of a Hill-Rom 2-crank Trendelenburg hospital bed. I find out the Trendelenburg position refers to a body “laid supine on a 15 to 30 degree incline with the feet elevated above the head,” used particularly in abdominal and genito-urinary surgeries.
When the Navy first assigned Sowder to venereal disease reduction efforts in the early 1940s, he learned quickly that smalltown authorities disliked federal campaigns into their jurisdictions. Regarding his mission to combat the spread of syphilis and gonorrhea among Navy personnel in Pensacola, he wrote, “Local authorities were not enthusiastic and took the position that if the federal government wanted the job done, it could do it.” On April 1, 1942, Sowder transferred to Jacksonville to oversee the Florida venereal disease prevention program, which led to his appointment as State Health Officer.
Alongside government successes came incredible new technologies and medicines, most notably, starting in 1943, penicillin. What happened in the next few years was staggering. By 1950, rates from syphilis and tuberculosis had dropped significantly. From 1944 to 1948, the infant mortality rate, though still astonishingly high by today’s numbers, dropped from 44.9 to 34.9 per 1,000 live births.
A public health campaign against rats and their fleas caused cases of Typhus Fever to drop by two thirds. The board’s water purity and sanitation efforts meant deaths from diarrhea and enteritis dropped by almost half. Other deadly illnesses disappeared altogether. The last case of smallpox in Florida occurred in 1946 and the last case of malaria contracted in the state (until one case surfaced in 1990, the year after Sowder wrote his recollections) occurred in 1948.
Polio, however, remained a nightmare. If parental worries abated in the winter and spring, the tide of childhood polio cases every summer and fall, with no means of prevention and no cure, wrought fresh terror. In response to a 1946 polio outbreak, Georgia and North Carolina invoked a two week quarantine against all visitors from Florida. When Jonas Salk’s polio vaccine became available for the masses in 1955, people stood in long lines in nearly every town and city, eager to be immunized.
By the 1960s, Floridians for the first time began to live free of the fears of countless illnesses that previous residents could only assume might sicken and kill family members and neighbors each year. When Florida created its Board of Health in 1889, life expectancy was 44 years. By the mid-1960s, American men could expect to live to age 67 and women to age 74. By 1965, no new cases of polio were reported in the state and tuberculosis rates had declined so much the state closed and repurposed several TB hospitals.
The Board of Health launched screening and education campaigns against diabetes, including providing insulin to the medically indigent, and against glaucoma, one of the leading causes of blindness. Other efforts targeted heart disease, rheumatic fever, food poisoning, tooth decay, poor nutrition and — when nearly half the American population smoked — cigarettes. The board implemented school health programs that tested children for hearing and vision deficiencies. Communicable childhood diseases plummeted. Instances of Whooping Cough dropped by 90 percent in the 1960s, diphtheria by 80 percent and tetanus by 78 percent.
Then came “Claudius Maximus,” as The Miami Herald called him. Elected with 55 percent of the vote in 1966, Governor Claude Kirk was a culture warrior who referred to himself as “a tree-shakin’ son of a bitch.” As a stunt in his opposition to desegregation busing in 1970, Kirk left Tallahassee for Bradenton, where he theatrically suspended the school superintendent and the entire school board and holed himself up in the Manatee County School Administration Building. He directly disobeyed a U.S. District Court order that he appear before a judge for Contempt of Court, until the court charged him a daily $10,000 fine as long as he remained inside the building.
Kirk demanded an entirely new Florida Constitution to replace the one in effect since 1885. Health officials could see what was coming. The existing constitution declared, “There shall be a State Board of Health and it shall supervise all public health activities in the State.” Dr. Sowder appeared before the Health, Education and Welfare Committee to request similar language in the new constitution, but legislators claimed the need for the Board of Health “so obvious” that constitutional wording was unnecessary.
As Sowder later recalled, “One committee member asked, ‘What’s the problem, Doctor? Don’t you trust the legislature?’ I replied, ‘No, I don’t.’ It seemed to me that there was no need for a constitution if the wisdom of the legislature could be depended upon at all times and in all cases.”
The new constitution required that the number of state agencies be reduced to 25. By the time headlines announced “State Board of Health is Dead” in June 1969, matters once considered primarily health issues, including mental health and pollution, moved to other departments. Narcotics prevention and control left the Board of Health and became criminal matters under the new Bureau of Law Enforcement.
As so often happens, those in government elected for professing a lack of faith in government produced weak governmental structures and systems almost doomed from the beginning for failure. Previously the Board of Health had its own funding, but now received 19 percent of its funding from the state treasury and most of the rest from voluntary, unmandated local appropriations around the state.
Sowder served as director of the Division of Health in the new Department of Health and Rehabilitative Services, but as he wrote in 1989, his “attitude toward the downgrading and de-emphasis of public health” made his 1974 retirement unavoidable.
By 1975, Florida deemed the Division of Health a poor replacement for the Board of Health, abolished it, and created in its stead the Health Program Office. In the following years, Sowder bemoaned HRS’s lack of public education efforts and the ways he felt it ignored such issues as “smoking, drug use and abuse, alcoholism, AIDS, mental disorders, sanitation and mosquito control.”
Graciously, Sowder said, “The 11 governors under whom I served were intelligent and honest men devoted to doing their best.” He wrote, “I am confident that the democratic process by which we govern ourselves will in time produce improvements for all residents of the state. I hope this will be soon.”
I hope so too. Walking these stairs from 1915 to ’45 to ’75, I realize how much the health of this entire state owes to decisions crafted in these abandoned offices and meeting rooms. From 1892 to 1975, millions of Floridians received a free monthly educational bulletin called Florida Health Notes at public health clinics, doctors’ offices, schools and libraries.
Until its abolition in 1969, the Board of Health published the bulletin and the new Division of Health continued publication until its abolition in ’75. Florida Health Notes “provided extensive information,” wrote Russell Jackson in a 1990 Journal of the Florida Medical Association article, “about personal hygiene, preventive health, control of chronic and communicable diseases, and basic sanitation” amongst other “subjects related to individual and community health.”
For more than five of eight decades of publication, an image of the neoclassical Board of Health Building graced the cover of Florida Health Notes. “Thus,” Jackson wrote, “the headquarters office was not only familiar to those who worked in it or visited there, but to millions of Floridians who received” the bulletin.
Fittingly, Jackson called his article “The Julia Street Building and Public Health,” and writes, “Thus, the building that appeared for over 50 years on the Florida Health Notes cover was a well-known symbol of the power of the state as a regulator in protecting the public’s health. It also stood for public health as an educator and a deliverer of health services to those in need.”
In 2002, the State Board of Health Building reopened as a new and short-lived public health museum, but today once again stands abandoned. The bored-sounding coverage in The Florida Times-Union failed even to state the museum’s name, though it said it was named for Sowder, and led lamely, “A small brick building where last century’s public health wars were plotted shone for a day amid shadows” of larger structures.
Yawningly, unaware of his own lack of suffering from smallpox, TB, polio, syphilis or fatal diarrhea, the reporter wrote, “Sowder, 91, strode to the podium beside the six-column front, and deflected praise.” The reporter added, again lamely, “Sowder helped cut epidemic tuberculosis rates dramatically and traveled 30,000 miles one year making speeches.”
Dr. Wilson Sowder died in February 2007. He was 96 years old. His obituary credited him with “rescuing” the “old State Health Department Building” from demolition. Perhaps this strange, landlocked, inward-facing temple of public health will one day receive recognition for the successes achieved here, progress so enormous as now to be taken entirely for granted. Surely all those people, mostly now nameless, whose work let today’s 22.25 million Floridians live longer and healthier, deserve — though they never asked for it — that we remember and acknowledge them, that we thank them, that we celebrate them.