The Urban Coroner
Photography By Sugarbomb
a.g. Holley tuberculosis hospital
The remains of Florida's last hospital dedicated to the treatment of Tuberculosis
Welcome to A.G. Holley Hospital | Photo © 2013 Sugarbomb
A.G. Holley State Tuberculosis Hospital was opened on July 16, 1950 under the name Southeast Florida Tuberculosis Hospital. The hospital was part of a group of tuberculosis hospitals located throughout Florida referred to as W. T. Edwards Tuberculosis Hospitals and later remodeled and renamed Sunland Centers. These hospitals were located all over the state of Florida, including Tampa, Lantana, Marianna, Tallahassee, Miami. The Lantana location, which would later be renamed A.G. Holley Tuberculosis Hospital in 1969, was the second of four state tuberculosis hospitals built in Florida between 1938 and 1952 and the last of the original American sanatoriums that continues to be dedicated to tuberculosis in the country.
All of the W.T. Edwards Hospitals were constructed in a similar fashion; the main buildings were very long and thin, consisting of five floors with several smaller wings branching off from the main building. At the time, it was a widely held belief that the best treatment for tuberculosis was fresh air and sunlight so the buildings had many multi-pane, crank operated windows lining every floor, especially in the areas that housed patients.
Picture from The Palm Beach Post, November 30, 1970 | Photo © 1970 Audrey Vickers
The hospital was originally built to serve 500 patients, with living accommodations for the physicians, nurses and administrative staff as well as its own power, water and sewage treatment plants. Originally, patients were separated by race with white patients housed in the east wing and African American patients in the west wing. The patients were also divided by how sick they were; the ones who were convalescent were able to walk through the landscaped grounds, or play pool or other games in the building.
Tuberculosis is a potentially serious bacterial infection that mainly affects the lungs. The abbreviation "TB" is short for tubercle bacillus. In the nineteenth century, tuberculosis was most commonly referred to as "Consumption", though the term "the great white plague" has also been used.
Second floor, east wing | Photo © 2013 Sugarbomb
Tuberculosis exists in two states; latent, or inactive, tuberculosis, and active tuberculosis. Active tuberculosis presents with symptoms that include a chronic cough, often containing blood, chest pain, weight loss, fever, fatigue, night sweats, and chills. Tuberculosis can also affect other parts of the body, including the kidneys, spine, or brain. In these cases, the signs and symptoms vary according to the organs involved but can include something as mundane as chronic back pain or a persistent headache all the way to meningitis, mental changes, liver and kidney failure, and permanent joint damage. People with untreated, active tuberculosis are contagious and can spread the disease to others by simply coughing, sneezing, spitting, laughing, talking, or singing.
With latent tuberculosis, on the other hand, the bacteria can exist in the body for years in an inactive state. Latent TB is not contagious and the main risk is that approximately 10% of these patients - 5% in the first two years after infection, and 0.1% per year thereafter - will go on to develop active tuberculosis. Risk factors such as a suppressed immune system due to medication, an unrelated infection, or advancing age increase the risk of latent TB developing into an active form of the disease. Once
identified, latent tuberculosis infections are also treated with antibiotics to prevent the infection from becoming active, though the course of treatment is often shorter and less intensive. It is estimated that over 2 billion people have latent TB.
Treatment for tuberculosis is long, often difficult, and not always successful. Antibiotics must be taken for at least six to nine months, depending on age, overall health, the infection's location in the body, and possible drug resistance. It was once believed that sunlight and fresh air were the most effective treatment for TB, but modern medicine has revealed that best way to treat the infection is with antibiotics. The common medications used to treat tuberculosis include Isoniazid, Rifampin, Ethambutol, and Pyrazinamide. Though if the strain of TB is drug-resistant , a combination of antibiotics called fluoroquinolones and injectable medications, such as Amikacin, Kanamycin or Capreomycin, are generally used for 20 to 30 months. Some types of TB are developing resistance to these medications as well.
The main challenge to treating modern day tuberculosis infections is the drug-resistant strains of the bacteria. Antibiotics have been used to treat TB for over 60 years and during this time, if not all of the infection is wiped out by the medication, the remaining bacteria will go on to become resistant to that drug and therefor harder to eradicate. Many strains of TB have become resistant to multiple drugs, making them that much harder to treat and often leading to the death of the patients before an effective combination of medications can be found.
The morgue | Photo © 2013 Sugarbomb
The medications used to treat TB can be very hard on the body with side effects such as nausea, vomiting, loss of appetite, jaundice (a yellow coloring of the skin), dark urine, and a fever that lasts three or more days with no obvious cause. A former pharmacist from A.G. Holley spoke of a patient who was jaundiced so bad that his skin was an unnerving bright, nearly neon, yellow color. He died soon after that.
As awful as tuberculosis was, it inspired a morbid fascination in poets, composers, novelists, and artists and has been romanticized in many forms of media over the centuries. It was even known as "the romantic disease" because of the poetic and artistic qualities it was believed to inspire in those it infected. Tuberculosis became an often reused theme in literature and is even believed to be the inspiration for the fictitious "Red Death" in Edgar Allen Poe's short story "The Masque of the Red Death." This artistic fascination with tuberculosis persists even now, as seen in Baz Luhrmann's 2001 movie Moulin Rouge, where main character Satine succumbs to the disease before imploring her lover Christian to write their story.
The hilarious moment when you find a Moulin Rouge poster in a TB hospital | Photo © 2013 Glades Kaine
By the mid-twentieth century, tuberculosis infections declined in developed countries with the discovery of antibiotics that could treat the disease even outside of institutional settings. Tuberculosis hospitals, more commonly known as sanatoriums, closed down slowly but surely throughout the US and in the state of Florida the Tuberculosis Board was dissolved in 1968 when the disease was no longer considered to be a public health threat.
The discovery of drugs that treated tuberculosis patients made treatment outside of a hospital setting more commonplace and by 1971 the daily census at the hospital had dropped to less than half of the original 500. Over the next five years, the staff at A.G. Holley was further reduced to serve a maximum of 150 patients.
Published in The Palm Beach Post on February 9, 1992 | Photo © 1992 Scott Wiseman
This reprieve from the great white plague was relatively short lived though, and by the mid-1980's tuberculosis infection rates began to rise once again. A perfect storm of factors facilitated this resurgence, including an increase in immigration from countries with sub-standard healthcare and high TB infection rates, the emergence of HIV, and an increase in homelessness and drug addiction.
As space became available, other agencies were invited to move onto the complex. Throughout the late 70's and early 80's, the west wing of A.G. Holley served as a minimum security prison for young, non-violent male offenders. After five inmates escaped, killing a Palm Beach County police officer in the process, the facility changed to only hold low-risk female inmates until 1992.
Closer to home, tuberculosis is still an issue in Florida, especially Miami and Jacksonville, because of these very same reasons. Though HIV is more effectively treated in the 21st century, tuberculosis is still relatively common among the homeless and immigrant populations. Antibiotics are still the only treatment available, though the masses are given a false sense of security by the existence of the BCG (bacillus Calmette-Guerin) vaccine that most remember being stuck with sometime before starting high school. It's given to children because it can prevent severe tuberculosis in that age group but it isn't recommended for general use in the United States because it isn't very effective in adults.
A.G. Holley TB Hospital & water tower | Photo © 2013 Sugarbomb
By 2012, though the hospital was licensed for 100 beds, it was only funded for 50. The Florida Legislature felt it was no longer cost effective to maintain the hospital at a deficit of $10 million per year, half of which came from Florida taxpayers. During the 2012 session, the Legislature mandated that the hospital close its doors by January 1, 2013.
While the Florida Department of Health was working to hasten the closure of the hospital, Florida was simultaneously in the midst of what the CDC confirmed as one of the worst outbreaks of TB anywhere in the United States for at least two decades. At least 3,000 people in Jacksonville may have been exposed to the highly contagious respiratory illness that had already claimed 13 lives in the city and left another 100 sick in the last two years.
News of the severity of the outbreak never reached Florida's politicians, who voted in March to close the doors of A.G. Holley six months early. As a result, patients who were once deemed too sick for contact with the public were released into the community and others newly diagnosed with the disease, mostly from the homeless population, are being put up in local motels in an effort to keep them on their medications. Charles Griggs, spokesman for the Duval County health department, claimed: "No patients who require the level of treatment and care associated with hospitalization are housed at local motels. Only low-risk clients who may require directly observed therapy as treatment are potentially housed in motels."
Box of medical equipment | Photo © 2013 Sugarbomb
On July 2, 2012, the last tuberculosis patient left the hospital. Jackson Memorial Hospital in Miami will take 16 of the displaced A.G. Holley TB patients who were ordered to be confined and treated by courts because they were deemed to pose a risk to the rest of society. The remaining patients will be released into the care of their own doctors and be supervised by their county health departments. Demolition of the building began in November 2014.
So rest assured, if you ever find yourself in an abandoned tuberculosis hospital, you won't have to worry about picking up the infection from there. You are way more likely to acquire the disease when walking the streets in Miami or Jacksonville than the halls of an old, abandoned sanatorium. On second thought, maybe that's not that comforting...