The history of public health in South Carolina begins with the earliest permanent European settlement. Charleston, founded in 1670, was the largest population center of the English settlements in South Carolina. The historical records from Charleston give us a picture of death and misery from episodes of widespread contagious and vector-spread diseases, including smallpox, diphtheria, malaria, and yellow fever. These  recurrent epidemics of deadly diseases swept through the settlements and the native American tribes and killed many people, with terrible suffering.  

Some of the earliest actions of the Provincial legislature addressed sanitary measures and quarantine, the two basic public health preventive strategies that were known at the time.  In 1692, the Provincial Legislature passed an ordinance against swine running free in the city, and ordered property owners to cut their stinking weeds. Towns were filthy places. People threw their wastes into the streets. Pigs were a major method of garbage disposal, but they didn’t add much to the ambiance. The 1698 ordinance began the quarantine measures that were an occasionally effective way of keeping contagion away from the city. Charles Town grew rapidly into one of America’s wealthiest and most cosmopolitan cities in the 1700’s. As the city grew it was beset with all manner of problems. There were fires, famine, epidemics, hurricanes, and attacks by pirates and Indians. There were extremes of great wealth and poverty. Health care for the sick and welfare for the poor were seen  as the responsibility of the community and church. The colonists recognized their dependence on one another for responding to all types of threats.  Mutual aid groups and parish organizations represented the community’s way of organizing a public health response. Mike Byrd, ‘Social Welfare Policy Roots, Charles Towne, 1732-1773.” PowerPoint presentation. USC School of Social Work, 2000. Farley, M. Foster. An Account of the History of Stranger’s Fever in Charleston, 1699-1876. Washington, DC: University Press of America, 1978.

Charleston had America’s first health officer, Commissioner Gilbert Guttery.  He was empowered to board and inspect all incoming ships before passengers were allowed to come on shore. Support for quarantine measures fluctuated, becoming of greater interest when epidemics struck. Enthusiasm for quarantine and sanitation waned between epidemics. State Board of Health.  Tricentennial Report on Health 1670-1970.  Columbia, SC. State Board of Health, 1970.

Smallpox is another of  the fearsome diseases that our ancestors experienced. Smallpox is a very contagious viral disease, with consequences that were often deadly or disfiguring.  Its characteristic symptoms are high fever, quickened pulse, intense headache, vomiting, pain, and eruptions of dark red spots on the third or fourth day that turn into pimples and pustules.  These distinctive symptoms make smallpox easy to identify in the historical reports.  Charleston suffered from major smallpox epidemics in 1711, 1738, 1760. Because Charleston was a major port city, most smallpox outbreaks began when a ship with infected passengers arrived. The city’s population was too small to sustain smallpox as an endemic disease, so all susceptible persons were at risk during the periodic epidemics. In the 1720's, variolation, or smallpox inoculation, was introduced as a preventive measure. A healthy person had pus from an infected person inserted into a small incision.  The result was usually a milder form of the disease that left the person with immunity, but death resulted for 1% to 5% of cases. This compared with a death rate of 10% to 50% for smallpox acquired naturally.  The practice of variolation also contributed to the spread of the disease in many cases.

Variolation was successfully used in Charleston during the 1738 smallpox outbreak by Dr. James Kilpatrick. Of 441 persons inoculated, 15 died. The death toll was much heavier among those who were naturally infected, so the results of variolation were seen as encouraging.  In September, 1738, the general assembly was called into session to deal with the outbreak. By the end of September, the death toll was 295 of 1,675 reported cases.  Charleston had fewer than 5,000 residents. The disease had a devastating impact on Indian communities, as it spread rapidly in a population with no immunity.  The Cherokees lost half their numbers during the 1738 epidemic. John Duffy. (1953) Epidemics in Colonial America.  Louisiana State University Press

In the epidemic of 1759-60, according to the South Carolina Gazette, “It is pretty certain that the Smallpox has lately raged with great Violence among the Catawba Indians, and that it has carried off near one-half of that nation, by throwing themselves in the river, as soon as they found themselves ill - This Distemper has since appeared amongst the Inhabitants of the Charraws and Waterees, where many Families are down.” The 1760 epidemic was staggering in scope: of approximately 8,000 residents of Charleston, an estimated 6,000 contracted the disease. In April 1760, the South Carolina Gazette reported 730 deaths due to smallpox. John Duffy. (1953) Epidemics in Colonial America.  Louisiana State University Press

There were recurrent episodes of yellow fever throughout the 1700’s and well into the 1870’s.  The last major outbreak in Charleston occurred in 1876. There was little that doctors of the time could do: they did not understand the causes of the disease or know any effective treatments. Farley, M. Foster. An Account of the History of Stranger’s Fever in Charleston, 1699-1876.  Washington, DC: University Press of America, 1978. Waring, Joseph I. A History of Medicine in South Carolina, 1825-1900. Columbia, SC: South Carolina Medical Association, 1967.

The Ladies’ Benevolent Society of Charleston was formed in 1814 for the “giving of skillful and sympathetic relief to numbers of the sick poor within the limits of said city.”  The Society provided assistance to the poor in the form of food, fuel, clothing, and nursing care. It was sponsored by contributions from individuals and churches and was non-denominational.  This Society was the first of its kind in the country. It was the origin of visiting nursing programs and public health nursing. Rosa Heyward Clarke. 1937. “History and development of public health nursing in South Carolina.”  Unpublished Master’s thesis. University of South Carolina.

Malaria was endemic in coastal areas. Practically everyone who lived in or traveled through these areas during the warm months experienced “seasoning,” which meant they suffered through the fevers and lassitude of malaria and other mosquito borne diseases. The word malaria comes from the Italian mal’aria  meaning “bad air.” Foul air, miasma, or swamp gas was deemed unhealthy. This cartoon portrays an epidemiological inquiry: Landlady: Malaria! If you mean lying down and sleeping and grumbling and going to bed late and don’t get up at all mornings – if that’s the disease, they’ve all got it bad!

As in other wars, disease was the major killer in the Civil War.  The camps brought together people and their diseases which flourished in the conditions of poor sanitation and  poor nutrition.  There were 204,000 combat deaths on both sides, and over 471,000 wounded.  Diseases and non-combat injuries claimed over 417,000 lives, more than twice as many as died in battle.  One in ten Northern men and one in four Southern men died or were incapacitated as a result of the war. Shelby Foote.  The Civil War: A Narrative Red River to Appomattox. Random House, 1974.

The Civil War left South Carolina in ruins.  This is the view from the Circular Church in Charleston, in 1865.

This is the view down Main Street in Columbia, after Sherman’s visit in 1865.

Interior of a Mississippi steamer crowded with ‘deck passengers’ Cholera epidemic 1873, National Library of Medicine Cholera was one of the most feared epidemic diseases of the 19th century. There were repeated worldwide pandemics of the disease.  Cholera is an acute bacterial infection of the intestines caused by drinking water or eating food contaminated with Vibrio cholera. Symptoms include watery diarrhea and vomiting that result in very rapid and severe dehydration. Untreated, death could result in a matter of hours. This illustration shows the interior of a Mississippi steamer crowded with ‘deck passengers’ during a Cholera epidemic in 1873. World Health Organization. 2000.  Report on Global Surveillance of Epidemic-prone Infectious Diseases.  WHO internet website.

Our safety depends upon official vigilance. Here the Angel of Cleanliness bars the gate to cholera, yellow fever and smallpox with Quarantine. Harpers Weekly 1885, National Library of Medicine Cleanliness was next to godliness, when it came to disease prevention. Here the Angel of Cleanliness bars the gate to cholera, yellow fever and smallpox with Quarantine. Sanitation and quarantine were still the first line of defense against the epidemic diseases, whose causes were vigorously debated.

Views of quarantine in New York about the 1880’s, National Library of Medicine This montage shows the steps in the quarantine process in New York during the 1880’s. Ships were met in the harbor.  Sick persons were transferred to the quarantine boat and then to an infirmary. Suspect passengers were kept in isolation wards. The dead were buried in a nearby cemetery. South Carolina established a quarantine system in 1868, with headquarters based in Charleston.

In France in the 1870’s, Louis Pasteur was continuing the studies that became the basis for bacteriology.  Pasteur changed the world with his elegant proofs for the germ theory of disease. He developed practical applications including the pasteurization treatment of food products, vaccination to prevent anthrax, and the dramatically successful rabies vaccine: these saved many lives. In 1878, he published “The Germ Theory and Its Applications to Medicine and Surgery” bringing the science of bacteriology to bear on disease prevention.

His German counterpart, Dr. Robert Koch was soon to discover the bacteria that caused cholera and tuberculosis.

Waring, Joseph I. A History of Medicine in South Carolina, 1825-1900. Columbia, SC: South Carolina Medical Association, 1967.

An Address to the Legislature was prepared by special committee of the Board, Dr. F. Peyre Porcher, MD Chairman, Dr B. W. Taylor, MD and Dr. J. A Robinson, MD. The committee requested a budget increase from $2,000 to $3,000 in the third year of the Board. Dr. Peyre Porcher was a distinguished Charleston physician. He and Dr.Benjamin W. Taylor of Columbia, who  was the Chairman of the Board of Health,  and Dr. J. A. Robinson addressed the Legislature "on the Sanitary Needs of the State…in 1881." Listen to some of their remarks: Legislators...will vote supplies for a good many different and indifferent objects, but for others with apparently remote advantages, such... as the preservation of health, ... the sanitary fat ...will keep up for a time a mighty sizzling! ... when a State Board of Health is organized and equipped... it can hope to add far more ... to the public welfare... to trace out and destroy the causes of disease, to protect the public from dangers and to compel the citizen,..., to take care of himself, his family and his neighbor.  It will examine everywhere into the economy of his household, the air he breathes, the water he drinks, the food he consumes. State Board of Health. Second Annual Report of the State Board of Health of South Carolina for the Fiscal Year Ending October 31st, 1881. Charleston, SC: Walker, Evans & Cogswell, 1881.

...If he is a dweller in the country the Board will drain the marshes which poison his residence, and teach him to remove his pigsties, privy, and dung heap to a safe distance from his house and well.... We declare...that three great scourges have afflicted this country with countless woes, namely: Bad air, bad whiskey and bad biscuits!  Their baneful effects cannot be easily exaggerated: The first deteriorates the blood, out of which are the issues of life and death, the second is the cause of frequent crimes and sufferings, and the third makes us pale, lean and miserable.  Bad teaching, though it has no influence on health, from the magnitude and importance of its evil results, namely the disastrous effects upon the education of youth, whereby the intellectual standard of the State is lowered, might well constitute a fourth... State Board of Health. Second Annual Report of the State Board of Health of South Carolina for the Fiscal Year Ending October 31st, 1881. Charleston, SC: Walker, Evans & Cogswell, 1881.

The Secretary of the Board, Dr. Henry Fraser was charged with keeping records of the Board’s activities, having custody of the Board’s books, papers, documents and property, conducting correspondence, filing correspondence processing vouchers, superintending all publications, and performing “such other duties as the Board shall from time to time direct.  He shall receive for his services a salary of $500 per annum, to be paid quarterly.”

Local boards were invited to report on disease outbreaks, climate and sanitary conditions in their districts. Four sets of meteorological instruments were purchased, and stations for collecting observations were established at Aiken, Newberry, Darlington and Spartanburg. Physicians on the local boards recorded meteorological observations. Food adulteration was commonly practiced: alum was added to flour to improve whiteness; confections and candy was adulterated with kaolin; milk was spoiled by careless handling. Selling of sick animals for slaughter was reported, “It is a common occurrence for people to discover that ‘the disease,’ is among their chickens, and immediately the whole crop of chickens are cooped, sent to the village, sold to the village merchant, and he in turn forwards them to market...parties so offending should be confined in the Penitentiary for at least twenty-five years...” Sub-board reports speculated on the causes and conditions that led to diseases like malaria, dysentery, and diarrhea. Cokesbury: “Although the profession differ wisely in their opinion as to the nature of the poison known as ‘malaria,’ there is one point upon which all are agreed, viz.: “That a very moist sub-soil, with a surface exposed to high temperatures and rapid evaporation, is the most congenial for its development and that it may spring from meadows, from the clearing of forests, from reservoirs, lakes, ponds, sluggish streams, and from turning up the soil.”...Experiment has demonstrated the fact that we can modify, if not wholly eradicate the poison.  Proper drainage and under-draining our low lands, removing obstructions from water courses, straitening the winding and tortuous course of streams, has been found sufficient.” Drs. FF Gary, Anton Berg & BC Hart Blackville: “In June dysentery prevailed to a considerable extent, which was no doubt attributable to the evaporations from the swamp bottoms, which had been overflowed by the large waterfall in the early spring, succeeded by a prevailing and almost unprecedented drouth in the summer.” Dr. LC Stephens Due West: “We would beg leave to call  attention of your Board to one fact that is very palpable to the profession as well as the laity, viz., the great increase and prevalence of consumption in our colored people...We are disposed to think that not one but a combination of causes, enter as important factors in the production of this stubborn, and in the main, fatal disease.  We would mention poor houses, insufficient clothing, irregular hours, scanty and inappropriate food.  Upon the latter cause we would place the greatest stress.” Dr. JL Miller

...the subject of a general vaccination of the people of the State, was, in view of a threatened invasion of small pox, urged upon the Executive Committee by its Chairman in a very able report, and measures were at once instituted to carry this work into effect in as far as the limited appropriation of the Committee, the prejudices of the people, and the non-existence of a compulsory law would permit. In the Spring, the Secretary was instructed to procure a supply of virus for distribution to the sub-Boards of Health; this was done with as little delay as possible, and non-humanized virus in sufficient quantity was obtained from Wisconsin to supply all counties in the State, and was distributed along with a circular for using it most effectively.  Unfortunately, the season was too far advanced, and the presence of the hot weather, rendering the lymph ineffective in a short time, caused the success of the undertaking to be limited. This engraving from 1873 shows public health in action, vaccinating the poor in New York.

In 1890, the Board’s budget was  $2,492.67, with expenditures of $2,025.87 Thirty-four counties had boards in one or more towns. The local boards failed to send in reports, with very few exceptions Influenza was the major disease threat for the year, according to the annual report: Our people, in common with almost the entire human family, have undergone during the present year one of the most widespread epidemics that has visited us within the knowledge of man. It showed no preference for high or low.  Its subjects were chosen equally from castle or cottage; rich and poor; young and old; weak and strong - all were amenable to its visitation...this influenza, without serious fatality, remained with us throughout the spring... State Board of Health. Eleventh annual report of the State Board of Health of South Carolina for the fiscal year ending October 31, 1890. Columbia, SC: State Printer.

Many of the soldiers in Cuba were exposed to the disease. Over 5,000 soldiers died from the disease, compared with only 968 in combat. University of Virginia. 1997. “Yellow Fever and the Reed Commission.” Internet website: www.med.virginia.edu.

Returning troops undergoing quarantine inspection, Daufuski Island SC, 1899, National Library of Medicine Here are some returning troops undergoing quarantine inspection at Daufuski Island in South Carolina, in 1899. The perspective from the State Board of Health was expressed in the annual report This year, 1899, has been a fortunate one to Charleston in relation to yellow fever.  In the earlier summer months it was generally feared that with the horde of soldiers returning from the West Indies, and especially the island of Cuba, that yellow fever would follow in their train, and we were generally considered in great peril. We have fortunately escaped. Another year is added to our long list of years since the great foe has been in our city...The most rigid precautions were taken to protect the city, and for several months great anxiety was felt...

In 1900, Dr. Walter Reed and an intrepid group of his colleagues on the US Army Yellow Fever Commission studied yellow fever in Cuba. The commission put together the puzzle of how the yellow fever virus was spread, and identified the aedes aegyptii mosquito as the vector.  Mosquito control measures were put in place throughout the Southeast – and the last yellow fever outbreak in the US occurred in New Orleans in 1905. University of Virginia. 1997. “Yellow Fever and the Reed Commission.” Internet website: www.med.virginia.edu.

Twenty-first Annual Report of the State Board of Health of South Carolina for the Fiscal Year 1900 to the Legislature of South Carolina. The state company, state printers, Columbia, SC 1901 Smallpox - “several outbreaks ...for the past three years have been promptly suppressed by vaccination of those exposed and proper isolation of the sick... There was a budget request for $1500 for a state bacteriologist. T. Grange Simons, Chairman, Executive Committee, SC Board of Health. Dr. James Evans of Florence was Secretary.  The Board again requested that the legislature enact a law for registration of marriages, births and deaths...”These statistics constitute a sort of barometer of the various moribific influences weighing upon the people, and they will give to your honorable body important information in regard to the laws of population, the possibilities of extending human life, and the causes of disease and the causes of mortality...p. 1481 Statistics were reported by each local board, in more or less detail, most completely by Charleston.  Sanitation was the big issue this year: “In the City  of Charleston, we have an inadequate supply of pure and wholesome drinking water. A large number of persons in the city drink cistern water and some well water...22.9% were polluted of the cisterns...over 50% [of wells]...With an abundant supply of good and wholesome water...and a sewerage system...an era of good health would be inaugurated that would be of incalculable benefit...” For the past twenty years we have, year after year, called to your attention the deplorable condition of the city as to the privy vaults and the storing of immense quantities of night soil, and the necessity for the foul and filthy removal of the same...There is but one and only one remedy, and it is to bring an abundant supply of water to the city.  Build a general system of sewerage and destroy these relics of an unscientific solution of a great municipal problem.  There were 2,006 privy vaults emptied in 1899.   These vaults not only pollute the air we breathe but poison the water we drink.  The Charleston Board had a budget of $21,600 in 1899.

The report described Dr. Williams initial duty: “It is a singular fact the at the first call upon your State Health Officer was to investigate the plumbing and sewerage of the State capitol.  The investigation disclosed a very unsanitary condition in one of the toilets, resulting in its being condemned and closed up... Clerk fund; $500; Pure Food & drug appropriation $1,000; Food inspection was an issue: the federal Pure Food Law of 1907 had been passed.

National Archives. Children’s Bureau, Department of Commerce and Labor. Lewis W. Hine, photographer. Work conditions in the textile mills were a public health concern.  These are children working as spinners and doffers in Mollahan Mills, Newberry, 1908.

National Archives. Children’s Bureau, Department of Commerce and Labor. Lewis W. Hine, photographer. This picture shows a group of boys working in Lancaster Cotton  Mills. The smallest boy in the middle said he has been in the mill off and on for five years. Many young children worked in mills, as there were no child labor laws. A federal child labor law was passed in 1916, setting a minimum age of 14 for employment, but this was challenged by southern mill owners and ruled unconstitutional in 1918. It was in 1938 that the Fair Labor Standards Act  established regulations for employment of young workers – age 15 is the minimum age, with minimum wages and rules regulating work activities, except for farm labor.

National Archives. Children’s Bureau, Department of Commerce and Labor. Lewis W. Hine, photographer. This little girl worked in the Lancaster Cotton Mills – there were many others this young. Mill workers frequently suffered from respiratory diseases and other diseases. Tuberculosis was widespread. Pellagra was a nutritional deficiency disease that was very common at the turn of the century. A national Pellagra conference was held in Columbia in 1908.  Many South Carolinians suffered debility, madness and death from this disease, whose causes were yet unknown.

The Rockefeller sanitary commission conducted a study of school children: of the 4,695 rural schoolchildren examined, 47% gave clinical evidence of hookworm Funds were requested for tuberculosis control and for enforcement of pure food & drug laws. The Board’s staff included FA Coward, the Laboratory director, a chemist,  and three sanitarians with the Rockefeller Commission who were all medical doctors. Prevalent diseases in 1910 included smallpox, diphtheria, scarlet fever, typhoid and poliomyelitis. State Board of Health. 1911. Thirty-first Annual Report of the State Board of Health of South Carolina for the Fiscal Year 1910 to the Legislature of South Carolina. Gonzales & Bryant, state printers, Columbia, SC.

At the April 1912 Board meeting,  Dr. James A. Hayne was appointed as the second State Health Officer. Dr. Hayne would lead the Department until 1944. By 1912, the Department had grown in size: there were now 12 full-time staff in addition to Dr. Hayne. Eight of these were medical doctors, one heads up the State Laboratory. The rest were working on rural sanitation efforts, largely funded through the Rockefeller Sanitary Commission. State Board of Health. 1913. Thirty-third Annual Report of the State Board of Health of South Carolina for the Fiscal Year 1912 to the Legislature of South Carolina. Gonzales & Bryant, state printers, Columbia, SC.

There were many health and environmental problems that Dr. Hayne faced during his first year on the job. In 1912, epidemics and outbreaks of infectious disease were the major health concerns.  Disease reporting was an inaccurate process, but some statistics were presented in the annual report. There were 392 reported cases of smallpox and two reported deaths: Dr. Hayne noted that the white population was about 75% vaccinated and the black population was about 60% vaccinated..."there is much work yet to be done before we finally succeed in stamping out smallpox."  State Board of Health. Thirty-third Annual Report of the State Board of Health of South Carolina for the Fiscal Year 1912 to the Legislature of South Carolina. Columbia, SC: Gonzales & Bryan, 1913.

Diphtheria "has been specially virulent during the last five months of the year...the public are learning the value of antitoxin and demand it at once from the physicians..." 

Typhoid was spread by unsanitary conditions and polluted drinking water. 1915, NLM "We believe that typhoid fever has decreased...due to the educational campaign...There has scarcely been a village of any size...that has not been visited....All our cities are provided with pure water.  There are 375 [reported] deaths from typhoid fever annually. This probably is an underestimate....

Here is an example of the type of health education materials that were widely distributed in hopes of improving sanitary conditions.

Sanitary surveys were made to ascertain the health conditions in rural areas. In 1912, Sanitary surveys [were made] ... of at least 200 rural homes to determine the type of privy, if any, on the premises. 

“Out of a possible 100 [per cent], no county scored higher that 7 [per cent] and most of them below 5...this condition more than any other...accounts for the prevalence of typhoid, diarrhoea and dysentery...hookworm.”

Much attention was paid to improving sanitation by constructing privies

Federal privy building programs in the 1930’s improved rural sanitation, 1930, NLM This photo shows the results of Federal privy building programs in the 1930’s.

In 1912, Dr. Hayne reported that “ Milk inspection is more and more carried on...  Proper sewerage systems exist in nearly all the towns…”

Tuberculosis.  We hang our heads in shame whenever asked what South Carolina is doing to prevent tuberculosis...We have repeatedly requested appropriations... for this cause, and as frequently have we been denied...never a day passes...that someone does not die of tuberculosis, and remember the average length of a case of tuberculosis is about two years...during that time millions upon millions of the germs have been thrown off, and thus the disease is spread....no other disease claims one-tenth of the toll... During the decade, the Board of Health grew to include a Tuberculosis Sanatorium in 1915 and a Bureau of Vital Statistics in 1915,  and a Division of Venereal Disease Control in 1918.

Hospital ward, Camp Jackson, Columbia SC, National Library of Medicine Venereal Disease Control was a high priority nationally in 1918, with the many  camps established for military training in World War I - over 10% of the recruits from SC had syphilis or gonorrhea when they entered the military

The influenza pandemic of 1918 was one of the worst disease outbreaks in human history.  The best evidence indicates that this disaster began at Camp Funston, an  army base in Kansas on March 8, 1918.  An influenza virus mutated into a lethal strain. It arrived in Europe on American troop ships in early April 1918, and perhaps mutated again. The epidemic traveled fast in three waves of infection, reaching almost every corner of the world by the spring of 1919, when the virus played itself out. Influenza killed over 20 million people in the span of a year.  This was more than twice the number of people who died in the horrific battles of World War I.

A child with influenza, her mother and a visiting nurse from Child Welfare Association. Public Health Nursing Quarterly, May 1919, National Library of Medicine There were over 6,000 deaths in South Carolina, 3,600 in October 1918 alone, and an estimated 170,000 cases in the state. State Board of Health. Thirty-ninth Annual Report of the State Board of Health of South Carolina for the Fiscal Year 1918 to the Legislature of South Carolina. Columbia, SC:

The Board of Health added the Bureau of Child Hygiene in 1919, under the supervision of Mrs. Ruth Dodd, the first State Supervisor of Public Health Nursing. The Bureau promoted the development of nursing services in the counties to improve the care of mothers and children.  Results were soon forthcoming. 

By 1920, 1,000 midwives were registered and received training on cleanliness, equipment and procedures for childbirth. 

There were 44 public health nurses, under a variety of sponsors, including the Tuberculosis Association, Red Cross, Metropolitan Life Insurance Company, industries and the counties. They made a real difference in maternal and infant health. In 1921, 358 women died in childbirth or from pregnancy-related conditions. This was an improvement of 14% from the previous year. Infant deaths numbered 3,980, a mortality rate of 104.4 per 1,000 live births. Many infant deaths went unreported. One baby in ten died before reaching one year of age.

In fact, a 1925 report on public health conditions found that “nearly one-third of the children born in South Carolina die before reaching the age of six years.” Donald M. McDonald. 1925. “A Survey of Public Health Conditions in South Carolina.” Bulletin of the University of South Carolina, (No. 159). Columbia, SC: University of South Carolina, Extension Division.

Let me repeat that for you: “nearly one-third of the children born in South Carolina die before reaching the age of six years.”

Most died from communicable and infectious diseases, mainly gastro-intestinal and respiratory diseases.

Tuberculosis was the leading killer of young adults, accounting for 29% of deaths in that age group in 1920.  Year in, year out, tuberculosis was a deadly plague.  There were over 16,000 reported cases in 1920, and thousands more unreported.  There was no effective treatment.  Public health efforts were very limited, emphasis was placed on basic sanitation, quarantine and  public education.

A family sitting on an unscreened porch was at risk for malaria. 1920, NLM A summer’s evening in South Carolina meant sitting on the front porch in the cool of the evening.  There was no air conditioning, windows were opened to catch the breeze. This put people at high risk for malaria.

Malaria control was in full swing in the 1920’s. According to the Board’s 1920 annual report: "The general plan of procedure in carrying out malaria control operations has been to emphasize the prevention of the breeding of malaria carrying mosquitoes..."

Here is what draining the swamps looked like in Panama. It was hard work.

Prevention of malaria largely involved draining or spreading oil in swamps and ponds, and constructing sanitary sewer systems.  According to the Board’s 1921 annual report, “the death rate from malaria has dropped by over half in six years, from 26 per 100,000 in 1915 to  12.5 per 100,000 in 1921.” Malaria control is one example of how today's solution creates tomorrow's problems. Think about the environmental concerns today over the disappearing wetlands. If anyone wonders why the swamps were drained in the first place, it was to get rid of the mosquitoes that carried yellow fever, dengue fever and malaria.  The swamps were drained to save lives and protect health.

Pellagra is a nutritional deficiency disease caused by inadequate intake of niacin, a B vitamin.  Pellagra was widespread in the South, particularly from the turn of the century and well into the 1930’s. In 1912 in South Carolina,  there were an estimated 30,000 cases and a mortality rate of 40%. Alan Kraut. 1996. “Dr. Joseph Goldberger & the War on Pellagra.” National Institute for Health internet website: www.nih.gov/od/museum/exhibits/goldberger/fulltext.htm

The effects of the disease were devastating. Pellagra is characterized by a progression from dermatitis to diarrhea, dementia and death. The germ theory of disease dominated medical investigation into the cause.  

It was Dr. Joseph Goldberger who refused to accept the germ theory, and who correctly identified a nutritional deficiency as the cause.  He conducted empirical studies and experiments in orphanages, prisons and mental hospitals to demonstrate that diets deficient in milk, meat and vegetables resulted in the disease.

Poverty meant that few sharecroppers or mill workers could afford to eat a well-balanced diet. Meager diets that consisted mainly of cornmeal, molasses, and a few vegetables were the rule. It took several years for Goldberger’s discovery to be accepted and for effective public health action to be taken. Dietary supplements of brewer’s yeast, and improvement of diets to include more meat, milk and vegetables resulted in reducing the prevalence of the condition in the 1930’s.  In 1937, niacin was identified as the specific nutritional factor related to the disease. Enrichment of flour, corn meal and other products with the B vitamins began in the 1940’s.

The 1930’s were a time of rapid change. When the Depression struck, funding for public health was greatly reduced. Federal  Sheppard-Towner funds were lost in 1929. In 1931, the Board of Health was in jeopardy of losing all its funding, and ended up losing over half of its funding. By 1933, the Bureau of Child Hygiene was reduced to only three staff. The situation was much improved in 1935 with the passage of the Social Security act, which provided significant funding for maternal and child health services. State funding for other areas of public health was restored.

to help children crippled by malnutrition, injuries, polio or other diseases;

In the environment, the major challenges were disposal of  wastewater and solid wastes. Annual reports described some of the conditions around the state:

Aiken - sewerage empties into small streams. No garbage disposal plant.

Anderson has 93% of the city sewered, and no sewerage disposal plant. Sewerage empties into the Rocky River and Generostee Creek.

Beaufort - Sewerage system: Adequate to provide all needs of City.  Emptying into salt water river.  About sixty per cent of buildings connected with sewerage system. No garbage disposal plant.

Columbia - Eighty-five percent of buildings are connected with City sewer and have water closets. Sewerage empties into Congaree River. Garbage is being dumped in out of the way places and covered with earth at present.

Dr. Ben Wyman replaced Dr. Hayne as the State Health Officer in 1944. He would be in this job for the next ten years. The Board of Health had 16 divisions in 1945, with a budget of $2,422,832 and over 500 employees.  The war brought special challenges as many public health workers entered military service. State Board of Health. Sixty-sixth Annual Report of the State Board of Health of South Carolina for the Fiscal Year 1945 to the Legislature of South Carolina. Columbia, SC: State printer, 1946.

Restaurant sanitation experienced major improvements in the 1940's: According to the 1945 annual report, “The developments and changes in this field during the year have been very gratifying.”

“We have definitely entered a new era in the field of restaurant sanitation and a great deal of study has been given to formulating suitable procedures…”

“We have approximately 2,500 restaurants in the state and practically all of them are overtaxed…with the difficulties of getting trained help, adequate equipment, [and] food supplies.…”

Venereal disease control was a particularly important public health function during the war years. There were dramatic improvements in the treatment of venereal diseases at this time.

Rapid treatment center for VD, Columbia SC, National Library of Medicine Here is a montage of scenes that provide an impressionistic view of the Columbia rapid treatment center and its clients.

In the early 1940's, treatment for syphilis still involved a series of injections of arsenicals and heavy metals over 18 months.

Of course, prevention was preferable to treatment.  While this poster shows a fairly aggressive approach to prophylaxis, it isn’t clear how effective it was.

There was a turning point in the treatment of sexually transmitted diseases.  Penicillin was introduced in 1943 and would soon come into widespread use to treat and cure syphilis, gonorrhea and other diseases. 

Public awareness campaigns  enthusiastically promoted the possibility of cure.

The laboratory performed nearly 250,000 serological tests for syphilis in 1945. 

Contact investigation was a part of the venereal disease control efforts. 

Over 25,000 tuberculosis patients were treated  in 1945, with 48,000 clinic visits

Miracle drugs to treat tuberculosis were discovered in the 1940's and 50's: such as streptomycin, and isoniazid. 

Tuberculosis is a very difficult bacteria to control - treatment resistant strains develop rapidly. Therapy is long-term, and uses multiple drugs. Failure to comply with treatment regimes results in breeding drug-resistant strains of the disease.

Efforts in environmental health during the late 1940's emphasized improving sanitary conditions and reducing the spread of vector borne diseases. “Typhus fever showed a slight increase...this year. It continues to be almost exclusively an urban disease…”

“It is generally believed that the rat is the chief reservoir of typhus fever...control...depends upon the control of either the rat or the rat flea…”

“Rats cannot be completely eradicated so long as there is food and harborage at their disposal.  Therefore, it is necessary to have an approved type of garbage disposal along with the rat proofing program.  A thorough clean-up campaign... should be included…”

“Malaria control and investigation was a major activity...The control program...was one largely of larvicidal control...70,849 gallons of larvicidal oil used, 2,744 miles of ditches and 3,227 acres of ponds controlled by larvicide... house spraying with DDT  was begun in ... 11 counties that showed the highest average annual death rate from malaria. “

“There was not sufficient DDT to spray all the houses in all these counties...19,512 homes were sprayed...the program was readily accepted by the people…”

The Board was given responsibility for licensing hospitals, nursing homes and other health facilities in the late 1940's. 

The Board administered Federal Hill-Burton funds for the construction of hospitals, health centers and other health facilities, beginning in 1947.

State Board of Health. Seventy-fifth Annual Report of the State Board of Health of South Carolina for the Fiscal Year 1954 to the Legislature of South Carolina. Columbia, SC: State printer, 1955.

Children’s health was an area of activity. According to the 1954 annual report: “Measles occurred in its usual epidemic form in many counties...no unusual complications”

“318 cases...occurred...the disease was still predominately one of children under ten...Charleston County was selected as one of the Polio Vaccine Field Trial Areas…”

After the development of polio vaccine, major public health immunization campaigns were successfully implemented.

There were 62,323 live births during 1954, a baby boom year and only 72 maternal deaths, a rate of 1.2 per 1,000 live births.

It began a program of plan review and monitoring to reduce pollution. The Pollution Control Authority was under the general authority of the State Board of Health, but there were frequent organizational issues throughout the 1950’s and 1960’s which were eventually resolved by the creation of the present Department of Health and Environmental Control in 1973.

In 1954:  “The division [of sanitation] ...emphasized garbage collection and disposal by the landfill method. ...Typhus fever which was once a major public health problem...now occurs at a very low incidence...only 10 cases reported…”

The state Board...has continued an insect control program... In 1955, the health departments sprayed 110,487 gallons of chlordane...; dusted 40,421 acres with 134,610 pounds of chemicals; and fogged 694,301 acres with 61,672 gallons of insecticide.” The Board of Health used DDT; methylchlor; chlordane; dieldrin; lethane; warfarin: all of which are now banned or strictly controlled pesticides.

These highly effective pesticides were used to kill the mosquitoes that spread malaria, and the rats that spread typhus.

Their use was partly responsible for creating new environmental problems. Agricultural and industrial use of pesticides and chemicals was largely unregulated and the consequences were not well understood.

 The 1960’s brought significant change in public health programs.  Medicare and Medicaid were created to provide health insurance coverage for the elderly and low-income population.  The Board of Health developed a home health nursing service in the mid - 1960’s to provide care to homebound patients in need of skilled nursing services.  The county health departments were organized into multi-county public health districts.

Dr. Kenneth  Aycock was named to replace Dr. Peeples who retired in January 1967. The agency had grown to 1,515 employees and a budget of $8,594,608.  Dr. Aycock had a lot to say to us today about the relationship between health and the environment: State Board of Health. Eighty-eighth Annual Report of the State Board of Health of South Carolina for the Fiscal Year 1967 to the Legislature of South Carolina. Columbia, SC: State printer, 1968.

“Most persons and health professionals focus their attention  on disease or the effects of diseases, rather than the cause or prevention of disease, or encouraging good health practices. Preventing disease is the best alternative to curing disease; particularly when unnecessary suffering and a possible lifetime of disability can be avoided…”

“the fate of the population's health is closely intertwined with issues that have not been identified primarily as health issues.”

“The environment in which man lives is as important to his health as is access to physician and hospital.  Once again, our society is the potential victim where environmental factors have come full circle”

“to pose an imminent threat to the health and social well-being of the people.” In 1973, the Board of Health was merged with the Pollution Control Authority to form the Department of Health and Environmental Control. The board structure was changed: no longer was the Board of Health under the auspices of  the South Carolina Medical Association.

The Mills Building has been the setting for a long, proud history of public service and caring.

The Michael D. Jarrett Building is a recent addition to the Mills Building.  Mr. Jarrett was Commissioner from 1986 until his death in 1992. He is remembered as a leader in public health, with great vision, courage and commitment to public service.

Two blocks away at the corner of  Pickens Street and Williams Drive,  is the Williams Building. This a mental health facility named for Dr. Fred Williams.   Dr. Williams served from 1908 to 1911 as the first full-time Health Officer hired by the State Board of Health. He went on to have a distinguished career as the State Director of Mental Health.

This is the Sims Building which houses the Department of Health and Environmental Control headquarters. The building is named for Dr. James Marion Sims.

The Aycock Building is part of the  Sims-Aycock complex.  The Aycock building was built in 1974 and named for State Representative R.J.  Aycock, chairman of the House Ways and Means Committee. At that time, his son, Dr. Kenneth Aycock,  was the Commissioner of the Department of Health and Environmental Control.  Dr. Aycock served as Commissioner from 1967 to 1978.

Peeples Auditorium in the Sims-Aycock complex was named for Dr. George Peeples, State Health Officer from 1954 to 1967.

At State Park is the Hayne Building, home of the public health laboratory.  Dr. James  A. Hayne was one of the outstanding figures in public health in South Carolina. He served as the State Health officer from 1911 to 1944, and built the basic framework for public health in the state.