Florence Sabin and the Struggle for Public Health Reform in

Post-War Colorado

by Patricia J.F. Rosof

[Begin with image of sculpture by Joy Buba, 1959, in

Statuary Hall of Capitol]

In 1944 the second world war was showing signs of

coming to a successful conclusion in Europe and governors in

the United States realized they had to prepare for the post-

war return of soldiers and their families. Therefore Gov.

Vivian of Colorado created a Post-War Planning Committee

with a subcommittee on Health. According to reports, the

Governor’s list of nominees lacked women, an absence noted

by Frances Wayne of the Denver Post. When asked for

suggestions of women by the Governor, she suggested Dr.

Florence Sabin, a Coloradan native, who had returned home

from the East Coast after a distinguished career in medical

research at The Johns Hopkins Medical School and The

Rockefeller Institute. Now 73, Sabin must have appeared to

The research for this paper was made possible by a Library Resident Research Fellowship from the American Philosophical Society, Philadelphia, PA and a Margaret S. Grierson Scholar-in-Residence Fellowship from the Sophia Smith Collection, Northampton, MA.

1

Governor Vivian as a safe choice unlikely to threaten the

status quo.1 Instead, she successfully challenged the

antiquated and inadequate public health system of Colorado

and achieved the implementation of far-reaching legislation.

And while the legislation did not focus on women, as she

herself acknowledged, women’s groups played a significant

role in its passage.

Sabin herself reflected on how she had achieved success

and what was replicable by other states and localities. In

an address entitled “How Citizens Make their Wishes Known”

she laid out some of the principles she had determined were

central to success. Among these was the one implied by the

title of her talk: one had to engage the citizens of the

state and make the demand for change become their own. In

order to do this, Sabin argued, one had to bring the facts

to the public. One fact, she shared, for instance was that

death rates in Colorado were higher than average for the

nation. Second, one had to educate the public not just

1 Albert Q. Maisel, “Colorado’s Lady Dynamo,” The Reader’s Digest, May 1947, from the Sophia Smith Collection, Northampton, MA. (hereafter SSC), Box 1, folder 4.

2

about the current state of public health but also about the

role of preventive medicine, which was often seen as

socialistic. And in educating the people, it was important

to identify leaders in each community who would take on the

role of convincing their fellow-citizens and legislators.2

Of course, Sabin had to rely not just on her fellow-

citizens but also on tremendous organizational skills as

well as on professionals who could provide the data she

needed. Two significant individuals in this regard were

Fred T. Foard, the Medical Director for the US Public Health

Service, and Dr. Lloyd Florio of the University of Colorado

Medical School. A third individual was Dr. Roy L. Cleare of

the Colorado State Board of Health. These efforts were

helped by the insistence by the Surgeon General that each

state establish a State Department of Health that would

conduct a health and hospital survey.3 A U.S. Senate bill

passed in the summer of 1946 allowed new hospitals to have

one-third of their construction costs covered but the needs

2 Florence Rena Sabin, “How Citizens Make their Wishes Known,” Series III. Box 17, Folder 1: Colorado Public Health, 1945-47, nd., SSC. 3 Fred T. Foard to Sabin, June 30, 1945, Series IV, Box 27, Folder 2: U.S. Public Health Service Correspondence 1945-49, SSC.

3

had to be based on the survey.4 Federal influence was

particularly useful in Colorado since the state had a dismal

record of funding its own public health needs. For

instance, the state, despite being known as a haven for

treating tuberculosis, did not provide funding for treatment

of the disease, nor for epidemiology, and covered only 2

percent if maternal and child health, relying on the federal

government for the rest. Overall, Colorado provided only

7.9% of the costs of public health, an abysmal record

compared to other regional states.5 The survey of the state

of Colorado health was financed from outside the state

government by the Commonwealth Fund and conducted by the

able Dr. Carl Buck, the Field Director of the American

Public Health Association.6

Not surprisingly, Sabin, unfamiliar with state

politics, faced a steep learning curve. She quickly

introduced a bill to the state legislature that went down to

4 Aug. 14, 1946 L.B. Byington to Sabin with follow up on Nov. 25, 1946, Series IV, Box 27, Folder 2, SSC.5 Feb. 12, 1945, Fred. T. Foard to Lloyd Florio, Series IV, Box 27, Folder 2, SSC.6 Sept. 5, 1947, Address by Sabin to the Illinois Statewide Public Health Committee meeting, Box 20, Folder 1, SSC.

4

resounding defeat. She learned soon enough that both the

Governor who had appointed her, and the Mayor of Denver, who

was at any rate under Colorado law independent of State law

as concerned health, nonetheless strenuously opposed the

health bills. The Civil Service and health appointments

tended to be political and the politicians did not want to

lose this plum.7 Therefore, Sabin had to adjust and

organize. This began with making sure the people got the

word of what was happening. For instance, when Dr. Buck’s

report on the state of Colorado health was due to be buried,

Sabin made certain that several thousand copies were

distributed throughout the state.8 Later, in a brochure for

the people of Colorado entitled “Health to Match our

Mountains” she enumerated the low health levels in the

state, with 47 states doing better than Colorado in death

from scarlet fever, 44 in terms of diphtheria, 43 having

lower mortality rates from diarrhea, enteritis and

pneumonia. Infant mortality rates were better in 42 states

and two-thirds of the states had lower premature births and

7 ibid.8 ibid.

5

maternal deaths.9 Note that these diseases especially

affected children and were of the sort to galvanize women.

Organization required a good committee that well-

represented the community and so hers included lawyers,

doctors and businesspeople, at least one of whom had

acquaintances throughout the state, who could be tapped for

local leadership positions. This was essential since the

basic organizational principle was local. Sabin, and a

hired Executive Secretary went throughout the state, in even

the worst of winter, meeting with local groups. Among those

relied upon to organize meetings at which they spoke were

the Parent Teachers Association, the American Association of

University Women, the League of Women Votes, the Federation

of Women’s Clubs, as well as Men’s clubs, Rotary and Kiwani

clubs and Church and teacher groups.10 This was an era when

women’s and men’s groups were very popular and so they

formed a logical bloc of support and access to the wider

population.

9 “Health to Match our Mountains,” p. 1, Box 23, Folder 3, SSC. 10 Sept. 5 1947 Address by Sabin to the Illinois Statewide Public HealthCommittee meeting, box 20, Folder 1, SSC.

6

Women played a significant role in this. As soon as

Sabin’s appointment to the Governor’s Committee was

announced the Chair of the Health Committee for the Colorado

State Federation of Business & Professional Women’s Clubs

wrote to Gov. Vivian requesting a brief outline of the

committee aims.11 Clearly women were directly affected by

issues of maternal and infant health, children’s diseases,

and the health of the milk they served their children. And

they took an active leadership role. For example, a

brochure was put out by The Special Health Committee of the

Colorado Congress of Parents and Teachers led by three

women. The brochure, entitled “Basic Health Needs of

Colorado” summarized the recommendations of Sabin’s

Committee and the legislation being proposed. It urged

readers to let the legislators know they care about these

bills and, in keeping with Sabin’s philosophy, stated

“Doctor Sabin and her health committee are relying on the

people of Colorado and their legislators to make possible a

11 Oct. 15, 1945 Helen A. Moore to Hon. John C. Vivian, Box 20, Folder 6, SSC.

7

fine health future for Colorado.”12 One issue that Sabin

sought to address in her legislation was the need for safe

milk, a concern of obvious interest to women. Among the

diseases that concerned her were Bang’s disease and

brucellosis, both of which could be spread by cattle

infected with bacteria. Again, she made use of the concerns

of the local people. For instance, she told of how a small

town woman physician reported that the Mayor would not

permit pasteurized milk. Upon the urging of this physician,

a meeting was called and over one hundred people attended.

The women of a larger town reported that they totally

avoided fresh milk because it had so much visible dirt.

Upon Sabin’s suggestion, twelve women and the Mayor attended

a demonstration of the process of milk production through to

pasteurization, and the result was that the local dairies

decided to send in pasteurized milk and build their own

plants.13 Sabin proudly pointed out that the group visited

a dairy “a perfectly run dairy—run by a woman, I am pleased

12 “Basic Health Needs of Colorado” Box 22, Folder 7, nd, SSC.13 Sept. 5, 1947, Sabin, Address to the Illinois Statewide Public HealthCommittee meeting, Box 20, Folder I, SSC.

8

to say—and a pasteurizing plan that is the last word in

excellence.”14

Of course, in order to gain this popular support and

initiative, Sabin had to learn the art of public relations.

In this she was helped by her persistence and her age.

Articles such as that in The Reader’s Digest entitled

“Colorado’s Lady Dynamo” depicted her as persisting in the

face of horrendous snow storms and implacable politicians.

There was the story of the time all cars were warned off the

roads due to the dangerous weather conditions with a meeting

scheduled 135 miles away. However, as reported by her

Executive Secretary and travel companion, “There she sat [in

the car] with a shawl tied over her head, like a quiet

little old grandmother on her way down the street to tea.”

However, this old lady was sitting in a car with the snow

reaching the hubcaps and thirty miles of travel still ahead

of them. They pushed onward to the meeting. Her passion

14 Sabin, “The People Win for Public Health in Colorado,” reprt. From the American Journal of Public Health, vol. 37, no. 10, Oct. 1947, p.1314 , Box 19, Folder 7, SSC.

9

for health and saving lives won people over and made them

workers for the cause.15

She knew the newspapers could be useful in presenting

her side and was responsive to their requests. In 1945 she

wrote a long letter in response to an inquiry by The Boulder

Daily Camera concerning the health conditions in the state.

Dr. Buck’s survey was not yet completed but she set forth

the findings to date: the high rates of rejection from the

army for poor health (43.1% from Colorado compared to 29.1%

from neighboring Wyoming), the high death rates from

diseases such as diphtheria, tuberculosis, digestive

disorders compared to the U.S. as a whole, and the ways in

which this could be addressed with a competent professional

local health department. She also mentioned the problem of

Brucellosis with counties having rates of cattle infection

as high as 40%, a problem that could be eliminated with

statewide cattle testing and pasteurization. Finally, she

enclosed a copy of the report prepared by Dr. Fred Foard

concerning the Public Health Services as well as a copy of

15 May 1947, Maisel, “Colorado’s lady Dynamo,” Box 1, folder 4, SSC.

10

her own first report to the Governor, with the caveat that

she was too optimistic concerning tuberculosis.16 This

thorough response gave the newspaper a good foundation for

understanding the problem and the motivations behind the

introduction of the Sabin bills to rectify these

deficiencies.

Sabin was convinced that a proper public health system

required a non-political civil service system with

appropriate pay scales. It undoubtedly helped her cause,

therefore, when the Denver News reported in Oct. 1946 that

the Director of the Colorado division for TB control, Dr. A.

R. Masten, had resigned due to his poor salary and the lack

of civil service classification for his job. The article

pointed out that in the prior ten years the General Assembly

had failed to appropriate any money for TB control and when

Dr. Cleere had written the Governor for having Dr. Masten’s

salary included in the Health department there was no

response. Finally, it was reported, that Dr. Sabin had

submitted a revised salary scale for Health Department

16 Nov. 18, 1945 Sabin to Robert Sommerville, Box 21, Folder 7, SSC.

11

employees to the Civil Service Commission.17 A similar

report was filed in the Denver Post. 18 Equally useful,

undoubtedly, was Time Magazine’s piece on her, calling her

the “Colorado Crusader.” The article reported on the survey

which found that the state had the third worst record per

capita in deaths from scarlet fever but then went on to

discuss recent support for change from Denver papers, PTAs,

and chambers of commerce, with five model bills being

introduced.19

However, it was not just newspapers she relied upon and

responded to. When Mrs. Moore of the Women’s Clubs wrote to

Gov. Vivian for information, Sabin wrote her own letter to

Moore explaining the purposes of the committee in some

detail. At the end of the two-paged, singled spaced letter,

she concluded that she took great pleasure in Moore’s

request for information since “I am sure that Women’s Clubs,

with their State-wide organizations, can be a decisive

17 Oct. 3, 1946 “Dr. A. R. Masten Quits Colorado Health Dept.” Denver News, Colorado State Medical Society Manuscript (Hereinafter CSMS) Collection no. 151, Clippings 1946-47.18 Oct. 3, 1946, “Pay Raises in Health Unit Asked, “ Denver Post, Ibid.19 Oct. 28, 1946, “Colorado Crusader,” Time, ibid.

12

factor in this undertaking.”20 Similarly, in 1946 she wrote

another two page letter to student Gertrude Sweeney of

Boulder responding to questions about pressure groups

opposing the Health Bills. In that letter, Sabin identified

three main groups that had undermined the 1945 attempt at a

Health Bill: the Denver City political machine, the Milk

interests, and the Chiropractors. She also made predictions

concerning the new health bills. She felt the Milk

Interests were more interested in reform now since they had

lost interstate business due to lower standards than other

states. Chiropractors would remain opponents because they

wanted to maintain the right to sign death certificates and

opposed any health bills that might lead to changes. She

also anticipated opposition from the Civil Service

Commission since her bills were meant to professionalize

hires.21 A third example dates from 1946, in which Sabin

responded to a letter by a Mrs. Frederic Shaw inquiring

about the reliability of the test for Bang’s disease as well

as vaccinations against it. Once again, her letter was to

20 Oct. 27, 1945, Sabin to Mrs. Helen A. Moore, Box 20, Folder 6, SSC.21 June 3, 1946, Sabin to Gertrude Sweeney, Box 22, Folder 8, SSC.

13

the point, technical and complete, covering over two single

spaced pages with a summary of four points of recommendation

at the end.22 In each case, Sabin treated inquiries from

all individuals personally, fully and honestly. Presumably

she knew that those answers would be shared and would build

support for the changes she advocated.

Another example of the involvement of women’s groups in

the push for Health Reform comes from a letter written to

Sabin from a member of the State Committee on Health of the

League of Women Voters. The writer, Mrs. M.L. Cummins of

Durango, had long been involved in Public Health and found

the doctors opposed to the prior health bill. Her

involvement began at the request of a nurse friend with the

TB fund-raising sales drive. At the time she sought to help

of local doctors and found them uncooperative, fearing that

the drive to counter TB, supported by the State TB

department, was one more step toward socialized medicine.

It was a public health nurse who led the work for a local

Health Council. With the 1945 law up for consideration that

22 July 2, 1947, Sabin to Mrs. Frederic B. Shaw, Box 23, Folder 4, SSC.

14

Public Health Nurse held a meeting which one State Senator

refused to attend and a Representative who did come opposed

the legislation on the grounds that the doctors feared it

would lead to socialized medicine. The public questioning

of this, however, led to a reversal of attitudes by the

local doctors. Furthermore, the League of Women Voters made

Colorado state health their concentration for the coming

year so Cummins was now optimistic about health reform.23

That optimism was confirmed in the summer of 1946 when the

locality passed a new Milk ordinance due to the support of

the League of Women Voters, the Local Health Council and a

bout of severe intestinal disorder believed to be due to

unclean milk.24

Note that not only did a Women’s group, play a lead

role here, but the leadership position was taken by a Public

Health Nurse. Sabin herself emphasized the key role of the

public health nurse. In fact in a speech she gave “How

Citizens Make their Wishes Known,” Sabin noted that it was

local groups that began actions and invited County

23 May 24, 1946 M.L. Cummins to Sabin, Box 9, Folder 8, SSC.24 Aug. 14, 1946 Cummins to Sabin, Box 9, Folder 8, SSC.

15

Commissioners, doctors and members of the State Health

Departments to meets, adding that in each instance

leadership was taken by a Public Health Nurse.25

As the Sabin health bills moved their way to passage,

the newspapers took note of the role of women’s groups. An

article in the Denver Post observed that “Probably no group

in Colorado is keeping closer watch on the Colorado public

health reorganization act…than the twenty-two state chapters

of the American Association of University Women,” who were

using this issue to plunge into political affairs, impelled

by the recent polio epidemic and the high death rate from

preventable diseases.26 Three days later the Denver News

reported on the work of the League of Women Voters in favor

of the health bills.27

Finally, Sabin reached out to those groups she knew

from the 1945 failure would be most likely to oppose the

bills, bringing their representatives into committee

planning sessions. For example, on July 1, 1946 guests 25 Sabin, “How Citizens Make their Wishes Known,” Box 17, Folder 1.26 Feb. 9, 1947, “University Women Back Health Bill,” Denver Post, CSMS,Manuscript Collection no. 151, Clippings 1946-47.27 Feb. 12, 1947, “League of Women Voters Works to Put Over Dr. Sabin’s Health Bill,” Denver News, Ibid.

16

from the Civil Service Commission were invited to discuss

proposed changes in order to gain professional personnel

whose appointment and salaries would not be subject to

political pressure. She pointed out to them that under the

current system, nurses, who were essential to any public

health system, lacked job security, being hired only as

provisionals.28 Representatives from the Denver Dairy

Products Association, Colorado A&M College, the Denver Milk

Producers Co-op Association and the Sate Dairy Commissioner

attended a special meeting later that month.29 A week later

there were appropriate guests to address tuberculosis.30

August saw the participation of the Dairy Association and

the Medical School in order to address issues of

sanitation.31 One result was that the Colorado and Denver

Diary Products Association put forth their own ideas for

legislation.32 After all these meetings and consultations,

Sabin’s Subcommittee proposed a series of bills to totally 28 Executive Committee of the Subcommittee, July 1, 1946, Box 23, Folder1: Governor’s Post War Planning Committee Reports, minutes, notes, statistics contents of Sabin’s notebook, 1946, nd., SSC. 29 Minutes of July 15, 1946, ibid.30 July 22, 1946, ibid.31 Aug. 19, 1946 ibid.32 Aug. 23, 1946, ibid.

17

reform Colorado Public Health. These included a

reorganization of the Health Department which was

functioning under a law dating back to 1876, the creation of

local health units throughout the state, a milk act for

proper grading, production and labeling, a Hospital Enabling

Act which allowed localities to make use of federal matching

funds,, the creation of a new tuberculosis wing, and

increased appropriations for tuberculosis, including for the

state’s indigent victims. In addition the Subcommittee

sought increased appropriations for the Health Department

and Medical School. The only clear failure of this effort

was a cow bill meant to overcome undulant fever in people

and Bang’s disease in cattle by the quarantining of infected

dairy cows, a measure strongly opposed by the livestock

interests.33

With the passage of the so-called Sabin bills, the need

to communicate with the public remained strong. So after

the passage of the legislation, Sabin put out a new pamphlet

to explain the changes to the people of the State. In an

33 April 23, 1947, Colorado State Medical Society, Box 21, Folder 9, SSC.

18

“Open Letter to the People of Colorado” she credited the

passage of legislation to “your active and effective support

of public health….” The pamphlet focused in particular on

the Local Health Units allowed by the law. In it she

explained that these units were there to help protect people

against disease in a way similar to a fire department

protecting against fire. Such units were to be staffed,

minimally, by a physician trained in public health and

preventive medicine, a public health nursing supervisor with

a staff of nurses, a sanitary engineer and a secretary. She

went on to explain the difference between public health and

medical care, in the process easing the fears of socialized

medicine. Public health officials were not meant to provide

medical treatment nor practice private medicine. Rather

their role was to address health issues affecting the

community as a whole, by containing communicable diseases,

ensuring safe water and milk supplies, and protecting the

health of mothers and children through teaching and

demonstrations.34

34 May 31st Revision, nd, Sabin, “Open Letter to the People of Colorado,”Box 23, Folder 3, SSC.

19

As Sabin recognized, the battled for public health

legislation had to be a political battle as well. In this,

as well, she was helped by the positive publicity she

generated while working for her health bills. Governor

Vivian was replaced by a new Governor, Lee Knous, who

campaigned on a good government platform, and Denver was

finally brought into the health reform camp when Quigg

Newton was elected mayor, with the support of Sabin, in May

1947.35 In fact, her support of Newton, even expressed

through a radio address, was the first time she had made a

purely political speech, and it occurred due to her

awareness that without change in Denver the health reform of

Colorado would be a badly incomplete affair.36

Sabin continued to work in public health in the city of

Denver until her death in 1953. Reflecting upon her

experiences in bringing health reform to Colorado, she drew

certain more broadly applicable lessons. Again, and again,

she emphasized the need to educated, inform and involve the

35 Sabin, “The People Win for Public Health in Colorado,” as reprinted in the American Journal of Public Health, vol. 37, no. 10, Oct. 1947, 1311-1316, Box 19, Folder 7, SSC. 36 Sabin, “Radio Address for Quigg Newton,” Box 17, Folder 2, SSC.

20

public. In 1948, President Truman called for a National

Health Assembly to take place in Washington with Sabin asked

to head a Section on State and Community Planning. 37

Sabin saw the role of her committee to focus on process, so

that state and community groups could achieve their goals.

Therefore she said the following organizational questions

would be among the most useful to consider: 1. “Have you

obtained all patient factual data…available from reliable

public and private organizations?” 2. “Have you posed our

planning problems to whatever overall citizen planning

groups are already organized for civic improvement….” 3.

“Have you consulted agencies and professional

associations….?” “4 “Have you discussed existing community

health problems with organized civic, professional,

religious, fraternal…groups?” She continued with “Have you

consulted representatives or your newspapers, your radio

stations….? And “Have you thought of seeking written and

audio-visual educational materials or aid in preparing your

37 Oscar R. Ewing to Sabin, nd. Box 24, Folder 1, SSC.

21

own….?”38 A quick perusal of these questions makes clear

that in fact these are the types of actions and

consultations Sabin engaged in during her own campaign. In

her notes prepared for the Steering Committee she advocated

an assumption that Americans have an interest in public

health but need a clear statement of why aspects of public

health such as immunization are proper governmental

functions. In addition, people should be taught that a main

function of a public health department is education and that

in fact preventative method is also economically sound.

Again, she advocated meeting with business groups in

advance, making clear to the public the costs of public

health services and seeking good leaders in each community,

in particular getting the assistance of groups already

organized around diseases such as TB.39

Sabin’s belief in relying on already existing local

groups was highlighted as well in a speech before the

National Tuberculosis Association given in 1949. Already 38 National Health Assembly section on State and Community Planning for Health, Box 24, Folder 2, SSC.39 March 23, 1948, Sabin, Notes prepared for Consideration of Steering Committee on State and Community Planning for Health, Box 24, Folder 3, SSC.

22

serving as the Manager of Department of Health and Charity

in the newly reformed Denver, Sabin spoke about the role of

the Public Health Service in comprehensive mass x-ray

surveys to find and treat tuberculosis. She noted that

while the health officials had to take the lead, health

education occurred with cooperation among the health

officials, TB organizations and the people themselves.

Asking how the leaders could be found among the people, she

concluded: “The people are already organized into all

possible groups and clubs….One has only to find the leaders

of these clubs and get them to join in one great effort to

reduce this still formidable communicable disease,

tuberculosis. Especially should one seek the leaders who

have shown independence of thought and imagination in

undertaking new endeavors. They exist in every

community.”40 In 1947, after a National Conference on Local

Health Units held in Princeton NJ, Sabin’s theme was

summarized as follows” Give the people the facts, they can

40 Sabin, “Basic Community Organization Cooperative Use of Leaders,” Rprt. From the Transactions of the Forty-fifth Annual Meeting of the National Tuberculosis Association, 1949, Box 19, Folder 7, SSC.

23

be trusted to act on them.”41 Sabin acted according to this

belief and achieved what had seemed unattainable.

41 The National Conference on Local Health Units, Princeton NJ, Sept. 8-10, 1947, conference summary, Box 20, folder 3, SSC.

24