The last of the USA’s original tuberculosis sanitariums sits, improbably, just off Interstate 95, near a Dunkin’ Donuts and a Motel 6, and just behind fields of children playing soccer. The fading signs out front simply say A.G. Holley State Hospital. There is nothing to suggest that one of history’s greatest killers lurks inside.

Florida lawmakers have tried for years to shut the place down. History, it seems, should be on their side. Holley’s counterparts, like the Trudeau Sanatorium in upstate New York, closed decades ago, after antibiotics nearly scrubbed the disease from the United States. These days, TB treatment usually takes place at home or in a handful of large research centers.

And yet somehow Holley remains. Sixty years after it opened, it is both a paragon of globalized public health and a health care anachronism, where strangers live together for months with boredom, pills, pain, contemplation and the same ancient disease that killed George Orwell, Franz Kafka and Eleanor Roosevelt. There used to be 500 patients here, surrounded by brush, with nursing quarters segregated by race. Now, no more than 50 live in the main building, above echoing, empty floors sometimes rented out as a location for filming horror movies.

They have all moved in, like generations past, because they are unable to control their illnesses. Some have traditional TB, the airborne contagion carried by one-third of the world’s population, which becomes a lung-wasting menace in only about 10 percent of the infected. A growing number of others arrive with drug-resistant mutations that can cost hundreds of thousands of dollars to treat.

Just keeping Holley air-conditioned costs hundreds of thousands of dollars a year, according to administrators, which partly explains the state’s interest in moving and privatizing the program.

Employees and patients, however, argue that the specialized care at Holley is a bargain for public health. Holley is a leader in research on drug resistance, and 93 percent of those who enter end up completely cured.

Patients also leave with more than just stronger lungs. Maintaining old sanitarium ideals, Holley offers care beyond TB, whether dentures and eyeglasses or cultural activities, including outdoor classical music concerts for the noncontagious. Many Holley residents who hated arriving end up leaving profoundly changed.

“It’s not uncommon, as patients get better, for them to see this as a second chance at life,” says Dr. David Ashkin, Holley’s medical director, a Brooklynite with a hard-rock ’80s mullet. “It’s very spiritual and life changing to go from nearly dead to alive.”

Most days in fact are a mix of profound appreciation for life, and gnawing sadness at the limits of institutionalized existence.

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