Year 2013 marks the 90th Anniversary for the Cattaraugus County Health Department, the first organized county health department in New York State. It is our privilege to share a brief history with the public over the next few months, most of which is taken from C.E.A. Winslow’s Health on the Farm and in the Village: A Review and Evaluation of the Cattaraugus County Health Demonstration with Special Reference to Its Lessons for Other Rural Areas, 1931.
Prior to 1923, Cattaraugus County, like all New York State rural counties at that time, had no general county health organization. Each city, town and village had its part-time health officer and each school its part-time medical inspector with no coordinated health system. The only step taken by the County was the erection of the Rocky Crest Sanitorium for tuberculosis, opened in 1916, with one public health nurse assigned to the institution. The Rocky Crest Sanitorium was located on Route 16, south of Olean near what was known as Rock City Park. Treatment for tuberculosis was relativity primitive with the assumption that if diagnosed individuals could be placed where they had access to fresh air in the mountains, it would be helpful. In its day, the Sanitorium site had many buildings on the property which included a water tower and nurses quarters in addition to patient housing.
In 1922, the Milbank Memorial Fund designated funding to Cattaraugus County as a demonstration project, “to demonstrate…whether by intensive application of known health measures the extent of sickness could be further and materially diminished and mortality rates further and substantially reduced.” The project was initiated in 1923, resulting in an organized full-time Cattaraugus County Health Department.
Initially there were bureaus of communicable disease, tuberculosis, statistics, and laboratory services. In 1925, the well-developed nursing service became a separate bureau and a bureau to control venereal disease was initiated. In 1926, a full-time bureau of Maternity, Infancy and Child Hygiene was created, and in 1929, the first trained sanitary engineer was appointed. Dr. Leverett D. Bristol was appointed County Health Officer and Director of the demonstration project, based in Olean. John Walrath of Salamanca was appointed the President of the County Board of Health by the Board of Supervisors. Many of these originally created bureaus, including those that oversee communicable disease, tuberculosis, laboratory, statistical records, maternity and infant/child hygiene, and health education continue to be core activities today.
Dr. Reginald M. Atwater, Health Official for Cattaraugus County in 1928, shared the following: “…the average adult individual becomes one of our County citizens who receive benefits from all divisions of activity. He finds that the public water supply is supervised by state and local authorities through routine laboratory analyses and field studies. His milk supply is protected within the limits of existing regulations. He and his dependents receive nursing service. His children receive oral prophylaxis and benefit from well-baby conferences, nutrition programs, venereal disease clinics, mental clinics, orthopedic clinics, and the manifold benefits from an adequate public health laboratory. If his family income is insufficient, the nurse or social worker stands ready to help him. His social adjustments, particularly as they relate to health, are made easier through the Social Service Department of Cattaraugus County Tuberculosis and Public Health Association. He profits from a constructive educational campaign maintained by public as well as private organizations…”
Dr. Atwater goes on to say, “Other needs which are scarcely met at all may be listed: hospital beds available to rich and poor; provision for hospitalizing communicable diseases and for correction of defects; obstetrical care for mothers unable to afford the ordinary costs; and the care of sick people in the county whose care by doctors represents a difficult problem for physician and patient alike. Services received by the average Cattaraugus County person are intended in no way to replace a private physician. The doctor’s place is extremely important and one of expanding possibilities in the new day of better health. The relationship between the private practitioner and public health workers is characterized by cooperation in a common task, not by competition in any sense. Only by thus cooperatively using all means at hand is it possible to reduce the enormous amount of disability that comes from improper hygiene, the accumulations from neglect of medical care, uncorrected defects and chronic disease that might have been prevented by proper foresight.”
The Milbank Memorial Fund, in its centennial report, noted the following results from the Cattaraugus County demonstration project: “…deaths from tuberculosis declined more quickly in Cattaraugus County than in comparison counties, from 55 per 100,000 in 1929 to 25 per 100,000 in 1930; infant mortality rates also fell more quickly; and the project launched a successful countywide school health service.” The report goes on to note that other rural counties launched their own health departments based upon the success of this demonstration. Further, in a report commissioned by the Milbank Memorial Fund 25 years following the demonstration, Yale University researchers noted that “the entire progress made in the United States in developing health services for rural areas owes its inception to Cattaraugus County.”
We look forward to sharing Part II of our 90 year history next month.
Submitted by Debra J. Nichols, Public Health Educator, July 11, 2013 (First in a series)
This article is Part II of the 90th Anniversary of the Cattaraugus County Health Department Series. Year 2013 marks the 90th Anniversary for the Cattaraugus County Health Department, the first organized county health department in New York State. It is our privilege to share a brief history with the public, most of which is taken from C.E.A. Winslow’s Health on the Farm and in the Village: A Review and Evaluation of the Cattaraugus County Health Demonstration with Special Reference to Its Lessons for Other Rural Areas, 1931.
(See Part I of the 90th Anniversary for the Cattaraugus County Health Dept. published in August Healthy Living edition).
In 1928, Dr. Reginald Atwater, Cattaraugus County Health Official, summarized achievements of his then 6 year old Health Department in this paraphrased report:
Prenatal – “unborn, the average Cattaraugus County individual receives attention equal to the services of one public health nurse. The child’s mother has the benefit of numerous classes on prenatal care under the auspices of the Health Department. If the unborn child’s life is in danger from the spirochete of syphilis, he may have the benefit of prenatal arsphenamine from a public clinic. His mother is likely to receive adequate hospital care at confinement because of follow-up for cases with complications. There is inadequacy in lack of sufficient beds. Unless the child’s parents can afford to pay hospital costs, he will scarcely benefit from additional safeguards in a maternity hospital. About 97% of births have a physician in attendance at the baby’s birth, 2% are attended by midwives, and 1% are without an attendant.”
“The average baby born,” continues Atwater, “one of 1,500 born annually in this county, has a fair chance of arriving in a home where a set of maternity supplies are on hand and where a layette has been prepared. He shares 2,500 visits from the public health nurse with other neonatal citizens; he may even be one of the 40 annual cases where the physician is assisted at delivery by a public health nurse.”
Infant – the average baby will have one visit from the public health nurse during the post-partum period and will have access to child health conferences in his district. In 1927, 1 in 4 babies outside of the Olean area attended these conferences, and 84 children received the prophylactic toxin-antitoxin. Substantial aid is given in promotion of breast feeding, the use of cod liver oil, and in teaching new mothers how to prepare the doctor’s feeding formulas.”
Preschool – “By the time a child reaches his first birthday, he has been the recipient of considerable public health effort. The child has access to further conferences and to nursing supervision that has become well-articulated with his doctor’s advice. His defects are sought out and a persistent effort is made to secure necessary corrections. His mother is urged to make his diet conform to best standards. There is a desire that he be trained in good mental health habits, emphasized by the public health nurse visits. The child and mother prepare for entrance to school by having an examination and detection of defects.”
School – Dr. Atwater continues, “on entering school at age 5 or 6, the child comes under supervision of educational authorities who provide medical examination. This examination is attended by a public health nurse and the child’s record becomes a permanent form, following him through his school career. In addition to defects and attempts to correct those defects, weight records, nutrition and communicable disease history are recorded. School days consist of morning inspections, nutritional advice, and frequent talks by the public health nurse, all educating the child on good approaches to hygiene and prevention. Throughout his school years, the child benefits from close supervision of communicable diseases by local and county authorities. He has opportunity to take toxin-antitoxin in clinics, has privilege of vaccination against smallpox, has access to curative sera and diagnostic tests, and has medical consultations. If he is a boarding home child, he receives even more attention through sanitary inspection of his home.”
“At some point,” Dr. Atwater adds, “the average child has access to a health camp, especially if he is underweight or otherwise in need of the benefits of outdoor life. If he is crippled, there is a committee of responsible citizens who obtain adequate funds, supplemented by state aid, for his rehabilitation. His tonsils may be removed by private physicians or through cooperative efforts between doctors, clinics and hospitals, or at public tonsil clinics. In short, this Cattaraugus County child has a fair chance of having a sound body.”
“Among the families supervised in 1927-1928, health progress was impeded by financial situations in 15% of the population. Many families were able to make the grade until such time as the costs of illness interfered, thus demonstrating the values of health and the need for effective intervention.”
Some 85 years later, we, the Cattaraugus County Health Department staff, continue to move toward the vision Dr. Atwater shared, hopefully with that same passion and integrity, on behalf of rural America.
Part III will be shared next month.
Submitted September 13, 2013 by Debra J. Nichols, Public Health Educator
This article is Part III of the 90th Anniversary of the Cattaraugus County Health Department Series.
Year 2013 marks the 90th Anniversary for the Cattaraugus County Health Department, the first organized county health department in New York State. It has been our privilege to share a brief history with the public, most of which is taken from C.E.A. Winslow’s Health on the Farm and in the Village: A Review and Evaluation of the Cattaraugus County Health Demonstration with Special Reference to Its Lessons for Other Rural Areas, 1931.
(Parts I and II were published in August and October)
“In the 30 years preceding the end of World War II, local and state health departments and the United States Public Health Service grew and flourished as guardians of the people’s health.” Milton Terris, 1976
Most county health departments were established with outside support, often by way of funding from private foundations. In his 1929 report, L.L. Lumsden estimated that of the 467 national county rural health departments, 88% received outside assistance. Among those foundations first to take a significant interest in rural public health, and subsequently to provide seed funding for county health units, was the Rockefeller Foundation. In 1909 the foundation organized the Sanitary Commission to Exterminate Hookworm Disease and conducted community-level surveys in nine states to assess the extent of the disease. The commission found infection rates as high as 43% among the 404,000 children inspected but was particularly surprised to find that the majority of homes and schools did not have privies. Between 1910 and 1913, the Rockefeller Foundation developed health programs in rural counties, which often led to the development of full-time county health units in three successive stages. First, counties were funded to educate medical professionals and the public about the importance, prevalence, diagnosis and treatment of hookworm disease; secondly, funds were provided to sanitize communities to protect against hookworm, typhoid fever, and other diseases; and finally, funds were then provided for the employment of full-time personnel within counties to enable continued work. In 1916, the Rockefeller Foundation began contributing directly to the budgets of county health departments. Other foundations helped establish county health departments in rural areas during this time including the Milbank Memorial Fund, which in 1922 provided funds that helped establish a rural health department in Cattaraugus County in 1923.
The importance of the Cattaraugus demonstration project was eloquently summed up by John A. Kingsbury, secretary of the Milbank Memorial Fund, who was quoted in the May 26, 1931 issue of the Olean Evening Times as saying, “green pastures, sunshine and rolling meadows apparently have little to do with the health of the individual. At any rate, they constitute less protection in the way of adequate rural health administration than the effective sanitation, clinical facilities, and hygienic measures available in congested streets and bleak tenement house districts of large cities. With few exceptions, rural communities have lamentably inadequate public health provisions. The Cattaraugus County Demonstration offers testimony of what can be accomplished by the intelligent and coordinated effort of public and private agencies in the alleviation of human misery.”
The Milbank Memorial Fund in its centennial report noted the following results from Cattaraugus County: deaths from tuberculosis declined more quickly in Cattaraugus County than in comparison counties, from
55 per 100,000 people in 1929 to 25 in 1930; the infant mortality rate also fell more quickly; and the Demonstration Project launched a successful countywide school health service. The report goes on to note that other rural counties launched their own health departments based upon the success of this demonstration. Further, in a report commissioned by the Fund twenty-five years following the demonstration, Yale University researchers noted that “the entire progress made in the United States in developing health services for rural areas owes its inception to Cattaraugus County.”
As county health departments rapidly expanded public health services into rural areas, services provided by public health nurses were gradually brought under the umbrella of the county units and nurses comprised the core programmatic staffing of many of these agencies. The county health unit initiatives funded by the Rockefeller Foundation, the U.S. Public Health Service, the Milbank Fund and others relied heavily upon public health nurses.
Despite the rapid increase in the number of health departments across the country, it was estimated in 1929 that 77% of rural Americans still lacked access to public health services.
Congratulations again to the Cattaraugus County Health Department, its past and present employees, for 90 years of ongoing efforts to protect the health and well-being of county residents.
One final chapter of the Department’s Anniversary will be presented next month.
Submitted on November 7, 2013 by Debra J. Nichols, Public Health Educator
This article is Part IV of the 90th Anniversary of the Cattaraugus County Health Department Series.
Year 2013 marks the 90th Anniversary for the Cattaraugus County Health Department, the first organized county health department in New York State. It has been our privilege to share a brief history with the public, most of which is taken from C.E.A. Winslow’s Health on the Farm and in the Village: A Review and Evaluation of the Cattaraugus County Health Demonstration with Special Reference to Its Lessons for Other Rural Areas, 1931. (Parts 1 through 3 were published in previous months).
In 1923, the Cattaraugus County Health Department (CCHD) was officially launched as the first organized county health unit in New York State by the County Board of Supervisors. The Supervisors established a County Board of Health, which in turn appointed the county health officer and director of the demonstration. Cattaraugus County was of particular interest to the Milbank Memorial Fund for its already active interest in health programs. To build on efforts already in place, the Fund issued the new county health department to specifically address tuberculosis control and maternal and child health. The first efforts initiated by the newly formed department were aimed at establishing organization. With headquarters in Olean, six distinct bureaus were created to address communicable disease, tuberculosis, statistical records, laboratory diagnostic services, maternity, infant and child hygiene, and health education and awareness. At the same time, six district health stations were created, each run by a public health nurse; county school hygiene services were developed to provide examinations; and a health education program and social service organization were developed.
Activities were extensive; see highlights provided from 1923 to 1929:
1923 – 6,647 children had been examined in 249 schools
1924 – 144 tuberculosis clinics held with 2,928 examinations made, raising the level of identified new cases from 77 in 1922 to 343 in 1924; thirteen public health nurses were now on staff – paid total of 16,855 visits over the year; the Tuberculosis and Public Health Association conducted a survey to identify disabled children – 175 were identified; five orthopedic clinics were held
1925 – 16 public health nurses on staff and an additional 8 public health nurses were employed by local agencies for a total of one nurse per 3,000 residents; tuberculosis mortality showed its first significant drop, from 50 to 35 deaths per year; an active campaign to detect tuberculosis among school children was initiated with 1,278 children being examined
1926 – programs were organized to address maternal and child health issues, with 740 children attending medical conferences, including 336 under the age of two; a second venereal disease clinic was opened in Salamanca with 41 sessions held, in addition to the 104 sessions held at the Olean clinic; a sanitary inspector was appointed and surveys begun, covering 26% of the county’s towns by end of year; dairy inspections were also initiated. A new children’s health camp was established at Allegany State Park; 141 children were enrolled in its first summer of operation. The County’s public health nursing staff had grown to 27. Work of the Laboratory had increased to 7,692 tests conducted. The HD began its first campaign to reduce auto crashes and the first appraisal of county health work was conducted by the American Public Health Association.
1927 – in recognition of high infant death rates during the first month of life, nursing staff more than doubled their efforts, increasing their prenatal case load from 115 in 1926 to 257 in 1927.
1928 – this was a difficult year due to an outbreak of typhoid fever in Olean. An initial outbreak in February involving 1,000 cases of enteritis was attributed to an auxiliary city water supply. There were an additional estimated 10,000 cases of enteritis during the first two weeks of September. In the end, 212 cases of typhoid fever developed in Olean and an additional 18 cases were traced back to Olean. Two emergency hospitals were opened to help handle the epidemic and the American Red Cross helped organize over 100 private duty nurses to provide assistance. The city paid for the private duty nurses, drugs, and hospital expenses, as well as 6,000 anti-typhoid vaccinations. Ultimately the Olean Health Officer and Board of Water Commissioners resigned and responsibility was given to the County Board of Health and County Health Department. On a more positive note, 211 of the county’s 268 village and rural schools had implemented a system of daily instruction.
1929 – During this final year of the demonstration, a mild outbreak of smallpox occurred in Olean, with 53 cases and no deaths; response from the HD was swift with 8,000 vaccinations performed including 90% of Olean’s school children. The Laboratory performed 18,631 tests. Full integration of sanitary efforts followed the 1928 outbreak; of the county’s 20 water supplies, 13 were reported improved by end of year and 90% of residents were served by satisfactory water supply. Nearly half of public health nursing visits were on behalf of prenatal cases, infants and preschool children; the infant mortality rate dropped to 53 per 100,000.
It has been our pleasure sharing our history with you. Feel free to call us at either 800-251-2584 or at 716-373-8050 if you have any questions or concerns. We look forward to serving you for another 90 years!
Submitted on December 12, 2013 by Debra J. Nichols, Public Health Educator