A Brief Look at Public Health Nursing in Kentucky

Public health nurse arriving to unclean, unkempt premises. Image from the Bulletin of the Department of Health of Kentucky, 1916.

In the early 20th-century in Kentucky, a growing movement to educate the public about communicable and preventable diseases began taking place. Kentuckians and, arguably, many other Americans were reluctantly content with allowing the progression of diseases for any number of reasons; largely due to a lack of public health education and tools needed to combat communicable and preventable diseases. This growing movement of men and women in Kentucky brought to light our content to permit diseases such as smallpox, yellow fever, malaria, diphtheria, childhood diseases, and various other diseases to claim the dead and take a toll on the sick by the tune of thousands. As time progressed, everyday citizens started demanding that leaders and scientists devote their time and efforts to preventing sorrows and saving lives. As tuberculosis stormed the country and began killing hundreds of Kentuckians every year the Kentucky Board of Tuberculosis Commissioners organized twenty Public Health and Welfare Leagues that employed nurses in their respective districts. The Commission, by 1916, had two state organizing nurses who could go from district to district and demonstrate by example and precept, the value of public health nursing and its advantages to communities by having nurses make home visits and help limit the spread of communicable diseases.

The growing movement of public health nurses was critical to educating and preventing public health crises. Though they could not cure communicable diseases they could instill the tools and education necessary for Kentuckians to prevent becoming infected. Public health nurses were able to make school inspections to look for defective eyesight (trachoma), enlarged tonsils, and other deficiencies in children. Additionally, the nurses could deliver educational health talks to schoolchildren and local neighborhood meetings where special agencies might not have been otherwise available. In 1916, physicians made a public plea for communities to come together and request the services of a public health nurse to Dr. W. L. Heizer, the Secretary of the Kentucky Board of Tuberculosis Commissioners. “If the facts stated in your request warrant the expenditure of the necessary money and time, one of the Commission’s organizing nurses will be sent to your district for two, three, of four weeks; long enough to demonstrate the value of the work and to secure the necessary funds for continuing it.”

According to Kentucky’s State Board of Health, the organizations of Public Health Nursing in small towns or rural districts began in September 1913, in Mason County. The State Tuberculosis Commission had a car in Mason County for several days in charge of Mr. Sapp and Mr. E. J. Faulkner. During the daytime hours, the car was open for visitors and at night both Mr. Sapp and Mr. Faulkner went out into the county schools and gave health lectures. Public health nurse Miss Hunt was sent out to do follow-up work in the three months’ campaign to try and unite the local community to concentrate on fighting the war against tuberculosis and other infectious diseases. Miss Hunt began her campaign by doing visiting nurse work; during her home visits, she found many cases to use as illustrations in public health talks to focus the public eye on conditions, and show the need for a permanent nurse. At the community level, talks were given to the Woman’s Club, Elks Lodge, Mason, Odd Fellows, and various other organizations along with the city council, fiscal court, and public schools. In a short period, the sentiment was to allow the visiting nurse work to keep going. Funds appropriated by the city and county and various other organizations in cooperation with Metropolitan Life Insurance Company, enough funds were secure to finance work for an entire year.

Turning Complacency into Action

Miss Marian Williamson. Image from the Courier-Journal, 19 November 1938.

And so, community by community, county by county, the idea of having a full-time public health nurse began taking traction. In 1913, registered nurse Miss Marian Williamson became one of the two state organizations and visiting nurses for the Kentucky Board of Tuberculosis Commissioners. In 1914, the Ashland Public Health and Welfare League were organized, and a public health nurse was employed; a remarkably similar league in Danville, Kentucky was established as well. Nurse Williamson also organized the Muhlenberg County Health and Welfare League, and a public health nurse was employed there as well. She also had a significant influence in the creation of the Health League in Hopkins County; through her efforts, a public health nurse was placed in Newport along with the organization of a county health and welfare league. Miss Williamson also managed to encounter issues during her public efforts; the fiscal court in Henderson County had, for quite some time, refused to declare the county as a tuberculosis district that would help with erecting a county tuberculosis sanatorium. Miss Williamson educated the public in Henderson County and they would eventually go on to vote to make the county a tuberculosis district. Not only was Miss Williamson instrumental in establishing a tuberculosis hospital where she, along with Hopkins Countians managed to furnish the entire place without any cost to the county, outside of the kitchen, laundry, and screens. The hospital opened to take care of eight white men, give white women, four black men, and four black women. The Henderson County Tuberculosis Sanitarium also had three private rooms for patients who could pay. The Sanitarium had a sterile, modern operating room, living rooms with Victrola, and its own laundry. It afforded two trained nurses, two housemaids, one cook, and two laundresses.

More than Just Communicable Diseases

Warning: the following information contains a description of physical (child) abuse/maltreatment.

Likewise, many nurses in Kentucky began spending the days, weeks, and months devoting their entire lives to helping educate and prevent communicable diseases. Registered Nurse, Mrs. Harriett P. Minaker, who operated under the Bourbon County Health and Welfare League, shared stories of some of her experiences during 1915 and 1916. She goes on to note that about eight miles from town in the heart of our Blue Grass district a tenant farmer lived with his wife and four small children, the wife being his second marriage. Late in the fall of 1916, word came to [Minaker] through the school superintendent who saw these two older children and asked me to visit the school because the children were not at school. Minaker made a home visit in her capacity as a public health nurse and was greeted by the wife cordially. She talked to her (the wife) about the children’s condition and she informed me that the children’s mother had died of tuberculosis. She took the little girl’s pulse and found it running 114 beats per minute and directed the woman to keep the child in bed. Minaker went on to make further inquiries about the children and found them to be badly abused. The girl was thirteen years of age and about the size of a child of eight years; the boy, eleven years of age, was about the size of a child of six years. The children went to school on one meal per day and had to sleep on the floor beside a bed that might have been used. The boy was struck in the face and his eye blackened. The little girl was whipped so that she ran away from home, and it was two days before she was found. On November 14, 1916, Nurse Minaker initiated proceedings for a warrant to be issued for cruelty and neglect; she went along with the deputy sheriff and found that the girl had been beaten so severely the night before and, knowing they would not get anything to eat, ran away as soon as it was light enough to see going two and a half miles, Barefoot, through snow and ice. Minaker had the children admitted to the hospital for ten days. They would eventually go on to the Kentucky Children’s Home Society where they began gaining weight and were happy.

Yearly Public Nursing Report

No. of visits during the year2,439
No. of visits made to schools19
No. of visits to churches4
No. of visits women’s clubs2
No. of visits made to others2
No. of schools visited19
No. of pupils examined540
No. found needing medical/surgical treatment142
No. of tuberculosis cases visited28
No. of visits made to them117
No. of typhoid fever patients visited14
No. of visits made to them115
No. of scarlet fever victims visited4
No. of diphtheria victims visited12
No. of whooping cough victims visited12
No. of measles victims visited60
No. of sick babies visited108
No. of all other patients visited25
Total amount of monthly salary$90.00
Total travel and incidental expenses$40.62
Yearly report of registered nurse Harriett P. Minaker, Bourbon County Health and Welfare League, 1916.

These babies were each born in a tubercular home of a tubercular mother. The Public Health Nurse was the only attendant at the time of birth, and cared for the mothers afterward. Image from the Bulletin of the Department of Health of Kentucky, 1916.

And so, many public health nurses from across the state hid similar yearly reports in 1916. Nurse Sarah F. Mulberry made 521 visits in just 5 months, Miss Colvin from Muhlenberg County made 1,970 visits during the entire year, registered nurse Miss Frances M. Bogard of Boyd County made 1,680 visits during the year, Miss Casey of Mason County made 1,808 visits during the year, and Miss Nan L. Dorsey, the supervisor of the District Nurse Association in Louisville showed that a total of 19,775 visits were made in Jefferson County during the year.

Registered Nurse, Mae Hicks with the United States Public Health Service, Central Office of Trachoma Investigation, made significant insight into trachoma in Kentucky but also sanitary conditions which can also lead to endemic status of communicable diseases. Nurse Hicks provided the following information over a 10-month period in 1916:

No. of homes visited2,820
Total no. of persons in homes15,510
Total no. of persons in homes with diseased eyes494
Total no. of old hospital cases visited72
No. of schools visited and inspected117
Total no. of pupils in schools visited2,940
Total no. of pupils in schools with diseased eyes346
Total no. of public health talks given110
Estimated no. of people in audience2,757
Total no. of miles traveled on horseback4,094
Water Supply for Homes–
Open wells56
Branch water21
Toilet Arrangements for Homes–
Sanitary closets17
Surface closets397
No accommodations2,282
Toilet Arrangements for Schools–
Sanitary closets17
Surface closets38
No accommodations62
No. of cases of typhoid found5
No. of cases of tuberculosis15
No. of trachoma pamphlets distributed849

Housing Inspection

Registered Nurse Miss Marie E. Durning who had charge of the Housing and Tenement Department of the Louisville Department of Health, provided a brief report in 1916 and outlined that smaller and rural cities in Kentucky had similar problems. Durning noted that since the passage of the Tenement House Act, the work of enforcement of the law under the Department of Health had been carried on with unflagging interest. She also noted that if we [as a society] were to recognize the function of a Health Department to be the prevention of disease, then housing should have an important place in the organization of every health department. The relationship between bad housing and disease is direct and intimate. Under poor living conditions, overcrowding, bad air, filth, and the many other insanity conditions, vitality is lowered, disease resistance is lessened, and the way is made easier for the inroads of infectious diseases, particularly with tuberculosis. The City of Louisville worked under the Tenement House Law, passed in 1910, and amended in 1912, which only covered cities classified as first class in the Commonwealth of Kentucky. Under those terms, a tenement was considered to be any house in which three or more families live. The amended law included tenements existing before the passage of the law and the erection of new multiple dwellings. Systematic inspections were made, all complaints were investigated, and every effort was made to enforce the law without court intervention. In Louisville, the health department was authorized to employ a scrubwoman to clean of tenements where, because of illness, disability, or some other good reason, the occupants were unable to do so themselves. This service was rendered when a social worker made the necessary recommendation. Though this was a small step, Durning pined that to get permanent results in housing betterment, Kentucky should have a state housing law covering the erection and maintenance of all types of dwellings, not just tenements.

Public Health Nursing in Action

These are just a few of the faces and reasons that kept public health nurses in Kentucky fighting for the cause.

Note: These photographs do not have any additional identifying information or descriptors.

Contributed by Shawn Logan | contact@kyhi.org

⁘ Works Cited ⁘

  1. The Lexington Leader, 9 December 1949
  2. The Lexington Leader, 12 December 1952
  1. Bulletin of the Department of Health. Commonwealth of Kentucky, v. 7 (1916).

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