Strategies for Preventing Disease in Kentucky, 1883-1914
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University of Kentucky UKnowledge Theses and Dissertations--History History 2021 Building Public Health in a Rural State: Strategies for Preventing Disease in Kentucky, 1883-1914 Abigail Stephens University of Kentucky, [email protected] Author ORCID Identifier: https://orcid.org/0000-0002-4972-3352 Digital Object Identifier: https://doi.org/10.13023/etd.2021.178 Right click to open a feedback form in a new tab to let us know how this document benefits ou.y Recommended Citation Stephens, Abigail, "Building Public Health in a Rural State: Strategies for Preventing Disease in Kentucky, 1883-1914" (2021). Theses and Dissertations--History. 68. https://uknowledge.uky.edu/history_etds/68 This Master's Thesis is brought to you for free and open access by the History at UKnowledge. It has been accepted for inclusion in Theses and Dissertations--History by an authorized administrator of UKnowledge. For more information, please contact [email protected]. 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Abigail Stephens, Student Dr. Kathryn Newfont, Major Professor Dr. Amy Murrell Taylor, Director of Graduate Studies BUILDING PUBLIC HEALTH IN A RURAL STATE: STRATEGIES FOR PREVENTING DISEASE IN KENTUCKY, 1883-1914 ________________________________________ THESIS ________________________________________ A thesis submitted in partial fulfillment of the requirements for the degree of Master of Arts in the College of Arts and Sciences at the University of Kentucky By Abigail Katharine Stephens Lexington, Kentucky Director: Dr. Kathryn Newfont, Professor of History Lexington, Kentucky 2021 Copyright © Abigail Katharine Stephens 2021 https://orcid.org/0000-0002-4972-3352 ABSTRACT OF THESIS BUILDING PUBLIC HEALTH IN A RURAL STATE: STRATEGIES FOR PREVENTING DISEASE IN KENTUCKY, 1883-1914 During the period from 1883-1914, the Kentucky State Board of Health developed strategies for preventing disease in the state by enforcing hard power measures of vaccination, quarantine, and isolation of disease suspects, and through the soft power measures of written and spoken communication. Throughout this period their efforts to prevent and contain disease were limited by inadequate funding as well as opposition from the public, local authorities, and the state legislature, demonstrating that while hard power measures can be effective in combating disease, they cannot be fully successful without support from the people they aim to protect. KEYWORDS: Public Health, Disease Prevention, Hard Power, Soft Power, Kentucky, Funding Abigail Katharine Stephens 4/27/2021 Date BUILDING PUBLIC HEALTH IN A RURAL STATE: STRATEGIES FOR PREVENTING DISEASE IN KENTUCKY, 1883-1914 By Abigail Katharine Stephens Dr. Kathryn Newfont Director of Thesis Dr. Amy Murrell Taylor Director of Graduate Studies 4/27/2021 Date DEDICATION To Tim, thank you for supporting me in working to get my M.A. Graduate school is not easy at the best of times, and it has been even more challenging during this pandemic. Your kindness, encouragement, and cooking has helped make this thesis possible. I love you. ACKNOWLEDGMENTS This thesis, while an individual work, benefited from the help of a number of people. Dr. Kathryn Newfont, my advisor, has encouraged me throughout this process, and has offered comments on every draft, from my first interest in writing about the life of Dr. McCormack to the investigation of the Kentucky State Board of Health’s strategies and shortcomings in preventing disease at the turn of the twentieth century. Dr. Claire Clark and Dr. Tracy Campbell, the other members of my thesis committee, have offered insightful comments that have pushed my analysis further. Dr. Amy Taylor’s feedback on the early drafts helped shape my thinking about discrimination and state-building in the context of public health. I also want to thank Mary K. Marlatt at the University of Louisville Kornhauser Library for her ongoing research assistance and help navigating the archives. Finally, I would like to thank my family and friends. To the members of the University of Kentucky Ferns, your advice and encouragement has kept me motivated throughout this work. Writing is so much easier when I know we are all working through this process together. To my parents and sister, I cannot express how much you mean to me. You have given me the love and kindness I needed through extremely difficult times. I miss you and I love you. Finally, to Tim, I am so glad to have you here to keep me going. Your love and friendship have made this possible. iii TABLE OF CONTENTS ACKNOWLEDGMENTS ............................................................................................. iii CHAPTER 1. INTRODUCTION.....................................................................................1 CHAPTER 2. EARLY PUBLIC HEALTH STRATEGIES, OR MAKING DO ON $2,500 PER YEAR ..........................................................................................................6 2.1 Early Public Health Communication .................................................................. 11 2.2 Early Public Health Legislation .......................................................................... 14 2.3 Preventing Yellow Fever in 1897 ....................................................................... 17 2.4 Containing Smallpox .......................................................................................... 20 CHAPTER 3. FIVE THOUSAND DOLLARS FOR A NEW CENTURY ..................... 33 3.1 Eradicating Smallpox ......................................................................................... 35 3.2 Preventing Yellow Fever in 1905 ....................................................................... 51 3.3 Preventing Routine Illnesses .............................................................................. 56 3.4 Education for a New Era .................................................................................... 61 CHAPTER 4. VITAL LEGISLATION AND THE PRICE OF A $30,000 APPROPRIATION ........................................................................................................ 65 4.1 Expanding the State Board of Health .................................................................. 66 4.2 Questioning the Machinery of Public Health ...................................................... 75 CHAPTER 5. CONCLUSION ....................................................................................... 97 BIBLIOGRAPHY ....................................................................................................... 100 iv VITA……… ............................................................................................................... 106 v CHAPTER 1. INTRODUCTION In 1911, nearing the end of his thirty-three-year tenure as secretary of Kentucky’s State Board of Health, Dr. Joseph N. McCormack mused that “government is only a great partnership formed to do those things which the individual cannot do, or cannot do so well or cheaply, for himself.”1 To his mind, the most important of these purposes was the protection of the public health, a project which required government resources to be successful. McCormack believed that the lives of the men, women, and children under his jurisdiction were “more valuable than all other interests combined.”2 Unfortunately, the state legislature disagreed. Throughout McCormack’s tenure, meager appropriations from the state’s lawmakers stymied the board’s efforts to protect the public health. In addition, they struggled to secure the cooperation of county fiscal officials and the support of the public necessary to prevent disease and contain epidemics. This work analyzes the board’s efforts to overcome these challenges and create a viable public health infrastructure in the largely rural state of Kentucky. Public health, as many scholars have demonstrated, represents the dual nature of government intervention in citizens’ lives by aiding and invading, sometimes in the same action. Barbara Rosenkrantz’s work on Massachusetts illustrates the pattern. “With a large proportion of the population