The more things change, the more they stay the same.
In 1920, the Wyoming State Board of Health deemed it appropriate to appoint Agnes Cogan as the supervisor of Public Health Nursing in the state of Wyoming.1 This was the first mention of public health nursing in the minutes of the board meetings. Her position was not funded by the state, but rather by a contribution to the state from the American Public Health Association.2 Two years later, she was appointed the director of the Maternal and Infant Hygiene Division.3
During the 1920s, there was always a concern for the lack of funds for the board as it was not able to afford a lawyer to defend itself from a lawsuit claiming that it had no legal standing to require school children to receive vaccinations.4 A year later a nurse named Ahrens is given the job of supervisor, and the position is given an office in the board of health.5 A year after that, in 1922, the position was eliminated from the Board of Health as “the State Department has no control by statute of public health nursing in this state” and despite the fact that “much good work and intelligent educational health work was done” “this service was discontinued” “owing to the exhaustion of funds.”6 A year later, in 1923, the Board of Health created the Division of Public Health Nursing. Although there was not a public health nursing staff at the state level (only one county, Hot Springs, had a public health nurse), there were many school nurses, and it became the duty of the new division as “this department has been asked to certify or pass upon the qualifications of the applicants for school nurse positions.”7
The initial focus of the nursing service was on education and maternal and child health. The board had nurses hold “better baby” conferences at state and county fairs as well as other public gatherings. The conferences would be held in tents and provided educational and clinical services.8 The fairs were conducted in cooperation with local women’s organizations as well as local physicians.9 Infants were given health screenings and mothers were given educational literature and lectures. The importance of breast feeding infants versus using baby formulas was especially highlighted.
Public Health officials in Wyoming saw it as their role to fill gaps in the health care system as it existed in Wyoming. To this end, members of the Board of Health could be very critical of private health providers, especially in the area of prevention and health education: “The medical profession has too long neglected to inform the public on medical matters.” “Had this group of men, the well trained physicians who are best fitted to inform the people, performed their duty in the past, there would be less adverse legislation on medical affairs and the people would accept more gracefully the enforcement of restrictions necessary to control communicable diseases”10
Early intervention and education were seen as the primary duties of the Board of Health. This came especially after the passage of the “Welfare and Hygiene of Maternity and Infancy” Act in the United States Congress in 1923. Nurse Georgia Zipfel was made the director of all maternal, infant, and child health programs in the state. The act gave assistance to the better baby clinics mentioned above. After the passage of this act, the clinics became more comprehensive as more physical and dental screenings were included. The Board of Health justified this expenditure as a sound investment in the future of the children of Wyoming: “prevention of illness and defects of
childhood insure a vigorous and healthy manhood or womanhood and limits in the only scientific way practical today, the amounts spent on curative measures of our adults. ”11 This was especially pertinent to the state as Wyoming had an infant mortality rate of 1/141 versus 1/227 for “neighboring states.”12
This program, funding wise, was tenuous. Their budget allocation for 1925 was $3,200, as opposed to an $8,000 budget that was given in 1920. Frustration was aired in the report as it stated that “at the same hour, on the same night, it [the State Legislature] appropriated $10,000 for the hygiene of bees.”13
The end goal of the programs was to insure that all women in the state of Wyoming had access to prenatal care.14 This would have been difficult at that time (1929) because a year earlier the federal government discontinued its support of the state programs; the board of health recommended that the state allocate money for the programs.15 Still, there was an increased reliance on assistance from private physicians to continue the program.16
1 Meeting Minutes. Wyoming State Board of Health. 24 May 1920.
2 6th Biennial Report of the Board of Health: 1921-22. pp. 6.
3 Meeting Minutes. Wyoming State Board of Health. 10 April 1922.
4 Ibid, pp. 6.
5 Meeting Minutes. Wyoming State Board of Health. 8 June 1921.
6 6th Biennial Report of the Board of Health: 1921-22. pp. 13.
7 7th Biennial Report of the Board of Health. 1923-24. pp. 13.48
8 6th Biennial Report of the Board of Health: 1921-22. pp. 12.
9 7th Biennial Report of the Board of Health: 1923-24. pp. 25.
10 7th Biennial Report of the Board of Health: 1923-24. pp. 14.
11 7th Biennial Report of the Board of Health: 1923-24. pp. 24.
12 Ibid, pp. 24.
13 8th Biennial Report of the Board of Health: 1925-26. pp. 11.
14 10th Biennial Report of the Board of Health: 1929-30. pp. 10.
15 Meeting Minutes. Wyoming State Board of Health. 26 October 1920.
16 12th Biennial Report of the Board of Health: 1933-34. pp. 1.