By Jann Wiswall

Cattaraugus County has been in the health care history books ever since 1923 when a rural public health demonstration project was established and funded by the Milbank Memorial Fund. It was the first-ever organized county health department in New York State.

Now in its 90th year, the health department was recognized in November by the legislature for its service to the residents of the county and commended the staff for their passion and integrity.

The story actually begins in 1922 when the Milbank Fund posited that a coordinated effort by multiple public and private agencies would more effectively address critical rural health care needs than an effort from disparate entities. It hoped to show that a “modern public health organization and methods could prevent disease, disability and mortality in a relatively short time … at a cost which communities will willingly bear.”

According to a history prepared by Debra Nichols, public health educator with the Cattaraugus County Health Department, which is substantially based on 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, “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.”

Tuberculosis (TB) was a major focus of the department, as the disease was rampant across the country at the time. The department held hundreds of TB clinics, “raising the number of identified new cases from 77 in 1922 to 343 by 1924.” By 1925, “tuberculosis mortality showed its first significant drop, from 50 to 35 deaths per year.” That downward trend continued over the next five years. “Deaths from TB declined more quickly in Cattaraugus County than in comparison counties … to 25 per 100,000 in 1930.”

As the department continually recognized unmet needs in the community by meeting and treating more and more residents, additional programs were created to address maternal and child health issues, venereal diseases and orthopedics. By 1926, the number of public health nurses had increased to 27 and the county laboratory conducted nearly 7,700 tests. During that year, the department also hired sanitary and dairy inspectors and established a children’s health camp at Allegany State Park.

In 1928, outbreaks of typhoid fever and enteritis hit Olean. The enteritis was attributed to an auxiliary city water supply. The department quickly set up two emergency hospitals to handle the epidemics and enlisted the help of the American Red Cross to organize 100 private duty nurses. More than 6,000 anti-typhoid vaccinations were given. In addition, water sanitation efforts resulted in significant improvement of the city’s water supplies, thereby reducing the threat of further spread of disease.

In 1929, the final year of the demonstration project, a mild outbreak of smallpox occurred in Olean. “Response was swift … with 8,000 vaccinations performed, including 90 percent of Olean’s school children.”

Due to its ability to mobilize and coordinate services, the demonstration project was proving that the concept of a rural public health department worked. As quoted in a story in the May 26, 1931, issue of the Olean Evening Times, John Kingsbury, secretary of the Milbank Fund, stated that “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.”

Indeed, in a report commissioned by the Milbank Fund 25 years after the launch of the demonstration project, 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.”

To this day, Cattaraugus County’s Health Department continues to promote health care for all of its residents through its extensive preventive, educational and treatment services. Its mission remains much the same as the demonstration project that formed the basis for its inception: “To engage and empower the public of all ages to live healthier lifestyles through efforts of education, prevention, promotion, monitoring, accessibility, affordability, technology, testing, diagnosing and treating.”

To read the entire history, visit For more information about services and programs, visit, or call (716) 373-8050.