Digital Snapshots

The Mississippi Board of Health photograph album captures a moment in the state’s history when a combination of local, state, and federal programs made great strides in addressing longstanding and pervasive problems in the health of Mississippians. By the end of the 1930s, the Executive Officer of the State Board of Health, Felix J. Underwood, M.D., could boast that the previous years had been “fruitful in public health accomplishments” that “will reduce death rates and increase the span of life now and in coming years.”[i] Underwood was not exaggerating. As he surveyed the public health infrastructure, Underwood could celebrate the creation of a Health Education and Medical Library (1936) that owned some 5,000 volumes, the formation of the Mississippi Public Health Association (1937), and the fact that thirty-nine of the state’s counties had full-time public health departments (the remaining forty-three counties had part-time health officers). Healthcare workers seemed to be everywhere. Between 1936 and 1938, county health offices sent out thirteen dental hygienists who performed 343,000 examinations and 38,200 cleanings. The Works Progress Administration built or modernized some 92,000 privies and undertook a statewide drainage program to combat malaria. Through it all, the photographers from the Board of Health were there, snapping photographs of school children learning to brush their teeth, of a concrete privy, and of an improved drainage ditch.

In documenting their achievements, the Board of Health was doing more than calling attention to itself. This was publicity with a purpose. Education was the cornerstone of public health work; it ensured support from the government, garnered public support, and disseminated vital information about diseases and wellness. Underwood noted that the State Board of Health had distributed 800,000 pieces of literature, issued 18,000 press releases, responded to 20,000 letters, and started a weekly radio program to promote its mission. We can see how public information and medicine dovetailed by looking at the campaign against infectious diseases. During the 1920s and 1930s, the state launched a vigorous campaign against communicable diseases like diphtheria, pneumonia, syphilis, and typhoid fever. Many of these programs began with education. During the fall and winter of 1938, for example, the state distributed a film describing what Underwood called “the salient points of pneumonia control.”[ii] It was a resounding success. “More than 200,000 people saw this film,” he enthused, “learning [the] best methods of preventing and treating Mississippi’s third leading cause of death.” State agencies offered vaccinations against diphtheria and used the media to underscore the efficacy and safety—not to mention the popularity—of the vaccine. One of the photographs in the album depicts a family of eleven children who were “protected against diphtheria, smallpox and typhoid fever.” Another photograph captures a public health nurse administering diphtheria shots to Black tenant farmers. The long lines of people waiting for their shots attests to the success of state vaccination campaigns, as does the precipitous drop in the number of diphtheria deaths. Between 1920 and 1922, 942 Mississippians died of this disease. In a similar three-year window from 1935 to 1937, that number fell to 217.[iii]

In addition to slowing the spread of infectious diseases, public health workers combatted infant and maternal mortality. The Mississippi Board of Health began tracking infant mortality in 1919 and the statistics were appalling. That year, 3,554 children under the age of one died. In 1921, that number had declined to a disheartening 2,886.[iv] The next year, 2,342 were born dead, a tragedy that state officials conceded did not include the “appalling number of miscarriages.”[v] As early as the 1920s, the state developed a multipronged approach to tackle these problems. State health officials determined that about half of the children born in Mississippi were delivered at home by unregistered midwives, whom they dismissed as “ignorant, untrained women.”[vi] In a program specifically targeted at African-American mothers, the state provided instructional materials to Black midwives and mandated that they establish “typical delivery rooms and other demonstrations…to inform the public of services they are able to render.” By 1937, the state had established some 1200 demonstration rooms. There were also more than 500 midwife clubs, which met on a regular basis to instruct midwives and disseminate information in their communities.[vii] The photographs in this collection document the professionalism and efficacy of Mississippi’s Black midwives. One photograph depicts a group of uniformed midwives taking a class, while another shows a beaming woman holding two newborns. The work of the midwives was complemented by home nurses, who visited families with young children, administered vaccines, and taught parents the “proper principles of infant, preschool, school, and maternal hygiene.” Photographers from the Board of Health followed some of the 138 nurses employed by the state, showing them giving educational materials to young mothers and visiting with mothers of infant children. Programs like this bore fruit. “In 1930, 9 and 10 mothers died per thousand live births,” Underwood noted, but in 1937 “maternal mortality was reduced to less than 7.” Infant mortality rates also fell. In 1930, 68 out of every 1,000 children died before their first birthdays. Seven years later, that number was 57. Underwood attributed these successes to “improved medical and nursing care during the prenatal and postnatal periods…better environmental conditions, protection against communicable disease and putting into practice…principles known to protect the health of the growing infant.”[viii]

Today, Mississippians are among the least healthy people in the United States. Their life expectancies are among the lowest in the nation, and they struggle with diabetes, hypertension, and obesity more often than other Americans. The infant mortality rates that the State Board of Health struggled to lower during the 1930s are, today, the worst in the country. This collection is, however, a testament to the power of public health programs. The photographs of doctors, nurses, and midwives—and the ordinary people who responded to their message—demonstrate that concerted and focused public health interventions can yield results in an impoverished and rural state. As such, it should be an inspiration for Mississippians today.

Mississippi State Department of Health
Photograph Album, ca. 1930s

An essay by Max Grivno, Ph.D.

A Brief History

[i] Felix J. Underwood, M.D., Progress of State Board of Health Activities, 1936-1938 (Jackson, Mississippi, 1939), 3.
[ii] Underwood, Progress, 5-7.
[iii] Underwood, Progress, 9-11.
[iv] Report of the Board of Health of Mississippi from July 1, 1921, to June 30, 1923 (Jackson, Mississippi, n.d.), 14.
[v] Report of the Board of Health, 203.
[vi] Report of the Board of Health, 204.
[vii] Underwood, Progress, 7-9.
[viii] Underwood, Progress, 11-13.

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About the Author

Max Grivno is Associate Professor of History in the School of the Humanities at The University of Southern Mississippi. Dr. Grivno teaches courses on economic history, labor history, slavery, and the American South. His research focuses on the evolution of slavery in early national and antebellum Mississippi and on how the legacies of slavery have shaped the history of the state.