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The American Women’s Hospitals at Home: Public Health in Depression-Era Appalachia

Explore how the AWH helped the people of Appalachia control disease during the 1930s

The American Women’s Hospitals (AWH) organization was founded by women physicians in 1918 to provide medical care to the people of war-torn France during World War I. AWH subsequently established hospitals in other parts of Europe and Western Asia, continuing to provide medical care to devastated populations after wars and conflicts had officially ended. On the heels of their work abroad in places like France, Greece, and Turkey during and after World War I, the leaders of the AWH turned their efforts inward, taking a look at what was occurring in their own backyard. The AWH concluded its help was most needed in United States, in a region known today as Appalachia.


Appalachia is a rural, mountainous area spanning several states, including parts of Kentucky, Tennessee, the Carolinas, West Virginia, Virginia, Alabama, Mississippi, and Georgia. AWH concentrated their efforts in Tennessee, the Carolinas, and Kentucky. Even before the Great Depression of the 1930s, Appalachia was a relatively poor, rural area of the country and was geographically isolated, with few roads or means of transportation in or out of the area. The economic crisis of the Great Depression only increased the severity of the region’s poverty and exacerbated the lack of quality education and healthcare.

Institutionalized, organized public health initiatives in the U.S. had taken hold in the late 19th century, but most activity was taking place in urban areas in response to the fast-growing populations of major cities. Rural areas like Appalachia remained neglected due to their isolation and limited access to major roads and railways. Yet rural populaces needed quality, affordable healthcare as much their urban counterparts. Medical science was advancing towards greater understandings of nutrition and preventive medicine, but Appalachia’s country doctors, limited by poverty and geographic remoteness, did not have access to the latest information. Malnutrition-related diseases like Pellagra and highly contagious diseases such as typhoid, tuberculosis, and diphtheria were rampant in the region. Into this remote, poor, and rural environment, the AWH forged a ground-breaking path of establishing a mobile health clinic on wheels--the “healthmobile”-- and an aggressive nutrition education campaign.

Essential Evidence
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American Women's Hospitals Service and an Appalachian Mountain family (photograph), circa 1935<blockquote class="juicy-quote">An [unidentified] doctor (in hat) from the American Women’s Hospital Service sits on the front steps of a porch in rural 1930s Appalachia with a local woman and children.</blockquote><div class="view-evidence"><a href="http://doctordoctress.org/islandora/object/islandora:1859/story/islandora:2084" class="btn btn-primary custom-colorbox-load"><span class="glyphicon glyphicon-search"></span> Evidence</a></div>

American Women's Hospitals Service and an Appalachian Mountain family (photograph), circa 1935

An [unidentified] doctor (in hat) from the American Women’s Hospital Service sits on the front steps of a porch in rural 1930s Appalachia with a local woman and children.

American Women's Hospitals Service photo of wooden building with a ladder (photograph), circa 1930<blockquote class="juicy-quote">A seemingly unstable but inhabited wooden home in the mountainous Applachian region of the United States.</blockquote><div class="view-evidence"><a href="http://doctordoctress.org/islandora/object/islandora:1859/story/islandora:2085" class="btn btn-primary custom-colorbox-load"><span class="glyphicon glyphicon-search"></span> Evidence</a></div>

American Women's Hospitals Service photo of wooden building with a ladder (photograph), circa 1930

A seemingly unstable but inhabited wooden home in the mountainous Applachian region of the United States.

American Women's Hospitals, Rural Services mobile clinic vaccinating a woman (photograph), circa 1935<blockquote class="juicy-quote">An American Women’s Hospital doctor (in hat and “AWH” armband) administers a shot to a local woman in Jellico, Tennessee.</blockquote><div class="view-evidence"><a href="http://doctordoctress.org/islandora/object/islandora:1859/story/islandora:2086" class="btn btn-primary custom-colorbox-load"><span class="glyphicon glyphicon-search"></span> Evidence</a></div>

American Women's Hospitals, Rural Services mobile clinic vaccinating a woman (photograph), circa 1935

An American Women’s Hospital doctor (in hat and “AWH” armband) administers a shot to a local woman in Jellico, Tennessee.

American Women's Hospitals, Rural Services mobile clinic vaccinating a boy (photograph), circa 1935<blockquote class="juicy-quote">An American Women’s Hospital doctor ( in “AWH” armband) tries to administer a shot to a local child in Jellico, Tennessee.</blockquote><div class="view-evidence"><a href="http://doctordoctress.org/islandora/object/islandora:1859/story/islandora:2087" class="btn btn-primary custom-colorbox-load"><span class="glyphicon glyphicon-search"></span> Evidence</a></div>

American Women's Hospitals, Rural Services mobile clinic vaccinating a boy (photograph), circa 1935

An American Women’s Hospital doctor ( in “AWH” armband) tries to administer a shot to a local child in Jellico, Tennessee.

American Women's Hospitals, Rural Services mobile clinic vaccinating a man (photograph), circa 1935<blockquote class="juicy-quote">An American Women’s Hospital doctor ( in “AWH” armband) administers a shot to a local man in Jellico, Tennessee.</blockquote><div class="view-evidence"><a href="http://doctordoctress.org/islandora/object/islandora:1859/story/islandora:2088" class="btn btn-primary custom-colorbox-load"><span class="glyphicon glyphicon-search"></span> Evidence</a></div>

American Women's Hospitals, Rural Services mobile clinic vaccinating a man (photograph), circa 1935

An American Women’s Hospital doctor ( in “AWH” armband) administers a shot to a local man in Jellico, Tennessee.

Annual Report of American Women's Hospitals Whitley County Health Unit (reports), circa 1932<blockquote class="juicy-quote">"We feel much gratified by the results obtained from an early start..."</blockquote><div class="view-evidence"><a href="http://doctordoctress.org/islandora/object/islandora:1859/story/islandora:2108" class="btn btn-primary custom-colorbox-load"><span class="glyphicon glyphicon-search"></span> Evidence</a></div>

Annual Report of American Women's Hospitals Whitley County Health Unit (reports), circa 1932

"We feel much gratified by the results obtained from an early start..."

American Women's Hospital and Health Service 1937 fundraising pamphlet (pamphlets), circa 1937<blockquote class="juicy-quote">"The spread of pellagra in Spartanburg County, South Carolina...has been checked and the deaths in the last two years has been cut by more than one-half"</blockquote><div class="view-evidence"><a href="http://doctordoctress.org/islandora/object/islandora:1859/story/islandora:2089" class="btn btn-primary custom-colorbox-load"><span class="glyphicon glyphicon-search"></span> Evidence</a></div>

American Women's Hospital and Health Service 1937 fundraising pamphlet (pamphlets), circa 1937

"The spread of pellagra in Spartanburg County, South Carolina...has been checked and the deaths in the last two years has been cut by more than one-half"

Protect yourself from pellagra (pamphlets), circa 1931<blockquote class="juicy-quote">"They had no cow, no pigs, no hens, not even a garden!"</blockquote><div class="view-evidence"><a href="http://doctordoctress.org/islandora/object/islandora:1859/story/islandora:2098" class="btn btn-primary custom-colorbox-load"><span class="glyphicon glyphicon-search"></span> Evidence</a></div>

Protect yourself from pellagra (pamphlets), circa 1931

"They had no cow, no pigs, no hens, not even a garden!"

American Women's Hospitals 1931 fundraising pamphlet (pamphlets), circa 1931<blockquote class="juicy-quote">"These people are not refugees in a foreign country, but Americans suffering from diseases due to malnutrition."</blockquote><div class="view-evidence"><a href="http://doctordoctress.org/islandora/object/islandora:1859/story/islandora:2103" class="btn btn-primary custom-colorbox-load"><span class="glyphicon glyphicon-search"></span> Evidence</a></div>

American Women's Hospitals 1931 fundraising pamphlet (pamphlets), circa 1931

"These people are not refugees in a foreign country, but Americans suffering from diseases due to malnutrition."

Related Primary Sources

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Consider these questions

  • Teacher guide for this story »

  • Why do you think the AWH chose Appalachia to be the first place they started public health initiatives in the United States? How was Appalachia in the 1930s different from or similar to the foreign regions that AWH usually worked in?
  • Why was it so hard to reach and help the people of Appalachia? What obstacles besides geographic isolaiton do you think they may have faced?
  • Do you think the AWH was successful in its efforts to educate and eradicate disease? Did the actions of the AWH help to permanently improve the health of people in Appalachia?
  • Are there other areas of the United States today that need broad public health services? Are they urban, rural, suburban?