Ninety years ago, Cape Cod became the first region in New England to establish a county health department. It had a variety of goals, including the installation of proper landfills for trash and the testing of all cows for tuberculosis. Ninety years later, the Barnstable County Department of Health and the Environment has new goals, but its public health mission is alive and well.

The department began operations on Jan. 1, 1927, with a health officer, a secretary, a sanitary inspector and an assistant. Writing in the state's quarterly public health bulletin several months later, Dr. A.P. Goff, the first county health officer, described some of the department's first objectives. They included “the immunization of young children against diphtheria, vaccination of all school children and others, and continued effective control by isolation and otherwise of communicable disease … the effective correction of defects found in school children … shellfish sanitation … regular inspections of food handling places, installation of proper dumping grounds and gradual introduction of sewer systems where necessary.”

In the first few months of his tenure. Dr. Goff observed that there was an uptick in scarlet fever cases in the state, with several reported illnesses on Cape Cod. In an article in the Chatham Monitor, he instructed those afflicted with the disease to remain in quarantine until their symptoms subside. For those who were exposed but not showing symptoms, it would be safe to return to outdoor jobs like carpentry, farming and trucking.

“For example there could be no danger involved if an adult contact should gather shellfish which are cooked before being eaten provided he simply did that, and did not open them. He would not however, be allowed to open scallops, or oysters, or handle milk,” Goff wrote. Though scarlet fever did not appear to spread easily, he wrote, the sometimes fatal nature of the disease meant it needed to be taken seriously. Though there's still no vaccine against scarlet fever, improved antibiotics and better testing have made the disease less deadly today.

Even in its early days, the county health department helped ensure the safety of the shellfish harvest. Later in 1927, the Chatham Monitor applauded Goff's statement “concerning Cape Cod shellfish [as] most reassuring to buyers and consumers. Probably few have realized how great precaution Massachusetts takes in keeping shellfish beds free from pollution. It is information that should be passed along. A Cape Cod label on shellfish means something,” the newspaper wrote.

“It goes without saying that the world is a remarkably different place since 1926 when the department was created,” said Sean O'Brien, the current interim director of the Barnstable County Department of Health and the Environment. “What hasn’t changed is the need for a range of public health services delivered to the community on a regional basis.”

Cape Cod towns have a long tradition of cooperation in public health and safety, and that cooperation has been accompanied by innovation. The creation of the Barnstable County Health Department was noteworthy, and not just on the Cape. An early report from the U.S. Public Health Service foresaw the value of the Cape Cod experiment.

“The Barnstable County health department will be the first county health department established in New England. The precedent is of historic interest and is expected to prove of far-reaching practical importance,” the report read.

“After 90 years, we can safely say that the prediction has been borne out,” Barnstable County Administrator Jack Yunits said. “The department is of historic interest and continues to provide services of practical importance today.”

In modern times, the department continues to focus on disease prevention and control, but is also active in health and safety education, hazardous materials reporting, environmental protection, emergency preparedness and more.

Interestingly, one of the department's initial goals – the gradual introduction of sewer systems – is closely linked to the Cape's number one health and environment issue today: wastewater treatment. The department's most recent director, George Heufelder, recently stepped down from the post to lead the state's alternative septic system test center, which has received substantial grant funding for advanced research. Heufelder has long been a proponent of seeking state and federal grants to bolster the department’s environmental work.

“It has been our goal to identify, in collaboration with the boards of health in the towns, the kinds of issues that lend themselves to regional approaches,” he said.