Pine Mountain Settlement School
Series 09: Biography – Staff/Personnel
Series 14: Medical, Health & Hygiene — Line Fork Settlement

ANNE RUTH MEDCALF, Community Nurse at Line Fork Settlement 1921-1924

TAGS: Anne Ruth Medcalf ; Line Fork Settlement 1921-1924 ; nursing ; community nursing ; American Child Health Magazine ; Elizabeth G. Smith ; working women ; children ; ballads; public schools ; poverty ; antimodernism

Ann Medcalf

Anne Ruth Medcalf on horseback. Road to Line Fork, Letcher Co., Kentucky. [ann_metcal.jpg]

Anne Ruth Medcalf worked at the Line Fork Settlement as a Community Nurse from 1921 – 1924. She came from Chicago, Illinois, to the Appalachian region sometime in the early 1900s where she worked at other settlement sites and became interested in the health issues of the people of Appalachia. She was recruited by Katherine Pettit to work at Line Fork in 1921, in the second year of the development of Pine Mountain Settlement School’s medical extension.

Following her brief time as a worker at Line Fork she wrote an article for the American Child Health Magazine in December of 1924, titled, “In the Line Fork Country.” It is one of the more thoughtful articles written on health literacy in the Appalachian region, particularly as it was practiced at Line Fork. In the article she describes the personal qualities required of health workers in the Southern Appalachian mountains as “ingenuity, tact, patience….” She spoke from her experience at Line Fork and her earlier years in other settlement locations in the area she calls the “Southern Highlands.”

In her magazine article she tells of the early struggle to find a place as a nurse in a new and isolated community. In the beginning, she notes that the role of the nurse “to her neighbors was not clear.” Most of the families imagined that a “nurse” would come and stay with the family through the duration of the illness and would help with chores not related to the medical condition of the patient such as “milking the cow and doing the family washing.” As she related in the article, “…the real purpose and function of the public health nurse was absolutely unknown [to the Line Fork community]. Hence the nurse had to lay foundations for her work in an almost untouched and uncultivated field.”

In the following accounts of Medcalf’s health work — the link to her full article from the American Child Health Magazine, as well as her “report” to Pettit of the time spent at Line Fork — there are statements that show the broadly held belief that saving Appalachian families was akin to saving the “pure Anglo-Saxon stock” — the “pure American.” This sentiment now strikes us as non-inclusive, as isolationist and parochial as the views the Line Fork community was said by the workers, to hold. It was.

As Medcalf speaks out on the money and attention given to immigrants in the urban settlements, she argues for the “pure Anglo-Saxon” in Appalachia to receive equal treatment.  Her regional and rural perspective about the “pure race,” while today is an anathema, was repeated by many of her colleagues and, today, is one of the controversial repeating themes of the rural settlement movement in the Appalachians. It contrasts sharply with the urban settlement movement and settlement houses, where the mission focused almost entirely on “raising-up” immigrant populations of diverse nationalities and ethnicities — but, ironically, both urban and rural settlement houses often excluded non-white races, though early industrial training institutes such as Tuskegee Institute served as a model for Pettit’s work and for others in the settlement movement.

While Anne Ruth Medcalf’s observations were non-inclusive, they were heartfelt observations, influenced in part by John C. Campbell, the Russell Sage Foundation and other early advocates of the Southern Highlander. She found sympathetic readers in her colleagues. She also found an audience in the country at large. Her narrative report to Katherine Pettit and her later magazine article give an excellent context for the development of the rural settlement movement and the struggle to re-mediate poverty in the early twentieth century. It was not until the Works Progress Administration’s efforts of the late 1930s and early 1940s and again in 1964 when the Johnson administration initiated the “War on Poverty,”  that Appalachia would find intensive government attention to rural poverty and health in America and they would still struggle to “get it right.”

Medcalf’s narrative and her article in the American Child Health Magazine form a good synopsis of the development of the Line Fork Settlement that is both thoughtful and thorough in its assessment of the work and workers. In her narrative, she describes her daily work at the settlement at Line Fork and includes photographs of the people she worked with both as patients and as co-workers. Her thoughtful narrative gives immediacy to the worker experience and demonstrates the profound impact her work had on her life and her belief in the education of the young as the means to move health literacy forward.

She was quite prophetic in the last paragraph of her magazine article:

The hope of the future lies in the proper training of the young, but the carrying out of a health program by such isolated units as Line Fork Settlement, while bettering in a degree local conditions, does not entirely cope with the general situation. Adequate care cannot be taken of these situations until the county and state assume the responsibility of the education and leadership of the people in these Southern Highlands. When this is done the people will shoulder their own responsibilities as they always have in the past according to their knowledge.

Following her departure from Line Fork, Miss Medcalf went to Chapel Hill, N.C., for further study. She wrote to Miss Pettit in answer to questions that came about policies and procedures related to her work at Line Fork, particularly the salaries paid to various workers. It is clear that Miss Pettit relied on Miss Medcalf for good counsel, even after her departure from Line Fork. The letter exchange occurred in April of 1925 when Miss Helen Little had just taken charge of the Line Fork Settlement. The letter follows:

2 Cobb Terrace
Chapel Hill, N.C.
April 1, 1925

My Dear Miss Pettit:-

I would have answered your recent note regarding the amount of wages we paid Bert Smith and the Lewis children right away, but many things have been pressing hard. At the time I was going thru examinations. Then I got word of the serious illness of my mother. I have been in constant Telegraphic communication with my family and I rather think I shall have to go up to Baltimore to-night. I have been very troubled.

As to what we paid Bert Smith: — Yes, we did pay Bert Smith .20 cents an hour and, although I impressed her with the fact that it was more than was usually paid at Pine Mountain, I never said you did not say to do it. I do not feel that’s the way to work with people. That, however, is of little consequence. Bert is worth twenty cents, in comparison to the men who were always paid twenty-five. She worked like a whiz and accomplished twenty cents worth every hour she worked. In case she was ever delayed in her job by her baby we calculated accordingly. Both Miss Smith [Elizabeth G. Smith, teacher at Line Fork] and I felt that our arrangement with her was the only fair arrangement. she was worth more than the women who averaged .15 cents the hour; in other words she was paid for the quality of her efforts and the results.

The Lewis children, however, are all off; they were never paid more than ten cents an hour and then only when they did an especially good job. They are indifferent workers at best. The least ones got about five cents an hour, Miss Smith says. Charlie — the big one — when he worked on the barn diligently got from .08 to .10 cents an hour.

I hope this is what you want.

I am enclosing a report of the tonsil and adenoids clinic we had at Line Fork. I meant to put it in the Line Fork Book. With very best wishes to you.

Sincerely but in much haste,

Anne Ruth Medcalf

Anne Ruth Medcalf was born 1896 in Baltimore, Maryland, to John A. and Sarah (Haslup) Medcalf. She married Arthur N. Estabrook in New York, NY,  on July 8, 1931. He was a widower, born c. 1885 in Leicester, Massachusetts.

See Also:

ANNE RUTH MEDCALF In the Line Fork Country 1924

ANNE RUTH MEDCALF Letter to Marguerite Butler 14 Mar 1922

ANNE RUTH MEDCALF Report to Miss Pettit Feb 11 1922

ANNE RUTH MEDCALF Report n.d. (1922? to Miss Pettit)


Anne Ruth Medcalf

 Alt. Title

Mrs. Arthur N. Estabrook




Pine Mountain Settlement School, Pine Mountain, KY

 Alt. Creator

 Helen Hayes Wykle ; Ann Angel Eberhardt ;

 Subject Keyword

Anne Ruth Medcalf ; Mrs. Arthur N. Estabrook; Pine Mountain Settlement School ; nursing ; teaching ; Line Fork Medical Settlement ; industrial work ; horses ; medicine ; settlement schools ; community nurses ; American Child Health Magazine ; health workers ; Southern Highlands ; patients ; Pine Mountain, KY ; Letcher County, KY ; Line Fork, KY ; Chicago, IL ;

 Subject LCSH

Medcalf, Anne Ruth, — born 1896.
History of Medicine — Biography.
Organizations — social service — Line Fork Settlement.
Pine Mountain Settlement School (Pine Mountain, Ky.) — History.
Harlan County (Ky.) — History.
Education — Kentucky — Harlan County.
Rural schools — Kentucky — History.
Rural health services — Appalachian Region — History.
Schools — Appalachian Region, Southern.

 Date Digital



Pine Mountain Settlement School, Pine Mountain, KY




Collections ; text ; image ;


Original and copies of documents and correspondence in file folders in filing cabinet within the Pine Mountain Settlement School institutional archive


Series 9: Biography – Staff/Personnel ; Series 14: Medical, Health & Hygiene — Line Fork Settlement




Is related to: Pine Mountain Settlement School Collections, Series 9: Staff/Personnel and Series 14B: Medical — Line Fork Medical Settlement

 Coverage Temporal

1921 – 1924

 Coverage Spatial

Pine Mountain, KY ; Letcher County, KY ; Line Fork, KY ; Chicago, IL ;


Any display, publication, or public use must credit the Pine Mountain Settlement School. Copyright retained by the creators of certain items in the collection, or their descendants, as stipulated by United States copyright law.




Core documents, correspondence, writings, and administrative papers, clippings, photographs, or books containing information on Anne Ruth Medcalf, a Community Nurse at Line Fork Settlement.




“Anne Ruth Medcalf Biography.” [Series 9: Staff/Personnel]. Pine Mountain Settlement School Institutional Records, Pine Mountain, KY. Internet resource.

 Processed By

Helen Hayes Wykle

 Last Updated

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Foderhase, Nancy K. “Eve Returns to the Garden: Women Reformers in Appalachian Kentucky in the Early Twentieth Century,” The Register of the Kentucky Historical Society, Vol. 85, No.3 (Summer 1987), pp. 237-261

Medcalf, Anne Ruth. “In the Line Fork Country,” American Child Health Magazine (Dec. 1924): 505-511. Internet resource.

“New York, New York City Marriage Records, 1829-1940,” database, FamilySearch ( : accessed 11 March 2018), Arthur N. Estabrook and Anne Ruth Medcalf, 08 Jul 1931; citing Marriage, Manhattan, New York, New York, United States, New York City Municipal Archives, New York; FHL microfilm 1,684,267. Internet resource.

Notes from the Pine Mountain Settlement SchoolI.7 (March 1922): 3 – 4. Internet resource.

PMSS Staff Database. Pine Mountain Settlement School Institutional Records, Pine Mountain, KY. Computer file.

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