The Lexington-Fayette County Health Department had its earliest form almost as long as the city itself has existed, when the newly formed city of Lexington would appoint a local physician to investigate reports of certain diseases for quarantine. As early as 1794, Lexington's citizens were getting smallpox inoculations. The city created a Board of Health possibly as early as the 1820s, as a young Lexington experienced cholera outbreaks, typhus, smallpox, and the various growing pains created by more people living and working closer together. In 1938, the Lexington city Board of Health merged with the county’s Board to become the Fayette County Health Department.  

The board minutes for January 1904 – April 1922 provided by the Health Department show the broad range of topics impacting local citizens, and the Health Department’s role in keeping its citizens healthier. Through the decades, the Health Department has tested the local milk supply for tuberculosis, led education and vaccination programs, inspected restaurants, set quarantines to prevent the spread of disease, improved sanitation, and at one point ran the local crematory and eruptive hospital.