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Public
Health and Private Doctors
by Daisy Lee Worthington Worcester
Co-Author, Volume 15 of the Federal Investigation of Women and
Child Labor
April 1934
IF hungry men had dynamited the
new $12,500,000 county hospital in Los Angeles, public indignation
would have rocked the country from coast to coast. Headlines have
blazed whenever news of the Washington hungermarchers or striking
Mid-West farmers so much as suggested damage to property, let
alone to life. Yet so quietly that even their own community has
not realized what was happening, an uprising of hungry men in
Los Angeles County has virtually deadlocked a project on which
the people of the county have spent $6,700,000 in the last fifteen
years, designed like the hospital, for mitigation of suffering
and saving of life. The hungry men are the doctors. The work which
has fallen before their organized opposition is the care of the
sick poor by the Los Angeles County Health Department, not a great
monument of stone and mortar, but an outstandingly effective public
service.
In
1915, when Dr. J. L. Pomeroy became health officer of Los Angeles
County, he was the county health departmentăits only employe.
The small cities were all outside the jurisdiction of the county
in matters of health, each limping along its separate, hampered
way, giving attention only to such routine matters as quarantine
and rudimentary sanitation. In 1919, Dr. Pomeroy was instrumental
in the passage of a state law which permitted the smaller cities
of the county to contract for public-health services with the
C:ounty Board of Supervisors. This was the first step in organizing
the county into a great coordinated health district, omitting
only the large cities, Los Angeles, Pasadena and Long Beach.
Between
1915 and 1923, the population in the health department's field
trebled. There was still only the one public hospital, in the
city of Los Angeles, eighty miles away from the far corners of
the county. The public health nurses and doctors found large numbers
of people in the county who could not get adequate medical care
because of their poverty and the long distance from the overcrowded
County Hospital. The supervisors ordered a survey, conducted by
a commission of which the chairman was the late Dr. R. J. Brodrick,
then president of the American Hospital Association and superintendent
of the Alameda County General Hospital. The commission's report
recommended the building of a modern county hospital and the establishment
of local health centers throughout the county, equipped for clinical
treatment and emergency hospitalization.
In
each of the health centers there was an emergency hospital
such as this at Santa Monica.
Now, like the curative clinics, these hospitals have been
closed |
Both recommendations
were carried out. The $12,500,000 hospital, more than six years
in building, is just now being occupied. The development of the
health centers began at once. The first one was completed in 1926,
in San Fernando, a little city in the northern part of the county.
By 1932, the county had a protective network of twelve completely
equipped health centers, owned or rented cooperatively by the local
community and the county. The local community donated the land upon
which the county erected and helped equip the buildings. Most of
the health centers became the social centers of their communities,
and parent-teacher organizations, Red Cross, county welfare departments
and Community Chest in manv places were housed within their walls.
The
program of the health centers included both preventive health
service and needed medical care. It was divided into three departments:
social welfare, which included food, clothing, lodging
and so on for the indigent poor and dependent sick in a broad
sense; communicable diseases, which provided immunization
for smallpox and diphtheria, and the diagnosis and treatment of
tuberculosis and venereal diseases, also the whole educational
program, the prenatal and well-baby conferences, sanitation, water
analysis, and so on; and curative medicine, where people
unable to pay the fees charged by private physicians, could receive
treatment for non-communicable disorders.
This
latter service was given by a staff of volunteer physicians from
the local community. A fee of from ten to fifty cents a visit
was always charged in these clinics. No patient was admitted who
could afford to pay more than fifty cents. This arrangement was
voted satisfactory by the volunteer physicians themselves. All
applicants to treatment clinics were interviewed by a trained
medical social worker. The fees collected were not paid into the
county, but were turned over to the volunteer physicians, who
sometimes prorated them among themselves according to the service
each gave, sometimes used them to buy books for a local medical
library. In addition, since the county's one public hospital was
so distant from many communities, each center maintained an emergency
hospital with a twenty-four-hour service, also manned by private
physicians of the community.
This
organization was the more remarkable in that it was carried out
in the face of great opposition to accepted medical science. A
recent survey showed that 50 percent of the county's population
rely upon types of service other than that of regular medical
men: upon osteopaths and chiropractors, upon Christian Science
practitioners, New thoughtists, drugless healers and no end of
cults. Physicians constitute only 59 percent of the individuals
licensed as nedical practitioners in Los Angeles County. With
half of :he public and an even larger proportion of the practitioners
opposed to scientific medicine, the development of a comprehensive
health program has required not only endless abor and never-ceasing
vigilance on the part of its director, but the continued loyal
support of the medical profession; and all these it had, even
the last, until hard times hit the doctors.
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