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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


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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.

Emergency Hospital
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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