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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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I tried to get an expression of opinion from some of those who are above the battle, but with little success. Mary Stanton, secretary of the health division of the Council of Social Agencies, was the only social worker among the large number with whom I talked who really knew what had taken place. She feared that the plan would result disastrously for the community. "When the depression is over, the doctors won't look at these patients for fifty cents a visit. Then what? Our health-center service has been destroyed. We shall have to build all over again."

Dr. Emory R. Bogardus, head of the sociology department of the University of Southern California, said, "Although there may be some saving to the county now, I believe that in the long run the San Fernando Plan will prove more expensive. Cases of illness that are now neglected will have: to be cared for ultimately by the county. I am glad to comment favorably upon the excellent health program that has been put into operation by Dr. J. L. Pomeroy and to say that it would be a calamity to have this progressive plan cut off."

Dr. George B. Mangold of the same school, chairman of the Social Legislation Committee of the Council of Social Agencies, said: "I object to the whole San Fernando Plan on principle. I object to spending the taxpayers' money in the interest-of a group of doctors rather than in the interest of the general public."

In Alhambra, the local conflict had acquainted the public with the situation and had roused strong feeling. Mrs. Rose Wallace, chairman of the board of trustees of the Institution for Women, the new women's prison, said: "I believe that the doctors should be paid for their work; but I believe also that our health center must be preserved for all of its original purposes."

Mrs. C. B. Hannah, also of the same community, a leader in women's clubs in Alhambra, said with feeling: "All that one has to do is to listen a few minutes to the type of men who are opposing Dr. Pomeroy; their selfish interests are apparent in every word that they speak. Our health center is going to remain open."

Grand Jury opinion, which is conservative if not reactionary when social work is concerned, evidently favors the new plan. The chairman of the Health and Sanitation Committee of that body expresses herself as follows:

These past few years, previous to 1929, were not normal years. Every department of government spread itself to encompass a supposed ideal, but with the coming of diminished income and a period of time as subnormal as the previous was abnormal, the ideal of the former time only became a top-heavy, awkward machine, a drag on the whole community whose private burdens are of a crushing weight at this moment.

She says further:

Our county institutions of all kinds are of so fine a quality that our hard-pressed taxpayer feels as if a premium were being offered by himself to those whose education did not seem to include that fine fact that the ability to care for one's self is one of the great privileges of life.

And then finally:

We do feel that the public-health work should be a public work alone, that a number of its activities should be dispensed with, and its entire time given to that type of work will protect the citizens of this county from dangerous exposure from any source that might prove contaminating to health.

MANY of us talk of public health as vaguely as does this member of the Los Angeles County Grand Jury, as if it were something unrelated to individual human lives. The "dangerous source of contamination," ultimately the only source, is a human being who is ill, in whose body there develop the germs of disease. Dr. Pomeroy maintains that no definite line can be drawn between curative and preventive medicine. A situation was discovered a few weeks ago in one of the health-center districts which makes this point clear.

Twenty-three cases of smallpox had suddenly come to the attention of the health officer. If these people had come to the health-center clinic when they felt the first symptoms of illness, instead of being sent as they were to private physicians' offices, where some of the cases were diagnosed as acidosis and high blood-pressure, there would have been no faulty diagnosis; for public-health nurses and doctors are trained in the symptoms of contagious diseases as few private physicians are. It took all the skill of that health-center doctor to avert a serious epidemic in that community.

A young social-worker diagnostician may send a case of incipient tuberculosis to some general practitioner who will fail in diagnosis until it is too late for a cure. Then the patient will be sent to the tuberculosis sanitarium to be cared for until the end comes, at heavy expense to the county. Those routine smears and examinations to which Dr. Berman referred are the means by which dangerous disease was discovered in its incipiency in the scientifically conducted health centers. The usual private physician is not trained to make them even for his remunerative patients. Is there much chance that he will do so when he is paid fifty cents a visit? What will be the cost of this San Fernando Plan if the depression is slow to lift? How long will it be before doctors other than those who served the health centers also will demand pay from the county?

Already men in Pasadena and Long Beach are asking for their share, although there has never been a health center in either of these communities. Suppose that prosperity does return shortly. How many doctors who now clamor for the fifty-cent fees will be willing to keep county patients when they can collect SIX times as much from private patients? The San Fernando Plan can be only an emergency measure. It has disrupted an orderly, scigntific piece of work which was years in the building.

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