Thursday, January 02, 2014

History of Public Health in Orange County

The 1914 County Hospital, which until recently stood at the center of UCI Medical Center.
Maybe you can help me with an article I'd like to put together for the Orange County Historical Society's monthly County Courier publication.I found an old article in the Orange County Health Department’s Public Health Report, Vol. 14, #9, Sept. 1964, outlining the history of public health in our fair county. It seemed a fine topic for an article, and I set about to edit, expand and improve on it for future republication. Here's some of the content excerpted from that article....


At the time of its formation, in 1889, Orange County had a population of about 13,000, and there were thirteen physicians in the area. Daily rounds were made either on horseback or in a light spring wagon or top buggy. Roads, by today’s standards, were hardly more than trails. They were dusty in the summer and muddy in the winter. Mud clung to horses’ hooves and loaded buggy wheels so badly that the doctor was fortunate to make two miles an hour. There were no bridges over the Santa Ana River or Santiago Creek, and there was water in these streams the year around. During the rainy season, swollen conditions made fording impossible.

Typhoid fever was everywhere, recurrent outbreaks of diphtheria and smallpox were common, tetanus (lockjaw) was frequent, and snakebite was often a cause of disability. Orange County also had one of the highest death rates from tuberculosis in the state. These conditions conspired to make the lot of the pioneer doctor a difficult one. However, events which occurred elsewhere in California at an earlier date completely altered the disease picture in this area.

The epidemics of cholera, typhoid fever, smallpox, plague, and typhus, which swept the gold rush communities of California in the 1850s, led to the establishment of the State Health Department in 1870. Under the far-sighted leadership of Dr. Thomas H. Logan, California became the third state in the union to establish such an agency.

Shortly thereafter, and as part of the same development, the feelings grew that local government should take primary responsibility in matters of the public’s health. By 1889, when Orange County was founded, it was required that every county and incorporated city have a health department. Guidance was usually provided by a local physician who also served as health officer.

Dr. James P. Boyd, who came to Orange County in 1888, was the county’s first health officer. He took office in 1889 and served until 1911. Dr. Boyd was succeeded by Dr. John Wehrly who served as County Physician and Health Officer until 1915. He was followed by Dr. Arthur H. Domann of Orange, who became the last part-time county health officer.

Dr. Domann -- a man of unusual vision -- advised the Board of Supervisors that the county had reached such a size (over 60,000) that its needs could best be met by selecting a well-trained public health physician to direct the health department’s activities.

After conferring with the State Health Officer, a representative of the Rockefeller Foundation, the Board of Supervisors, and other prominent citizens, Dr. Domann succeeded in obtaining a county appropriation of $10,000 for the first year. To this was added $2,500 each from the state and the Rockefeller Foundation, making a total of $15,000 for operating funds for the first year.

With the help of the Rockefeller Foundation a qualified health administrator, Dr. W. Leland Mitchell, was obtained. He assumed his duties on December 1, 1922. The first health department staff consisted of Dr. Mitchell and a public health nurse, Miss Isabel Durgan, who served as “assistant health officer, county nurse, and dairy inspector.”

This marked the beginning of full time public health services in Orange County. Health Department business was conducted from a small basement office – shared with the coroner and welfare director – located in the County Courthouse in Santa Ana.

Soon, another public health nurse was recruited; a sanitary inspector, Mr. W.W. Chandler, was hired; and a stenographer was employed. They were joined a short time later by a dairy inspector, Mr. John Bichan; and a bacteriologist, Miss Dorthy Beck, who was sent by the State Health Department to serve until another one could be found.

In September, 1923, the City of Seal Beach became the first incorporated city to contract with the County of Orange for health department services. The agreement called for the city to pay the county the lavish sum of $10 per month for these services.

In January, February, and March of 1924, the City of Santa Ana suffered a disastrous typhoid fever epidemic. Actually, there were three epidemics in succession – two traced to water and one to contaminated milk. In all, there were 632 cases of the disease.

At that time, Santa Ana’s “health department” consisted of a part-time physician who recognized that the epidemic could be controlled more efficiently by the county health unit. He advised the city council to make arrangements with the County Board of Supervisors to provide public health services for the city. This agreement was signed in March 1924.

The Santa Ana typhoid fever epidemic provided the opportunity for the health department to demonstrate the values to be derived from a full-time health agency with strong leadership, adequate resources, and skilled auxiliary staff. The State Health Department was contacted and, together with the County Health Department, engineers, physicians, bacteriologists, and other technical personnel were quickly rushed to the stricken city. The source of the epidemic soon became known, primarily through the efforts of the health department laboratory.

The cities of Orange, La Habra, and Huntington Beach, benefiting from the experience of Santa Ana, soon followed suit. In 1932 Newport Beach wrote a contract with the county and, since then, each new incorporated city has contracted for county health department services. Through this arrangement, the cities of Orange County and the county government have been able to provide facilities and professional staff of a quality and quantity that would not be possible, individually, except at a prohibitive cost.

The major responsibility for public health in a democratic society such as ours, falls, naturally, on the medical professionals, the medical institutions, and the people who are formally represented by the voluntary health agencies. In this triangular relationship between, the professions, the institutions, and the people, one part is as important and essential as another. Among the medical institutions (which include hospitals, medical schools, research institutions, and the health department), the health department is a relatively small but important institution. Because of its responsibility to help community leaders in identifying health problems and needs of the community and its obligation to provide support to the medical professions and other medical institutions of the community, the health department most often is cast in the roll of consultant and helper in community health.

In the discharge of its duties the Orange County Health Department had numerous and varied responsibilities. In addition to those mentioned above, these included:
  1. The accumulation and analysis of vital statistics, such as births and deaths, and the incidence of communicable disease – “the bookkeeping of humanity.”
  2. Investigation into community health problems and needs. These may include anything from a suspected nuisance to the need for additional hospital beds.
  3. Enforcement of laws and regulations relating to health.
  4. Education and communication between institutions, within the health profession and to the public.
  5. Direct services in the field of immunization – sufficient to supplement the efforts of the medical profession and medical institutions so that community immunization levels are adequate to control communicable diseases.
  6. Research activities designed to add new and useful knowledge about man and his environment and to develop better methods for solving old problems.
And that's about where the article ends. It definitely needs some pepping up, vetting, and great deal of fleshing out. And of course, a lot has happened since 1964, including the dawn of Medicaid and Medicare in 1965 and a host of organizational and philosophical changes. 

I'm hoping someone out there will be able to point me to some existing resources on the more recent history of public health in Orange County. I could plow through half a century of annual reports, monthly publications, and news clippings, but if someone's already done some good solid work on this subject, I'd rather just ask to quote them instead of reinventing the wheel. As for the current incarnation of the County health agency, I gleaned the following information from the Interwebs:

In the early 1980s, the Orange County Health Department became the Orange County Health Care Agency (HCA). By 2010, it was serving a population of well over 3 million. Today’s HCA provides public health, behavioral health, and medical services. It also provides administrative and financial services related to health care, and provides health services to those in county correctional facilities. The agency has 180 different funding sources and over is responsible for fulfilling at least 200 State and Federal mandates.

One could end such an article, of course, with something pithy about the new era of Obamacare and the related challenges and changes. Anyway, let me know if you have any good leads. Meanwhile, maybe the information posted above will do someone else some good...


Anonymous said...

Thank you very much for the brief history about the health department establishment, I wish the department of public health will have some type of history on their web page. I have researched their web page without any success. Perhaps in the near future you can write about some historic events on public health nursing in Orange County, it sure has changed. Once again thank you for your informative blog.

Anonymous said...

THANK YOU SOOOOOO MUCH FOR THIS INFORMATION. I am doing a report on the OC HCA and it has been very difficult to find information of how it began. You have been a very fruitful source to my paper, thank you immensly!