Cultivating Health: Los Angeles Women and Public Health Reform

Chapter 1: Paid for by the Public Purse: Public Health Nursing

Chapter 1 10 On Monday, November 22, 1897, Los Angeles became the first municipality in the United States to fund a public health nurse.1 This action answered a petition made six months earlier by Maude B. Foster, president of the Los Angeles College Settlement Association (LACSA).2 In her request, Foster claimed that the city had already begun taking steps toward acknowledging its responsibility for promoting health. In May 1895, the board of health appointed physician Louise M. Harvey as a sanitary inspector after listening to a report made by LACSA representatives Evelyn Stoddart, Mary Bingham, and Harvey on conditions in “Sonora Town,” an immigrant working-class neighborhood in the second ward.3 The city did not provide pay, however, and limited her authority to the district in question. In the course of her work, Harvey dispensed medical advice and attention. Foster referenced Harvey’s activities in her petition to justify LACSA’s new request. She argued that LACSA functioned as an important health care center for residents of the city’s second ward and that it could no longer shoulder the fiscal burden of caring for the public’s health in this district. Beyond financial considerations, Foster appealed to the city to assert its ideological power over public health. As a Wellesley-educated, affluent, unmarried, socialist woman, Foster believed in the state’s capacity for social justice. Neither her biography nor her political philosophy made her exceptional in Los Angeles in this historical period.4 Foster argued that if the city agreed to fund a nurse, then LACSA would consign a certain degree of control over the program to the city’s health department; the city’s health officer would select and supervise the nurse in conjunction with LACSA. A brief letter of support from Luther Milton Powers, the city’s chief health officer, accompanied LACSA’s request. Paid for by the Public Purse Public Health Nursing Paid for by the Public Purse 11 The city council considered the settlement’s petition along with requests from two other local organizations engaged in issues of social welfare, the Boys and Girls Aid Society and the Day Nursery. Initially, the council’s finance committee recommended that each group receive a monthly sum of fifteen dollars, an amount not nearly enough for a nurse’s salary. The national average was fifty.5 Lost from the historical record are the documents that would reveal exactly what transpired next, but a process of negotiation must have taken place. Upon councilman Charles H. Toll’s recommendation, the city amended the finance committee’s suggestion and raised the settlement’s appropriation to fifty dollars per month and the other societies’ to twenty. While we may never know who or what persuaded Toll to offer this revision, by his action Los Angeles became the first city in the nation to salary a public health nurse.6 In return for the funds, the settlement provided the facilities and equipment , and conducted outreach to the city’s working poor and the indigent. This joint venture remained publicly financed and privately controlled until the women of LACSA sought and secured the passage of an ordinance to merge the program into the city’s health department sixteen years later. By obtaining municipal funding, female reformers in Los Angeles blurred the boundary between private initiative and state responsibility for public health. In developing social services for the city, these women also created a space within which they could direct public policy. Consequently, how they understood germs, motherhood, health, and sickness came to inform the machinery of the local state. Yet reformers’ beliefs alone did not structure the distribution of health care in the city. Instead, the negotiations within people’s homes among nurses, patients, and their families played a crucial role in shaping the character and expression of LACSA’s public health nursing program. As policy makers and as patients, women reconstructed the relationship of the city to its residents. By establishing a public health nursing program, Los Angeles joined a transatlantic health movement to bring modern medical care into the home.7 Despite the existence of American charitable organizations in the early nineteenth century that provided home care to the poor, female reformers in the United States in the late nineteenth century looked to England for their model.8 Yet these programs took on different dimensions in the United States because its health care system was decentralized and localized. In terms of timing, the formation of the...