by Paul R. Spitzzeri
As we continue with our deep dive into the report of the Los Angeles City Auditor for the year ending 30 November 1904 and turn to the report of the Health Department, we should note that the city’s health officer, Luther M. Powers, who served in that role for over thirty years until his death in 1924, was a major figure in city government if forgotten now. Perhaps his most prominent public presence was during the flu pandemic of 1918-1919 when, among other measures, he ordered mandatory mask wearing to try to stem the skyrocketing rates of infection from the virus that killed tens of millions worldwide.
When he issued his statement, though, another major health issue had to do with the quality and safety of foods and medications which, thanks to exposés like Upton Sinclair’s novel The Jungle and other means, led to the passage by Congress of the Pure Food and Drug Act of 1906. Medical care was also improving by leaps and bounds with life expectancy rising, as well, so the early 20th century is a very interesting one when it comes to matters of health and Powers’ report is notable given the context.
He observed that there were 2,981 deaths reported in the Angel City, which had an estimated population of 180,000, during the previous year and of these, 758 occurred in the several hospitals with 321 of these taking place in the county facility also serving 110,000 persons outside city limits. The passing of 328 people was certified by the coroner and Powers noted that there were 62 cases of suicide, with 84% of these male and 73% born in the United States.
As to the mortality of children, the health officer noted that there were 341 of these for infants under a year of age, or about 11.5% of all deaths, while almost a quarter involved digestive system diseases and 43% of those took place during the summer months. Powers added that, for one to two year-old toddlers, there were 49 deaths and 83 among those between two and five years of age.
Births exceeded 2,900 during the year, with 76 stillborn and 99 premature and other the 2,531 living children reported, the proportion of males and females was about the same, with a slightly larger number of the former. Two-thirds were born of parents from the United States, with 2.5% of these delineated as “colored,” while 21% of the total number of children were of parents born outside the country, 15% were from families in which one parent was born in another nation and 14 children did not have identified parentage.
Under a short section headed by “Communicable Diseases,” the officer wrote that “inspection of Chinatown has been enforced, and the sick and dead have been inspected for bubonic plague,” though he added that after autopsies were performed, there was “no evidence of plague having existed in the city.” Media and other accounts of the era routinely identified this section of town east of the Plaza as a breeding ground for infectious diseases, so this comment of Powers’, brief as it is, is notable.
As to smallpox, a scourge in Los Angeles through much of the 19th century but for which a vaccine long existed, there were under two dozen reported cases with no known fatalities. While there were 206 cases of tuberculosis, another major disease from the era, reported to the office, it was added that “physicians do not freely report all living cases,” though it was hoped that there would be “better co-operation . . . soon for we preparing outfits for sending specimens of sputa to be tested.
There were, however, 651 deaths from TB, accounting for 22% of all deaths and it was observed that “many cases . . . were sent here in the last stages, which was unfortunate as they could not be benefitted, and died away from home and home comforts, etc.” As has often been stated in this blog, among the hordes of health-seekers who flocked to greater Los Angeles during the late 19th and early 20th centuries were sufferers from the disease, many of whom went to the many sanitariums found in the northern San Gabriel Valley and elsewhere in the region. About 35% of those deaths were of people in the city for under a year and about a quarter were there for an unknown period. Powers added, “the apartments occupied by tubercular patients have been fumigated” when his office was notified of these situations.
A scourge among children before widespread vaccination was achieved after the mid-1910s was diphtheria and there were 872 reported cases, with 57 proving to be fatal and this lower number was “no doubt due to the prompt use of antitoxin” in treatment. While it was noted that this was the largest number of incidents ever in Los Angeles, the total of deaths was not and Powers wrote
There is no doubt that the dusty streets during the Fall and early Winter months, due to the suspension of sprinkling pending a trial between the city and the street car company [Henry E. Huntington’s Los Angeles Railway], contributed to the rapid spread of the disease.
A table from 1889 showed the increase in cases, correlated in no small measure to the increase in population, but, perhaps also the density of settlement in many areas of the Angel City. In 1890, after the bust of the great Boom of the Eighties, there were 116 cases and 27 deaths, though after an increase the following year, cases and fatalities were less than half for the next two years. There was a major spike to 146 cases and 37 deaths in 1894 and instances climbed dramatically to 1897 when there were 316, though deaths were at 37. Cases dropped to between 221 and 287 from 1899-1902 and deaths from 18-34, but, in 1903, there was more than double the instances, to 528, and deaths leapt to 49.
The 1904 count of typhoid fever was 372, with 54, or about a fifth, of them fatal, though Powers noted that many cases were unreported, which made the death rate seem much worse than it actually was. While there was no major known variation among the city’s nine wards, it was stated that “many of the cases have been brought to the city from grading and railroad camps” and he felt that vegetables and milk were unlikely to have contributed much to the rate of cases.
Another table from 1889 tracked cases and deaths, though the former were not listed until 1894, when there were 71 cases and 43 deaths, a very high fatality rate, which held true for the following year—though, again, underreporting of instances was likely. In 1896, there were 122 cases and 28 deaths and the former nearly doubled from 1897 to 1898, dropped significantly from 1900 to 1901 and then rose again. Fatalities ranged from 33 to 53 during the prior half-dozen years.
Other primarily childhood diseases briefly mentioned were scarlet fever (205 cases and 7 deaths); measles, of which no requirements existed for reporting, but from which there were eight deaths; meningitis, which took the lives of 43 persons; and whooping cough, which caused five fatalities. Vaccines for children eventually made these maladies increasingly rare.
Powers noted that “one of the most important purposes” of his department “is the inspection of food . . . and the prevention of food adulteration and substitution.” He continued,
We are so situated that the sharp competition between manufacturers and other producers of food stuffs makes it the more necessary for us to work for purification of these supplies and the punishment of adulterators because to a great extent the health and lives of our citizens are conditioned on the food supply.
Anticipating the national legislation mentioned above, the officer added that “clear definitions of adulterations and substitutions” were needed, though the completion of a chemical laboratory was a major sign of progress. A decade’s worth of inspections, Powers went on, improved the quality of milk, though he cautioned that “the sanitary condition of the dairies and farms, and the handling of milk . . . has not reached near a satisfactory degree.” A constant inspection regimen, without help from the state or federal governments, was needed, but, with only two inspectors working in a wide area, including outside of the city, posed enormous challenges. What was required were a veterinarian and stock inspector.
With respect to the inspection of meat, there was one full-time and some part-time assistance, but, Powers commented, “the inspection of meat and poultry cannot be satisfactorily done under the present system of slaughtering” so he asked for a public facility for butchering animals as well as at least one more inspector. A poor crop did not bode well for fruit and vegetable inspection, so that, while such produce might be condemned, there was no provision for destruction, so some items might be “exposed for sale, or even sold in spite of the vigilance of the inspector.” Moreover, spoiled fruit could go to animal feed, while better sorting might salvage produce that was still acceptable.
As Los Angeles embarked on the massive aqueduct, completed in 1913, which allowed for the continued untrammeled growth of the city, water inspection improved, but, in 1905, Powers wrote, “we cannot congratulate the consumers upon great success, for the laws under which we have been working are very defective.” He offered the wish that there would be “filtration galleries” for the Los Angeles River north of town to make water as pure as what was obtained from wells and tunnels.
With regard to school inspections, the officer noted that, in instances in which children were in unsanitary conditions and then sent to school, the need was pressing for a nurse and this was finally established in May 1903, while, in September 1904, the council passed an ordinance to create a position and a second woman was hired. Powers also observed that Thursday and Saturday afternoons “have bene devoted to the free vaccination of pupils” with Powers’ assistant in charge of this program.
Noting the importance of the proper collecting and disposing of trash to the health of the Angel City’s citizens, the officer lamented that “the contract system . . . has not been successful . . . for the reason that it is not to the financial interest of the contractor to encourage a complete removal, and indifferent or ignorant householders . . . fail to do their duty,” as well. He also denigrated the feeding of garbage to hogs and chickens, while recommending the city take over trash collection and disposal either under his department’s authority or “a scavenger system” overseen by the public works department. Regardless, Powers suggested an ordinance on trash collection and a permit system for collectors.
The officer also called for free bathing facilities and urinals, noting that, for the former, “the city could advance the heath and morals of the poor . . . for cleanliness tends to self respect and morality,” while, for the latter, “the city could aid in keeping clean the alleys and dark corners, and prevent them from becoming so foul and unsanitary.” As to tenements and lodging houses, these were “often the source of disease” because of “overcrowding ad want of cleanliness,” so Powers called for permits to force owners of these dwellings to :maintain a clean and sanitary place.”
Dr. E.L. Leonard, the city bacteriologist provided data on culture testing and examinations for diphtheria, tuberculosis, and typhoid fever. For the former the positivity rate was about 17%, while it was more than double that for the second and about 20% for the last. There were 28 water sources tested for “colonies,” likely of bacteria, and it was found that the highest levels were in the “head of tunnel,” probably north of downtown at 5350 in one c.c. of fluid, while the lowest was 23 in “West Side Wells.” The average for all the sites was 977. At two-dozen dairies and 56 tests, it was found that the average number of colonies per c.c. of milk was 481,000, with the highest at 1.5 million and the lowest at under 37,000, while, for delivered product, the amounts were 507,000, 1.28 million, and 85,000.
City Chemist Robert V. Day stated to Powers that nearly 600 tests were made by him of all manner of food products, 22% of which involved milk and 17% for “hamburger steak,” while olives, honey and butter made up another quarter. Adulteration was found in about 15% of instances, with them being almost total with jelly and vinegar, while only one instance in 128 was found with milk, about 10% in honey and olives and about 15% in hamburger steak. He also provided data from four analyses of water with either no or little nitrates found and no nitrites or ammonia located, with levels of chlorine, carbonates and sulphates given.
George L. Pierce and George W. Hood, the milk inspectors, stated that there were not far under 2,000 inspections, with 7% calling for notices to clean facilities or provide better buildings, along with five sworn complaints and convictions. While noting that quality was improving, they also observed that the city’s rapid development meant dairies were further away and “the milk supply . . . is gradually coming under the control of a few large concerns” and inspection was rendered more difficult, as Power stated.
A.W. Sanborn, the sanitary inspector, recorded 1,124 complaints for non-collection of trash, but just more than half were considered unfounded and, as to causes, these included ones that proved to have no legitimate reason or because the collector had not yet arrived; garbage not separated as required; trash put out too late or not at all; the contractors not required to collect; and receptacles too heavy to handle. Sanborn did note that, despite the challenges of dealing with more material as the city grew, service improved, but recommended to Powers that the city handle collection and cremation.
Meat inspector Fred T. Hughes stated there were more than 11,000 inspections at above 2,000 meat markets, 233 poultry markets, 357 restaurants, 96 slaughterhouses, 73 ranches and 461 peddlers, as well as almost 8,000 animals checked. There were eleven complaints filed and ten convictions, though the fines amounted to under $300 total, with condemned product including over 2,300 pounds of beef, 2120 of pork, 2105 of fish and 7,739 pounds of turkey, with small numbers of chickens, hogs and rabbits included along with 40 cows and 29 cans of corned beef and other food. Hughes added a public slaughterhouse was urgently needed for many reasons, including more accurate and meaningful inspections and, with massive local growth posing difficulties, including the assertion that “peddlers have grown more tricky,” he called for three additional inspectors.
R.E. Drummond, the fruit and vegetable inspector, noted he examined 15,000 stalls and 23,000 wagon at markets, over 6,000 commission houses and stores, 1,300 wagons on streets, as well as bakeries, rail cars, and samples given to the city chemist, though just three complaints were filed, leading to two convictions. He stated that over 185,000 pounds of fruit and nearly 38,000 pounds of vegetables were condemned, but asked for an ordinance amendment, as noted above, for the power to dispose of these items.
School nurse E.M. Thornton reported 281 visits to three dozen schools and 334 to homes, with more than 3,000 children examined and nearly 90% of them card for in some way, while about 10% were referred to a doctor or dispensary. Department clerk William H. McGill noted receipts of under $700 from providing vital records and permits along with $84 in the sale of tents from the smallpox hospital, while expenses were almost $37,000, 70% of which were encumbered in salaries, with $3,700 in drugs and laboratory materials, $2,300 in smallpox quarantine guards and $2,400 for labor and supplies at the smallpox hospital and quarantine area.
A very interesting “Health Department Historical Facts” section noted the earliest record was from Julián Chávez, who referred to health measures as “one of the principal duties of any municipal body,” from March 1847, just after the American seizure of Mexican California and concerning the incineration of cattle heads, keeping houses and streets clean and that zanjas (water ditches) be kept clear, all for the health of the town’s denizens. Three years later, the first ordinances were passed with respect to cleaning premises and keeping filth from zanjas. In 1855, a public slaughterhouse was established and a stock and meat inspector position created. In July 1868, a smallpox hospital was established at Chavez Ravine, named for the aforementioned, and it was noted that many cases of the disease affected
Indians who were employed to pick grapes in the city and vicinity. These Indians when first attacked with the fever would plunge into the zanja or river, and then lie around the banks until they were picked up in a critical condition or perhaps dead.
In August 1874, the council passed a sanitary ordinance calling for free vaccination, reporting on births, deaths and occurrence of illnesses and a ban on adulterated milk sales. When Dr. Walter Lindley was elected health officer by the council, he began free vaccinations of schoolchildren, got an ordinance passed banning the handling garbage on the streets during daylight hours, began reporting births and deaths, inaugurated a sewer system for major thoroughfares and issued annual reports.
More recent history went into more detail about those serving on the Board of Health (including William H. Workman, mayor in 1887 and 1888, with chief executives always members); garbage collection by contract; the health officer also acting as police surgeon; improvements to the pest house; better inspection regimens; a revamped plumbing ordinance; a new milk ordinance; the first use of antitoxin for diphtheria treatment in 1895; the opening, three years later, of a bacteriological laboratory; a smallpox epidemic in 1898 from “tramps” and those in railroad camps; vigorous prosecution of milk adulteration by the turn of the century; “thorough inspections” of Chinatown in 1901 because of plague concerns/fears; and much more.
For the nearly 3,000 deaths reported in 1903-1904, an exhaustive table listing causes, age groups, gender, and places of origin was provided. On a general level, 60% were male and there were 88 “African” and 46 “Mongolian” deaths, Latinos being included as “Caucasian.” The age bracket with the largest number of deaths was the 20-45 groups, comprising a third, followed by the 45-65 cohort at almost a quarter, the 65 and older category at about 20% and that 11.5% under a year. As for places of birth, 52% were in the “Atlantic States,” whatever that comprised, a quarter were foreign-born, 10% were from the Pacific Coast and an eighth from Los Angeles.
Lung diseases took nearly a fifth of the deceased in the Angel City and 7.5% died of broncho-pneumonia causes. Other than the 62 suicides, there were 58 “other accidents,” 38 railroad accidents (only one being female), 36 who perished from surgical shock, 26 who succumbed to alcoholism (all but one were males) and 11 by violence, nine being men (one was a baby, another a teen, the others ranging from 20-65 years of age.) There were 185 persons who died from brain issues, 147 persons who died of heart disease, 126 from nephritis (a kidney malady), and 114 from senility. There were few causes from which women died more than men, including septicemia, meningitis, gastritis, peritonitis, uremia, senility, surgical shock, “genito-urinary” disease, and stomach issues. Other tables covered births; sanitary, meat, milk and fruit inspections; and deaths from tuberculosis by month as well as nativity and age and by month.
It was initially thought we might include other department reports, but we will defer the public library and others for the next part, coming tomorrow. Please check back then!