The Journal of San Diego History
Fall 2002, Volume 48, Number 4
Gregg Hennessey, Editor
Michael Kelly, M.D., Guest Editor

Edited by Michael Kelly, M.D.

Images from the Article

San Diego’s first “county hospital” was said to be the cobblestone jail built in 1851 by Sheriff Agoston Haraszthy in what is now Old Town.2 The “hospital” was relocated to the Emmett House on Twiggs Street in Old Town.3 Dr. Edward Burr,4 one of three members of the Board of Health appointed in 1869, lived in Casa de Lopez on Twiggs Street and served as San Diego County Physician from 1869-18715 and County Coroner from 1867-1871.6 But until 1880, San Diego’s indigent sick and disabled had no regular hospital or home. The San Diego County Board of Supervisors would contract with the lowest bidder each year for the care of the County’s few indigents.7 In 1880, County Supervisors established the County Hospital and Poor Farm as the County’s safety net for its indigent. It offered hospital and health care for the sick and injured who had no other means of support.8

A public notice in August 1878 requested proposals of available land for the location of a new County Hospital.9 Several offers were submitted by citizens wanting to sell land for this purpose.10 The request for proposals specified valley land with easy access to water and located within six miles of the courthouse. Many people, including several prominent citizens, signed a petition requesting that the Board of Supervisors of San Diego County purchase “the new City Hospital building located on the northwest corner of City Park” (now Balboa Park) for $1800.11 That location, however, was not among the final proposals considered when the Board of Supervisors reviewed four offers in January of 1880:

Board of Supervisors. Board met yesterday morning pursuant to adjournment for the purpose of opening sealed proposals for lands for County Hospital and Poor Farm purposes. The Clerk presented bids received by him, in pursuance of advertisement and due notice given, as follows: L.L. Roberts (Joe Faivre, agent,) offered 30 acres in the National Ranch, on the Sweetwater, with improvements thereon, for $4000 gold coin, or its equivalent in warrants on County Contingent fund. Manasse & Schiller offer 40 acres in Pueblo Lot 1120, known as the Crosthwaite ranch in Mission Valley, for the sum of $1700 in warrants upon the Contingent fund. William Llewelyn offered 60 acres in Chollas Valley, known as the “Llewelyn place,” for the sum of $25 per acre in gold coin or its equivalent. Commercial Bank of San Diego offered 120 acres in Mission Valley and known as the “Jose Maria Estudillo place,” for the sum of $1500 in warrants on the Contingent fund. On Motion, several bids were ordered on file, with the understanding that they be taken up at any time for further consideration.12

A final decision on the purchase seemed near when, the following week, the Board of Supervisors appointed appraisers to assess the value of the Estudillo place:

Tuesday, Jan. 27. In the matter of lands for Poor Farm purposes, it was ordered that Messrs. E.W. Morse, G.G. Bradt and D. Burroughs be appointed appraisers to appraise the lands submitted by the Commercial Bank for Poor Farm purposes, known as the Jose Ma. Estudillo’s place in Mission Valley, and that said viewers report as soon as possible.13

The Board of Supervisors received an appraisal of the Estudillo place at $1500 on Jan 28, 1880, and accepted the proposal to purchase the Estudillo place from the Commercial Bank, one Supervisor voting against the purchase. The minutes noted that this land was in Pueblo Lot 1118. The purchase was contingent on a survey showing at least 24 acres of valley land.14 Improvements included an adobe four-room house with attached kitchen.15

The 140-acre site is described in the 1889 County Hospital Report as being “three and one-half miles from the City of San Diego, at the foot of the grade leading to Mission Valley, about midway between Old San Diego and the old Spanish Mission.” The location was on the south side of Mission Valley just downhill from the future site of the three-story County Hospital building built in 1903 on the south rim of Mission Valley. On March 15, 1904, 90 patients were moved from the old County Hospital and Poor Farm to the new County Hospital in horse-drawn express wagons, three tallyhos, four hacks and two ambulances.16 That new hospital building was adjacent to today’s UCSD Medical Center in Hillcrest.

During the twelve-month period covered by the 1889 County Hospital Report, the number of patients ranged from a low of 25 to a high of 48, with a total of 60 beds available. The indigent sick who were able to work did chores within the facility itself or outside on the Poor Farm. Indigent patients were those who could neither afford their own care nor had they family able to support them. Proximity of family might explain why only 8 of the 222 patients were female.

The County Hospital had facilities for surgery where amputations were performed, abscesses drained and one bladder-stone successfully removed. The Superintendent’s office was equipped with a telephone, the San Diego Telephone Company having been in operation since 1882. By 1888, the Poor Farm boasted “four acres of garden, producing vegetables enough to supply present demand” and “four acres of orchard under cultivation, producing figs, apricots, and peaches.” The San Diego River provided ample water for irrigation and was a principal reason for selection of the site. The San Diego Flume began operation in 1889 and brought fresh water to the County Hospital from the Cuyamaca reservoir.

Dr. Joseph P. LeFevre, County Physician and author of this 1889 County Hospital Report, was born in Indiana, attended the Simpson Centenary College of Indianola, Iowa, and graduated from the Missouri State Normal School. He came to California in 1876 and “matriculated with the medical department of the State University, from which he graduated in 1881.” After serving as San Diego County Physician for three years,17 he returned to San Francisco in 1891, where he was appointed Superintendent of the City and County Hospital.18

The 1889 County Hospital Report provides us with demographics on the national origin of the 222 indigent patients who spent time in the County Hospital during these 12 months. Only ten were born in California. More than 2/3 were born outside the United States. Most of those were from Ireland, followed by England and Germany. There was a broad representation of other western European natives, eight Canadians, and only two Mexicans.

The County Physician was responsible not only for the care of patients at the County Hospital but also for treating other indigent sick, averaging about 20 per month and including 17 prisoners in the County Jail. Apparently, those treated by the County Physician were all within the City of San Diego, despite the title of County Physician. Dr. David Gochenauer, San Diego’s Health Officer and City Physician, described the Hospital of the Good Samaritan on the corner of Cedar and Union Streets, with sixteen beds open to all, supported by voluntary contributions, as well as a free Receiving Hospital for the care of the indigent sick and injured. Dr. Gochenauer stated that he, as City Physician at that time, attended “all indigent sick at their homes in all parts of the city.” The boundaries of responsibility between County and City Physician are not entirely clear, since similar duties are described here by the County Physician, Dr. LeFevre.

The most common cause of death at the County Hospital was phthysis (tuberculosis) which killed five of the 21 who died. These were “recent arrivals from distant localities, too far gone to derive benefit from change of climate.”

A highlight of the 1889 County Hospital Report is its “Classification of Diseases” of patients treated at the County Hospital. Unlike the causes of death, this table summarizes the incidence of common ailments and injuries, and lists some of the chronic diseases affecting this population. There were seven leg amputations, although we are not told the reason—presumably trauma. Uninterrupted recovery was apparently made in each case. There was no mention of sexually transmitted diseases in Dr. Gochenauer’s 1888 Health Department Report, despite the flourishing of prostitution during the Boom in San Diego’s red-light district, the “Stingaree.”19 The County Hospital, however, turned up sixteen cases of syphilis, one of tabes dorsalis (a disease of the brain and spinal cord caused by late-stage syphilis), two cases of gonorrhea, and one of chancroid (a bacterial infection resulting in genital sores and swollen lymph glands). Among the indigent sick were ten alcoholics and one with cirrhosis of the liver. Tuberculosis of the lung was the most frequent infectious disease (19 cases of phthysis, including the 5 deaths). Other infections listed included malaria (10),20 typhoid fever (2), empyema, or lung abscess, which was fatal (1), a fatal iliac abscess (1) and an abscess of the liver (1), also fatal.

There had been several reports of inadequate facilities and lack of medical care or services at the County Hospital over the preceding years.21 An investigation by a San Diego Daily Sun reporter determined them groundless in 1888,22 but there were suggestions for improvement when Dr. Henry. S. Orme, head of the California State Board of Health, and Dr. Gerrard.G. Tyrell made a visit and inspection of the County Hospital on September 11, 1888.23

Many newcomers who suffered from tuberculosis and other chronic ailments came to San Diego with the hope of making a recovery aided by the healthful climate. Cities like San Diego and Los Angeles went out of their way to promote their climate to health-seekers of all sorts, but would have preferred not to count these newcomers among their local populations when they died. Nor, no doubt, would the former hometowns of the tuberculous expatriates choose to count these deaths in their own mortality statistics.

The reader should keep in mind that the patients of the County Hospital and Poor Farm were mostly men who had lost the ability to provide for themselves, whether from injury or disease. Almost all were born outside of California and most of them came from other countries. Far from home, without friends or family to support them during their time of need, most of them recovered and were discharged.


[Text of the original document is presented below.]




J.P. LEFEVRE, M.D., County Physician.

LEE H. ESTES, Superintendent of Poor Farm.



Title page










This Hospital was established July 1, 1872, and up to June 30, 1889, has accommodated 1,237 patients.24



It is located three and one-half miles from the City of San Diego, at the foot of the grade leading to Mission Valley, about midway between Old San Diego and the old Spanish Mission. The grounds and farm cover an area of 140 acres.


The Hospital is capable of accommodating about 60 patients. A plan is now being considered by the Board of Supervisors for the construction of several additional cottages for the accommodation of sick and indigent families.


Ward I is built in the shape of a T in two sections of 24×85 feet each, and will accommodate 32 patients. Ward 2 is 24×85 feet, having accommodations for 20 patients. Ward 3, built in the shape of an L comprises the Morgue, Carpenter Shop and Old Men’s quarters, and has accommodations for 8 patients. The dining rooms and kitchen are located between the two large wards, and have a floor area of 24×36 feet. The Superintendent’s quarters, a T shaped building of three rooms, is located immediately west of the dining rooms. His office is supplied with telephonic connection with San Diego and surrounding towns. The Store Room, 14×16 feet, and Laundry, 14×20 feet, are immediately east of the kitchen.


The farm is provided with two first-class windmills, chicken houses and general outbuildings.


The pipe has just been laid bringing water into the valley from the flume which supplies the city of San Diego, and now an abundance of pure mountain water is supplied to the hospital and farm.25


On this farm there are four acres of orchard under cultivation, producing figs, apricots and peaches; and having a few orange trees not yet bearing.


There are also about four acres of garden, producing vegetables enough to supply present demand.




[NOTE — Owing to change of administration which occurred about January 1st, 1889, the present officers are unable to give exact statistics as to expenses for the six months ending December 31st, 1888.]

The total amount expended from January 1, 1889, to June 30, 1889, for groceries, provisions, coal, milk, clothing, additional bedding, furnishing, etc., was $1,635.57, or an average of $272.59 per month.

The average number of persons fed has been 39.

Average cost of maintaining each individual per diem, 23 1-5 cents.

Superintendent and wife $100 00
Steward 50 00
Cook 50 00
Laundress 30 00
Assistant nurse 20 00
Total monthly salaries $250 00


Respectfully submitted,
L. H. ESTES,                        




Report showing number of patients remaining on the first of each month, the number admitted and discharged during the month and how discharged, for fiscal year ending June 30, 1889:




Two patients were transferred to the Stockton Insane Asylum.

Number remaining July 1,1888 38
Number admitted during year 222
Number discharged during year 174
Number remaining July 1, 1889 48




table   table




Of the twenty-one patients who died during the past year five were admitted in a dying condition. Two of these lived less than forty-eight hours after being brought to the hospital. The five who died from Phthisis were recent arrivals from distant localities, too far gone to derive benefit from change of climate.

  California 10  
  Other United States 83  
  Ireland 41  
  England 15  
  Germany 15  
  France 10  
  Norway 7  
  Scotland 6  
    Canada 4  
  Greece 4  
  Sweden 3  
  Nova Scotia 3  
  Finland 3  
  Mexico 2  
  Italy 2  
  Spain 2  
  South America 1  
  New Brunswick 1  
  Prussia 1  
  Austria 1  
  Jamaica 1  
  Portugal 1  
  Unknown     6  
            Total 222  

Males, 214; females, 8.

The number of indigent persons over sixty years of age who have resided in the hospital during the fiscal year ending June 30, 1889, has been 33.

The number remaining on July 1, 1889, is 14.


The number of indigent patients treated outside of the County Hospital during the six months ending June 30, 1889, was 114—17 were prisoners in the County Jail and 97 resided in the city of San Diego—distributed in months as follows: January, 23; February, 17; March, 19; April, 17; May, 16; June, 22.

  Expenditures for Drugs, Medicines, Surgical
Dressings and Appliances, Wines and Liquors.
  Month. For Hospital. Indigent and Jail. Total.
  January $52 35 $67 10 $119 45
  February $98 10 $40 65 $138 75
  March $49 05 $65 35 $114 40
  April $67 10 $34 40 $101 50
  May $73 10 $33 60 $106 70
  June $59 85 $57 95 $117 80
  Total $399 55 $299 05 $698 60

The number of patients treated at the Hospital for six months ending June 30, 1889, was 124. The average cost of medicines and supplies per capita for that period was $3.22.

The number of indigent patients treated outside the Hospital for the same period was 114, and the average cost per capita for medicines was $2.62.

Total number of visits made to indigents in the city of San Diego by the County Physician for six months, 196.



In order to learn the character of prevalent diseases, if any, throughout the County, and to collect other health statistics, the County Physician addressed circular letters to leading physicians of the principal localities within the County, and he wishes here to acknowledge his thanks for the ready response given to his inquiries.

From these replies it has been learned that there have been no epidemics and no contagious or malignant diseases in any of the localities heard from, during the past year, and the proportion of deaths to population has been remarkably small. In many places the practice of the physicians is confined in a measure to the treatment of non-residents suffering usually with pulmonary or bronchial troubles.

Below will be found the statements of the different physicians addressed:

Dr. M. R. Toland, of San Jacinto, in speaking of the healthfulness of the San Jacinto Valley, states that it has been especially free from all epidemics and contagious diseases during the past year, and that the proportion of deaths to population is about 2 to 1000. This Valley being about 1,500 feet above sea level, with air light and dry, and free from all fogs and dampness, makes the locality particulary healthful, as is evidenced by the fact that there has been very little sickness other than mild fevers.


Drs. Pruett & Parker, of Fallbrook, report an unusually healthy locality, with no disease very common or general, no epidemics of any kind, and state that the practice of medicine is principally confined to the treatment of non-residents.

Dr. J. Wadsworth Keene, of National City, furnishes a very flattering health report of his locality for the past twelve months. The death rate is about 5 or 6 to 1000, and many of the deaths were recent arrivals advanced in Phthisis. While there have been no epidemics during the past year, there were a considerable number of cases of malaria and fever during the year previous. This he considers due to the great amount of soil disturbance at that time, and which had a marked effect on the general health of the community.

Dr. H. P. Woodward, of Otay, who has practiced medicine for a number of years in New York and the Northwestern States, and for the last three years in Otay, is particularly enthusiastic, and claims that the San Diego Bay region is the most healthy spot in the United States, perhaps in the world. The almost total absence of sickness and mortality among children during the summer, as compared with other places, especially in the East, is remarkable, and is attributed to the extremely small variation of temperature.


Dr. L. N. Hilleary, of Poway, states that his district has been absolutely free from all epidemics, and that the most common disease has been a mild type of fever easily controlled, with no deaths during tile past year, and only twelve during the past six years.

Dr. D. B. Hoffman, of Helix, writes that Spring Valley, with a population of over 300, has been during the past year a very healthy locality. There has not been a single death, and the most common forms of disease are colds and mild fevers. There have been only four deaths from disease in three years.27

Dr. S. H. Washburn, of Elsinore, makes a report, similar to these received from the physicians of other localities in the County, as to absence of epidemics and contagious diseases in and around Elsinore during the year just past, except that whooping-cough was prevailing when he wrote. The proportion of deaths to population in that vicinity, according to his estimate, is about 8 to 1000.

Dr. H. E. Stroud, of Oceanside, writes that the condition of health in his locality has been most satisfactory, there having been no disorders of a contagious or epidemic character, no deaths from disease contracted there, and children having been remarkably free from illness. He very properly attributes this condition of affairs to the entire absence of unhealthy elements in the location of the town.

Dr. D. Gochenauer, Health Officer and City Physician of the City of San Diego, makes the following report:

1. This city during the last year has had only one death caused by contagious disease under your classification; that being a case of scarletina28, directly traceable to a filthy and unsanitary condition of the yard and defective drainage of the house.

2. We have more deaths to record from Phthisis Pulmonalis29 than from any other cause, (Thirty-four deaths from this disease during the past year.)

3. The estimated population of this City is 32,000. Total number of deaths from all causes during the year is 205, classified as follows:

    Zymotic Diseases 61  
  Cachectic ” (chronic degenerative) 30  
  Nervous “ 15  
  Heart “ 20  
  Accidental Deaths 6  
  Suicidal “ 2  
  Consumption 34  
  Pneumonia 20  
  Old Age 4  
  Not classified “ 13  
  Total 205  

4. The Hospital of the Good Samaritan, situated on the corner of Cedar and Union Streets, is regularly incorporated under the laws of the State of California, and is one of the best managed institutions of its kind to be found anywhere.30 This hospital is open alike to all, irrespective of creed or nationality. The medical staff of this institution is composed of medical gentlemen well known in this city, who stand at the head of their profession. Cleanliness and the best of discipline and order prevails, and the sanitary arrangements are good. A liberal endowment was bequeathed this institution by the late George J. Keating, but as the fund is not yet available the hospital is now supported by voluntary contributions. There are at present sixteen beds, but the managers intend soon to enlarge the building.

The city also maintains a free Receiving Hospital for the care of the indigent sick and injured. It is also the duty of the City Physician to attend all indigent sick at their homes in all parts of the city.

5. The following reliable chemical analysis of the Coronado Waukesha 31  water, from the springs recently discovered in the Otay Valley, is made by the eminent chemist, C. Gilbert Wheeler of Chicago, and bears favorable comparison with another of the celebrated waters:

The Analysis32 

.092 .135
Iron (sesquinide)
Sodium chloride
Potassium chloride
Potassium sulphate
Calcium sulphate
Calcium carbonate
Magnesium carbonate
Organic matter
Sodium sulphate
Sodium carbonate

6. There is no locality known where nature has done her part so well for perfect sanitary conditions as that which she has done for this section of our country. Our mortuary statement is the lowest of any I know of, and this may be still further reduced as the sanitary condition of our city is improved. Much defective plumbing and very unsanitary conditions otherwise still exist throughout the city; but as the general sentiment of our city government, as well as that of our people, is in favor of the best possible sanitary conditions, it is safe to say that our death rate for the coming year will be even less than that for the year just reported.



The very flattering reports from physicians in various portions of San Diego County show it to be one of the most healthy localities in the State; owing, perhaps, to the climatic conditions and small range of temperature; but in addition to this it is bountifully supplied with many kinds of mineral springs which, as far as have been tested, have proved to be very efficacious in relieving various maladies of a chronic nature.

Perhaps the most accessible of these watering places is the Carlsbad Mineral Springs, situated on the California Southern Railroad, about forty miles north of San Diego City. The water of these springs is rich in iron, sulphate and carbonate of magnesia, sodium and potassium chloride and free carbonic acid gas, in proper proportions to be mildly laxative, tonic and diuretic in character. Numerous testimonials from as many invalids show that these waters have produced marked improvement in health in a short time from their use.

At Elsinore, on the California Southern Railroad, about eighty-five miles north of San Diego, are located the Elsinore Hot Sulphur Springs. The bathing facilities here are particularly good, and are perhaps unsurpassed on the Pacific Coast. Dr. Alexander de Borra states that 2,000 patients have been successfully treated at these Hot Springs during the past year by the internal and external use of the hot sulphur water.

The Murrieta Hot Sulphur Springs are worthy of mention here. The water is soft and extremely pleasant for drinking and bathing, and many cures of rheumatism and kindred diseases are recorded from their use.

Dr. Toland mentions two mineral springs of considerable medicinal value at San Jacinto, but no complete analysis has been made of the water.

The Tia Juana Hot Sulphur Springs may be classed among the mineral springs of the County, as they are located immediately across the line, in Mexico, and the increased use of their waters by residents and tourists is a good testimonial of their value for sanitary purposes.

The Agua Caliente Hot Springs, located on Warner’s Ranch near Julian, are well known to residents of San Diego County, and are said to be of great value in the treatment of rheumatism and kindred diseases.

The Buckman Springs, situated twenty miles south of Julian, on the road to Campo, are cold soda springs. The flow is abundant; the water clear and sparkling and very pleasant to drink. It contains latent carbonic acid, which is liberated by agitation, so the water may be kept fresh by being bottled. When better known this will undoubtedly become a popular watering place.

The Volcanic Springs, near Volcanic Station on the S. P. R. R., and the springs of Dos Palmos, Coahuila Valley, are enumerated among the medicinal springs of this county.

There are numerous other mineral springs throughout the county, but owing to their comparative inaccessibility it is considered unnecessary to particularly mention them. In fact, nearly every locality is supplied with one or more which has been sufficiently used to give it local reputation.



San Diego County during the past few years has become noted for its mild and even climate, and might be called the Great Southwest Sanitarium. There is a constantly increasing demand for accommodations for Eastern and European invalids, which has caused the contemplation of numerous sanitariums.33

Within the past year several have been opened and are now in active operation. Among these may be mentioned the following:

Dr. William A. Edwards’ Sanitarium and Private Hospital, is situated on the crest of Florence Heights and overlooks the city and bay. It is accessible by two lines of street cars, and is replete with all that is essential for the comfort of invalids. None but well trained nurses are employed, and every facility is at hand for the skillful performance of surgical operations. The surroundings are pleasant and make this a most desirable home for those seeking change of climate, combined with skillful nursing and medical supervision.

Drs. Virginia W. Smiley and Lucia M. Lane have a private hospital at No. 1817 First Street. During the past year a variety of cases have been received and treated, and with recently increased facilities they offer a most desirable home to those in need of medical attention.

Mrs. Dr. Potts’ Sanitarium, recently opened, is located in Paradise Valley, near National City. The building is situated on a commanding eminence, overlooking National City and the Bay of San Diego. It is beautifully and completely furnished, and has baths on every floor. There are resident physicians and trained nurses in attendance. Owing to the tastefully laid out grounds, the natural beauty of the surroundings, and the complete arrangement of the institution, this is one of the most desirable homes for invalids on the Pacific Coast. It will accommodate about one hundred patients.

The Brewster Sanitarium, opened a short time ago, is located in the same valley, and is a beautiful and comfortable home for invalids.

The bathing sanitarium at Elsinore, previously mentioned under the head of “Mineral Springs,” is under the supervision of a resident physician and is well fitted for the accommodation of invalids.

The Day Nursery established in August, 1888, is a branch of the Woman’s Home Association, but having a separate Board of Managers, some of whom visit the institution every week. Although the original design was simply to care for children during the day, while the mothers were employed outside their own homes, yet to meet the demands of the time many children are regularly boarded and taken care of by the week or month. At present the County is allowing $10 per month each for several orphan children who are boarded and cared for at this institution.34

The San Diego Benevolent Association was organized several years ago by old residents of San Diego. Its object was to create a fund by voluntary contribution to aid the deserving poor of this city. Two years ago the amount on hand was between four and five thousand dollars. During the past year the applications for relief have been so numerous that the accumulated funds have become exhausted and the association bankrupt, after having relieved more than 300 families, besides many single individuals. The County Board of Supervisors kindly came to their assistance, allowing them $100 per month. This, with private contributions, has enabled the society to continue its generous work for the relief of suffering humanity.

Besides maintaining a combined hospital and almshouse, paying for the care of orphan children and assisting benevolent associations, many individual cases have been brought directly before the Board, and an allowance granted from the County contingent fund. Quite a number of individuals stranded here without money, who had homes in the East, but were unable to return to them and would have been on the indigent list had they remained, have been furnished transportation. These direct contributions have amounted to more than $1,000 during the past year.

It can truthfully be said that the Board of Supervisors has spent prudently the means at its command; that San Diego County has been liberal in dispensing charity, and that the sick and indigent have been well cared for.

Respectfully submitted,
J. P. LEFEVRE, M. D.,            
County Physician.

[NOTE.The present County Physician wishes here to note the satisfactory work done by Dr. Thomas Keefe, who filled the position last year; and to express his thanks to Dr. T. A. Davis, Dr. C. C. Churchill and Dr. Fred Baker, of the city of San Diego, for efficient counsel and assistance in surgical operations.]




1. First Annual Report of the San Diego County Hospital and Poor Farm to the Board of Supervisors, for the Year Ending June 30, 1889. J.P. LeFevre, M.D., County Physician. L.H. Estes, Supt. of Poor Farm. This report will be called the 1889 County Hospital Report. MS 149, file 2. San Diego History Center Research Archives.

2. “The first county hospital was in the old cobblestone jail which Haraszthy built at Old Town. It was used for a short time, and then, about 1869, a large frame house at Old Town was rented for the purpose.” William E. Smythe, History of San Diego, 1542-1908, San Diego, The History Company, 1908, p. 598.

3. Donna Fosbinder, M.S.N.,R.N., “Hospital Based Nursing Schools in San Diego, 1900-1970,” Journal of San Diego History, 1989, v. 35, no. 2, p. 100.

4. Edward Burr, M.D., who was a “graduate of Medicine and Surgery of the New York College of Physicians and Surgeons” agreed to “give medical and surgical attendance to the indigent County sick (without medicine) for the Sum of Two Hundred dollars a year.” July 6th 1868. MS 149, file 1. San Diego Historical Society Research Archives. Burr was County Physician from 1869-1871 and County Coroner from 1868-1871. Clarence Alan McGrew, City of San Diego and San Diego County, the Birthplace of California, 1922, pp. 434-435.

5. “Hospital Based Nursing Schools in San Diego,” p.100 .

6. “Selected Chronological List of San Diego County Officials,” Journal of San Diego History, Winter-Spring, 2001, p.123.

7. “New $60,000 County Hospital Completed,” by Dr. David Gochenauer, County Health Officer. Dr. Gochenauer discussed the new County Hospital, which had not yet opened, and the history of the County Hospital and Poor Farm. San Diego Union, January 1, 1904, p. 26.

8. The County also paid for the care of a “large number of indigents now being cared for outside of the County Hospital.” What appears to be an editorial in the Local News section suggests that “if all the cases now being relieved were unable to obtain relief except as they become inmates of the County Hospital, more than half of them would cease to be a public charge…. Whenever a case is known of parties receiving aid who are able to work, or who are not properly entitled to relief, let the fact be known to the Board and all such cases stricken from the charitable rolls.” The amount of relief being paid was estimated at “three hundred dollars per month, or possibly more—we do not have the exact figures.” There was concern even then that the system “places a premium on pauperism.” There were cases cited of parties “receiving charitable aid from the County, who at the time of making application were direct from Lower California, and were in no sense residents of the County for any other purpose than that of receiving its bounty.” San Diego Union, February 19, 1880. This may be an early example of the media unfairly fanning public sentiment. Mexicans accounted for only 2 of 222 patients in the County Hospital according to the 1889 County Hospital Report.

9. San Diego Union notice “by order of the Board of Supervisors,” dated August 14, 1878. There were originally nine proposals submitted. For some reason the matter was delayed and taken up again a year later. Minutes, San Diego County Board of Supervisors, October 7, 1878. San Diego Historical Society Research Archives, MS 149. File 1-18.

10. Some of these offers are on file in the Research Archives of the San Diego Historical Society. The offer from the Commercial Bank for sale of the Estudillo place is not among them. San Diego History Center Research Archives. MS 149, file 14.

11. Alonzo Horton was the first to sign this petition, which included the names of laborers, tradesmen, and prominent citizens such as Douglas Gunn, publisher of the San Diego Union; Drs. Peter Remondino, Robert Gregg and C.M. Fenn (then City Coroner); Ephraim W. Morse, City Treasurer; Joseph Coyne, Sheriff; William J. Hunsaker, attorney and future San Diego Mayor. San Diego Historical Society Research Archives, MS 149, file 2-1

12. The San Diego Union, Saturday, January 24, 1880. Three of these were among nine properties offered previously, but the Estudillo property was not included in that previous list of proposals. Minutes, Board of Supervisors, October 7, 1878.

13. The San Diego Union, Thursday, January 29, 1880.

14. Minutes, Board of Supervisors, January 28, 1880.

15. The site for the County Hospital and Poor Farm was purchased in 1880 by County Supervisors J.M. Pearce, Sam McDowell and Mr. Borden. “New $60,000 County Hospital Completed,” San Diego Union, January 1, 1904, p 26.

16. Describing the event, the San Diego Union reported: “Only a few witnessed the strange procession as the hospital folk had been careful not to announce it and thus draw a morbid crowd.” San Diego County General Hospital dedication brochure, August 21, 1963. San Diego County Department of Health, Box 25. San Diego State University Library, Special Collections.

17. Smythe, History of San Diego, p. 727.

18. Biographical Files, under “J.P.LeFevre, M.D.” San Diego Historical Society Research Archives. Handwritten notes refer to Joseph P. LeFevre, P & S (Physician and Surgeon), listed in San Francisco city directories of 1897 and 1903. Retyped from an original article in the San Francisco Examiner, March 6, 1892, which is not in the file. The previous County Physician, Dr. Thomas Keefe, was involved in some controversy in 1888. It was reported that “the assistant physician, Dr. LeFevre, was dispensed with and Dr. Keefe’s salary raised.” San Diego Sun, November 10, 1888. On December 6, 1888, the Board of Supervisors accepted Dr. Keefe’s resignation effective December 10, 1888, and appointed Dr. LeFevre to take his place. On January 18, 1889, the Board declared the office of Superintendent of the County Hospital and Poor Farm to be vacant when it became known that the current Superintendent was not a citizen of the United States, and they appointed L.H. Estes to that position. Minutes, Board of Supervisors.

19. “The Public Morals” counted thirty-five bawdy-houses, 120 lewd women, fourteen Mongolian prostitutes, three opium-joints, fifty licensed saloons, and more unlicensed places where liquor is sold. San Diego Union, Editorial, April 3, 1888, p. 4, column 1.

20. These may not have all been cases of malaria, which was not widespread in California. Fevers caused by other infections were probably responsible for most of these.

21. MS 149, box 1, file 24. San Diego History Center Research Archives.

22. There were newspaper reports of abuse of County Hospital “inmates,” including one of Superintendent McKay abusing an old German named John Wilson. San Diego Sun, November 10, 1888. A San Diego Daily Sun reporter visited the County Hospital and interviewed “an old soldier named Hannon,” who said he had received the best of treatment and well-cooked food during his three-month stay. The reporter also interviewed “an utterly helpless blind boy” named Cliff Carpenter, confined to bed because of his rheumatism, but quite intelligent and observant. The boy is quoted as saying that “before Mr. McKay became superintendent there were times when we were badly treated, but I have no complaints to make now—he is very kind to me.” Superintendent Lee H. Estes, noted in the 1889 County Hospital Report, must have been new to his position, for Mr. McKay was reported here to be superintendent of the County Hospital in December of 1888 “The County Hospital. An Inquiry into its Management and Condition.” San Diego Daily Sun, December 15, 1888, p. 5, column 1.

23. Following is the full text of the report from that inspection:

“Report of Committee on San Diego Hospital and Almshouse.

The committee appointed by the State Board of Health to examine into the sanitary condition and management of the San Diego County Hospital and Asylum, beg leave to report that at the date of visitation, September 11, 1888, the hospital contained forty-five patients; twelve receiving alms. We find the wards large, well ventilated, comfortably furnished, and clean. The bedsteads are iron, with wool mattresses. The food given to the patients is good in quality and quantity, but not well prepared, owing to a deficiency of help. The kitchen is small and not clean. The bathing facilities are sufficient, and each inmate gets a bath once a week. A detached building contains rooms for female patients. The dining room is small and not over clean. The privies are very dirty and need better attention.

The institution is well conducted, and no complaints were made except in regard to the cookery of the food, which can easily be remedied, but we must condemn the sanitary condition of the outhouses and the want of cleanliness in the kitchen and dining room. We stated these conclusions to the officers in charge, and they promised that this matter would at once receive their attention and be remedied.

The inmates appeared to be free from vermin, and had no complaint to make, upon private interviews with several.”

Tenth Biennial Report of the State Board of Health of California, 1888, p. 89.

24. It is not clear what event established the hospital on this cited date. There are plenty of references to a “County Hospital” before 1880, but there is no evidence that there was a dedicated structure for this purpose. There are letters from patients in the “County Hospital” complaining about their care. One is dated October 10th, 1879. MS 149, box 1, file 1-24. San Diego History Center Research Archives. Dr. Gochenauer called the county hospital system before 1880 an “itinerant plan,” one that caused patients to be moved from year to year, depending on the lowest bid that the County Supervisors received for the care of patients at some close-in ranch home. “New $60,000 County Hospital Completed,” an article by Dr. D. Gochenauer, County Health Officer. San Diego Union, January 1, 1904, p. 26.

25. The San Diego flume was built of redwood, six feet wide and 16 inches high. It could deliver millions of gallons of water per day to local farms and cities via its 36 mile-long aqueduct, through 4000 feet of tunnels and over hundreds of trestles as high as 86 feet and up to a half-mile long. “The San Diego Flume,” The Golden Era, v. 37, no. 11, 1888, pp. 610-612.

26. Twenty-one patients died at the County Hospital during the year, out of the total of 174 who were discharged, so it appears that the prospect was one of ultimate recovery and discharge for most patients.

27. Dr. David B. Hoffman was a pioneer San Diego physician who graduated from Toland Medical College in San Francisco and came to San Diego in 1853. He was the first president of the County Medical Society in 1870 and held many public offices over the years. He died in 1888, not long after he wrote to Dr. LeFevre that there had not been a single death in Spring Valley during the previous year.

28. Scarletina (or scarlatina) is an illness marked by a skin rash and caused by a streptococcal infection of the throat or tonsils. The terms scarlet fever and scarlatina are used interchangeably. Before the advent of antibiotics, there was no effective treatment and some patients became septic, or toxic. The instance referred to in the text was serious enough that the patient died. Defective drainage of the house was probably not the source of the bacteria, commonly passed from person to person.

29. Phthisis Pulmonalis meant tuberculosis of the lung. Consumption, mentioned in the table that follows, was the fatal wasting disease caused by tuberculosis.

30. The Hospital of the Good Samaritan opened in January 1889. “The institution cared for many patients, most of them charitable cases, at a time when San Diego had no other hospital.” “Daniel Cleveland, San Diego Patron,” Journal of San Diego History, v. 11, no. 1, 1965.

31. This appears to be an error in the text. The same table is printed in the 1888 Health Department Report, which states that this was a comparison of Coronado water with the “celebrated water of Waukesha, Wisconsin.” 1888 Health Department Report, p. 93.

32. “Hundreds have been cured of troubles, which had long resisted medical treatment, by using Coronado Natural Water simply as a beverage. This provision of Nature in so bountifully supplying these springs with an endless volume of pure, wholesome water, stamps Coronado as a sanitarium that has no equal, as well as a delightful retreat, where life is a continual pleasure.” Excerpt from an ad for the Hotel del Coronado, Journal of San Diego History, v. 12, no. 1, p. 7.

33. Local sanitariums and private hospitals became home to “Eastern and European invalids,” many with tuberculosis, who came to San Diego for the climate. “As a national sanitarium, San Diego is unsurpassed. Hundreds of invalids have been restored to health, or greatly benefited, by our health-giving climate…the late Prof. Agassiz whose testimony is worthy of the highest consideration, after spending some weeks in San Diego, thus expressed his opinion with regard to the climate, at a public meeting: ‘There is one advantage that I, as a scientific man, may lay more stress upon than is necessary; but I hardly think it possible. It is the question of latitude. You are here upon the 32nd parallel, beyond the reach of the severe winters of the higher altitudes. This is your capital, and it is worth millions to you.’” From a San Diego Chamber of Commerce pamphlet published in 1874, quoted by Richard Pourade in The Glory Years, p. 120.

34. The Woman’s Home Association was founded in 1887 and soon added a Day Care Nursery, becoming the Women and Children’s Home in 1889. After the Boom, the Woman’s Home Association changed its focus entirely to children. Kyle Emily Ciani, Master’s Thesis, “Surviving Through Prostitution: A Comparison of Los Angeles and San Diego Prostitutes, 1850-1890.” University of San Diego, 1991, pp. 101-102. Nursery workers believed that single parents should not have to raise their children alone, and they encouraged these parents to leave their children at the facility until a “proper” (which for them meant nuclear) home could be secured. Kyle Emily Ciani, Ph.D. dissertation, “Choosing to Care: Meeting Children’s needs in Detroit and San Diego, 1880 to 1945,” Michigan State University, p. 118. Both documents are in the Research Archives, San Diego Historical Society.