The Anatomy of an Archive: The Renée Hoffinger Papers

Introduction by Polina Ilieva

During the spring semester 2018 the archives team co-taught and facilitated a new History of Health Sciences course, the Anatomy of an Archive. The idea of this course was conceived by the Department of Anthropology, History and Social Medicine (DAHSM) Assistant Professor, Aimee Medeiros and UCSF Head of Archives & Special Collections, Polina Ilieva. Kelsi Evans, Project Archivist, co-facilitated the discussion sessions and Kelsi, Polina and David Uhlich, Access and Collections Archivist, served as mentors for students’ processing projects throughout the duration of the course.

The goal of this course was to provide an overview of archival science with an emphasis on the theory, methodology, technologies and best practices of archival research, arrangement and description. The archivists put together a list of collections requiring processing and also corresponding to students’ research interests and each student selected one that she/he worked on with her/his mentor to arrange and create a finding aid. During this 10 week long assignment students developed competence researching and describing an archival collection, as well as interpreting the historical record. At the conclusion of this course students wrote a story about their experience and collections they researched for the archives blog. In the next three weeks we will be sharing these posts with you.

This week’s story comes from Aaron J. Jackson, PhD student, UCSF Department of Anthropology, History and Social Medicine. 

Post by Aaron J. Jackson

In the Spring term of 2018, my fellow History of Health Sciences (HHS) students and I in the UCSF Department of Anthropology, History & Social Medicine (DAHSM) had the opportunity to take a class on archival science with the staff of the UCSF Archives and Special Collections. Led by Archivist Polina Ilieva, Ph.D., and DAHSM Assistant Professor Aimee Medeiros, Ph.D., this class provided us with an overview of archival science with an emphasis on theory, methodology, and best practices of archival research, arrangement, and description. Most of us had used archives in the past—I even had experience with the UCSF Archives and Special Collections through a blog on the experiences of Base Hospital No. 30 in the First World War—but few of us really understood how archives work, how collections are cultivated and maintained, or the considerations that go into archival collection, assessment, processing, preservation, and presentation. This class provided us with a rare insight into a sector of knowledge production that is all-too-often taken for granted by historians.

UCSF Archives and Special Collections Reading Room and Parnassus Storage Facility.

Many historians and other scholars—myself included, before this class—believe that archives are mere repositories of historically-important data, objective interlocutors who merely preserve the past. Material is collected, inventoried, and stored for future researchers to come along and “discover” the contents and subsequently draw out the stories therein; yet, this is a myth, and one that Drs. Ilieva and Medeiros intended to dispel in their students. To achieve this task, students were allowed to choose from a list of as-yet unprocessed collections. We would be assigned an archivist mentor and process the collections while also meeting each week for a seminar discussion on the historical development and modern concerns of archival science. With my own interests rooted in the history of veterans’ care, I choose the Renée Hoffinger papers because the accession record indicated (with my emphasis) “Renee Hoffinger, MHSE, RD worked in the field of substance abuse for over 20 years at the North Florida/South Georgia Veterans Health System in Gainesville, FL.” While I did not find much of use for my own research, what I discovered while processing the Renée Hoffinger papers will undoubtedly prove to be far more beneficial in the long run.

The Provenance of the Renée Hoffinger Papers

Renée Hoffinger, MHSE, RD, image from “Dietetic Career Spotlight: Renée Hoffinger, MHSE, RD,” by Sarah Koszyk, MA, RDN, https://www.nutritionjobs.com/blog/blog/dietetic-career-spotlight-renee-hoffinger-mhse-rd/, accessed June 3, 2018.

Renée Hoffinger has been a dietitian since 1982 and interested in nutrition and HIV/AIDS since pursuing a health sciences education in the 1990s. While processing her collection, I had the pleasure of being able to correspond with Renée about her collection and why she donated her papers to UCSF’s AIDS History Project. She noted that her experience of researching HIV/AIDS and providing care for patients in Gainesville was vastly different—in terms of support and information availability—than that of health professionals in larger cities like New York, San Francisco, and Miami. During her volunteer work at the North Central Florida AIDS Network, Renée said she was “given a desk and access to patients at the HIV clinic at the local health [department], and spent a lot of time at the medical library tracking down any information I could get my hands on…. Not feeling like I knew very much, I soon unwittingly became the local ‘expert’ on nutrition and HIV.” Renée spent the rest of her career working with other dieticians interested in HIV/AIDS, and even after her retirement in 2013, she has continued writing about and leading hands-on nutrition education workshops. She had heard about the UCSF AIDS History Project and reached out to Archivist Polina Ilieva to find out how she could contribute, and so she decided to donate her papers to the archive.

This story reveals more than just the background of how Renée Hoffinger’s papers ended up at UCSF to be processed by a first-year Ph.D. student in the HHS program. It provides an anecdotal example of how collections end up in archives. Polina Ilieva’s background as an archivist does not make her an expert in HIV/AIDS nutrition, but it does give her training and insight into what future researchers may look for when investigating the history of AIDS and how contemporary medicine attempted to address it. Renée Hoffinger’s papers are stored at UCSF because they provide a small window into how parts of the country outside the urban epicenters of the disease and aspects of medicine not usually associated with the disease dealt with the epidemic’s effects. Thus, Ilieva decided to choose to take on the archival responsibility for the Hoffinger papers—to assess their potential value, to inventory and process their contents, to build finding aids that would serve future researchers, and to be responsible for maintaining the artifacts in the collection for the use of future generations. But she could have just as easily chosen to leave the responsibility to others for any number of reasons including limited archival space and funding, or because the archivist felt the collection would be a better fit elsewhere. In other cases, archivists actively solicit new collections, seeking permission to preserve the data. The decision to donate/accept the papers was therefore only the first step in the archival preservation of data, and it calls to question: what is missing from archival collections, and why?

Archival Concerns and Overhead

A Selection of HIV-AIDS Nutrition Documents from the Hoffinger (Renée) Papers at UCSF.

The story of how the Hoffinger papers came to reside in UCSF’s archives was only the beginning of a journey in what, at times, could seem like a foreign country. The archives have a unique vocabulary and vernacular. Archivists may speak of the accession or deaccession of artifacts or collections. Their language includes terms like “provenance” and “fonds” as well as concepts like “original order” and “finding aids.” Many of these terms may seem somewhat familiar, but their meaning within the archival space can often be different than the assumptions of those outside it, and those meanings can change over time, which is only one of the difficulties that archivists have to navigate in their mission to collect, preserve, and process archival collections. They put a great deal of work into cultivating collections, processing their contents in accordance with laws, regulations, and industry standards, and making the product of that work available to their target audience, which is often the public but may be restricted in some cases. For example, archivists at healthcare institutions like UCSF must pay special attention to the privacy restrictions of the Health Insurance Portability and Accountability Act (HIPAA). They also need to concern themselves with copyright protections and dozens of other concerns, including securing funding and finding the manpower to process and reprocess miles of archival material. For reference, a 12 x 10 x 15 inch banker’s box contains only 1.25 linear feet of material by archival measurement standards—all of which requires storage space that not only protects the archived data but makes it available to public access. Digitization of archival material puts more stress on archivists’ time and resources, not less, as someone has to digitize the materials and provide for electronic storage and access points, often in addition to caring for the original documents. And all of this can be further complicated by unwilling donors. Some communities, particularly those who have been traditionally marginalized, are difficult to archive, requiring archivists to build long-neglected relationships and partnerships to preserve those aspects of history. In other cases, such as the UCSF Industry Documents Library, many of the contents are collected through court order from institutions who are less than thrilled to be forced to hand over internal documents. Such collections often require extraordinary processing efforts precisely because the donors are uncooperative, leaving the archivists to do their best to understand and arrange the documents in a useful manner.

The Contents of the Renée Hoffinger Papers

The Hoffinger Collection Contains AIDS Line Documents and Industry Publications.

In the case of the Hoffinger papers, the process was relatively straightforward. Renée Hoffinger, being alive and well at the time she deeded her papers to UCSF. The collection includes no patient records, so HIPAA was not a concern. Some of the documents are protected under copyright and therefore not likely to be digitized and posted online, but researchers are always welcome to view the documents in person. Regardless of the relative simplicity of this collection, I realized that what goes into the archives is very much the result of a creative and complicated process of selection, compliance, and access on the part of both the author of the papers and the archivists who collect and process them. In other words, archivists play an important role in precisely what is preserved, and this is something that researchers should keep in mind.

Patient Handouts & North Central Florida AIDS Network Newsletters.

The Hoffinger papers contain information chronologically ranging from 1980 to 2006, topically from the concerns of nutrition on AIDS/HIV wasting syndrome, lipodystrophy, prescription medications, substance abuse, alternative medicine, steroids, protocols, and phosphatidylethanolamine drug combinations known as AL-721 and COQ. Hoffinger also included various publications including many AIDS Nutrition Services Association conference materials and presentations, industry and lay press publications, presentations, course syllabi, and patient handouts and publications. Her papers reflect more than twenty years of professional work in the interests of her patients. How future researchers use these materials is impossible to predict, but it is important that when they access this collection, they understand the role played by everyone involved in the collection, from Renée Hoffinger’s selection of materials to donate and UCSF’s willingness to preserve the papers, to a relatively inexperienced history Ph.D. student who helped process the collection and build the finding aid—the collection of metadata that helps researchers find useful materials within the archives—all played an important role in creating, processing, and preserving this information. If you are interested in this collection or others, you can visit the Renée Hoffinger papers at the UCSF Archives and Special Collections. I would also highly encourage anyone interested in the wealth of information available in this collection to provide feedback to the archivists about this collection or any others that you may explore. Would a certain keyword or phrase be useful to others if included on the finding aid? Did you encounter confidential information that was not flagged as such? Did the archives raise questions about potential gaps in the record? These things and others are useful bits of information that the archivists would appreciate.

The Anatomy of an Archive course in the Spring term of 2018 provided students with an invaluable insight into the behind-the-scenes processes of archival work. It helped us identify some professional blind spots and to think critically about archival data. It also helped us earn a profound appreciation for all the work that our archivists do for their fellow scholars and for their role in helping to create, not just preserve, the historical record. And if there is one invaluable piece of advice I can pass along, it is this: when starting your research, always ask an archivist for help. They know their archives better than anyone else and asking their advice will likely save hours of frustration and/or bear unforeseen fruits. And when you ask them for help, make sure to ask about the provenance of the collections you research. It will not only show that you appreciate their work but also provide you with invaluable information in how you approach your research.

Acknowledgements

This blog post was possible not only because it was a requirement on the syllabus, but because this course provided the author with a novel opportunity to peek behind the curtain. It is with the sincerest thanks to Dr. Aimee Medeiros and archivists Dr. Polina Ilieva, Kelsi Evans, and David Uhlich for making this experience possible and to Renée Hoffinger for being so indulgent with a graduate student’s questions. I would also like to extend appreciation to UCSF digital archivist Charlie Macquarie and Dr. Mario Ramirez of Indiana University for taking the time to join our seminar session discussions and to the members of the Archivists and Librarians in the History of Health Sciences association for so warmly welcoming a historian like me among their ranks. I will endeavor to do for my students what all of you have done for me. Thank you.

Base Hospital No. 30, One Hundred Years Later – Part Two: France

This is a guest post by Aaron J. Jackson, PhD student, UCSF Department of Anthropology, History and Social Medicine. 

One hundred years ago, the men and women of U.S. Army Base Hospital No. 30—the University of California School of Medicine Unit—arrived in France to support the American war effort after more than a year of preparation in the United States. They had already faced many challenges by the time they first set foot in Europe, including navigating the Army bureaucracy, going through extensive military and medical training, traveling from San Francisco to New York, and treating thousands of soldiers who had developed acute infections as a result of the massive mobilization efforts taking place in 1917 and 1918. They crossed the Atlantic in late April and arrived in France in May, expecting to occupy a prepared site, where they could set to the important work of caring for America’s wounded soldiers as the American Expeditionary Forces moved into the Western Front and helped blunt the German Spring Offensive of 1918. But they would still have to overcome significant obstacles before that work could begin. In this entry—the second part of four planned posts—I will cover the experience of Base Hospital No. 30 as they landed in France and made preparations to support the wounded between May and June, 1918. These stories are derived from primary source materials on Base Hospital No. 30 kept at the UCSF Archives & Special Collections, and it is with great appreciation to the archivists there that I am able to write about the experiences of the men and women of the University of California School of Medicine and their experience in the Great War. If you have not done so yet, please read Part One: Organization, Mobilization, and Travel here.

The U.S.S. Leviathan arrived in Brest, France on May 2, 1918. The port city at that time was a bustle of activity as the Americans established supply depots and warehouses and scrambled to offload the massive influx of war materiel and men arriving from across the Atlantic. Base Hospital No. 30 was but one of hundreds of American units transitioning into France at the time. Until that point, the unit managed to keep track of the $100,000 worth of Red Cross supplies and equipment it had drawn from the quartermaster and medical supply depot back in San Francisco. But with everything operating at a frantic pace in Brest, they found it impossible to ensure that these supplies remained with the unit. They received orders to board a train for Royat a mere two days after arriving in Brest, and while they were assured that their supplies would catch up, Lieutenant Colonel Eugene S. Kilgore later recalled that the unit was “dismayed at the apparent rough handling of [their] cargo in shipment, and were not surprised that much of it failed to reach us in Royat.”

Figure 6 – Royat Advertisements ca. 1900-1910.

“Royat les Bains is a small town, situated in the very heart of France, in the Auvergne Mountains,” begins the U.S. Army Hospitalization Report prepared by acquisition officers who scouted the location and rented the buildings that Base Hospital No. 30 was to occupy. Royat was (and remains) a spa town that advertised its natural hot springs and a history dating back to the Roman occupation of Gaul—the Romans constructed baths that utilized the hot springs, making Royat’s tourist heritage a truly ancient affair. Unfortunately, for an American hospital unit interested in operating a modern medical institution, Royat’s ancient roots left much to be desired, despite its charms.

In their hospitalization report, the acquisition officers noted that the town was “clean, quiet and healthful” with plenty of fresh air and sunshine—an atmosphere that attracted a clientele “of a very high class, comprising, as it does for the most part, the wealthy and nobility.” Due to this, the acquisition officers noted that the rents were quite high in Royat, but the environment seemed appropriate to them for a hospital due to the town’s reputation as a health resort and the advertised healing properties of its thermal springs, which “are taken for gout, rheumatism, gravel, kidney and bladder trouble, and… anemia, blood trouble, diabetes and dyspepsia.” With this in mind, the acquisition officers rented eleven buildings—eight hotels, one villa, one casino, and one garage—for the purposes of establishing a base hospital in the town. They left detailed instructions for the officers of Base Hospital No. 30 regarding the costs of tram fares to the nearby city of Clermont, the costs of maintaining and operating telephone service in the rented buildings, and how to go about securing sewage and garbage disposal. They were even so helpful as to provide the locations of local laundries and markets and to coordinate with local restaurants and cafes to ensure that price lists were printed in English as well as French “to prevent the unfair exploitation of foreigners.” However, they advised the officers of Base Hospital No. 30 that, as elsewhere in France, manpower for labor was in drastically short supply as almost all of it was involved in the war effort. They warned that the enlisted men of the hospital unit would likely be tasked with “street cleaning and watering and removal of rubbage and waste,” for which the local municipality would be grateful.

In short, while the acquisition officers obviously considered Royat to be an ideal location for a hospital due to its atmosphere, access to clean water, location relative to a railway, and the availability of seemingly suitable buildings—assuming, of course, that one believes a hospital and a resort hotel are sufficiently alike as to seem suitable—they noted that Base Hospital No. 30 would have its work cut out for it. The acquisition officers had done what they could and moved on. The rest would be up to the medical personnel, some of whom arrived in Royat on the morning of May 7, 1918, and immediately set about the task of transforming the sleepy spa village into a modern medical facility.

The nurses of Base Hospital No. 30 were diverted to Vichy, France for a short stay while the men went ahead to prepare the hospital site. In Vichy, the nurses attached to Base Hospital No. 1, which had organized out of Bellevue Hospital in New York City. While there, the nurses tended to a number of personnel who had contracted measles, which head nurse Arabella Lombard described as “a childhood pleasure evidently foregone in younger days.”

In Royat, Base Hospital No. 30’s officers immediately noted that the requisition team had secured the most undesirable hotels in the town and that the task before them to prepare the site to receive patients was indeed Herculean. The kitchens, primarily located in hotel basements, were particularly bad. Lt. Col. Kilgore later recalled in The Record that the kitchen in the hotel Continental was a veritable dungeon, but it had to be used because the adjoining mess hall was the only place large enough to install the main patients’ kitchen. Unfortunately, concerns about the kitchens were only the beginning.

The electrical supply, generated by hydraulic powerplants and initially reported to be ample, was found to be woefully insufficient in the dry summer months, leaving the hospital without electricity three days out of every seven and without power to run the new X-ray and laboratory incubator equipment. The hospital personnel installed multiple gas lines only to find that France’s coal scarcity reduced the gas pressure to such a point that the lines were practically useless. Worse, the water supply to the hotels, intended for a few dozen tourists, was inadequate for the needs of a several-hundred bed hospital. After installing a make-shift shower and bath system, hospital personnel discovered that it could not be operated without completely depriving at least one of the hotels of water entirely, and it was necessary to carry water in buckets up several flights of stairs in order to operate toilets and wash dishes. In spite of these complications, hospital personnel were able to establish well-prepared surgical clinics and patient wards, but the continuous complications they encountered certainly made the work more difficult than they anticipated.

The many complications were frustrating, “but worse than all these together was the hopeless inadequacy of the drainage system,” reported Lt. Col. Kilgore. Only two of the buildings had direct access to sewer lines with the rest relying on antiquated cesspool systems that were, again, intended to service the needs of at most a few dozen tourists. Kilgore noted that, “even in our condition of what we felt to be disgraceful water economy, it was evident that the numbers we put in the buildings and the use they made of water was greatly in excess of that contemplated by those who have used the buildings heretofore as summer hotels and boarding places. And very shortly after our hospital became open to patients, our cesspools began to overflow.” This problem was compounded on multiple levels. First, the only way to deal with an overflowing cesspool was to have it pumped by the Societe d’Assainissement of Clermont, whose horse-drawn steam pump and tank wagons—dubbed “honey wagons” by the Americans—had to serve the entirety of Clermont and Royat and so required three weeks’ advance notice for services. This was an impossible situation for Base Hospital No. 30 as the cesspools would overflow again as soon as seven days after they had been emptied, and even when the honey wagons could be secured, they were insufficient to empty all the hospital’s cesspools at one time, often leaving the work half done, at best. And if the misery of overflowing cesspools alone was not enough, the pools were often located directly under the hotel basements, where the kitchens were often located, including the main patients’ kitchen in the basement of the Continental. Thus, when the Continental’s cesspool overflowed, it did so directly into the newly refurbished main patients’ kitchen and dining hall. The officers and enlisted men attempted to deal with these issues as they were able, but they often lacked the tools and experience necessary to properly tackle the various tasks. The problems grew so great that the Army was forced to divert an engineer detachment from the front lines in August to install better drainage, additional cesspools, showers, wash troughs and heating stoves.

The nurses arrived from Vichy on May 23 and found that the hospital was far from the promised state of preparedness required. They immediately set to work sanitizing the hotels to “get them ready for the boys from the front,” as Arabella Lombard put it. The nurses scrubbed the rooms so thoroughly that one of the officers remarked that “three coats of paint were scrubbed off before we considered the buildings ready for occupancy.” It was hard work that left the nurses weary and sore, but there were breaks. On May 28, the nurses were invited to celebrate Decoration Day—the precursor to Memorial Day, celebrated in honor of the Civil War dead through the decoration of grave markers—with an aviation unit stationed in nearby Clermont. They observed an afternoon of sports, enjoyed a buffet dinner outside the Red Cross Headquarters overlooking the hills and the setting sun, and were entertained by a band concert, speeches, and dancing after dark.

By June, the men and women of Base Hospital No. 30 were still dealing with the cacophony of unforeseen difficulties associated with occupying Royat. The cesspools were still overflowing from time to time, the water and electrical supplies were still inefficient, the enlisted men were still helping clean the streets of Royat and installing new kitchens, and some of the old hotel rooms remained to be cleaned and refitted for the purpose of housing patients, but the hospital was operational enough to receive its first trainload of patients on June 12, 1918. Thankfully, the 360 patients aboard the train were convalescent for the most part, but even so these men represented a significant difficulty for hospital staff as the kitchen installations were not yet complete.

After more than a year of preparation for the deployment to France, the men and women of Base Hospital No. 30 found themselves scrambling to prepare their ad hoc hospital to receive patients, and time had run out. Patient trains were arriving, and the hospital was about to get very busy indeed. Approximately five-hundred kilometers north of Royat, near Château-Thierry, the German Spring Offensive of 1918 was grinding forward as the Germans attempted to cross the Marne River. Standing in their way were the men of the 5th and 6th Marines and the 9th and 23rd Infantry. The resulting fighting was among the most intense experienced by any Americans in the war, and as Base Hospital No. 30 attempted to figure out how they were going to feed their first trainload of convalescent patients, several more hospital trains carrying troops fresh from the front lines and in need of surgery were making their way to Royat.

In Part Three of this four-part blog installment, we will explore what Lt. Col. Kilgore characterized as the “Work of the Hospital” in treating battlefield casualties and how they dealt with the Influenza Pandemic of 1918. We will also discuss the experiences of the forward-deployed surgical teams led by Lt. Col. Alanson Weeks (Surgical Team No. 50) and Maj. Herbet S. Thomson (Surgical Team No. 51), who operated under extreme conditions between June 1918 and the Armistice in November.

Figures:

5 – “Loading at Brest for a Long Journey,” circa 1918, Woolsey (John Homer) Papers, UC San Francisco, Library, Special Collections, Calisphere, https://calisphere.org/item/8caee2bc-704e-4647-9218-d32ed2a4d9c8/, accessed May 21, 2018.

6 – “Royat Advertisements,” author’s compilation from “Affice Chemin de Fer D’Orleans Auvergne Geo Dorival,” circa 1910 (left) and “Royat Vintage Poster” by Gustave Fraipont, c. 1900 (right).

7 – “Base Hospital #30 at Royat, France,” ca. 1917-1919, Woolsey (John Homer) Papers, UC San Francisco, Library, Special Collections, Calisphere, https://calisphere.org/item/2cb5cbf5-d0c0-412a-9e15-a161a291d1e2/, accessed May 21, 2018.

8 – “Surgical Clinic, Metropole Hotel,” 1918, Base Hospital #30 Collection, UC San Francisco, Library, Special Collections, Calisphere, https://calisphere.org/item/b7ca9276-989e-468f-adb2-ece162e4ad01/, accessed May 21, 2018.

9 – “Base Hospital #30 Nurses,” 1918, Woolsey (John Homer) Papers, UC San Francisco, Library, Special Collections, Calisphere, https://calisphere.org/item/500d7be8-79c5-430e-86f6-f3a15d3a0d87/, accessed May 21, 2018.

10 – “Hospital Train with Hiram Miller and ‘Rug’ Ruggles,” 1918, Woolsey (John Homer) Papers, UC San Francisco, Library, Special Collections, Calisphere, https://calisphere.org/item/f4ec0c1f-b30c-48b4-9746-2d34420fcc4d/, accessed May 21, 2018.

Early Days of the San Francisco Emergency Service: From the Police Infirmary to Mission Emergency

This is a guest post by Griffin Burgess, ZSFG Archivist.

The first San Francisco City and County Hospital located on Potrero Avenue was completed in 1872, but it was far from the city center and difficult to get to, which made it less than ideal for emergency cases.

At the time, City Hall housed the police prison, which included an infirmary. This infirmary always had a physician present, so the police and the public became used to using the prison infirmary for emergencies. In 1877, the city formally changed the prison infirmary to the Receiving Hospital and put the Department of Public Health in charge of it.

While the Receiving Hospital provided emergency care to anyone who needed it and played an important role in providing care to the people of San Francisco, the city had no ambulances. To help with this, the police department purchased Chicago-style police patrol wagons, which could carry a stretcher and transport the sick or injured.

In 1893, The World Columbian Exposition and Fair was held in Chicago, Illinois. The new publisher of the San Francisco Chronicle, Michael de Young, attended the fair and saw the working display of the new Studebaker horse-drawn ambulance. When the fair that he organized in San Francisco the next year needed an ambulance, he sent away for a Studebaker ambulance to serve the fair’s hospital.

The first San Francisco ambulance in front of Park Emergency Hospital on Stanyan Street, circa 1910.

After the fair, the Studebaker sat in a warehouse until two members of a women’s society group, Theresa Fair Oelrichs and her sister Virginia Fair, bought it and donated it to the Receiving Hospital. It was up to the city to buy the horses, which was done after a bit of politicking.

The director of the Receiving Hospital, Dr. George Somers, insisted that the ambulance be staffed by interns so that medical care could be provided immediately and en route to the hospital, a unique idea at the time. The ambulances were staffed by male nurses until WWII, when former medical corpsmen began working ambulances. Paramedics were introduced in 1973.

Ambulance in front of the temporary Central Emergency, built after the 1906 earthquake. From left to right: James O’Dea, Annie Andrew, Dr. Fred Zumwalt, Theresa Gile, Charles Bucher RN, William Sullivan, John Thoma (in ambulance).

The 1906 earthquake and fire destroyed much of the city, including City Hall and the Receiving Hospital located in its basement.  A new, temporary Central Emergency building in Jefferson Square on Golden Gate Avenue was the first structure completed after the quake.

Ambulance in front of the temporary Mission Emergency building at 23rd St. and Potrero Ave. Circa 1915.

The first Mission Emergency opened in 1909 at 23rd and Potrero. It was later demolished when the red brick San Francisco City and County Hospital was completed and the new Mission Emergency at 22nd and Potrero was opened in 1917.

In 1912, the Emergency Service received its first automobile ambulance. It was stationed at Park Emergency Hospital so that drivers, who until then had only driven horse-drawn ambulances, could learn to operate it on the relatively empty roads of Golden Gate Park.

Ambulance beside Mission Emergency at 22nd and Potrero Ave, completed in 1917. Photo circa 1920.

Not all of the drivers adjusted well to the switch to automobiles, however. “One of the Park Emergency ambulance drivers eventually required transfer to another City department. On his transfer orders, the hospital’s surgeon wrote, ‘… after numerous attempts to convince him to the contrary, this driver still persists in trying to stop the automobile ambulance by pulling back on the steering wheel as hard as he can and screaming at the top of his lungs, ‘Woooh there!’ I feel he is better suited for a department that still uses horses.'” (From Catastrophes, Epidemics and Neglected Diseases by F. William Blaisdell and Moses Grossman, page 134).

Ambulance at Central Emergency Hospital, circa 1930s.

The new City and County Hospital was one of the most modern complexes in the country and Mission Emergency soon became the hospital best equipped to care for the severely sick and injured, with updated operating rooms, staff, and equipment. By the end of the 1930s, all of the city’s ambulances were taking emergency cases to Mission Emergency rather than the Central Emergency hospital in Civic Center.