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University of California Berkeley 



Regional Oral History Office University of California 

The Bancroft Library Berkeley, California 

University History Series 
School of Public Health Oral Histories 



Henrik Blum, M.D., M.P.H. 

EQUITY FOR THE PUBLIC'S HEALTH: CONTRA COSTA HEALTH OFFICER; 
PROFESSOR, UC SCHOOL OF PUBLIC HEALTH; WHO FIELDWORKER 



With an Introduction by 
Dr. William C. Reeves 



Interviews Conducted by 

Caroline Crawford 

in 1997 



Copyright 1999 by The Regents of the University of California 



Since 1954 the Regional Oral History Office has been interviewing leading 
participants in or well-placed witnesses to major events in the development of 
Northern California, the West, and the Nation. Oral history is a method of 
collecting historical information through tape-recorded interviews between a 
narrator with firsthand knowledge of historically significant events and a well- 
informed interviewer, with the goal of preserving substantive additions to the 
historical record. The tape recording is transcribed, lightly edited for 
continuity and clarity, and reviewed by the interviewee. The corrected 
manuscript is indexed, bound with photographs and illustrative materials, and 
placed in The Bancroft Library at the University of California, Berkeley, and in 
other research collections for scholarly use. Because it is primary material, 
oral history is not intended to present the final, verified, or complete 
narrative of events. It is a spoken account, offered by the interviewee in 
response to questioning, and as such it is reflective, partisan, deeply involved, 
and irreplaceable. 



************************************ 



All uses of this manuscript are covered by a legal agreement 
between The Regents of the University of California and Henrik Blum 
dated May 1, 1997. The manuscript is thereby made available for 
research purposes. All literary rights in the manuscript, including 
the right to publish, are reserved to The Bancroft Library of the 
University of California, Berkeley. No part of the manuscript may 
be quoted for publication without the written permission of the 
Director of The Bancroft Library of the University of California, 
Berkeley. 

Requests for permission to quote for publication should be 
addressed to the Regional Oral History Office, 486 Library, 
University of California, Berkeley 94720, and should include 
identification of the specific passages to be quoted, anticipated 
use of the passages, and identification of the user. The legal 
agreement with Henrik Blum requires that he be notified of the 
request and allowed thirty days in which to respond. 

It is recommended that this oral history be cited as follows: 



Henrik Blum, M.D., M.P.H., "Equity for the 
Public's Health: Contra Costa Health 
Officer; Professor, UC School of Public 
Health; WHO Fieldworker, " an oral history 
conducted in 1997 by Caroline Crawford, 
Regional Oral History Office, The Bancroft 
Library, University of California, 
Berkeley, 1999. 



Copy no. 




Dr. Henrik Blum, Professor of Health Planning and Policy, 
UCB, 1984; Chairman of HEALS HMO, Chairman of Alta Bates 
Hospital. 



Cataloging information 



BLUM, Henrik L. (b. 1915) Public health educator 

Equity for the Public's Health: Contra Costa Health Officer; Professor. UC 
School of Public Health; WHO Fieldworker. 1999, xii, 425 pp. 

Growing up on a farm in Napa; UC Berkeley, 1931-1937; UC San Francisco 
Medical School, 1942; military service, 1942-1946, US Public Health 
Service: venereal disease research projects, faculty position at Johns 
Hopkins; Rockefeller Research Fellow, Stanford; M.P.H., Harvard, 1948; 
County Health Officer, Contra Costa County, 1950-1966: the multipurpose 
healthcare worker, sanitation, mental health, birth control, the Orinda 
Vision Study; Professor, School of Public Health, UC Berkeley, 1966-1984: 
health planning curriculum, affirmative action, authoring health planning 
texts, Joint UCB-UCSF Medical Program; Alta Bates and Herrick Hospitals, 
HEALS HMO, thoughts about managed care; international fieldwork with the 
World Health Organization in Sri Lanka, Colombia, Chile, 1970-1973; with 
the Agency for International Development in Nepal, 1977; health care in 
Europe and Australia, American Samoa and Northern Marianas; Fulbright 
teaching fellow in Sweden, 1986; teaching health planning in China, 1987; 
Over 60 and On Lok health programs. 

Introduction by Dr. William C. Reeves, Professor emeritus, UC 
Berkeley School of Public Health. 

Interviewed by Caroline C. Crawford in 1997 for the School of Public 
Health Oral History Series. Regional Oral History Office, The 
Bancroft Library, University of California, Berkeley. 



ACKNOWLEDGMENTS 



The School of Public Health and the Regional Oral History Office, on 
behalf of future researchers, wishes to thank the following individuals and 
organizations whose contributions made possible this oral history of Henrik 
Blum. 



Anita Addison 
Balan and Gurdeep Arakoni 
Katherine Armstrong 
Richard Bailey 
Willa Baum 
Cheryl Belcourt 
Joan and Howard Bloom 
Sandra and John Boeschen 
Patricia and Richard Buffler 
Chin Long and Fu Chen Chiang 
Joanna Ciaglia 
Sylvia De Trinidad 
Anne Donnelly 
Eleanor Fletcher 
FMC Foundation 
David and Sylvia Frost 
Margaret Hall 
Judith Hibbard 
Pat and Harry Hosel 
Sharron Humenick 
Carlessia Hussein 
Lucy Johns 

Donald and Inez Johnson 
Olive Johnson 
Kaiser Pennanente 
Barry Kaplan 
Jane Kenyon 
Margo Kerrigan 
Kathryn and Niels Kjellund 
Joyce and Richard Lashof 
Dan Lindheim 

Richard and Roselyn Lindheim 
Memorial Trust 



Susan Lindheim 

James Lubben 

Merle Lustig 

Dextra Baldwin McGonagle 

Foundation 
George McKray 

Donald and Elizabeth Minkler 
Meredith Minkler 
Patricia Mullen 
Ed Nathan 
Thomas Novotny 
Dorothy Nyswander 
Martyann Penberth-Valentine 
Janet Perlman 

Mary Pittman and David Lindeman 
Nancy Presson 
Florence and Paul Raskin 
William and Mary Jane Reeves 
Joseph and Nancy Restuccia 
Frances Saunders 
George and Linda Sensabaugh 
Sandra Shewry 
Takeo Shirasawa 
Ralph Silber 
Rosalind Singer 
Harvey Smith 
Shoshanna Sofaer 
Lucia and Peter Sommers 
Sandra Stein-Starr 
Mary Stevens 
S. Leonard Syme 
David Taylor 
Cheryl Wyborny 
Ruth Young 



TABLE OF CONTENTS- -Henrik Blum 

PREFACE by Patricia A. Buffler i 

INTRODUCTION by William C. Reeves v 

INTERVIEW HISTORY xi 

BIOGRAPHICAL INFORMATION xiii 



I FAMILY HISTORY, CHILDHOOD AND EDUCATION: 1915-1934 1 
Caveats and Oral History 1 
Wartime Experiment Using Human Guinea Pigs 3 
Parents and Childhood in Napa 12 
The Community in Petaluma and Farming in Coombsville 15 
Schooling 23 
High School Egalitarianism and Elitism 27 
The Depression Years 35 
Music Studies and Cultural Exposure 41 

II COMING TO UC BERKELEY: UNDERGRADUATE STUDIES, 1931-1937 45 
From Engineering to Chemistry 45 
Perry R. Stout and Daniel Arnon: Mentors 49 
Choosing a Career 54 

III UNIVERSITY OF CALIFORNIA MEDICAL SCHOOL: 1938-1942 57 
Happy Jack: Starting Medical School and Finding Housing 57 
Chauncey Leake and Pharmacology 59 
Being a Pain in the Neck in Pathology in Our Second Year 60 
Housing During Medical School 62 
Obstetrics at San Francisco General 64 
Treating the Poor and Thoughts of a Career in Public Health 69 
More About Medical School and Student Activism 78 

IV SERVING IN THE U.S.P.H.S. IN WORLD WAR II--PART OF THE ARMED 

SERVICES: 1942-1946 80 

An Internship at the Marine Hospital in San Francisco and a Brief 

Stint at a Venereal Disease Hospital in Arkansas 80 

A VD Research Project at the Penitentiary in Terre Haute, Indiana 83 

Applying to the Regular Corps 89 

A Faculty Position at Johns Hopkins University Medical School 90 

Assignment to San Diego 101 

Going AWOL: Back Surgery at the San Francisco Marine Hospital 107 

V RESIDENCY AT STANFORD AND ON TO HARVARD: 1946-1948 110 
Treating and Studying Syphilis 110 
Harvard University and the School of Public Health 118 
A Special Bostonian Family 122 



VI SETTLING IN CALIFORNIA- -CONTRA COSTA COUNTY: 1950-1966 126 
The California State Health Department: A Year in San Diego, and 

on to Contra Costa County 126 

Serving as County Health Officer in Contra Costa County 130 

Expanding the Budget and the Department: Testing for TB 134 

Signing Off on Septic Problems 138 

The County Hospital and George Degnan 140 

Sanitation Problems and County Restaurants 146 

Labor and Industry Politics: Tidewater Oil 156 
Growing Wild in Contra Costa: More about Sewers and Other 

Amenities 158 

A Privately Owned Development; A Municipal Utility District 168 
Dealing with the AEC and other Federal and State Watchdog Agencies 171 

Anne Leslie: "Office Wife" 172 

The Civil Service and Other Frustrations 173 
More about the Mental Health Program, and Serving with the 

Space Cadets: 1956-1965 176 

Being Considered for a Faculty Position at Harvard 181 
Co-Authoring a Book about Administration: 1963; A Housing 

Project in East St. Louis; Lincoln Hospital in New York 184 

Funding for Navajo Projects 187 

The Multipurpose Worker and the Rodeo Center: 1964 188 
Studying Health Care Systems in Europe on a 1962 WHO Fellowship 

and a Later Study of Health Care in Australia 193 

Birth Control Programs and Governor Pat Brown 202 

Elizabeth Jolly and the Crippled Children's Program 212 

Training Peace Corps Volunteers: 1964 215 
Other Streams: Creating Air Pollution Control Legislation (1955) 

and the John F. Kennedy University (1964); the Orinda Vision 

Study (1959) 218 

Business Activities in Contra Costa County 233 

A House in Berkeley 236 

VII MOVING TO BERKELEY: THE UNIVERSITY AND OTHER INVOLVEMENTS: 

1966-1984 240 

Joining the University of California Faculty and a Campus Revolt 240 

Job Offers from Stanford, New York City, and Los Angeles Health 243 
A Joint Masters Program: Department of City and Regional Planning 

and Health Planning: Collaboration with Nathan Glaser 245 
A First Course in Health Planning, 1967, and New Legislation: 

The 89th Congress, 1966 248 
A 1968 Planning Grant from the USPHS; a Program for Minorities and 

Native Americans; Abandoning Our Marvelous Planning Grant 256 

Pressure to Publish, Public Administration, and Alex Meiklejohn 267 

Building a Planning Faculty 269 

Serving on Committees of the Academic Senate 272 

Thoughts about Teaching and W.C. Fields 275 

American Public Health Association Involvements in the 1960s 277 

Advising Governor Reagan--Greed is Great: 1967 280 
Planning for Health and Expanding Health Care Horizons. Two 

Textbooks: 1974, 1976 " 282 

The Hospital World: Alta Bates and Herrick Hospitals and HEALS 290 



VIII INTERNATIONAL FIELD SERVICE: 1969-1981 307 
Dr. Hilleboe and the World Health Organization 307 
Working with WHO in Sri Lanka: 1970 310 
WHO and a Planning Handbook 324 
Assignments in South America with the Pan American Health 

Organization 325 

A USAID Project in Nepal 333 

Planning in Color Country, Utah 340 
A Keynote Speech on Prevention in Paris: 1982, Courtesy of the 

Drug Companies; A Contrast, Consulting for MDI 344 

Fieldwork in Three Pacific Islands and Yemen, 1980 347 

A Fulbright Award in Sweden (1986) and Thoughts about Fieldwork 354 

Teaching Health Planning in Chengdu, China, 1987 361 

IX THE 1980s AND 1990s 363 
Reviving the Joint Medical Program 363 
Ronnie London and Maggie Hall 368 
The Over 60 and On Lok Programs and Managed Care 371 
A Hypothetical Health Care Study 381 
Awards and Afterthoughts 385 
Reflections on a University Career 391 
A Sweet Finale 394 

TAPE GUIDE 395 

SAMPLE EDITED AND INSERTED PAGES 398 

APPENDIX 

A Henrik Blum Curriculum Vitae, 1994 400 

B University of California Oral History Series List 408 

INDEX 420 



PREFACE by Patricia A. Buffler 



It is a pleasure to introduce the University of California School 
of Public Health Oral Histories which highlights contributions of Public 
Health faculty members to the health and well being of populations in 
California and worldwide through their teaching, research, and other 
scholarly activities. 

The idea of an oral history series in Public Health was proposed 
in 1993 with the successful completion of the oral history of William 
Reeves, the fourth public health faculty member to participate in the 
Regional Oral History Office program of The Bancroft Library. 

The foundations of the School of Public Health date back to the 
beginning of the twentieth century when the University of California and 
Stanford University initially collaborated on a graduate curriculum in 
public health. Subsequently in response to the urgent need for more 
public health professionals in the Western United States, the 1943 
California State Legislature and Governor Earl Warren enacted into law a 
bill mandating the creation of the first school of public health west of 
the Mississippi River. The school was established at the University of 
California, Berkeley, where public health had its origins more than two 
decades earlier with the creation in 1917 of a Program in Hygiene in the 
Department of Zoology. 

Since its founding, the UC Berkeley School of Public Health has 
become one of the world's preeminent centers dedicated to the promotion 
and protection of the health of human populations, and noted for the 
excellence of its programs in teaching, research, and service. These 
programs, grounded in an understanding of theory and mechanisms of the 
basic sciences, are integrated through a focus on communities that reach 
from Berkeley's surrounding neighborhoods to settings around the world. 

For example, encephalitis was largely suppressed because of the 
work of Professors William Reeves and James Hardy; Dean Charles E. 
Smith's pioneering studies of coccidioidomycosis (Valley Fever) resulted 
in the development of a vaccine for the disease; and Professor Dorothy 
Bird Nyswander's contributions in public health education and 
administration are renowned both nationally and internationally in the 
areas of family planning, school health, and prevention and eradication 
of malaria. 

The tradition continues with teaching and research in such areas 
as AIDS, cancer, violence, infant mortality, the toxicity of industrial 
waste, tobacco-related diseases, human genetics, health care financing 
and delivery systems, reproductive health, infectious diseases, and the 
impact of media on behavior. 



ii 



Today, the School of Public Health at Berkeley enrolls 

approximately 475 students annually-- 13 percent from other countries and 
approximately 25 percent from diverse minority cultures within the 
United States. 

The School of Public Health faculty is drawn from a variety of 
disciplines, including epidemiology, biology, economics, political 
science, anthropology, and chemistry, and from professional fields such 
as medicine, engineering, business, and social work. Faculty 
distinctions include six American Association for the Advancement of 
Science Fellows, three Fulbright Scholars, five members of the National 
Academy of Sciences, Institute of Medicine; and advisory appointments to 
the Centers for Disease Control, the National Institutes of Health, and 
the World Health Organization. 

Over the past fifty-five years, Berkeley has consistently been on 
the cutting edge with innovative programs including: 

-The Health and Medical Sciences UCB/UCSF Joint Medical Program, 

which was established twenty-five years ago as an alternative to 

the traditional four-year medical school located in a medical 

center complex. Medical students at Berkeley not only complete 

their preclinical training on the Berkeley campus but are 

introduced to medical care in a variety of community settings and, 

by committing an additional year, also earn a Master of Science 

degree ; 

-A long standing progressive teaching program in Maternal and 

Child Health, which since 1955 has prepared over 900 specialists 

in Maternal and Child Health with a strong research and 

professional practice orientation; 

-A nationally recognized and model field training program for 

public health students, which ensures an academically supervised 

internship for all professional students seeking to earn a Master 

of Public Health degree; 

-The American Indian Graduate Program, which has trained about 200 

Indian/Alaskan natives from over eighty tribes since its inception 

in 1971; 

-Centers of excellence in research and service, including the 

Prevention Research Center for Family and Community Health, the 

Center for Health Management Studies, the Northern California 

Center for Occupational and Environmental Health, and the Center 

for Children and the Environment; 

-A mission statement which incorporates a commitment to human 

rights and multicultural perspectives, the first school of public 

health to do so; and 

-A sponsored research and research training portfolio which today 

exceeds $25 million and amounts to more than $500,000 per ladder 

rank faculty member, ranking the school among the most productive 

and extramurally well-funded units on the Berkeley campus. 



Ill 



The oral history of Professor Henrik Blum is the seventh in the 
Public Health Series following volumes by six early faculty members: 
Karl F. Meyer and his research on zoonotic diseases of public health 
significance, Jessie Bierman and her research on maternal and child 
health, Sanford Elberg and his research on brucellosis, William Reeves 
and his studies of arthropod-borne encephalitides, Dorothy Nyswander and 
her international work in health education, and, still in process, 
Warren Winkelstein who was one of several pioneering investigators in 
the San Francisco AIDS epidemic in the 1980s. The oral history of 
Henrik Blum represents a unique contribution to this series with its 
emphasis on health planning, community development, and humanism in 
medical and public health education. 

During its distinguished history the school has undergone 
successfully several transitions. The evolution of public health 
education and the need for these transitions are well illustrated in the 
careers of faculty who provided leadership during these critical times. 

The leadership and vision of the public health faculty is evident 
in all of these oral histories. These true pioneers anticipate not just 
the health problems consequent with certain conditions, but new 
solutions to these problems. The lives and careers of these faculty 
members provide a rich account of the history of public health and 
public health education in California. 

Patricia A. Buffler 

Dean Emerita and Professor of Public 
Health Epidemiology 

February 1999 
School of Public Health 
University of California 
Berkeley, California 



ii 



Today, the School of Public Health at Berkeley enrolls 

approximately 475 students annually-- 13 percent from other countries and 
approximately 25 percent from diverse minority cultures within the 
United States. 

The School of Public Health faculty is drawn from a variety of 
disciplines, including epidemiology, biology, economics, political 
science, anthropology, and chemistry, and from professional fields such 
as medicine, engineering, business, and social work. Faculty 
distinctions include six American Association for the Advancement of 
Science Fellows, three Fulbright Scholars, five members of the National 
Academy of Sciences, Institute of Medicine; and advisory appointments to 
the Centers for Disease Control, the National Institutes of Health, and 
the World Health Organization. 

Over the past fifty-five years, Berkeley has consistently been on 
the cutting edge with innovative programs including: 

-The Health and Medical Sciences UCB/UCSF Joint Medical Program, 

which was established twenty-five years ago as an alternative to 

the traditional four-year medical school located in a medical 

center complex. Medical students at Berkeley not only complete 

their preclinical training on the Berkeley campus but are 

introduced to medical care in a variety of community settings and, 

by committing an additional year, also earn a Master of Science 

degree; 

-A long standing progressive teaching program in Maternal and 

Child Health, which since 1955 has prepared over 900 specialists 

in Maternal and Child Health with a strong research and 

professional practice orientation; 

-A nationally recognized and model field training program for 

public health students, which ensures an academically supervised 

internship for all professional students seeking to earn a Master 

of Public Health degree; 

-The American Indian Graduate Program, which has trained about 200 

Indian/Alaskan natives from over eighty tribes since its inception 

in 1971; 

-Centers of excellence in research and service, including the 

Prevention Research Center for Family and Community Health, the 

Center for Health Management Studies, the Northern California 

Center for Occupational and Environmental Health, and the Center 

for Children and the Environment; 

-A mission statement which incorporates a commitment to human 

rights and multicultural perspectives, the first school of public 

health to do so; and 

-A sponsored research and research training portfolio which today 

exceeds $25 million and amounts to more than $500,000 per ladder 

rank faculty member, ranking the school among the most productive 

and extramurally well-funded units on the Berkeley campus. 



Ill 



The oral history of Professor Henrik Blum is the seventh in the 
Public Health Series following volumes by six early faculty members: 
Karl F. Meyer and his research on zoonotic diseases of public health 
significance, Jessie Bierman and her research on maternal and child 
health, Sanford Elberg and his research on brucellosis, William Reeves 
and his studies of arthropod-borne encephalitides, Dorothy Nyswander and 
her international work in health education, and, still in process, 
Warren Winkelstein who was one of several pioneering investigators in 
the San Francisco AIDS epidemic in the 1980s. The oral history of 
Henrik Blum represents a unique contribution to this series with its 
emphasis on health planning, community development, and humanism in 
medical and public health education. 

During its distinguished history the school has undergone 
successfully several transitions. The evolution of public health 
education and the need for these transitions are well illustrated in the 
careers of faculty who provided leadership during these critical times. 

The leadership and vision of the public health faculty is evident 
in all of these oral histories. These true pioneers anticipate not just 
the health problems consequent with certain conditions, but new 
solutions to these problems. The lives and careers of these faculty 
members provide a rich account of the history of public health and 
public health education in California. 

Patricia A. Buffler 

Dean Emerita and Professor of Public 
Health Epidemiology 

February 1999 
School of Public Health 
University of California 
Berkeley, California 



iv 



February 1999 



University History Series 
School of Public Health Oral Histories 



Jessie Bierman, M.D. (1900-1996) 

Maternal and Child Health in Montana, California, 
the U.S. Children's Bureau, and WHO. 1926-1967, 
1987. 

Henrik L. Blum, M.D. and M.P.H. (b. 1915) 

Equity for the Public's Health: Contra Costa 
Health Officer; Professor. UC School of Public 
Health; WHO Fieldworker. 1999. 

Sanford S. Elberg, Ph.D. (b. 1913) 

Graduate Education and Microbiology at the 
University of California. Berkeley, 1930-1989, 
1990. 

Karl F. Meyer, Dr. Med. Vet., Ph.D. (1884-1974) 
Medical Research and Public Health. 
1976 

Dorothy B. Nyswander, Ph.D. (1894-1998) 

Professor and Activist for Public Health 
Education in the Americas and Asia. 1994 

William C. Reeves, Ph.D. (b. 1916) 

Arbovirologist and Professor. UC Berkeley 
School of Public Health. 1993. 



Pediatrician; 

professor; 

public health 

administrator 

Health planner, 

administrator, 

professor 



Microbiologist ; 

professor 

and administrator 



Epidemiologist ; 
Director, Hooper 
Foundation, UCSF 

Public health 

professor and 

educator 

Epidemiologist ; 

Professor, UC Berkeley 

School of Public Health 



INTRODUCTION by William C. Reeves 



When I was asked to prepare an introduction to Henrik Blum's oral 
history, I wondered if our frequent but usually casual associations for 
forty-plus years would be an adequate base of operations. Then, I 
decided: What the hell, if The Bancroft Library staff and Henrik want me 
to do it, I'll do it. It should be fun and it will reload my memory 
bank. I can play the role of a fan on the sidelines watching a star 
play the health planning game, a star who over his career has improved 
the health of people throughout the world. This was not an easy task to 
take on, but one worth doing. I was given an opportunity to read drafts 
of several chapters of Henrik 's opus and as I expected, I found that he 
has called a spade a spade, is fair in his judgments about the character 
of other players in the game, and has given damnation or praise as it 
was earned. 

Henrik Blum's early life was spent on a farm in the Napa Valley of 
California. Many of his views still reflect the imprint left on him 
from growing up during the economic Depression of the 1930s. He was 
exposed to high standards of honesty, and learned how to use direct 
approaches to solve problems. He also discovered the need to evaluate 
the character and competence of associates and not to yield to the 
ethnic prejudices and other biases that still prevail in most 
communities almost seventy years later. As an undergraduate at Berkeley 
he was fortunate enough to meet and wed Marian H. Ehrich. They have 
spent almost sixty years together as loving partners, sharing career and 
home changes, worldwide travels, and a deep love of music and the arts. 
Whenever I comment to Henrik on his unusual capacity to judge the 
character or competence of people, he tells me he is an amateur compared 
to Marian. She has been a remarkable person with whom to share and 
enjoy life. 

Recruiting Henrik to the faculty of the School of Public Health in 
the early 1950s was no big problem. At that time, the epidemiology 
faculty was very small. The number of courses was very few and in fact, 
some days I was the only instructor present. Henrik was the Health 
Officer for Contra Costa County and we asked him to teach an 
introductory course in epidemiology which previously had focused largely 
on infectious diseases and was required for all public health students. 
Only epidemiology majors and a few physicians were exempted because we 
assumed they already had some background in epidemiology. They were 
placed in a so-called "advanced" course. Dr. Blum was well trained in 
medicine and basic epidemiology and, most importantly, was handling 
epidemiological problems at the community level every day. We wanted to 
bring that experience into the classroom for students who had a wide 
range of backgrounds and interests, most of whom would someday be 
employed by health agencies. Henrik welcomed the opportunity to meet 



VI 



with students and share his experiences, and he did not limit the course 
to infectious diseases. It was unfortunate, in retrospect, that a 
majority of the physicians and all of the epidemiology majors who were 
enrolled in the more advanced and theoretical course in epidemiology 
were unable to benefit from Henrik's wisdom. 

During those early years, Henrik was publishing widely, not only 
on epidemiological problems but also to illustrate how such problems 
interfaced with community concerns and family needs for health services. 
Most local health programs were focused on control of communicable 
diseases and usually within a fairly rigid administrative framework. 
Henrik published on problems that he had dealt with in Contra Costa 
County such as diabetes detection, genetic counseling, school lunch 
programs, mental health, vision screening, safety education, and 
fluoridation of water. In each case, he focused on recognition of the 
community's needs, its resources, and concerns, and whose participation 
was essential to the resolution of the problem. Each required a new 
approach to planning and organization to identify community concerns and 
resources that could resolve the issue. 

One landmark venture occurred in 1966 when Henrik and Dr. George 
Keranen developed a handbook entitled Control of Chronic Diseases in Man 
which was published by the American Public Health Association. This was 
to be a companion volume to Control of Communicable Diseases in Man 
which was published by the same association and which sat on the desk of 
most public health workers. Unfortunately, the chronic disease manual 
was not reissued and expanded in future years when such problems became 
the primary focus of most public health programs. This visionary 
publication foresaw a need and paved a pathway that public health needed 
to travel. 

At a time in Henrik's tenure as a health officer, his staff became 
unionized and he was required to work and bargain with the unions. His 
approach to this situation was to join the union himself. You can 
imagine the turmoil and consternation of the union officers when they 
found out that the person they had to deal with concerning employment by 
his agency was a member of their union, could attend their meetings, 
vote, et cetera. This innovative approach had a twist of Blum humor 
behind it. 

When Henrik retired after fifteen years as Health Officer of 
Contra Costa County, he had many ideas about the future approaches to 
public health problems. Although several agencies were anxious to 
recruit him, when Dean Charles Smith offered Henrik an appointment as 
Clinical Professor of Public Health at Berkeley in 1966, he decided that 
this could provide him a base of operations, an outlet to advance his 
interests in health planning, and an opportunity to extend his teaching 
in public health administration. The original position did not have the 
campus clout or financial security of a tenured position, but when I 



vii 



became Dean in 1968, I was able to obtain a tenured appointment for 
Henrik as Professor of Community Health Planning. 

By this time, Henrik had made it clear that health planning had a 
separate identity from public health administration, and there was an 
opportunity for the Berkeley School of Public Health to become the 
national, even international leader in this field, exposing the 
students, faculty, and other associates to a new frontier in health. 
Henrik presented his new approaches in the publication Public 
Administration. A Public Health Viewpoint. He developed dialogues and 
collaborative arrangements with campus and outside professionals who 
were leaders in aspects of planning from many other fields. At this 
time the campus had entered a period of strife and turmoil over the 
Vietnam War, free speech, minority needs, et cetera. It was a tough 
time to carry out the orderly planning of a new curriculum or major 
program which required the joint effort of individuals who might not 
only have different concepts of health planning but were on opposite 
sides regarding current campus issues. As Dean, I was known as a 
conservative and Henrik was considered an activist; hardly likely 
"bedmates" for a concerted activity. Nonetheless, we recognized from 
the beginning that we could both meet our academic and social objectives 
by joining forces to develop health planning as a new field of study. I 
decided to give him a relatively free rein to see what he could and 
would do. The proposed program stressed recruitment of minority 
students into the school and development of affiliations with other 
academic departments on campus. It also addressed many community issues 
and needs concerning health. 

If there was a secret to the development of this new field, it was 
first that Henrik had an idea and he obtained a large three-year federal 
grant. The grant assured financial support for minority students to 
fill nineteen new student admissions he had obtained from the graduate 
division, allowed for the appointment of a variety of new non-tenured 
faculty and staff from a variety of fields and backgrounds, and provided 
resources to bring in eminent visiting speakers from many other fields. 
It was a great venture and it succeeded. In his oral history, Henrik 
discusses all of this very candidly and with no holds barred on 
inclusion of controversy. 

One side of Henrik Blum that is sometimes hard to adjust to is his 
response when a colleague, student, or outsider asks for advice. 
Usually he asks the person to describe the problem, how he got the 
information, and how the problem is being approached. If the approach 
does not show a good comprehension of the problem at hand and a 
receptivity to alternatives, Henrik might tell them a story about a 
parallel experience and outcome. If the person still doesn't understand 
what is going on or insists there are no alternatives, Henrik may just 
relate his version of the "facts of life" in no uncertain terms. This 
approach wakes up most people and frequently solves their problems if 



viii 



so, they usually thank him and end as good friends, and he never forgets 
them. He is one of the few people I know who can give you hell and then 
have you thank him for it. 

Henrik awakened a wide audience to the breadth of community health 
problems. Three of his publications stand out as landmarks in the 
emergence of health planning as a field of study and an approach to the 
health needs of communities. The first is Public Administration; A 
Public Health Viewpoint (1963). The second is Health Planning (1969), 
and the third, Planning for Health (1974), devoted 621 pages to a broad 
and in-depth coverage of this new field. It quickly became a bible for 
health planners. Each of these publications received national and 
international acclaim, and what had been conceived for health planning 
at a community level in California soon came to the attention of the 
World Health Organization. Henrik 1 s account of his national and 
international experiences are completely fascinating as he describes how 
he functioned within each system. In truth it was hard work and 
extremely time-consuming. Many of his concepts and objectives were not 
understood or were rejected by the people assigned to carry them out, 
and getting them implemented in the real world was a challenge which 
required worldwide travel. Marian accompanied him on all his adventures 
and they made many new friends wherever they went: Geneva, Nepal, Sri 
Lanka, Sweden, Denmark, Australia, China, and Canada, to name a few. A 
senior faculty member of our school tells me that anywhere he travels in 
the world today, he encounters followers of Henrik who are still quoting 
his books on health planning, or perhaps remember a visit he and Marian 
made and want to send their thanks and regards. 

The American Public Health Association paid its respect to Henrik 
in 1985 when he was presented its most prestigious award, the Sedgwick 
Memorial Medal. The focus of that award was to recognize the 
contribution of his health planning concepts to the field of public 
health. 

The final chapter of Henrik 's oral history might be called an 
encore before his third retirement. It is devoted to his experiences 
from 1991 to 1994, when six years after retiring as Emeritus Professor 
he was recalled to serve as interim chair of the Health and Medical 
Sciences program at Berkeley. In this program, students receive three 
years of intensive training which covers the first two years of medical 
school and also requires completion of a master's degree in Health and 
Medical Sciences. This was to be a temporary one-year position while a 
new permanent chair was being selected. Instead it turned into a stormy 
and difficult task, requiring four years of Henrik 's time. The program 
was being assailed by several individuals and groups who wished to 
destroy it, but fortunately since Henrik had been involved with the 
program since its inception, he believed deeply in its objectives. The 
original conception of such a program had come from meetings of a core 
of faculty from the School of Public Health and a group of practicing 



ix 



physicians and hospital staff from the East Bay. Its roots went back to 
the 1930s and earlier when students in the University of California, San 
Francisco medical school program spent their first academic year on the 
Berkeley campus taking basic science courses, which had not yet been 
developed in San Francisco. Henrik had been a student in that program 
in the 1930s. 

Henrik dedicated his time as interim chair to fighting for 
survival of the program, recruiting faculty, and broadening and 
increasing relationships with campus faculty in other departments. He 
opened a "gateway to faculty" on the campus for students to use as 
resources for their theses. He personally met with as many student 
applicants and new admissions to the program as possible. He had an 
"open door" policy for his office and was available for consultation on 
any problem. Rather than carrying out formal teaching, he attended 
seminars where problems were presented by students and discussed. This 
was his ballpark for personal enjoyment. Within the School of Public 
Health, Henrik is referred to at times as the "John Wayne" of public 
health and medical education. He continues his dedication to correcting 
the wrongs of society, fighting for the rights of the downtrodden, and 
challenging the "bad acts" of some individuals. If you asked Henrik 
about this he would probably smile and say, "And I don't even own a 
gun." 

When Henrik retired in 1985 to become Emeritus Professor, his 
friends and associates paid their respects by establishing the Henrik L. 
Blum Award for Distinguished Social Action. The award is given annually 
to a graduating student of the school. Each candidate is evaluated for 
his or her public health activities that symbolize the spirit of social 
justice and democratic action which Dr. Blum has epitomized and which he 
implemented in the minds and hearts of students, professors, staff, and 
alumni. The selection committee includes representatives of all those 
groups. In the past ten years, this award has become the most 
prestigious and sought-after recognition by graduating class members. 
The recipient gets a standing ovation at commencement and a very nice 
plaque. There is no monetary award and none is needed. Recognition is 
the award. The award will long stand as a reminder of Henrik 1 s 
standards and goals. 

Another important current event in Henrik 's life occurred on May 
22, 1998, when he received the Award for Excellence in Teaching by a 
Pre-Clinical Teaching Faculty Member at the commencement exercises of 
the School of Medicine at UC San Francisco. This awardee is selected by 
the students and not by a faculty committee, and if I know Henrik, this 
makes it a very special award for him. Although I will be guilty of 
plagiarism, I would like to repeat a statement made at the presentation 
of this most recent award: "Dr. Blum has inspired generations of 
medical students with his personal example, innovative leadership, and 
commitment to promoting the health of communities. His analysis of 



forces underlying the politics and sociology of medicine makes students 
aware of their own role as physicians in society. When it comes time 
for students to write their master's degree theses, he opens important 
doors by sharing his many academic and community connections. He 
continues to use his wealth of knowledge and experience in medicine and 
public health to guide and challenge students in their exploration of 
the fundamental issues in health care." 

It has been a privilege and valuable lesson for all of us to be 
associated with Dr. Henrik Blum and we thank him for sharing his history 
with us . 



Professor William C. Reeves 



School of Public Health 
University of California, Berkeley 
June 1998 



xi 

INTERVIEW HISTORY- -Henrik L. Blum 



Henrik Blum was an obvious choice for the Regional Oral History 
Office's public health series; he has been a giant in the health 
planning field for over forty years. Dr. Blum, M.D. and M.P.H., came to 
the University of California faculty in 1968 with much more than 
theories on his mind. Unlike many of his colleagues, he had headed a 
health department (Contra Costa County, 1950-1966) and before that 
served the U.S. Public Health Service as part of the armed services 
working on a number of venereal disease assignments and research 
projects . 

He joined the UC faculty at the time when the university was in 
great turmoil and quickly showed himself to be an activist. He was one 
of few to insist on an open-door policy that persists today well into 
his emeritus years. Students remember his health planning courses, the 
first in the university's history, as life-changing experiences where 
they learned the difference between mere medical care that dealt with 
disease and health care that dealt with life. 

Dr. Blum's students always came first and they knew it. He could 
always be counted on to take up the fight for an individual's rights or 
a student cause. When the 1998 UCSF medical school graduates wrote Dr. 
Blum that they intended to give him a preclinical teaching award last 
May, they cited his brilliance and excellence, his passion and 
compassion, his status as "one of the best role models we have 
encountered in all our years at UCSF." 

Dr. Blum came to the oral history with reservations, wondering if 
he would be able or willing to deal with the "down times." During the 
seven two-hour sessions in his office on the fifth floor of University 
Hall, he proceeded to work through them with utmost candor; the politics 
of medical research and academia and his involvements in those arenas, 
the injustices of contemporary society. 

Through the years he was always where the action was: he 
coauthored the original San Francisco Bay Area air pollution control 
legislation in 1955, helped create John F. Kennedy University in 1964, 
established an early and important HMO called HEALS--now HealthNet-- 
wrote signal texts in health planning, and managed to consult for WHO, 
PAHO, and AID all over the developing world as late as 1986 he was a 
Fulbright teacher in Sweden. 

A highlight of the oral history is his documentation of the School 
of Public Health, where he was on the faculty for almost two decades. 
As a professor of community health planning in 1968 he pioneered the 
school's first health policy course and became chairman of the then-new 
program in planning and policy and wrote the landmark textbook in the 



Xll 

field, Planning for Health. Dr. Blum arrived on the scene in 1966, when 
the School of Public Health was all but shut down by student unrest, and 
from the beginning of his tenure often took unpopular positions. With 
no support by fellow faculty, for example, he was able to create 
nineteen slots for minority graduate students and initiate successful 
recruitment programs for Native Americans. 

Dean Patricia Buffler suggested that the Regional Oral History 
Office document Dr. Blum's life and work and has written the preface to 
the series; we are indebted to her and to Pat Hosel for organizing the 
fundraising, and to Dr. William Reeves for his fine introduction to the 
volume and for serving on the project's advisory committee. Others on 
the committee were Rosalind Singer, Richard Bailey, Joan Bloom, Patricia 
Buffler, Lucy Johns, Joyce Lashof, Mike McDonald, George McKray, Theresa 
Pipe, Mary Pittman-Lindeman, and Shoshanna Sofaer. Lucy Johns also 
provided important perspective as a student of Dr. Blum's in the 1960s. 

The seven interview sessions, from January to early May of 1997, 
were held in a relaxed atmosphere, with students often greeting Dr. Blum 
as they passed the office, and often went over the scheduled two hours. 
There were as many review sessions with him, and after he reviewed the 
text, Dr. Blum wrote out in longhand substantial additions; these are 
indicated by "##" notations in the text and on the tape guide, and 
sample edited and inserted pages appear after the text. 

In addition, Dr. Blum donated his collected papers to The Bancroft 
Library, where they may be viewed by researchers. 

Dr. Blum is openly irreverent about many things in the oral 
history. The resulting document is candiddescribing the downside of 
local politics, academia and international helping agencies; on the 
upside it documents high incidents of morality of health care, esteemed 
colleagues, and the life of an individual who mattered. 

The Regional Oral History Office was established in 1954 to 
augment through tape-recorded memoirs the Library's materials on the 
history of California and the West. Copies of all interviews are 
available for research use in The Bancroft Library and in the UCLA 
Department of Special Collections. The office is under the direction of 
Willa K. Baum, Division Head, and the administrative direction of 
Charles B. Faulhaber, James D. Hart Director of The Bancroft Library, 
University of California, Berkeley. 

Caroline Crawford 

Interviewer /Editor 
September 1998 

Regional Oral History Office 
The Bancroft Library 
University of California, Berkeley 



xiii 



Regional Oral History Office University of California 

Room 486 The Bancroft Library Berkeley, California 94720 

BIOGRAPHICAL INFORMATION 

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I FAMILY HISTORY, CHILDHOOD, AND EDUCATION: 1915-1934 



[Interview 1: January 23, 1997) 



Caveats and Oral History 



Crawford: Let's begin at the beginning. Tell me as much about your 
family, and as far back as you can. 

Blum: I have a couple of caveats. I've long since made up my mind 

that even well-kept notes are not necessarily trustworthy, and 
I never keep any notes. There's nothing I own that I think is 
worthwhile enough to keep. People send me a letter. I get 
through with whatever has to be done, and then I usually chuck 
it, along with my responses. 

So I just don't have the frame of mind that a properly born 
upper-class person or an obsessive saver would havethat every 
scrap of paper I have either received or filled out needs to be 
saved for posterity. I've been spoiled by some magnificent 
biographies, such as Churchill' s--which is really a wonderful 
bit of writingbut I really don't trust the documentation he 
provides, because I don't find in it some of the idiotic things 
that he was responsible for, such as Gallipoli. 

Crawford: You're talking about biographies? 

Blum: Well, it is an autobiography, in Churchill's case. 

Crawford: Are you talking about the war books? 



'## This symbol indicates that a tape or tape segment has begun or 
ended. A guide to the tapes follows the transcript. 



Blum: Yes. I mean his whole series; all the volumes. So, I'm quite 
sure that diaries and autobiographies aren't necessarily 
trustworthy. I keep thinking, Will I really tell you some of 
the down times I've had? 



Crawford: 
Blum: 

Crawford; 

Blum: 

Crawford; 

Blum: 

Crawford; 
Blum: 



Crawford: 
Blum: 



Won't you? 

I don't know. I mean, I just keep debating, 
kind of lousy. 



Some of them are 



Let me tell you right at the outset that you should feel 
perfectly free to tell me whatever it is about the down times 
you want to. 

Some of them don't speak well for me, you see. 
Because you'll take the whole text and review it. 

Oh, yes. I realize that, but do I or don't I want to get into 
these things? Everybody tends, I think, to protect themselves. 

I understand you're a candid person. 

Yes. But I've got to be sure about this. So, one, I really 
don't trust the best tended-to biographical material, and mine 
is not well-tended-to. Second, I don't trust anybody's 
integrity for sure. Third, I think each of us smooths over 
some thingswe'd like it to be seen more and more our way. 

Fourth, how good is our information? Just recently I've 
had a chance to look at the origins of the UCB medical school 
this experimental medical school called the Joint Medical 
Programwhich has been such a controversial, interesting 
thing. Accidentally I recently ran into Chancellor Bowker, who 
really carried the ball and created it. He has a totally 
different memory of what happened than I do. He sees all the 
problems that he had, which I have really ignored. I always 
see the problems that I had. 

Well, that's the value, of course, of your telling it. 

And then a third person coming throughwho really wasn't close 
to it, but who would like to imagine he was because he was an 
interested bystander had a totally different version of it. 
So here are three versions of the same thing, and I don't think 
any of them are totally erroneous; but the focus is so off here 
or off there or off elsewhere that any one of these stories by 
themselves is really only a partial picture and therefore a 



very different picture, emphasizing different actions and 
different actors. 

Crawford: Of course. 

Blum: The worst of the caveats is simply that I think that if I had 
done this history, say, five years ago, before I got involved 
again with the medical schoolthe Joint Medical Programand 
with Tommy Kushner--who' s an ethicist in JMP who asked me to do 
some presentations on ethicsthat I would not have seen the 
situations five years ago as I see them today. 

I'm talking about the involvement of, "Okay, let's bring 
out the ethical view, so that students and others can see what 
some often overlooked issues are." You suddenly realize that 
things that are very crucial now to an ethical understanding of 
the situation didn't even exist at the time of the event at 
least not in my mind anyway. So, that by dint of going back 
over parts of my career, I keep finding these episodes that I'm 
not so sure were terribly ethical. Here I am lecturing to the 
class about, "I thought this was good stuff, and look what I 
did. Now, my god, I would like to retreat from that. I would 
like to not even have been a participant." 

Crawford: Well, I would think you would enjoy that going back and 
bringing it all forward. 

Blum: I have enjoyed it, but I guess I'm saying that I have reason to 
doubt the real authenticity, significance, of retrospective 
stuff. It wouldn't make any difference how well I had 
documented it then because I would have had a view that I was 
doing good things. Now I look back in horror and say, "That 
was not only not good, today it would be almost criminal." 

Crawford: I wonder, aren't you being a little hard on yourself? 



Wartime Experiment Using Human Guinea Pigs 



Blum: Well, for Tommy's seminar, I found the article that part of the 
seminar presentation was based on. I tackled the issues of 
coercion in my career, my involvement in coercive activities; 
physicians are always in the position of being coercive, you 
know. But when I was in the service [stationed in Terre Haute] 
during World War II, we experimented on human guinea pigs. 

Crawford: Yes, you mentioned this to me. 



Blum: Of course, it wasn't altogether horrible. Nobody got hurt. 

Nobody was treated maliciously. We thought that everybody was 
treated rather nicely--that is, the folks who were being 
experimented on- -but notwithstanding, the whole setting was 
terrible, in retrospect. 

I would say that we were kind of pleased with ourselves, 
doing that work. When we handed out the article, 1 lo and 
behold, it was endorsed by the National Research Council and 
the United States Public Health Service, which also carried it 
out . 

Crawford: It was related to the Tuskegee Study? 

Blum: No, no. It wasn't Tuskegee. Thank god I wasn't in that. Ours 
was a smaller kind of a thing, but also an experiment on 
humans. Somehow, the subjects being experimented on were not 
really human beings. It was just how life was, you know. 
True, but I was four steps removed from my boss who also was 
the boss of the Tuskegee Study. 

Crawford: I think that's what you told me. 

Blum: Yes, and the boss was a lovely man--I mean, a neat guy--and you 
would never have qualms about him marrying your daughter. He 
just didn't know any better. Black people weren't people for 
him. That was how he grew up in the South. 

It was disgusting that we missed every call on it. I kept 
squalling all the while because I have sort of an orderly mind, 
and saying, "Hey, you can't do science this way. This is 
garbage, you know?" And it was garbage, and nobody spotted it. 
It was published, practically a book-sized article in a major 
journal. 

Crawford: But don't we have to feel good that we have a new perspective 
with which we're looking backwards into history? 

Blum: Oh, yes, we've come a long way, but I guess this is my caveat 
about biography or autobiography, and that is: supposing I 
hadn't really come back to the medical school, and supposing I 
hadn't met Tommy and worked on several ethical things with her? 



'Mahoney, J.D., C.J. Ven Slyke, J.C. Cutler and H.L. Blum, 

"Experimental Gonoccocal Urethritis in Human Volunteers," American Journal 
of Syphillis, Gonorrhea, and Venereal Disease. 30:1, 1-39, January 1946. 



I was aware of ethics, but I wasn't that discerning. She 
was the one that got me into giving a couple of lectures, and I 
couldn't think of anything more pertinent than to take a look 
at my own career. Wow. That was quite startling. That study 
involving experiments on prisoners was my first significant 
venture. Part of this experience I had was being coerced into 
doing it wrong. I was in the service, in uniform, and I knew 
we were doing the study badly, but I didn't object because it 
was done under orders shades of Nuremberg. 

Crawford: You were aware that it was being done wrong? 

Blum: Yes. It was so bad it was gross. I kept complaining to my 

immediate boss, who had one half stripe more than I did. And 
the excuse that you use is, "Well, I'm in the service and what 
am I going to do? Am I going to fight it?" I did nothing 
about it. Oh, I knew it was lousy work; and I don't think 
anybody should be exposed to an experiment that ' s no good and 
can never teach us anything. 

Crawford: Did you say it? 

Blum: Oh, yes, and my boss said to me--we had four layers of bosses 
up to the guy who ran the Tuskegee Study, who was an assistant 
surgeon general--"Look, when any of our bosses come through and 
visits, just lay off this stuff." And he said, "If the boss 
says that black is white, it's white. Get that through your 
head." This was from my immediate superior. He too went on to 
be an assistant surgeon general--! thought he would at the 
time . 

Here's this whole Nuremberg story of can you hide behind 
orders, can you say that you had orders and therefore you can 
do this, that, and the other? I never thought about such 
things. I knew that it was lousy work, but I never thought 
about the coercion. Of course, the prisoners on whom we did it 
were coerced in a gentle waythey were bribed. Two hundred 
dollars for an experiment. That was a lot of money for most of 
those people. This was in Terre Haute, and the bulk of the 
prisoners came out of either the ghettos of Chicago or, more 
likely, from the hills of the Ozarks. Also, each "volunteer" 
got a very positive letter to the parole board. 

Crawford: What were the experiments? 

Blum: Infecting them with gonorrhea, which was not a health threat to 
our subjects because we already had penicillin. We were fussy 
about the technical side. 



Crawford: Infecting and then treating? 

Blum: And then treating, but the issue was really to develop a 

prophylactic for the armed forces that troops could take prior 
to intercourse. Well, we never could infect routinely enough 
to ever trust any work with prophylaxis. So we never got to 
the prophylaxis part of the experiment. We just quit after a 
year. 

Crawford: Were the prisoners aware of what was being done? 

Blum: Oh, yes. Oh, yes. Straight up. No question about that. 

Crawford: It was the money that attracted them? 

Blum: Yes, and a letter to the parole board. We would not call it 

coercion. We didn't see it that way. We thought it was being 
generous; but the truth of the matter is it's coercive as hell 
to a desperately poor prisoner or one who needs a boost with 
the parole board. 

Crawford: They knew. 

Blum: They knew, but it doesn't keep it from being coercive. In 

other words, if you're poor and somebody offers you something 
to pull you through, like real moneythey couldn't get 
cigarettes, or postage stamps, without some cash. 

Crawford: A kind of coercion, isn't it? 
Blum: Well, it ' s a version, I think. 
Crawford: What do you wish you had done? 

Blum: Well, I've since written a position paper that was used by the 
California Medical Association--! was on their committee, the 
equivalent of an ethics committee, from 1983 to 1991. This 
paper said that prisoners should never be used for experiments 
because they are in an unstable position. They're always 
subject to fear or rewards that they couldn't get otherwise; 
and so they're not necessarily willing participants. 

Of course there were also very practical concerns, which I 
learned by dint of making rounds, every night, on my prisoners. 
And that is they traded every conceivable pill they got their 
hands on. Illicit drugs cannot be kept out of the 
penitentiary, not even narcotics. They're trading this all the 
time for a cigarette, for a this, for a that, for a sexual 
favor, whatever. So, you don't even know what else they're 



taking or what they are not taking when you're doing an 
experiment in a penitentiary; i.e., you can't say what is 
really going on with your guinea pig. 

Crawford: Which really invalidates everything. 

Blum: It invalidates the whole business from scratch. Well, I don't 
think we understood that then; but when I wandered around the 
penitentiary at night, making rounds and talking to each of my 
"good" patients, I discovered this reality. They leveled with 
us because we were not doctors working for the penitentiary, we 
were outsiders. So, the doctor gets a little extra trust. 

Crawford: Was there value in what you learned? 

Blum: Well, some value in what I learned, yes. So I have no 

hesitation in presenting a lecture that said, "Not only is this 
research probably valueless because we didn't know what we were 
doing, we also didn't know what the patient was doing." In 
another sense the patients are not really free actors. They're 
being bought and sold. Practically speaking, it was 
interesting that we did have about one in ten prisoners who 
would neither take the money nor the letter, who felt that they 
were expiating their crimes or sins. 

Crawford: The letter? 

Blum: They wouldn't take the letter to the parole board, and they 
wouldn't take the money. They said, "I'm doing this because 
I'm trying to do some good." Now, that's the kind of person 
that you probably should be doing experiments on. If you're 
going to have human volunteers if you tell them not to smoke, 
or not to do this, or not to do that, they won't and they want 
to do whatever the experiment calls for. They have their own 
reasons for wanting to do it and helping society, as they see 
it. 

Crawford: When you talk to your public health students about this very 
issue, what do they say? 

Blum: It was one of a good many examples of ethical ignoranceit was 
so gross that I don't think the students got overly involved 
with this one. There were some less clear-cut versions of 
unethical actions that they and I thought were more 
interesting. 

Crawford: But are they horrified? Or are they weighing, balancing--? 



Blum: Since I was telling the tale, students can't be too horrified 
with me. Their attitude has more to do with the spirit of how 
I presented the matter. Acknowledging our ignorance and 
pointing out the strong support we were given by the nation's 
top scientific bodies to do the study effectively puts the 
blame elsewhere, on ignorance and perhaps on the urgency of war 
needs. 

This study was number one on my list. It began my career- - 
my first work when I became a physician, my first real job. 
Here I was, subject to coercion. I didn't dare talk back to my 
bosses, and used that as an excuse to myself. 

We even had another form of coercion on that project which 
I thought was funny--and this was really my own doing. My 
boss the one who told me, you know, "when the big boss comes 
in," and, "black is white is white, "--was a person I totally 
despised. Everything about this person ran contrary to 
anything I'd ever been taught a decent human being should be, 
let alone a smart one, who could even be an M.D. 

There were three of us working under him: two lab techs, 
who were nice people, decent human beings; myself; and he was 
our boss out there on the site in Terre Haute. We figured out 
very soon that he didn't know anything. He knew no medicine, 
he knew no lab work, he knew nothing. He was a miserable 
hypocrite. He couldn't even do a physical exam. 

Crawford: But he'd been told by higher authorities what to do? 

Blum: Well, it wasn't that. He made his way through medical school, 
sounded good, knew all the text book stuff. He couldn't 
examine a patient or know what he was feeling, seeing, or 
thinking. Thank god he went into administrative medicine. But 
coming into the lab and hearing the lab techs say, [half- 
whispering] "Come over here. The boss says these are red cells 
and he's crazy. I mean, it just ain't so." But they couldn't 
tell him any thing- -they were too far down the ranks. 

So I went over and looked at the slide, and I could see 
that he was mislabeling red cells and calling them white cells. 
Well, it wouldn't change the world, but just the same, that's 
not science, you know, and could be unfortunate if one of our 
clients had an untoward result. 



So I said, "Boss, we need to go through some things. We 
have to learn how to agree with one another. Now, let me cut 
my finger and put some blood in the specimen, here." Which I 
did. "And, let's look at what a red cell looks like in a spun- 



down urine specimen." So, he got to learn for the first time 
what a red cell looked like. 

Crawford: That is shocking. 

Blum: Well, this is a man who had been out of medical school for five 
years. So that's the kind of circumstances we worked under. 
You don't have much respect for a boss like that: technically 
insolvent, morally insolvent. You know, it was tough. 

Crawford: Did you do what you could? 

Blum: Yes, but the experiments I couldn't change. They were all 

worked out. First we were going to do this, then we were going 
to do that. These were crazy experiments. They were stupid, 
they never changed less than two or three variables at one 
time, so we couldn't attribute the results to any one thing. 
You couldn't learn anything. 

Crawford: You still read about this today, don't you? 

Blum: Yes. Well, today, I don't think people are stupid, they're 

just vicious or dishonest, but then it was stupidity. Anyhow, 
so we used to be absolutely uncivil to the guy. We had to eat 
lunch together each day, and when he'd come in the lab, we just 
sort of said, "Get out. You're contaminating the atmosphere." 
This was our boss, you know. We had it pretty well figured 
out. We coerced him. We never discussed it as such, but we 
thought a good administrative boss can't acknowledge that he 
has lousy assistants. If his superiors find that everybody 
that works for him is not very good, there's something wrong 
with the boss. He wouldn't dare give us all bad reports, and 
he didn't. 

Crawford: All three hundred percent? 

Blum: Right, right. So, we coerced him. That was a different 

version of coercion, but that one situation had all these three 
levels of coercion. The nature of the experiments, the 
prisoners, and the staff mistreatment of the boss. I think 
that was kind of interesting. 

Crawford: That's very interesting. 

Blum: If it hadn't been for Tommy, I'd have never spotted the gross 
nature of the experience. 

Crawford: Oh, I'm certain this worried you all the time. 



10 



Blum: I don't know. Three levels of coercion in one show. We lived 
with it for almost a year, eleven months. 

Crawford: But doesn't everybody, including students, have these kinds of 
confrontations and conflicts? 

Blum: Oh, I'm sure many do. But at the time, only one version of the 
coercion came through, and that is that we were ordered to do 
lousy experiments. But I didn't rebel at being forced to do 
them--I just took it for granted and accepted it as part of 
service life. 

Crawford: Do you think you dealt with your superior in the best way that 
you could? 

Blum: Not effectively, never complained above him, just like he never 
went above his superiors. 

Crawford: This was your first such confrontation? 

Blum: I suppose, yes. Even our boss' wife was aware of his view of 
getting ahead. We all lived near one another. We all came 
from Stapleton, that's Staten Island, a big marine hospital, 
part of the armed forces during the war, and it meant that in 
those circumstances, in a pseudo-military situation, the lower 
ranks have to salute you, and you've got to salute back, you 
know. When somebody comes along that's got more braid than you 
do, you've got to salute them. 

His wife tells us how he's just coming out of the PX 
entrance with a great big bag of groceries in each arm, and up 
drives an admiral. Here he is, what the hell does he do now? 
[laughter] So he drops both bags and salutes. She just loved 
that story, and I do, too, because it's too close to what 
taking orders can become. [laughter] 

Crawford: That's the way you like to remember him? 
Blum: Yes. 

Crawford: Well, I suspect your students are very lucky to have this story 
presented to them because it ' s a real story--tangible--it ' s not 
just ethics in the mist. 

Blum: So we went on in class about ethics, along my career, and we 
walked into bad situations. Very bad--. 

Crawford: After that? 



11 



Blum: After that. Yes. 
Crawford: In the service? 

Blum: Well, I was out of the service in four years, and I was treated 
royally in the service. I really can't complain about that; I 
got all good duty assignments even if the workaday realities 
left a bit to be desired. There was one momentarily shocking 
episode to which I'll return later. 

Crawford: But isn't that why every medical school has an ethics section 
now? 

Blum: About two-thirds still don't; and what's worse, those that do 
usually talk about hooking up somebody to life support or 
unhooking them, or allowing people to make decisions. The bulk 
of these people that you're worrying about are going to die. 
Some of them wish you'd leave them alone. Often their families 
are torturing them, and you're caught between the family and 
the patient, when you're supposed to be worrying about the 
patient. For sure, we need to know these things, but there is 
so much more to ethics. 

Crawford: We're a long way from our humanity--. 

Blum: A long way, but I regard these end-of-life confusions as 

relative trivia. The real ethical issues are denying health 
care to people to begin with people who had become sick. The 
routine: "Well, I'm sorry. You're not eligible. Good bye." 
Their eyes may be bugging out of their head, or their legs and 
feet are swollen and oozing. You look at street people with 
legs like this, many of them from standing in cold, heat, wet, 
and standing, standing, standing. Or maybe they have just a 
little heart disease thrown in, and they have no coverage-- just 
40 million presons without coverage in the U.S. today. These 
are the real ethical issues. 

Crawford: That isn't something we used to have to deal with in great 
numbers . 

Blum: True, but we're sure getting used to it. For this ethics 
class, where I was able to produce two hours' worth of 
material, I started looking at different aspects of what I had 
done, and some that I was only modestly aware of. 



12 



Parents and Childhood in Napa 



Crawford; 



Blum: 



Crawford : 
Blum: 



Crawford: 
Blum: 



Crawford: 
Blum: 



Almost the first thing you said to me was that when you were 
very small, you were drawn to public serviceyou knew that 
there was some kind of expectation and mandate for public 
service from your father and mother. 

Well, to go back to my childhood, neither of my parents ever 
went to school. They had no formal education, and they came 
from tiny Jewish communities somewhere between Poland and 
Russia. They were on the border, and so sometimes they lived 
in one country and sometimes in the other without having to 
move. 

Where did they meet, and what were their full names? 

Here in San Francisco. Pauline Leplin and Haiman Blum met 
about 1906 after the earthquake and fire. Neither had family 
here initially, but ultimately both had brothers and sisters 
come to San Francisco, some then leaving for New York, Los 
Angeles, Mojave. 

Were they farmers in Russia? 

Jews in Russia or Poland couldn't be farmers. You couldn't own 
or have any real ties to the land. You might sell produce, buy 
and sell, but you couldn't farm. It was verboten in Russia, as 
it was in most European countries. Neither of them went to 
religious or secular schools, so their exposure to education 
was really through apprenticeship and living. My mother was 
apprenticed as a dressmaker in a well-to-do home. She lived 
with the family for nearly a decade. The woman was a well- 
known opera singer, and my mother just made clothes for that 
lady. 

Do you remember the name of the singer in the family? 



The opera singer? 
nothing to me. 



No. I probably heard the name but it meant 



My mother spent her life in Russia until she was sixteen, 
making clothes on a very elegant scale. She probably had 
marvelous teachers, people who could have elegant clothes made. 
She was a superb seamstress, and when she came to this country, 
in various hard times, she turned back to that to make a 
living. 

Crawford: Was she elegant? Did she like to dress that way? 



13 



Blum: Nope. It didn't mean a thing to her. She did like her clothes 
to be just so. I mean, there's no such thing as a sloppy hem 
or a bad-fitting garment; but as far as elegant, no; but if you 
made a garment, it ought to be just so. She made all her own 
clothes, most of mine when I was small, even shirts when I was 
in high school. 

Crawford: High standards. 

Blum: Yes. Nobody ever sold shirts like that. They were things of 
beauty. Even I appreciated how elegantly they were made. 
Everything was done just right. Well, by the same token, she 
learned about the world of opera, music, literature. 

it a 

Blum: She read all the great Russian authors, certainly, and some of 
the English and French, too. So, it wasn't a boring existence, 
even though she had never gone to school, she'd learned 
probably a hundred times as much as she might have in any 
school that she could have gotten into. 

Crawford: She lived with this family? 

Blum: She lived with them, yes. So it was a pretty good background 
without ever going to school. 

My father had a really different experience. At age five, 
he was apprenticed to a woodworker. The virtue of these 
apprenticeships is that they feed you, and they house you, and 
they are exacting. He never went to school, but you know, 
being in a Jewish community, they were always exposed to 
pogroms and in their teens faced the reality of going into the 
armed forces. Being in the armed forces was not too much 
different than a death sentence. They'd probably find some way 
of getting rid of you, disposing of you, and you'd never come 
home . 



Crawford: 



Blum: 



The environment was probably somewhat radical in these 
apprenticeships; and the people you apprenticed for were 
probably Jewish, too, and probably radical. So there was no 
being part of the synagogue, no studying the Torah, and all 
that sort of thing. 

When you say radical; define that for the purposes of the 
history, if you would? 

Politically and socially radical; i.e., being a socialist. 



Who were their heroes? The heros were writers. After all, 
Tolstoy was a religious, peculiar figure; but his standing was 
very much pro-social justice, and he felt that human behavior-- 
whether you were rich or poorhad to be decent towards other 
people of any class. So you start with that, and then, of 
course, you immediately get involved with the sort of romantic 
figures the Victor Hugos and Emile Zolas--who were, all said 
and done, very pro-social justice. This was socialism. 

Crawford: And they would have been exposed to those writers--? 

Blum: Oh yes. Yes, they had all been translated, and they were 

exposed. My father was one of the best-read men I ever knew. 
He read everything, I mean everything. We'd go to the library, 
well, he'd tell you about this, and that, and the other thing. 
He'd read it all. 

Crawford: He told you about Zola? 

Blum: Early. I was probably five or six when I started reading that 
kind of literature. 

Crawford: I remember you told me that. 

Blum: By the time I was eight or nine, I'd gone through whole 
sections of the library. 

Crawford: Did your father have an extensive library? 
Blum: No, no, he used the public libraries. 
Crawford: He used the library, yes. 

Blum: There were two nice libraries downtown- -about three miles away. 
Every Saturday we always had to go to the library, that was 
part of the routine. You just knew you were going to the 
creamery because we had to deal there, and you knew you were 
going to buy some groceries, and you knew you were going to the 
library. That was just par for the course. You never skipped 
that. Well, rain or shine, too; and originally, I guess, in a 
horse and buggy; although I don't remember a horse and buggy. 
I only remember a car. 

Anyway, my father had this tremendous exposure to politics 
and literature and left Russia before he was drafted. All his 
brothers came over, and they brought the sisters, and so on. 
It was a large family, but other than my father they were not 
intellectually or politically oriented at all. 



15 



Art meant little to my father, whereas to my mother it was 
a big deal. Her treat in life was to go to the city (San 
Francisco). We lived up in Napa, and we would get on the train 
in Napa, and go to Vallejo and get on the boat, and go to San 
Francisco. Then we'd spend a couple of days, and a couple of 
nights going to operas or a ballet or a concert. 

Crawford: Oh, she brought you to the theater? 
Blum: Oh, yes, yes. 
Crawford: Your father as well? 

Blum: No. Never, as far as I can recollect. So it was a different 
stance. They knew the same literature, they knew the same 
political logic, but he was much more politically active, and 
she would say, "That was interesting." She didn't disagree, 
but that kind of action wasn't critical to her life. 

Crawford: So, what he took from the great novelists was the political 
ideology. 

Blum: The political. If you read Zola you can't help but get that 
sort of thing. Victor Hugo and Charles Dickens, likewise. 
It's there. You'd have a hard time missing it. Well, I think 
you'd have a hard time missing it in Shakespeare, too. 

So this was the kind of a background. No siblings. I was 
delivered by Caesarean, and in those days few of our friends 
seemed to want a second child, least of all my mother. We 
lived on a farm. Looking back at that era now, it was fine to 
live in the United States, where I started. There's a book 
recently out called Comrades and Chicken Ranchers that recalled 
many things for me. 



The Community in Petaluma and Farming in Coombsville 



Crawford: You told me about this book. Was it about the Petaluma 
community? 

Blum: Petaluma community. 
Crawford: Talk about that, would you? 

Blum: Well, really, my folks were kind of clever, as I look back on 
it, by not going there, because so much of their lives in 



16 



Crawford: 



Blum: 



Crawford: 
Blum: 



Crawford: 
Blum: 



Crawford: 
Blum: 
Crawford: 
Blum: 



Petaluma would still be reliving what they had escaped from. 
It was typically Poland, Russia, in terms of what people argued 
about and believed in. 

In other words, they wanted to stay away from those populations 
when they settled here? 

I think so. I think they didn't want to lose them, but they 
didn't want to live in them because everybody was very 
argumentative, and nobody was in agreement with anybody about 
anything. I'd say about four times a year, we went to visit 
families in Petaluma. They really only occasionally came to 
visit us. This involved a two- or three-hour trip with lots of 
flat tires. 

They weren't relations? 

No relation. These were people who had many similar kinds of 
experiences and feelings about things. Reading this book, I 
can mostly understand now what was going on. For instance, 
there were tremendous battles between the Zioniststhey ' re all 
the Jewish people who wanted to create a strong and great 
Israel where all Jews would be equal and would have reasonable 
opportunityand the anti-Zionists, which my parents were, who 
said "that's no solution to anything. So, it's great for the 
Jews, but how about creating a world where it would be great 
for all peoples? Jews aren't that important." That was a 
miserable minority view because "Jews are the chosen people" in 
the eyes of most Jews. Both my parents were thrilled with the 
idea of being in the U.S.A. and working for the betterment of 
peoples here and everywhere in the world. 



A very strong view, yes. 



They 



My folks were saying, "What's so chosen about the Jews? 
must be pretty corny if all they want is something for 
themselves." Well, you see, we didn't have to get into that 
battle but maybe a couple times a year, and we picked families 
to visit who felt more or less the way we did about things. 

To be your friends? 

Yes. 

Were there organizations? 

Yes, there were many, some of which cut across these Zionist 
divisions. There were many Jewish families whose goal in life 
was to make it big. Zionism was not the issue for them. These 



17 



people were further subdivided into those who wanted their 
children to be professionals and others who wanted them to 
become successful businessmen. Even further apart were those 
like my parents. The things that really counted in my 
childhood were from my mother's standpoint being an artist of 
some sort, or an intellectual or writer. 

For my parents, making it wasn't what living was all about. 
It was about making a living, all rightyou shouldn't be 
starving, but you should be worrying about a decent society. 
So any of those acquaintances who became significant business 
successes slowly were dropped out of sight, we just didn't 
associate with people like that. 

Crawford: Looked down upon? 

Blum: Yes. We just didn't associate with them. 

Crawford: Did she write or keep a diary? 

Blum: No, no. 

Crawford: She was busy. 

Blum: Yes. We were on a farm, and she did more work than my father 
did. That's an old Jewish custom, of course. The men prayed 
and studied the Torah (my father never really did), and the 
women made a livelihood for the family, took care of the home, 
the husband, children, and everything else. So it wasn't easy, 
but it wasn't something she thought was remarkable. One 
worked, that's all; and if she could do more, she did more. 
Now, of course, for many years off and on, when things were 
tough, my father, who was an excellent cabinetmaker, went to 
work full-time, earned good wages, and my mother did most of 
the work on the farm. Heavy duty tasks fell to my father at 
the end of the day and on weekends. 

Crawford: What was the balance? 

Blum: Well, fifty-fifty. About half the years were bad so he had to 
work away from home. About the half the years we could see a 
possibility of earning a normal living off the farm, so we all 
worked on the farm. [laughter] 

Crawford: But you always had good food, you said? 

Blum: Oh, always, because he was a disciple of educated farm 

management people. He doted on UC Davis, which was the aggie 
school. 



18 



Crawford: Were there resources there for him? 

Blum: Well, yes, because they had farm extension services they still 
have. So, if you're in grape growing country, there's an 
extension agent there who really knows about grapes. If you're 
in chicken country, he knows about chickens; and if it's 
turkeys, it's turkeys. We always turned to those people for 
advice. They've got booklets, and they come out, and study 
your situation and advise you. If you have a sick plant or 
animal, they'll take it and get a diagnosis for you. It's a 
really remarkable relationshipthe old land grant colleges to 
the farmers that was the tie. That was meant to be the tie, 
politically. 

So, at least once a year, we would go to UC Davis. That 
was Aggie Day. It was open house for actual and potential 
clients. People gathered from all over California up there at 
Davis. We always went, and it was kind of a holiday. You got 
to see all the wonderful cattle and sheep and goats and 
chickens and orchards, and all kinds of new gadgetry and 
methods. But in between time, you didn't have to go there. 
The extension people would get this stuff for you. In my 
childhood 1915 to early twenties--! think, looking back on it, 
they also had an intellectual plague they kept teaching self- 
sufficiency. That meant diversification. 

Crawford: A plague? 

Blum: I call it an intellectual plague because they were certainly 

not concerned with the farmer's survival in a practical sense. 
We had forty-two acres, and we had twenty kinds of food crops 
on it. Well, you can't make a living from anything with twenty 
tiny different crops. 

Crawford: But they proposed that? 

Blum: They said, "Well, you should raise these kinds of apples: this 
is for early, this is the middle, this is the late, this will 
store." We had ten, fifteen kinds of pears; apples at least a 
dozen kinds; cherries a half a dozen. It's insanity. I mean, 
you can't sell them. You've got more than you can eat, but you 
can't sell them because you don't have enough of any one kind. 
We concentrated on giving things away. 

Crawford: So, with a single crop, you would have been able to do better? 

Blum: On occasion, with a single or a few crops, you at least had 

volume enough to attract somebody to buy it, but you couldn't 
sell ten boxes of this or five boxes of that. For a brief 



19 



period of time, Safeway in its early days would buy such small 
quantities. 

Crawford: About when did Safeway come? 

Blum: It's got to be in the twenties. If it wasn't Safeway, there 
were some other outfits: Scaggs, Purity, and Piggly Wiggly. 

Crawford: And they could buy small amounts? 

Blum: They could, but it wasn't long-term good business for them; 
they were just wasting their time. 

Crawford: Not the way they market? 

Blum: Not the way to do business. If they bought an item for one 

store, then this store has to get rid of it, but they couldn't 
mass advertise it. Folks have to come in and see it because 
they don't hear about it and can't plan on having it. So the 
farmers who diversified were practicing a kind of economic 
suicide. But we did eat well. 

Crawford: Did your mother can like crazy? 

Blum: Oh, yes. The house had a full basement because that was the 
hatchery ultimately the main activity was raising chickens, 
and often turkeys. But much of that basement was filled with 
canned fruits and vegetables of our own production. Poultry 
meat we always had available. 

Crawford: That was in the days before freezing, I suppose, of meat? 

Blum: Yes. I should say that the hatchery was seasonal, but a major 
undertaking. We had two, three, four, five thousand chickens 
and we hatched them all. So Mother had a short eighteen-hour 
day which included turning each egg twice a day while it was 
hatching; and when the chickens began laying, before shipping, 
each egg had to be candled--put it in front of a light to see 
that it was free from blood spots. Today chicken farms have 
millions of birds, but then all the work was done by hand-- 
every bit of it. We even mixed up the mash they lived on by 
hand, distributed it to each chicken house, likewise cut the 
greens and distributed them, and collected the eggs twice a 
day. 

Crawford: You did a lot of that? 

Blum: I did some of it. There were times when I did, especially when 
school was out, although I'd more likely be involved with the 



20 



crops than with the chickens, 
see . 



It went on simultaneously, you 



Crawford: Now, was this diversification true of the farmers you knew in 
Petaluma, as well? 

Blum: No, in Petaluma I don't think there was a fruit tree in the 

lot. They went into chickens pretty exclusively. And when we 
were raising three or four thousand, some of them had thirty 
and forty thousand, primarily white leghorns. These were for 
eggs and, also, the young male ones for meat. So, in any case, 
they would have great years and bad years, but as this book on 
Petaluma brought out, there were a few years in which many 
poultry raisers got liquidated. When you get liquidated with 
only one crop, that's all you've got to eat. They really got 
liquidated. 

Crawford: Who published Comrades and Chicken Ranchers? 
Blum: Kenneth L. Kann, Cornell University Press, 1993. 

But that kind of a life on the small farms meant that 
farmers lived at most a few miles apartbut at least a block 
apart from most people. It meant you went to a country 
school. I went to Harmony Country School. Children came in 
from about a mile radius. It was a wonderful community in an 
international sense. There were a few families of English 
background, several Irish, several Scotch, there were Swiss and 
Romany Swiss gypsies. There were Italians from several 
regions, there were French, Alsatians, Australians, there were 
several kinds of Germans --Bavarian and otherwise. There were 
Polish, American Indian, Jews from Russia, Portuguese, Danes, 
but no Hispanic or black families. 

Crawford: Was there wine activity already? 

Blum: No, not a great deal because it was Prohibition most of that 
time. Some people were gambling, as we did, that it would be 
gone, and so started planting vineyards; but the wine business 
was dead. And we lived in a part of Napa that is not ideal for 
grapes to this day. 

Crawford: Where was the farm? 

Blum: In a place called Coombsville, it's just due east of Napa, and 
the road doesn't quite go anywhere. It's not the road to 
Sacramento, that's a little different; but it goes up into some 
hills. Vallejo City used to have its water supply there. It 
moved the water from up there in Napa down to Vallejo. 



21 



Crawford : 
Blum: 
Crawford : 
Blum: 



Crawford : 
Blum: 



My father just had a wild old time. I'd get in the car 
with himusually my mother was busy and we'd go visit the 
Pole, and we'd hear about things. He had a radio set about 
four feet long with a hand full of dials. He got news from all 
over the world. Next door to him there was an Englishwoman who 
wrote for various papers and magazines. 

The English lady, who'd been a writer, was kind of fun. She 
was a very vivacious character. She had a prune orchard and 
didn't know a damn thing about it; and my father would always 
tell her what to do next. We also had a Scotch man up the 
street, and he grew apples about eight inches in diameter; they 
were just indecent to us ordinary farmers. He'd remove many of 
the apples on the tree and leave a dozen, and he'd sell the 
dozen for more money than anybody could make by the usual 
methods of raising apples. 

Well, I'm thinking of the kinds of people that we had. All 
of them sort of spoke English; it was our common language, and 
we all got along. Some of them were in the same mess we were 
with diversification, and some were not. Some were poor- 
nobody was really wealthy. My father was a great organizer, so 
he helped organize the school district, and this and that. The 
school was already well-established when I got there; but they 
finally combined with another district and got a bigger school 
and more teachers and buses after I had graduated. 

Good school? 

Good enough, yes. 

And certainly international. 

Oh, yes. That was good. Our Native Americans were showpiece 
people. They were the favorite family aroundmother , father, 
two grown sons. Everybody went to visit and look at them 
because they were so beautiful. 

They weren't ostracized? 

Oh, no. No, they were elites. They were carpenters or 
something--well-skilled. They were Carlisle Indians and their 
name was Carlisle. They'd been well-educated, probably spoke 
English better than most of the others in Coombsville. They 
were also very friendly people. 



Crawford: Kept their traditions? 



22 



Blum: Not really. No, they were Americanized. They were just 

handsome, tall, well muscled, slightly reddish smooth skin, 
somewhat acquiline features, gorgeous. 

Crawford: Were there churches for all the different faiths? 

Blum: Well, the churches were not out there. This community was out 
in the sticks, but it went the three miles downtown to the 
churches. I didn't even know there were Jews downtown. On 
thinking about it, it turned out there were. The druggist was 
therewe always patronized that druggistwell, it was the 
main one; and the hardware store; and one of the clothing 
stores which we couldn't patronizeit was too elegant; and one 
housewares family; and there was a cider factory. These were 
all Jewish families. Oh, and there was a huge tannery, and 
it's still in business in the Bay Area. Those were Spanish- 
Jewish people, and I never dreamt they were Jewish: they were 
so fancy and they were among the elite of local society. 
Living in the country, I never had any idea there were other 
Jews around. 

Crawford: Really? Didn't talk about it? 

Blum: No. 

Crawford: Your father wasn't a religious practitioner, was he? 

Blum: Oh, lord no; and I don't know if these other people were or 
not. There was certainly no synagogue. We had one Jewish 
family neighbor and I believe my father had talked them into 
moving out there. They brought some uncles and brothers along 
with them, who were as highly skilled as he was. They were 
machinists and machine operators. They had to commute to San 
Francisco, though, where their work was. So they finally gave 
up after a few years, as their farm was even more useless than 
ours for making a living. 

That was the only Jewish family that I really knew, and 
they lived near us for three or four years. They had a boy 
older than me. This was part of my Jewish experience. It was 
interesting because they weren't the least bit concerned with 
the arts or ethical and political issues. They kind of went 
their way. They were the making-it crowd, although at one time 
they had been more political. That kid and I both hit grammar 
school at the same time, and he was a great success. Everybody 
loved him. He was a good athlete, small, but could do 
any thing- -tough, courageous, very, very gregarious, the perfect 
ail-American kid. And here's me a year behind him, playing the 



23 



piano, stuffed shirt, couldn't mix with the kids. I was a year 
or two younger. 

Crawford: That was a kind of an intellectual disparity? 

Blum: Yes, and more than that. I was always smaller wherever I was 
because I was younger. So I started retreating, and then I 
commenced to treat myself as a superior. That's part of it, 
I'm sure: the defensebecause I couldn't play football and 
couldn't run fast enough, or hit a baseball- -was to look down 
on the "clods" who could. 

Crawford: But you played the piano. 

Blum: Yes. And that's a big deal. You earn a lot of cordial hatred, 
and you in turn despise these people who think you are a sissy, 
and you look down on them as poor low-brows who play football. 

Crawford: Did you exaggerate that or did they react that way to you? 

Blum: Oh, yes, because on the way home, I used to get beaten up, and 
they'd call me interesting names and so on. It wasn't too evil 
and it wasn't too vicious, but it was clear that I was a Jew, 
yet this other Jewish kid never got this. He wasn't a 
ringleader in their activities when they were pestering me, but 
he was totally acceptable to the other kids and I wasn't. 

Crawford: And that was on the basis of his being an athlete, I suppose. 

Blum: Well, no. It was on the basis of being a real all-around guy, 
you see. He wasn't a nuisance. I mean, he was one of the 
folks, and I was not. One could say that this was 
discrimination because I was a Jew, but the truth of the matter 
is that I wasn't one of them and they just found that I was 
Jewish, and that was handy- -something to torture you with. 

Crawford: You were different. 



Schooling 



Blum: Yes, so they made an issue of my being Jewish; but, in fact, as 
I look back I'm sure that had nothing to do with it because 
there was our Jewish neighbor having a great time. 

Another awful thing happened. I skipped the second grade, 
and this helped set the stage. This is a little country school 



with about forty kids--and about that time they divided it into 

two rooms with twenty each: the first four and the highest four 

grades. So, I'm the guy that skipped, and they had never had 
that, apparently. 

Shortly thereafter, the state examiner came by. That was a 
big event, the state examiner. Here I was in the third grade 
down here, and there was the five to eight grade room. They 
took me into that room, and had me read for the state examiner. 

Crawford: Into the fifth grade? 

Blum: Well, in front of grades five, six, seven, and eight. I'm 

reading for the whole school so the examiner will be impressed 
with how well we read. 

Crawford: So you were definitely singled out. 

Blum: Oh, boy. 

Crawford: Which is never good? 

Blum: Yes. [laughter] Particularly when it's clear that you were 

chosen as the one that can impress the state examiner, and the 
rest of the people are sort of --if you can just keep quiet, 
we'll do better. [laughs] 

Crawford: That's teacher's pet, magnified by thousands. 

Blum: Oh, yes. So I can still see it; and I enjoyed that, you see. 
I mean, I wasn't unaware of what was going on. I still get a 
kick out of it. 

Crawford: You liked being different? 

Blum: I didn't mind it for a positive cause, i.e., showing that you 
can read. Subsequently, I had a lot of anti-Semitic remarks 
made, and was beaten up on the way home from school and this 
thing and that thing; but I don't think it was really anti- 
Semitic at all--. 

Crawford: It was just being picked on. 

Blum: Yes, but it would happen to a Jew, though, because that's 
exactly their tradition of being into cultural things, 
intellectual things, readingyou know, the whole shmeer. 

Crawford: Would there have been only two Jewish families in this school? 



25 



Blum: Yes, and the other family was soon gone. 
Crawford: The school was out of town. 

Blum: Out of town in Hannony--a little country district. There were 
only forty students, even at its maximum. The school's still 
there. The building's kind of cute. Somebody cleaned it up, 
and it's a home now. 

I went to the town school at about the seventh grade or 
eighth grade. You weren't supposed to, but my folks figured 
that I wasn't getting everything that I should get in Harmony. 
So I switched to the town school. Unfortunately I had also 
skipped the sixth grade, so I couldn't parse sentences when I 
got to town. So this is the bright kid coming to town, and I 
missed the world of parsing. I still don't know what it is. 
It just scared the hell out of me to be such a dumbbell in 
front of the whole town class. 

Crawford: Nobody parses anymore. 

Blum: Well, I knew I wasn't missing too much because it was clear 

that I knew more literature than the teacher. I knew more math 
than the teacher. This was the good town school. It was clear 
I was in great shape, except not in phys . ed., and not in the 
carpentry shop. I could no more do what my father did than 
fly, perhaps I was blocking because I couldn't stand him. 

Crawford: And your father was so skilled. 

Blum: Well, first, I wasn't allowed to mess around at home. That 
was, "Well, you won't do it right." So I worked out an 
arrangement when I was probably eight or nine. The steps were 
falling off our house, which was up above this big basement. 
My father said he'd fix them. So he bought the boards and they 
lay around for two or three years. Stair boards are expensive 
and nicely-shaped, rounded edges, and so on; but they don't go 
on the stairs by themselves. They just sat. The railing 
started to fall off. 

I cut all the stairs to size, cut all the risers. And I 
did all that very secretively, and filched the nails, and 
tucked away the tools; and then one day when I knew my father 
was going to be gone for several hours, (I didn' t go downtown 
on that Saturday) I stayed home, and I put those stairs in. 
And we had some bitter times over that because this was a 
"lousy" job. It really wasn't done very well, but the stairs 
were solid and safe and I felt good every time I looked at 
them. 



26 



Crawford: It was done. 

Blum: Done, you know. So, to this day, I have strong feelings 
against perfection. 

Crawford: It's intimidating, isn't it? 

Blum: Not only that, it's a way to see that nothing happens. I can't 
say that my father didn't want anything to happen, but he 
certainly didn't make the stairs happen while we waited for the 
perfect job. 

Crawford: Well, he wasn't afraid that he wouldn't do a perfect job, was 
he? 

Blum: Oh, no. All the while he wasn't doing it, he was out 

rebuilding somebody's house or barn for free. This used to 
gall my mother and me. He'd go over there, and he'd set in 
cabinets for a neighbor; and, it was nice--I don't begrudge him 
the fun of doing it- -but he could have done our stairs in the 
course of one of those jobs. 

Crawford: Never did appreciate your stairs? He never did? 

Blum: He never took them out. Then, when I put in the second set, 
the back stairs, well, we didn't hear about that. [laughs] 

Crawford: Good for you. 

Blum: We had a longhalf-mile long- -driveway through our farm, and 
it was just a big mud hole. We had a little stream that would 
run through in the wintertime, and would wash up a lot of nice 
gravel. So I had a kid's wagon, and I'd load up the gravel and 
haul it into all the mud holes; and, you know, after a couple 
of years, we had a pretty good driveway. He didn't object to 
that. 

Then, once, when we switched over to raising turkeys, we 
had to build a huge chicken house that was two hundred twenty 
feet long. That's a lot of chicken house. It was about 
twenty-four feet wide. It was also built for chickens, and 
there was a roost--a platform and the roost on it--and I did 
the whole thing. 

My father and some neighbors poured the concrete floor. 
That was a big job, and I helped. Then, when it came to 
putting up the wood, I did it all. That was quite a job. It 
took me the whole summer. That was kind of fun. So, again, 
perfection was not my style, but we got it done. 



27 



Crawford: That's right. Was he very exacting? 

Blum: I think he gave up on me. For himself, yes. I mean, even if 
he was just patching a barn or a door latch or something: 
everything just so. 

Crawford: What were your parents' expectations for you? 

Blum: Oh, from my mother it was very clear. I should amount to 
somethingbe a writer, an artist. 



Blum: 



Crawford: 
Blum: 

Crawford: 
Blum: 



I should also be capable of making a good living, but that 
wasn't regarded too highly. One could be a doctor, one could 
be an engineer as second best. It turned out that my talents 
were not as a musician, and not as a writer--. 



But she would have loved that? 

Yes. That would have been good, 
ranch. 



We even had a piano on the 



Well, we'll get to that. We want to explore that, too. 

So they settled for my doing engineering, creating structures, 
you see. Not the kind of thing you think of today, more the 
heroic stuff: the bridges, the big building. So that's what I 
settled for, and, since my math was adequate, and since 
drawing- -which was not my forte--didn' t seem to be imperative 
for engineers, although many of them are good at it; why, we 
all settled for engineering. My father really had very little 
to say about all that. In fact, at the time I went to college, 
I think he would have liked me to have stayed on the farm and 
just done the work. Except there was no farm because it was 
the Depression and the farm went for the mortgage. 



High School Egalitarianism and Elitism 



Blum: Something more about my childhood, before we get to UC. The 

truth of the matter is that one part of me is totally missing; 
and that is that I was brought up, as I said, never to fight. 
A physical encounter was absolutely for animals. It was just 
inconceivable that you fought people with your fists or any 
other way. So there was very little fighting in my life, and 
certainly very little fighting back; and other than the gentle 



28 



Crawford: 

Blum: 

Crawford: 

Blum: 



persecutions I described, which weren't all that bad, I was 
never in a fight. In the country situation, we were spread out 
enough so you didn't have to fight. It wasn't like being in a 
ghetto or in the big city, where you had to fight for 
everything, I gather, at least nowadays. 

So, when I got to high school at age eleven, I started gym. 
The people I was tossed in with were from mostly fourteen to 
eighteen. At eleven years, you're not too well-formed; I 
wasn't. I had a hell of a time with gym, and got to dread the 
gymnasium, and the tumblingall that stuff. I was just scared 
to death of it and stayed away from it as much as possible; 
and, at the same time, I was thriving on the intellectual side 
in high school. 

The intellectual side, as I indicated before, is heavily 
weighted towards fairness and justice, and romantic ideals 
about just people, fair people, the whole bit. So finding that 
that wasn't typical of my classmateswho really hadn't read 
much of anything, thought about anything, didn't care about 
politics as I did, which was in our house all the time I 
developed this interesting dichotomy of being very much an 
egalitarian in spirit, and very much an elitist in reality. 
This really hung on for all my life; and I was well aware of it 
when I got to the university. It's kind of an oddball 
combination, supposedly; but not oddball at all, it turns out, 
it's very common. One of the things that you do is to put 
aside the physical people: the athletes and the folks who 
really do all the wonderful things in the way of dance and this 
and that, unless it's on stage. And by being a clod, in fact, 
you sort of protect yourself by being an elitist. So you're 
above all this physical expertise, and that isolates you even 
further. 

Yes. I can see it. 



It 



just really has plagued me all my life. 



Weren't there students like you? 

Very few. I had very few friends. The handful of friends I 
had were all oddball. One of the close ones just died the 
other day. He came to see me, thought he was dying, and 
thought we might not see each other again, and so he set up a 
visit. He's a little older than I. He was a huge Irish kid, 
Catholic, who lived right on the banks of the Napa River where 
it always flooded. Their house was on stilts. They were poor, 
desperately poor. His mother was a washerwoman- -a woman over 
from Ireland a wonderful lady, who had horrible hypertension. 



29 



I just can't believe what her blood pressure must have been 
before she died of a stroke. 

Crawford: How did that manifest itself? 

Blum: She was red in the face, and she was very volatile. You just 
knew she was going to burst one of these days in front of you. 

Crawford: And she was not treated for hypertension? 



Blum: 

Crawford: 

Blum: 



Crawford: 
Blum: 

Crawford: 
Blum: 
Crawford: 
Blum: 



Oh, there was no treatment. There was no treatment for high 
blood pressure in the good old days. 

They wouldn't have detected that, then? 

They could detect it but couldn't control it remember FDR. So 
what's the use of bothering? They wouldn't have done anything 
but talk about it. I met Bill in high school. It was also the 
very first year we had a great crop of apricots; I knew 
something about him from school. He was a nice person, a giant 
of a fellow. 

I asked him if he cared to come out and work in the fruit. 
Well, it turned out he was desperate for a job. I would say 
that he worked for us for at least four years, off and on, on 
every job there was. My father thought he was fabulous, and he 
thought my father was fabulous. Well, I never got along with 
my father. But we didn't get into that. Bill and I were very 
close friends, and he was my big, physical buddy. 

And what a rich friendship, that you kept it for decades. 



From '27 to 
didn't come 



'96. That's almost seventy years, 
out with Bill, thank goodness. 



My eliteness 



What was Bill's last name? 

Mills. 

Bill Mills. And what happened to him? 

Well, very nice things. We graduated together, and when I came 
to Cal, he went to Richmond to a job in the Ford assembly 
plant. I think they were just opening it up. There, he met a 
local girl, got married. Her family finally cleared out, 
saying, "We don't want to work on assembly lines," and they all 
went up to Grass Valley, across the highway from Auburn. There 
are two little towns there, and one of them, Grass Valley, is 
the home of the Empire Gold Mine, an exciting landmark that you 



30 



can visit now. It's a state park. This is the place 
associated with Filoli on the peninsula, and plays a part in 
Wallace Stegner's Angle of Repose. They settled up there with 
two kids, and he bought a big piece of land for near nothing. 
He was in the television repair and sales business. When the 
land suddenly skyrocketed in value he took up contracting, and, 
every year, built a house. He became a prosperous builder, 
built quality homes. 



We'd meet at class reunions, 
there. 



He'd drive the biggest car 



Crawford: This would be Napa High School reunions? 
Blum: Napa High School. 
Crawford: So you went to those? 

Blum: A couple of them. It was really nice to see this kid making 
it. 

Crawford: He did very well. 

Blum: Yes, and not the least bit boastful or a show-off or anything-- 
except for the car. He loved cars. He always did when he was 
a kid and never had any. Didn't have a car until halfway 
through high school. Then it was stolen by the dealer, who'd 
never filed the license plates with the state. The company- 
General Motors repossessed the car, and all this money that he 
put into it was gone because the dealer absconded with it. 

Crawford: He couldn't trace it? 

Blum: Not that, the dealer went to Brazil with everybody's money-- 
from hundreds of cars. That's a lot of bucks. 

Over these years, I was sort of picked up at high school by 
another group of people, also Catholic. The Smiths, just 
lovely, lovely people. They had just moved to Napa. There 
were three kids in the family: one in my class, an older sister 
a year ahead, and a younger boy a couple years behind. The one 
in my class was a personality kid--as different from me as you 
could get-- just full of jokes, a character. He's still up 
there. We went through school together; and, gathered around 
him was this group of kids that we associated with. These two 
sets of associates were very separate groups: Bill Mills and I 
in one setting, these other people and I in another. I was 
very close to those people too. The Smiths practically adopted 
me when my family split up--I was the only child. My mother 



31 



had to have a hysterectomy for fibroids, and we had no money. 
A wonderful Napa doctor who did surgery at St. Mary's in San 
Francisco was our usual doctor. He said, "I'm not going to do 
it, I'm going to have a better qualified doctor do it." He 
paid for the hospital and the surgeon, and took the whole thing 
on his back. 

Crawford: This private doctor? 

Blum: Yes, and so my mother went to work for him in his home. He had 
little kids. She worked there for quite a few years. So the 
Smith family, knowing that I was left on the farm with my 
fatherwe didn't really fight; I was going my way and he was 
going his waythey sort of practically adopted me. It's 
interesting. These people who were so different, and accepted 
everything, and God's authority, all but this one son who was 
my classmate. He was really a rebellious rascal, in a quiet 
way. I went to Cal. He went to Stanford and became an 
engineer, the kind that explores for oil, and did so all over 
the worldan interesting career. The father was a magnificent 
stone mason, and ran the local business of making headstones. 
Mrs. Smith was a tough, small woman, but very kindly. There I 
was surrounded with different kinds of people really not my 
kind of people at all but those are the people I got along 
with so well. 



Crawford: 



In the year when I dropped out of college--! did that after 
the first half a year, when engineering had fallen apart and I 
was sitting there with no money, having spent all my savings--! 
went back and worked for him part of the time, setting 
headstones. That's a kind of brute labor. The rest of my 
time, I worked on a prune dehydrator, and picked fruit. 

By the time I got through high school, I started to grow a 
bit. When I got there, I was fifteen and probably 5 '10" or 
something. You asked me, was I tall. Well, at the first class 
reunion, which was fifty years after we graduated from high 
school, when my wife and I came in the door, many people were 
already seated we had driven up primarily to see Bill Mills 
and his wife. We came on in, and my wife kept hearing, "that's 
little Henry." [laughter) 

But back to being an elitist. A message that I grew up 
with was, "if other people think it's good, you'd better watch 
it, it's probably crap." That certainly set the stage for 
being isolated. 

Well, that's what you had said. Your mother had taken you to 
cultural things in San Francisco, and I'm sure many of those 



32 



children had not been exposed that way. 
of a common grounding, was it? 



It wasn't really much 



Blum: No, and you get the habit of looking down your nose out of 

self-protection because you can't compete for athletics, for 
games. Nobody wants you on their team when it comes to a real 
game. So in high school, what did I do? Joined the debating 
team. 

Crawford: Talk about that. 

Blum: Well, it was interesting because the subject is picked by 
somebody else. By happenstance, your team will get the 
positive or the negative side of an issue, and that's what you 
do. You don't come into it taking the side you want, you have 
to perform on a clean table. You have a couple of weeks to 
prepare for a debate. We would debate with other high schools. 
I was relatively good at it, and just a wee bit nasty, just to 
keep the folks in the audience happy. [laugher] Well, it's 
not quite nastiness, but it's kind of making fun of the other 
guy's arguments or logic, undermining their credibility. 

Crawford: You don't mean demeaning? 

Blum: Well, as I look back on it, I think that some of the comments 

were just at that edge of taking a popular side of an issue and 
then making a joke of it. I remember one of the debates was 
about the chain store business: the chain store versus the mom 
and pop. Well, my girlfriend in high school was the daughter 
of a family with a mom and pop grocery. Her folks were very 
pleasant, but kind of austere. They were really quite 
religious, but not Catholics Protestants of some sort. I 
remember a crack that I made about the issue, that if we were 
not going to allow the chain stores to come inthen we were 
going to be stuck with these poor little places where they 
weren't too keen on hand washing and sanitation. I knew that 
household all too well. [laughs] 

Crawford: You really knew what you were talking about. 

Blum: But one is not supposed to say that kind of a thing. One is 

supposed to talk about the economic aspects. And I suspect my 
girl was sitting there and laughing. She came to Cal a year 
after 1 did. The first book she wrote was reasonably 
successful. She dumped me for a very handsome, lovely, big, 
powerful Irish guy. 

Crawford: On the basis of that debate? 



33 



Blum: 



Crawford: 
Blum: 
Crawford: 
Blum: 

Crawford: 

Blum: 

Crawford : 
Blum: 



Crawford: 
Blum: 
Crawford; 
Blum: 



Oh, no, for some reason, she decided we were a very poor match; 
and we were. I was not very keen about having a lot of kids. 
She was going to raise as many as possible. Intellectually, we 
had a lot of things in common, but in terms of practical 
living, no. I was sort of on her trail for several years. In 
that first book of hers, the heroine was her, the hero was part 
me, part her husband, but they surely had lots of kids. They 
were living up in New Monterey, you know--Steinbeck country, 
Tortilla Flats. I had a chance to visit with them when I was 
stationed at Fort Ord in 1941. 

He was an artist and she was a writer? 

Yes. He was really handsome--a powerful fellow. 

Would their names be known? 

I think so: Jean Ariss. She didn't write under her maiden 
name, she took her husband's. 



Well, let me ask you before we go there, 
high school? 



Were there mentors in 



No. Some teachers did take hold, but I don't remember a person 
in that role, although my English teacher and my chemistry 
teacher were both impressive, and not just to me. 

So these very strong f riendships--a couple of themwere really 
what you held onto? 

Interestingly enough, another one was a kid whose father was an 
administrator at Napa State Hospital. We were quite close and 
had a lot of interests in common. He too was not an athletic 
person. He was more like me than almost anybody else I knew in 
high school. He went to Stanford. I met him thirty years 
later, here on the campus. He was visiting people that he 
knew, who were also friends of mine. I hadn't realized that I 
was going to meet him, but did. It was fun. He was a very 
sweet person. He's since passed away, as I've learned. 

What was his name? 

Jeffries. 

So several people went on to Stanford from your high school? 

It was a class that really blossomed. The high school did not 
have a strong tradition of sending people to college, and all 
of a sudden with the arrival of a new superintendent, there 



were college students bursting out all over, and particularly 
into chemistrythere were a lot of people here in chemistry 
from that high school. 

Crawford: Was he a chemist? 

Blum: No, but he brought in good teachers; and one of them, a Mr. 

Buchanan, was a wonderful teacher; and everybody got enthused 
about chemistry. We'd never heard of it before, but suddenly 
everybody took chemistry because it was such fun. He was good, 
technically. I was here at a dinner some years ago at the 
chancellor's house, and a man who was once head of the 
chemistry department here and then became a chancellor at 
another one of the UC campuses was at the table where I was. 
He asked me where I went to high school," and I said, "Napa." 
He said, "Didn't you have a wonderful chemistry teacher?" This 
was a professor in chemistry, hereworld-famous too. I said, 
"Yes, we did." He said, "I remember the man. He sent us 
wonderful students." You kind of wonder, where were the 
students before and after this teacher who induced so many 
students to become chemists. 

Crawford: That's extraordinary. 

Blum: Yes. And here is the former dean of the school of chemistry, 
aware that there was a great teacher out there because there 
had been so many of his students here. There were Phi Betas, 
and more Phi Betas; and one UCB valedictorian. All kinds of 
good students from such heretofore barren Napa soil. 

Crawford: All who came from a small class of sixty or so. 

Blum: Yes, tiny, and for several years in a row. Even schools take 

on characteristics; but you wonder: is it the teachers or is it 
the school, or demographic changes? 

Crawford: Were you close to this teacher? 

Blum: Not personally close, but as a student, I just loved the class. 
I said if I didn't become an engineer, I'd be a chemist. 

Crawford: What else do you remember studying, and what made an 
impression? 

Blum: Well, a lot of English, a lot of literature. That's where I 
goofed because if I hadn't done all that, I could have taken 
typing. So I'm still crippled for lack of knowing how to type. 

Crawford: One of the most important courses. 



35 



Blum: I know it, and nobody ever said, "Are you going to college?" 
They took for granted I was going to college. I was not 
encouraged to waste time on "commercial" courses. Stupid. 
Although I also I never took Latin out of pig-headedness , so I 
might not have taken typing even if encouraged to do so, being 
an elitist. 

Crawford: Latin was offered? 

Blum: Greek and Latin. But I was emancipated from what was 

apparently current. I did study French for three or four 
years, in that way picking up a lot of language background. 



The Depression Years 



Crawford: Talk about the Depression. 

Blum: I came to UC Berkeley in '31, and the farm went under in about 
'32. It was really already under in '31. There was a mortgage 
of five or six thousand dollars. The Petaluma book makes it 
clear how it occurred. Every year you borrowed the money for 
the eggs, the chicks, the feed, the whatever you bought. Then, 
after so many months, you'd suddenly have this flood of 
chickens or eggs or whatever, and you'd pay the debt off. 

You lived that way all your life. When they had a couple 
of bad years in Petaluma, and people couldn't buy the poultry, 
the people suddenly had these unpayable mortgages. So farms 
all over just folded. And ours did, similarly. But, in any 
case, there was nothing to stay home for, either. I mean, you 
could talk about taking care of the farm, it was pointless. 
Who was going to turn on the pumps to irrigate the trees or the 
vineyard when the crops couldn't be sold? Who was going to 
raise and feed chickens when you couldn't sell them? 

Crawford: Nobody had the wherewithal, did they? 

Blum: Nobody had the wherewithal, and you couldn't get rid of 

produce. We hit the Depression when we were into turkeys. We 
were selling them, then, at cost. We would get--on the hoof 
with all the feathers and every thing- -maybe thirty-two cents a 
pound. You could survive. It wouldn't lose money. Once in a 
long while--come Christmas or Thanksgiving- -you'd get forty- 
eight cents. Incidentally, it's of interest to note that those 
prices are not too different from the prices today. 



36 



Crawford: You're kidding? 

Blum: Oh, no. If you buy turkeys around Christmas time or 

Thanksgiving, you'll find the price is often not too different 
from what I was used to in the twenties. 

Crawford: So that was a good deal of money, then? 

Blum: Yes, also evidence that farmers produce food at much lower cost 
today. 

Crawford: When you were getting it? 

Blum: Yes. When we were getting it. The one market we had for heavy 
chickens was Chinatown, San Francisco, because they wanted big, 
beautiful, live birds. You know the current squabble in San 
Francisco about live birds? Well, the Chinese were the only 
people who were fussy enough to insist on having a good, 
healthy, live bird when they bought it. 

Crawford: Everybody else wanted them dressed? 

Blum: Others didn't give a damn where they'd been or how they got 

there. The Chinese were the only fussy customers we had. When 
we were in the heavy chicken business, much of it went to 
Chinatown for premium prices. They paid more, they were 
willing to, they wanted good birds. 

Crawford: For restaurants? 

Blum: Not really. They were in the windows, and the people would 
come in and pick one out for their own family. 

Crawford: Did they come get them at the farm? 

Blum: We delivered them live to Chinatown. That was the nicest kind 
of arrangement we ever had: with the Chinese merchants who sold 
live poultry. People came and picked them out. We had 
beautiful birds, and people were willing to pay extra. It's 
kind of funny because now live birds have become an issue, an 
animal cruelty issue. 

In any event, the farm went under, and so there wasn't any 
use in talking about me staying on the farm; besides, I had no 
intention of staying on the farm. I couldn't conceive of a 
more idiotic way of making a living. You never knew whether 
you were going to have a living or not. We did because my 
father always went to work as a cabinet worker, and was so good 



37 



at it that he could always get a job. When the farm died, why 
stay? 

Crawford: Did he love fanning? 

Blum: Not really. No, the point to the farming, and the point to the 
Petaluma situation was very straightforward. It was kind of 
socio-political. Where could you go and be your own boss you 
come from a city life; and with really no great money to 
investbut you can always borrow on the farm, and have a 
mortgage going; have no bosses that was critical- 
Crawford: Independent? 

Blum: Independent. And you didn't have to have much help. You 

didn't have to boss anybody else. That was part of the credo, 
be on your own. 

Crawford: That's why not to choose a city existence? 

Blum: Yes. So the whole Petaluma scene, in that sense, was familiar, 
acceptable, because they mostly felt the same way. That was an 
odd kind of socialism. 

Crawford: Were they politically organized in any way? 

Blum: My father spent his time organizing farmers, much of his spare 
time. He helped the poultry producers of California found 
Nulaid Eggs. He got people to sign up. It was a co-op. He 
helped organize the prune growers- -the Sunsweet people, who've 
become something other than a lovely farm-centered operation- 
he helped found that crowd because we had prunes, you see, and 
dried fruit. So he was into all these organizing things--. 

Crawford: He was organizing? 

Blum: Yes, and it was always at the co-op level, on his own time and 
out of his own pocket. It wasn't to set up a big industry, it 
was to allow the little guy to come out even. 

Crawford: What did he do when the farm closed, then? 

Blum: Since the people who foreclosed it couldn't do anything with 
it, they said, "Well, stay there. Watch over it." So he 
raised a little of this, and raised a little of that for a year 
or two. Then he just cleared out. My mother and he had 
separated, maybe four years before the ranch went under they 
had separated. I started here, and she came and joined me 
after a year or so. 



38 



Crawford: You had told me that she influenced your attitudes? 

Blum: Well, she was an elitist, in a sense. There's no question 
about that. I mean, she expected the most from me, she 
expected the most from everybody, didn't see my father 
producing the most of anything, and was very disgusted with 
him. 

Crawford: So, the political organizing was not her interest. 

Blum: She didn't object to it, she approved of it in principle, but 
it was nothing that she did. She took a back seat in all of 
that. Her goals wereshe wanted to see social justice, she 
was willing to spend- -we spent money whenever we had it on all 
sorts of good causes. She wanted a good world; but, for me, 
she wasn't interested in organizing. She wanted me to be 
something worthwhile, and it was really cultural, you know. So 
I came here when I was fifteen and started Cal--. 

I didn't really see any justification in my going back to 
the farm. My father wasn't holding anything together. He 
wasn't supporting my mother or me or anybody else. It was just 
himself, it got to be that. He wasn't one of those that was on 
the bum, he actually worked in orchards. He knew how to do it, 
but that wasn't his forte. He worked as a millwright in the 
timber business. He worked in shipyards, doing ship-building 
kind of jobs. There weren't many jobs in the early thirties. 
It was a long, barren period. He kept going for about fifteen 
years, I guess. He would go from one thing to the next, and 
particularly because of his carpenter-type skills, he could 
always find something; and he worked cheaply. He did what he 
could. 

Crawford: And he kept organizing? 

Blum: No. Something happened to him during these years and he lost 
all interest in everything political and cultural. He stopped 
reading. He didn't bother about organizing or politics, he 
just kept alive. 

Crawford: Was he pleased when you came to the university? 

Blum: I don't know that I ever heard a word from him on the subject. 
He wasn't actively opposed. It was clear that he thought maybe 
I should stay on the farm, but there was nothing to stay on. 
So, we really parted company pretty thoroughly. I hated him. 
He was vicious to my mother from time to time. I didn't 
hesitate to threaten to shoot him, once. I thought that would 
be a good move. It wouldn't have been, I guess, but--. 



39 



Crawford: Were you serious? 

Blum: Oh, yes. 

Crawford: You were defending your mother, I suppose. 

Blum: Yes. I wouldn't go for that sort of thing. I had a lot of 
guns, having lived on a farm, went hunting. 

Crawford: Did you hunt and fish togetherthe two of you? 
Blum: Never. He had no interest in that. 
Crawford: He was not an outdoorsman, I guess. 

Blum: Not really. He worked on the farm, and loved being outdoors, 
but in regard to sport, no. None of that. He wouldn't object 
to my going deer hunting, or this hunting, or that hunting, or 
fishing; but he never did. 

Crawford: Well, let's talk about your piano studies. We need to go back 
to that because I know you were serious about music. 

Blum: Well, I really was, and I wasn't. I had a wonderful teacher in 
the town. Lessons also had to be fitted in on Saturdays. 

Crawford: How did you get into town? 
Blum: There was a car. 

Crawford: You had a car? And you devoted Saturdays to all these 
different things? The library--. 

Blum: All these things. So while my father was here and there and 
elsewhere doing the bulk of the shopping--my mother would go 
once a month, while he and I would go every Saturday. So I'd 
go get lessons. It was an hour. It cost a dollar an hour. 

Crawford: Do you remember a name? 

Blum: Yes. Miss Leah Grigsby. There was a Mrs. and a Miss, and I 
had Miss. Mrs. was not related to Miss, and they were always 
competing, which was kind of funny. Each had a large 
following. I loved my teacher because she was kindly. Some 
people loved the other lady because she was so stern and 
disciplined. I didn't go for that at all. My teacher would 
have a hyacinth picked, or something, sitting on the piano that 
you could smell. She was a very human human being, and she 
would buy me presents of sheet music. She had two lovely 



uprights. So, on occasion, we'd both play. I was technically 
rather proficient, but I'm not a musician. I mean, I can't 
play without music. I could memorize something but it was a 
grueling investment. 

Crawford: Did you practice? 

Blum: About an hour a day. There wasn't any let-up on that. My 

mother saw to that. [laughs] I don't know that I hated her 
for it, but I just didn't enjoy it. Everybody else was out 
playing, and at prime time, I had to go in the house and 
practice. I did well enough. After four months' lessons I 
went on to recital. My teacher had a big recital, and I played 
a tiny piano part of "II Trovatore." 

Crawford: That's ambitious. 

Blum: I sat there playing the gypsy chorus. It's a couple of notes 
up and a couple notes down; but there I was, about so big. 

Crawford: How old were you when you started? 

Blum: I suppose four or five. So that was a great success, 
tantalized everybody into thinking I was going to be a 
musician. At four months it looked good. I stayed with it for 
seven or eight years until we went broke. Part of the ritual 
in fruit season was a box of cherries one week, one week a box 
of apples, another a box of apricots, a box of grapes for my 
teacher. 



Crawford: Your teacher? 

Blum: My piano teacher always got something. We liked giving things 
to her. I got to high school in '27. The Depression was 
starting to be visible. We didn't have any money anymore. So 
I stopped taking the lessons, went through high school, and 
never touched the piano. 

I started Cal in '31, and then at the end of the first 
semester I took a year off because I was broke, all my savings 
were gone, and I wasn't doing very well. I'll tell you about 
that experience. So I stayed out a year; and, in that year, I 
just picked fruit, got jobs here and there, worked on a 
dehydrator, packing boxes, set tombstones. I was getting 
pretty husky then. I've shrivelled a lot since then. 



Music Studies and Cultural Exposure 






Crawford: Were you tall as a very young person? 

Blum: No, tiny, tiny. I got to be about 6 "2", ultimately. In my 

year out of high school I did all kinds of work around. In my 
spare time, I ran. I built some gymnastic equipment and used 
that for an hour a day, and I practiced the piano three or four 
hours a day. It had two broken strings, which we couldn't 
afford to fix. 

Crawford: This was your upright? 

Blum: Yes. I got quite proficient. I finally bought a lot of good 

music, and I studied the Beethoven concertos. Real music never 
deserted me--I mean, the technical proficiency. I didn't 
practice for years at a time, didn't touch a piano for years in 
medical school. But my mother got her money's worth out of it. 
She knew that I could play; and ultimately, when I first got to 
be a health officer we bought a new house and we built her an 
apartment as part of it. She got to hear me play on a good 
piano after all those years. 

Crawford: That's great. She must have been very pleased about that. 

Blum: I don't remember that she ever said anything, but I'm sure she 
was . 

When I was going to Cal, I lived in a terrible boarding 
house across from the Durant Hotel. The head of the music 
department at Mills College lived in that hotel. It seems to 
me her name was Mrs. Swayze. She heard me playing, and she 
came over, knocked on the door and invited me to come and 
practice in her apartment. She had a beautiful, big Steinway 
right there. She had a large suite of rooms, and she made her 
home there. So, I did that once in a while. It was better 
than that terrible piano at the boarding house, and no one to 
heckle me for playing classics. Those were some of the few 
good moments that I got out of it. There also was a wonderful 
piano on the campus in Stevens Hall. It was a gorgeous 
Steinway: unusual colored wood, a wonderful tone. I used to go 
up there on Sunday mornings. With nobody around you could 
play. Finally, it became popular. There were always groups 
meeting there, but my first year here in '31 I did play on it. 

Crawford: You mentioned the blue books, the little blue books. 



42 



Blum: 



Oh, that was an interesting part of my life on the farm, yes. 
Those were a nickel and a dime a piece, and in that Petaluma 



Crawford: 



Blum: 



Crawford: 
Blum: 



Crawford: 

Blum: 

Crawford: 

Blum: 

Crawford; 



book they discuss them. I mean, 
book after I talked to you.) 



it's all there. (I got that 



Maybe you had just heard of it when we talked because I made a 
note of it, but you hadn't seen it. 

I don't know, a friend just gave it to me. In any event, I 
remember the blue books because we had stacks of them in the 
basement. We had a room down there which was built as a 
sleeping room. We used to give hoboes a ride when my father 
would drive along. Most of the hoboes in those days were folks 
that came out of the skilled trades there was the IWW. 

Where did you find them? 

Oh, on the road when traveling to town or to Sonoma or to 
wherever we were going, we'd see these people. They would be 
walking along with a small bundle. You'd stop and ask them if 
they wanted a ride, wanted to go anywhere. Often enough, these 
people had work experience in common with my father: they were 
mechanics, woodworkers, one thing or another. So some of them 
would say, "Yes, I wouldn't mind staying on the farm for a 
while." And my father would say, "Well, stay for a while, and 
if you want to work, I'll pay you, if there's work to do," and 
there often was for brief periods. 

We used to hire some day laborers to do this and do that, 
particularly if my father was doing cabinet work. So some of 
these people lived in this room, and that's where the blue 
books were. Sometimes I'd get into conversations with them 
about these books. The blue books were all excerpts from the 
world's famous literature: philosophic, political, and the 
romantic literature. Although I had plenty of library books, 
these books were kind of a kick because they were so diverse, 
you could cover a lot of territoryin a few minutes one could 
see what an author had to say from a key excerpt. 

Excerpts? They were excerpts? 

Excerpts. Yes. 

Who published those? 

The word Haldeman comes to mind, but I'm not sure. 

Haldeman. But your father collected those, did he? 



Blum: Well, he went to the city and to meetings, and if he saw one, 
it was no more than a nickel or a dime, the price of a candy 
bar or a package of peanuts. In Petaluma, the blue books were 
evident as a very common institution. But our big affair--my 
mother and I--was to go to the city and take in something that 
was big time culturally. 

Crawford: Do your remember what you saw? 

Blum: Oh, yes. Caruso--. 

Crawford: Oh, you heard Caruso? 

Blum: Yes. Geraldine Farrar, Ezio Pinza, Chaliapin. 

Crawford: Where were they singing? 

Blum: The Civic Auditorium. All the great performers. One thing we 
did have, and nobody else in our neighborhood had, was a good 
phonograph. We had all the classical records that cost three 
dollars if they were on one side, and four or five dollars if 
they were on both sides. 

Crawford: That's a vast amount. 

Blum: In fact, a vast amount. So there was everybody: Gallicurci, 
Heifetz, Rubenstein, all the great singers and 

instrumentalists. A friend of mine, without knowing about this 
part of my existence at allhe's a collector has brought me 
several volumes about all the old opera performances and the 
singers; the pictures and the events. 

Crawford: And the recordings? 

Blum: No, I have some of the recordings left over from the farm, but 
they're so grim. I mean, who can waste the time that's 
involved? Every three minutes you've got to change the record; 
and they're technically terrible. Well, we've still got a box 
of them. 

Crawford: Seventy-eights? 

Blum: Seventy-eights, but I don't listen to them. Five years ago I 
got rid of the last device that we had that would even play 
them. Ordinary players don't do seventy-eights. Well, I 
finally got rid of it. It failed, and I just gave it up. But 
I remember, those were the days when Gigli was a young man, and 
Schipa was a young man. I go through these old books about 



opera now, and relive it. 
see their faces. 



You sort of hear these people as you 



Crawford: They don't come like that anymore. 

Blum: They do and they don't. There are fabulous voices now, just 

fabulous; but those were hard times. You could go to the opera 
house and hear them once in a while, and then the seventy- 
eights helped you relive the real events. 

Crawford: Coming to San Francisco was a day-long visit, wasn't it? 

Blum: Yes. We'd be there for a couple of days, and we stayed with a 
woman that my mother knew from Russia. She lived across the 
street from Mission Dolores. It's a beautiful spot, really. 
Lo and behold, my neighbor, nowfor the last thirty years- 
turns out to be the niece of that lovely old lady. 



II COMING TO UC BERKELEY: UNDERGRADUATE STUDIES, 1931-1937 



From Engineering to Chemistry 



Crawford: 



Blum: 



Crawford: 
Blum: 



Crawford; 
Blum: 



What a coincidence, 
be an engineer? 



Well, by now you decided you were going to 



An engineer, and that's how I got to Berkeley. The university 
made a few exceptions on my account because my grades were not 
very good. I only got good grades when I was minded to. The 
principal vouched for me. The high school had a bad 
reputation, then. The university didn't want to take students 
from Napa High, but it had a new superintendentor principal-- 
and he was a fuss-budget, and he really turned the school 
around. I was one of his new products even though my grades 
weren't so hot. So I got in. The first thing I did here was 
flunk Subject A. I hadn't done a lot of writing, actually, but 
was thought to be pretty good at it. That was kind of a shock. 

In high school? 

Yes. In high school. I was sort of a teacher's pet there, 
too, because I knew stuff that nobody else ever heard of; when 
you enter the world of literature, there's a lot of things you 
know. I had a wonderful English teacher, her name was Blume of 
all things, a tiny little darling woman whom I saw in recent 
years and she was still a tiny little darling woman who 
remembered me. 

From Napa? 

She actually was from Berkeley, originally, as it turned out. 
She went there to teach school when she graduated UCB. She 
wasn't much older than we were, and a marvelous teacher, so I 
had a great time with that. Well, I came to the university, 



here, and the first thing I did was flunk Subject A. 
not too highly thought of. 



That ' s 



46 



Crawford: 
Blum: 



On my first day of school, I went over to engineering, 
that's where I was going to be, and I went to take Civil 
Engineering 1A. They had a brand new building called the 
Engineering Buildingthat nice marble-looking buildingbut in 
the catalogues that we were given, the instructions showed all 
the rooms for the engineering classes in a building that had 
been shut down, and they hadn't modified the books. So I went 
up to old North Hall, which used to be, I think, where the 
engineers were. It was an old building that was just on the 
verge of being torn down, and it was locked up. 

I looked around, and finally asked some people, and they 
said, "Oh, well, I think engineering's right over there." So I 
got there about half an hour late with three others and it 
was our first day of school. In those days you didn't pre-sign 
up. They had a sign-up in terms of paperwork, but you enrolled 
in class the first day of school. 

I got there and they said, "Well, we're very sorry. There 
are no more transits the survey instrument that you're going 
to use in the course there are no more measuring tapes, and 
there are no more levels, and there are no more desks." This 
was '31, and being an engineer was serious business for a lot 
of people. Well, they thought maybe somebody would drop out. 

So the four of us which is the size of a work group used 
to go up in the hillsides up where Bowles Hall is now; there 
used to be cattle there. We "measured" from one cow flop to 
the next, you know. This was the pasture; but these other 
people had tools with which to do the measurements. 

So we measured with our feet. It was a joke, a bad joke. 
We'd come in and we'd get an F or a zero. Just like we'd done 
a bad job. Then we sat in class and listened to the comments, 
and for four weeks we got zeroes. It was clear that nobody was 
dropping, it was time to quit because we weren't going to get 
any equipment and we were going to fail in the basic course of 
our chosen career, perhaps get flunked out of Cal as well. 

Find a new major. 

Right. This was Cal, very impersonal, nobody gave a damn. So 
I went up to the professor. He was a very handsome, powerful- 
looking middle-aged man by the name of Wiskocil. I said, "I'm 
going to have to drop." He said, "Yes. We're just glad to see 
you go." I was fifteen years old. That was the end of my 
career as an engineer. 



Crawford: What an attitude. 



47 

Blum: So, I switched to chemistry. 
II 

Blum: Thinking back, I had had a wonderful chemistry teacher in high 
school. I took physics, mechanical drawing, art--which was 
truly an experience. It took a year for me to draw one tulip, 
and it didn't look like too much. [laughter] 

Crawford: You weren't cut out to be draftsman? 

Blum: No. So, leaving engineering probably worked out for the 

better. So I started off, but now I had a gap of four units, 
and it was too late to make it up. Of course, one can make it 
up in due time. Then I forgot my Subject A class. I got so 
busy with chemistryit involved labs three times a week, and 
I'd stay there as long as I could, I was having a good time-- 
and that's when I was supposed to be taking the Subject A 
course at four o'clock three days a week. 

Crawford: That was English? 

Blum: English composition, yes. So I woke up about the end of the 
semester, and I trotted over there to the last Subject A 
class, and the teacher said, "I remember your name. You signed 
up. What happened to you?" I said, "I forgot about it. I've 
been in these labs--these chem. labs--and I suddenly 
remembered." "Well," she said, "I'll tell you what, you can 
take our final exam, and we'll see how you do. You can always 
take it over again next year." So I took it, and I got an A in 
it, don't ask me why. 

Crawford: Reading? 

Blum: It was writing, not reading. But I had forgotten about it 

because I was doing chemistry. So the chemistry was pleasant, 
and a lot of hometown kids were there, a very industrious crew, 
mostly sober with a few interesting exceptions. Alcoholism was 
rampant in those days, even amongst chemists. 

Crawford: Now you're talking about student life, and drinking among 
students? 

Blum: Yes. That kind of steered me away from some of those groups; 
but we didn't have always the best faculty examples. I 
remember, we had two Scotchmen on successive lectures, famous 
menone of whom I couldn't enjoy. He was such a prissy 
character. The other one I just loved. He was a hard-drinking 
guy. 



Crawford: Real Scots? 

Blum: Real Scots, oh yes, red hair, everything. We came in the 

classroom one morning, and the first professor- -the fussy one 
who never smiled or anything, just steely-eyed, all business, 
probably a nice guy--and we all smelled gas. He said, "There 
are a lot of metal plates here, and some of you have metal 
cleats on your shoes. Take it easy, let's not have an 
explosion." So we sat through our class. The next Scotchman 
comes in and [makes sniffing sound] he said, "I smell gas," and 
he gets out his cigarette lighter and he goes around looking 
for the leak. [laughter] These are two separate worlds. The 
second man, of course, was the man who liked to drink. He was 
truly an imaginative, lovely human being. I did some research 
with him in later years. 

Crawford: What was his name? 

Blum: Gerald Brancha great guy. The story went that he'd fallen 
into the Strawberry swimming pool more than once. Any event, 
it was a nice educational experience, and Cal was probably the 
elite chemistry school in the United States. 

Crawford: You were close to these professors, then, as an undergraduate? 

Blum: Fairly close; if you were a good student, and they got to know 
you, it was just that simple. I was good enough. I wasn't as 
good as the best, but I was pretty good. I started realizing, 
though, that there were some that were so much better. Truly, 
their minds were good, good, good. I didn't want to be a 
second-rate chemist; and that's what I would be. Most of my 
classmates who did about as well as I did ended up doing tests 
for the oil companies out here. I didn't see that as a career. 
So I started looking around for some applications in biology in 
particular. That seemed to make sense to me. I took 
bacteriology and just loved it and met some wonderful people, 
like the recent dean of the graduate school, Sanford Elberg. 

He was a T.A. in my student days. We had a great time. I 
was making a point then, of getting the best grade in the class 
by knowing the most. It was kind of satisfying. If you're 
going to do it, do it right, know all the material. Then we 
went on to more advanced courses, and the advanced course was 
eight units. We lived in this lab because there was a lot of 
lab work. We were there day and night, practically. I loved 
it. Tonight I'll meet with a nephew of the student who was my 
lab partner in that course. 

Crawford: So you've stayed in touch? 



Blum: 



Crawford : 
Blum: 



Yes. Sort of long-range, but we did. I met my wife there as 
well. Her older sister was a bacteriologist and had a close 
friend working on her Ph.D. in bacteriology who shared the lab 
with us at night as we worked on our experiments. Marian and 
this friend of her sister's were both in a botany course and 
studied together in the lab every few nights. 



Was she in the sciences? 

No, she was in social work, an undergrad program, 
freshman and I was a senior. 



She was a 



Perry R. Stout and Daniel Arnon: Mentors 



Blum: 



Crawford : 
Blum: 



Crawford: 
Blum: 
Crawford; 
Blum: 



In that high-powered bacteriology course were all the future 
hot-shot biologists. I made up my mind that I would do better 
than anybody else and didfor which one sort of gets marked 
out. But this is no longer grammar school. Now you're 
amounting to something, and to beat out all the folks who had 
it made for instance, one of the professors of zoology who 
then was a doctoral student; and I wasn't a doctoral student, 
but I just kept getting better results than he did. It made me 
feel good because he was the anointed one there. I discovered 
that I was good at something, but it wasn't chemistry. 
However, I later went on to work for a group of chemists here, 
some famous ones, in plant nutrition. One was Daniel Arnon. 
He came close to getting a Nobel. 

What was Arnon 's field? 

He was a chlorophyll metabolism expert, an expatriate from 
Poland. Then, I worked for a fantastically wonderful guy- 
Perry R. Stout, who became a big wheel at UC Davis in due time. 
These people did the most interesting experiments; and there I 
was, the hired hand as a chemist, fifty cents an hour. You 



day. That's how I saved 



might work eighteen to twenty hours a 
money to get to medical school. 

You were working on their projects? 
On their projects, yes. 
As a research assistant? 



Assistant. Much of it was, "Hey, run these potassiums, run 
these sodiums, go feed the tomatoes, do this, do that." So you 



50 



were a gopher. But on the other hand, if you had brains enough 
to cook something up, you might be allowed to do it; but that 
wasn't what you were there for. Stoutparticularly Stout did 
the most fantastic experiments; and he only belatedly got 
credit for them because his experiments were seen as "too 
easy." I'll never forget that. 

Crawford: What do you mean? 

Blum: Well, he was trying to get a Ph.D., while he ran the storeroom 
for the Department of Plant Nutrition, for which he got about 
one hundred and ten dollars a month. Then he'd do all this 
stuff. He was the man who discovered what happened to the 
added phosphates in some phosphate-depleted soils. This was a 
great mystery to everybody. The farmers pumped on the 
phosphate and the trees blossomed. But the next year, the 
trees declined. On an analysis of the soil, "It's there, but 
why don't the trees get it?" Well, he figured out just exactly 
what the crystalline structure of the soil was, and that 
particular soil absorbed the phosphate into a new crystalline 
format where it became unavailable to the trees. 

Crawford: So, after initial application, it wasn't there? 

Blum: It wasn't there for the trees to get it. It had been a great 
mystery. Perry R. did all this work with crystallography and 
x-ray diffraction patterns. He had taught himself mineralogy. 
He was no mineralogist, he was an agricultural chemist. I'll 
never forget, he sent away to the USDA for soil specimens- -or 
mineral specimens because he was learning how to do 
diffraction patterns on the x-ray. 

He established the diffraction patterns of the well-known 
minerals that the USDA had sent to him. He got the diffraction 
patterns, but one of them doesn't come outone of these from 
the USDA all labelled and everything. So he does it again. 
He assumes he may have miscalculated or mislabelled that 
sample. Again, it came out with this wrong pattern. So he 
figured out what it really was, and he wrote back to the USDA 
saying, "You know, the sample you sent me as thus-and-so is 
really not thus-and-so, but is something else with the 
structure I've established." He became a hero overnight. USDA 
had never been able to identify what that specimen was, and 
they told him that. He was using relatively new technology x- 
ray diffraction patterns, you see and they were using 
something else. Well, he went around the world before it was 
over, explaining this way of doing business and this wonderful 
experiment. He just did one exciting thing after another. 



51 



Crawford: He was a Ph.D. candidate? 

Blum: Candidate. He never got a Ph.D. because his committee would 
sit there and say, "Well, you only worked on that for two 
months, you can't get a Ph.D." So, he went from one 
spectacular thing to the other, and he never spent more than a 
couple of months doing them. True, he'd spend maybe six months 
or a year thinking about it, but when he hit the lab, it was 
all streamlined with all the options laid out. He did work 
with radioactive material that was then commencing to be "the 
thing," and Perry R. was finding new isotopes every day. He 
and I would work on them, and he was just an absolute genius. 
He'd say, "Well, if it is in the filtrate, it's this; and if 
it's in the residue, it's that." I hardly kept up with him. 

I'm just reading, now, the life of Lisa Meitner, the famous 
German physicist who worked in the area of radioactivity, and 
had exactly the same sort of responses to her findings. Here 
Perry R. Stout was banging it all out, and he's not even a 
physicist. 

That further convinced me that I didn't want to be a 
chemist. I told him when I left, "Perry R. , you work one hour 
a day extra, and that will take care of everything I ever would 
have contributed." I mean, that's the relationship: about 1:8 
in terms of capacity. 

I worked with him a lot. We used to go up all through the 
Sutter bypass, that floods each spring. He was a consultant. 
He'd make one major trip a year. We'd get in his old car, go 
up there and take soil specimens and water specimens. From our 
analyses of the specimens he'd tell the farmers what to put on 
their crops, how much to irrigate, what to do, what not to do. 
I would do all the analyses here; but he was the one who 
figured out what they should do about their crops, each of 
which had different needs. 

That was a marvelous experience with a real scientist. 
Then, when the war came along, I knew that he was in D.C. I 
was stationed nearby in Baltimore. So I went over to see him. 
He was in the old Bureau of Standards Building; and I came up, 
and I was in uniform. The marine guard there said, "What can I 
do for you?" I said, "I want to see Perry R. Stout." "Oh, 
fine," he said, "just wait a minute." He disappeared for a few 
minutes, and there comes Perry R. Stout. He's a great big man, 
and he looks at me, and he says, "How did you get in here?" I 
said, "I told the guard that I wanted to see you." He said, 
"That same guardhe kept the British Radar Scientific 
Delegation waiting for a week before he would even tell them 



52 



that I was here." And what is he? He's the head of all the 
radar research in the world, exclusive of the German efforts. 

When they hired himhe still didn't have his Ph.D., but 
somebody knew that he'd done his x-ray diffraction work, he'd 
built radar-type equipment, he'd built geiger counters, pH 
meters. He just made these things in passing because he couldn't 
afford them or they weren't available and he needed them. 

Scientists had heard about him and shipped him to Harvard, 
where the radar program was starting. On his first day there- 
he's a big burly guy--he dropped the one piece of radar 
equipment they had and broke it to smithereens; and they just 
lost their minds. He said, "Look, just relax. I'll put it 
together by morning. Just don't wear yourself out." And he 
did. Well, they didn't even know how to put it together after 
he put it together. 

In short order he became the head of all radar research for 
the Allies. They moved him to the Bureau of Standards and gave 
him this building for a place to work, but he's still earning a 
hundred and forty dollars a month because they had a deal with 
universities that they wouldn't pay any more than the person 
was getting when he was drafted. This is the University of 
California at Berkeley at its best. He couldn't make his Ph.D. 
in about five attempts, each of which brought him world 
recognition. 

Crawford: Would that happen today? 



Blum: I suspect that it might. But the armed forces told the 

university, "We're going to pay him what we think he has to 
have. As the head man here, he's going to get the head pay, 
whether you like it or not, whether we have an agreement or 
not." So he earned a decent salary for the first time in his 
life. We went to his house and had a drink. It was quite 
something. A couple of kids three kids and living on nothing 
all this while. He didn't much care. He was a real scientist. 
Well, the university figured the only way out of that 
embarrassment was to give him his Ph.D., and they did. 

Crawford: Oh, so they did? 

Blum: They did. They cooked up something. They gave him a Ph.D. on 
one of the studies that he was already famous for. I remember, 
when he flunked one of his doctoral exams- -he flunked it- -well, 
the real point was that he hadn't spent enough time on 
conquering the phosphate project. I remember Dr. Greenberg, 
the great biochemist, had flunked him ostensibly because he 



53 



Crawford : 
Blum: 

Crawford: 
Blum: 

Crawford: 
Blum: 

Crawford : 
Blum: 
Crawford: 
Blum: 



hadn't memorized the structures of the amino acids. Here, the 
next day, I'm working; and here's Greenberg sitting at Perry 
R.'s desk saying, "Would you teach me how to do these x-ray 
diffraction patterns so I can do my work?" Can you imagine the 
son of a bitch? He had really flunked Perry R. because he made 
important research look too easy. 

It's pretty surprising. 

I knew the professor because I had taken biochemistry, and he 
was one of the nicer guys. But he flunked Perry R., and then 
wanted Perry R. to teach him how to do his own work. 

Maybe a little envy? Sounds like it. 

A little something. It was pretty damned odd, yet not really 
unusual. Other examples come to mind. 

What happened to Perry R.? 

Perry R. became famous, of course. He ended up in Davis as one 
of the department heads. He died thereprematurely, I'm 
afraid. 

And how about Arnon? 



Arnon just died about two years ago. 



Never got his Nobel? 



One 



Didn't get his Nobel, but had a tremendous funeral affair, 
of his daughters was one of my favorite health planning 
students. I first knew her when she was a baby when I worked 
for her father, but years later she came through public health 
and was one of my students in health planning. An interesting 
woman who has gone out to Santa Fe, and has lived there ever 
since, didn't want to stay here. She has a brother who's a 
well-known doctor, from Stanford. Kids scattered all over the 
world; some of them living in England. 

I can't resist telling you about Nancy. In the week before 
her graduation she insisted I join her for a picnic lunch at 
the Haas Strawberry Pool on campus. She would take us in her 
father's car and bring the picnic. When we got there she had a 
swimming suit and towel for me so I could go swimming and take 
a sun bath. She confessed to subterfuge, she felt I worked 
much too hard, was getting pale, and she wanted me to relax for 
a couple of hours at least. She had to study finals and would 



be back for me, and I couldn't cheat on the rest because she 
was taking the car. 

Crawford: They were sort of mentors for you then, the two of them when 
you were an undergraduate? 

Blum: Oh, yes. These were true scientists and fine persons, yes. 

Crawford: And they inspired you to go on with medicine? 

Blum: Not really. Oh, no. We never mentioned medicine. 

Crawford: Thought you'd be a scientist? 

Blum: Yes, a scientist, but my observation, particularly where it 

concerned Stout, was that, "I'm just wasting everybody's time. 
This man sees so much better, so much faster. I'm just going 
to waste a salary and a spot if I stayed in his field." 



Choosing a Career 

[Interview 2: January 28, 1997] 



Blum: I told you that at Cal, I was fishing for a career that would 
use my chemistry; and one of the things I found was the wine 
curriculum, because we had a vineyard, you see. I took all the 
courses on campus for that. That was in about my third year, 
when I'd done basic bacteriology. I had a good time there, as 
I was trying to get more applied. I looked into the winemaking 
business, and that was kind of fun. But just like being a 
chemist in an oil plant, you do a thousand tests every week. 
Forget it. 

Crawford: You didn't see yourself as a vineyard owner? 

Blum: Oh, no. Then I took all the biochemistry courses. Finally, I 
took a course in pharmacology. I said, "Here we go. This is 
how I'm going to get into research and use my chemistry. This 
is going to be it." I was already going with my wife and it 
seemed okay to her. 

When I graduated from chemistry with honors and was 
therefore offered a job at Shell Chemical where I discovered 
barrel-rollers were paid more than good chemists, I said to 
Marian, "Let's go over and look into the pharmacology program 
at UCSF. It's a doctoral program, and that should be really 



55 



Crawford: 
Blum: 
Crawford: 
Blum: 

Crawford: 
Blum: 



Crawford: 
Blum: 



fun." We went over there, and the professor who ran the 
program sat us down and explained that I'd be lucky to survive 
such tough studies and the competition from medical students in 
the basic courses. 

This must have been during your senior year? 
Just at the end, yes. 
And who was he? 

Oh, he was a great man. He was a dean once at a medical 
school, Chauncey Leake: a big faker. 

How do you mean that? 

Well, he said to us--as we were sitting there, out in the sun 
in San Francisco--"! don't know that you can make it. You see, 
you've got to take the first two years in courses of the 
medical school, and I don't know that you can get through. But 
sure, we'd like to have you. You have a good background in 
chemistry and biochemistry. Now you have to take all the 
courses that make up the first two years of medical school." 
It turns out that to take them in medical school will cost 
seventy-five dollars a semester; taking them as a Ph.D. 
student, in those days, cost twenty-five dollars a semester. 
My wife got very upset with this professor because he repeated 
several times that he didn't know whether I could make it or 
not, getting through the equivalent of the first two years of 
medical school in competition with the medical students. 

Why? You were head of your class. 

Well, but neither he nor I knew that then, that was yet to 
come. We sat and thought about it. If you take the first two 
years in medical school, you can go on to complete your M.D. if 
you want to; or you can always go back to pharmacology. If you 
take the same course work on the Ph.D. track, you can never use 
it to complete medical school because you weren't enrolled in 
medical school. Written into state law by turf-oriented M.D.s 
was the fact that you had to take these courses as a student 
registered in a bona fide medical school. We thought about it 
for the time it took us to get home. I said, "The hell with 
that. I'll get into medical school, and I can always go back 
to pharmacology if I don't want to complete the M.D." 



Crawford: 



But you can't go the other way? 



56 



Blum: You can't go the other way, and the difference in cost is only 
two hundred dollars. Well, there was one other difference: to 
go to medical school, I had to have Shakespeare, zoology, and 
embryology as prerequisites. I said, "Okay. I'll get the 
money, so I'll go on working in gardening and chemistrydo 
whatever I canand I'll make up these courses, get them done 
within the next year, and then I'll apply." So I only applied 
to one school- -UCSF. I didn't have the money or the vision or 
the interest in going elsewhere. My wife still wasn't done 
with college here in Berkeley, anyway. So, that's what I did, 
and I got in as soon as I applied in 1938. 

Crawford: Did you apply other places besides UCSF? 

Blum: No. There was no point to applying elsewhere to medical 
school. I didn't have any money. I had about a thousand 
dollars in the bank saved up from all the odd jobs. With 
tuition being rather cheap at UCSF--it was seventy-five dollars 
a semester for two semesters a yearyou knew that you could 
get by. My wife was still in school, she was still an 
undergrad, supported herself. So we knew we could get by for a 
year. UCSF made you sign a statement that said you had at 
least three thousand dollars available. I didn't, so I had to 
go get my father's signature. He was still up in the Napa 
Valley, and I got his signature. He didn't much give a damn 
one way or another. He thought I was crazy but he felt under 
no promise to help me, nor did he have any means even if he 
wanted to. 

Crawford: He didn't think much of that choice? 

Blum: No, and I'd never thought of medical school before. 



57 



III UNIVERSITY OF CALIFORNIA MEDICAL SCHOOL: 1938-1942 



Happy Jack: Starting Medical School and Finding Housing 



Blum: It took me a year to do the extra requirements, but that's how 
I had the time to earn the money to go to school. That was not 
a struggle. I was young, so I had those extra years. I made a 
lot of nice friends taking these courses. Some of them are 
still around here in the sciences. 

Crawford: People are still in those departments? 
Blum: Oh, yes. 

Our first day in medical school was in anatomy. We 
received a sixty-pound oak box made in San Quentin that 
contained a five-pound human skeleton. This had to be taken 
home as it could not remain on the laboratory premises. I got 
a ride for me and my skeleton, but a block from campus there 
was our tiny classmate Bertha bogged down with about a mile 
more to go with her box. We got her home, but I'm still not 
free of that memory of my medical school's concern for the 
welfare of its students. 

In the next twenty-four hours, we had chosen partners, four 
of us to a cadaver. In spite of all that one hears about the 
trauma to medical students that comes from dismembering a dead 
person, our trauma came suddenly and repeatedly from the 
faculty dismembering us. By noon of that second day, we had 
our first taste of good teaching relationships. Our 
instructor, who was best known as "Happy Jack," summoned us to 
the front of the lab, sitting on our stools, and began to quiz 
us on our assignment that we had more or less begun. 

As he settled himself to the joys of intellectual sadism, 
he looked around and saw one of us who had facial paralysis and 
a wry paralytic smirk as a result of a birth injury. This so 



58 



demoralized Happy Jack, who didn't believe that anyone should 
be smirking as he was about to lash us into shape, that he 
snarled, "Wipe that stupid smile off your face when I'm 
lecturing." 

Our partner in medical school couldn't wipe his paralysis 
off; he was embarrassed at being picked on for his disability, 
and as I got to know him for what a kindly person he was , his 
embarrassment was probably mostly for our instructor, who was 
such a pitiful physician that he couldn't even recognize a 
common birth injury. Happy Jack lived up to his nickname and 
committed suicide a year later. 

Our next hurdle came in histology next afternoon. The man 
in charge was competent but apparently somewhat resentful of 
only being number two in the hierarchy. He made us feel right 
at home by disapproving of most of the microscopes which we had 
to and did purchase on our own. Since they couldn't be 
inspected prior to beginning classes, it was a bit 
disheartening to find out that we couldn't proceed to do the 
course work, which was 90 percent microscopy. But few of us 
could afford another scope. Mine was an unused although 
secondhand one that did a good job. An earlier admittee had 
gotten about this far on his medical career, thought better of 
it, or was plain intimidated, and sold his investment in 
medical school. No one offered to help us so all of us fiddled 
around, cleaned our scopes, and went on with our assignments 
with some trepidation, but the instructors looked through our 
scopes after all, and we all survived. These events made for a 
most enjoyable entry into a medical career, one not to be 
forgotten, although often suppressed as each of us came to 
enjoy the benefits of being an M.D. 

I had a most disquieting few minutes about two nights after 
we had taken our finals. Marian and I were to be married the 
day before Christmas and her sister came to stay with her for a 
few days before the marriage in our newly rented apartment. 
Marian's sister was an old friend of our professor of histology 
and had arranged to meet her at our apartment, unbeknownst to 
me. I got there from work and was astounded to see one of my 
key professors there. This professor was presumably a very 
stern woman, not unfriendly, but all business. I wondered, 
"What could she be doing at our apartment, what could be 
wrong?" As she learned of my impending marriage she said, "I 
have a present for you. You're sharing first place in your 
class in medical school." 

Two days later we took the streetcar to the Hall of Justice 
and had a most unromantic ceremony. Then we went to Richmond 



59 



to see Bill Mills, his wife, and new baby. To finish the 
wedding day off, Marian's father took us to dinner. 

Marian still begrudges the streetcar and the ceremony at 
the Hall of Justice. 



Crawford: The Hall of Justice in San Francisco? 

Blum: No, Oakland. We still lived on this side. The first year of 

medical school was in Berkeley. In the Life Sciences Building. 
We did anatomy, histology, biochemistry, all those courses 
here. The first year was moved in later years to San 
Francisco. So that was a good start, and there were no regrets 
at that point, except my wife's having to take the streetcar to 
get married. 



Chauncey Leake and Pharmacology 



Blum: In the course of those first two years in medical school, we 
also had to take a course called pharmacology, taught by this 
great man, Leake, who had told me I'd probably never make it. 

I took pharmacology, and I'll never forget this professor. 
He was a real blow-hard, a good storyteller. The first thing 
he told us was to go out and buy a book that he had written 
with a newspaper man called Medicine: Magic in a Bottle. This 
was our textbook in pharmacology. Well, it was a fun book. 
But, at the same time, the most beautiful of all medical 
textbooks came on the market, Goodman and Oilman on 
pharmacology, still a classic, how one should really write 
textbooks. I heard about it from somebody and went down and 
bought it. In those days, it cost around twenty dollars. That 
is like a hundred dollars or more now. It was a joy to study, 
it was so good. It was a whole bible of medicine in itself, 
built around how each drug affected human metabolism. 

So I got a little worried. This man's giving us a two-bit 
paperback to read because it's a best-seller--as I said, he 
also turns out to be one of the authors of this thing- -and to 
overlook a classic. 

I'll never forget the first day we were going to do animal 
experiments with drugs. We were going to do it on rabbits. We 
were to put some drops in their eyes, some fairly innocuous 
substance. The professor has this big, tall, blond lady 
assistant, whom I remembered from Berkeley. They are 



Crawford: 
Blum: 



60 



illustrating how you keep the rabbit happy, 
animal abuse in this class. 



You don ' t want any 



While he's yakking, and petting the animal, it is getting 
more and more nervous and agitated. Really, it was kind of 
pitiful. Here's a class of sixty-five, pretty critical 
characters who already sense a debacle. Sure enough, he said, 
"Now we've got to put the animal on its back." He tried, and 
the rabbit was all over the place. They have to be tied down, 
you know, strapped down on a little platform. Finally, he 
yells, "Grab the bastard!" And they tie him down. [laughter] 
This is after all the garbage about how to be gentle and take 
good care of an animal. That's Chauncey at his best. 

I worked in this lab with three other students. One 
fellow, Aaron Davis, who became a family practitioner out here 
in the East Bay for many years, was a lovely man who had a 
touch with animals. He got the animal practically mesmerized; 
and he didn't turn the animal onto its back, but put the ropes 
over the animals earsdidn't tie them at all, just to keep the 
animal comfortable. He put the drop into the animal's eyes, 
and we can see the pupils dilate, and this and that. It's just 
a lovely way of doing an experiment with a happy rabbit. But 
the dumb blonde came by, and she took one look and screamed, 
"That's not the way to do it. You can't have the ropes over 
their ears." All of a sudden our table is a grim spectacle. 
Chauncey rushes over to us, and after their fiascothey 
couldn't even get the rabbit turned overthey start picking on 
us for bad animal handling. Well, that was the end of my 
notions of ever going into pharmacology as long as Chauncey was 
around. Just a bunch of dunces; and it's an important field. 
It's a huge field. 

Why was he in the position that he was? 

Well, a great talker. He went on to Texas to be dean of a 
medical school there. 



Crawford: What was Chauncey 's whole name? 
Blum: Leake. 

Being a Pain in the Neck in Pathology in Our Second Year 



Blum: In our second year we began our pathology. It was my favorite 
course because it not only described but explained the 



61 



abnormalities underlying and subsequently resulting from each 
disease. We studied organs and tissues both in the gross and 
under the microscope as part of understanding what was going on 
normally and then what was going on in the disease process. 

Once a week we had a fifteen-minute quiz, each of us 
getting a comparable slide from some part of the body to 
determine what disease process was going on. 

I flunked the first quiz by putting down inflammation and 
an organized clot in a vein. The correct answer was 
hemorrhoid, which, of course, is exactly what I described. The 
rest of the class all had the correct one-word answer and got 
an A. A little sleuthing revealed that each fraternity house 
had a box of all the slides to be used in the quizzes, along 
with the correct answer. Since the exams were the same each 
year they knew what to call each slide. Next week was a 
repeat. I got a flunk for describing a skin break when 
everyone else knew it was a "stab wound." I was mad and went 
to the professor, who seemed shocked by what was going on. 
From then on we got new fresh slides. I got A's from then on 
and most of the class just got by. 

Several of my classmates berated me for making life tough 
for themwhy hadn't I come to them and they would have shared 
the slide boxes and the answers? 

I was no more but no less of a loner than before. I had 
not joined the Jewish fraternity under some pressure. One non- 
Jewish frat had indicated a willingness to have me as a member. 
However, the frats had little to offer a married student since 
their main function was to provide reasonable board and room 
arrangements for single men. True, belonging to a frat was the 
proper thing to do and the frats were the center of what little 
social life there was in medical school. 



Blum: Another story from medical school, sophomore year, practicing 
physical diagnosis on patients at the Laguna Honda Nursing 
Home. We passed a patient out in the hall and she was purple 
in the face. She was puffing and breathing hard and looked 
like the end was near. Our instructor pulled us aside and 
said, "What do you think that is?" I said, "Lobar pneumonia." 
He looked a little grim, like, "These students are really 
ignorant." He was a nice person, and he didn't berate me for 
it, but it was clear he didn't think much of my diagnosis. 
This other kid, whom we called the Vermin--it rhymed with his 
real name took a chance and said this was Kussmaul breathing: 



62 



Crawford: 
Blum: 



deep, diabetic, acidotic breathing. We were sophomores and 
didn't know very much, and the instructor looked pleased, like, 
"Hey, we've got a genius in this class." 

So I got kind of upset about my poor showing. When the day 
was over, I wandered back to the nursing station and pulled 
this lady's chart. She had lobar pneumonia. It was so typical 
one didn't need experience to diagnose it. The instructor was 
a nice person, one you could talk to. Years later when I got 
to know him I asked, "Jack, how in the world could you ever 
think that was Kussmaul breathing? I verified from the records 
that the patient had a typical case of lobar pneumonia." The 
response was, "They never put lobar pneumonia cases out in the 
hall." [laughs] 

That's a great story. 

That's how you learn medicine. 



Housing During Medical School 



Blum: In the third year of medical school at UCSF, we were at the San 
Francisco General [then County] Hospital. We got an apartment 
at 24th and York. The landlords were born in Italy and had 
lived in Argentina and had a son about our age named Tony, who 
was a golden gloves champ who ended up getting a masters in 
Italian studies here at Cal. 

They were lovely people named Calonico and were very good 
to us they had bought us some furniture for this apartment, as 
we had none. We then moved across the street from UCSF for my 
last year and then we were gone for years and years , but at the 
end of the war when I came back to Stanford we went to see the 
Calonicos. They still had the four apartments, lived in one of 
them and had the downstairs grocery store, which opened at six 
in the morning and closed anywhere from eight o'clock on. This 
was seven days a week. First a little kid would come in and 
get bread, someone else come in for this and that, and this 
went on all day long. They knew everybody in the neighborhood. 
There were Italians, Germans, Irish, Spanish, a basic mix for 
this Mission District area. 

It turned out the parents had never taken a vacation 
together. Sometimes Papa could go away, sometimes Mama could, 
and Tony was in the middle holding onto things too. Well, we 



63 



weren't settled yet, so we offered to run the grocery store for 
them so they could take a long weekend vacation. 

They said Tony could show us how. They trusted us, and we 
went down at six in the morning to buy producethe produce 
center was on the north side of Market then. We would open up 
in the morning and come dinner time we would eat all the stuff 
that was getting too ripeyou've never seen such gargantuan 
desserts of figs, peaches, melons, bananas and whipping cream! 
[laughter] 

So the folks got away to Yosemite, and in the course of 
this I delivered groceries--! 'd put an orange crate on my 
shoulder and take the groceries around the neighborhood. I 
started meeting residents who were quite shook up. The 
customers whom we knew from when we lived upstairs would say: 
"Doctor! What are you doing here? Did you buy the store?" 
[laughter] They knew I had been in medical school. Well, I 
thought that was kind of fun, the neighbors remembering us, 
five years later, and we remembering the neighbors. 

Tony lives in our neighborhood in Berkeley now and has 
raised five kids; in fact, his folks came here ultimately and 
we visited with them after they retired. They wanted to be 
with the kids. 

And then on Parnassus--! had taken part of my senior year 
and become a substitute intern, primarily, as I said, to avoid 
unpleasant services. My substitute internship was in surgery, 
not that I thought I'd be a surgeon. During this time we lived 
in an apartment house across the street from the hospital, and 
I remember the first couple of nights I was away--I often was 
away all night--and I came home and Marian said, "What's going 
on over therethey are killing people." Turned out we lived 
across the street from the obstetrics unit and she was hearing 
the delivery room shrieks. [laughter] We were in that 
building when the Japanese bombed Hawaii and we knew we'd soon 
be in the war. One day all our Japanese classmates 
disappeared. I don't think we felt any fear, but to have these 
people disappear right out of medical schoolone of them I was 
close to, a woman surgeon who lives in Palo Alto now Bertha 
Akimoto. She was sent off to camp and then like other women 
was freed to live elsewhere. She ended up under my aunt's wing 
at medical school, Mt. Sinai in New York, and became a surgeon. 
It was a horrible thing and the real point is that nobody 
objected. I kept thinking that was the way Germans must have 
felt about Hitler's increasing viciousness. 



Crawford: No sense of outrage. 



64 



Blum: The concentration camps were in part the handiwork of our good 
governor, who became such a great man as a Supreme Court 
justice. I told you we went to visit the Jimmy Carter Library 
in Atlanta, and the first section there is devoted to the 
Japanese incarceration. We were on a tour and there were some 
California Japanese people with us and we were just curious to 
know how they felt about it, and they said it was just was one 
of those things that happened. I was depressed about that 
because most of the Japanese I know didn't feel that way about 
it. My associate, Yoshiye Togasaki, wasn't very happy about 
itlost everything to boot. 



Obstetrics at San Francisco General ## 



Blum: My first significant participation in patient care came at the 
beginning of my third year in 1941 at the San Francisco General 
Hospital. It was in obstetrics and for our debut we were put 
in a beautiful new delivery suite, lots of glass for the family 
to look in, gorgeous green everything, including the lovely 
slick new tile floor. My partner was an old friend from 
chemistry days. We students were to take the delivery as far 
as we could, and had for guidance probably the best obstetrics 
resident anyone had ever seen, Earl Marsh, a majestic, 
charismatic person as well as being an acknowledged superlative 
obstetrician. 

He was one of the few higher-ups that we all trusted, and 
we knew that he was genuinely interested and wanted us to learn 
how to do things and to succeed. Although women have by 
themselves been delivering babies forever in an apparently 
straightforward way, this is not how our first case appeared to 
us, and we were apprehensive. Our patient was a beautiful 
young lady having her first pregnancy. She was also deaf and 
essentially dumb. None of her three doctors, if we two 
students can be pretentious, could do sign language. 
Translators of any kind were unknown in those days. So Bob and 
I made a series of one-foot by two-foot signs, the first 
saying, "Take a deep breath," the second, "Hold it and bear 
down," the third said, "Let it out," and the fourth said, 
"Relax." I think there was one other. We couldn't explain any 
of this to our patient, who was going into active labor, but 
she caught on pronto and we were underway. 

For some reason, perhaps out of deviltry, or a feeling that 
Bob and I weren't getting sufficient exercise, our mentor, Earl 
Marsh, had the lady put one foot on one of Bob's shoulders and 



65 



one on mine instead of into the usual stirrups on the delivery 
table by means of which the deliverers braced themselves. We 
cleansed her perineum, and in the process made this beautiful 
new green tile floor quite slippery. As we peeled off the 
first sign saying "Deep breath" and then the second saying 
"Hold it and bear down," this healthy young woman leaned into 
the process and Bob and I went scooting across the floor and up 
against the back glass wall, no help to our patient. We went 
back, put towels on the floor, and went sailing again. Nothing 
helped and she kept us skidding helplessly until we connected 
her with the stirrups. Then her labor pains got powerful and 
Bob and I got the signs all mixed up and all three of her 
doctors got hysterical. She was clearly in no danger and 
undoubtedly would have done better if three male clowns weren't 
laughing uncontrollably. 

I can't forget her cute and distressed smile as she 
enunciated, "What's so funny?" We sobered up magically and I 
swore off obstetrics for life. Bob became an ophthalmologist 
and I an internist-preventive medicine specialist. Earl Marsh 
continued as the superlative obstetrician, hopefully avoiding 
neophyte shoulders and slippery floors. The new baby was a 
great success. 



Crawford: Well, would you like to venture in to what happened to Vermin 
in his career? 



Blum: It was desperate. He went into a specialty practice that I 
knew in the Bay Area, and they had to get rid of him in a 
matter of months. 

But his father was a professor at UCSF. So it hadn't been 
all accidental; there was some leeway for that. But he was too 
much for a practice or should I say, too little. 

Crawford: It was connections. 

Blum: Yes. Apparently, they must have told the practice that he was 
good. To go to that practice, you had to be good. Such 
episodes were also part of the joys of medical school. 

I remember I couldn't stand the chief of neurosurgery when 
I was in medical school; he was also the president of the board 
of regents of the University of California, and the dean of the 
medical school, and was a horrible person. 

Crawford: Do you want to say who? 



66 



Blum: Howard Naffziger. He was very famous in his field. I remember 
when we were seniors, early in the semester, being in 
orthopedics clinic along with a girl classmate. We were seeing 
patients, and somebody came up to her and said, "Naffziger 
wants to see you." She said to him, "Well, please tell him 
that he knows where I am. If he wants to see me, he can see 
me." That was pretty wild. Naffziger was a god. By four 
o'clock that afternoon, she was locked up for psychiatric 
observation, never came back to medical school. 

Crawford: Locked up for observation? Because she said that? 

Blum: Yes. I don't think she was mentally ill. I think she was so 

frustrated, so sick of the old bastard. She never came back to 
medicine. She changed her career. 

He was that authoritarian. I could tell at that moment how 
I was going to relate to him when I came on his service as a 
senior. I knew I'd never survive. One could switch out of 
fourth year services into an internship if an intern got sick, 
and one of the surgical interns did get tuberculosis when I was 
a senior. I raised my hand as fast as the poor guy departed to 
go into a hospital for six months treatment. So I became a 
surgical intern. That was wonderful, and I managed to stay out 
of neurosurgery because I was volunteering service by service. 
I never did neurosurgery and never had to deal with Naffziger. 

I had some other interesting intern experiences at UCSF. 
The head of surgery at that time was kind of a farmerish, plain 
person, and very pleasant to me, pleasant to his patients. I 
worked up a patient for him. He took out the patient's 
stomachmost of his stomachand I did all the scut work. I 
tested, did this, and did that, and did an extensive history 
and physical exam. Then I watched the surgery. We made rounds 
on him several times a day and I kept close contact with him. 
When the chief of surgery said, "You can go home. You're fine, 
and we won't see you for such and such a time," the patient 
said, "I don't want to go home until I see my doctor." He was 
talking about me. The surgeon just about busted a gut. Not 
with happiness, either. He was a very fine surgeon; but this 
was too much for him. [laughs] 

I never held it against him. In fact, later on, he did 
some surgery on my wife, and turned out to be a pretty crude 
guy, as I should have expected. 

Crawford: Pretty crude? 



67 



Blum: Yes. She said she didn't want a spinal, and he said, "Fine, 
you don't have to have a spinal." And lo and behold, when it 
came time for surgery, she got a spinal, willy nilly. She 
objectedthat was tough--just shut up and take it, it's over. 
I don't go for that sort of doctor approach. So, he wasn't 
such a sweet farmer type after all. 

Medical school was quite an education up and beyond 
technical skills. When we graduated, we put on a play and 
invited the faculty to attend. Of course, the play was always 
a takeoff on our education, and there was plenty to take off 
on: a roast. So I got the task, thanks to my grade point 
standing, to invite a couple of the professors that we had 
never seen in four years of medical school. 

One was the chief of obstetrics. He was kind of a sweet, 
old guy. From what we heard he used to drive everybody nuts in 
surgery because he always listened to Jack Benny on the radio. 
And all during the surgery, he'd be telling all the wonders of 
Jack Benny the night before. I caught him just before he went 
into surgery, and he was pleasant about it--a good man, an old 
man. I said we wanted him, particularly, to come as our guest 
--we were roasting him goodto our senior party. So he said, 
"What do you want me for? I'm an old man." I said, "I don't 
know about everybody in the class, but I've never seen you 
before, and I'm graduating; and you're chief of obstetrics, and 
we thought it would be nice if we could see you." That was the 
kind of medical school it was. 

Crawford: You just never got posted to his service? 

Blum: Only a handful of students ever saw him. He was making a 

fortune. He wasn't there to teach medical students. He taught 
residents, to be sure. He said, "Well, that's a thought." He 
said, "I'll come." [laughs] 

Crawford: You got him? 

Blum: Got him. But he never did come. Then I tried to get the chief 
of urology, who was really a world-famous surgeon, one of the 
truly famous professors at UCSF, a Hopkins man. I came down to 
his office early one morning before surgery would ever start- 
he spent all day long in surgeryand his secretary said, "He 
never sees students." I said, "Yes, but I want to invite him 
to the senior party, and so I've got to talk to him." She was 
a nice enough lady. I knew her- -a nurse- -she was the head of 
his pool of people. She said, "I'll get you in here some 
morning between seven and seven-thirty." Well, he threw me out 
when I accosted him! He wasn't dealing with students. No way. 



68 



So he never did get invited, but that was not atypical of 
senior faculty at UCSF in those days. 

Crawford: That's enough to take you away from medicine, right there, 
isn't it? 

Blum: Yes. One gets a funny feeling that such professors weren't all 
that good about patients either. There were some nice people, 
in fact there were wonderful people, such as the pediatrician 
Mary Olney in charge of the diabetes service. 



Crawford: Was there a mentor in medical school? 

Blum: We had some faculty who were decent folks, all of whomthe 

decent oneswere friendly. I got involved in a few things. 1 
brought the American Medical Students Association to UCSF when 
I was a junior. It involved my going to a big meeting in 
Boston, and then coming back with the info. Everybody joined 
up, all the medical students. The membership was like twenty- 
five cents. But it was thought to be a Communist front by the 
faculty. We knew that the school was scared to death of 
horrible things like that. AMSA, now, is a big deal. Many of 
the students here at the JMP [Joint Medical Program] are 
officers in AMSA these days. 

Well, I was the first one from the West, so I was quite a 
hero back there in Boston; but when I brought it back, it was 
very clear I was going to have trouble. There was talk about 
the Communist menace and all that sort of thing. One of the 
first things we did was to ask for lockers for the students, 
and a few other minor things. The reason the lockers were in 
my mind, I had a classmate who had rheumatoid arthritis, and he 
had to carry his microscope up the hill to classes from where 
he lived, and he was on crutches. He died about our junior 
year, about the time that I brought AMSA to UCSF, and I asked 
for lockers. There was no place for him to store a microscope. 
Nobody gave a damn about a medical student. It was horrible. 

Crawford: That kind of activism must have been uncommon? 

Blum: Yes, it was, in those days. The reason I did it and the reason 
everybody said, "Go ahead, go ahead," was that I was number-one 
scholar of my class. 

Crawford: You could get away with it? 



69 



Blum: Yes, and wasn't going to get wiped out academically. When I 
did get back, I immediately lost my scholarship. Within a 
matter of hours, one of the nice professors a really lovely 
fellow, became quite a big wheel elsewhere came up to me and 
said, "You've lost your scholarship. I don't know if you know 
about it." He said, "Professor Goldman, who is chairman of the 
committee, saw to it." Well, Goldman happens to be our Senator 
Feinstein's father. He was a great surgeon and probably our 
best teacher, but he was a cheap son of a bitch, too. 

Crawford: He didn't want any trouble. 

Blum: Correct. He wasn't the dean or anything, he was just chief of 
surgery at that time. So I started getting all F's in surgery. 
It didn't really knock my standing all that much because I'd 
built up too much of a lead in grade points. He stopped me in 
the hall a couple of days later and said, "Did you get your 
scholarship?" The other man tells me that this man has wiped 
me out, and he stops me to see if I got ita neat person. 

Well, we didn't expect to get scholarships when we went 
through school. My wife and I always said it doesn't make any 
difference. We're not knuckling under to anybody. This is the 
way it is. But this was another reason to push people like me 
towards public health. 

Crawford: That must have been a horrific experience. 

Blum: The loss of a scholarship was just a wake-up call. 



Treating the Poor and Thoughts of a Career in Public Health 



Blum: My wife and I both got over any notions about my being a 

pharmacologist, and I continued on through medical school. 
Ethics had an odd way of popping up in my life. One of the two 
lectures we had on ethics, for example, was by a Catholic 
gynecologist. When I was an intern later on, he was the head 
of the service that I was on, OB-GYN at Franklin Hospital (now 
Davies). I worked up one of his patients. I couldn't figure 
out why we were doing a hysterectomy. It was a Catholic lady, 
in her late thirties. I took a history nothing. What are we 
doing taking out her uterus? That was not a Catholic hospital, 
but it was a Catholic patient and a Catholic doctor. 

When we got to surgery and she was under the anesthetic, 
and we were happily cutting away, I said to the doctor, "I 



70 



never could figure out why we're doing this when I worked her 
up for surgery." "Oh," he says, "Doctor, prophylaxis. 
Prophylaxis." And I got a funny feeling about who was teaching 
ethics and what ethics were. Was he talking about making 
money? Was he talking about her avoiding having any more kids? 
It turns out, of course, that is a not uncommon occurrence in 
the Catholic world, and also in the Mormon world where women 
don't feel able to use contraception. 

Crawford: Among Mormons? 

Blum: Yes, because they can't stop having kids otherwise, given their 
religious teachings. 

Crawford: Doctors prescribe it when it's not necessary? 

Blum: Well, they just do it whether it's medically necessary or not. 
When a woman is getting desperate with her third or fourth kid, 
one every nine months, she wants something done, and responsive 
doctors will find something. You've got pains, you've got 
aches, you've got bleeding, you've got something, but a woman 
cannot, on her own, use birth control in many religions. But 
if a doctor says, "I think you should have a hysterectomy," 
then the woman can thank the Lord and go on about her business 
knowing that she has not violated any religious teachings. 

Crawford: And that was this case? 

Blum: Yes. It doesn't sound altogether ethical, but I don't think it 
was unethical. If that's what she wanted, that's her business. 
But he was parading as a good Catholic doctor, too. I 
commenced to see that this was one more reason that I would do 
better in public health as I waded through medical school. 

Crawford: This is what you were seeing? 

Blum: Yes. There were all kinds of remarkable things. Nearly half 
the students in my class were Jewish. Seventy percent of the 
patients were Irish, Italian, or French Catholic. 

We were never, ever given one word about the fact that 
these people might not believe in the things that we believe 
in. We were very casual about hysterectomies. You don't want 
any more babies, that's no great sin. Go do it. Yet that's a 
real sin for a Catholic. 

Crawford: And that bothered you at the time? 



71 






Blum: You commence to wonder. We don't know anything about these 

people. We just treat them like they're one of us, and they're 
not. Then you wonder why they often don't do what you tell 
them, better known as non-compliance. 

Crawford: So you felt that you were coercing them? 

Blum: I don't think we even thought that hard. I don't think more 
than one or two of us ever thought about it . We never had 
discussions of these kinds, but in my mind it was kind of 
obvious. I was always aware of race and ethnicity and that 
sort of thing, given my background. So it struck me that we 
were being less than wonderful doctors. 

We were also taught the most stringent statistics. These I 
called Mayo statistics. They usually came from a place like 
that. You had a patient with gall bladder disease, an acute 
inflammation, and if you didn't operate, you would have 5 
percent mortality; if you did operate you would have a 1 
percent mortality. These were known as Mayo indications, 
teaching us how to be a good doctor. The only thing that 
nobody ever seemed to mention was that we were getting Mayo 
indications for surgery, but we weren't learning how to do 
surgery like they do at Mayo. We don't even know how to do 
surgery, yet we're going out to do practice with that kind of 
irrelevant guidance. 

The thing was, if I went out to be a family practitioner, 
I'd remember, "We're better off operating." That would be true 
if you're a Mayo surgeon, but it ain't true if you're a Cal 
general practitioner. 

Crawford: But that was the sense of it? 

Blum: The sense of it was you had to memorize this garbage about when 
to step in and when not. This is not irrelevant. What we 
should have been taught was, if you're a G.P., you'll probably 
get 20 percent mortality; if you're a good surgeon, 1 percent; 
if you leave them alone, 6, so make up your mind what you are 
and act appropriately. 

Crawford: Now, at that point, if you graduated and went to be a G.P., 
would you also be a surgeon? 

Blum: You could be. The bulk of general practitioners were. It's 

where the fun was , and the money was , yet you might only have a 
year's more training, or you might not even have that. 

Crawford: Not up to Mayo standards. 



72 



Blum: Well, I know where Mayo got their standards. They're 

describing the work done by Mayo surgeons. In good hands, yes, 
it's much better to have your gall bladder taken out. But we 
medical students kept seeing disasters from docs who had done 
this or that surgery and sent what was left of the patient back 
to UC to patch them up. 

This isn't positive learning. So, more and more, I kept 
moving towards what I might have done anyway, and that was 
public health, saying, "That's where I'm really going to go." 

Crawford: Was that evident to you in your first year, already? 

Blum: Well, maybe not first year, but in the third year when we 

really started seeing patients. It struck me that there were 
going to be better uses of my talents, some broader aspect of 
things. Much of what we saw was unnecessary illness and could 
have been prevented. We'd also see a lot of seriously ill 
people who could have been treated better, differently. I 
remember we had a visit from someone at Yale, a famed teacher 
and practitioner who went on to become a critical figure in 
public health, C.E.A. Winslow. I suspect his name is on that 
award I got from public health. 

Crawford: Is that the Sedgwick Prize? 

Blum: Yes. I'm sure he's on that list of awardees. Well, he came to 
lecture to us. It was marvelous and we got wildly 
enthusiastic. Public health was very tempting, and, again, it 
fit in with my notions of how things ought to be done that we 
ought to get there sooner, and it shouldn't be dependent upon 
whether people have the money to pay for it. 

Crawford: Was the hospital treating people who couldn't afford treatment? 

Blum: Yes. Many if not most of the people we practiced on were 

charity cases. At nearly all the medical schools, this was the 
case. Of course, that's another travesty: teaching on the 
poor. You learn all sorts of bad habits because these people 
are very different in many ways, very dependent, and had little 
if any freedom of choice. 

I could give you all kinds of examples. I remember when I 
was a junior, one of the famous professors at Cal was treating 
a patient. The patient was hard of hearing. Four students 
were standing around the bedside, and the patient wanted to 
know something and said something to the effect that she 
couldn't hear us. She was hard of hearing, and our professor 
shouted at her, "Lady, there's nothing worth hearing these 



73 



days, anyway." And shut her up. 
touch at the county hospital. 



This was a common patient 



I taught medicine at Stanford in the city--their medical 
school used to be in San Francisco--and I taught for ten years 
there. Then Stanford moved its medical school to Palo Alto in 
1960. In San Francisco we used to have mostly ghetto patients 
in the clinics. When we went to Stanford in Palo Alto, no. 
There were no ghettos. True, a few of our patients followed 
usactually found their way down there; but I couldn't believe 
the difference. For instance, in San Francisco, patients often 
had everything removed out of them. You had a symptom here and 
a symptom there, well, we'll take out your thyroid, we'll take 
out your stomach. I mean, all justifiable, but you might have 
a patient who was minus everything that was removable by age 
thirty. Down on the Farm there was none of that nonsense. I 
mean, these people are workers, business people, professional 
people, merchants. You don't routinely put anybody to bed with 
their ulcers stomach ulcers like we did at Stanford in San 
Francisco. They had work to do and were helped to do it. 

Crawford: And this was the fifties? 

Blum: This was from '50 to '60. Of course it's different now. But I 
went with Stanford and taught down there on the farm a couple 
of years. The commute was a little much for me, though; I 
lived in Walnut Creek and worked in Martinez. The first 
patient I worked up at Stanford had been a Caterpillar driver. 
The Cat overturned, crushed his shoulder but good so that 
there was no way Stanford or anybody else was going to restore 
the function of his arm and shoulder. The medical student who 
presented the case to me a senior medical student came up to 
me saying the patient has a date for vocational rehab. We've 
figured out he's going to be a tractor salesman. He knows 
tractors backwards and forwards. This is a new world. I 
looked at this student, neither faculty nor students had ever 
heard of voc. rehab, in the city. There they were only dealing 
with poor discards who never had a chance; and here we have a 
patient and we are already fixing him up to go back to a good 
job. This a new world and it's because we're not just dealing 
with the desperately poor. 

Crawford: Was that a function of too many numbers when you were in the 
clinics? 

Blum: No. When you always practice on the poor, you kind of give up, 
because such people have so little going for them. When you 
always work on the poor, so what can you expect, so what can 
you do to make the necessary changes to let them lead a 



Crawford: 
Blum: 



healthier life? They've got to go back home. They're not 
going to have this, they're not going to have that. I learned 
at that point clearly why doctors became so asocial, paid no 
attention to patients or their lives or their problems. There 
was very little you could do about it. We had social workers 
at Stanford in San Francisco. All they ever were concerned 
about was how much money you could get out of the patient or 
from someone on their behalf. Our patients in the clinics were 
poor. They came from the black ghetto right around Fillmore. 

What could they pay? 

Nothing, or very little, so that was all right, too; but the 
point is that you don't spend your time figuring out what they 
should be doing for a living, or how they should be doing it, 
and yet this was your workday in and out. This was how you 
were learning to practice, so that when you practiced on your 
own patients you still ignored preventive measures or social 
needs. 



I remember another patient I had in San Francisco, Mr. 
Redmond. A big, tall, handsome, black man, in pretty good 
shape; but when I examined him, his liver was down to his 
pelvis. 

Crawford: Enlarged liver? 

Blum: Enlarged liver, and I said, "Do you drink?" He said, "Oh, yes, 
I drink at least a fifth every day." He said sometimes more, 
and all this very calmly. I said, "Your liver--the next thing, 
it's going to shrink up, and you're going to be done for. 
You're going to have cirrhosis of the liver. You'll never make 
it back, next year, for a check-up. You'll be gone." 

Crawford: How old? 

Blum: Oh, maybe forty. And I never expected to see him again. One 
year later--my charts are laid outand I looked at this 
Redmond's chart, and he's still alive. I can't believe it. 
So, I go out there and I say, "Mr. Redmond," and I'm looking 
around. Here's this sharp, young-looking guy, and I said, 
"You're supposed to be dead." He said, "Yes, I know it. You 
told me that last year. Well, I stopped drinking." You see, I 
hadn't even bothered to tell him to stop drinking. I did, and 
I didn't, if you know what I mean, it was implied, but I 
expected no results and I didn't try for any. 



Crawford: Many times maybe you hadn't seen any results? 



75 



Blum: That's right. These are poor people; they do what they do. We 
act as though they're hopeless. He told me--I didn't even know 
thishe said, "I used to kill cattle in the slaughterhouse in 
South San Francisco. My job was hitting the cattle and the 
sheep over the head with a pipe." He said, "You can't do that 
without keeping yourself pretty well drunk all the time. It's 
a horrible job: they cry, they scream, it's awful. So I quit 
the job, and I got a job down on the Peninsula on an estate, 
and outside, and it's wonderful." 

Crawford: You turned his life around. 

Blum: Yes, but look how I went about it, if you see what I'm getting 
at. No concern at all for the man or his life, saying, "Hey, 
you're going to kill yourself. Do something." You kind of 
shut off all the social and psychological concerns. Finally, 
after a few such cases, you may start pursuing it, pursuing it, 
and I did. 



I did a lot of it at Stanford. In fact, that convinced me 
that I could never practice, that I would always be taking care 
of desperately poor people with serious problems, and I could 
never make a living. Also I'd go crazy earning that kind of 
living, with that clientele who had so little support. 

Crawford: You could have left. 

Blum: Oh, yes, but such patients gravitated to me. I won a prize 

there, once, at Stanford when I was a resident. It turned out 
after about six months in the new year the faculty took some 
sort of a patient poll as to who was their favorite young 
resident, and I won it. I can see why. All my customers had 
been discarded by other people. Discarded. 

Crawford: So it was your patients who voted you in? 

Blum: Sure, because you're spending time on them. But you can't make 
a living on them. You try to get resources. You can't do it, 
so you fall back on the old ways and don't love yourself for 
it. 

Crawford: What resources were lacking? 

Blum: Well, I mean, somebody to help them get jobs, somebody to help 
them to go to school, somebody to help them think through how 
to get their lives together. That's what's critical. That's 
medicine. When you practice on the poor, you've got problems 
bigger than the textbook medical ones. 



76 



Crawford: 
Blum: 



Today there are some interesting exceptions. There are 
parts of San Francisco General Hospital, which is UCSF, which 
are good. They really do quite a job. They speak forty 
languages in some of those clinics. 

I remember at Stanford, I couldn't get over that, a 
patienta Japanese ladyshe could barely get along with a 
translator, and they gave her Chinese forms to fill out. I 
called the social worker, and I said, "This lady's not Chinese. 
She's Japanese." She said, "The alphabet and language look the 
same." Here we are talking about taking care of people, but 
this is not taking care of people, this is taking care of your 
job. 

There's a black lady that I'll never forget. She was a 
husky thing, and the medical student spent hours working her 
up. Every part of her ached, hurt, and almost everything had 
been removed that was removable. Her name was Mrs. Jones. She 
was probably thirty. She had had two grades in Arkansas or 
someplace. She looked pretty messy and disheveled and upset, 
and the student presented me the case saying, "This is a 
retarded black woman, thirty years old." Well, I got a little 
antsy about that. All black women are retarded to persons in 
some walks of life. This lady had had everything removed from 
her: her thyroid, half her stomach, her appendix, her uterus, 
ovaries, gall bladder. 

How can you be without a thyroid? 

She had part of it left and you replace it with drugs. One or 
another symptom had led to all these repairs, and a lot of 
residents got a lot of good training in surgery. Not 
necessarily at Stanford. She was from elsewhere, but that's 
how it was done. I worked her up with the same student 
standing alongside me. I went completely over her again, 
everything about her. She told me about her thyroidectomy, her 
oophorectomy, her hysterectomy, her partial gastrectomy. I 
kept watching the student because those are the words that she 
used- -he hadn't yet learned them all. This lady was a 
brilliant woman: this dishevelled, uneducated, "retarded" black 
woman. I didn't make any great progress, but noted that she 
had ulcer pains again. With the stomach mostly removed, that 
could be curtains. 

The student had to go to class, and I took over and got her 
squared awayspent a little time with her then dismissed her 
with ulcer prescriptions which she could get filled free, and a 
fairly liberal diet. I was sitting up there writing all this 
in her chart about 5:30 it just was endless and I hear this 



77 



clomp, clomp, clomp up the stairs of the old beat-up building 
we worked in. I think I've told you about Bloomfield welcoming 
me to Stanford, didn't I? Well, that was the building where 
that happened. So, she bursts in on me, and she says, "Doctor! 
My husband's leaving me." This is why she was there. This is 
a whole other ball game, and we'd never gotten a clue about it 
acting as her medical doctor. 

The next year I went to Harvard and bumped into some people 
whose lectures emphasized, "and you don't know anything about 
your patients unless you know why they're here today." Well, 
that's why she was there. So we sat down, and it was a very 
different discussion; she'd been kissed off and every removable 
piece of her had already been removed. So I said, "Well, let's 
pick up the phone and talk to the district attorney. Who 
knows? It's Friday night, and maybe he's sitting there." 

Well, sure enough, we got a San Francisco Assistant D.A. , 
and he started talking to her. I listened in. He was saying, 
"Lady, you don't know when you're well off. You don't need 
that kind of a husband. Nobody needs a husband like that." So 
we sent her on her way, convinced. You should have seen her in 
the clinic the next week, after she had pills to cut her pain, 
and a new diet. Oh, yes. I also told her she could go to 
work. Previous clinics told her that since she had ulcer pains 
she should be in bed. 



Crawford: Did she have ulcers? 

Blum: Undoubtedly, but we did no more x-rays. She had most of her 

stomach gone. With the medications and real food and a job, a 
week later here comes this nice-looking, powerful woman--a 
totally different person, all cleaned up and sharp, two years 
of schooling--and she's feeling better. I said, "Go get 
yourself a job. What can you do?" She said, "I can do laundry 
work," and she'd already gotten a jobstrong as a horse, what 
was left of her. She was feeling good. 

So you see the difference. You've got to look at the 
patient. But traditionally you haven't got time to care for 
ghetto people. Do the best you can and be gone. Well, that 
was just before we moved to Stanford, down on the Farm. When 
we left we had a party for all of the patients in our clinic. 
We're leaving them in the lurch, but it's the best we can think 
of doing. Stanford is moving to the Farm. At the party I see 
that Mrs. Jones looks ill and I asked her what was the matter. 
She said, "My husband came back." 



78 



More about Medical School and Student Activism 



Blum: I'd taken ROTC in medical school, and the war broke out just 
before I graduated. I graduated in July of '42, and the war 
formally started with the December attack by Japan in 1941. 
I'd already been to ROTC summer camp down at Fort Ord, and that 
really clinched my choice of a career because we went on 
maneuvers. Fort Lewis invaded us down at Fort Ord and 
destroyed our kitchens and everything. These were games, but 
it was truly a horrific experience. 

We were all medical students. We were reserve officers, 
ROTC. I was the tallest one of our group at ROTC, and the 
smallest man and I got all the non-fitting uniforms. He got 
all the small ones that didn't fit anybody, and I got all the 
big ones that didn't fit anybody. They just threw them at us. 
So we'd keep trading until we'd get a better fit. Poor little 
Mel, he never did get anything more than atrocities; and I got 
all these huge things that didn't really fit me, but I had room 
for a lot of food. So, when we went on maneuvers, I'd fill my 
outfit with cheese and chocolate bars: a regular walking 
commissary. [laughs] 

Our major- -who was a true idiot, a physician- -walked us 
through the fields where the live ammunition was supposed to be 
landing. 

Crawford: Where was this? 

Blum: Fort Ord. Then, when we were captured by the enemy- -by the 
Fort Lewis people--! got to see some real doctors who were 
really in the army. They didn't even own a stethoscope. I 
thought, oh, no. I'm not getting all this training to go be 
something like our dumb major, walking people through targets. 

When we got back to San Francisco in September or October, 
we had a choice of the army, the navy, the air corps, the 
public health service, the CIA. Well, there were a whole bunch 
of agencies, and you could be going into any of these; but I 
went in the public health service because I knew they had all 
these marine hospitals, and they were doing medical care for 
the coast guard and the merchant marine. Over time, I learned 
more about it. They also were the doctors for the commandoes, 
and they were the doctors who went on the Burma Trail; all 
sorts of goodies. So there were some exciting parts to it. 

Crawford: Before we go on with that, let's get you out of medical school. 



79 

Blum: I simply got absorbed into the public health service. When I 
graduated, I went to the San Francisco Marine hospital as an 
intern and was an officer in the armed forces, uniforms and 
all. 










^HBIHPIIIpk mk 



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BBHHkftiJBBBHI J^^^W* -^* 




Entering Medical School at University of California, San Francisco, 1938. 




Medical ROTC, July 1, 1940 (Dr. Blum at far left) 




Entering the U.S. Public Health Service in 1941 

as an intern. 



80 



IV SERVING IN THE U.S.P.H.S. IN WORLD WAR II--PART OF THE 
ARMED SERVICES: 1942-1946 



An Internship at the Marine Hospital in San Francisco and a 
Brief Stint at a Venereal Disease Hospital in Arkansas 



Crawford: What was the term of residency and internship? 

Blum: Well, when I went into the service, I went to the Marine 

Hospital in San Francisco, and I was out of UC, gone, gone. I 
got my internship in the service. I graduated in July and I 
was already assigned in June to the San Francisco Marine 
Hospital. 

Crawford: So you weren't drafted? 

Blum: It was the equivalent of drafted. If you were drafted, you 
might not go as a doctor, but if you signed up, you could go 
for what you were. So, in June, I picked out the U.S. Public 
Health Service; and in July reported for duty in uniform. That 
was a whole fiasco, too. 

Crawford: This is one of those ridiculous situations? [laughter] 

Blum: The Public Health Service is kind of sloppy about military 

distinctions, but you've got to get a uniform. Well, I went 
down to the uniform store. 



Crawford: Where was this? 

Blum: San Francisco. And they gave me the wrong uniform. So I show 
up, and everybody says, "You can't wear this and you can't wear 
that." The basics were all right. It was the right color, but 
the gold braid was wrong, and so on. I remember one of my 
first tasks was to go down and take somebody off a ship, an 
injured sailor. Here I am, climbing up the ladder in my 
uniform and I don't know whether to salute the front end of the 



81 



ship, the back end of the ship, the captain who's waiting for 
me- -I don't know anything. 

Well, you just feel like an idiot. You're walking down the 
street, as I did with my wife the day after I got my uniform, 
and she said, "What are those men doing? Looks like they're 
saluting you." I said, "Oh, my god. They must be." So then I 
had to salute them back, you see, and nobody's given you a book 
to read, nothing. 

Finally, I found a book in the library in the Marine 
Hospital where I'm doing my internship and it shows a dress 
uniform. Well, I don't know whether we have to ever use a 
dress uniform. I look at the front of the book. It was 
written in 1914. That's the latest word on Public Health 
Service uniforms in the 1940s. 

It was just one big, fun game; but I had some good doctors 
to work under at the Marine Hospital in San Francisco, and 
enough time to really study. I studied like crazy, and learned 
a lot. I'd taken my license exams to practice in California 
just before I started my internship. So I was licensed to 
practice in California. 



Blum: A few strange diversions. There were some ridiculous aspects 
to the assignment, to be sure. One day I was on ambulance 
duty, heard the siren at about nine a.m., pulled my uniform 
together and headed out to the emergency portico. We had the 
most beautiful ambulance in San Francisco, a grey Packard with 
a siren on the roof that looked to have about a five-horsepower 
motor. I jumped in, the two techs tooled out, the siren going 
full blast while we proceeded at about fifteen miles per hour. 
The men were already pretty well looped and fortunately were 
the kind that went slowly, not rapidly as a consequence. Our 
siren stirred everyone in the neighborhood. We finally ended 
up about five blocks away, parked in front of Shnibben's bar, 
gathering a crowd. My two men got some beers and sandwiches, 
and then we headed down the coast to pick up an officer who had 
had a heart attack. 

It was a picnic the ambulance men had in mind. I was going 
nuts. We did get the man back alive, but no thanks to us. 

Towards the end of our year I was on urology. As we were 
making rounds one morning, our chief, a fairly young man, was 
summoned away, and I never laid eyes on him until four years 
later at a party. He told me that he had been flown to his 



82 



next assignment, sea duty, that same morning. He was assigned 
to a ship under construction and spent the year in Long Beach 
watching the ship being built. By the time a year had gone by 
the ship was launched and he was relieved as he had put in one 
year of sea duty. 

ft 

Blum: I finished my year in the Marine Hospital, and then was 

assigned to Arkansas. In Arkansas, I worked in a venereal 
disease hospital: four hundred beds, scores of new patients a 
day, I mean every day. On the first day I go out to the clinic 
and I say, "Mr. Smith." A black man comes shuffling up. These 
are very badly educated people. I examine him, doing whatever 
has to be done, and then another one, and another one. 

Toward noon I get a little message, "Please go see the 
commanding officer at noontime." Well, I knew him, so that 
didn't bother me too much. I went over to see the commanding 
officer, who is a bright young major, not much older than I am. 
He said, "For christsakes, you've got to stop calling all those 
black people mister and missus. You're just starting a ruckus 
here." I said, "Where I came from, they were citizens just 
like anybody else." He says, "Don't tell me. I'm from 
California, too, and I know all about it; but you're setting 
the stage for trouble for these people. They're going to be 
beaten up, they're going to be discriminated against by the 
whites who are here. You call a black person mister and 
missus, you're setting the stage for some awful thing for 
them." So I started learning about the South. I listened to 
him, and you say "Mary" and "Sam"--a different world. From 
there I was shipped to a research center. 

Crawford: And how long were you there? 

Blum: Oh, just six weeks, but it was a revelation. 

Crawford: I see, and you were what rank? 

Blum: As an intern, I had one stripe. In Arkansas I got my stripe 
and a half, and was a junior grade lieutenant. 

Crawford: Lieutenant J.G.? 

Blum: Yes, I was really moving. In Hot Springs I met a person who'd 
been two classes ahead of me at UCSF, who had also been number 
one in his class. He was well on his way to being Surgeon 
General, and he did become Assistant Surgeon General. 



83 



Crawford: What was his name? 

Blum: David Price, lovely man. There he was, in charge of the wards 
that I'm working on in this Arkansas hospital. And he, too, 
was just marking time. We were waiting for them to move him up 
to something else. We renewed conversations, and in a way I 
had probably followed his tracks. As a student I'd known he'd 
gone into the Public Health Service. He was a very bright, 
nice person. There was another such person ahead of him, three 
of us in a rowthree number ones from three classesthat had 
done the same thing. The other one became an Assistant Surgeon 
General too. I did not. 

Crawford: Did your high ranking as a student affect your assignment? 

Blum: Ultimately, perhaps; no way of telling. This man had probably 
two or three stripes, and I had one and a half; but he was nice 
to work for. It wasn't unusual. I'd worked under him when he 
was a resident and I was a student. It was old times again. 



A VD Research Project at the Penitentiary in Terre Haute, 
Indiana 



Blum: From there, I was sent to the Venereal Disease Research Lab in 
Staten Island, New York, which is a very famous one, and is 
where they discovered the use of penicillin for syphilis just 
before my arrival. My assignment there was ultimately to go to 
Terre Haute for a year as part of a research team, and work in 
the penitentiary on human guinea pigs. We had our own 
penicillin plant at that time we couldn't get penicillin, so 
we made our own. My first job at Staten Island, my first day 
they don't waste any time was to go collect the urine of all 
the people in the hospital who had been given penicillin the 
day before because you can get the penicillin back out of the 
urine. We purified it and used it all over again. 

Crawford: Is that true? 

Blum: Oh, yes. Sure. The body takes it in, and most of it is 

excreted in the urine. It was cheaper at that time to do that 
than to make a new batch. Then we were shipped to Terre Haute, 
and that was an experience. I told you about my research 
experiences and my senior officer there in my opening 
discussion of this history. 



In Terre Haute people didn't know there was a war; a wee 
bit isolated, and they resented people in uniform. They 
couldn't go hunting because they didn't have bullets and they 
really denounced the government, and their children were in the 
service! The people next door had stacked over a hundred one- 
pound tins of coffeenice peoplebut the war didn't involve 
them at all. At the same time Terre Haute had a wonderful art 
museum. The city was most famous for being the home of Calumet 
Baking Powder. 

Crawford: You went into that story quite a bit. How do you evaluate it 
now? How do you weigh it in terms of the impact that that had 
on you? 

Blum: The Terre Haute? 
Crawford: Yes. 

Blum: Oh, it's just surprising that you do those things. You just do 
them. In retrospect you start sweating it. I knew we were 
doing bad research, but nobody seemed to care, so what could I 
do? I was just a junior officer with all these people above 
me, right up to an Assistant Surgeon General, and nobody 
listened, so that was that. You're not going to be a whistle- 
blower in the service during the war, that's for sure. At 
least, that's how you feel when you're in the service. When 
you're outside, you say, "Well, you're supposed to be a 
whistle-blower. What kind of conscience do you have?" It's a 
real problem. 

One of my physician friends from another outfit was 
stationed in Texas. He went to a bar one night and was sitting 
next to a Coast Guardsman; and the Coast Guardsman looked at 
his insignia and he said, "You're in the Public Health Service. 
Well, I'm Coast Guard, and you guys take care of us, you know?" 
"Yeah, that's true." They got talking about my case, and this 
Coast Guard said, "I know what they do up there in that 
penitentiary. " 

This was all top-secret research, and this friend of mine 
says, "What is it? I've often wondered what he's doing up 
there." This sailor said, "Well, they're breeding this real 
tough strain of gonorrhea; and they're going to infect 
prostitutes, and they're going to parachute them into Germany." 
[laughs] This is news. So my friend writes this to me, and 
I'm sure he was bright enough to know that it couldn't possibly 
be the case, but who knows? So that was our top-secret 
research. I learned a lot about penitentiaries, I learned a 



85 



lot about bad research, and even about prison breaks on my last 
day there. 

Crawford: You didn't tell me about the break. You told me that you got 
quite close to the prisoners, and that they were very candid 
with you because you were coming in from outside. 

Blum: Oh, I could write a book about it, and a kind of funny book, 

too. I mean, of all the crazy things that they did, and of the 
wonderful food. They grew it all themselves, prepared it all 
themselves. 

Crawford: Why should it be wonderful food? That's interesting, 

Blum: Because they're doing it. It was run by a marvelous warden. A 
man by the name of Swope. In any event, later on he was the 
last warden of Alcatraz, but then he was the warden at Terre 
Haute. We got to know him well as his guest doctors. 

Crawford: And you lived in Terre Haute? 

Blum: Yes. Oh, yes. 

Crawford: You didn't live at the prison? 

Blum: No. We commuted every day and night, just a few miles really. 
My job--I had a wonderful job--one, I examined prostitutes to 
find gonorrhea bugs to bring fresh bugs in because it was part 
of our experiment. So, I was doing practical work. Another 
part of the job was to get blood for the laboratory because 
bacteria grow on blood agar best. Horse blood is fine, so it 
was my job to get the horse blood. 

Crawford: How did you do that? 

Blum: Well, they taught me while I was on Staten Island. So, I get 
to Terre Haute, and I'm the horse bleeder. They take me down 
to a boarding stable. They have the most beautiful, gigantic 
Percherons, like the beer companies havebig , lovely animals. 

When I practiced in New York, we went to riding academies 
where they had broken-down race horses; and we had a twenty- 
foot long tube, and a needle--a fair-sized needle, about as big 
as a pencilthat went up into the jugular, and then you 
skedaddled because the horses went wild. I mean the race 
horses just went crazy. 



86 



Crawford; 
Blum: 

Crawford: 



Here I went to work on the Percherons, and I had my long 
tube, and I stabbed them, and the Percherons sort of flick 
their necks. [laughter] 

The race horses were that much more sensitive to pain? 

Oh, my. I mean, it was a wild scene. It was risking your 
life, and here are the Percherons and they don't even notice 
the needle. 



You must have been scared to death, 
horseman. 



You're not exactly a 



Blum: No, but you were going to do the job in the service, for the 
service, and these horses and the prostitutes were equally 
insensible to my presence. I mean, it didn't make a bit of 
difference to them. 

Crawford: How did the prostitutes identify themselves? 

Blum: They didn't. They'd been picked up by the police. Terre Haute 
was a town famous for its prostitution because it was the soft 
coal mining center. The miners came to Terre Haute for 
recreation--R & R, rest and recreation. 

Crawford: Were they in pretty bad shape? 

Blum: No worse than I've seen elsewhere. I had plenty to do with 
them ultimately in San Diego. Similarly in Terre Haute, we 
worked with the prisoners. 

The jail-break was something else again. The security 
system is like that which exists in private homes in much of 
Latin America now. There is a big fence around one end of the 
penitentiary; and there's a guard house with a guard sitting up 
in a loft with guns who watches you. You come in under where 
this guard is perched, and he lets you through one door and 
talks to you and sees who you are, and looks at your insignia, 
but he's above you, out of reach. At least he was in that 
penitentiary. Then he lets you through the next gate and into 
the yard. There you'd be visible to the front office and its 
many guards for maybe fifty yards. Then you come to another 
station where they scrutinize you and let you into the 
penitentiary building itself. 

So, I'm coming back from town and I've got a jar of blood. 
It's about my last week at Terre Haute. I get in through the 
gates, through the yard, get inside the prison into the foyer. 
Here all the guards are throwing out ammunition belts, machine 



87 



Crawford: 
Blum: 



guns, and all sorts of armor, putting them out on the floor and 
sorting them out, each person taking their share. I'm looking 
and thinking, "Well, they're going out to do target practice or 
something." I never thought much about it. 

There was a man, the associate wardennot the guy that I 
said was such a fabulous overall warden, but his chief of staff 
who was from my home town, from Napa--a big, burly fellow. We 
knew one another. I'd been there almost a year. He looked at 
me and he said, "Doc, what in the hell are you doing here?" I 
said, "Well, I'm going down to the lab. I've brought some 
blood in." He said, "We've got a break! This is no time to be 
here. Get out!" He opened the door and sort of booted me out. 
I was just on the verge of going into the corridors. 

When you review it, you discover that the breaks are 
terrible times. Many prisoners don't get to go who were 
planning to go, and they're furious. They've lost their cool. 
They go quite berserk sometimes. Others become berserk under 
the pressure of going. None of the guards inside the prison 
were armed, in this prison. I mean never, ever, everbecause 
you could have the arms removed from you and then you'd be at 
the mercy of these people. 

What were the crimes of these men? 

Oh, all kinds from the most desperate to the mild but it was 
a short-term penitentiary, the logic being that even if one was 
a desperate criminal, if he's only got six or twelve months to 
go, he won't get violent. The majority were there for more 
modest crimes prostitution, drugs, homosexuals from the armed 
forces all sorts of neat people in there. Some of them were 
Jehovah's Witnesses, who were conscientious objectors some of 
the nicest people you'd ever meet. It takes more guts to be a 
conscientious objector, let me tell you, than to fight in the 
armed forces. 

During the break about twenty or thirty men got out, cut 
the fences and everything, and ended up camping along the 
Wabash in the trees at nightfall. Some of them stayed up in 
the trees for a couple of days. The guards who lit campfires 
and camped under the trees didn't even know that. They finally 
were all caught, and they brought them all back. It was really 
a revelation as to how other people live, and then to discover 
that many of the people were just poor souls who had had a 
still in the Ozark mountains, while others were pimps from 
Chicago. 



88 



Crawford: 
Blum: 



Crawford: 



I'll never forget old Frank. He pushed a broom. He was a 
pimp from Chicago. It was his third or fourth time in the 
penitentiary. I said, "Frank, what the hell are you doing? 
You've got to be crazy to live your life this way. Why don't 
you do something else?" He said, "I don't know how to do 
anything." I say, "Yes, but this crime life is for the birds. 
Here, you're pushing a broom in the penitentiary." He said, 
"Doc, look, I won't make these mistakes the next time." He was 
learning all sorts of things here at the penitentiary. 

Then as you get into it further, you discovered that the 
judge who sentenced him also owned the house of prostitution 
where Frank worked. Just a small reminder of how things are 
really run. And that Frank had paid off all the cops. This 
was his world, and crime does pay. There were all these nice, 
honest people out there, and he was going to do it differently 
the next time so he wouldn't be back. 

I'll never forget the story I heard when I first got there. 
The penitentiary had opened up the year before, and on the 
other side of the Wabash was the ghetto for Terre Haute. It 
was across the Wabash in a different state, Illinois. It was 
notorious for criminals and little gangsters, and living 
conditions were awful. The teachers took all the school kids 
and paraded them through this penitentiary to teach them that 
crime doesn't pay. 

Well, this penitentiary had paintings on the walls done by 
the inmates. The kids saw a bakery the likes of which they'd 
never imag-ried. They smelled food that they never would get to 
taste. Then the cells everything was concreted down, lights 
built in, wash basin built in, toilet built in, bed built in 
with a steel mattress frame and sponge rubber six inches thick, 
all spotless. 

That's all looking pretty good. 

They converted every single kid, I'm sure, to a life of crime. 
They'd never seen anything this nice. [laughter] I mean, the 
virtues or the rewards of crime were pretty good. These kids 
had never had a bed, never had enough food. I noticed that I 
gained weight. I got fat--I just ate lunch there. There were 
marvelous meats, pastries and breads. It was a real revelation 
as to how some parts of the country lived as compared to 
others. The prisoners raised all the food, took care of the 
plant, did all the work. 

Tell me about the paper that resulted from the research, 
because you said that everybody accepted it 100 percent. 



89 



Blum: Not only accepted it 100 percent, they started off in the first 
paragraph that the National Research Council endorsed this 
study. 

Crawford: What was the name of the study, by the way? 

Blum: Well, it was called "Experimental Gonococcal Urethritis in 
Human Volunteers." It was published in 1946January. 1 



Applying to the Regular Corps tit 



Blum: In the early spring of 1944, the USPHS was giving examinations 
for the regular corps. For anyone contemplating a career in 
the service, there was no choice but to pass the two-day exam. 
This was to be given in Chicago so Marian and I took the train 
from Terre Haute and stayed with old friends from Berkeley 
days. Since there were only four Jews in the entire regular 
corps, all well known in academic circles, it seemed unlikely 
that I would pass. When I arrived, all the other candidates 
came up to introduce themselves and several undertook to inform 
me that I would obviously pass since Jews never got through the 
physical exam which I had just taken in order to qualify for 
the exam. 

We had a patient to work up and then a lot of questions to 
answer. I have no idea of how well I did, but it was no 
scintillating performance. 

Came the last half day and we got down to serious 
discussions. The presiding Assistant Surgeon General who was 
an obvious Southerner whom I didn't always understand wanted to 
know what newspapers I was reading. I told him PM, which was a 
liberal Marshall Field offspring. He wanted to know how I felt 
about their position to do away with the poll tax. I told him 
that it was unconstitutional and should be ended. He quite 
vociferously assured me that it was constitutional, and I just 
as vociferously told him that if it was, it shouldn't be. 

I was well aware of what this meant to my career in the 
USPHS. But who wanted a career if it was to be oriented to 



'Mahoney, J.D., C. J. Yen Slyke, J. C. Cutler and H. L. Blum. 
Experimental gonococcal urethritis in human volunteers. American Journal 
of Syphilis, Gonorrhea, and Venereal Disease 30:1, 1-39, January 1946. 



90 



getting along with political Neanderthals? I didn't pass my 
exam and was told so before I left that day. Good fortune 
takes many forms. 



A Faculty Position at Johns Hopkins University Medical School 
II 



Blum: In Terre Haute, I got a telegram telling me to report to J.E. 
Moore, M.D., Chief of Medicine #1 service at Johns Hopkins 
University Medical School. 



Blum: Hopkins was the place to go for venereal disease training in 
the United States in the world, in fact. The only thing is 
that being sent to Hopkins was always kind of an in- joke in the 
Public Health Service, your reward for being a good fellow, 
which one in a hundred USPHS physicians might get. I figured 
that one of my buddies or classmates sent me that telegram, and 
that I'm going to show up at Hopkins where they've never heard 
of me. [laughs] There were no other official orders for me in 
Terre Haute, just this telegram. So I got on the phone and 
called the Assistant Surgeon General in D.C. who was in charge 
of personnel, and I said to him, "Sir, I have this telegram 
telling me to report in so many days to J.E. Moore." "Doctor," 
he said, "goddammit, we don't send these telegrams out for fun. 
Now get your ass over there. Show up when we said." "Well, 
okay." Now that's been settled. This is clearly not a joke. 

So Marian and I took a train to Buffalo and came down the 
Hudson to New York City on ship. Then we went on to Baltimore. 
It was an awful city, a dreadful city; it's better now in some 
areas and reported to Hopkins, and sure enough, that's where I 
was supposed to be; but I had not been sent as a student. I 
was part of the faculty at Johns Hopkins. This was a wonderful 
break because one can work there forever and never become 
faculty. 

Crawford: You didn't apply for this? 

Blum: No, no. This was just duty. The reason this all happened was 
that Hopkins had been stripped of faculty. The services had 
taken a whole group and made a hospital unit for Europe, and 
another whole hospital unit went out to the South Pacific. 
Then they drafted everybody else that could walk. All of a 
sudden Hopkins had very few faculty who could get around- -a lot 



91 



of old timers, really old timers. So they were replacing the 
doctors who had been drafted. Don't ask how they got me, but 
they did. I was two years out of medical school: one of those 
years as an intern, and another year as a kind of a researcher 
on that terrible project in Terre Haute. 

Crawford: How do you think they did get you? 

Blum: I never did inquire, and I certainly couldn't complain. The 
only thing we knew was that I was still earning a hundred 
eighty- five dollars a month, and the cheapest hotel room that 
had running hot and cold water was a hundred eighty-five 
dollars a month. So I went down to the USD, and they found us 
an apartment out on the Chesapeake where the Martin bomber 
workers lived. They had new apartments out there, and we got 
one. We had an hour and a half commute each way. 

Crawford: Was your wife with you all this time? 

Blum: Oh, yes. Always. 

Crawford: She went to all these different places? 

Blum: Oh, sure, might as well. That was quite a fabulous experience 
for us kids from small-town California. I learned all kinds of 
things. My first day there at Hopkins, they said, "Now, you're 
going to be on the book at one o'clock. You'd better eat your 
lunch early. You go down to the main dining room," and they 
told me where it was. "Book" meant that I was going to see all 
the new patients that come into Medicine One, and anybody who 
comes to Medicine One may have any kind of disease, but 
somewhere in their history there's a possibility of venereal 
disease and so they are going to be seen here first. But it 
was straight medicine, internal medicine. We really saw every 
conceivable disease. 

So I got down to the dining room, a vast placethey "ve 
since changed it- -where everybody ate. Apparently nurses and 
residents ate there, and doctors, and senior staff. I was 
there early, so I couldn't tell too much about who was going to 
sit where. I looked around. I thought, "Well, this has got 
the makings of trouble because I'll probably sit at somebody's 
table, who knows?" Nobody had told me and there was no one to 
ask. So I picked out this huge tableit looked like a bunch 
of slobs would eat therebecause it was right next to the 
kitchen with the big swinging doors; not a very comfortable 
spot. The least likely place you would sit at if it were up to 
you. So I'm sitting there and approaching the end of my meal 
around noon when a cute little old man comes in and says, "I'm 



92 



Dr. Longcope." Well, this is one of the world's famous 
internists, and he sits down at the table. I've got this lousy 
uniform on with one and a half stripes. Then another old man 
comes in and introduces himself, "I'm Doctor Parks." Well, 
that's the most famous name in pediatrics at that time in this 
country. 

Then TeLinde came in, who was Mr. Gynecology. Then Eastman 
came in, Mr. Obstetrics. These are the folks who wrote all the 
textbooks that I studied from. So, you get that right away. 
There was Walter Dandy, the truly famous neurosurgeon. Then 
there was Blalock, the cardiac surgeon who did the first big 
open-heart transposed artery surgery. These are the gods of 
medicine. So I'm sitting at their table. [laughter] 

Crawford: Well placed. 

Blum: Yes. Very auspicious. And all these people were nice except 
Walter Dandy, who was a little insensitive. Well, then there 
was Rich, the pathologist, and I don't know who all else. It 
was the place to be for lunch, I tell you. So, after that, 
Parks kind of walked me down the hall, and he said, "If you're 
not too busy," he said, "why don't you make rounds with me in 
the morning? We make rounds at eight o'clock, and you'll see 
all the babies and children." He was being real nice, you 
know. He knew I'd been traumatized by this; and I had been. 
Every once in a while, if I had time and I'd go make rounds 
with Parks, a very sweet man. 

Crawford: What did you learn from him? 

Blum: Well, I learned a little bit of pediatrics. It turned out that 
a classmate of mine from UCSF, who had become a pediatrician, 
was the chief resident at that moment. Training was speeded up 
very drastically during the war and especially at Hopkins, 
because there weren't many people left there. In three years 
from the day we'd graduated, he was already chief resident. He 
had an old infection of the bone, osteomyelitis a nasty 
disease before there were good drugs to treat it, and even now 
it is still not a happy thing; and he couldn't walk very much 
or very fast. 

So, I'd help him make roundsgo see all the kids and 
little babies. That was an interesting experience. In the 
basement, they had all kinds of kids who lived there, little 
deformed children, crippled children, and kids who apparently 
weren't going to leave and were being studied. It was like a 
hidden zoo, but these were all little kids living there at the 
time, and being cared for, and Walt Tasem, until recently a 



93 



practitioner in Pasadena, would gather them all together and 
read them stories every evening. It was beautiful. 

Crawford: What a place to be. 

Blum: Yes. They were swarming all over him as he read to them. This 
was their one real human contact. I'd go visit Pediatrics 
whenever I could. I was doing a lot of experiments in the lab 
at night, and so oftentimes I was available at night to go 
around when he was seeing the babies before they kind of shut 
the place down for the night. 

We saw a lot of fantastic illness. One night a little kid 
came in and we couldn't get him or her goinga little one, 
like a year and half. So we called for the resident in 
neurosurgery, not Walter Dandy, but the chief resident, who'd 
been there for perhaps nine years. Residents went on forever 
at Hopkins. His name was O'Tannesack, I believe. He came in a 
matter of half an hour. Often the residents stall you off 
because they're trying to sleep. This was probably ten o'clock 
at night. We tell him about the case, and he just fell asleep 
on the desk. We decided, "The child has survived up til now. 
Let's let the resident sleep for fifteen minutes, and he'll 
feel better." And sure enough, in fifteen minutes, we woke him 
up, and he was very bright and ready to roll again. But in any 
event, we got as good advice as you could get anywhere in the 
world, I'm sure, about what to do with that child. 

I just don't remember the details of it anymore, but I do 
remember us telling him, "Boy, you're beat, aren't you?" He 
said, "Look, I make rounds every six hours day and night on all 
the patients in neurosurgery." Every six hours, day and night, 
he said, he'd done it for over six years. This is what you 
call training. This was about midsummer because there was a 
tremendous summer storm, I remember. We had to go and close 
all the windows because the water was splashing in on the kids. 
He said, "I got married at Christmas. I don't even know where 
we live. I've never been there." 

Crawford: That's rough, isn't it? 

Blum: Yes. That's how they train specialists there, you know. 

So it was quite an experience. I learned, and I learned. 
It was the best place in the world for me to be. Not only were 
there marvelously experienced people, they were all sharp and 
fast. I also learned something else. Some of my students 
turned out to be some of my superiors in the Public Health 
Service, and I told you about the one from Hot Springs, 



Crawford: 
Blum: 



Crawford; 
Blum: 
Crawford: 
Blum: 



Arkansas, who went on to be Assistant Surgeon General. Well, 
he comes in with his three stripes--he' s one of my students-- 
and he works up a case and he presents it to me. We had a good 
time because we were really old friends; and so I learned more 
from him than he ever learned from me. 

David Price. 

David Price. But that was a kind of reversal of roles. Here I 
was faculty and he's just one of the students. They sent them 
there for special training; but I got to be there as one of the 
trainers. 

Isn't that remarkable? 
It's really just crazy. 
What were your rounds like? 

The way the clinic was set up, I didn't make regular rounds in 
the hospital. I was in a clinic and I consulted with students. 
Everybody who worked up cases had somebody they had to consult 
with unless they were faculty like me. When I wasn't 
consulting I would have my own cases to work up, and nobody 
would consult with me. If you were one of the faculty, you did 
your own work. But the students, or anybody who was sent there 
for training, had to consult with one of the faculty. The 
faculty were marvelously knowledgeable physicians. 

Crawford: These famous doctors at Johns Hopkins: did you see more of them? 

Blum: Yes, whenever they did anything significant. I was there when 
they paraded all the blue babies--the first series of infants 
whose abnormally transposed blood vessels were restored 
surgically so that the mostly unoxygenated blood which was 
going through the body was sent to the lungs as in normal 
people and the oxygenated blood then went to the body. These 
kids are blue or purple because they're not oxygenated 
properly. Another great pediatrician there, Helen Taussig, who 
picked out the kids to get surgery, was really deaf and yet she 
had to listen to all these children's chests. She listened to 
all this and figured out what had to be done. Don't ask me how 
she did it. They didn't have all the pictures they do now so 
you can see where everything is. We had a parade of about 
twenty of these kids, and Blalock had transposed the aorta and 
the pulmonary artery. Well, that's something, moving the two 
main vessels. 



Crawford: I had no idea. 



95 



Blum: Oh, it's tremendous, a world-celebrated kind of thing. They 

held an open house in the big auditorium in the medical school. 
Everybody who was anybody went to that. That was the deluxe 
Hopkins touch. I mean, at UCSF, they happily cut one another's 
throats in different faculties. At Hopkins, they really pull 
together. So everybody was there, and there were tears shed. 
It was a magnificent event to see these kids walk, and no 
longer purple, and some were no longer kids, they had survived 
longer and were getting about quite well. They had been 
restored to life, really; and there was Taussig, bowing this 
great big bow. Blalock was kind of a proud guy--he never 
really deigned to notice the audiencebut there it was. 

When I worked in the clinic, people would commonly have 
come from all over the world to Hopkins. It was quite the 
place, more so than Mayo's actually. I remember once we had 
people from Buenos Aires. One of the old-timers said, "How did 
you happen to come here to Hopkins?" The patient said, "We 
were referred here as the only place to go," and there was some 
truth in it, but what they heard was, "You didn't have to come 
here. One of our graduates is in Buenos Aires--here is his 
address . " 



Crawford: 

Blum: 

Crawford: 

Blum: 

Crawford; 
Blum: 



Really? 
there? 



They would have referred these people to a doctor 



Back home, to an alumnus of Hopkins. 

So was Johns Hopkins the most famous clinic, then? 

It was the place, yes. Harvard was creeping up on it, for 
sure; and Mayo always had been good, but Hopkins was better, 
really. It was the Mecca. It was called the Mecca. 

What other very dramatic things were happening? 

Oh, well, for instance, that was the place where, as far as I 
know, they made the vaccine for yellow fever, just before I was 
there. I don't know if you remember, but tens of thousands of 
soldiers who got the yellow fever vaccine also came down with 
hepatitis. Hepatitis was not yellow fever. It was good old 
fashioned hepatitis, probably B. The reason that happened was 
that the virus in the vaccine was weakened with immune serum. 
To make immune serum, you had to get volunteers and inject them 
with the yellow fever virus. Well, one of the lab people that 
I worked with as I was doing the lab experiments was a nice 
spunky gal, who volunteered to be the guinea pig to make the 
anti-yellow fever serum which would then be put in with the 
yellow fever vaccine, and neutralize it, so it would remain a 



96 



Blum: 



living vaccine, but one that wasn't going to cause yellow 
fever. She got hepatitis while they were doing this. She 
worked in the lab all the time, which is a good place to get 
hepatitis. So, even though her blood was diluted out a 
millionfold, one smidgen of her blood was in each dose of 
vaccine. Just that much is what caused the hepatitis. It 
caused something like eighty thousand cases. 

Crawford: Caused it? 

Blum: Yes, the vaccine was good, but it also carried hepatitis, which 
nobody understood or could test for at that time. 

Crawford: They didn't know that she had hepatitis? 

Blum: Well, they didn't know that that made any difference. That 

mishap was when they started catching on. Those were still the 
dark ages for much of immunology. 

Crawford: So you just surmised that, but nobody charged Johns Hopkins 
with it? 

Oh, no. Who would have known differently? It so happens that 
when I was an intern in San Francisco I had taken care of 
eighty of these hepatitis cases who were in the Coast Guard 
when they were vaccinated for yellow fever. 

Crawford: These people had been vaccinated? 

Blum: They had been vaccinated, and they were troops from the 

Aleutians, and going overseas to various destinations in the 
Pacific where they might meet yellow fever. 

Crawford: Was that a bad strain of hepatitis? 

Blum: It was mean, but there weren't too many deaths. Out of the 

eighty, only one looked like he was going to die from the acute 
disease. If it really was hepatitis B, a sizeable fraction or 
more would die from it, sooner or later. If it was hepatitis 
C, many more would die. In those days we couldn't even tell 
which was which, didn't even know of the many varieties of 
hepatitis. If it was hepatitis A, none of them would die. One 
kid that I took care of speciallybecause he was the only one 
that looked like he was dying- -was in and out of a coma for 
months. Lo and behold, the last I heard of himwe fought to 
get him out of the service but couldn't he was doing four 
hours on and four hours off marching guard duty at the Coast 
Guard in San Francisco. If you want to bring about a relapse, 



97 



this would be a great way of doing it. We couldn't convince 
anybody. They said, "He's all right." So, that's that. 



Blum: Although medicine at Hopkins was probably as sophisticated as 
anyplace on earth, how one lived in Baltimore was not. One of 
my early patients had a grim flesh-eating disease girdling his 
genitalia and starting around one thigh. Called granuloma 
inguinale, it was probably more a product of lack of hygiene 
than a venereal disease. Fortunately, it responded to lots of 
warm water sitz baths. The lesion was a horribly malodorous 
one and victims soon made themselves known when they entered a 
waiting room. 

I had a nice enough male with the condition, carefully 
explained the soaks, the temperature, and sent the man on his 
way to return in a few days . When he came back I knew he was 
there from the odor wafting into my office. I called him in 
and asked him about the sitz baths. He responded, "Doc, I've 
got to level with you. I live around the corner from here in a 
unit with eight other people. There is no running water, the 
toilet is a communal affair out in the centrally located back 
yard shared by about a dozen buildings that enclose it. To 
soak myself four times a day in a tub of warm water means I 
have to get a tub, take over the living room, where all nine of 
us sleep on the floor. To get warm water, I have to heat it on 
the kerosene heater after I haul the water up from the back 
yard, and it's hot as hell in the room now without using the 
heater." This man was turned over to the most effective social 
service unit I ever saw in a hospital and they got him 
relocated so he could have warm soaks. It became pretty clear 
that medical advice by itself isn't enough. 

Many years later I was the opening speaker at the National 
Social Workers Convention being held in San Francisco. I was 
making my usual thrust about what was most important to health 
and recounted an episode from Hopkins that pointed up the 
relationship of medical care to other social needs. I had come 
in to Hopkins fairly early on a truly cold wintry day and found 
the grand tunnel which connected all the medical buildings 
totally jammed. I spotted someone in a white coat and asked 
him what had happened, imagining a disaster of some sort had 
driven all these people to the hospital. I got a laconic, "Oh, 
it's really cold." I immediately understood the reality that 
the ghetto neighbors couldn't afford the twenty- five cents for 
a gallon of kerosene to heat their house, and I proceeded to 
work my way along the hall to our building. 



98 



On reconsidering what was taking place, it was obvious that 
for lack of some small amount of money for fuel, thousands of 
persons came to Hopkins to get warm. But there was a price, 
people had to say what was bothering them and be assigned to 
the appropriate clinic. A clinic workup at Hopkins was no 
casual affair, taking student, staff, and faculty time and 
facilities. Basic lab work was always done. So, on such a 
morning hundreds of thousands of medical dollars were spent to 
offset the need for a few hundred dollars of kerosene. 

But that isn't all. Patients don't tell you they are cold, 
they think of something. When nothing of consequence 
eventuates, the patient may get more tests, and if one of them 
shows any deviation, they will get a referral for a more 
elegant and costly clinic for a workup. If the cold spell 
lingers on, and the patient is persistent but seems physically 
well with no abnormal tests, he or she might well end up in 
psychiatry. I untangled just such a case that had been sent to 
a mental hospital ultimately and it took our social workers 
days to get her out. Thus are social needs converted to 
medical care. 

I had a few more such tales, made my point about the need 
to look at people in a more comprehending, comprehensive way, 
and asked for questions. A grey-haired tiny lady rushed to the 
nearest microphone placed in the aisle for questions and 
started in: "I'm a social worker from Hopkins." I was sure my 
goose was cooked and that she was going to undo my good work in 
one way or another. "And," she went on, "I want you to know 
that now we have exactly the same problem in the middle of 
summer because in the hot days everyone is afraid of the 
riots." 

There were other regional differences to be observed about 
how health care and health intersected. On my second day in 
Baltimore, I took charge of a medical ward at Baltimore City 
Hospital as part of my assignment to Hopkins. Going to the 
dining room for lunch put me at a table which included two 
newly returned interns who had shared a month's duty relieving 
a rural practitioner on the Eastern Shore. He was taking his 
first vacation in decades and asked the interns to share the 
work and keep all the income they generated. They were full of 
the rural practice they encountered as compared to what they 
were learning in Baltimore. 

Their most memorable encounter apparently was with a 
youngster from a rural ghetto who had crashed through a window 
and was badly sliced up. They spent hours meticulously 
stitching him together so that he would have minimal 



99 



disfigurement. When they got done and were admiring their 
handiwork, the doctor's nurse, who was the mayordomo in charge, 
explained that the doctor had an immutable rule of charging two 
dollars a stitch and that the bill for this poor family would 
run into several hundred dollars, which they could never pay 
and thus would leave the doctor and the family in a bad 
relationship. The interns debated for a while and then very 
carefully removed every other stitch. 

They had been somewhat afraid of the rural obstetrics 
aspect of this busy practice, but were relieved to learn that 
the doctor always charged fifty dollars per delivery, but if 
the people chose his nurse to do the delivery, it only cost 
them thirty-five dollars. Essentially no one ever used the 
doctor as a result, and the interns were home free as they had 
no deliveries. Lunch was over and my tour of rural general 
practice in Maryland in the mid-forties was also over. 

I* 

Blum: One more story about that time: When we lived out on the 

Chesapeake, almost everybody in our building was classified by 
us as hillbillies, most from the South, many with college 
degrees. There was one family we were close to. He was a high 
school principal with a lovely wife, Edna Mae, who went around 
in her bra when it was hot--just as modest and sweet as you 
could ever want to see. There were eight apartments, each with 
a refrigerator and no stove, but we had a couple of burners. 
As I mentioned, I was earning $185 a month as a first 
lieutenant, and that was the rent at the Hotel Baltimore 
downtown, so the USO found us this apartment, a part of the 
housing for the work force at the Glen L. Martin bomber plant. 

A month or so after we were there, we were sitting at 
breakfast and saw this tick crawling up the wall, so I put it 
in a bottle and took it to Johns Hopkins for inspection. 
Everybody there got hysterics: "That's not a tick, that's a 
bedbug!" [laughter] Marian was a social worker and her 
district was around Hopkins, which was a bedbug's paradise with 
all that poverty, and Marian thought she'd brought them home. 
I thought I might have gotten them at Hopkins, for they were 
not unknown on the wards. 

One night soon, though, the place was crawling with them 
and it was hot, and we went outside to sit on a bench to decide 
on suicide, escape, or what. There were some schoolteachers 
from next door sitting outside. We found out they had the same 
problem. We soon asked all the other tenants about it, and 
found out that one of the previous tenants who had no spouse 



100 



Crawford: 
Blum: 



and had to fend for her kids on her own had left the building, 
and the bedbugs she abandoned in her apartment had gotten 
hungry and gone searching for food. [laughter] 

So I went down in my uniform and told the rental service 
that they had to do something about this. But where we were 
wasn't in the city of Baltimore, and no one could be forced to 
do anything. So I decided to refuse to pay our rent, using my 
status as an officer, and that made a difference to all our 
neighbors who joined in the boycott. Within a day or two the 
management came in with oil sprayers and destroyed everything 
we had, and that worked for about an hour. Then in another 
week, since we still refused to pay our rent, we got notice to 
leave so they could fumigate the entire building with cyanide. 
We left practically in our bathing suits so we wouldn't take 
bugs out, we stayed with friends, and when we got back it was 
like a morgue there were dead animals and bugs all over--yet 
it was a new building, about six months old! Welcome to the 
subtropics. 

In the course of cleaning out our building they had 
discovered about a hundred aborted fetuses in jars. Nobody 
accused me, but it didn't look good. An army doctor who lived 
in the same housing told me he had left his name with the 
management in case of emergencies and he said he had been 
called for a childbirth. It had been messy, the mother was 
taken to the hospital, and when it was over no one could find 
the born-alive baby. Well, one of the well-meaning neighbors 
in attendance had put the baby in the refrigerator to get it 
out of the way, as the mother was bleeding. For the heartland 
of civilization, famed for the School of Public Health and for 
its Department of Public Health, it was easy to see that public 
health must be in desperate shape elsewhere, or that a good 
publishing record needn't be based on accomplishments. 

You left Johns Hopkins when? 

The war was nearly over, so that would be what? Forty- five? 
Actually, I was shipped out of there to Hot Springs, Arkansas, 
for a few months. The war was over in '45, and then I was sent 
to San Diego to be part of the County Health Department. They 
couldn't get people for public health jobs that early in the 
demobilization. 

The U.S. Public Health Service assigned people to all kinds 
of places. I was assigned to the San Diego Health Department 
to complete my tour of duty before I would be decommissioned 
and be allowed to take my fellowship at Stanford. San Diego 



101 



had a fine health department. It was a wonderful place to 
work, a very enlightened kind of county/city government. 



Assignment to San Diego 



Blum: There were all these prostitutes that was a huge business with 
the air force, the army, the navy and marines based in San 
Diego. San Diego was hopping all the time. Most of these 
people were separated from their usual family and friends, and 
therefore from any restraints. If they had a wife, that would 
be the exception, and that was not an issue. So the exposures 
were fierce, and the rates of venereal disease were 
spectacular. 

Every day and night the police were raiding, raiding, 
raiding, and then every night the prostitutes were brought into 
the city jail, and somebody had to examine them for venereal 
disease. In the first place, just looking isn't that 
convincing, but if you think you suspect gonorrhea, you can do 
slides. As far as syphilis is concerned, you've got to do 
blood tests. It takes a day or two to get a result. So 
somebody had to go down there and examine all these women, and 
do the various tests. You line up these poor ladies, and prop 
them up on a GYN table, and do the exams, take specimens as 
indicated. And there are several other venereal diseases that 
had to be kept in mind. We didn't know about chlamydia in 
those days. 

That was a pretty hectic scene, but I soon discovered by 
looking at the blotter in the jail that 90 percent of the 
prostitutes who had been arrested weren't there. If there were 
a hundred of them arrested last night, you might see ten or 
fifteen. So it was kind of an idle gesture. I asked, "What's 
happening here?" "Oh, the bail bonds people have released them 
all." They've come in with the bail--a few hundred dollars 
bailand the prostitutes forfeit the bail and go back where 
they were working. That's a good old-fashioned way of handling 
problems in the courts and in the jails. 

So I said to the chief of police, "You'll have to do 
something about these people coming in here with venereal 
disease; you're not keeping them." "Well, we don't put a hold 
on them until you see them." I said, "But then they're not 
here to be seen. What are we going to do about it?" They 
said, "Nobody's ever been able to do anything about it." I 
said, "I can think of a way. You don't mind if I put a cot 



102 



here on the jail patio under a banana tree? I'll spend the 
night here and examine each of these women as they're brought 
in." That gave them something to think about. So they said, 
"You don't have to do that, Doctor, that would be too much to 
ask of you. They'll be here in the morning." And they were. 

I had to examine armies of prostitutes. Sometimes you'd 
see them, and they were black and the next time they were 
white. You'd say, "How can this be? They can't be turning 
different colors?" Well, they wanted different clientele for 
the night, given the ship, so they put on a routine of being 
black for that occasion. 

Crawford: The same women? 

Blum: The same women. Oh yes. I mean, they were appealing to 

different customers. Really quite beyond belief, what you'd 
recover from the vaginas of these woman. All kinds of gadgetry 
that the males were using and lost. It was quite an education. 
I didn't know there were such things. This work wasn't exactly 
exotic, and surely not erotic, but it was interesting. 

Crawford: Did you ever write anything about that? 

Blum: Oh, lord, no. 

Crawford: Were they treated? 

Blum: Of course, and fast. 

Crawford: In the jails? 

Blum: Yes, wherever. It was a rough, a rough scene. And then I 

remember, the armed forces wanted us to go down and treat all 
the prostitutes in Tijuana because the troops were at liberty 
for one, two, three, four days, or just even for a night. So, 
somehow or other, we got roped into checking prostitutes in 
Tijuana. 

Crawford: The Mexican authorities wanted that? 

Blum: No, they didn't, but our military did, and business is 
business. These armed forces people leave hundreds of 
thousands of dollars, and maybe millions, in the course of a 
week. So no one in Tijuana was going to interfere with that. 
We finally came up with a brilliant idea. I don't know how 
good it was, but they lined the prostitutes up, they knew who 
they were, and we gave each of them a million units of 
penicillin. And that was that. In those days before 



103 



Crawford: 
Blum: 



Crawford: 
Blum: 



Crawford; 
Blum: 



Blum: 



resistance to penicillin it would get rid of their gonorrhea 
and would get rid of syphilis as well. 



Quickly. 

Quickly. And so we didn't examine them at all. 
routine: we'd go down once a week. 



We had a 



1 remember when I was at Hopkins, we already were getting 
stories from Europe about the Germans. They had beautiful 
houses of prostitution in France, and checked every prostitute 
every day, and did this and did that. 

The French did? 

No, the Germans. Oh, the French, that's another story--they 
did nothing. But the Germans this was rest and recreation for 
the troops. Yet they had a rate of venereal disease that was 
spectacular. You can't control it just by inspections of 
prostitutes. The same prostitute will service maybe fifty, 
eighty, a hundred men a day. So, if one leaves a disease, the 
next one picks it up. The prostitute doesn't have to be an 
incubator. She can just carry it from one to the next. Well, 
they finally dismantled all their inspections of prostitutes. 
The United States got all the records as they were captured 
early. They established a new rule: if a soldier got venereal 
disease, he was shipped to the Eastern front. The Western 
front wasn't hard ball. 

Did that help? 

I don't know. The war was almost over. But in Tijuana we 
wasted no time on inspections. We treated according to 
occupation, e.g., prostitute. 

** 

Then we had an experience with smallpox. Smallpox kept coming 
back with the troops off and on. Here I was, the junior 
person. So, I got to do whatever was interesting or looked 
like it was a little crazy, a little dangerous. We get a call. 
There's a small aircraft carrier coming into the harbor--San 
Diego is a big naval headquarters. It's been at sea for three 
years. It's coming in flying the yellow jack--a little 
international flag that says, "We have a plague aboard." It 
could be smallpox, it could be yellow fever, it could be 
bubonic plague. This carrier was not allowed to dock in the 
Philippines. It wasn't allowed because of the case of 



104 



smallpox-- just one on board. It wasn't allowed to dock in 
Hawaii, and they came to San Diego, their home base. 

It's not up to the navy to let these people ashore. It's 
up to the local health department to make the decision whether 
the crew can come off or not. In Hawaii and the Philippines 
they wouldn't let them off. "You stay right on and go 
somewhere else." These were men who've been at sea for three 
years. So the commanding officer starts telling us what to do, 
as they usually do, but we didn't pay much attention. It's 
like, "This is our decision. We want to ask you a lot of 
questions, but don't tell us what to do." My wife is sitting 
out there in the car, waiting for me, because that night we 
have to go to a meeting way up in the mountains to explain to 
people something about polio. It was one of those places you 
drove for two hours to get to. 

Crawford: You had no idea what you were going to find? 

Blum: Sort of. So, I went on board, and here is the most classic 

picture I've ever seen of a case of smallpox. The fingernails 
are coming off, his skin is coming off. He's going to survive, 
but all this shedding skin is contagious, and where is he 
berthed? Well, the only cool place in the ship, the sick bay, 
is in the center of the ship, and here's an air pipe two feet 
in diameter blowing across this patient. He's under the blast, 
but it's moving the scabs all over the ship. 

[Interview 3: February 3, 1997] //# 

Blum: The patient is lying under the major air vent at the center of 
the ship in the sick bay. He was put there to keep him halfway 
comfortable because that area was cooler for patients when they 
were in the tropics for years at a time. So all of his crud 
and scabs were carried all over that ship. 

I went to talk to the two medical officers, who were 
younger than I was. They said, well, he didn't really have 
smallpox. It was probably syphilis, and syphilis does give 
people all kinds of skin diseases. His disease converted his 
blood test to a positive for syphilis--a weak positivebut 
smallpox does that. Even smallpox vaccination will sometimes 
give you a weak test for syphilis. So they were praying to god 
for syphilis, and they said it couldn't be smallpox. 

They were navy doctors. They had just gotten out of school 
a year previously and there they were. But they had not taken 
any chances; they had gotten shipped to them some water buffalo 
vaccinethe strongest smallpox vaccine. Apparently the 



105 



smallpox virus grows beautifully on the water buffalo; and they 
had used that vaccine to immunize everybody on the ship three 
times against smallpox, just in case it wasn't syphilis. So 
you can tell that their confidence was a little low when it 
came to saying it was not smallpox. I said, "It i,s_ smallpox as 
far as I'm concerned, and that's the end of that." So we 
negotiated about how to get the men off the ship. I mean, you 
can't keep them forever after three years. There were 
thousands of women and children waiting for their husbands 
right there on that dock. The patient went to the San Diego 
naval hospital. 

So we said, "Okay, a third of them off. We'll clean them 
up, and they're off." And they get two weeks leave. So we 
figured out how to best clean them off. Well, that isn't what 
the naval officers understood that we negotiated. They thought 
we had negotiated eight hours leave, one-third of the ship off 
and two-thirds on. Then that third would come back and the 
others would go. I discovered that a day or two later. We 
threw up our hands in horror because men were coming back to 
the ship day and night, and the clean-up is kind of a scary 
j oke anyway . 

Crawford: What is the clean-up? 

Blum: Well, making sure that they're not walking out with any scab 
material on them, contaminated clothes, gear. 

Crawford: But they could be carriers? 

Blum: Yes. They themselves are not sick, and as they were immunized 
they will never get sick; but they could be carrying the scabs 
from the disease and that carries the virus. 

So we decided to start sending them home after a few days. 
A third were gone, then in so many weeks another third could be 
gone. In the meantime, they were already off the ship. So we 
immunized all San Diego: every man, woman, and child. 

Crawford: How many? 

Blum: Hundreds of thousands. Five, six hundred thousand. Probably, 
that was about all the people there were then. I don't 
remember the details. 

Crawford: Was there a public health scare? 

Blum: We decided to immunize. It turned out that there were cases in 
Seattle coming off ships where just the blankets were infected. 



Crawford : 



Blum: 



106 



So we had ample ground for, "Here's a ship with smallpox." All 
on my say-so. It was kind of scary to use such authority, and 
then make a mess of it. 

The alternative, the only real alternative was just to 
quarantine the men? 

But they had been at sea for three years and they didn't need a 
quarantine, it's the ship that's the problem. They were on 
that ship and supposing the wind blew a few more scabs around 
anyhow . 

So we made it. Some of these people went across the 
country to their families. Well, that was the end of it, but 
at the time of the ship inspection I said to myself, "I think 
I'll get an immunization right here on board ship. You guys 
can immunize me." One only gets immunized every so many years, 
and I hadn't had any for a couple of years. So they immunized 
me with that nice water buffalo vaccine, [laughter] and I 
vaccinated my wife with more of that vaccine right in our car 
before we dashed off to our night meeting. 

Where did they find that? 

Oh, they picked the vaccine up from the Philippines. Somebody 
delivered it to them. 

How did you call the population in? 

There were announcements in the paper that there was a 
potential for smallpox. Ships were coming back. People 
already heard about cases in Seattle, and here was a ship with 
a case on it. 



Crawford: Quite a story. 

Blum: Well, the life of a health officer needn't be dull. [laughs] 

Crawford: Did you have anything else as critical in San Diego during your 
time? 



Crawford: 
Blum: 

Crawford: 
Blum: 



Blum: 



Not particularly. 



107 
Going AWOL; Back Surgery at the San Francisco Marine Hospital 

Blum: My departure from San Diego had a special personal aspect. My 
time in the service was drawing to a close and we were looking 
forward to Stanford. At that point I had a recurrence of a 
herniated intervertebral disc (my first had been in my second 
year of medical school and had slowly cooled down over the 
years, leaving me in good physical condition). 

Nothing seemed to help the back and leg pain. Since I was 
entitled to care at the tremendous Naval Hospital in San Diego 
(at the edge of lush Balboa Park and with broad ocean views as 
well), I turned in and found myself in a quiet junior officers 
wing. I didn't know it then, it only came out later that the 
head of the hospital was bucking for a commodore's rating, 
achievable most directly by increasing the numbers of patients 
at the hospital. The easiest way to do that was with a policy 
of easy admittance and difficult discharge. 

After four days of pleasant care without much medical 
attention, I got a basic exam. Because this was not a new 
condition, one that in fact predated my entrance into the 
service by several years, I was told that I could get no 
surgery for a preexisting condition, but that I should remain 
in the hospital. Since my condition wasn't changing a great 
deal and I was soon to begin at Stanford, I asked for a 
discharge. Lo and behold, I was not fit for duty and therefore 
could not achieve a discharge from the hospital until I was. 
No treatment could be given, nor could I go on about my 
affairs. A lifetime, or even just a few months doing nothing 
in a hospital (no rehab or exercises were offered either) would 
be like a prison sentence. 

We called some friends in L.A. who had a car, my wife 
shipped our belongings to San Francisco for storage, and on one 
of her afternoon visits we clumped up the bedclothes on the bed 
so it looked like I was asleep and got me dressed up for a 
stroll. 

Marian carried a few parcels, essentially my bedclothes, we 
met our friends at their car, and went on to L.A. where we had 
pullman reservations for San Francisco. We went to a friend's 
house in San Rafael. I'm still AWOL, no doubt, from the San 
Diego Naval Hospital. 

At that point I decided to begin my residency at Stanford. 
Took the bus from San Rafael and completely collapsed with back 
pain when I got to San Francisco. We had gotten an apartment 



108 



by then, and our belongings were in it. I lay on the floor 
until Marian came along, got an ambulance and had me delivered 
to the Marine Hospital. Although I was discharged from the 
service, I had several months leave coming, and the USPHS had 
no problem about accepting and treating me. We forgot about 
the San Diego Naval Hospital. 

Crawford: So you came to Stanford. 

Blum: Yes, but let me backtrack to say how I got there. When the war 
suddenly looked like it was going to be over. I was in San 
Francisco on V-E Day, I went over to UCSF to see about further 
training. The chief of medicine was a windbag and when I got 
to his office I could hear him gossiping. His secretary said I 
could see him in a week, that it was tough that my furlough 
would be up before then. So I went over to Stanford. Had 
never been there before. 



Blum: I came to the reception area for the medical school and asked 
to see Dr. Bloomfield, one of the celebrated internists in the 
U.S., and certainly the dean of them all on the West Coast. 
The receptionist got him on the phone and he told her to send 
me up to his office. I got up to the fifth floor of the 
horrible old building in which the medical school was housed, 
but couldn't find his office, only a door marked fire escape. 
So I went back down to the receptionist and asked her to call 
him and tell him I was starting again because I had gotten 
lost. 

She said, "He says to stay here, he'll come to get you." 
He did, and his office was behind the door marked fire escape. 

He found out what I wanted, more training in internal 
medicine. He asked me to get a letter from my chief at Hopkins 
who had been a fellow resident with Bloomfield at Hopkins. 
J. E. Moore sent off a letter when I got back to Baltimore, 
Bloomfield accepted me that same week and awarded me a 
Rockefeller research grant as well. 

I had become a Stanford person for life when Bloomfield 
came downstairs to fetch me, a person totally unknown to him or 
to anyone else for that matter. And I've been a Stanford 
person ever since, as we shall see. 

II 

Crawford: So he was waiting for you? 



109 



Blum: Yes. I got the recommendation Bloomfield asked me for, and 
eventually it all came about, the residency and the 
Rockefeller, and I found myself at Stanford. 

Crawford: Did you have surgery for the disc problem? 

Blum: Yes. I was still in the service and had surgery in the San 

Francisco Marine Hospital and got an infection. If it hadn't 
been for penicillin, I probably would have died. I got an 
infection between two vertebrae. I had a fever of a hundred 
and five, a hundred and six, day after day. My doctors really 
paid no attention to me at all; but, of all things, the head of 
the Marine Hospital in San Francisco was a tough old curmudgeon 
named Hollingsworth, and he had shaped up the Marine Hospital 
in Stapleton--the one where I had first started my career in 
the VD research lab. 

He took over. He had shaped that hospital up from a 
disaster area; then he took over the one in San Francisco about 
the time I got here, and it too had become a disaster area 
since 1 left as an intern. He had rounds every morning at 
eight o'clock; and every morning at eight o'clock, if a doctor 
wasn't there, let me tell you, he'd soon hear about it. 
Doctors and everybody had to show up unless they were in 
surgery. He always knew more about the cases than they did. 
He knew more about medicine than they did. 

This was a grand old man. He discovered me with this 
wonderful fever, just lying there. No one was doing a 
goddamned thing. So he moved me, and I started getting 
treatment. Once the old man starts looking after you, you're 
going to be looked after, you know. 

Crawford: So he took you under his wing? 

Blum: Yes, and the Stanford people who knew I had been unable to come 
to work at Stanford started coming in at that time. They may 
have been aware of the fact that I had been operated on by 
nobody less than Stanford's chief of neurosurgery . 

Crawford: Who was that? 

Blum: Lusignian. He was a well-known neurosurgeon. He worked in the 
Marine Hospital as a consultant, and he did their tricky 
neurosurgery. 



110 



V RESIDENCY AT STANFORD AND ON TO HARVARD: 1946-1948 



Treating and Studying Syphilis 



Blum: At Stanford I was getting the training a resident would get 

even though I got a good bit more money as a research fellow. 
That was a friendly environment. I've never seen anything 
quite that friendly. Hopkins was friendly, but Stanford was 
more so. I'd known that as a student at UCSF. We were 
students side by side at County Hospital in San Francisco in 
our third year. The Stanford people were happy, cheery folks, 
and we were always a bunch of disgruntled bums. They laughed 
at us. They used to kid us about the sad sacks we were. 

Crawford: What was the difference? 
Blum: How students were treated. 
Crawford: Was it a matter of numbers? 

Blum: No, same size class, but there was a different attitude. I 

remember when I first came to Stanford and I had a fair bit of 
free time. I got into all kinds of things. I went to x-ray 
almost every day, fluoroscopy, to learn how to handle a 
fluoroscope. They had, probably, the number one x-ray man in 
the world there at the time, and he was teaching the students 
in small groups. 

I remember one x-ray session. There was Newell--a famous, 
kindly manasking the students questions about "why are we 
doing this?" and "why are we doing the fluoroscopy this way?" 
One of the students was just abysmal. He just didn't know 
anything. It was kind of funny--or sad. Newell finally got a 
little exasperated, but he wouldn't be mean. He finally asked 
the student to classify the foodstuf fs--they were looking at 
the gastrointestinal tract. The student came up with animal, 
vegetable, and mineral. It sounded like kindergarten. Poor 



Ill 



Newell didn't have any hair, but he was reaching for it. The 
rest of the students were shying away from this poor victim, a 
kid who drove a big, beautiful car. He was, I think, bright 
enough; just not interested in learning anything. 

Finally, Newell said, "So-and-so, you're going to be a 
doctor next year. How can you pass yourself off as a doctor 
and be this ignorant? You can't do it. You've taken on some 
agreements with society when you're a doctor. You can't go out 
there and be an ignorant bum." That was a bawling-out at 
Stanford. At Cal, we were used to, "Okay, one more trick like 
that, and you're out." That was a different world. True, this 
student probably should have been out. But the appeal was made 
to his better side, and in no way was it made as a threat to 
his survival. 

Crawford: Did he straighten up? 

Blum: I don't know because it was too close to the end of his 
training, and he wasn't one of my students. 

Crawford: What was your duty? 

Blum: As a resident, I was supervising students, taking care of 

patients primarily, and doing research because I was a research 
fellow so I had taken on a research project. We had just a 
wonderful population to do research on. It was a project, 
again, which might raise some ethical hairs. We were looking 
at what happened to patients with syphilis clearly proven 
syphilis some who had been treated satisfactorily, and some 
who had not. There were many who had not taken treatment for 
one reason or another. 

Crawford: Why? 

Blum: Sometimes they had decided not. At other times, they had had 
the disease for years and years, and had never known it. The 
treatment wasn't without its dangers and miseries, and we and 
the patients had come to an agreement not to treat. So we had 
the chance to follow and study these people at some length over 
many years. The people who had not had adequate therapy did 
have more than their share of ultimate vascular system disease, 
nervous system disease, and so on. There's just no question 
about it. That study was one of my major publications. 1 



'Blum, H.L., and C. Barnett. "Prognosis in Late Latent Syphilis." 
Archives of International Medicine 82:393-409, October 1948. 



112 



Crawford: What was the treatment? 

Blum: Well, it depended on what form or stage of syphilis a patient 
showed up with. Penicillin was just available, but the older 
cases had all gone through the arsenic or arsenic plus bismuth 
treatment. There was more than one version of arsenic. If one 
had ocular damage, which was not rare, one was treated with 
another kind of arsenic. That arsenic, of itself, was 
dangerous and it commonly caused loss of vision, too. 

So if you saw the patient after they had such treatment 
with bad results, you saw the blank nerve heads when you looked 
inside the eye, yet you couldn't tell whether it was due to the 
arsenic or the disease. That was tricky therapy. One had to 
know a lot about eyes. One also [had to know] a lot about 
heart disease, and one had to know a lot about other nervous 
system problems if one was going to treat cases of syphilis. 

Syphilis just caused all kinds of hell--bone disease, 
tumors, all kinds of unexpected pathology. The tumors 
fortunately would dissolve away with drug therapy. 

So that was the research project. We had hundreds and 
hundreds of patients: treated and not treated. It was a 
respectable study. I learned something about research methods 
at that point, and a lot more about internal medicine as a 
practitioner. 

Crawford: What year are we talking about? 

Blum: 1946-47. We residents in medicine had a small journal club- 
nothing like the kind we had at Hopkins where the whole 
department came--but this was just the residents. There were 
some remarkable people amongst those Stanford residents, some 
of whom I'd already met, one of whom I'd worked with at 
Hopkins. We were a fairly diverse group of about a dozen who 
met once a month for a long evening, and would review the more 
interesting journal articles that we had found. But it wasn't 
the high-powered operation that I was used to at Hopkins, where 
the chief of the service was there, too, which kept everybody 
on their toes. 



Crawford: Is that East Coast versus West Coast operations? 

Blum: No, it's just that Hopkins was a big, ultra-scientific 

operation; and the West Coast operations were poor, piddly, new 
little places by comparison. UCSF and Stanford, in those days, 
were not very much by Hopkins standards. They had a few famous 



113 



people, each of them; but they didn't have the huge faculties 
or the facilities, equipment, residents, and researches. 

Crawford: And the clientele was different, wasn't it? 

Blum: Well, no. It was primarily desperately poor people in all 

these university settings. In addition, well-off and famous 
people came because they were referred from practitioners for 
care that was only available at university centers. Very 
similar in that sense in all these institutions, the wealthy 
got care on the private wards, the poor on charity wards. 

For example, when I was at Stanford, Thomas Addison was the 
chief of kidney diseaseworld-famous, the best-known name in 
the field. When he got sick and developed a serious problem, 
he went out in the wards with the poor people. The faculty 
hated him for that. [laughter] He was an old-time liberal. 

Crawford: You would have done the same thing. 

Blum: Might have. It wasn't a big gesture, but it was certainly 
heartening to the patients. 

Crawford: Everybody hated him for that? You mean the staff. 

Blum: The staff, yes. "That bastard," you know, "putting on a show 

like that." But he probably felt that this is where he got the 
best care. The residents, who did most of the care--some on 
the private side but mostly on the clinic or poverty sidewere 
the same residents, but they probably got raked over the coals 
harder on the public or clinic side; because there, where 
chiefs did make rounds, they didn't hesitate to tell the 
resident that they didn't do this right or that right. 

The clinic patients were really subjected to the closest 
kind of scrutiny. That's where the medical students trained, 
that's where the interns and the residents trained, and that's 
where a whole retinue of big-shots would come by on rounds, 
which took place at least once a week, and, on most services, 
by the chief once a day. 

So there was the feeling that there might be some risks 
there from more mistakes made by trainees, but overall patients 
would get better care. 

On the private side, the physician in charge of the case 
would come through, and he'd trust to the resident, and maybe 
there wouldn't even be any interns or residents on the private 



114 



side. At least this nephrologist , Addison, made it clear that 
he thought the clinic side was the best side. 

Crawford: And he survived? 

Blum: Oh, he survived. I think that he wasn't alone in his thinking. 
A lot of people felt that the clinic side did very well, but it 
is true; a patient there was exposed to more novices. It might 
be where the trainee couldn't hit your veins, or if they did a 
spinal tap, they would spend twice as long getting in. 

Trainees also go home and crack the books because tomorrow 
when they make rounds, they've got to know everything which 
might set a new light on the case. I remember about the first 
week I was there at Stanford, Bloomfield, who was the man who 
brought me there, was the grand old man on the West Coast for 
internal medicine. He made rounds on the clinic patients every 
Thursday. Sometimes a hundred or more doctors would be there 
from all over northern California. This was a famous event, 
making Grand Rounds with Bloomfield. It would fill up a whole 
ward with people trying to see or just even hear what was going 
on. 

Crawford: What was that like? Describe that. 

Blum: Well, he was an older man, a bit bent, very scholarly-looking, 
bald-headed, with glasses. The patient had been carefully 
worked up by the intern, and a resident, and a senior resident, 
and the chief resident, you know. Then god knows how many 
other physicians had seen this poor patient. This was on the 
teaching side, the clinic side. Bloomfield would ask for a 
recitation from some of these people to tell him what the case 
was about, what had been learned, the tests and their results. 
Then he would develop the data and go to the heart of whatever 
the critical issue was. 

It was never a simple case. He didn't bother with simple 
ones. He might examine the patient. He was not, in my 
opinion, a great examiner. He wasn't good at physical 
diagnosis, I didn't think. What he did was use his wits. 

When he heard what a good resident had found, he'd start 
putting the odds together very scientifically, as though he 
were a computer, you see. He'd say, "Well, this kind of rules 
out this, and this kind of brings this in." Even though he 
examined the patient, that wasn't where the action was going 
on. It was going on in his head, and his diagnoses were 
famous. He'd find the answers in a real haystack; but it 



115 



wasn't because he saw the needle by looking at it or touching 
the patient. It wasn't that kind of skill. 

The first time I went, there was a wonderful and famous 
European radiologist, Windholz, in attendance. Stanford 
radiology was always great, and this man was a refugee who had 
come to the top x-ray department in the U.S.A. 

II 

Blum: It was Bloomfield's show, but Windholz was also a prima donna, 
and a superb one. As they went through a case, sometimes 
Bloomfield would turn to people and say, "What do you think?" 
if it might concern their specialty. Thus he could get more 
ideas before he'd finally pronounce; and I don't think he 
called on Windholz. Windholz was just standing by the bedside, 
though, as a very senior man. When Bloomfield got all through, 
Windholz said, "Did you look at the patient's neck, Doctor?" 
And here were these great big old tubercular scars, and that 
was the key to the case. This was not appreciated at all. 
[laughs] 

Crawford: How was this handled? 

Blum: Well, you thank goodness that the good Lord sent Windholz to 
tell you what the answer was, but if the chief never saw him 
again, it would be too soon. The next time we made Grand 
Rounds, I remember Bloomfield saying to him something to the 
effect of, "I'll call upon you if I want you." [laughs] 

Crawford: Keep your observations to yourself. 

Blum: But it was done decently. I don't think anybody snickered, 

except maybe a few of us residents. Windholz was a superb man. 
I remember he died that year. All of a sudden, a vicious 
cancer. It just carried him away. I became very fond of him. 
We had encountered patients together, and I was one of the few 
people that enjoyed him, his brilliance, his remarkable 
experiences, and kept visiting him as he was dying in the 
hospital. 

Crawford: Was it a very grueling schedule? 

Blum: I didn't think so. I loved it. You were doing what you should 
have done, and that is a careful job of examining patients, 
studying medicine, and doing your research. 

They didn't have anybody there to do cisternal punctures in 
the clinics, and I'd learned how to do that somewhere along the 



116 



linein Arkansas, no less. Sometimes one couldn't get spinal 
fluid out of the spinal column. Some people had back injuries 
so bad that their spine was all messed up, and one couldn't 
find a place to go in to get to the spinal fluid. This spinal 
tap was always done for syphilitics to see whether their 
nervous system was being affected. In these different cases I 
did the cisternal punctures, which required putting in a long 
needle at the base of the brain, to get spinal fluid to test. 
That was quite awesome to observers--! was glad I was trained. 
I'd be scared to death to do one again. 

Crawford: How did you learn that? 

Blum: In Arkansas, just by watching. You watch one, and then you do 
one. [laughs] How else can you do it? An expert is sitting 
there guiding your hand, saying, "No, no. Tilt the needle this 
way, or that way." You're pushing the needle in, and you're 
waiting for a feel of going through the outer lining, which is 
kind of the tough one; and then the inner one, which is 
delicate and easy to go through. Then you're in. Your needle 
has a plug in it, so it isn't open. You pull that out, and 
then fluid starts coming, and there's beautiful, clear fluid, 
and you capture it for the test. 

There's a limit to what area of the spinal cord you want to 
tap. You always go in where the spinal cord has ended, to the 
lower three or four inches of the spinal column. In a 
cisternal tap, you're right up against the base of the brain 
where there is a pool of spinal fluid, which lends itself to 
tapping. However, I heard after I left Hot Springs that they 
had stopped doing them. I said, "Why?" We used to do twenty, 
thirty in an afternoon, lined up the patients and one of us 
would get there and do them. 

Well, two patients in a row had perished. Somebody was 
going in too deep and hit a blood vessel, causing a hemorrhage 
at the base of the brain. Perhaps if there were a good 
neurosurgeon, I think they could have done something about it, 
but they didn't have any neurosurgeons . So there were some 
drawbacks. I'm not sorry that I didn't keep on doing that for 
a living. Anyway, residents had moments when they were 
obviously smart and knew how to do something that nobody else 
did. Other than that, it was just a high-quality operation and 
you weren't expected to do heroics. We got a lot of referrals, 
but the bulk of the clinic patients were ours- -our own 
patients, and we proceeded to the limits of our skills, which 
were being extended by with every new case. 

Crawford: And you lived where? 



117 



Blum: Oh, ten, twenty blocks from the hospital; on the Mission side, 
near Mission Dolores. 

Crawford: Where was the hospital located then? 

Blum: Stanford? Where the California Pacific Medical Center is now. 

Crawford: That's what I thought, but that was a long walk. 

Blum: I didn't walk. The streetcar would take me across town. I may 
have walked home sometimes after the day was over. That was 
kind of fun. A former classmate of mine at UC was living right 
near Stanford and was a resident at UCSF. So I'd go by there 
and see him and his wife if I got off early. He and I 
generally compared notes about what we were learning and how 
life was treating us. He didn't get his promised payments at 
UCSF after all, but he did get his laundry done. That's all he 
got. I was earning real money. I forget what it was, but it 
was over two hundred dollars a month. 

We would trade stories about our residency. I was so 
pleased with where I was, and the people that were around me 
were so nice to us, and he was still being treated like dirt. 
He became a very fine orthopedist. 

I'll never forget one day he said, "You won't believe what 
I went through this morning. We have a resident who put the 
pictures of the legs of a patient upside down in the viewing 
box." He said, "You know, there's nothing wrong with putting 
them upside down, but whoever studies x-ray pictures upside 
down?" [laughter] He said, "I can't believe it. This guy is 
a senior resident," and I guessed who it was. He said, "How 
did you know?" I said, "Well, there was only one guy that lame 
in my class." That had to be him. 

Crawford: Well, so you finished your residency at Stanford? 

Blum: Yes, and then it was a matter of, "Where do I go from here?" 
The resident that I had met at Hopkins during the war- -we 
worked in the same service- -was leaving Stanford also. We 
decided that maybe we would go into practice together in Palo 
Alto. He had his eyes on glory and wealth. I never focused 
well enough, I suppose. So we thought through the whole 
business of how we were going to run our affairs as the best- 
quality practice in town. Then the opportunity came for me to 
go to the School of Public Health at Harvard. 



118 



Harvard University and the School of Public Health 



Crawford: How did that happen? 

Blum: Well, as a matter of fact, while I was exploring the Palo Alto 
situationand we would both get teaching appointments at 
Stanfordlife looked kind of rosy. But I still was thinking 
about living in the East Bay and opening an office there 
because we'd spent many years there. So I went to see a man 
who ran the clinics for what was then the Oakland Health 
Department. I said, "I'd like to work in some of the clinics." 
I'd do the VD clinics, immunization clinics--! wasn't going to 
do any pediatrics or obstetrics. I was exploring the options 
for being on my own and needed income while I built up a 
practice. He said, "I'd be happy to put you to work in the 
clinics. We can find a place for you so you could start a 
practice. But you've done this, you've done that, some in 
public health- -why do you want to go into practice? Why don't 
you go into public health?" I said, "I've thought of it, 
really. It's kind of been my long-term direction, but, then, 
on the other hand, this past year all I've done is clinical 
medicine." Well, for two and a half years, really: Hopkins for 
a year and a half, Stanford, a year. "Why don't you think 
about it?" he said, "I went to Harvard School of Public Health, 
and 1 loved it. I had a great time there, and I've done public 
health ever since, and never regretted it." He didn't have the 
internal medicine training I had, but he'd been trained in a 
general way. He said, "There are openings coming for 
physicians at your level who will be paid to go to the Harvard 
School of Public Health for a year. You can earn a master's 
degree in public health, and then you can do what you want. 
When you come back, you can still go into practice, if you 
still want to, but you could also go into public health, here 
or elsewhere." 

That was the fork in the road. I had to make up my mind. 
The other resident said, "Well, I'm going to Palo Alto to set 
up practice, and if you're not coming I'll just forget about it 
and do it on my own." And he did. He went there on his own, 
and I succumbed to the lure of Harvard and public health. 

I had an interesting year there. I also worked in the 
clinics at Peter Bent Brigham with internists there, and had a 
great time. They were very, very nice, but I was already 
clearly a physician who was coming back for a year at Harvard 
School of Public Health. 

Crawford: What did you get out of Harvard? 



119 



Blum: The degree, a master of public health, in 1948. 
Crawford: Yes, but what hadn't you known? 

Blum: Oh, I didn't really know anything about public health. My 

exposure to public health as public health was a bit of a joke. 
I had prison experience, and research lab experience, and this 
one year in San Diego in venereal disease control, but really 
never learned any basic public health. The intern year in the 
Marine Hospital was all medical practice, a general rotation 
from ENT to OB/GYN. But the stuff I got the most of was 
medicine. Hopkins was all medicine. So I really got no public 
health training. 

At Harvard the first thing I discovered was that I had a 
co-worker from Hopkins. She too was on the faculty at Hopkins 
when I was there. Her name was Bowditch. Well, that's a great 
name at Harvard, also at Berkeley. She was a lovely person, 
not married. She was a true Boston Brahmin and had just moved 
back to her home on Beacon Hill the same year that I ended up 
there as a student. She also was taking a master's in public 
health. She already had her boards in internal medicine. At 
Hopkins we'd met one another, but here we became closer as 
classmates. Faculty wouldn't let either of us take a couple of 
courses at Harvard School of Public Health because the 
instructor said, "You know too much about the subject matter, 
and I don't want to put up with that sort of a thing." [laughs] 

Crawford: What was the course? 

Blum: It was about control of venereal diseases. 

Crawford: You were somewhat of a reigning master. 

Blum: Well, not so much. I knew the clinical side, but not the 

public health side. The professor didn't want us in class. 

Harvard was a great place, and in my class was a lady 
physician who ultimately became my assistant in the Health 
Department in Contra Costa County for maternal-child healtha 
Japanese lady, a fantastic history, Yoshiye Togasaki. She's 
still alive. She was a bit older than I. She was from a 
prominent Japanese family. Her father was a minister- - 
Presbyterian I thinkand the mother was one of the first 
suffragettes in Japan. 

They were a San Francisco family, or Berkeley /San 
Francisco, and had quite a name here. One of her brothers was 
a manager or president of the Sumitomo Bank here, and another 



120 



one was the manager of the Nippon Times in Tokyo. This was a 
very hardy group of folks who had had all kinds of advantages. 

My classmate had gone through Cal and then did her M.D. at 
Hopkins. She was subsequently trained in pediatrics at USC or 
UCLA in Los Angeles. When the war came along, she was put into 
one of the Japanese concentration camps. She had just opened 
her office and everything she owned subsequently disappeared. 

She had two sisters who were also doctors. One was known 
as the Angel of Buchanan Street in San Francisco. She was an 
obstetrician. The third sister was, I think, also a 
pediatrician, practiced in Hawaii when I knew her. 

Crawford: That's remarkable: three sisters. 

Blum: Yes. The fourth sister was the head of nursing at a huge VA 
hospital in New York. These were fun people. I got to know 
them very well. 

Yoshiye, my classmate at Harvard, had Boston connections- 
she lived in the home of a lady who was a Lowell and a Cabot--! 
mean, one of those Beacon Hill families. We occasionally went 
there for dinner. These were old homes that have a certain 
elegance about them, so we thought we moved in good company in 
sort of a second-hand way. 

We once went to an open house on Beacon Hill. We thought 
it offered one way of seeing how other people lived. We'd seen 
two such homes previously, but that wasn't very much. So we 
paid--I don't knowsix, eight, ten dollars to feed the 
starving Bryn Mawrians. As I remember, that's what the 
collection was for, and we got into some really wonderful 
homes . 

In one, the lady came to the door--a brisk lady, striding 
in fairly short skirts. She was an interesting, pleasant- 
looking womanbut she didn't look Bostonian. She began 
showing us around the place, and everything about it seemed out 
of keeping. We were with another person on this tour who was a 
San Francisco interior decoratorone of the first gay people 
that I'd really ever known. We became rather close friends 
because he was an enjoyable person. "This fireplace we redid," 
she said, and he's down on his hands and knees, feeling it. 
Well, they had painted it to look like green marble. It was a 
fake. 

Crawford: Marbleized. 



121 



Blum: Yes! This is an old Beacon Hill home. A showplace on Beacon 
Hill. Next we go out in the backyard, and it's one of those 
small Beacon Hill backyards, Louisburg Square, and it's just 
about the size of this room, maybe a little deeper. There is 
almost no garden there. This is in the spring, and the walls 
are all painted in azaleas and camellias. [laughs] It turned 
out our hostess was from out West and she was just having a 
great old time terrorizing the natives, I'm sure. You just 
don't do things like that on Beacon Hill. 

Crawford: She made a reputation for herself. 

Blum: Reputation for sure, but she was on the tour, so you can 

imagine her status, that in spite of all the monkey business, 
she was on the tour. Well, that was part of going to the 
School of Public Health. We didn't kill ourselves there. 

Crawford: Did you have a lot of statistics? 

Blum: Yes, a beautiful course. That's one of the best courses I've 
ever had. I really learned a lot of statistics there. Or do 
you mean statistics about the school? 

Crawford: No, the course. 

Blum: Oh, it was excellent. It had always been superb, and it still 
was. They didn't waste any of our time making us do all the 
mechanics of additions and subtractions and running through the 
statistical formulae. What they did was what should have been 
done at any other school. They gave us a series of articles 
that were out of the best journals the best statistics and 
they said, "Go through these and see what's right and see 
what's wrong about the premises, the methods used, the 
conclusions drawn." 

One learns right away that many of these great articles 
were garbage. The way they assembled the numberswell, they 
weren't the right headings for the numbers, or the researchers 
had lumped things together that were not lumpable. On and on 
and on, very basic stuff, so that we acquired a new respect for 
statistics, and even if we weren't going to be statisticians, 
we could start looking critically at work when we read the 
literature. 



So we had a wonderful program in statistics. And we were 
left to study what we wished. That was the beauty of Harvard. 
You don't have to do something because it's required. If you 
don't need it, don't do it. 



122 



Crawford: So it was a fruitful year? 



A Special Bostonian Family 



Blum: Oh, it was a good year in many ways. I also made some 

remarkable acquaintances. We couldn't get any place to live 
initially. It was right after the war was over. We'd heard 
from the previous class about a medical student who lived in a 
great big old house up in Brookline. It was a three-story 
mansion built by some old-time gambler. The current owner does 
not live there and wants to rebuild the place into a nice home 
for one son, and has another house she will rebuild for her 
second son, the medical student. 



Blum: Currently each of her two sons has one floor and there is an 
attic- -a huge one with a bathroom that has been let to SPH 
students in previous years. 

The student's mother owned and operated a big clothing 
factory. One year they'd be millionaires, and the next year 
they'd be broke; a fascinating, big-city Jewish family. When 
things were going good, she'd send a thousand blankets to 
Israel or something like that. 

"She just doesn't want anybody to come in the house," the 
medical student said. "I'd be perfectly happy to have you. I 
live on the ground floor, and my older brother lives in the 
next floor, but I just can't do it; Mother is starting to 
rebuild." So we looked and looked for days, and we finally 
came back and rang the bell; and there he was again. School 
hadn't started yet. He was still in his bathrobe, and we said, 
"Gosh, can we just stay here as long as we can, until the 
rebuilding starts? We can't find a placenothing. " "All 
right," he said, "all right, let's find my mother." And he 
gave her a story about these poor, starving Calif ornians--he 
turns out to be a real characterand they have no place to 
stay. So she didn't even realize she was going to get rent 
from us; she thought she was putting us up, that appealed to 
her. 

The medical student son was quite the storytellera real 
Danny Kaye-- looked like him, acted like him--a tall, gracious, 
handsome fellow. He had just finished his first year medical 
school, and he had won both first year prizes at Harvard, so 



123 



you know the kind of character he was. He'd come via Purdue 
where he'd been an engineer, summa cum laude. 

His mother's home was there in Brookline, which is right 
next to the medical school, and he thought, "Maybe with my 
engineering, I should go into orthopedics." He went over to 
Harvard, and talked to them a little bit, and they said, "Well, 
why don't you come in in the fall?" None of this crap about 
have you had biology, and haven't you had Shakespeare--just 
another world from Cal. There's a difference. They're not 
number two and trying harder, they're number one. They don't 
have to try harder. 

He came in, won both their awards for freshmen students. 
When I was there as a student in the School of Public Health, 
he was a second-year medical student. For the fun of it, many 
nights we'd spend hours going over whatever he was doing. It 
kept me refreshed. It probably didn't do him much good, I 
don't think he needed much. Well, he went on to be the first 
Jewish resident in surgery in Harvard. 

Crawford: At Harvard? 

Blum: At Harvard, at the Mass. General Hospital. He was something 
else. His name is Glimcher. He's chief of Orthopedics at 
Harvard today. 

Crawford: Is he really? How do you spell his name? 

Blum: G-L-I-M-C-H-E-R. His youngest daughter is now a full professor 
in the School of Public Health and Medicine in immunology. 
They're bright people and fun people. Years later he would 
come out here for the orthopedic meetings, and we'd get 
together. He might be asked to do a four, five, or six hour 
session on all the new information for the nation's 
orthopedists. 

Crawford: Still head of the department. 

Blum: Still going strong, yes. He did some fantastic work when he 

finished his residency, for which everybody thought he'd get a 
Nobel Prize. He never did, but I do remember his being invited 
to Russia to lecture on the formation of bone, which was the 
research area. He learned Russian in six weeks at a cram 
course, and he gave his lectures in Russian. 

Crawford: Oh, that's unbelievable. 



124 



Blum: It was frightening: tremendous, rampant brilliance. [laughs] 
Plus, he's such a gracious, determined, handsome, fun person. 
I remember when we were living in his house up in the garret, 
which we converted into about four rooms, including a bathroom 
with an ancient old copper tub which had the seams in the 
bottom. 



Crawford; 
Blum: 



He came home one night. He'd gone to see a movie, and I 
don't think we knew about it. He came into the room, and we 
knew exactly what it was. The way he came in, he was the 
horses prancing on Queen Elizabeth's coronation carriage. He 
could convey the royalty, the horses, the carriage, the 
ceremony of her procession. He was another Danny Kaye. 

That was quite a household. His older brother wanted to be 
a doctor, and was a tremendous salesman. He worked in the 
factory for the family. If ever his older brother felt 
depressed or ill--he was a huge man--he got into his hospital 
bed and we knew that Norm wasn't feeling good. He wouldn't be 
in his regular bed. [laughs) It was a medicalized household. 

They took care of us. They gave us overcoats, and they 
gave us clothes. Here were these poor starvelings from 
Calif ornia--we were kind of a decorationthat ' s us, these poor 
devils from California. But in moments of reality, they knew 
quite well that we weren't any such things, just students at 
Harvard. 

Your wife enjoyed this? 

She got a kick out of it, yes. It was fun. It was great fun. 

I do remember we had this horrible car: the only one we 
could get at the end of the war. It was a Hudson we bought in 
San Francisco. It was cheap enough, but it was a piece of junk 
as it turned out. They told us, "You can't go over thirty- five 
miles an hour because we have a governor on it." I bought it 
when I was at Stanford as soon as we came back from the 
service. 

After we'd gone our thousand miles, we went down to have 
them take off the governor. They told us, "Oh, well, there 
really isn't any governor on it. It just won't go more than 
thirty-five miles an hour." [laughs] We got it back to 
Boston, and getting it back home was even worse. That car was 
truly a nightmare. In Boston we kept it parked in front of our 
house, and of course it had California license plates on it-- 
and to see the kids pet the car--I never got over that. 
California had that kind of magic about it. 



125 



Crawford: Oh, it was California that did it. 

Blum: The California license. They were petting this horrible old 
Hudson. 

Crawford: What was special about California? 

Blum: Well, it was the dream. It was the Golden State. It wasn't 

just the Chinese that called it Gold Mountain. It was kids in 
Boston. Your car would not be damaged. Kids would come along 
and gently stroke it. 

Crawford: And did you experience that too? 

Blum: Yes. We were from California, and that didn't do any harm. 
Getting our attic was just such a fallout. 

Crawford: It sounds like a wonderful time. 



126 



VI SETTLING IN CALIFORNIA- -CONTRA COSTA COUNTY: 1950-1966 



The California State Health Department; A Year in San Diego, 
and on to Contra Costa County 



Blum: When I came out of the Harvard School of Public Health in 1948, 
I worked in the State of California Health Department for a few 
weeks because they had sponsored me at Harvard. They sent me 
around the state doing odd jobs. I ran the health department 
in Tulare County for three weeks while the health officer took 
a breather. Then I went to San Mateo County. They had a 
health officer, but not an assistant. So I was there for some 
weeks as an assistant. 

Then I was sent to a meeting of all the health departments 
in California down in Long Beach. I came in late, sat down in 
the dark next to Alex Lesem, the health officer of San Diego 
County for whom I'd worked when I had been in the service two 
years previously. He was an old fidgety man. He's fidgeting 
around, and he leans over and pulls my badge about to see who I 
am. He says, "What are you doing here?" I responded, "I'm in 
the State Health Department, returned after a year at Harvard." 
He said, "Let's not waste any more time. Let's you come down 
to San Diego and be my assistant. I'm retiring in two years. 
Then you can have my job." So I went out and told my wife 
about it. We both loved San Diego, although there were some 
problems about it. We knew that we would always commute from 
there back to the Bay Area to see friends and so on. 

Crawford: Her family is here, as well? 

Blum: Yes. But, in short order, we moved back to San Diego, but only 
for another year, as it turned out. This year I was number 
three person in the department. The health of f icer--this old 
man who thought I was such a good guy, and his current 
assistant director, an Indian, pure-blooded American Indian 



127 



from Oklahoma, well trained in public health- -and myself, 
number three. It was a big health department. 

For the fun of it, on the way home back from Harvard, I got 
a short hair cut, which I'd never had before. I also bought a 
bow tie and a pair of suspenders to hoist up my trousers. It 
was intended to be kind of a joke. The Indian who was chief 
assistant always wore bow ties. (He had also gone to Harvard.) 
It turned out that the old man hated bow ties; just couldn't 
stand them. I guess I had luck enough not to wear the bow tie 
to work the first few days. He said, "Do you know? That chief 
assistant of mine wears bow ties. What kind of a pimp is that? 
The only people I ever saw wear bow ties in Indiana were 
pimps." He had grown up in Terre Haute. [laughing] 
Fortunately, I was not wearing my bow tie, and I never did wear 
my bow tie in San Diego. 

The chief assistant realized right away that our boss was 
undercutting him. The boss turned to me to deliver all the 
messages for the department, and I'd have to go back to the man 
above me who was really the chief assistant health officer and 
let him know what was going on, tell him, "The old man wants 
this or wants that." We got along, which was surprising 
because there I was, being set up to take over his job. 

As I got into the job in 1949, a great polio epidemic was 
underway in San Diego. Every day I'd make rounds on all the 
cases in the county who were cared for on the isolation ward at 
County hospital. Although this wasn't my assignment, I took 
care of every one of the 360-plus cases that occurred. We did 
everything, iron lungs and all. We wrote an article about 
everything we learned. 1 

It was when polio was just unraveling. Bill Reeves, now my 
next-door neighbor, and one of his sidekicks were unraveling 
the mysteries of why our people, Americans, tended to come down 
with polio in countries where there didn't seem to be any polio 
cases. Well, it turned out that countries without polio really 
were riddled with polio; they had been infected in infancy, had 
passed through it, and were immune. Our troops, in a country 
that's fairly clean like the United States, had never really 
been exposed to polio, and so as adults placed in backwards 
countries they were getting heavy doses of polio virus. In San 
Diego we backtracked every case to where it came from, where 



'Blum, H.L., W. Chiapella and A.W. Lesem. "The 1948 Epidemic of 
Poliomyelitis in San Diego County, California." Stanford Medical Bulletin 
7:4, 169-179, November 1949. 



128 






they lived- -and lo and behold, the bulk of these cases occurred 
in new San Diego neighborhoods. San Diego was rebuilt, 
practically, during the war, and this was at the end of the 
war. These were people living in new neighborhoods that didn't 
exist before; but if you went one step further in checking on 
the victims, which gives you an idea of the pitfalls of 
research, it turned out these were typically longtime residents 
in those new neighborhoods. 

The new neighborhoods were composed mostly of migrants from 
all across the countrydisrupted people, families, and kids. 
So it was more likely to be members of old families who had 
already been there who got new exposures, and the new ones were 
really not at as much risk because they had been infected early 
in life. At the same time, we took care of the two cases from 
Tijuana. Tijuana was a tenth the size of San Diego, and should 
have had at least thirty-six cases, and they had two cases. 
Tijuana's a destitute place, you know, poor and dirty, 
unsanitary. 



Crawford: They were immune? 

Blum: Yes. But the two kids who 
wealthy families. They had 
started learning kind of by 
care of the casesyou know 
respiratory paralysis cases 
got three hundred and some 
all kinds of polio that you 
they were clearly polio, at 



got sick with polio came from very 
been protected too long. So we 
accident. I learned how to take 

, used respirators for the severe 
We did everything. When you've 

cases, you're in business. We saw 
never read about in books. Yet 
the middle of an epidemic. 



It turned out that, before the year was over, the old man 
put in his bid for retirement, and the county opened up the 
exams and I was not yet qualified for his job plain and 
simple. I didn't have enough experience. The chief assistant 
had to have two or three years. I didn't have it. I had a 
master of public health. So did the other candidate, also from 
Harvard, but he had the experience. That was that. So he got 
the job, and we were all happy. 

He was a nice personnever held the boss 1 favoritism 
against me. The old man had his quirks. The new director 
offered me his old job. I'd move up and be number- two man 
under him. I thought about that for a while, but we were 
getting a little tired of San Diego because our life was up 
here. It was kind of crazy, and San Diego is not an easy place 
to get into things. We got involved with a little theater, and 
we got into this and that, but organizations wouldn't look at 
you if you were a newcomer. They were so used to the service 



129 



Crawford: 
Blum: 



peoplein and out. They thought they were wasting their time 
and money on transients. We thought we'd settle there at first 
and so we started joining. In the long run they did waste 
their efforts on us when we decided that we really didn't want 
to stay in San Diego. It was beautiful, but not for us. 

Then I applied for jobs for the one in San Mateo and the 
one in Contra Costa. San Mateo was being the assistantchief 
assistantand Contra Costa was being the health officer. The 
health officer in San Mateo met my wife in the parking lot one 
day and said, "Where are you going to live when you come here?" 
Because he knew I was applying for the job. She smiled, and 
she said she loved the Peninsula and would be happy to settle 
anywhere. She hadn't picked anything out. It was very clear 
in her mind that he was saying, "You'll be here shortly." Then 
he picked the lowest-rated doctor on the exam list, dead last. 
He never spoke anywhere about anything in the twenty or so 
years he was in the job. 



What do you mean, never spoke? 



He went to meetings and we never heard from him. He had worked 
with the health officer in a previous job, so the health 
officer knew perfectly well what he was like. To take a risk 
on me, I guess, would have been crazy, but to go through that 
fraud with my wife was kind of pathetic. 

The head of the school of public health here, Chuck Smith, 
was a world-famous public health figure, and he sat on the 
selection committee that picked out the people to go to San 
Mateo, and he picked me as number one. So everybody else on 
the committee went along with that- -number-one candidate. When 
I didn't get San Mateo, at the same time, more or less, they 
were selecting the health officer for Contra Costa. Dr. Smith 
was on that committee too. As the dean of the SPH, he was 
everywhere. He was quite a scientist as well as being public 
service oriented. 

So he picked me again as number one for Contra Costa. That 
job I got. They didn't need as much experience, they weren't 
as fussy as San Diego. It was a kind of a cow county. It had, 
historically, a horrible health department. I was told that if 
you go out there, you're going to wipe yourself out. You 
shouldn't even go. If you take the job, for goodness sakes, 
don't make any moves. Just take it easy because the same man 
has been on the board of supervisors for over forty years, and 
has been chairman for twenty-four; and he doesn't go for public 
health. So take it easy. This was advice from the state 
health department. 



130 



Crawford: Who was the chair of the board? 

Blum: Billy Buchanan. He was a stocky old Scots fellow who ran a 
grocery store up in Pittsburg: a straightforward, straight- 
shooting guy, but so ancient. He didn't believe in newfangled 
crap like public health, but state law said he had to have a 
health department, so he had one. He ran the board with an 
iron fist. 

Crawford: The board of supervisors? 

Blum: Oh, yes. He was chairman of the board. So I got picked. One 
other person on the selection committee was the head of 
personnel for Tidewater. I guess that's Tosco now. Tidewater 
was a big oil company. The county administrator was also on 
the committee. He wasn't the administrator then--he was the 
county auditor, sweet lovely man. I got the job, and I came to 
work for Contra Costa County, and I wasn't sorry. I was sorry 
to leave San Diego in some ways. It was so beautiful. We 
lived near the water: a block from the ocean. The climate was 
out of this world. We had quite a love affair with it because 
our last station in the Public Health Service had been in San 
Diego. 

Crawford: So you had some connections? 

Blum: Yes. I knew everybody there in the health department, and 

finally a lot of other people, too. Well, not a lot, but some. 
We really loved the place, but it wasn't where our life was-- 
all of our friends were up here. 



Serving as County Health Officer in Contra Costa County 



Blum: I came to Contra Costa and could find no place to stay. (We 
ultimately found a motel with a vacancy in Lafayette in 
February.) Some people met us at a party. They were just 
youngsters; he was getting a degree here at UCB. They said, 
"Why don't you come and stay with us. We have a place in 
Berkeley." So we stayed with them, and that was really funny. 
They were total New Yorkers, and they had picked some poison 
oak, and it was on the mantlepiece--beautiful leaves, you know. 
They were always having these outbreaks of horrible skin 
disease, and it was, of course, poison oak. They were just 
keen, lovely people. 



131 



Crawford: 
Blum: 



Crawford: 

Blum: 



Crawford: 
Blum: 

Crawford; 
Blum: 



She came from a well-known family, and he from not so well- 
known family, but a fun character who'd fought his way up 
Montecasino for a year in World War II. His squad lived in 
tombs--hollowed-out tombs--on Montecasino--were held up there 
for the best part of a year. A fantastic sense of humor, which 
I guess you'd have to have, if you lived in graves; and always 
watching out for the mailman to make sure you wouldn't shoot 
him. He'd bring the mail every couple of days while they were 
lying in these tombs and slowly inching their way up the 
mountain. A tremendous casualty load. 

Finally, I can't help but think of these people as so sweet 
because they housed us, and that started us off right. Then we 
found a little house. Bishop's Better Bungled Buildings, as I 
remember, we used to call them. 

What did you call them? 

Bishop's Better Bungled Buildings. The builder had some sort 
of B-B-B moniker. He wasn't very good, and things would always 
go wrong in these little places. We found the little shack; it 
was fairly new and on the main drag between Martinez and Walnut 
Creek. We decided to live in Walnut Creek, and the office was 
in Martinez. The reason for it was pretty straightforward. As 
soon as I came to Martinez, I discovered that I was going to be 
asked to join the Rotarians, the Kiwanians, the Lions, every 
little social circle, the bridge club. I just couldn't live 
that way. There's no way I could socialize and enjoy the 
prominent citizens, lawyers and doctors, in town. That's not 
living to me. 

In Martinez? 

In Martinez. So we discovered that if you lived in fast- 
growing Walnut Creek, you belonged to nobody. Walnut Creek was 
the home of everybody and nobody. Yes, there was a little 
ancient inner circle, but most people were newcomers and had 
ties elsewhere, at least initially. 

Why was Martinez so social? It was, I guess, the county seat? 

It was the county seat. If you were going to live there and 
had an income, a title, so on, you had to fit in to a 
relatively stable little town with a life of its own. 

You didn't like all that socializing? 

Well, the people were small-town people. Some of them became 
important jurists, but they were not our kind of people. We 



132 



Crawford: 

Blum: 






didn't have trouble with them, you know, but in Walnut Creek we 
were left alone. Since we worked in Martinez, that kind of 
dismissed us. Walnut Creek was full of strangers. In Walnut 
Creek, we were in a crossroads. Well, it wasn't even a 
crossroads. It was a dead-end road. Highway 24 dead-ended in 
the middle of town, when we came there. Our friends were 
wherever we had made them, and of course, we did make many in 
Contra Costa County and many in Walnut Creek. 

We ended up living very much in Walnut Creek, and that was 
the beginning of, probably, our most fun years, in many ways. 
I was the health officer, and knew from nothing. We had had 
two years in San Diego, thank god, where we had a heavy 
exposure to all kinds of situations. We had the international 
border, we had the navy, we had the aircraft carriers, we had a 
lot of Indians, and we had a lot of problems. So in a sense we 
were a lot more sophisticated coming from there where they had 
big problems all the time. Contra Costa was kind of a suburban 
bedroom community then. There weren't the big office buildings 
that are out there now. 

There was the strip of heavy industry all along the 
waterfront. That was something we really hadn't dealt with in 
San Diego. Heavy industry really called the shots, you know, 
very much so because they were staggered along the waterfront 
and they were in almost every supervisor's district with one 
exception. Industry had plenty to say and had something to do 
with how the supervisors voted. 

How did you begin in Contra Costa? 

We were welcomed in Contra Costa by a lady with whom we also 
became close, who is now in her mid-eighties. She was a very 
regal-appearing person with a wonderful hair-do, a good robust 
figure, and well dressed, a smart person. Then she was in her 
forties, and she was the president of the Tuberculosis 
Association. It was the big voluntary health agency. They 
decided since they had such a terrible health department and 
they didthey were going to do something about the new era. 

She didn't know me from the man in the moon, but she 
undertook to have a welcoming party for the new health officer. 
It was held in the C & H Auditorium, Californian and Hawaiian 
sugar, in Crockett. There were hundreds of people there and 
everybody welcomed me and my wife, like we were closest of 
buddies. That's how we started. 



Crawford: Who was she? 



133 



Blum: Helen Vurek. She worked in the post office in Orinda, and knew 
everybody that lived in Orinda because she was the mail person 
there. Her husband George was an artist, but during the 
Depression he turned into a pattern maker, which takes good 
artistic skills. He had a big pattern-making shop in San 
Francisco--the kind that builds propellers for ships and in 
his spare time did art things. He was that kind of person who 
could do things accurately to the nearest thousandth of an inch 
if it was needed, but beautifully, toobeautiful work. So 
they had a good, basic business. They weren't rich, just 
basically well off. They had a son who was just starting 
Caltech to be an engineer. He's already retired. 

We were suddenly part of their circle. They were amongst 
the most gregarious people that I ever met. They were liberal 
people, well read, even though neither had been to college. 
They knew more than most college people that I knew; they were 
just up on their toes. They went to something every night: a 
lecture, a play, an opera, a concert. We never could keep up 
with them. They've been everyplace in the world. In fact, we 
just had dinner with Helen a night ago; George died about two 
years ago. 

So we were thrust into a kind of a ready-built group, and 
most of them were similar kinds of people. A Supreme Court 
judge, Ray Peters, was one of their old intimates, a wonderful 
man. I don't know if you ever heard of him, but he was one of 
California's great Supreme Court judges. Right away, we 
started meeting all these people. These are your friends, you 
see. That was kind of fun because I think we could have met 
these people only very, very slowly, if ever. They were not 
just Contra Costans. They were in San Francisco and the 
Peninsula. They were in Marin. Their folks or friends were 
scattered all over--it was a big family. 

Crawford: But that meant the community valued you and the position you 
were taking? 

Blum: Yes. It completely changed the flavor. The previous health 

officer never moved a finger. I'll never forget the first day 
I came to the office, and here's the director of nurses, who 
was a great galpowerful, big Minnesota lady and she had her 
feet up on my desk she denies that it was true but I remember 
it. It's just like she lived there, and she did, too. She ran 
the health department for the previous guy. There wouldn't 
have been a health department if it hadn't been for her. 

Crawford: What was his name? 



134 



Blum: I don't even remember. The director of nurses tells me, "We've 
got a big clinic tomorrow morning, and you have to give shots." 
That was the way it was set up--you give the shots, and they 
prepare everybody, and move them along. So I said, "What do we 
use for needles?" "Well, in your desk, there are three 
platinum needles. And that's the extent of the stock here, and 
three syringes to go with it." They were going to do a clinic 
of five hundred people. I was kind of baffled; I'd never seen 
anything like this. She said, "Well, that's the reason they're 
platinum." It's that you can put them in a flame and it 
doesn't hurt the needles. They stay sharp. This was 
sterilizing. You go from one person to the next. Well, that 
isn't safe sterilization because there's often pull-back into a 
syringe, and you can get some blood or a little plasma from one 
person and you can spread it to a thousand more by using the 
same syringe. Really, it's horrible. 

So I kind of shuddered, and I proceeded. We went to the 
clinic, and I got them to take along a few ordinary needles 
that could be boiled and sterilized on the spot, although 
boiling is hell on their sharpness. I didn't wait too long 
until I completely destroyed those three needles. They're very 
delicate, and they kind of crumpled up in my clumsy hands. So 
we got rid of the three needles. We didn't ever replace those. 
In the next day we bought a couple thousand needles and 
syringes, starting to do business. At least you could breathe. 
The disposables didn't come in for another five years. 



Expanding the Budget and the Department: Testing for TB 



Crawford: What was your budget like? 

Blum: Oh, it was almost zilch. I don't know. It was pennies. It 

was pitiful. It went up spectacularly the first year. One of 
my selection examiners, who had been the county auditor, had at 
this point become the county manager, Desmond Teeter by name, 
and was now my immediate boss. There were about twenty 
candidates for the job, and since he had selected me, I had a 
buddy in the right spot. He was a nice man, a lovely man, and 
inadvertently he gave rise to this medical school at UCB--quite 
inadvertentlybecause of various things that happened out 
there. What a small world this is. He kept going to the board 
on my behalf. I got there February the first, and the budget 
had to go in in March or April. In those days, a county like 
that finished with the budget in July or August. Our health 



135 



department budget went up severalfold over the year. Billy 
Buchanan, our board chair, had a heart attack and died. 

Crawford: No! 

Blum: No. I can't blame it on the budget, but I can't be sure about 
that. But it surely happened. And in this turmoil, and with 
the auditor becoming the administrator and really running the 
county, my boss was this kindly older man. The TB Association 
wanted to do a TB survey of the citizenry as soon as I got 
there. Chest x-ray surveys were very popular then. Everybody 
got a chest x-ray. I had just been in charge of the one in 
San Diego, and, lo and behold, the people here were clamoring 
for one. 

So I got the same team from the USPHS that we had in San 
Diego to help run it. I got the same crew and one extra. That 
was Leonard Duhl. He and another doctor were sent here by 
USPHS to read the x-rays. That's how 1 met Len Duhl. The 
survey went so easy and fast that he would spend most of his 
time working and doing general public health, not just reading 
x-rays. He was here for two years. So we spent a lot of time 
together, learning about public health. He was totally free 
wheeling, so he could find all kinds of problems and approaches 
to them. 



Blum: All of a sudden, this TB thing had landed on us and we x-rayed 
every adult, and it's a tremendous and very visible campaign. 

Crawford: Where does that mandate come from? 

Blum: From the U.S. Public Health Service, but to get it meant that 
California had asked for it, and the county asked for it. I 
thought it hadn't been too productive in San Diego. If the 
citizenry are not too poor, and reasonably well-off one is not 
going to find much TB that way. TB is going to be in people in 
your jails, and in your slums. There were some bad, poor 
neighborhoods in Contra Costa, especially Richmond and 
Pittsburg--some really ghetto areas. We did those, and a lot 
more, to see what we'd learn. We learned a lot of things about 
our citizenry, their awareness, their health, their medical 
care, and what they thought of county health services. 

But I also thought this would double the size of the health 
department, which was miserable, and it did. So even though 
the money was put up as temporary, somehow it never left our 
budget. Our budget just skyrocketed because of the doubling of 



136 



staff. Of course, that earned me the ill will of the 
taxpayers' association, and that was kind of an unpleasant 
aspect of our department coming of age. 

In the course of a couple of years, our budget kept 
doubling. The nursing budget brought in all the schools. 
There were "only" thirty-four school districts in Contra Costa 
County. They hadn't amalgamated yet, and the county was full 
of parents, full of kids, and everything seems to be run by the 
PTA. What the unions and industry didn't run, the PTA did. So 
we dealt with the school districts, and their PTAs, and they 
wanted school nurses. I thought that through for a while that 
would double our nursing staff again, maybe triple it. 

Crawford: Schools had no nurses then? 

Blum: Some schools had a lot of nurses. They wanted us to take over 
their nurses, and the ones that didn't have any wanted us to 
provide them. I thought, "Now this is kind of dumb. We will 
have the biggest empire in this county in short order. We will 
be a target forever more they 're not used to spending this 
kind of money on the health department." So we developed a 
philosophy--Dr. Yoshiye Togasaki and I, with a few others. 

We developed the philosophy that it would be better if 
other organizations had the huge payrolls and the huge budgets, 
and we would give them professional or expert direction. We 
struck up a dealand the county board wasn't disapproving- -we 
would hire another assistant health officer to be in charge of 
the school work, another to lead the children's dental program, 
and the schools would hire the nurses. If the school district 
couldn't afford nurses, we'd put in a minimum of nursing time, 
but that's all. We'd provide the medical consultation, the 
dental program (which was rather elaborate), and we would do 
the things they couldn't do- -we would provide the technical 
leadership for their health program. 

That turned out to be wise because if our budget had kept 
expanding endlessly, we were going to be the perfect target for 
all kinds of interests. Moreover, we would probably not get 
the cooperation from the schools if they were faced with using 
services directed by outsiders. They were marvelous. We had 
no end of cooperation, but we gave them preventive medical, 
dental, other kinds of services. If they had health problems, 
we'd get there right now to take care of them. And they had 
problems a-plenty, so we made lots of supporters for the health 
department. 

Crawford: How was your budget allocated? 



137 



Blum: We presented it first to the administrator; then the 

administrator worked it over and it was presented to the board 
of supervisors. But I personally presented it to the board as 
health officer. 

Crawford: Generally speaking, what needed to be done? 

Blum: Oh, well, everything. We didn't even have a laboratory. When 
I took the job, the state health department said, "This is the 
worst health department in the state. So take it easy." My 
logic was, "No. If we take it easy, that is what we'll have-- 
the worst health department in the state forevermore . " Then 
those things that I just described fortuitously happened. The 
Tuberculosis Association offered all their big-wheel support, 
and then the PTAs . These are the folks that make up the grand 
jury and all the community organizations, and are the voters 
who vote. 

Then the PTA asked me to make a few talks here and there, 
and I did. The next thing you know I had an honorary badge, 
and pretty soon the PTA will come and testify about what they 
need, and what their kids need. Then you have the health lobby 
all built, if you're willing to use it. Most health officers 
were not, apparently, afraid that they would have to pay 
something back. But PTAs, Leagues of Women Voters, and health 
associations don't want things for themselves; they want good 
health for everyone, and that is truly easy to live with. 

As I indicated, we didn't need everything in our program. 
The board tried to give us the dog pound, and we said, "No way. 
We're not taking the dog pound." I offered to quit if they 
gave us the dog pound. I said, "There are people who can and 
have run the dog pound. It's either public works or the 
sheriff's department where there are trucks, communications. 
That's not a health department job." What was worth our time 
was helping the school nurses, and guiding the uses of the huge 
amount of money spent on various school budgets. The school 
nurse is tremendously important. In those days, they were not 
just the doers, they were the teachers, too. They taught the 
teachers about health matters, organized the school health 
programs. You could get health services and observation in the 
schools through the nurses that you couldn't get in any other 
way. Some of their nurses were ex-nurses from our service. If 
the schools would pay more, our nurses would go there. They 
did, and it didn't hurt us as they got employees who knew what 
good programs were. It also helped raise the salaries of our 
nurses . 



138 



Signing Off on Septic Problems 



Blum: There were many, many interesting problems of many different 

sizes. One day early in my career, the district attorney came 
in (he was really a characterultimately became a state 
senator) and said, "Here, I want you to sign these papers." I 
said, "I don't know what they are." It was to the effect that 
I was supposed to vouch for the fact that this, that, and the 
other thing is getting done in a subdivision. "I don't even 
know where the subdivision is." He said, "Well, that's all 
right. Your predecessor never worried about that. He just 
signed. Now, here, sign them." Well, I'm not signing a thing 
if I don't know what I'm signing. 

The district attorney is a powerful man, and so I suggested 
that maybe he spend a little time with us, telling us what it 
was all about. If we signed, we were testifying that the 
subdivision could get rid of sewage, had safe water, and a few 
other things. I said, "How do I know what the sewage disposal 
is like?" "Well, it's got all septic tanks, and the building 
department's inspected it. The building department signed off, 
but their signature doesn't count. It has to be the health 
officer's." On quizzing our own sanitary inspectors, it was 
their impression that the septic tanks wouldn't last more than 
a month or two or three, and then the sewage would be out in 
the neighborhood. I told him, "If you think I'm going to sign 
this, you're crazy." 

About ten minutes later, the chairman of the board of 
supervisors, who was a nice guy--an electrical contractor named 
Jack Cummings-- comes in. He's a great, big, handsome fellow. 
He said, "Doc, I hear you won't pass this subdivision. You've 
got to sign these. My god," he said, "A couple of us have a 
quarter million dollars in it." He said, "That's the kind of 
money they owe us for the work we did there." He had nothing 
to do with the septic tanks and he was the chairman of the 
board of supervisors. 

I said, "Well, Mr. Cummings," I got to know him as Jack, 
ultimately, "if I sign, there's going to be nothing but 
trouble." I said, "We've been thinking about it. If we open 
up a couple of septic tankswe'll let them open them up and 
if they look like they'll work, we'll let the subdivision go. 
But I'm never signing another one because I don't think any of 
these will work from what I've heard, even though it's been 
inspected and cleared by the building department." 



139 



He said, "Well, what would you have to have?" I said, "We 
have to have a new ordinance, we've got to have the manpower to 
inspect, and contractors have got to meet certain standards." 
They're well-known, basic standards. Everybody else is using 
them. In a way, this was blackmail. Another member of the 
board was the real estate agent for the subdivision. He was 
another nice guy. These were kind of fun people, but this had 
been going on forever, and the health officer had been the 
stooge who allowed it to happen. 

So I passed the word: "I want to see three septic tanks"-- 
there were probably thirty--"in different places in that 
subdivision. Open up any ones you want. If you think there's 
a good one out there, we'd be glad to see it." 

So they opened up three septic tanks. They were all 
disasters, all of them. They were made out of redwood bark, 
not woodthey used to get big slabs of bark from big redwood 
trees. They were about six feet long and two inches thick, six 
or eight inches wide. The builder put one nail in at each end, 
put a little tar paper over it--not even wood, you know, just 
bark. They had scooped out a hole with a clam shell. Then 
they put this box down, brought up some terra cotta piping to 
it from the house, and some more from the tank to make up the 
drain field, and used a caterpillar to push the dirt back in 
around it, and it was done. Our inspectors, who had not had 
anything to do with the inspection but who couldn't resist 
watching because they knew they would be called in as soon as 
the septic tanks failed, said the tanks would almost for sure 
be collapsed because the cat had gone over them while pushing 
the dirt around, and the pipes were being broken and 
disconnected. This "tank" would hold sewage for a week, a 
month, two or three months, and then it's over. There's no 
septic tank there. 

I had told the contractor that I didn't want them to fix 
anything, that I wanted to come out and see the tanks as they 
were exposed. I get out there, and here's one that has all new 
pipes and fresh cement. It was still a disaster, and this guy 
said, "Oh, it's them goddamned niggers that work for us. They 
just do these things." Really "nice" people. So we suggested 
that they dig up a few more and fix them all, and shape them 
up. We approved the subdivision on the understanding that the 
board was providing a new ordinance, that we doubled our 
sanitation crew and started life anew with a suitable permit 
and inspection program. Over my desk, for all the years I was 
there, was this great big piece of bark that came from one of 
those septic tanks. I also learned, though, that when we had 
trouble in these situations, I could not take colored pictures 



140 



with my camera, because even sewage looks good in a colored 
picture. So we turned to taking black and white pictures for 
evidence. [laughs] 



The County Hospital and George Degnan 



Blum: The county hospital was totally separate from the health 

department. That was run by a master politician and super 

surgeon, George Degnan. A tremendous fellow. He was the chief 

surgeon, and chief doctor, and chief everything. He was 
actually a fabulous surgeon. 

Crawford: Talk about him--I believe he was medical director from about 
1948 to 1980? 



Blum: Oh, he was a handsome, great, big guy--a woman's dream of a 

chunk of man. Women were always tagging after him. He was a 
star football player here at Cal in his earlier years. 

Crawford: He was a local person, wasn't he? 

Blum: He grew up in Richmond, I think. He was a fine athlete, and a 
marvelous doctor. I was impressed, because at the county 
hospital, I undertook to make the rounds on the contagious 
disease ward. They didn't have any expert on that and they had 
done some stupid things as a result. So I did that because I'd 
done a lot of it in San Diego, and I saw a lot of George and 
his work as a result. 

Crawford: Was that part of your role? 

Blum: No, but everybody would be happy if I did become the visiting 
M.D. on the infectious disease ward. I had a good time there, 
and saw all kinds of interesting cases. We got contagious 
disease cases from Solano County, and we saw a fair variety of 
contagious diseases. The ward served the contagious disease 
needs of the 300,000 persons in the county at that time. 

Crawford: Was that where services to the poor were delivered? 

Blum: Yes, but everybody with contagious diseases also, because other 
hospitals didn't want to fool around with them. They were too 
expensive, too tricky, and if the disease spread in the 
hospital, it would be a true disaster for them. 



141 



George was a magnificent character. He was a strong labor 
man. He had ties to the unions that even an episode of 
scabbing couldn't kill. George actually could tell the board 
of supervisors what was going to happen because the unions had 
the votes. One supervising district was controlled by farmers, 
but unions ran the rest of them. Even though the big oil 
companies and the chemical companies had a lot to say, the 
truth of the matter was that their unions often had more to 
say, since it was their members who voted, and they often 
agreed. So it wasn't all that hard to get what they wanted. 
George had the union vote. I had the PTA vote, which was 
growing more powerful each year as the county became a major 
bedroom suburb of the Bay Area. 

Crawford: Were you opposed to each other? 

Blum: Yes, you see, he would influence the budget one way, and I 

would tend to influence it another way. We would draw from the 
same basic pool of funds for competing purposes. 

Crawford: Oh, his budget was a generalized medical budget? 

Blum: His was a big county hospital budget, while ours had little for 
medical care as such. They also did the tuberculosis patient 
care, and did a terrible job as far as we were concerned. We 
finally forced the issue and then he put his chief assistant on 
the job--a physician by the name of Louis Girtman--and Louie 
was another marvelous person. He came out of the Ozarks, and 
he didn't care to work with rich people. He loved poor people. 
He could empathize with them. He worked all his life with poor 
peoplehe worked day and night at that county hospital. Louie 
took over the TB program and paid attention to what we believed 
had to be done, and they started doing a good job. 

We were always crossing paths. We had the contagious 
disease people in common, and we were responsible for them, but 
they took care of them. We were responsible for TB, but they 
took care of the TB patients. They were responsible for rehab, 
but we ran the crippled children's program. We even built a 
rehab unit there at the county hospital. We found money for 
this and money for that, and if we could create anything for 
the county hospital, it was great by them. We created a 
building in Richmond, I got the money for it because of the way 
funding was arranged for; the county hospital used most of it. 
I was on the governor's hospital council which made all the 
decisions on the awards of Hill-Burton Act funding. We created 
a building in Pittsburg, and the county hospital used most of 
it. It was an odd sort of competition. We wanted the same 
things done, but they were usually at a different part of the 



142 



ball game than we were. So we were always competing, and 
George had more influence, so we had to work harder. 

Crawford: Where did he get the influence? 

Blum: Labor. You see, even the merit board in civil service that 

would set salaries was run by labor, and George had the civil 
service board at his beck and call, but not the civil service 
department employees. We both hated the civil service 
department employees. They always kept telling us what we 
wanted, and they didn't know anything about health. So we 
could sort of commiserate. 

But when we'd get there for negotiations, we'd sort of be 
pulling apart for other reasons. For instance, he wanted to 
pay his nurses more than we wanted to pay ours. Well, ours 
were all better trained. Ours all had an extra degree. But 
we kept up a fairly friendly exchange. He was at our house for 
dinner, and he'd take us out. He was, at that time, a 
bachelor; although he shortly had a wife and children. He may 
have had another child from a first marriage to a very 
prominent San Francisco socialite. 

Crawford: I know June Degnan. 

Blum: June. That was his first wife. I don't know for sure if they 
had children or not, but I knew the second wife. They had a 
couple of kids who are now doctors. I never did meet June, but 
we saw George a lot of times. We'd go here and there to dinner 
together. We really wanted the same things for the same kind 
of people. We had the same general approach to life. But he 
was a surgeon, and I was a public health officer--! mean, we 
were getting to heaven through different worlds. 

Crawford: What was the practical basis of the difference? 

Blum: The difference wasn't so much about what we wanted, but he 

wasn't fussy about how he got things. I was very, very queasy 
about getting things in what I saw as underhanded ways. 

Crawford: By means of labor tactics? 

Blum: Yes, just across the board. I remember one night we were at 
our house, and he was saying, "With the politicking you're 
doing...." I'd just won something away from him, you see. 
"You know, this is terrible," he said, "You go around kissing 
babies and all this PTA stuff." [laughs] Well, you just had 
to laugh, you know, because that's how he saw it. Here I was 
"playing the women's side of the street," and he was playing 



1A3 



the men's side of the street, all those tough labor guys. Yet 
we pretty well pulled together over the years. We got some 
really good programs going between us. 

Crawford: That's where the first county-run HMO came out of, wasn't it? 
Blum: It came out of his bailiwick. 
Crawford: Were you involved with that? 

Blum: Not really. I'd give it moral support, but it was not ours to 
organize. He had dreams that we'd have universal coverage one 
of these days, and he wanted to work his people into a system 
where it would work that way. When he was allowed to replace 
the hospital there, he built a temporary hospitalone that was 
only going to last twenty or thirty yearsbecause county 
hospitals would be past history, and there would be no more 
county hospitals when there would be universal coverage. He 
was very alert, and his heart was in the right place, but his 
timing, as well as mine and everyone else's, was off by a half- 
century or more. There's still no universal coverage in sight. 

Crawford: He thought everything would be universal coverage. What was 

coverage like back then? I guess we're talking about the early 
fifties. 

Blum: You got insurance with some jobs, but a lot of people didn't 

have that kind of a job. Almost nobody could ever afford their 

own private insurance. Nobody had it. Not for health care. 
It was a dilemma. 

Crawford: Was that at all unethical to build a hospital for twenty years, 
with built-in obsolescence? 

Blum: Oh, no. It was wise. Everybody else was building monuments, 
and here's George saying, "Okay, we don't need a monument. It 
will be gone. We won't need it." This is the head of the 
county hospital saying we don't want a county hospital. 

Crawford: Did the two of you reinforce each other in the community? 

Blum: In a sense, yes. Yes. I mean, we were constantly friendly 

enemies or friendly competitors, or something. I remember when 
the Easter Seal Society came around and wanted us to do 
something. They were going to put on a big campaign, and the 
campaign was to state that our county health department had the 
best crippled children's service in the state. Well, it 
probably did, but that's nothing to put into a campaign which 
is going to tell my board that their health department is the 



Crawford; 
Blum: 

Crawford: 
Blum: 



best in the world therefore it won't deserve any significant 
new funding. I mean, one just can't say stupid things like 
that. 

George was at the meeting. It was in my office, I 
remember, he was this big handsome guy, and he was listening to 
these ladies who were driving me nuts. They just could not be 
talked out of it. I said, "Look here, it's our county, and 
you're coming from San Francisco and are telling me how to play 
ball here. We'll get you whatever you want, because we want 
the same things, but don't come out with this kind of 
propaganda, like it's the best program in the world. It's 
insane." They just couldn't hear me. So I got up and walked 
out, slammed my own door, and left. George, they tell me 
afterwards, turned to look at these people and he hadn't said 
a thing all this time and he said, "Well, I think that settles 
that, doesn't it, ladies?" He was a good ball player, a good 
card player, a good poker player, and it worked. They came 
around and did what we wanted. It all worked out very well our 
way without our telling the world we had the best health 
department. If you do something like that, you're crazy. 

We worked together all the time. We got in the mental 
health program. We got a huge program. 

You got a huge one for his hospital? 

Well, for the county. It included the hospital's needs. But 
the only way we were going to get it decently done was to let 
him run it. So we did. 

Was it a good mental health program? 

It was super, the only one of its kind. In its day, it was a 
very fascinating thing. We hired psychiatrists to come in and 
work with human service departments once a week so much time 
spent with department heads, then some more time with people in 
charge of the mental health aspects of their programs. The 
partners included the school districts, junior college, 
hospital, health department, police departments, sheriff's 
department, probation, and welfare. We even taught cops how to 
bring deranged and violent persons into custody without having 
to knock their brains out. "You don't have to subdue violent 
people with violence. There are many ways of doing this, even 
if persons are violent when you come to get them." We did all 
sorts of thingsadvised judges. It was a tremendous mental 
health program. It was a kind of "trickle-down" business. 



145 



Crawford: 
Blum: 



Crawford: 
Blum: 



There were no psychiatrists in Contra Costa County when I 
came there, and by means of this program we got outstanding 
psychiatrists to give the key departments a way to proceed. 
The next thing you know, every department had a mental health 
trained person as each hired folks that had Ph.D.'s or M.D.'s 
or some degree in mental health, and they advised the various 
human service workers, teachers, police how to better deal with 
mental illness or emotional problems in their own department. 
George finally got some psychiatrists at the county hospital. 
All of a sudden, we had a program that really trickled down all 
the way to the thousands of people who needed help. 

The next thing you know, Contra Costa was a bonanza for 
psychiatrists. I never was sure we did the right thing, 
because everybody who could not be cared for by our 
intermediate-level workers was being referred to psychiatrists. 
But the county's program was relatively low-cost. Of course, 
we still had to hospitalize the serious mental health cases in 
the county hospital. That was George's real leg to stand on, 
and they indeed had a very interesting service there. They did 
all kinds of good things. Well, the overall program went to 
George for administration, and nobody fought it. We had all 
fought together to get him the money so he could do it. The 
same psychiatrist who headed it up in the fifties is still 
there . 

The county hospital was in Martinez? 

In Martinez. It's still there. Now it's being rebuilt. The 
old monster had to be torn down. The new one's going up. It's 
a highrise, and there's a great question whether it's needed 
now. That wasn't his fault. 

The community wanted that? 

Well, it was a huge battle because organized medicine and the 
other hospitals didn't want it to be rebuilt. The county 
pointed out that it had to take care of the people the other 
hospitals didn't want. "Oh, we'll take them, we'll take them," 
was their response. But before it was all through, they didn't 
want the criminals, they didn't want contagious disease, and 
they didn't want this, and they didn't want that. 

So all the tough cases were going to be left for the county 
hospital. That means the county hospital had to have a 
pharmacy and surgery and x-ray and all those social services. 
So the county still had to create all the expensive parts of 
the hospital, for just a few special and very expensive kinds 
of clients. 



146 



Crawford: Did he want them to be treated in their own communities? 

Blum: Oh, George was gone already. George had retired, but he 

continued to fight against the new hospital. He thought it 
ought to be disposed of, once and for all. That's what he died 
over, supposedly. He was in his eighties, still fighting. 
Didn't think a new hospital should be built just for the poor 
and a few special categories of patients, that the poor could 
just as well be served where everybody else went. But the 
private facilities wouldn't play ball as late as 1995, and the 
board of supervisors had no choice since they have the legal 
responsibility to cover those with no other source of care- 
best known as the county "safety net". 

Crawford: So that must have been a major frustration for Degnan? 

Blum: Yes, his big dream--and mine toothat we wouldn't need things 
like county hospitals. Who the hell needs them, really? Just 
another set of facilities for everyone to pay for. 

Crawford: It's discrimination. 

Blum: Of course it is, and a terrible waste of money, full in hard 
times, empty in good times, just the reverse of the other 
hospitals . 

Crawford: What other major problems did you confront initially? 



Sanitation Problems and County Restaurants 



Blum: Well, on the other side the sanitation side there were other 
messes like those with the septic tanks. Food sanitation was a 
terrible thing. 

Crawford: You touched on that; said you closed down scores of places. 
You weren't very popular. 

Blum: Oh, hundreds, literally hundreds. I remember going as one of 
the honored guests to the annual banquet of the food 
distributors in Jack London Square. All the health officers in 
the East Bay were invited, and there were quite a few of them 
at that time. I remember that they had this lady from Broadway 
and ColumbusCarol Doda. With the tremendous superstructure. 
She was the entertainment and she was going to introduce us. 
[ laughter] 



147 



Oh, well, this is not a highly cultured crowdthe food 
distributors, liquor distributors, and tobacco distributors. 
But these are all the real folks that count. When they 
introduced us, and my name came up, you never heard such a 
booing in all your life. [laughter] I thought, "Boy, I'm not 
even safe here." 

Crawford: Well, what did you expect? 

Blum: Well, I thought they'd be civil. [laughter] So, then, we had 
Carol Doda, and they didn't treat her like that. She danced on 
the table tops. So that was my standing. It was pretty good, 
in one sense. At least they knew we were there. We had closed 
hundreds of unsafe places. 

Crawford: What did you find? 
Blum: Filthy operations. 
Crawford: No health standards whatsoever? 

Blum: No, yet we had inspectors college trained, most of them but 

business is business, and if the boss doesn't insist on it, the 
inspectors go along with the operators. For instance, San 
Francisco was a scandal. Its food places always were. 

Crawford: And it is still? 

Blum: Of course. I'll never forget, I took somebody out to dinner at 
a fancy place down on Maiden Lane with a French name. It used 
to be out on Geary Street. 

Crawford: Is that the Fleur de Lys? 

Blum: No, no. Not that one. This is another one. Any event, it was 
very ritzy and expensive, and here comes the butter dish, and 
out from behind the butter cubes comes the biggest cockroaches 
you've ever seen. [laughter] Things to admire, like in the 
tropics. And these were just little old cockroaches grown to 
giant size! 

Well, San Francisco always had filthy food handling places. 
I remember I used to eat in the New Pisa. One night my wife 
was in the city. I was coming from the airport, and we invited 
one of my assistant health officers to dinner there in the New 
Pisa. He'd never been there. We met there, and they had very 
good food. I mean, they really had good food. They knew how 
to make raviolis. You can't get them like that anymore. Well, 
he was in the men's room to wash his hands, and he comes back 



148 



and he says, "Say, Boss, would a place like this be allowed to 
be open in Contra Costa County?" I said, "No, not by any 
stretch of the imagination." [laughter] That was not the 
worst in San Francisco, but their men's room was something else 
again, and their ladies' room wasn't any better. The new New 
Pisa is okay. 

Contra Costa had been like that. I had a dear auntie who 
came out to spend a few weeks with us in the fifties, and 1 
asked the inspectors, "Where's a good place to take my aunt?" 
I knew the San Francisco restaurants, but then you have to go 
back and forth to the city. They said, "Well, to tell you the 
truth, there's only two clean ones. There's a third one, 
sometimes." This is in all of Contra Costa County. I said, 
"You've got to be kidding." They said, "No, no. Cape Cod 
Housethat ' s good. That's how a restaurant ought to be run." 
Then there's this little place I'd never heard of--this Italian 
place in Pittsburg. They said that was a really nice and 
clean place. So I decided to start visiting restaurants myself 
at night, after work. I'd start out sometime around four or 
so, and inspect half a dozen, even a dozen places in an 
evening. 

it 

Blum: Once at a San Pablo restaurant early in my career as a health 

officer, another aspect of law enforcement came to my attention 
rather abruptly. A Chinese inspector, one of two Asians in a 
team of fifteen, called to say that an irate cafe operator had 
driven him out, saying that "no Chink was going to tell him 
what to do." What should we do next, the inspector wanted to 
know. 

This seemed like a good educational opportunity, so I asked 
him to get me the phone number of the cafe. I made a call to 
the operator, telling him who I was, and that we had no 
intention of making him accept any one inspector, and that I 
would be happy to inspect his place myself the very next 
morning. 

This would give him time to clean up, but the place was so 
bad that it probably wouldn't look a lot different the next 
day. I came in quite cordially, repeated my friendly offer of 
doing the inspection myself, took out the rating sheet that we 
always used, and went to work. I interpreted the ratings quite 
literally, and the operator got sicker and sicker, assured me 
that he loved Joe, couldn't Joe come back and they would get 
the corrections done in jig time. 



149 



Joe told me that he never had a more cooperative operator, 
and that they got along fine after that. 

I guess the method was not to back down if we were right, 
but to try another tack and not attack frontally, such as 
shutting the place down, which we had the authority to do. 

The matter of law enforcement remained a fascinating area-- 
a kind of battleground between ethics and the presumably 
justified exercise of power. One incident that I find hard to 
forget is St. Mary's College in Moraga. Their students and the 
faculty ate their meals there. As part of our routine 
inspections, we gave them a Catholic inspector who had a hard 
time educating them up to standards. The food service was 
leased out to a major so-called first-class operator, but the 
plant itself was decaying and impossible to maintain. It 
finally got too bad and we gave them a notice of forthcoming 
closure if repairs weren't underway in two weeks. 

The senior Brother Albert in charge (there were two 
Brothers Albert, and the senior one seemed to fancy himself as 
a direct emissary of God) called me to tell me that he was 
going to have ray job, four county supervisors being Catholic, 
the fifth in a Catholic district, and the county manager was 
also a Catholic. 

I didn't object to his approach but explained that there 
would be an official closure (if there wasn't compliance) and 
that anyone violating the closure would be served with a 
warrant for arrest. At this point some 200-plus students came 
down with food poisoning and we closed the food facility on the 
spot, a week or so ahead of the threatened date. 

I never did know if Brother Albert also got the crud as 
extra punishment. I suspect not, because he went skiing at 
this point, and on the way home drove into a tree and killed 
himself. I always hoped that we were not a contributing 
factor, rather that the Good Lord's way simply took place, 
solving all Brother Albert's problems and one of mine. 

II 

Blum: There were many kinds of things in the sanitation field. I 
mentioned that I had a wonderful sanitarian who was born and 
raised in the Ozarks, who'd gotten his training during the war 
in the navy. Bill Martin. I don't know if he's alive now, or 
not. He became the head of the sanitation program in another 
county when he retired from Contra Costa. He could see the 
unfairness of a lot of these things. It bothered him. He was 



150 



just an unsophisticated person who hadn't been educated to 
overlook the real problems. He had enough education to carry 
out the law and do it well, and as I told you, we were fairly 
tough about enforcing the food laws. 

Crawford: That's what you said. You got booed at the annual banquet. 

Blum: Yes, well. I don't know if I told you about this or not, but 

Bill led me out to a little place that he was going to clean up 
in north Richmond- -a black community --where one way or another 
you'd say, just as you did in any other community, "Do this, do 
that, and if you don't do it in so many days or weeks, we'll 
close your store." That's itvery simple, very fast, very 
direct, very legal. Well, he said, "Boss, I want you to see 
this see how you feel about it." Having presided at the 
closure of a Safeway and a lot of other stores, he had a good 
idea of what we did for businesses that wouldn't stay clean. 

Here was a little old shack; it was kind of cute. It had 
all new roofing on the outside- -the fireproof kind. You 
couldn't really complain, you just weren't used to seeing 
roofing on the wall. I got inside, and here was a brand new 
floora maple floor and it had funny little white bands here 
and there. I asked what kind of floor it was, and he said, 
"It's an old basketball court I found." Those were the little 
white marks. [laughter] Well, they put it all in just so, and 
then the shelves were all painted white. There was a little 
stack of groceries on this shelf, and a little stack on that 
one. 

The owners couldn't afford anything. It was a little 
neighborhood store, and it probably fed them at wholesale 
prices, but they were there, serving their immediate community. 
Then he had a stainless steel sink, and I said, "Bill, how did 
you ever get that?" He said, [drops his voice, so is almost 
inaudible] "I saw it out in a wrecking yard and they got it for 
a couple of bucks." He said, "How do you feel about all of 
these changes?" I said, "Wonderful. It's fabulous." He said, 
"Well, that's what I was thinking. They couldn't do this by 
themselves, but with a little help, they could. Otherwise, 
we'd close them and send customers to Safeway up the street." 

That was Bill's way of doing the job without following the 
steps laid out in the food ordinance. He got them to achieve 
the sanitary results called for in the law. In other words, he 
was coming out with the results that the law intended. 

Crawford: He didn't like to see them closed up? 



151 



Blum: He didn't like to see people hurt. His education hadn't 

overcome his good sense. He did many such things. He cleaned 
up the city of San Pablo. We knew it was a death trap in many 
places. There were rubbish piles, rodents, big piles of 
lumber. Many of the people who came in for the war effort 
could barely afford a packing box for a house. 

Crawford: San Pablo was worse than Richmond? 

Blum: Oh, yes. Richmond had pretty good standards. Richmond had 
poor people, but everything was done according to the book. 
There was a health officer therean independent one and 
ultimately we absorbed that department. He was good. He got 
good support. It was a strong labor town, so there wasn't too 
much trouble targeting for reasonably safe housing and streets, 
public services. 

San Pablo was a whole other story; that was the home of 
gambling and prostitution; it was a rough little neighborhood. 
The mayor of San Pablo owned a restaurant, and it was filthy, 
vile. I remember going down there because we were going to 
close him. He wouldn't correct it. There were mouse droppings 
all over everything. He was a belligerent gorilla, and I said 
to him, "Look, here's mouse droppings. What the hell more do 
you want?" He said, "Prove to me that they cause illness." I 
said, "I don't have to prove a goddamned thing to you, mouse 
droppings aren't tolerable." 

Well, he didn't take us to court, but he might have. He 
was that kind of a guy. He was also president of the hospital 
district-- just everything. He was a real political animal. To 
clean up San Pablo, you weren't going to get much support from 
people like that, at that point. Well, we simply used our 
basic authority, since I was the health officer for the city, 
too. 



Blum: One last episode about food sanitation. There was a two-story 
Safeway in El Cerrito that had a bad manager. Although we had 
closed a store from every other food chain at one time or 
another, Safeway was well above the average and fixed any 
violations as soon as we spotted them. This store ended up 
with a burst sewer on the lower floor, and people were getting 
their milk, vegetables, meat sloshing through this mess. The 
inspector gave them a day or two to get it repaired, came back 
and found it worse, if anything. He called me down--I couldn't 
believe my eyes--I would have given them two hours. 



152 



We found the manager and told him that he could put a 
closed sign on the door, and keep it closed until we let it 
open. If he didn't wish to do that, I would put up our sign, 
"Closed by order of the Health Officer." He squalled around 
and when I started to put up our sign and warned him that I 
would stand by and have him arrested if anyone were allowed in, 
he decided to be "closed for repairs." 

I got back to my office to an earful of protests. The CEO 
of Safeway, who lived a few houses from me, called to demand 
the store be reopened. And since that wasn't going to happen, 
would I hold the closure in abeyance until his chief lawyer got 
back from England where they were just opening up Safeway. 
This closure was a new experience for them and they were 
mortified and furious. 

When it settled down that we meant business, they offered 

to sue and I told them that that was their prerogative under 

the law, and we wouldn't object, but we did have a lot of 

photographs of what was wrong, and that they might not like the 
protracted debate that would result. 

This resulted in a date for a luncheon the next day at the 
Safeway headquarters in Oakland, where I met my neighbor for 
the first time. We had a lovely lunch, they got the picture, 
and shortly thereafter they were back in business in an 
exemplary way. 

This event became well known for no one had ever dared 
close a Safeway. Some thirty years later, I was consulting for 
the Contra Costa Health Department on a rather tricky issue 
which involved about thirty prominent citizens. As the meeting 
got underway and I was introduced by the chair, who was 
currently involved in the new Orinda Vision Study from UCB and 
was most flattering. A husky female voice followed on in the 
pause in a well heard aside, "He's the guy who closed a 
Safeway." That was apparently a critical accolade regarding my 
credentials. 

1 should conclude the food sanitation concerns with a truly 
heartening tale. One stormy wintry night I was in bed in our 
Walnut Creek home with a good achy, fevered, old-fashioned flu. 
The doorbell rang at about eight-thirty coincident with some 
lightning and my wife peered out to see two huge men at the 
door. She cracked an adjacent window and asked what they 
wanted. They announced that they were the Burroughs brothers 
and had to talk to the health officer. She explained that I 
was ill and surely contagious as well, but that didn't bother 



153 



them. She cleared with me, brought two chairs into our 
bedroom, and led them in. 

I knew of these men because they ran the largest milking 
herd in California still in private hands, over 1,000 cows. 
They were located in the far eastern end of the county along 
the Sacramento River and sold their milk under the Cloverdale 
brand. 

Their problem was an odd one. Their longtime herd master 
had left a few years before and had just returned. He reported 
that there were a lot of cows with bloody urine, that there had 
been a drop in milk production and a rise in abortions. These 
were ominous findings. He had verified that there was no 
brucellosis and suspected some new-fangled disease whose name 
the brothers couldn't remember. Moreover, one of their 
milkhouse men had just died in the county hospital on the 
contagious disease ward, cause unknown. Their question: should 
they shut down the dairy that night and start dumping the milk 
until the problems were clarified, and any suspicion of milk- 
borne disease laid to rest? 

It so happened that I was in bed studying the latest on 
leptospirosis , a kind of new infectious threat to cattle that 
waded around in the heavily irrigated lush river valley 
pastures. I had also taken care of the man who had died on the 
isolation ward and had sent specimens to Holland for 
confirmation of our suspicions of leptospirosis, all of which 
were negative and his cause of death remained unknown. 

This was a predicament. The herd probably had 

leptospirosis, but my books didn't say whether it was spread to 
humans by cow's milk, nor whether it was clearly prevented by 
pasteurization of milk. This was now about nine o'clock, the 
men were overwhelmed that I was studying their problem, but I 
didn't have a secure answer to what could well be their 
voluntary bankruptcy if they shut down. The one world's 
authority available was K. F. Meyer, a Swiss veterinarian with 
an honorary M.D. who was head of the UCSF Hooper Foundation, a 
revered and world-famous scientist who had been one of Bill 
Reeves 's major mentors. I got him on the phone and in his 
inimitable style he said, "You haf no problem, pasteurization 
will keep the milk pure, let the dairy continue to operate." 
K. F. was a fearless man, the most knowledgeable person in the 
world on dozens of diseases, and perfectly happy to take the 
responsibility. The Burroughs brothers were obviously happy 
and then wanted to know when we could get going on their cattle 
disease problem. Since we had K. F.'s ear there was no doubt 
that we could get into it even though we had no lab of our own 



15A 



at that time. As an aside, oil and gas were shortly found on 
the Burroughs property, and I can't think of nicer people to 
whom that could have happened. 

K. F. Meyer helped me organize a meeting at the veterinary 
school at UC Davis and we had the State Departments of Health 
and Agriculture and the federal USPHS and Department of 
Agriculture. I presented the problem, twenty or thirty 
employees and family members whom I would bleed and test, and 
who would do the 1,000 cows? Nobody would, it seemed. Yet 
this was a critical new problem in California. I got disgusted 
and said that we would do it. A big bluff because we didn't 
even have a laboratory, let alone a fancy one to do relatively 
new and complex testing. That was too insulting for the high- 
level agencies to hear and resulted in a bidding war between 1 
them until all parts of the job were assigned and all I had 
left to do was drawing the blood of the people at the dairy. 
This problem was found to be a huge one for the cattle industry 
on wet pastures, but not a human problem. 

II 

Blum: We had been very active in setting up a poverty program to give 
folks a job doing useful labor, and Bill Martin got twenty or 
thirty of those people to work for the health department. He 
sat down with them and showed them how to fill out an 
inspection form as they were close to being illiterate. He 
took them to different lots, and told them what was wrong; 
showed them what to check on the form. He had a good touch 
with them; he was from Missouri or Arkansas, and these people 
were his kind of people from way back. 

He taught them how to do the inspections. We inspected 
every house in San Pablo, found all sorts of messes; everything 
was written down and all of them were cleaned up first time in 
history. Nobody believed it. We had hearings for the two 
people that held outthat didn't get their place cleaned up as 
scheduled. I sat there at my big desk, and Bill ushered the 
first one in. It was a lady- -very heavy and probably twenty, 
twenty-five, just had a baby. In the course of that she had 
dislocated an intervertebral disc and she had terrible sciatica 
pains. She came in with tears in her eyes --wouldn't we give 
her time to recover so that she could clean her place up? I 
said, "Well, sure," and gave her all the time she wanted. Bill 
found her some help. 

The next one was a man who had rheumatoid arthritis so 
badly he was scissor-gaited. I mean, his legs were actually 
crossing one in front of the other. His hips were gone; and he 
wasn't that old a man, but he was thin as a rail. He was a 



155 



critically ill man. He too asked for a few more weeks to clean 
up his yard. Well, as you think back on it, if it hadn't been 
for the poverty workers and Bill, we probably would have been 
shot as we attempted to enter these places; but here were 
inspectors, our poverty people, coming in to see people who 
were very much their own kind. They weren't all that hot on 
reading and writing; they weren't college-degreed inspectors, 
but they were pleasant, and they could recognize folks and 
their homes their kind of poverty, their own problems, and 
help them solve their sanitation problems. 

Crawford: Did you get OEO [Office of Economic Opportunity] money for that 
project? 

Blum: Yes. As the health department, we were the main figure in 

writing up the OEO proposal for Contra Costa County. We spent 
weeks on it and got a huge grant but, interestingly enough, I 
went to Washington with it, and Washington dismantled the whole 
thing. They said, "You're not doing it right." Well, we had 
put together monies for the several ghettos--we had Pittsburg, 
Richmond, and San Pablo, poverty areas in particular and we 
wanted money to go to the schools, to public works, and to 
welfare, and for some health things, and we wanted it all to go 
to the same communities in order to create a significant 
simultaneous effort. Washington said we can't do that; we'll 
put the school money in this place, and we'll put the welfare 
money over in that place, and the health money over in that. 
We'll divvy up the money, so all the communities will be 
satisfied. 

So, we never had enough to work with in any one place that 
could train for jobs, put the trainees in a job, get their kids 
into beefed-up schools feel the full effect. 

Crawford: Just fragmenting everything? 

Blum: Just stupid, but supposedly good for votes. I went to 

Washington over this, and I sat with a bunch of hot shots. I 
took what we used to call the red-eye special. I remember 
coming in there, dopey and sleepy, to this big meeting. I was 
the only health officer there from the United States, and I 
told them that we were just tired of disintegrating. We wanted 
to take the kids, the parents, and the housing and get it all 
together and fix the bad neighborhoods, get folks going. But 
doing it their way when the poverty administrators got through 
spending the money there would be a little more for schooling 
in one place, the housing would be somewhere else, and the 
parents who would get jobs were from somewhere else. I thought 



156 



this was insane. Well, I was the insane person, and that's the 
way it was. 

Crawford: They didn't accept your ideas? 

Blum: No, politics is politics. They were doling out money. They 
wanted to spread it as thinly as possible. They didn't say 
that. They said widely, but it was thinly. In any case, we 
got a big chunk of poverty workers, and Bill used them as I 
described, and got a job done that you couldn't have done with 
trained inspectors. Nobody would have understood who was 
talking to whom nor why. Here's what a good human being can 
do--really pretty remarkable. 

Crawford: So that's a major accomplishment. 

Blum: Yes, but it was just one man's dream that you could do these 
things if you dealt with people like people. 



Labor and Industry Politics: Tidewater Oil 



Blum: The bald realities of crummy politics were charmingly presented 
by some of the less usual but not rare occurrences. One was 
created by Tidewater Oil, also known as Associated and now a 
part of Tosco. In anticipation of selling out it was 
neglecting its still-operating old plant just to the east of 
Martinez. One day we got a call from a group of Port Chicago 
householders just downwind of Tidewater, that several horses, 
sheep, and goats had just died and that paint was pitting on 
cars that had been left parked outside. 

Inspectors took hold, verified the report, and gathered a 
lot of plant material on which the animals had been feeding for 
analysis. It should be noted that herbivores would perish 
first as their diet was principally the vegetation on which 
toxics had settled out. By this time we had an excellent lab 
and soon determined that contrary to our expectations of acidic 
sulfur compounds, the culprit was arsenic. Fortunately, our 
industrial engineer had a hobby of keeping track of who bought 
arsenic and other dangerous chemicals in large quantities. 
Tidewater used arsenic as a catalyst in its cracker. However, 
the catalyst supposedly remains, but Tidewater obviously was 
losing it and thus using large amounts, a pretty callous 
performance. We also had a wind recorder in operation nearby 
that showed day after day prevailing winds from the plant 
directly targeting the homes affected. 



157 



Interestingly enough, the Monsanto plant adjacent had a 
sulfuric acid pipe failure at the same time. They had a 
somewhat different outlook on how to live with their neighbors 
and had already sent their insurance people out to obtain and 
pay claims for damages they mistakenly thought were due to 
their breakdown. All this was very confusing for the 
householders and we called a town meeting for the next evening. 
I presided, giving out what we knew for sure, including the 
wind data, which was pretty irrefutable. Monsanto turned out 
as the good guys, but Tidewater showed up in force and made it 
clear that the health officer was an illiterate M.D. and 
refused to take any further part in discussions or 
clarifications about what had to happen. 

That did annoy me, an erstwhile chemist, to hear them make 
up arrant nonsense, as well as denounce the health department. 
So I put a letter on the board of supervisors' desk first thing 
next morning, asking for a public hearing on Tidewater's 
negligence, threat to health, and dishonesty. Anything on the 
board's blotter is public business and they had no escape 
because my written request for a hearing was a prompt media 
event. The board set a hearing for a couple days hence. That 
night I got a call from the president of the Chemical and Oil 
Workers Union, a so-called liberal union, asking me to back off 
because this might hurt Tidewater and thus his union members 
who worked there. I countered, asking if his members might not 
be hurt if we backed off, since some of them lived exactly in 
the area affected. 

However, the union head, who was at that very time chairman 
of the Civil Service Commission, told me that he was sorry that 
I was unaware that our department had several matters of salary 
rectification coming up before the commission at their very 
next meeting and that it would be unfortunate if our employees 
didn't get what they deserved. Apparently, his union was only 
modestly if at all interested in the fair treatment of working 
people other than their own. In any case, I made it clear that 
there was no turning back, and that we had all the evidence 
lined up for the hearing. 

When the hearing opened, I presented the situation to a 
sizeable crowd. The first witnesses to be called were the 
union's representatives who in an embarrassingly stupid way 
denied any possibility that Tidewater could be at fault. The 
second witness was the Tidewater P.R. man, a harmless guy, who 
made two points clear. The first was that it couldn't possibly 
be Tidewater's doing, and the second was that Tidewater had 
found the problem, that it had been fixed, and that they would 
make sure it never happened again. 



158 



I don't believe that our employees were ultimately 
penalized for having a politically inept boss. 



Growing Wild in Contra Costa; More about Sewers and Other 
Amenities 

[Interview 4: March 21, 1997] ti 



Crawford: When we started talking about your work as health officer you 
said, "Contra Costa County was just one ethical issue after 
another. " 

Blum: All health departments face one ethical dilemma after another. 
Contra Costa was no exception. 

The sanitation situations taught me a lot about practical 
ethics, but primarily in retrospect. That is an interesting 
sphere. Most of what you do in sanitation is to carry out 
state laws: the health and safety code has hundreds and 
hundreds of pages of what you're supposed to do. Of course, 
you don't have the personnel or payroll to do these things, but 
you do whatever you're forced to do whenever the situation's a 
bad one. So you do something. In some health departments, if 
the situation is bad, the practice is to look for another page, 
and to stay away from this portion of the health and safety 
code . 



Contra Costa went from probably 120,000 people before the 
war to over 300,000 by 1950. It was a wild growth scene. When 
I got there in 1950, the population was made up mostly of young 
familiesthe new population. People were moving out there to 
a bedroom community. There was a fair bit of commuting back to 
jobs in San Francisco and the East Bay, and a fair number of 
new jobs were being created out there. 

One of the things that didn't strike me until later--! 
don't know whether it's an ethical issue or not, but- -we 
typically forced the farmers to give up their land by allowing 
subdivisions. Then the farmers couldn't resist the new land 
values. In turn, their property taxes went up and farmers 
couldn't face them. So high land taxes and higher land values 
forced or encouraged more and more farmers to sell for 
development. So, when there is rampant subdividing, you 
automatically flooded the soils with gardening irrigation and 
all the waste from septic tanks, because there weren't sewers 
in this backwoods country. 



159 



Crawford: It was done so quickly? 

Blum: Yes. You couldn't get sewers in to begin with. You have to 
have somebody to vote for the sewers. You have to have 
sufficient value to the property. You can't sell bonds unless 
you've got something of value. So first the community builds 
to get the bond value, and then it sells bonds, and then you 
put in the sewers after you've already built the roads and the 
houses and septic tanks. The whole process is all backwards, 
but there's a reason for it. If you drove to Oceanside in 
years gone by, you saw streets all laid out, with lampposts, 
and the sewers all in- -but no houses. That went on for thirty 
years. Somewhere in the late twenties, somebody decided to do 
it right, and they put in all the infrastructure, but then 
there was the Depression, and nobody could build. So here were 
these tremendous numbers of improvements at great cost, but no 
people to help defray those costs. 

Crawford: So that you jumped into the middle of an expanding situation. 

Blum: When an area first develops out of a rural setting, there is a 
near inevitable progression. People buy a piece of land and 
expect and want to build on it. There are no sewers to connect 
to so they seek a building permit which requires a 
"satisfactory" scheme of disposing of liquid wastes and sewage. 
The first step is to get soil absorption or percolation tests, 
a rough scheme to tell if water from a septic tank can be 
distributed over the part of the land not to be built upon, and 
kept from surfacing by means of underground drain lines of 
specified length. 

The tests are done after the rainy season is past so that 
the soil will take more moisture. If the results are favorable 

and if an appropriate septic tank and drain fields are 
designed, a permit is given. 

Some soils are marginal, some are a bit marshy if there has 
been a good wet season. But what is worse, as lawns and 
gardens get planted, they are irrigated and much of a lot can 
be saturated that way. All adjacent lots have the same fate 
and the whole area can become waterlogged. 

Then, toilets won't flush, the drain fields overflow, and 
people live in a daily nightmare of sewage, sometimes for 
months on end or permanently. You just can't appreciate the 
misery of a family in a new home that becomes almost unlivable. 
And most people are from a city home where such problems never 
existed for more than a few hours and are corrected promptly. 



160 



Such a neighborhood comes to a rebellious state of affairs 
and the health department preaches, "Let us bring in sewers." 
But sewers need treatment plants and an ultimate discharge 
point for the treated sewage, i.e., a bay, a river, sometimes a 
lake in a pinch. The costs are huge. A majority of the 
property owners have to vote in favor of the proposal and 
accept the taxes that go to pay off the long-term tax-exempt 
bonds that are used for financing. If there aren't enough 
property owners, the costs to an individual householder are too 
high. 

Large developers tend to do all this in advance, but not 
all neighborhoods lend themselves to large developments. 
Contra Costa had hundreds of septic tanks, and at some point 
the misery boils over and there comes a sorting out among 
property owners. If not enough of them join, there won't be 
enough property to justify the bonds needed for the sewage 
disposal machinery and pipelines. 

Today when cities and counties have matured, they demand in 
advance that subdivisions provide not only streets but all the 
utilities as part of their package. Even parks, space for 
public buildings, and schools are typically part of the 
package. 

Should I have made a career of fighting for such more 
mature ways of doing development? I didn't, never saw it in 
that light. Would I have accomplished anything in the sense of 
getting a more reasonable set of outcomes earlier, or did our 
approach of fixing bad situations lead to the better current 
practices anyway? 

Typically, the sanitary districts that would have to 
provide these services would either run an election and see who 
voted against it, or they would go from door to door in advance 
and find out who was going to be against it. Then they drew 
new district boundaries which left out people who were against 
it up to the point where the majority left in the district 
would vote for it. The word gerrymander really came into its 
own. You might have a cherry stem- -meaning that up to a point, 
all landowners want it, and from here on there's a mile along a 
road where nobody wants it. So the district boundaries run 
down the road. When the district comes to another batch of 
property owners who want the district's services, the 
boundaries extend once more and take them in. The district is 
cherry-stemmed and gerrymandered by this maneuver. 

Crawford: The supervisors were doing that? 



161 



Blum: Not the county board but the sanitary district boards. 
Crawford: Somebody must have been making a tremendous amount of money. 

Blum: Yes, developers and labor and all the businesses that sold to 
them, but that isn't really the issue. After a certain point 
when septic tanks can no longer be tolerated, you have to build 
sewers. By then there are a whole bunch of vested interests 
who are now living there. Once an area starts developing, the 
health officer is key in signing all the papers and agreeing 
that yes, new developments are safe and sanitary when they have 
safe water and safe sewage disposal. The value of the land 
adjacent also goes up so the farmers can't afford to stay there 
as farmers, and they too will vote for new utilities. 

Crawford: Were you pressured to do this? 

Blum: No, not pressured in a direct sense, but indirectly, yes, 

because you have no choice. If people are flooded with sewage, 
the health department has to press for sewers, because this is 
a dangerous situation for all people in the area and a truly 
miserable one for people who can't use their plumbing. 

Crawford: Did you eventually get the situation turned around? 
Blum: Yes, you eventually always end up getting the sewers. 
Crawford: What happened in that subdivision? 

Blum: Oh, that one with the ersatz septic tanks? The sewers came in 
ultimately, there was a sanitary district to accept this 
sewage. 

Crawford: It wasn't a disaster? 

Blum: It wasn't a total disaster, but it cost householders extra 
money. You build a septic tank--junk--and then you have to 
throw it away. And you also have to cut up the streets to put 
in sewers later on, and pay for their repair, but there are no 
options. Practically no options. 

The Orinda community was very hard to sewer--big lots, very 
expensive. The Contra Costa Central Sanitary District runs a 
sewer line from Orinda out to Martinez to the waterfront where 
their plant is. That cost a fortune. They couldn't sell bonds 
on empty land. So it was developed- -a little piece here, a 
little piece therethen finally it's developed and produces a 
mess of sewage. Then the health department says, "Well, folks. 
You've got to get sewers." Some of the devices that are used 



162 



are that the health department doesn't permit new schools, or 
further new construction. Well, everybody that's involved in 
this place suddenly decides that they've got to have sewers. 

Crawford: And this is your decision as health officer? 

Blum: In a sense, the health officer's always pushing it. All of a 
sudden, you realize that you're the king of the developers 
without meaning to have anything to do with it. In fact, 
you're forcing it. 

Crawford: You must have had feelings about that? 

Blum: You finally do. But it was many years before I saw that I was 
the key facilitator of this badly functioning scheme for 
development. As I look back, I don't know whether you'd say 
it's ethical or unethical. The crux of the matter is that our 
society has no method of doing development sensibly. 

Crawford: So, in balance, how did you feel about your dealings with this 
issue? 

Blum: One always ended up saying, "There's no choice." It's 
happening, and so we have to improve the situation. 

Central Sanitary District started out with an eight-inch 
line from Orinda to Martinez, but within a couple of years, an 
eight-inch line wasn't adequate. Then you need a two-foot 
line. So you tear up the whole highway again- -and the 
taxpayers are paying for this. Then people are able to build 
further up the hillsides because of the bigger sewer, and in a 
decade you may need a six-foot line. 

Highway 24 was torn up all the years I lived there. First 
you had a little sewer, then you had a bigger one. Then EBMUD 
needed a larger water line, and then BART came in, and that 
tore it up again for a couple more years. People never had a 
decent road. Highway 24 was a disaster, always and forever; 
and always because there's no way of building what is 
ultimately needed to begin with. You can't put up the money in 
advance when nobody will float those bonds, and if there isn't 
anybody to use the facilities, you really are speculating. 
Well, there are very few places in the world that can handle 
that sort of thing. 

Crawford: Who handles it best? 

Blum: Well, as you can imagine, Sweden. In Stockholm, the city went 
out and simply acquired all the peripheral land, and then said, 



163 



"This is how it will be developed. When we decide it will be 
developed, we'll put in transport, we'll put in water and 
utilities and sewers." But even in Sweden, this didn't always 
work well because of political decisions. It's been kind of 
shaky and not every city in Sweden did it. Britain tried to do 
it, but could not control planned development well because the 
games that are to be played with real estate are monstrous. 
Millionaires, billionaires are made out of these things. 

It was kind of interesting. Over in the west side of 
Contra Costa County, there were a lot of bad areas with homes 
on septic tanks that we had approved. The net result was that 
there were great slippages; houses slipped after a big rain. 

In west Contra Costa the El Sobrante area was swimming in 
sewage. It was horrible. All of a sudden, we had a few cases 
of little children with dysentery. You wonder, but you can't 
prove it is the sewage, but it's very suspicious. Of course, 
sewage carried polio, hepatitis, and other infections. 

I remember we had a sewer bond election- -which is the 
prelude to getting the sewer--and it turned out that everybody 
in the El Sobrante area would be against it. I discovered who 
the key figures were, and phoned from my desk in Martinez to a 
man who was the president of the overall association of all the 
El Sobrante community organizations. There were twenty-three 
of them. He was also the president of three or four of the 
twenty-three organizations. He was an upholsterer. 

I got him on the phone, told him who I was, and said, "You 
know, you've got a big problem there. I gather you're leading 
the movement to fight the sewers. I think you're making a big 
mistake because, in the first place, you can't build a new 
school there. We're not going to sign for it because it's 
going to be swimming in sewage. There's no way of getting rid 
of the sewage properly, and we won't permit any new 
construction. El Sobrante' s a growing area, and we simply 
won't sign off on new construction because you're swimming in 
sewage . So let me come down and draw you some pictures . " 

His response was very typical, as it turns out. He said, 
"Well, now, Doctor, I'll come up and see you in Martinez." I 
said, "Oh, no, no. There's no reason for that. This is my 
job, and I'll come down and talk to you." He said, "Oh, no, 
no. You're too important. I'll come up and talk to you." 
Well, my logic was, "Okay, I'm not going to fight the man over 
this. If he wants to, and it makes him feel better, I'll let 
him come to Martinez." 



164 



This is how that battle was won. You knew that you had the 
battle won when this man insisted he would come to see you 
because you were important. This is an interesting kind of 
dynamic. So he was in my office in a matter of hours. I 
explained the whole picture to him, how they couldn't get a new 
school which they needed. 

Crawford: Who was he? 

Blum: Oh, he was an upholsterer, with a small business, and he was 
probably the president of the chamber of commerce, as well as 
the president of the association of all twenty-three community 
organizations. 

Crawford: Why didn't he want sewers? 

Blum: Because it meant taxes he and all the other residents would 

have had to pay. It would make his business and his home more 
expensive to maintain, but, on the other hand, his whole future 
was tied up in the community's growth so his upholstery 
business would grow. All of his buddies are in business. The 
folks who are key in this are typically small businessmen. 

Crawford: So there weren't any big developers who were reaping big 
financial rewards? 

Blum: No, it wasn't that kind of a place. It was just little people. 
So we sat and chatted for a while, and I said, "As I see it, 
from where I sit, you'd be better off paying some more taxes 
and getting in sewers, and getting a new school, and allowing 
developers to build, and letting the place grow. Is that what 
you want?" It sure was. He said, "Well, I didn't really 
understand all this." 



He went home, and late that night I got a phone call from 
him. All twenty-three organizations had already met that 
evening. They had reversed their position, and they were now 
in favor of the sewers. That sewer bond went through with over 
an 85 percent positive vote-- just unheard of. 

Crawford: So there was finally some well-planned development in 
connection with that issue? 

Blum: Well, not reallyunless you think unplanned development is 

necessarily good, then we did it. But if, on the other hand, 
you're not so sure about helter-skelter development, which it 
was, in the sense that people are speculating on creating 
various usages scattered over miles, then it's not well-planned 
development. So we often push the community into becoming a 



165 



modest disaster area, but possibly better than the one they 
were already in. Well, this sort of thing just goes on and on. 

Crawford: Are you working around shady practices? 

Blum: Well, these are not shady practices. These are political 

reality aspects of growth. These are issues that our society 
has never decided to settle. Patchwork is how they get 
settled. A health officer gets used to making case-by-case 
decisions without having a satisfactory overall scheme to go by 
until his community develops and legalizes specific standards 
on how things are to be done. 

In one Walnut Creek area, we had the same sort of battle, 
and lo and behold, who's against the sewer? A couple of 
physicians. They happen to own property and buildings, and 
they are going to face more taxes, and they don't want to; 
also, they have no problem themselves. These situations can be 
fun because you go to a public meeting where the physician gets 
up and makes a speech, and you're also a physician and have to 
take up the opposite side of the issue. 

I remember the Walnut Creek debate. The physician was a 
fairly young man. I said to the attendees, "Let me tell you 
about the health side, which the doctor doesn't seem to care 
very much about." 

Crawford: These would be public meetings? 

Blum: Public meetings, and the doctor commenced to look like a bum. 

Here he is, worried about his taxeswhich aren't all that bad, 
and he's making a good livingand the health officer is 
concerned about getting rid of sewage out of schoolyards, and 
sewage out of backyards, that sort of thing. Your medical 
opponent creeps away, and you're so very virtuous, even if you 
helped the neighborhood get into its mess to begin with by 
okaying some development on septic tanks which you knew 
couldn't hold up, no matter how well they complied with the 
regulations when they built. 

You could really question the ethics of all that behavior. 
Yet no health officer could have stopped the initial 
development; people had a right to use their land, as he would 
soon find out. And you can question my ethics here, and do a 
good job on it, too. 

Crawford: Why? 



166 



Blum: Well, because here I'm taking advantage of a situation to make 
this guy look like a jerk, particularly because he's a doctor. 

Crawford: He is_ a jerk. 

Blum: Yes, he is a jerk, but only because he is unsophisticated about 
the origins of the problem, which neither he nor I nor the 
community will set right for the long term. 

I bought a house, which was finished within a month or two 
of the time I bought it. It was in an old neighborhood, a nice 
neighborhood called Upper Lakewood in Walnut Creek. And, 
little realizingwell, I guess I did realizethat the road 
was not a public road; it was a private road. The water system 
was a private water system although it was in the middle of 
East Bay MUD territory but still, a private water system. 
There was no maintenance for the roads, no maintenance for the 
water system. So one moves into a situation like that. There 
were sewers, thank god. 

We'd no more than moved in when roads and water system 
started falling apart in the whole neighborhood, and everybody 
came to me: "You're the health officer. Fix it! Make 
something happen, it's unhealthy." 

I said, "But I don't run the roads department. The road is 
owned by us. You can't ask the county to fix this road, we own 
it." So there were long negotiations, but always with me in 
the middle of this stupid mess because I am the county health 
officer. Finally, all of us put up enough money, and paid the 
county to come in and take care of the roads. 

Crawford: You did? 

Blum: All the owners did. Come Saturday afternoon, everybody is 

getting cleaned up I presume that was what was going on and 
there would be no water. You turn on the faucets, and the 
faucets are gasping. Yet there is this big water tower that 
everybody in the neighborhood could see, up on a high piece of 
land, which was our water storage facility. 

Crawford: But you couldn't buy into that? 

Blum: Well, it was ours, but it turns out that the man whose house 

was adjacent to it would turn off the water for the rest of the 
community so that he could have water. It was just a limited 
amount of water. 

Crawford: And he was part of your private enclave? 



167 



Blum: Yes! He was just one of us, but who's going to go up there and 

hit him over the head with a wrench and open that tap? It 

doesn't work that way. So we had these big meetings a couple 

hundred people. People would bring their kids. It was a real 

picnic, but it was also serious because people couldn't get any 

water to flush their toilets, take a bath, particularly on 
weekends . 

I remember one of these meetings. There was a resident who 
was a bakery driverkind of a red-faced fellow, cute, nice. 
His wife was a cherubic, red- faced, little lady, and they had a 
couple of cute little, cherubic, red- faced children. They'd 
all come to the meetings and sit there and kind of chat at one 
another in a nice way. The president of our neighborhood 
association opened up the meeting about the water problem. We 
had no more than started when some man raised his hand, he 
wanted to speak, and it was the man who controlled the water 
tower, who had the knobs under his thumb. 



Crawford: 



Blum: 



The chairman said, "This is Mr. So-and-so," and this little 
red-faced bakery guy jumps up and says, "So that ' s Mr. So-and- 
so." Well, the audience got hysterical because they all knew 
the name of the villain but didn't know him. That just 
completely wiped out the credibility of this man, settled his 
hash once and for all. He never even said a word. He sat 
down. 

Then we got into the business of discussing a new water 
system. "This is going to cost this much and that much; and 
what's the old system worth?" Well, it wasn't worth a damn at 
best. I'm sitting there, cringing all the while, because the 
health officer is supposed to be guaranteeing that you've got 
clean water where you live, and up gets a lady who sort of 
hysterically is saying, "This water system is worth thirty, 
fifty, no, seventy thousand dollars." The bakery man calls 
out, "Sold!" That was the end of that. [laughs] The meeting 
dissolved peacefully, everybody put up their money, shut up, 
and we bought into East Bay MUD. 

Is that considered elitist, when you live in these private 
enclaves? 

Perhaps it was. The bad roads and decrepit water system could 
have been the result of speculation, or in our case an example 
of how little even well-off homeowners really understand about 
what they are getting into when they choose a homesite. I sort 
of knew what I was getting into. It was a lovely house by a 
fine, careful builder, with good neighbors; not small matters. 



168 



Crawford: Who was the architect? 

Blum: I don't think there was any professional architect. The 

builder's wife was the architect. She was a fun lady. They 
lived just across the street from us. We always got along 
well. He did beautiful work. His name was Curt Muller. He 
was a subdivider, too; lived there for fifteen or sixteen years 
until he had built on all the parcels he owned. 

The bakery truck driver, whom you wouldn't think of as 
being the great solver of problems, got rid of the old rascal 
who used to screw up our water system; got rid of the lady who 
was getting hysterical about how valuable our present junk 
system was. That must have been the tenth meeting we had, and 
if it hadn't been for this driver, we'd have had ten more. 

Crawford: What were the forces out there? You said that labor was very 
strong? 

Blum: In a situation like that, labor was irrelevant. It was 

strictly a problem for the homeowners. The developers would be 
on the side of fixing things because they're going to sell, but 
there weren't many big developers. Our builder was one of the 
many small ones. They built four or five homes, ten homes at 
the most. So it was no big deal. There's nobody to bribe; 
there's just a past history of doing your own thing until the 
mix got intolerable. 



A Privately Owned Development; A Municipal Utility District 



Blum: One special developer came into the county. He and his mother 
and father got their hands on a huge piece of landthousands 
of acres. This land surrounded the Mt. Diablo Country Club. 
That's a nice spot with a large golf course. The developer 
formed a district, a municipal utility districtjust these 
three people governed itand it had as much legal standing as 
East Bay MUD. They did whatever they felt was necessary, and 
they wrote their own sanitary laws. The only people who had 
any supervision over them at all was the state health 
department. We could go and admire and scream, but the county 
health department had nothing to say about it. 

fi 

Blum: They were going to build several hundred homes, and they built 
at least fifty to begin with. The sewage all ran by gravity 



169 



down to a big sump. There they had big pumps which pumped the 
sewage back up to the top of the mountain behind the Diablo 
Country Club. There they had built a huge dam to hold the 
sewage. Around the perimeter of the dam they had a pumping 
system with sprays so that the sewage was sprayed up in the air 
to evaporate, and the State Health Department approved this-- 
the last word in modern something or other. 

We were pretty sure it was a disaster area. It turned out 
that these subdividers, who were totally unscrupulous, used a 
six- inch pipe to pump the sewage up to the top of the mountain 
--it was about a mileand they used second-hand invasion pipe, 
which had been through the war in Europe. It wasn't very good, 
[laughter] 

Crawford: Is piping that expensive? 

Blum: Oh, yes, it costs a fortune; and this stuff was the cheapest 

kind to begin with-- just for the invasion of Normandy. Then it 
was brought back to the United States, and this outfit used it 
to pump sewage up a mountain. They also had inadvertently put 
the big pumps in on a slant so that the bearings burnt out 
every few days and the pumping system would come to a halt. 
Then they would put in new bearings, which might take a week or 
two or three. The people who set it up now were out of it. 
The folks who were stuck with it were the members of the 
utility district, meaning the folks who bought homes there. 
The developers settled in Australia with which we have no 
extradition treaty. 

Crawford: They were criminals, basically? 

Blum: Yes. 

Crawford: But the state was passing it? 

Blum: Passed it. They probably had over fifty homes built. They 

were inexpensive in those days; $8,000 for a home. Most folks 
could afford one by getting a near total mortgage. It was a 
lovely spot, overlooking the country club, nice oak trees 
around. One day one of our sanitarians came in the office and 
announced, "I've been up there looking at this dam. The 
squirrels are tunneling in it, and it's going to go. It's an 
earthen dam, and it has started dripping a little bit." 

Crawford: Just a dam of sewage? 

Blum: Yes, of sewage. "Of course," he said, "the sprinkler system up 
there isn't working, and there's much more sewage than they 



170 



thought they would have to deal with, volumes of it in the dam. 
It's going to go. I don't know what day or what hour, but it's 
going to go." And while he's talking it goes. It floods over 
the Mt. Diablo Country Club, over the golf course, and catches 
all the golfers by surprise. 

Crawford: Is this raw sewage we're talking about? 

Blum: Yes, it's raw, just that it's been pumped up a hill. So that 
was the end of that sewage system. Before it went, every so 
often we'd go look at it because the invasion pipes would be 
giving out, and we made them put these huge patches all along 
the invasion pipe. And the pump doesn't work half the time. 
It was a wild mess and you could see the end coming. So when 
it went, we ended up putting an "unoccupiable" sign on every 
single house. All these families were forced out of their 
houses, and these were not rich people, left with an unusable 
house and payments on their mortgage. 

Crawford: Permanently? 

Blum: Well, until something could be done. This went on a year or 

two, and that forced the issue of Contra Costa Central Sanitary 
District putting in a sewer all the way past Danville, 
essentially to San Ramon. 

Crawford: Did the sanitation situation eventually work out? 
Blum: Yes, eventually, when Central San took the job on. 
Crawford: That must have been very uncomfortable for you all the time. 

Blum: It's a game, all the time, but it is perfectly legal. However, 
the state's approval of that horrible system was unbelievable. 
Our men wouldn't approve it, but the state did. Yet I doubt 
that there were any bribes involved, just the lure of 
developing California. 

Crawford: Could you get that approved today? 

Blum: We might. I'm sure worse things are approved all the time, but 
not routinely. 



171 



Dealing with the AEC and other Federal and State Watchdog 
Agencies ## 



Blum: A most alarming situation occurred when we discovered that the 
AEC, the national Atomic Energy Commission whose infamy was 
highlighted by Tom Lehrer's little ditties, was operant in our 
county. They had taken over an old abandoned cement plant and 
were putting radioactive contaminated wastes in secondhand oil 
drums with plastic liners. Pieces of contaminated equipment as 
well as liquids and various solids were mixed in with cement 
and water and allowed to solidify in the oil drums which were 
then sealed. The drums were hauled to a Sacramento River site 
adjacent to where Antioch was obtaining its city water. They 
were placed on tiltable racks on a small ship, taken to the 
Farallones and dumped overboard to sink to the ocean bottom. 
This was a brilliantly conceived, somewhat less than long-term 
method of radioactive contaminated material disposal. 

Our inspectors had chanced on it at the Antioch waterfront, 
brought along a Geiger counter, and discovered that the 
secondhand drums were leaking radioactive materials at the 
Antioch water intake even as they were being loaded for their 
burial at sea. The inspectors took the boat ride to the 
Farallones and discovered that not all barrels sank, some 
having more air than concrete. The AEC remedy was simple: they 
carried a rifle and shot the floating barrels to let out the 
air so that they gurgled and sankso much for long-term 
entombment . 

Sounds unbelievable, but it was worse. When I got on the 
phone to the local AEC operation, they made it clear that no 
stupid local health officer could mess around in their 
business, and would I please shut up and go home. My response 
was pretty automatic: padlock the cement plant, close out the 
loading dock, and remove the ship and all vestiges of the river 
site operation by morning. If we found any evidence of AEC 
activity remaining, there would be a press briefing at mid- 
morning at the shipping and plant sites explaining how the AEC 
was exposing the users of Antioch water to a mindless 
radioactive disposal operation. It was all gone. Years later, 
I met the physician in charge whom I had called and he made it 
clear that there never had been such an operation as the one I 
described. Thus one built trust of federal agencies. 

A similar kind of event occurred around a grapefruit 
incident. A man bought Arizona grapefruit from a truck in 
Lafayette, drove on home to San Jose, started to eat the 
grapefruit, and got violently ill. The Santa Clara County 



172 



Health Department was called, checked it out, and found cyanide 
in the grapefruit. Was this a murder attempt, some accident, 
or something to do with the life of a grapefruit this day and 
age? They called us, we found the vendor, bought a good many 
sacks of fruit, and found cyanide inside many grapefruit. 

Quick calls to the state health department, state 
agricultural department, the USPHS, and the U.S. Department of 
Agriculture gave us no information. But they all warned us not 
to go to the press to warn people of the danger because it 
would be bad for the grapefruit industry. A very impressive 
concern for the public's health. We made it clear that we 
would go to the press that day unless the whole matter was 
cleared up. 

It turned out that Arizona and Texas grapefruit were given 
a cyanide spray at the California border for some irrelevant 
plant pest so as to put Arizona and Texas grapefruit at an 
economic or cost disadvantage. If the sprayed fruit in open 
trucks got into a rain, the cyanide spray would be dissolved 
and would go through the skin and poison the meat of the 
grapefruit . 

That border control process discontinued that day. 



Anne Leslie; "Office Wife' 



Crawford: We haven't talked about your staff. 

Blum: At the very heart of it was Anne Leslie she was my office 
wife. 



Anne was a very pretty, friendly but feisty person, about 
my age--who was the health officer's secretary when I got 
there. So I took her on as my secretary, and was I ever lucky. 
She was quite diffident about herself and her family, only 
recently did I learn that her father had been an Oxford don. 

She was very defensive of me and used to describe herself 
as my office wife. She and my domestic wife formed a close 
team as they became good friends with at least one task in 
common, keeping me afloat. 

When we became involved in vaccinating everyone in the 
county for polio, it turned out that my long-planned tour of 
Europe's health programs found me in Finland at Mannerheim's 



173 



gravesite on the Sunday that the department did probably 50,000 
persons by taking over a few shopping malls. I must say that I 
enjoyed that day, was sure our people would cover all the 
bases, and they did. When I got back I asked Anne if she had 
had a decent, restful time of it while 1 was gone, no 
dictation, no arranging, no appointments, no grant projects to 
write up. In her charming and delightful way she asked, "Whom 
do you think runs the department and makes all the decisions 
while you are gone? Sure, we have well-paid assistant 
directors in charge, but what do they do when you aren't here 
for a final okay? They come in and say, 'Anne, what would the 
boss have done about this?' That's a lot of responsibility." 
I could just see it once she painted the picture. Probably 
happens in lots of places. 

She had a wonderful trait of being able to deliver a well- 
deserved comeuppance to people who deserved one. As soon as I 
became health officer I asked for a half day off per week with 
pay for me and for any of my assistants who wished to teach or 
participate in university courses. I taught Friday afternoons 
in internal medicine at Stanford University Medical School in 
many ways the highlight of each week. One Friday Anne called 
me there at about 4:00 to tell me that she had had a most 
unpleasant encounter with a prominent Richmond attorney who 
wanted to talk to me. When she told him that I wasn't in, he 
wanted to know where the health officer was and why wasn't he 
at his desk. When she said she could get me at Stanford 
Medical School where I was teaching, he became even more 
unpleasant and wanted to know how it was that a county employee 
could be working elsewhere on county time. 

He went on to say that when anyone wanted to reach him, he 
was always at his desk. This had been too much for my Anne, 
and she came back ever so sweetly, I'm sure, "My, it's too bad 
that you have such a poor practice!" This concluded their 
conversation and she then called me, fearing that she may have 
made us a lifelong enemy. 

When I called him back the following Monday, he made some 
remark about my having a delightful secretary. A few months 
later, he called her to see if she would come to work for him. 



The Civil Service and Other Frustrations 



Crawford: What were the most frustrating things, and what were the 
biggest accomplishments in Contra Costa? 



174 



Blum: Oh, I don't know. The reason I probably left, ultimately, was 
I was simply getting tired of recurring hassles such as those 
with the civil service. The county was very much pro-labor, 
and civil service was strong. You couldn't kick employees 
around, that was good, but the civil service department somehow 
got the notion that they were the saviors of mankind. Every 
time the health department had a job to fill, they would decide 
what kind of person we needed. I know about health and health 
care--but they would come over with the specs, and say, "Okay. 
You've got a job. Here's what we're going to advertise and get 
for you." I said, "The hell you are. That's not what we need 
or want. It's not what we asked for. It's not what was 
approved for us." I was so sick of it, and I wasn't the only 
one. George Degnan felt the same way because of the county 
hospital's needs. But I hated to join forces with him because 
he was such a notorious rule-breaker. 

So I stalled, and that may have been a mistake because we 
could have gotten rid of civil service at the time. However, 
if we had broken the civil service department, then we would 
have the problem of getting people that the board of 
supervisors wanted to hire. If we didn't have something like a 
merit service, the board of supervisors could say, "Well, Mary 
Jones would be good for that. Why don't you hire Mary Jones?" 
The spoils system would be back. 

Crawford: They put that kind of pressure on? 

Blum: Well, they used to before my time, but that was all gone in my 
day. Civil service had gotten rid of it. So there was a very 
strong, good side to the civil service. They ultimately 
brought us well-qualified people, by and large, so I was always 
reluctant to help break their necks, but it was more than I 
could stand to always be told that we needed the wrong kind of 
people. If the specs were wrong, then you spent six months or 
a year hassling civil service, and might spend more time before 
finally getting the board of supervisors to tell them, "Okay, 
this is what we want." Another monotonous event every year 
was, "You have to cut the budget." Or somebody would bring in 
a new issue which was in fact ancient. I had a drawer of 
scenarios that was kind of a joke--when you'd get one of the 
repeat issues you'd say, "Oh, that's started again," you'd pull 
out the drawer and you get the folder, and say, "This is the 
scenario we have to follow to handle this issue." 

Crawford: Same rigmarole? 

Blum: Same rigmarole of what you're going to have to fight, except it 
might take longer this time, or shorter, whatever; but there's 



175 

a point at which you get tired of seeing the old scenarios 
dusted off, although they're very helpful. 

II 

Blum: One interesting case is worth recording. One of the more 

unpleasant duties of a CEO is demoting or firing a longtime 
employee who is well liked but less than useful. As I began my 
drop-in inspections of restaurants, I discovered that the 
territory of one of the inspectors would never lead anyone to 
expect the presence of a health department or a sanitary 
inspector. I went through all his functions with him at his 
next review, put them in writing in his folder. The next year 
my surprise visits found no improvement. This time I called 
him in and demoted him to a lesser rank. 

His fellow inspectors and their supervisors didn't like 
this ugly new phenomenon, hired a lawyer, and asked for a 
hearing at the Civil Service Commission. Their lawyer was a 
very popular fellow, and in fact, our congressman at the time, 
for whom I had voted, no less. He knew me well, told me I 
didn't have a chance with the pro-labor commission, and should 
rescind my action before the hearing, which he assured me would 
be a trial about me, not about my sanitarian. I told him that 
there wasn't going to be any turning back, that the demotion 
was deserved, and if lawyers like himself were inclined to 
lessen the quality of county services, that was their 
prerogative. 

The hearing went as predicted and the inspector was 
reinstated. However, my ratings of his work and reasons for 
them were made a matter of public record, and I looked pretty 
good in a situation where Tightness was irrelevant. The net 
result was very good. No other employee wanted a night in the 
bright lights, so what 1 put in their ratings became very 
meaningful from then on. 

A few years later when I was at the university, I was asked 
to give an evening lecture on aging and mental health in Contra 
Costa. There were about 400 people in attendance and who 
should be sitting in the front row nodding and smiling at me 
but this same sanitarian and his wife, who was also a health 
department nurse. When it was all over they clapped and 
clapped, and came up to tell me how nice it was to see me 
again. That was the nicest part of the evening. 

it 

Crawford: So those were some of the frustrations? 



176 



Blum: There were frustrations. On the other hand, though, as you 

look over my files, you'll see the number of papers we wrote, 
and the number of areas we worked in; it was fun. We had a 
school health program that was years ahead of its timewe did 
some work on genetics counselingthat was twenty years ahead 
of its time. 

Crawford: And you said you could get funding easily? 

Blum: Yes. If you didn't get it from the county, you'd get grants. 
Everybody's so interested in what you're doing that you can 
find money here and money there the TB Association, the Heart 
Association, the Mental Health Association. 



More about the Mental Health Program, and Serving with the 
Space Cadets: 1956-1965 



Crawford: How would your county have stacked up with San Francisco in 
mental health, at that point? Or another county? 

Blum: Well, it was just backwoods [in the beginning]. There were no 
services. San Francisco had a million agencies to do 
everything, and still does. It doesn't mean they do well; they 
often do badly, but at least it had those things. Instead of 
talking about setting up an agency to do psychiatric help, we 
said, "Well, let's have the teachers do a better job; let's 
have the cops do a better job," the nurses, the social workers, 
and so on. It was a big thing, but, in turn, it led to the 
demand for more specializing. The psychiatrists worked as 
consultants in the program. That's how they got their foot in 
the door, and they could make a living. They'd be hired for so 
many hours a day to work with the school teachers or with the 
nurses or with the police, or whatever. It was a big program. 

It was kind of fun, and it resulted, ultimately, thanks in 
good part to Leonard Duhl, that I worked with the National 
Institute of Mental Health for years. I was on several of 
their committees awarding grants, studying various issues. 

Crawford: While you were in Contra Costa? 

Blum: In Contra Costa, yes. It really started with Len Duhl and 

something he called the Space Cadets. He convened a committee 
for NIMH, "Social and Physical Environment Variables as 
Determinants of Mental Health" pretty wild. Len called the 
committee the "Space Cadets." He was the first health planner 



177 



Crawford : 
Blum: 



in the National Institute of Mental Health, although they 
didn't call him a planner, but that's what he was. 

He and I had spent a lot of time wandering around the 
county, studying all these issues of sewage and health and 
schoolsyou name itduring his two years with us. He and I 
were very well aware of the fact that important issues are not 
going to be solved by any one discipline. There was no way; 
the issues are much too broad, involved all kinds of people. 

So in 1956 he had created the Space Cadets, made up of 
people from every major disciplinethe famous lay worker Alice 
Day from the Catholic church; Doxiodes, the world-famous 
planner from Greece. He had this man Miller, who founded the 
general systems theory in this country, from the University of 
Chicago; he had an astrophysicist from Chicago, Rashevsky. He 
had some wonderful sociologists and anthropologists Sandy 
Hollingshead from Yale. Then he had Sir Jeffrey Vickers from 
England, and the head sister from Webster College, Jacqueline. 
She left the order, ultimately, and became the president of 
City College of New York, and married a Jewish banker. She was 
something else; she was fantastic. Mel Weber from Berkeley, 
and before Mel Weber, Catherine Bauer, who was Mrs. William 
Wurster a famous planner, housing expert, in her own right. 

So there were all these and many more interestingly placed 
people from different parts of the world. We met for three 
days at a time three or four times a year, usually in D.C. 

In Washington? 

Usually, not always. Duhl was putting these people together 
and, for at least the first year, every one of these people 
would spend a half a day describing to the group what he or she 
was doing or what they felt they were doing, and then everybody 
else would chew on it. It turned out we didn't understand one 
another's work, not even their vocabularies. It was a very 
interesting learning experience. 

All these people many of them world- famous --really didn't 
understand what the others were doing. John Seeley, the 
Canadian sociologist, was there, and it fell to him to sum up 
briefly what each person seemed to be doing. Usually, the 
people who had been the subject for the day wrote down 
everything he said, because it was usually a lot clearer than 
what they had just told us. It was a fantastic experience for 
me, a country hick, you know. Also from Berkeley, there was 
Alex Meikle John- -the world-famous educator and expert on 



178 



constitutional law, and, ultimately, Scott Buchanon from 
Annapolis --St. John's Academy. 

Crawford: All these people were on the committee? 

Blum: The committee, yes. That is what I was exposed to, and these 
people had all, more or less, been involved in academia, and I 
had not. They were used to philosophizing on the world's major 
issues, but not even they were aware of the confusion and 
relationships between the outlooks of the various disciplines, 
particularly when the group focused on clarifying an issue or a 
societal need. 

Crawford: What years were these? 

Blum: We started out in 1956, and it ran until '65--a tremendous 
time. In 1956 I received this letter from Len Duhl saying, 
"We'd like you to be a member of the Space Cadets," so I went 
to the board of supervisors with the letter, and when you go 
before the board this is public information- -and here we go, 
Space Cadets. Well, I was Buck Rogers. All the newspaper 
reporters were there, and the board was sort of looking at me 
and smirking like, "Good Lord, this health officer hasn't got 
an ounce of brains, coming with a request like that." I wasn't 
asking for money, I was asking permission to be gone for three 
days . 

The chairman of the board, an attorney from Concord, said, 
"Well, I don't think we're paying the doctor so that he can go 
to Washington to join the Space Cadets." If you were an 
officer of the county, you couldn't leave the county because of 
an old California law that said you had to get permission from 
the board to do so. There had been a long history of officers 
leaving with whatever cash was lying around in their 
department . 

II 



Blum: This was the first time I'd ever really asked for permission to 
do anything, so the next board member gave his little spiel and 
another and another member then said that it was ridiculous. 

Finally, there was a new member of the board, Joe Silva, 
about whom I shall elaboratea wonderful man, a great big man 
--who called himself a "black Portuguese." This was typically 
his warning to stupid people to not throw around racial 
epithets. The chairman said, "Well, Joe, what do you think?" 
So Joe sort of sat back, and rocked in the fancy board chair, 
and he said, "Well, you know, I used to be the mayor of 



179 



Brentwood"--it 's a little city in Contra Costa--and he said, 
"One year I thought I ought to go to the meeting of the 
California mayors, but the city council never would let our 
mayor go to meetings. They didn't want to waste the money on 
them, so I paid my own way, and what do you suppose I found? 
We weren't even getting our share of the sales taxes. We had 
never put in a request for our share of the money. Mr. 
Chairman, I move that the doctor go to Washington." 

One, two, three, four, five yes votes and I'm off to 
Washington. This man used to run a roadhouse, and he became 
the mayor of Brentwood; he was this and that and had been a 
judge. He used to say he'd never been to school. He might 
have been right. Other people said he'd been a football player 
at Oklahoma in their great days. I never did know, really, 
where Joe stood educationally. 

Then it came up budget time. I remember I had to appear 
before a little subcommitteea couple of board members and it 
was after lunch, about two o'clock. Joe was a big eater, big 
drinker. I don't mean a drunk, but he would have several 
drinks at lunch, and eat big meals and so on. So this was 
right after lunch and he just dozed off. The other man, who 
was a real wisenheimer--a lawyer and a board memberwas taking 
apart our budget, and you sort of give ground because you have 
to. If they don't get to cut your budget, well, then they feel 
badly about themselves irrespective of whether it may or may 
not be destructive or helpful to your department or the people 
of the county. 

So he was pleased with himself, he'd screwed up a half a 
dozen things, and he shook Joe's shoulder, and he said, "Joe, 
how do you feel about this budget?" Joe sort of shook his 
head, woke up, and said, "Tom, you know how I feel about your 
messing around with this budget. We're gonna buy a truck, but 
we're not gonna have the guy to drive it. If we're going to 
buy a typewriter, we're not going to have the secretary to type 
on it. We're going to do some other damn fool thing. That's 
what you always do with these budgets," and he went back to 
sleep. Our budget was put to rights at this point. 

Joe was a real philosopher from the sticks--! always 
appreciated Joe. In recent times, he's made headlines. He's 
been dead for some years. Recently it was ex-Mayor Christopher 
from San Francisco who took the credit for having gotten Joe 
Silva to vote for BART. 

For BART to succeed, to go into business, it had to have 
three counties of the five Bay Area counties, and in each of 



180 



the three counties, of course, at least three members of the 
board of supervisors had to vote for it three out of five. 
Alameda and San Francisco, naturally, voted for it, and Contra 
Costa was the only one left at that time. San Mateo wouldn't 
do it. 

Crawford: Marin didn't. 

Blum: Marin didn't. Contra Costa was potentially for it. That 

afternoon, I was presenting something or other to the board of 
supervisors. Then they had an adjournment in the middle of the 
afternoon, and I went into the little board room. Joe was in 
there, and I was there with another man who ultimately became a 
professor here. 

Joe started soliloquizing. He said, "Now, this BART thing 
is coming up this afternoon," and he said, "it isn't going far 
up into the county, and everybody up there is against it 
because they'll never see BART in their lifetime, and I won't 
see it in my lifetime. So," he said, "we're split two and 
two." Two supervisors at the west end of the county are for 
it, two on the other end are against it. And Joe is way out 
there at the far end of the county, the Brentwood end. He 
said, "I've got to decide what to do." 

So for half an hour, I listened to him figure out what to 
do. It was just magnificent. He thought of his brother-in- 
law, who had an orchard. He said, "Now what '11 this do to him? 
Well, the taxes will be about this and this, and if it's as 
good as everybody says it is for the development of Contra 
Costa, he'll get those advantages." 

Crawford: So, very practical, pragmatic? 

Blum: Fabulous. He thought of farm owners, he thought of school 

teachers, he thought of businessmen. He said, "I can't see how 
it would do any damage to any of them. The only person being 
damaged would be me because they'll vote against me- -they '11 
get madbecause BART is so far away. Well, I'll vote for it." 
And we had BART. This is the same Joe Silva that sent me to 
Washington. It really changed my whole life, too. 



181 
Being Considered for a Faculty Position at Harvard 



Blum: In 1959, as our mental health work went sailing along, and as 
we published a paper on its thrust, 1 I was asked by Dr. Erich 
Lindeman, Harvard's chief of psychiatry, to consider joining 
his faculty in a community and administratively oriented mental 
health position. 

I had met Erich in 1949 when I took my M.P.H. at Harvard 
and attended his class in community mental health. Erich had a 
miserable squeaky voice, especially for a plump, cherubic, mid 
sized man of fifty-five. I had assumed he was going to be our 
worst lecturer. His course took place in one of the ancient 
amphitheaters of Mass General Hospital (MGH) such as ether 
anesthesia had been demonstrated in. Our huge class of about 
100 was stacked from the central hole or working space up to 
the rafters. Our first session was a demonstration of a 
psychiatric therapeutic intervention. Erich was down in the 
hole with just the young woman patient whom he was reassuring 
in his squeaky voice that all the people above were his 
friends; and that she could relax as he and she went about her 
therapy session. Erich was a magician, she relaxed, and we all 
became intent as we heard a magnificent therapeutic exchange. 
Erich was promptly our favorite professor, whose presentations 
we never missed. 

When I received the offer to come to Boston, it seemed 
unlikely that we would ever want to leave the Bay Area again, 
as much as we had loved the Boston area a decade previously. 
Our four years away from home had pretty well confirmed our 
addiction to the Bay Area where both of us had been born and 
grew up. But Harvard was Harvard, and we decided to give it a 
try. We got an agreement to spend the month of September there 
and make up our minds on the job, so to speak. I received 
travel and living expenses and the equivalent of a month's 
respectable professor's salary. We took leave from Contra 
Costa and went via Canada with our bicycles anchored on the 
back of our station wagon. 

Boston was socked in every day we were there, no leaves 
that year. Our motel was adequate, but didn't add much to the 
ambiance. Some of my former students tried to cheer us up, but 
that wasn't an unmitigated success. Visiting the Glimchers, in 



'Blum, H.L., and W.A. Ketterer. "A Health Department's Activities in 
Mental Health." Public Health Reports 78:7, 619-626, July 1958. 



182 



whose home we had lived ten years before, was the one 
restorative and we had some fun times, including reminiscences. 

The work with Erich was exciting and more. He asked me to 
begin with a full review of all aspects of his department, 
which included a tiny community center based at Wellesley, the 
McLean Hospital outside Boston, and his immediate department at 
Massachusetts General Hospital (MGH) . I soon discovered that 
Erich had a significant inferiority complex and wanted me, an 
administrator, to overcome all his imagined inadequacies as an 
administrative head of a huge empire. It reminded me that in 
Contra Costa our department had always used an outside 
psychiatrist to keep us level-headed and honest, sort of a 
magical amulet. In Boston, Erich felt that an administrator 
was to do the same thing for a group of mental health 
academics, whose department he felt was not functioning 
adequately, even though it was probably the best one in the 
U.S. 

I started visiting the overall administrative entities at 
MGH in which we were embedded. No one seemed depressed about 
Erich's performance except Erich. 

I learned a bit for myself when I interviewed the 
administrative head of the private wing of the hospital. He 
had a longstanding problem of persuading his personnel that 
they were being fairly treated if they were not graduates of 
the MGH programs. He had invited in the Boston Globe and 
ingeniously given an interview about the background, origins, 
and training of all of his department heads. It so happened 
that very few had trained at MGH. As I interviewed him, he was 
suffering from a barrage of complaints about how no one who was 
trained at MGH had a chance to get ahead, overkill in spite of 
his deft public exposure of the realities. 

In Erich's own unit I soon gained the confidence of his 
administrative people and was promptly urged to avoid letting 
Erich buy any more recording devicesthey had a closet full of 
them. It seems that his lectures and public addresses were 
typically a wild success and he wanted to capture themhence 
the recorders. What he overlooked was that he read any 
audience like a book and what he gave them was so astutely on 
the mark that he was indeed always enthusiastically received. 
When such a talk was transcribed, there was no such audience 
and the magic the talk had evoked was irrelevant to a 
subsequent audience. This led to a never ending search for 
better recording devices. 



183 



Erich had been carefully excluded by the Harvard Divinity 
School from addressing its graduate students, apparently out of 
fear that he would draw the best into the fold of psychiatric 
counseling, a subject which was, of course, central to their 
own divinity careers. As I arrived there, he had broken 
through that taboo and was giving his first major address to 
the divinity school classes. Prior to that their students had 
to find time to join Erich's classes as best they could. He 
had me go along, and for sure, it was another wild success and 
probably did result in the feared student defections. It was 
all too clear that the lecture by itself without the presence 
of its intended audience wasn't going to be nearly as exciting. 
We got that point across subsequently. 

Mrs. Lindeman, who was an outstanding psychiatric social 
worker, regarded me as an anathema because she saw that Erich 
might be bamboozled into letting an administrator take control. 
However, at the end of three weeks I told him that there was no 
likelihood that I would ever live happily in Boston, much as I 
would like to be with him at Harvard. We set aside a full day 
for a recounting and discussion of my observations. On that 
day he invited me into his inner office and offered me the 
reclining chair next to his desk. I declined, telling him that 
roles were reversed, that he was the client and I was the 
therapist. He was a good sport and took the recliner. 

I began on my list of observations. He was bitterly 
unhappy that few of his division chiefs came to his weekly 
staff meetings on time and many hardly ever came. I pointed 
out that when he had been brought to Harvard a few years 
previously, he had been directed to create the finest 
department extant. In turn, he had recruited each of his 
division chiefs as the keenest person in their area and each 
was told that all that was expected of them was being the best 
in their field, and keeping Harvard number one. None had ever 
been told that Erich meant to supervise them or have them 
participate in staff meetings. He had sought out potential 
prima donnas . Did he want to change them now that he had them? 
I indicated that if I were the boss and wanted these associates 
to toe the line and come to staff meetings, they would, or they 
wouldn't be there very long. So did he really want them to 
show, given that each was bringing fame to Harvard, as was he, 
and if they didn't, would he really pursue their replacement 
insofar as the Harvard structure would allow? He seemed to say 
that yes, he would demand their cooperation. I couldn't let 
this show of bravado go as Erich wouldn't push a cat out of his 
way. So I said, "Would you really let someone go?" He slowly 
allowed that he'd have lots of trouble even talking about it, 



184 



and I suggested that he live within his own capabilities and 
stop torturing himself. 

I tried to leave him with my belief that he was 
administering in a way that was right for him and that the 
proof of the pudding was the quality of the department, 
discipline or no. 

The next day, my last one, I got a call from Mrs. Lindeman, 
who was gasping with an upper respiratory problem, apologizing 
profusely that she couldn't send me off appropriately, that she 
had come to appreciate my help for Erich, that I really wasn't 
the threat she had feared originally. So we left happily and 
never regretted what was a good time after all, reunion with 
our friends the Glimchers, and a chance to bicycle in some of 
the eastern Canadian provinces as well. 



Co-Authoring a Book about Administration; 1963; A Housing 
Project in East St. Louis; Lincoln Hospital in New York ## 



Crawford: That was your first consulting then, wasn't it? 

Blum: First big-time, yes. Not really consulting, just participating 
at this level. 

As another benefit from working on the Space Cadets, I got 
acquainted with Alex Meiklejohn and commenced to understand 
what our constitution was about. I came home, and I said, 
"I've got to learn about and then write a book on 
administration because what we're doing is a joke; it's a 
travesty, and the books I've studied are irrelevant. We're 
paying no attention to the history of this country or to our 
political and cultural heritage in the course of administering 
a county agency. As an administrative agency of government, we 
ought to be in line with our people and our country." 

It led me to write a book that was way ahead of its time- 
twenty-five years ahead of its time. 1 All the traditional rules 
of administration that I'd been taught were garbage. That's 
the reason the teachings on administration changed every five 
to ten years--a whole new look. There were a whole set of 
interests that had been left out at one time, then another set 



'Blum, H.L., and A.L. Leonard, Public Administration; A Public Health 
Viewpoint. The Macmillan Co., 1963. 



185 



of interests at the next look, and so on. The book was devoted 
to looking at all the interests that have to be relevant to a 
health department. Its own doctors are one group, its own 
nurses are another. Nurses typically were the first 
professionals in their family; they don't see the world like 
doctors do. 

Crawford: You have a lot of respect for nurses. 

Blum: Oh, yes. They did the real work for the health department, 

there was no question. That was where it was at. That was a 
strong nursing group in Contra Costa; the guts of the 
department. 

Then, as you look at other people in the department, you 
realize their backgrounds are very different. But more 
importantly, when you look at the consumers that you're dealing 
with, there are all kinds of them ranging from Orinda and 
Moraga to far into Pittsburg, or enclaves that don't even know 
English. So your clients are all different; you can't pursue 
the same approaches with all of them. This is what America is 
really all about, or should be. 

So I found another health officer by the name of Al Leonard 
who thought like I didthe only thing wrong with our writing a 
book together was that we agreed on almost everything. The 
book was released by Macmillan in 1963, and that book opened 
the door for me to become a professor. The book was pretty 
eloquent thinking for me. All the other things I had done were 
clearly diverse--! was not specializing in anything; I worked 
on one thing, went on to the next, and the next, and the next. 
But the diversity of issues and the diversity of the people or 
interests involved got me thinking, and this book wrapped it 
all up with the message that administration had to be built 
around taking differences into account. It was a systems view 
before I understood what systems thinking was all about. 

At that committee of Space Cadets we did a lot of fun 
things- -we explored. I ended up visiting East St. Louis long 
before its housing was blown up, before it had become known for 
the jungle it was. The government built all this wonderful 
housing and then blew it up in recent years. It was 
intolerable, a ghetto that was a dozen stories high and solid 
with trouble. 

I was a consultant for a lot of issues--! got on other 
committees as a result of that one. Some of them were granting 
funds for mental health projects. I made the field visit to 
Lincoln Hospital in New York for National Institute of Mental 



186 



Crawford: 
Blum: 



Crawford: 
Blum: 



Health (NIMH) --the one that became so famous because the 
workers took it over. My wife was accompanying me, and when we 
got there for the NIMH annual visit for renewing the grant, the 
workers had taken over the whole place that morning. It was a 
far-out, fantastic situation. We got there early, and we were 
welcomed by some of the workers who had taken over. 

In anticipation of your coming? 

It's possible, but we never heard that. I think the takeover 
was in the wind for a long time. We got into a little old 
Volkswagen, and a black man--a big, heavy-set guy--started 
taking us around, showing us the community and all the various 
little extra clinics and things that related to Lincoln 
Hospital. Books have been written about it; Fitzhugh Mullen 
wrote a book about it. He is an important figure in the 



Clinton administration somewhere, 
physician. 



He's a fine person, also a 



In any event, it was a pretty tense day, and so we were 
kept away from the hospital for about the first half day, and 
instead looked at all the little ancillary things they were 
doing. I remember this man showing us a Puerto Rican grocery 
store on a corner, just across from a city parkthis was South 
Bronx countryand saying, "That man is a dope dealer. He's 
killed so many of our people." He said, "He has to stop 
selling drugs. We're not going to put up with it anymore. 
There he is out there in the park with his little ice cream 
wagon, and he's peddling dope. He's been warned." He said, 
"We'll bring boys in from across town, and he will be gone." 
And he was; he was killed shortly thereafter. 

Really? 

Oh, yes. They were playing for keeps. This was a community 
saying, "We just can't tolerate these parasites who are 
destroying our kids and our families." And this is a mental 
health clinic! 

Then we went here, we went there, and finally came back to 
the headquarters, and things were cooling down, and people were 
taking on duties. Some of the docs were there. 

In any event, at the end of the day, they let the director 
of the clinic in so I could see him. The director of the 
clinic was a famous psychiatrist; I'm trying to think of his 
name. He went to UCLA from New York, as I recollect. I knew 
this man because we were on many of the same committees in 
Washington, D.C. So I reminded him, "You know, when you sold 



187 



us on this project, you presented what you wanted to do here, 
and one of the things you told us was that if this were really 
a success, they'd kick your ass out of here at the end of the 
year." I said, "Do you know what? This is a year, today." I 
said, [laughter] "Get your ass out of here. You're a success." 

Crawford: That's a really charitable evaluation, I would say. 

Blum: He was really furious. He wasn't the least bit happy, but the 
truth of the matter is that there was some virtue to his 
prognostication, and to the fact that it could happen, and that 
people could run it without him for a day or two. In any 
event , I think we ended up giving them the money again for the 
next year, and the lesser staff and the patients earned the 
right to a lot more say in the operation. 

Crawford: That's great. Did you write about that? 



Funding for Navajo Projects 



Blum: No, I didn't. That was just part of the job. Then I remember 
we went to see the Navajos, who were asking us to train a few 
medicine men. We gave them the money for training medicine 
men, which lasted for quite a few years; because the 
practitioners were dying out, they were disappearing. What was 
clearly evident when you visited them was that there were 
Indians who wouldn't, for example, take treatment for TB 
without the intervention of the medicine man, and the 
physicians might not get to treat a tubercular patient without 
the family participation that the medicine man brought to the 
relationship. 

Crawford: Was that controversial? 

Blum: Well, sure, very; but I had a wonderful couple of committees 
that I was on because I was free-wheeling and didn't know all 
the rules. It looked like a good idea, and when we talked to 
the Anglo doctors out there, we could see why they wanted it. 
It wasn't just a notion of the Navajos; so many of them can't 
receive our therapy until they're all quieted down, and, of 
course, much of the medicine man's routine is reconciling 
people with their families. People don't appreciate that, but 
they bring families together. 

People whose families are split apart, and people who are 
very disturbed, are all brought together with a ceremony for a 



188 



day or a week or a couple of weeks. When the ceremony is over, 
they're kind of all together again, and now the sick person can 
go on with his or her life, or with Western medical care. 

I remember going up to this big mental hospital near the 
airport between Tacoma and Seattle and making the site visit; 
we turned over big grants to those people. Ex-patients were 
starting to do therapy on the new patients. It was kind of 
like that San Pablo thingif you got people who could relate 
to others in trouble because of experiences in common and could 
use information positively, it was possible to reach people you 
otherwise couldn't reach. 

So that was an interesting use of ex-patients, and it was 
good for them, of course. Alcoholics Anonymous, in many ways, 
is doing that. They're keeping themselves well by helping 
others. It was not all that different. There were things that 
were similar, and we were the NIMH committee that made those 
decisions. I did that for quite a few years for NIMH. That 
all started with Len Duhl and his creation, the Space Cadets. 
And that is how I became an academician. 



The Multipurpose Worker and the Rodeo Center: 1964 



Crawford: Well, we didn't talk about that multipurpose worker yet. Do 
you want to talk about your research in that area? 

Blum: Well, that was a dream, also, because part of the thinking 
about how you could help people who were unhealthy had 
something to do with how you could reach them, and something to 
do with what caused the problems. What became clear as one 
looked around the health department was that the same people 
were in trouble on multiple fronts, and our one-discipline 
professional workers didn't always reach them. 

We found that the same family had all kinds of health 
problems, endless--and was also having all kinds of probation 
problems and welfare problems. So we got to looking at it, 
wondering if we could really separate the health work from the 
welfare work from the probation work from mental health work-- 
could you really do patient care by having an army of 
specialists, each working on one aspect of a person's problems? 
You've got to put one person's problems together, and treat all 
of a person with good timing as to what is a priority. A 
multiprofessional team as a basis with one or another member 
carrying the therapy is ideal. A cross-trained professional 



189 



doing the basic work with the team in the background was our 
goal. 

Crawford: Goes way back. 

Blum: Goes way back. I mean, folks were writing about this two 

thousand years ago. We wanted to give it a practical trial, so 
we cooked up what we called the multipurpose worker; well, it 
was really a multiservice operation; multipurpose worker was a 
poor term because that got us into nothing but trouble with all 
the workers. Nobody wants to be multipurpose; everybody wants 
to be specialized. 

We approached the little community, Rodeo, because they 
were isolated. They agreed: yes, they would love such a 
service center. We said, "We'll give you a health center, and 
out of this health center will work mental health workers, 
nurses, social workers, probation workers; and the county 
services will be available to you, near at hand. We can't 
always get you what you need here, but they'll be made 
available as soon as we know what you need." 

I got an agreement from our wise county administrator to 
pull all this stuff together. We asked the probation and the 
health and the welfare departments and the school district, 
which was independent, to give us the names of the families in 
trouble that they were working on. It turns out that there 
were five extended families who were the crux of much of that, 
as is usual--a few people are taking all the services and have 
all the trouble these five families have a couple dozen 
people, and they're always in trouble. 

We asked each agency how many workers they had working on 
these families, and what kinds of workers. At first count we 
found ninety workers serving these five families over the past 
couple of yearsso you know the kind of money the county was 
spending on them. I dragged that information over to the 
county administrator- -he was a characterand he said, "Oh, 
you're crazy. It can't be. You go back and count. There's no 
way we can have ninety workers in a little town like Rodeo." 
Well, it turned out we had forgotten to count the probation 
workers. By the time we added it all up, there were a hundred 
and twenty workers . 

So I applied for a grant, and we got a half a million 
dollars , which we never really got in the long run because 
that's when I came to the university, and the USPHS would no 
longer give the county the grant when I was gone. 



190 



Crawford: What happened to the project? 

Blum: Well, it stayed on without any grants, and it worked for about 
ten years, from about 1964 to 1974. Each of the departments 
picked the worker who was appropriate, and in several cases it 
was the worker who was already in Rodeo, but in our nursing 
department that wasn't true. It turned out that our nurses 
were berating any nurse who wanted to go there, saying, "This 
is betraying nursing." 

Crawford: Kind of looked down on it as compromising? 
Blum: Compromising, yes. 

Crawford: Is it possible to do all those thingsbe an employment 
counselor, and social worker, and so on? 

Blum: No, but you can be the basic person. In other words, you're 

the primary person, and you obtain more refined expertise when 
you need it. It's like the physician world. The primary care 
practitioner can do 90 percent of it, and that was really what 
that was all about, except we weren't going to base it on 
physicians. It was based around nurses and social workers. 
The probation department had all trained social workers, too. 

Crawford: How did the doctors like it? 

Blum: I never heard from them because they still got their referrals. 
They were outside the team, you see. They got referrals; they 
did their work, and paid no attention to it, basically. But 
our workers held the families together. 

Before we got started in the field, we had a little session 
with the big shots of the four county departments and the 
school district that was involved. We pulled the five family 
cases with the charts from each agency. The very first one we 
pulled--a very small familyinvolved a girl that the health 
department knew because we had spent a fortune on her through 
our crippled children's program. She had had this done, and 
that done, and she never really thrived. She was just a poor, 
miserable little kid; she was not retarded or anything like 
that. The assigned nurse "knew all about" the case. All these 
workers from the four departments knew the case, or so they 
claimed. 

Contra Costa had very elegant human services programs, of 
which all the workers were very proud. It really was a 
remarkably good setupstill is. They knew all about the case 
that was there boasted they knew their cases. 



191 



Then welfare described the problems with the family: a 
ne'er-do-well father and a mother who was not with it, and so 
on. They verified what the nurse had to say from the health 
department perspective. 

Probation didn't want to talk. We said, "Come off it. 
This is part of your assignment. You're delegated to sit in on 
this and go to worknever mind fooling around." So they gave 
us what they knew about the case, which was a case of incest 
with this little girl, and all that the health department 
didn't know about the little girl was about the incest, and all 
that welfare didn't know about this family was the incest- -what 
was the matter with the girl, and what was the matter with the 
mother. Just shows you what you don't know if you're coming at 
it from a health standpoint or a welfare or a school or a 
probation standpoint. This was the first case we studied. 

That stopped all the nonsense, and really brought everybody 
together in a hurry because we obviously didn't know a damn 
thing unless we could see the whole case. Yet this is what the 
rest of the world still does. Nobody ever looks at the whole 
person if they can avoid it. 

We opened up the Rodeo Multipurpose Center; the citizens 
had a big meeting and told us what they wanted out of it, and 
everybody was looking kind of happy. Of course, nobody knew 
about this first casebut everybody seemed to be moving with 
the intent and the spirit of having a nearby, easily reached 
center of their own. 

We hired a wonderful secretary--a half dozen professional 
people in the office picked this girl out. She was somebody 
who had worked around the community as a secretary. Then after 
a couple of months, we commenced to get the impression that 
folks were coming in to see the secretary. This was not a new 
experience for us. We'd had this happen in alcoholism clinics 
before. She was a great gal. She could take care of many of 
the patients' problems, and then she would line them up if they 
needed expertisewith the nurse or the social worker, 
probation worker, mental health worker whoever was necessary. 
So it was this common little theme of being able to talk to a 
good human being that was meaningful to people seeking help 
with whatever kind of a problem they had- -truly one stop. 

Then the nurse and social worker in the office said, "Can 
we break the routine? Instead of asking the patient to wait 
until the right person comes back because the secretary says, 
'I think you really should see the nurse,' that whoever is in 
the office take these cases from the secretary. In this way 



192 



there would always be a professional available in the office, 
and the patient wouldn't have to come back another day." 

This was the multipurpose approach. By experience, all the 
workers were discovering that most of them could do much of the 
work for any of the cases. Our nurses knew everything the 
welfare workers did, and vice versa to a great extentnot the 
detailed health care stuff, but very close to it. The net 
result was that that's how the center began to operate. The 
secretary would see people, then would assign them to whoever 
was in unless it was clear-cut they had to go to special care, 
which was arranged. This approach changed the life of the 
center, and it really worked; it worked beautifully. 

Crawford: And you had to come into the center? 

Blum: The center was in Rodeo, and just for Rodeo residents. 

Otherwise, our offices for the people in the area were in 
Richmond, and the welfare offices were in a different building 
in Richmond; the mental healthwell, hell, they were in 
Martinez; the school people were in Rodeo. The workers came to 
the center and were available to the locals. Previously the 
people traveled to one or more of these offices. There was no 
public transportation and patients were killing themselves over 
keeping conflicting appointment times and places. I finally 
saw this Rodeo approach in real operation in Canada years 
later; in Australia; in Finland; in Sweden. 

Crawford: Before your work on the Rodeo center you gathered data on 
multipurpose workers in Europe, didn't you? 

Blum: Yes, I went to France and England and to Denmark and Finland. 
I told you about Ollie Randall. She was the Ford Foundation's 
super social work consultant, and she heard that we were 
working at putting this together in 1960-61. 

Crawford: She'd been working in the field after World War I? 

Blum: Yes. She came to visit us looked us upand wanted to hear 
about this multipurpose worker thing, and she was so pleased, 
and said, "Well, this is fabulous. You know what? At the end 
of World War I, when I was working in France, we set this up 
there." [laughter] 

Crawford: Similar thing? 



193 



Studying Health Care Systems in Europe on a 1962 WHO Fellowship 
and a Later Study of Health Care in Australia 



Blum: Same thing. By the time I finished listening to her, I 
realized this might be new for the States, but it wasn't 
exactly new for the rest of the world. So that started me, and 
I got an eight -week WHO [World Health Organization] fellowship 
in 1962 for a tour of Europe that I designed. It took me to 
places that were doing this sort of thing: amongst others, 
France, where they had really carried it a long, long way 
formally, to the point that some of their nurses were also 
trained as social workers and some of the social workers were 
also trained as nurses. 

I went to a big eight-story building in Paris, where these 
people were being trained, and part of that buildingthe top 
floorwas a nursery for foundlings. The students, who were 
getting the training in nursing and social work combined in a 
total of three years, had to take care of these foundlings as 
part of their training. So here they are all cooing and 
working with these kids, and you realize right away that many 
of the images that we have of babies are poorly conceived. 
Here are the little babies sitting in slanting kind of little 
troughs, facing one another-- just three, four, five, six months 
oldreally holding forth, you know. 

Crawford: Just conversing! 

Blum: And we supposedly know that babies don't do that, but nobody 

ever got them to try. We say babies are this way until they're 
a certain age. Well, any event, part of the training these 
people got was to take care of babies because they hadn't yet 
had their own families. Then when I went out in the field and 
got to Orleans, they took care of me, showed me the district 
offices, and I met the workers. I went with the health officer 
to lunch let me tell you, that was an affair one of the 
finest meals I've ever eaten at the railroad station. 

II 

Blum: In this setting they had these multiskilled workers. One of 

them was paid for by the railroads because there were a lot of 
railroad workers in the area. One of them was paid for by 
agriculture because there were a lot of farmers, and another 
one was paid for by the health services, still another was paid 
for by some other agency. They all worked out of the same 
office, but the only difference was that if you were a railroad 
worker, you went to the one that was paid for by the railroads. 



194 



The workers were hired and paid by the source of pay, but 
each covered all the bases; they did the health, welfare, and 
mental health kinds of things. That was kind of shocking 
because the professions wouldn't let you get away with that in 
the States. These workers knew one another's business, they 
knew the community inside out, and they covered all the 
servicesnot like that mess I told you about where innumerable 
visiting workers from three separate agencies never knew 
anything about the troubled little girl who was a victim of 
incest, a well-kept secret by the social workers in probation. 

I went from there back to Paris to see the national head of 
the nursing-social worker operations. There was a lady in 
charge and she spoke English, thank god--and I said to her, 
"Where are all the agreements that hold this together? Here's 
workers from four separate organizations, all working side by 
side, taking care of folks in Orleans." "Well," she said, 
"that's very simple. There's really not much to that. Our 
organizations just made up their mind to do it." She pulled 
open a file drawer, picked up about three or four inches of 
files and said, "These are all the agreements for France about 
who does what." You know, in the United States, it would be a 
thousand tons of agreements. 

Crawford: Why? 

Blum: Because every health department goes its own way. Every 
welfare department in every city and every county does 
likewise. In France a lot is settled at the national level. 1 
couldn't get over itthese files covered all the agreements. 
Well, if I'd never seen the workers, I'd say it was probably in 
their minds, but when you see them at work--. 

From there I went to Finland, and I saw comparable things. 
It's more on a village-by-village basis in Finland, and less 
well organized in Helsinki. From there, I went to England to 
see the combined human services, which weren't combined very 
well. I remember visiting a home in Oxford, and the lady had 
to contend with about twenty home visitors, just like here. 
She was complaining to me as an outside person about the 
fantastic imposition of all the home visitors on her time. But 
England had more services than the rest of the world has ever 
seen. We never had services that good or inclusive, but one 
can't inflict them all one by one through innumerable 
specialized workers on one poor lady who has a couple of little 
kids and no husband. They were driving her crazy. You've got 
to report to a clinic at this hour, but at the same time you've 
got to be over there for something else; and nobody's paying 
any attention to the real needs of the person. 



195 



Crawford: 
Blum: 



Crawford: 
Blum: 



This was just the opposite of our Rodeo situation, or the 
French situation, where you were put in the hands of one person. 

In Finland, they got away from that pretty much. A single 
public health nurse would be in the community and in the 
schools, and would be doing the social work and covering all 
kinds of human needs. She worked as part of a team with the 
local doctor who did part private fee-for-service practice and 
part public health, caring for everyone in his area. 

In Denmark, in those days, and this was in the sixties, 
people didn't trust social workers, because the ethos of the 
Danish people was that you ought to do these things for your 
family, friends, and neighbors. They didn't want professionals 
coming in to help a family because the people in the community 
should help one another. The health workers were specialized 
enough so that they were okay. Denmark had a very interesting 
family practitioner and public health nurse team in every 
little community. Social workers were a late arrival on the 
scene, because people said, "Shouldn't we be doing this 
ourselves?" As I learned--! spent quite a bit of time there- 
one of the biggest threats you can make to a professional was 
that "I'm going to commit suicide," which really was a threat 
to the family and neighbors as well; it said, "Everybody's 
failed me." 

They do have a high suicide rate. 

Yes, the highest in the world. And this was probably a way to 
vent their hostility. They had no murders. When I was there 
they could remember only one murder five years back on the 
Copenhagen waterfront, but suicidesyes . This also was a 
nasty threat for psychiatrists, even those who had been trained 
in the U.S.; they got shaky about their professional competency 
or caring when somebody threatened suicide. There are major 
different cultural things that have to be taken into account; 
quite fascinating. 

You wrote up the visit. 
Yes. 1 

I'm going to follow this set of concerns forward over 
several decades because of the theme of multiservice care for 
persons, families, and communities. In later years I got to 



"'The Multipurpose Worker, A Family Specialist." 
Public Health, 1966. 



American Journal of 



196 



Crawford: 
Blum: 



wandering around the world for other reasons and found many 
different human services and some beautiful examples of 
combined services, well-coordinated teams, and multi-cross- 
trained workers. Under the cross-training rubric there should 
be a lot of educational effort put into creating multipurpose 
human-service workers as a result of the economic pressures 
posed by HMOs. Maybe it's going to start. 

In Australia rather recentlyin the 1980s it turns out 
that there were several physicians who had escaped from South 
Africa, a family that had been involved in the world's really 
pioneer community-oriented primary care (COPC) with the Zulus, 
saying you can't provide health care just in the way you were 
taught in medical school; it's got more to do with who the 
people are than with who you are. You've got to pay attention 
to religion, to customs, to the social, economic circumstances, 
and to the community and the individual that results. It was 
community- oriented primary care it would take the community 
into account. Who are these people? The key figure was Sidney 
Kark. When South Africa became intolerable he went to Israel- 
took his ideas there. He had two cousins who were family 
practitioners also, and they went to Australia. One cousin was 
Sidney Sax. 

It turns out that in years gone by, Sidney Sax had been a 
visitor here about the time we built our home. I took him home 
for something or other, gave him some sherry, we sat and looked 
at the view together. When I went to Australia for two or 
three months, some fifteen years later, people hooked me up 
with various people to visit, and he was one of them. When I 
got to Canberra the national capitalhe really took over and 
we went everywhere; he did everything for us. I finally said, 
"I don't see why you should do this." He was the head of the 
Institute of Health and Welfare. He said, "Well, you did it 
for me fifteen years ago." [laughs] 

And you had forgotten? 

I'd forgotten. He said, "I remember sitting in your living 
room"--then it commenced to come back to me "sipping sherry 
and looking at the beautiful world." Australia had had what 
they called a Liberal government, meaning anything but a 
liberal government, for years and years and years. Then Labour 
came in in the early 1970sa Labour government --and they came 
in on a promise of universal health care, which Britain already 
had, you see. It was another world- -not like here. Sidney Sax 
had been picked to be the Minister of Health and Welfare [by 
Labour] , but they figured that he would be shadow minister in 
the British tradition because they could never win the 



197 



election. Well, they won the election, and the first night 
they were sitting there in Canberrathey're in. 

The new prime minister said, "We ran on a platform of 
health care for everybody, Sidney. When can you have me a plan 
for the works?" He replied, "In six months, nine months, we'll 
have it all laid outeighteen months." And the prime minister 
looked at him and said, "Eighteen hours . I want it tomorrow." 
And they did it. You don't have to work out all the goddamned 
details. 

Part of what they did was to offer funding for multihuman 
service units in every state in Australia; multihuman service 
units including health, as well as universal health care. 
There was money for it. Every medical school in Australia was 
forced to have a unit of social health planning, and Sidney 
just sat down and cooked it all up essentially overnight. He'd 
had this wonderful background in South Africa, thinking about 
people as whole persons who were a part of a community. 

Crawford: Where it had worked. 

Blum: Where it had workedwith very disadvantaged people, to be 

sure. So every Australian medical school does have a social 
health department to this day. 

Crawford: It's a good system? 

Blum: For medical school? Yes, it's imperative to know something 

about human beings and the relationships between them and their 
society. 

Crawford: Does it work out in the communities? 

Blum: The Labour government only lasted a couple of years because 
they didn't carry the upper house- -the equivalent of the 
British Lords. And that house had, in Australia, the authority 
to sign off on money bills, so the lower house, which Labour 
carried, put all these programs into place, and the upper house 
wouldn't fund them. 

After a couple of years, government debts were mounting 
the money wasn't being voted, you see. So the conservative 
people in the government appealed to the Governor General of 
Australia, appointed by Her Majesty, the Queen of England, 
saying, "You've got to do something about this." This business 
of being a Commonwealth country is not without its interesting 
angles. And the Labour government was turned aside; the 
government was handed back to the Conservatives. If you keep 



198 



current on Australian politics you will hear about this episode 
as part of the reason Australia will probably be leaving the 
Commonwealth soon. 

But overall it was a tremendous new program. To be sure, 
many pieces of it fell apart, but I was there ten years later 
and there were still many of these community health centers. 
Some of them weren't called that, but they were multiservice 
centers providing for all kinds of services in one place with 
an integrated team of human service specialists. 

One of them was a fantastic operation in Adelaide- -until 
you see it you can't believe it--in a newer part of the city, a 
working man's community with a lot of poor people living in 
government housing; a lot of women and kids with no husbands; a 
huge, beautiful new pair of schools. Tied to the schools are 
the service arms of the community. So here's a library, but 
it's also the health library, and welfare library, and the 
nutrition service. There's a swimming pool; there's a gym; 
there's all this available to the community. It's not just a 
school. There's a physician, nurses, social workers working in 
this center. 

Then I went to one further out from Adelaide , known as 
Friendly Farms. I met the doctor who started it--he'd 
graduated when the Labour government came in. The community 
had been built up to house the workers at a huge new auto 
factory at the periphery of Adelaide. It was not very 
successfulbig layoffs ultimatelyand a lot of poor people. 

This doctor was fresh out of school with a tiny office, 
about eight by eight. He came there while business was still 
booming. What he discovered was that people kept coming for 
care, but they really were mostly disoriented. They were 
newcomers to Adelaidethey 'd come from other parts to get 
jobs and they were just having babies, and new families, and 
were having a hard time getting their lives together. 

Every night he had classes, talking with people who had 
similar problems, and this is how his practice started. 
Instead of giving them more pills and more vitamins, he was 
looking at the social, human, economic, health side of the 
whole thing. He was a remarkable physician, and his practice 
went like wildfire. 

The next thing you know, he had a building, and then he 
hired a social workerand this is a doctor, you see, and he's 
not going to get money out of it because it was all paid for. 
It's not the usual use of medical social work as we think of it 



199 



Crawford: 
Blum: 



in the U.S.A., which is to get dollars out of people's pockets 
to pay for services, which is what happened in the hospital 
business, or get them out when it's time. This was the real 
thing to help people. He had mental health workers; he had 
public health nurses, and this is a private practitioner. This 
was not government. True, government was underwriting all the 
human services, but he was putting them together so that a 
patient's needs were understood and met, no pills for worry, no 
surgery for worry-produced bowel distress. 

We visited this center. It was a big, beautiful plant. We 
got there, sat around and chatted with him, and he brought in 
his head administrator, who used to be the superintendent of 
schools a fairly young man. Much of his training was in 
bringing people together, and they were teaching one another. 

This man had taken over as the doctor's majordomo, his 
administrator. But when we were there, the auto industry was 
dying in Australia and, at this time, he said that it was very 
interesting that they still had all these classes, and patients 
groups still met with the doctor, but they had a whole 
different set of problems now. The kids were growing up, and 
some of them were starting to go away to school; some of the 
families were breaking apart, and there was a whole series of 
new social phenomena that were making these people want to see 
the doctor, and they were now dealing with new social 
situations, but still on the basis of working things out 
together. This was covering the bases. Fabulous! 

When did you first see this? 

That was late, already, fifteen years after Rodeo. Of course, 
in Canada you'd see things like that. In '77, I had a 
fantastic year--I took a sabbatical. Went across Canada seeing 
multiservice clinics all the way from Vancouver Island, where 
they had some wonderful clinics with hundreds of volunteers 
right near the Empress Hotel in Victoria. It's in an older 
neighborhood, a nice neighborhood, but there are a lot of old 
people, a lot of problems. They had this joint clinic with all 
kinds of services and a couple hundred volunteers and were 
servicing all kinds of people. Most of the servicing is not 
straight health care such as would be reflected here in terms 
of pills, and surgery, and doctors visits. There it was 
concern for loneliness, for some Alzheimer's, and some this, 
and some that. Also, a lot of hippies had moved into this 
neighborhood as it was getting old and less expensive, and they 
had very different demands. They had drug problems, growing-up 
problems, which, again, are not medical in the usual sense. 



200 



We got to see it all operate, and to see how apartment 
house people worked it out with the clinic. They would call on 
the clinic if they had problems of any kind. In return, the 
clinic would notify apartment house managers and say you've got 
somebody there that you've got keep an eye on. It was just a 
marvelous cooperative venture of a health clinic with all 
elements of the community. They had a large group of people 
who by means of a health clinic were concerned with other 
people's problems. 

Studying the diverse approaches taken in Australia to 
provide health care, much of it started under the brief tenure 
of the Labour government, brought us to Alice Springs. It's at 
the very center of Australia and home to a very large 
Aboriginal population. As in much of Australia, the 
Aboriginals were just sort of tolerated here, a kind of 
subclass, enjoying more nearly the status of our American 
Indians where there are significant numbers of them, rather 
than the more formal disadvantaging offered our black people. 

Their culture is also more nature- and land-based, with no 
corporate or individual ownership of land, farms, not unlike 
our Indians. In fact, when we were there we had just followed 
a Navajo delegation interested in learning about this 
particular Aboriginal health center's activities. 

It had been founded over a half dozen years earlier by a 
professor of medicine from the University of British Columbia. 
The doctor currently in charge was a young Australian with half 
a dozen kids who very much wanted a public health degree from 
UC Berkeley, but couldn't afford to get away. 

On the day of our visit, the founding doctor, who had gone 
on to create a medical school in New Guinea, had come back to 
see how things were doing. We sat together for most of a day 
and heard a wonderful story. 

The Aboriginals with their Canadian doctor had gotten a 
grant from the national Labour government to start a clinic and 
had gotten involved in doing all the things that they thought 
were good for their health. After getting the doctor and a 
nurse they had branched out and set up a small bank of their 
own because they didn't trust the big ones, probably wisely so. 
This was done because as they came in from their station jobs, 
they soon wasted or drank up all their money because they had 
no place to keep it and no use for it. 



201 



Another early step was the creation of a pharmacy in the 
clinic so they could get what was prescribed without getting 
robbed or insulted. 

Another step of a major sort was their creation of a radio 
station, which soon served many purposes. It taught English to 
the huge Aboriginal population within its thousand-mile radius, 
the heart of Australia's Aboriginal population. By popular 
request it branched out into educating about cattle raising for 
cattle stations and their workers, which were generally 
Aboriginals who were becoming stockmen. The station did 
cultural things, news and whatever Aboriginals wanted. 

In one of our excursions we visited and ate at a huge 
cattle station, were cared for by Anglos but saw many 
Aboriginals about. It turned out that this and an adjacent 
station were now owned by the Aboriginals who operated the 
health center and were learning how to run it from the Anglos, 
as well as raising cattle. 

With their savings they bought the ranches from Anglos who 
could no longer make a go of it with their jeeps and airplanes. 
The "Abos," as they are usually called, lived with their stock, 
moving them for food and water as they had always done for 
themselves. They were earning money and buying back their 
land, and learning about ownership, which had never been part 
of their lives or culture. 

The health center brought in a lawyer to look after the 
legal needs. Arrests in Alice Springs were primarily an Abo 
phenomenon even though these people were a minority. 

Before a year was out, their arrests were less than 10 
percent of the total because the lawyer looked into each arrest 
and the fun was over for the Alice Springs police force. 

The Abos had had houses created for them, simple affairs, 
which they had no intention of occupying, as they preferred 
living outside in a simple shade-providing structure. But 
their kids were being disadvantaged by their non-dwelling 
lifestyle. The health center took charge of two schools which 
served primarily Abos, arranged for showers, laundry, meals, 
health care, and a couple of school buses to facilitate 
covering their needs and education. 

The health center also serviced anyone, as well as being 
free for Abos. A little sign at reception said, "Please pay 
what you can." There were backpacks scattered around as this 



202 



was a stop for mostly college students from the States or 
Europe. 

As we were there, an Aboriginal man came in for his follow- 
up visit. He had been hit by a car a few weeks preceding and 
had been taken to emergency at the adjacent, beautiful, new 
community hospital. He spoke no English, was cursorily 
examined, and sent away. 

Fortunately, he stopped by the clinic, where they saw that 
he was leaking cerebro-spinal fluid from one ear, an absolutely 
diagnostic sign of a skull fracture and a dangerous one as it 
meant there was an open passageway for infection to the brain. 
The doctor had picked up the phone, gotten the M.D. in charge, 
and the patient was promptly admitted. This was their special 
duty, keeping an eye on the quality of care at the community 
hospital, and forcing it to change its practices for the 
better. 

Some health center, was all I could think. When I asked 
the founding and the current doctors what was their purpose in 
making this the kind of a health center that was relevant to 
the lives of the Abos, they immediately chimed in, "We want to 
give them a breathing spell, to decide do they want to join in 
with the Euro lifestyle, and if so, we will help them come in 
with a more nearly equal chance of succeeding, or do they want 
to go back to their walkabout, communal-pastoral-desert 
lifestyle? We'll help them in whatever they choose. The 
health center is the logical place from which to help the 
Aboriginals navigate the never-ending social changes which 
determine their well being." 

Marian and I had to go to the center of Australia to hear 
this, spoken as it never would be anywhere else, at a health 
center . 



Birth Control Programs and Governor Pat Brown 



Blum: There were other interesting things that happened in Contra 
Costa. Did we ever go through birth control! When I first 
came to the Contra Costa health department, maternal and child 
health was a big thing. One of the things that you had to 
offer if you were going to be serious about maternal health was 
birth control; some women shouldn't be having a child at one or 
another time in their lives. 



203 



But no government agency west of the Mississippi or north 
of the Ohio ever did birth control, apparently. It was done in 
the Southand for a good enough reasonby nice white folks 
who meant well by serving nice black folks. However, it was an 
intolerable idea out here, particularly wherever Catholicism 
was a significant force, or thought to be. 

We thought , There ' s no use running an MCH program if we 
can't do the most important things, which for some women, 
certainly as far as sparing their life is concerned, just might 
be birth control. Big families that are in a disaster mode 
can't keep adding babies every year just casually. 

We sat down and worked it through, and decided that, yes, 
we would undertake to provide birth control as part of the 
maternal and child health program. We created what we called a 
"white paper." Dr. Yoshiye Togasaki did the homework on that. 
As I've said, she was my classmate from Harvard, a pediatrician 
now full time in the health department. She developed a white 
paper which was based on some very ethical principles. 

For example, if you knew that somebody needed this service 
and the only thing between you and providing it was doing 
it there were no laws against it, just an unwritten political 
law that government shouldn't be involved. But if you're 
really playing the doctor and advising a woman about her health 
and her survival, maybe you'd better worry about the things 
that were relevant to her survival, such as birth control. 

Then our white paper went further to point out that any 
other woman who had money and didn't depend on the health 
department for services could and would get such services 
privately, so there was nothing terribly immoral about it. It 
was just that if you had money you could have this necessary 
service, and if you didn't, you couldn't because you depended 
on the health department. The white paper took the moral stand 
that poverty should not be the determinant of risking death or 
of ensuring life. 

We hauled it around to the California Conference of Local 
Health Officers, and got approval with the exception of one vote 
--the Catholic health officer of Santa Barbara County, which had 
a big Catholic population even in those days. It would probably 
be the early sixties when we finally brought it off. 

The Conference of Local Health Officers a legally 
constituted entity adopted the white paper as its policy. But 
there wasn't anybody going to do anything about it. Then we 
passed it on to the California State Board of Health. In those 



204 



pre-Reagan days, early to mid-sixties, it was a very powerful, 
independent body, like the Regents are supposed to be; they 
were appointed by the governor and the legislature. It was 
really a state board of health. It was among the best of the 
state health boards and really had a lot of power. There were 
always powerful representatives on it from the California 
Medical Association. To be sure, they didn't always see eye to 
eye with non-physicians about public health measures, but 
generally speaking they did do what was best for Calif ornians. 

I remember the last chairman of the board was Roger 
Eggeberg, who was dean of the medical school at USC and 
subsequently chief of medical services for Douglas MacArthur. 
He was a wonderful guy, a huge manhuge in spirita good 
mind. The state board adopted our white paper as California 
public health policy. However, it didn't motivate anybody 
except us. We got Planned Parenthood to set up our first 
clinics for us because we had never done a birth control or 
family planning clinic ourselves. 

Crawford: What was the format of the clinic? 

Blum: Oh, it was a straight health department clinic. Public health 
nurses were the mainstay of the health department; they 
referred people into various clinics: ours, others, even over 
to the hospitals in Berkeley or Oakland, even San Francisco or 
wherever, if necessary. In our clinics we hired physicians to 
do the medical work, the nurses and volunteers assisted and 
educated the patients at each clinic session. 

Crawford: Was it an aggressive program? 

Blum: I would say it was. If a public health nurse thought that one 
of the people she was assisting needed family planning, she 
would refer her to one of our clinics. Planned Parenthood 
provided staff from their Oakland office to come and train our 
nurses in our own clinics. Some of our people may have known 
all about the procedures, but we hadn't done it ourselves, it 
was not something that we regarded ourselves as very expert at. 
Just the other day I was with one of the people who remembered 
how she'd come to help us in Contra Costa County. 

As helpful as they were about helping us set up, Planned 
Parenthood said, "Why don't we come in and do all the clinics 
for you?" I really could see the end of the program in a hurry 
because if they offered to do it, then the county would never 
do it. But we knew that if they had one clinic in Oakland, 
they weren't going to have much more in Contra Costa; they were 
going to meet a tiny fraction of the needs, and keep us from 



205 



doing the job. Yet it would give our board of supervisors an 
excuse to avoid taking on a hot potato, but what a lousy excuse 
it would be. We ultimately had about twenty clinics monthly in 
different parts of the county. 

Crawford: And why would that be in Planned Parenthood 's best interest? 

Blum: There was nothing evil about their intentions. It was just 

part of the "good work," as seen from their standpoint. From 
our standpoint, it was just a way of ultimately keeping us from 
doing the size of a job that was needed in our county. 

They finally quieted down and taught us how to do what they 
knew very well. They created a very superb service. One of 
their board got us a grant to get started from an unnamed, 
numbered bank account in Switzerland. You might say that we 
were sent a gift of birth control services. 

Crawford: Who was that? 

Blum: I don't know who created it. I would guess it was a woman. I 
think it was a Dr. Smith, associated with Children's Hospital 
for years and years, who worked for nothing down there, and 
gave her whole life to kids. I don't know that it was she; I 
have a feeling that it was. 

In any event, we had some money to get a few extra things -- 
whatever was needed. We got training materials and patient 
education materials and we started. The first clinic we 
started was way out in the Brentwood area, in the eastern 
county, which was almost entirely rural in those days. 

Crawford: Largely Hispanic? 

Blum: Not remarkably Hispanic. There were people there from Arabia, 
mostly a lot of American agricultural migrants settling out. 
It was just all kinds of poor people. These were people still 
settling out from the Dust Bowl and working in agriculture. 

We got our referrals, initially, mostly from a Catholic 
priestwhich we thought was a good idea. He was quite pleased 
to send us people that he thought needed the services. The 
three doctors who serviced our clinic were wonderful. One of 
them was an ex-Catholic, one of them was a practicing Catholic, 
and one of them was a Jew; they were partners. They were 
superb people. One or two of them are still left in the 
community on school boards and city councils. They do 
everything. They're people-oriented. They were family 
practitioners, and they had one of these Sears & Roebuck 



206 



Crawford : 
Blum: 



Crawford: 
Blum: 



offices. Sears & Roebuck had, at one time, put out loan money 
for offices for doctors who would go into truly rural, unserved 
areas . 

We gave them the optionthey could run our clinic in their 
office or we would set up a clinic. They thought it would be 
better in their office. It would be simpler for them. They 
had their routine, their people, and everything. 

They were also doing well-child clinics for us. They were 
true general practitioners. In fact, they ultimately took one 
of the students from the first class here in the medical school 
at UCB who had to do a month of field work of that sort as the 
students started in the first year of our medical school. 

I remember that their office billed us for their services, 
but they had to do it on county forms, and I remember them 
asking, "Couldn't we skip the county forms? Why can't we bill 
you on our forms? You're setting the stage for our staff to be 
snooty about these customers who come with county forms, while 
our private patients just come in. We don't need to set the 
stage for discrimination in our office." This was very 
atypical for physicians in those days, and we were proud of 
them for their sensitivity. 

To be sensitive in that way? 

Yes--their attitude of, "Let's not add any needless problems 
for these folks; these folks have got their share of problems." 
I thought that was marvelous. 

So, we had a Catholic referral source a priest of a local 
parish and we had these docs, two of whom were Catholic. It 
was really a nice operation. It was made clear by us to our 
nurses that if they didn't want to work in a birth control 
clinic, they didn't have to. There were certain of the nurses 
for whom that was not a happy prospect. 

Somewhere about this time, a man by the name of Weingand, 
who was the state senator from Santa Barbara County, heard 
about this, and he had introduced a bill this was in Pat 
Brown's time- -which said that health departments had to do 
birth control. Weingand was very interesting, and a wealthy 
man. He and Ronald Colman--do you remember that name? 

Yes, I do. 

A movie star were partners in Rancho San Ysidro, just outside 
of Santa Barbara. 



207 



Crawford: San Ysidro? 

Blum: San Ysidro. That's the one that John F. Kennedy and Jacqueline 
had their honeymoon in. 

Well, he introduced the bill. We weren't totally secretive 
about what we were doingwe just didn't advertise it--but 
first thing I know, Weingand asked if I would please come up 
and testify at a legislative hearing in Sacramento. 

We got to the hearing, and everybody was there: cameras, 
reporters, everybody. There was a Catholic legislator on this 
committee and he didn't want the trouble of having to vote yes 
or no, so he started out on a clever tack. He said, "Doctor, 
is there anything in the California state law that you are 
aware of that would prevent a health department from offering 
birth control services?" Well, he certainly had me in an 
interesting spot, since we were doing it already on a huge 
scale all over the county. I said no, of course not. 

Crawford: Was the nature of this investigative? 

Blum: No, no, this was not an investigation, this was a hearing on 
Weingand 's bill requiring all health departments to provide 
birth control services. 



Crawford: 
Blum: 



He repeated himself, and I said, "No, absolutely not. We 
know that's the case. We investigated it totally." So, this 
committee member turns to the committee and says, "Mr. 
Chairman, I move we table this bill. There's no point in it. 
There's absolutely no reason we have to deal with this bill 
since health departments can offer birth control services now." 
Everybody on the committee was so glad to get rid of it, they 
tabled it. That was the end of the bill. 

That was in the morning in Sacramento, and at noon, the 
Contra Costa County Health and Welfare Federation was holding 
its annual meeting of about 450 guests and members in Concord 
at the Sheraton. I was president of that organization, and our 
guest speaker was the head of health and welfare for Pat Brown. 
Winslow Christian was a lawyer, and became a well known judge 
afterwards. He was a Mormon, and a very lovely man. He 
helicoptered down, and I drove like mad to get back in time. 

Luckily it was in Sacramento. 

I got to Concord, and didn't know what else the future held 
because the Sacramento hearings were the first news to most 
people in Contra Costa that we ran birth control clinics. 



208 



Crawford: Well, you weren't trying to keep them quiet? 
Blum: No, but we weren't making an issue of it, either. 
Crawford: Did you anticipate some trouble? 

Blum: Oh, we anticipated plenty of trouble, and that was the reason 
for the white paper, and getting it adopted by the Conference 
of Local Health Officers and then by the State Board of Health. 

We sat down to our meal, and Winslow Christian said, 
"Doctor, do you have any feelings about what 1 talk about?" I 
said, "Oh, no. We asked you to bring what you at the state 
level thought was the most pressing business here." There were 
some members of the press there too, of course. This was a big 
gathering of all the elite Contra Costa County folks. He said, 
"Well, the governor and I talked about this, and we are going 
to present this statement about birth control and family 
planning." And it was our white paperthe one that we had 
created in Contra Costa several years before. He said, "This 
is the governor's official position; this is my position; and 
this is where we go from here. This is service we expect every 
health department to offer. We don't need any new laws." 

As an aside, people probably don't remember, but Pat Brown 
was always a good Catholic. Pat Brown even got remarried in 
the church just a couple of years before this happened, because 
he'd had a civil marriage originally. So you know that he was 
a serious Catholic and making a point of it. Here's his 
ministerthe Secretary of Health and Welfare who" s a Mormon 
and supposedly more apt to talk about procreation than how to 
avoid it. 

When I got back to my office about two-thirty, every 
newspaper in the country wanted to talk to me. This was really 
a big deal. I called the Richmond Independent first because 
that was our lousy, local, little paper and it was a lousy 
little paper. The reporter whose call I was returning was a 
fellow by the name of Archinal. He was a mean little cuss, and 
I'm sure if he's still alive, he hasn't improved any. He said, 
"Doctor, did you clear this with the Archdiocese in Oakland?" 
I responded that I'd never thought of that because I'd never 
worked for the Archdiocese, I worked for the people of Contra 
Costa County. He was looking for some vulnerable point. 

Well, at that point the Richmond Independent was already 
out with foot-high headlines: "Health Officer Admits Operating 
Birth Control Clinics." So you can see that we weren't wrong 
in anticipating trouble. I said, "Why don't you clear it with 



209 



Crawford: 
Blum: 



Crawford; 
Blum: 



the Archdiocese and find out what they have to say? It would 
be interesting." So he did. 

This was national news? 

Yes, and especially the Chronicle, the Examiner, the Tribune- - 
the big local papers. We got visibility, to put it mildly, and 
here's this Richmond Independent trashing us. 

The next day there was a full page in the Richmond 
Independent on what the Archdiocese had to say about it. We 
read that page, and it listed all the sins that we were 
committing. Well, I think we knew them just as well as the 
Archbishop because we had studied the ethics book from the St. 
Louis Catholic University Medical School, and much of that book 
was on birth control. We had studied it before we wrote the 
white paper and countered all the issues that they raised, most 
of which were irrelevant from my standpoint of social justice. 
The Archbishop of the Oakland Archdiocese ended up saying, "The 
Archdiocese plans no action at this time," and that was the end 
of it. 

Before many days were over, health departments all over the 
country were in the business. It wasn't bad, you see, but 
there still were a few states that had laws against 
disseminating birth control information. 

Can we endorse programs abroad at this point? 

Oh, we spent more money on that than we ever did internally. 
We had been doing this work all over the world, but we had 
different eras of being for or against it, depending on who was 
president and who's singing the loudest. In this country the 
result to allow sale of birth control devices started in Boston 
and New England years before, when you couldn't even buy 
contraceptive materials in drugstores. That was a real late 
development in this countryit was mid-century. Although the 
ban on contraceptives was taken off the books in most states 
before 1960, it just wasn't offered in public agencies. If it 
was, it was done surreptitiously. So we broke that taboo which 
only discriminated against the poor. 

Then I went on the circuit, I was invited here, and invited 
there to talk about it. One of the first places that I was 
invited to was Santa Barbara because Santa Barbara, as well as 
being a strong Catholic community, is also a very strong New 
England-Protestant community with summer homes of very, very 
wealthy New Englanders. There is a regular Protestant social 



210 



roster down there in Santa Barbara, and some of these people 
were very pro-family planning. 

Crawford: That's interesting, because it's such a conservative place. 

Blum: Oh, yes, but not about birth control for the Protestants. The 
real wealth in that community is the Eastern wealth, old East 
Coast wealth, Protestant wealth. 

So I was down there first thing. We stayed in that San 
Ysidro Ranch as a guest of Senator Weingand and we were treated 
like royalty. The first night we were there, we went to their 
famous restaurant with big adobe wallsit was historically 
used to keep the lemons cool when they picked them on the 
rancho; but now it's a fine restaurant. 

It was where he invited us, and we had a beautiful meal. 
He said, "I should tell you something about what you've been 
through." Here I thought I 'd been through it and we had 
figured all this out. Well, it seems that he and Pat Brown and 
his Health and Welfare director had dinner the night before 
those hearings. So I wasn't really in the middle of putting 
all this together at all, I was just a tool. [laughter] They 
had decided that the thing to do was to use these hearings to 
get an airing of the issue, but irrespective of how they turned 
out, they knew that that new law wasn't required. Weingand was 
just doing it to force the issue. Then, since the Secretary of 
Health and Welfare was speaking in Contra Costa on the same 
day, he would trot out our policy, just get it all over at one 
big bash. Moreover, the inconclusive hearings at Sacramento 
took the edge off the issue while the governor's statement at 
the lunch in Contra Costa County got the policy out with a 
minimum of fanfare. 

Crawford: This was all rather elaborately orchestrated, then? 

Blum: Elaborate, and I'm the thing being orchestrated. [laughter] 
My wife and I sit, listening to this, and you don't know 
whether to feel foolish or smart, because you're very clearly 
just a pawn, but a useful one by being the first in the 
business when the risk was still high. 

Crawford: Well, they probably chose the right man, then. 

Blum: Yes. I knew Pat Brown fairly well and it was he who appointed 
me to several statewide commissions before that. I hadn't done 
many political things, so I wasn't startled, you know, but for 
a Catholic to take that kind of a risk and to use a Mormon to 
do it is really so damn subtle. They really killed the 



211 



opposition cold, but took the chance of killing themselves, 
Laudable governance at the least. 



Crawford: Well, he didn't worry about that, 
admirable. 



I think that ' s rather 



Blum: I loved Pat Brown, he was all right. But the net result of all 
of that, really, I haven't yet told you. Everything subsided, 
and my board of supervisors is sitting there, aghast. Four of 
them are Catholics, the county manager is a Catholic, and the 
fifth board of supervisors member is in a Catholic district, 
but isn't a Catholic. So he's the most vulnerable of all. How 
do you like that for a potentially stacked deck? 

The next budget hearing was coming up, and this time in the 
budget we had lines showing what the stuff was for. In the 
past, we really lumped like things together, e.g., drugs, 
instruments, personnel hourswe didn't specify everything by 
the purpose it was to serve. This time they had told us we had 
to specify. That was the game. So if anything about birth 
control would show up as such, they could knock it out with a 
scratch of a pencil. 

I went to the finance committee meeting of the board, with 
the Catholic administrator who had only two children and didn't 
mean to have any more. In fact, none of the board members did 
either. [laughs] But business is business. They said to me, 
"Doctor, you have to knock this out all the birth control 
items." And I said, "Look, you're the ones that asked for the 
itemization." They said, "Yes, but we just can't have this in 
the budget." I said, "It seems to me that you had better not 
knock this out because I have a feeling that at least a 
thousand people will descend on the boardroom the day after you 
knock it out. You'll be lucky to ever go home. It might be 
five thousand people." These are the realities, and if they 
didn't understand these things, I thought I'd better explain 
them. 

They said, "Oh, gosh, Doctor, we treat you real good, don't 
we?" It's a whole new line of reasoning. [laughs] I said, 
"Yes, you're very fair, and I have nothing to complain about 
really. I can't complain at all. You're a good board." Then 
they said, "We're very generous, really, with the health 
department, aren't we?" I said, "Well, I guess you could say 
that. You don't cut stuff out willy-nilly, and so on, yes. We 
don't ask you for much fancy stuff, but we surely ask you for 
things all the time." The budget was getting big, in spite of 
our attempts to hold it down. They said, "Well, let's cut 
these birth control items out, and then you do what you damn 



212 



well please about which categories you dip into to do your 
birth control work." 

Crawford: Call it something else? 

Blum: Don't call it anything, just cut these labeled items out, 

they'll disappear, and our budget could take it by skimping 
here and there. It wasn't that much--maybe twenty-five 
thousand dollars. 

Crawford: Were you still operating with the Swiss money? 
Blum: No, that was just chicken feed, long since gone. 
Crawford: That had been used to set up the clinics? 

Blum: Yes, that was just to get started. I think we may have paid 
that to Planned Parenthood because they had to pay the salary 
of their people to come and work with us. So I said to the 
board, "This time we'll agree to knock it out, but don't think 
it's going to be knocked out again." So the next year, there 
it was all the birth control items, and nobody said a word. 
It was past history. 

Crawford: It was a line that clearly defined it as birth control? 

Blum: Oh, yes, birth control supplies. 

Crawford: Did it ever stop being sensitive? 

Blum: Yes, that was the end of it, really, the end of it. 

Crawford: It was publicly approved by even the church, tacitly? 

Blum: Tacitly, the church hadn't said, "God bless you," but, yes, 

that was all over. I'll come back to the payoff for me when I 
get into our move to Berkeley. 



Elizabeth Jolly and the Crippled Children's Program 



Blum: In the 1960s the health department hired Elizabeth Jolly, a 

young M.D. with a degree in public health, to run its Crippled 
Children's Program which provided specialist medical care and 
therapy services for children with disabilities. It enabled 
people to get what were very expensive services irrespective of 
what they could afford. The position involved arranging for 



213 



and then approving medical, surgical, and therapist care. 
Doctors were a major source of referrals, and our own doctors 
and the public health nurses found cases in the course of 
visiting homes, new arrivals, and PTA and other school-based 
health activities. 

This was obviously a very expensive program, but it rebuilt 
hips, overcame disfiguring head and limb and internal organ 
abnormalities. It also provided ongoing clinics staffed by the 
best Bay Area specialists for kids with heart and other long- 
term serious diseases and congenital defects. Dr. Jolly 
inherited the program from a fine public health-trained 
pediatrician who remained full-time with Maternal and Child 
Health, since the child population was literally doubling in a 
decade. At the end of her first week in the Crippled 
Children's Services (CCS), she made some interesting 
observations. She asked me to come by and look at the caseload 
with her. She took the file card for each case (this was 
decades before computers) and put them in three stacks. One 
was about four inches high, one about two, and the last one 
about one inch high. She explained that these were sorted by 
whether the case was almost certainly genetic in origin, likely 
but not certainly genetic, and clearly not genetic, such as 
trauma, burns, poisoning. She asked me to guess which stack 
was which. I only remember that I was totally wrong and that 
the big stack was genetic and the smallest one was not genetic. 

On the genetic stack she then showed me several families 
that had more than one child with the same condition, some 
truly grim, such as hereditary young male adult blindness. 

This set us off on quite an intellectual spin, particularly 
since we were already providing birth control advice and 
services. Some of the families with multiple cases were 
tragic. One mother contemplated suicide because of her 
inadvertent role in transmitting a male-only blindness which 
her father, a physician, developed after she was born. Her 
oldest son just got the diagnosis, and her two younger boys 
also faced early blindness. 

Dr. Jolly had been interested in things genetic, as so many 
people are, but this soon became her life's work, not just a 
concern. She found a keen human geneticist, Curt Stern, at UCB 
who had not been involved in doing anything about it other than 
studying the various diseases caused by genetic disorders, and 
the nature and extent of their hereditary transmission. She 
took him the records of her families and they worked out what 
options might be offered in each case. In some, basic birth 
control was the answer, and applicable along the family tree. 



214 



In others, this was irrelevant or too late. But advice to 
involved persons and potentially involved family members could 
be life-saving where prompt medical diagnosis and care could 
hold the disease, or where avoidance of certain exposures could 
minimize or delay damage from inherited disease. 

Thus began the first formal genetic counseling program that 
any of us had ever heard of. In getting grounded we used a 
family tree approach to get necessary information for the 
counseling and to begin the search for other persons who might 
be hereditarily involved in order to find them long before 
there would be any evidence of the familial disease. In some 
cases it meant watchful waiting; in others, the need to prevent 
further offspring; in others, blood testing. 

Nurses helped the involved families to fill out the tree, 
who was on it, and what had happened to them to date. Families 
loved this, contacted long-abandoned relatives, and got 
information that varied from critical firm diagnoses to wild 
guesses. Sometimes it would be a year or more later that a 
family would call in to say that so-and-so, who was related in 
certain ways, had developed a clear-cut diagnosis that had 
genetic implications or had confirmed the presence of suspected 
familial disease. 

Looking at a family history was a favorite way for our 
public health nurses to get acquainted with a family even when 
the introduction to the family had no relationship to genetic 
concerns. The nurses asked for the freedom to use this mode of 
introducing themselves and many did so for any but the most 
inconsequential family contacts. 

Someone heard about this activity, I suspect from the 
papers we published, 1 and we soon made the newspapers. We 
started getting family trees from families in other parts of 
the U.S. and even from other countries, with requests for 
advice about one or another aspect of a problem. Much of it, 
of course, was about what to expect from having children under 
various disease-shadowed circumstances. 



'Jolly, E., H.L. Blum, G. Keyes, and G. Smith. "Experience of Public 
Health Nurses in Obtaining Family Pedigrees." Public Health Reports 80:1, 
41-46, January 1965. Jolly, E. and H.L. Blum. "Genetic CounselingA 
Health Department Service to Physicians." California Medicine 103:5, 330- 
333, November 1965. Jolly, E. and H.L. Blum. "The Role of Public Health 
in Genetic Counseling." American Journal of Public Health 55:2, 186-190, 
February 1966. 



215 



When I came to UCB I brought Betty Jolly with me, and she 
also obtained a nontenured faculty slot to teach public health 
genetics, and continue her research on genetic diseases, 
transmission, and genetic counseling. These were the first 
courses on genetics at the UCB School of Public Health. 

One morning Dr. Jolly awoke with a painful abdomen, and in 
a few days was diagnosed as having far advanced gastric 
carcinoma and was dead in a year. She was not only a handsome 
woman but one with a lovely personality, had a husband with 
comparable qualities, and two lovely teenaged daughters. She 
had a youngish mother and a physician sister who was a county 
health officer in California. 

When it came time to acknowledge her life and death, the 
family descended on me to say what had to be said about her 
life and her accomplishments at a family-only ceremony. I had 
never undertaken such a task, knew her family hardly at all, 
and tried to avoid it. But her family insisted that I 
undoubtedly knew more about her work life than anyone else and 
that was what they knew so little about, and what they wanted 
to know more about . 

I started out, broke down, had plenty of company, started 
again, we broke down again, and that's pretty much how it went 
for two hours when it suddenly seemed that we had done the job 
and it was time to say goodbye to Betty and to one another. We 
all hugged and parted. 



Training Peace Corps Volunteers: 1964 f# 



Crawford: 



Blum: 



Crawford; 
Blum: 



There are some consultancies in the 1960s, 
did Peace Corps work in '64? 



For example, you 



Oh, that was just a small thing, but again, really reaffirming 
my notions about what we were talking about. We were training 
Peace Corps workers in the Contra Costa County Health 
Department in some of the basics of sanitation. 

To go out into the field? 

Go out into the world, you know, a world with nothing. We had 
our own little disaster manualwe'd give this to them, and 
explain how to clean oil tanks, purify water, protect food, how 
to do this, how to do that. Chances were they would never get 
the necessary modern equipment, but we had prepared different 



216 



simple methods of doing all sorts of health-related tasks, even 
tables about which kinds of drugs to use for what indications 
if you were not a doctor. It was all do-able, workable; we 
created this for disaster preparedness, and had a good time 
doing it. Even a manual on toxicsthe first one, I guess 
anywhere. It was nice to have someone to use it on, as we 
never had a disaster of the dimension that Peace Corps workers 
were going to face routinely. 

Crawford: In Contra Costa? 

Blum: Yes, we had prepared it for an ultimate disaster in Contra 

Costa--in the U.S.A., or anywhere else. The toxics manual was 
used at UCSF. The Peace Corps people were going to areas that 
were permanent disasters, by and large. So maybe they would 
use it; we trained them how to protect or clean things, how to 
fight various problems. 

Crawford: How did you get this association? 

Blum: I don't know, I just volunteered, I guess. 

Crawford: In other words, the Peace Corps might have written health 
departments and asked for this training? 

Blum: Yes. However, I remember that Len Duhl was Sargent Shriver's 
health advisor Shriver, the head of the Peace Corps and Len 
was very close to the Kennedys. He might have had something to 
do with our involvement . 

The Peace Corps worked for two-year terms, typically and 
by the third year, all the Peace Corps people who had returned 
after their two years were invited by Shriver to the State 
Department for a big week. They weren't very fond of Shriver, 
which was kind of funny because he kept the CIA out of their 
ranks and really seemed to be quite involved in their well- 
being. I guess it was a generic distrust of political people 
by folks who were prepared to put their lives at risk. 

II 

Blum: The Peace Corps also got one hundred people like me to come and 
sit down with these folks for a couple of days and consider how 
these returnees, who were from every walk of life, could put 
what they had learned overseas to use at home. A marvelous 
program. I loved what I saw because here were people of all 
races throwing their arms around one another. They hadn't seen 
one other since Africa, Asia, wherever; and here they are just 
obviously really entranced to see one another. 



217 



Then we sat down, and the advisors kept rotating to groups 
of twenty returnees. Every two hours or so I'd go to another 
group. Their theme was, "What can we do here with what we 
learned overseas?" It was going to be damned little, but many 
of them intended to try, and some ultimately went back overseas 
because our ways of doing things were pretty entrenched and not 
necessarily burdened with the human touch. 

The miscue of the first half really was the opening address 
by Shriver, who was on the edge of getting the business from 
the attendees. But then Earl Warren spoke for an hour, and 
they just went crazy. He was great. Then Hubert Humphrey 
spoke, and he spoke too much. I remember that he didn't play 
the hero, and ultimately he came across well. He said, "If you 
don't like what you see in Washington, remember that's no more 
than a mirror image of you folks back home. If you didn't want 
what you don't like, you wouldn't have it." That was pretty 
insightful. 

Then Sister Jacqueline from Webster College the one I 
spoke of a while agogave the closing address. She happened 
to be a very beautiful woman. She was still in her habit, and 
I had ridden to this affair in a taxi with her from the hotel 
where we were staying, at the Dupont Circle. I had always been 
a bit patronizing, I think, to nuns, and there she was, in her 
habit. I asked her something about Webster Falls, which she 
had made very famous as a little Catholic university. As a 
matter of fact, she started to explain to those of us in the 
cab that she was free to leave now; she had done her job there. 
She had left a new, non-Catholic board of regents in charge of 
this Catholic school where she had been the boss. Webster 
College now had a board of regents and the chairman was also 
the chairman of MIT: I can't remember whom- -a nice Jewish name. 

I was sitting up front of the taxi, these three women were 
in back and I said, "Sister, what in the world are you trying 
to tell us? Why is it so important for a Catholic university 
to have an independent board of regents with no Catholics on 
it?" She said, "How would you like to go to a university run 
by Standard Oil?" I thought, "Wow, this lady is really 
something else, again." You don't talk like that as head of a 
Catholic school. 

She was last on the program that day. She made it clear 
that she was a woman; the three speakers preceding were all 
famous men. She said she was an educator, and that she worked 
for God through the Church as an institution, that she believed 
in the words of God and the works of God, which had to be 
taking place here and now not in the future. I suspect many 



218 



people in the Peace Corps, particularly, were prepared to hate 
a Catholic nun, but not this one; everybody loved her. For 
this person to steal the show from Earl Warren, and Humphrey! 
She left a message: "You folks went out there and did, here and 
now, the Good Lord's work. Now is when it has to be done. 
It's not going to be done in the hereafter." She was a 
liberation theologist at Webster College. 

Crawford: You have to hand it to Shriver or whoever found her. 

Blum: Well, yes, I think Len Duhl got her. He was advising Shriver. 
I don't know that he thought she would steal the show, but she 
surely was the most important person for the returnees. She 
was reaffirming what the Peace Corps was all about. Then we 
went back to our groups. People spent the next couple of days 
trying to figure out how they could use what they had learned 
about working with strangers on their terms in their homelands 
to improve life. Also, you don't join the Peace Corps because 
you think everything's perfect here. It was really one of the 
highlights of my life. In fact, I was on a high for several 
weeks reliving the wonderful feelings I got from the returnees. 

Crawford: And did you work something out that was positive? 

Blum: Not specifically, but I don't think too many people left 

feeling that their life was wasted or that their Peace Corps 
experiences were useless. We see them coming through here all 
the time at the School of Public Health, School of Social Work, 
ethnic studies, planning, anthropology, sociology, and so on. 

Those were experiences that reaffirmed the relevance of 
taking care of human beings through more than medical care, and 
helping people to help themselves as a community. Medical care 
is just a small, little piece of it; this is the big stuff, and 
yet it's health. Some of these streams have run all through my 
life and reaffirm my beliefs about democracy and social 
justice. I've never changed. The same theme is still in my 
mind. I suspect that's sort of narrow-minded. Maybe also I'm 
not bright enough to think of anything else. 



Other Streams; Creating Air Pollution Control Legislation 
(1955) and the John F. Kennedy University (1964); the Orinda 
Vision Study (1959) 



Blum: There was another aspect of the environment that we played a 
role in--air pollution control. That was very fascinating; I 



219 



had an opportunity to work from scratch on that. I was invited 
to a Bay Area Council meeting- -it was at the Cow Palace or some 
such placewith all the big business people of the Bay Area. 
I was sitting at a guest table, and they were speaking against 
having any government intervention on air pollution. They 
dredged up this big old chestnut: "We will do it voluntarily. 
Look around the roomwe control the world. We'll do it 
voluntarily. We don't need government screwing this up." 

I listened to that for a while, and got to the point where 
I thought, "Well, I'll just inform them about what they're 
talking about." I stood up and there was no way they were not 
going to have me stand up since I was a guest and I said, "I 
want to comment on your posture. You're taking a very peculiar 
and, I would say, unfortunate position in favor of voluntary 
control. 



"In the first place, you are now telling everybody that you 
caused the air pollution, right? How can you control it if you 
don't cause it? That's an interesting point I'm not sure you 
want to make. The next thing is that you don't produce it you 
don't seem to understand that. Sixty-five percent of the air 
pollution in this region is caused by automobiles. There isn't 
anybody in this room can do a damn thing about it, as they 
stand, voluntarily. So one you admit to being the guilty 
party, and two you offer to fix it, and of course it can't be 
fixed the way you're going to go about it. So, you're going to 
look very interesting to the populace. You're going to look 
like criminals for causing all the pollution and like fools 
because you can't fix it." 

Crawford: This was before the Air Pollution Control Board? 

Blum: Before there ever existed any such thing. There was no 

applause or response to these comments; I guess they were sort 
of insulting. I got back to my office, and there was a phone 
call from an engineer named Bill O'Connell whom I had known for 
a long time shrewd, brilliant man and he said, "The oil 
companies in Contra Costa County would like to have me sit down 
with you and develop an air pollution control law." The same 
outfit that just got through yammering about voluntary control. 
It finally dawned on them that they would be blamed for all of 
it, and they couldn't do anything about it. So we sat down and 
wrote out what became the Bay Area Air Pollution Control 
District Law in the next few days. 

It was an interesting experience for me to work with a 
superb engineer, and a superb lobbyist, and superb politician, 
who wasn't about to have the thing fail, even though he was 



220 



Crawford: 
Blum: 



hired by each of the four major oil companies in the state, and 
then by the Contra Costa board of supervisors. In a few hours, 
we had written out the basic law, which is the law today. 

He was tremendous. He figured out that each of the 
counties ought to have one supervisor as a member on the board 
--and each set of cities in a county should have one vote on 
the board, too. That would keep them all happy, and establish 
limits. These elected officials would make up the Bay Area Air 
Pollution Control Board. Then he picked out the individuals 
from each county who ought to sit on its governing board. He 
started out with San Mateo County, and picked the chairman of 
their board of supervisorsthat was all right, because it 
happens that Martin Poss owned a huge nurseryhe raised 
carnations and every smoggy day he lost a fortune. 

He had very stringent standards? 

Bill O'Connell had super standards. And he found an 
industrialist whose name I don't remember a retired 
industrialist from Marin County who had other reasons for 
wanting air pollution controlled, who was on a city council 
there. He got the chairman of the board of Alameda County. I 
knew him from when he used to take tickets on the Key Line 
ferryboats. He was a jovial, red-headed Irishman with a great 
accent he was on the board. 



Crawford: 
Blum: 



So we went through each county selecting by name the board 
member and the city council member. And he lobbied so cleverly 
that each of these persons was selected by their group as Bill 
had intended. Masterful, unbelievable. 

Then he said, "We need a technical advisory board. They 
are going to have to develop the rules and standards." He's 
picking out all the people, and he says, "You be the health 
person on it, and I'll be the engineer." He picked a wonderful 
architect from San Francisco who's still very active in 
community affairs. He picked a wonderful planner as well. 
Again he lobbied the yet-to-be governing board members and got 
us all appointed to the technical advisory group. 

Do you have names? 

No, I can't think of many, but Livingston was the planner. 
These were just fabulous people. You couldn't get better 
people. 

The thing went right through the state legislature so fast 
it makes your head swim. We left out counties that didn't want 



221 



to play ball by giving them time to join later and when it 
became imperative they cooperate all the ways of getting 
around negative votes. With the four major oil companies for 
it, let me tell you, it wasn't much of a deal to get it through 
the legislatureand there we had it. 

In any event, the very first meeting we had, Goyak from 
Contra Costa got up and said, "We shouldn't make the garbage 
operators stop burning." Contra Costa was full of garbage 
dumps which burned the year around. It turned out he was the 
garbage interests' point man, so it started out looking bad for 
the district. 

Then this wonderful Irishman from Alameda County got up, 
and he started a long speech about pioneers coming across the 
plains, and I thought, "Oh my, oh my. He should have stayed 
with ticket taking. This is bad." 

Then- -it ' s just really wonderful how some of these 
uneducated people thinkhe said, "What do you suppose the 
first thing these folks did when they got to California? They 
set up state government so they could control all the messes 
that they found." He said, "I'm suggesting that we're in 
exactly in the same position. We've got a new mess. This air 
pollution is burning everybody's eyes." This man, it seems, 
was very pro-real estate, and they didn't like smog. 

So the whole thrust of his speech was history and cops and 
robbers, and that the first thing we did was to have 
government, and this could be no exception. It really got off 
to a great go, and the whole board worked from that day on. 

I remember when we held our first organizing meeting. I 
don't member how we arranged it, but Poss was the chairman of 
the board, just like we'd figured. We're sitting at the Top of 
the Mark Hopkins Bill O'Connell and I are sitting right 
alongside of a bunch of newspapermen- -and Martin Poss accepts 
the chairmanship, and he says, "Well, we do need a technical 
advisory committee." He reaches into his coat pocket and pulls 
out a three-by-five card and he reads off all the names, and 
the newspaper guys are looking at one another and they're 
saying, "How can he have that list with all those names on it? 
How did he know he was going to be chairman; that just 
happened." [laughter] 

So there was a technical advisory board. We met over the 
years at least once a month or more, and I was always having to 
support Bill O'Connell. Everybody on the technical advisory 
board knew that he was the ultimate politician, that he was the 



222 



rascal that put us all together, and although they didn't have 
any reason to be against him, they didn't trust him, because he 
was such an effective politician. 

So if he would come up with a technical recommendation, 
they would automatically set it aside. He was usually right, 
but it was interesting that despite his role, which had been so 
astute about creating what is a remarkably successful 
operation, he still was not trusted by the technical people. 
Here he is, amongst his peers in the technology advisory board, 
and they don't trust Bill O'Connell. It's really kind of 
funny. He saw that; he always got a kick out of that; but I 
was defending him all the time. I remembered what he went 
through, and I thought he'd done a wonderful job; I never could 
have done it. 

Crawford: And that legislation is still in place? 

Blum: It is. Yes, the Bay Area Air Pollution Control District is the 
same district, set up by an engineer to do exactly what he 
wants it to do for some very special interests, and he does it 
right and beautifully, and inexpensively. 

Crawford: That must have been pretty progressive for the times. Did you 
get called on that? 

Blum: No, I don't think I was even perceived as an actor. I made my 
spiel in the right place on the right day; the oil companies 
produced Bill O'Connell, and the job was done. 

Crawford: It's a real success story. 

Blum: It was taken for granted I would be on the technical advisory 
committee. I was at least as alert as any other health 
officer. In fact, being a chemist originally, I might know 
what we were talking about. So that was kind of a fun 
diversion. I loved the Contra Costa job that made this and so 
many other things possible for me. 

Crawford: Your stock must have been very high with the funding 
organizations. 

Blum: I think it was with various nongovernmental organizations. I 
think it was, but all it required was that you were doing 
something that was tangible and needed. 

Crawford: Were there such programs elsewhere? 



223 



Blum: There were in some counties and not in others. Alameda County 
Health Department had its bright spots. It was a real pusher- 
conservative in some ways because they wanted to be big and 
they absorbed everything they could, which was kind of tragic 
because they couldn't get away with it. We didn't want to be 
big, so we weren't, but we got the programs going even if they 
weren't in our department. We had a much better school health 
program than they had, much better mental healthall kinds of 
things --without us owning any of it. 

Let me go into one more thing: I was on the original board 
that set up the John F. Kennedy University in the early 1960s, 
and I've been bumping into them again recently. It's 
interesting how these things circle around. 

Crawford: Is that what you call another stream? 

Blum: Yes. And this was how we could get something indigenous into 
the county that would teach mental health, teach this, teach 
that all sorts of health and social justice things. Harry 
Morrison, who used to teach administration at St. Mary's, had 
become a banker, and all of a sudden, he was well-to-do. His 
wife is still alive, I understand, and still on the JFK board. 
He got the idea of setting up the university, and decided on 
the name J. F. Kennedy because, amongst other things, he 
thought we would get big money from big folks, which was wrong 
--we never got a single dime from that crowd. 

He and I had been opponents forever; he represented the 
taxpayers' association, and every time our budget came in, it 
was always growing as the county grew. He was the 
representative, the spokesperson, for the "poor" taxpayers, and 
what is this health department doing? It has gone crazy. So 
Harry and I were always tangling in front of the board of 
supervisors. He'd give them this big spiel--he was kind of a 
bombastic character, but not a fool--then afterwards, he'd put 
on a big smile and take me out to lunch or something. Business 
is business. He worked for the taxpayers association which, of 
course, is paid for by large taxpayers. 

Harry got the idea of setting up this university, and he 
came over to see me about it. We weren't the best of buddies, 
but we weren't enemies. He said, "Why don't you sit on the 
board and maybe take a hand at shaping the health part of this 
thing? Here's what this university is about: in the first 
place, anybody can come in who wants to- -there is no such thing 
as prerequisites. Many people who have bad high school 
records, bad college records if they want to try here, they 
can. If they can't do it, they will leave." I loved that. 



224 



Second paragraph was even betterand this from a banker. 
"We are living in a new world. This world is one world, and 
yet we don't know about other religions, other cultures in this 
world and in our country. We don't even care. That's got to 
stop. We're just going to be in endless wars and stupidity. 
So every student has to take a year's worth of courses on 
religion and culture before they graduate, so they feel that 
there are other people in this world." So I said, "Harry, 
you've got something," and I signed up. It was just before I 
came to UC Berkeley. 

He got the head of the county library, one of those superb 
people who came out of Louisiana, where she hauled her books 
around through all the swamps on a boat. She was a real 
operator, a tremendous librarianset up all the good libraries 
in Contra Costa. The county wouldn't pay for them, so she got 
the neighborhoods to do it. 

Crawford: Public libraries? 

Blum: Yes. First class. And then Harry got the county assessor to 
join. You say, "Why would that be?" Well, to establish a 
university in the state of California, at that time, you had to 
have at least thirty-two thousand dollars worth of assessed 
propertyassessed evaluation that was the criteria for 
universities in California. We had gotten as a gift an 
abandoned undertaking parlor. We got the assessor to assess it 
for thirty-two thousand dollars. [laughter] It was a big 
funeral parlor in Martinez which was used by JFK for ten years 
as its headquarters. 

So here was the assessor; then we had the county 
superintendent of schools office the assistant superintendent, 
actually giving it their blessing, the county superintendent 
of schools office can be very powerful, especially in a 
negative way. 

Harry gathered up some folks from industry like DuPont and 
others who would help set up the chemistry department and give 
it some status. He got some good lawyers to set up a law 
school and some psychologists and that's a big school there 
now, the psychology department. The reason I am thinking about 
it is that I was invited to give a lecture there the other day. 
They have now moved to Orinda. The man who headed up the San 
Francisco Foundation, for which I worked off and on as a 
consultant, was the first full-time president out there. 

Crawford: Who was that? 



225 



Blum: Bob Fisher. So, all of a sudden, JFK kind of looms large in my 
head again when I was asked to give a class. It was a fun 
class. It was psychologya graduate psychology courseand 
the students were older people, not kids. They're using 
classrooms in one of the grammar school campuses which they 
have as a gift from Orinda. Harry was a devilHarry Morrison, 
the guy that started all this had to get the accreditation for 
the university, so he borrowed it from St. Mary's, where he was 
a professor. They agreed to the use of it. They were an 
umbrella for JFK. 

Crawford: They can do that? 

Blum: Oh, they do all sorts of things. He needed a library, so the 
librarian Bertha Helium contributed thousands of discards, but 
that wasn't enough. If you were accredited, you could get a 
free library- -many thousands of volumes. But you couldn't get 
the accreditation without the library; on the other hand, you 
couldn't get the library without accreditation. So, one day, I 
came to a board meeting in the mortuary, and here's Harry and 
two other men shaking hands, and one of them is the 
accreditation guy, and the other is the library guy he's got 
them to sign on at the same moment. 

Crawford: [laughter] This is a real mover. 

fi 
Crawford: It sounds as if whatever was going on, you were a part of it. 

Blum: Sometimes, yes, that was the fun of Contra Costa. I remember 

Harry Morrison and I going to the University of the Pacific in 
those days it was the College of the Pacific and a former 
president of the student body at UC Berkeley was the president 
there. We went to ask him how to raise money, and had a pretty 
long talk about it. We spent a whole day with him in his tank 
house you know, the big, rural tanks, the kind with the long 
stilts and the big round ball on top? There was a lot of space 
in the structure, and his office was underneath the tank. 

We took an elevator up there, and we sat in this wonderful 
location at UOP/COP and learned how you raised money, how you 
had to put people ' s names on things , and how you had to do 
this, and how you had to do that. 

Crawford: Were you active in the fund-raising? 



226 



Blum: Not really, because I came to the university at that point. I 
resigned there, saying, "I work here; I'd better not play games 
out there." 



Crawford: You moved here, I'm assuming, as soon as you changed jobs? 

Blum: I moved here, yes, within the year. So I left that behind, but 
then my wife knew about all these games that were going on at 
JFK, like getting the library and accreditation together, and 
that we got a big piece of land from a lady in Yolo County who 
thought that we were going to move there, and I don't think 
that Harry dissuaded her. 

We moved here. One day my wife is in Safeway, and she 
hears a lady talking to an old friendthey 're meeting at the 
counter- -and saying, "Where's your son?" "Oh, he's out at JFK 
University." My wife couldn't believe it was real because she 
knew all the monkey business side of it. So she turned to the 
lady and said, "Going to school out there? Really?" "Oh, yes. 
There's six thousand students." She remembered very well the 
two Sundays I had to go over there when we first got the 
funeral parlor and help clean it up. There were these big 
baskets where you kept people, and there were thumbscrewsto 
keep people looking relaxed- -well, we got quite an education at 
the funeral parlor. We painted, we cleaned, we scrubbed, and 
there it was. I can tell you that some of us got a little 
queasy. We just weren't used to the undertaking business. 

Crawford: What is the reputation of the school? 



Blum: 



Pretty good, pretty good. The psychology thing is fun. There 
are some fun people there, and we had quite a day a couple of 
weeks ago when I gave a two-hour class on aging and the utility 
of combined human services. 



Crawford: You can get your degree? 

Blum: Oh, yes, and they contribute people to Over 60 's clinic to work 
there. Over 60 has volunteers from both students and faculty. 
So it's a real part of the community; it's for real and it's a 
big operation. So I always feel good about JFK University. 

Well, there's one other stream of concern from Contra Costa 
that also influenced much of my life ever since I left there. 
I wasn't there too long when I discovered that a couple of 
optometrists who belonged to the Lion's Club--the Lion's Club 
is always doing things with visionwere going to do an eye 
exam of every grade-school student in Contra Costa County to 
find the kids who couldn't see well and needed care. That's 



227 



always been a problem. People wonder why their kid drives a 
bicycle down the stairs and never seems to learn--well, maybe 
they can't see. So the whole business of learning in schools 
is partly lost on kids who've never seen the blackboard and 
don't see the teacher all that well. 

They are going to do a real checkup, but there's great 
argument in the field about how best to do it. The 
ophthalmologists don't want anything to do with it; they say, 
"Let the school nurses use an eye chart," and the optometrists 
are saying, "That's pretty sick. It ought to be done 
properly. " 

So the optometrists got some big machinery and planned to 
do the whole county. The only catch is when the optometrists 
go into the school district, every kid who's found to have a 
problem tends to be sent to the optometrist who came in to do 
the exams. It's just the way it would work out. Whose card 
are you going to give them if the kid needs eye care? 

Well, that's pushing it a little--that ' s unfair trade; and 
I hear about it from the school superintendent. "We're getting 
ready to have this big thing, is this all right? Does this 
make sense?" He's calling the health officer for advice. I 
said, "Hold it up just a little bit, and let me think about 
it." So I found some articles in the literature, and those two 
instruments they were going to use gave terrible results. They 
refer about as many people who are normal as they do abnormal, 
and they miss about half of the abnormals. Those two machines 
are not worth a damn. 

So I said, "Well, these folks are serious, and the Lions 
are serious, so why don't we really figure out how to do it 
properly? Let's set up the Orinda Vision Study." It wasn't 
called that then, but we would pick a community where everybody 
could afford to go to the doctor, so we wouldn't be examining 
kids who could not get needed care afterwards. When we got 
through testing with seven methods that we knew about, we could 
send a group of these children to UC Berkeley Optometry and to 
Stanford Medical School Ophthalmology- -which was in San 
Francisco--to be reexamined to see how good these tests were. 

We'd have all the reports from all the tests in front of 
us , and every kid who was found with something abnormal would 
go to these two centers, as well as a sizeable group of 
normals. It really was the first good vision study ever put 
together. 



228 



Crawford: 
Blum: 



I decided that we would do the testing out of our own 
budget, but we needed a little extra for records and phone 
calls to parents about the results. The county administrator 
who had been involved in selecting me for the job said, "All 
right. The county will put in five hundred bucks." Well, 
that's nothing for a study like that, but really it was good. 
The optometrists will do their tests for free; our staff will 
do the other tests. Then we have to call the parents. 

It was a perfect situation, and the logic was that poor 
people don't have much different eye trouble than well-off 
people, therefore, we're going to work with the well-off people 
who could get the tests at UCB and Stanford, as well as buy 
needed care, glasses, whatever. 

We got the state health department to do the statistics. 
We found an optometrist, who was a neighbor of mine and a 
professor at UCB, and who later became the head of health 
sciences at an Alabama University, to invent a quick way of 
testing in the schools. 

What was his name? 

His name was Henry Peters. He's the second author on the 
studythe Orinda Vision Study. Henry designed a whole new way 
of testing kids. It was cheap and brilliant, and it took an 
optometrist to do it. Of course, they were willing to work for 
nothing to prove the point that they could do a good job. 

So we did a thousand kids, roughly, in Orinda for two 
years, enough to follow the same kids to see if they changed, 
and nobody had ever done that before. 

What we discovered was that not only did we find all the 
bad eye problems that we needed to find, but we also discovered 
that some of the changes at the end of the year were not the 
ones that were predicted in all the textbooks, which is that 
everybody gets more and more short-sighted: not so. And there 
were visual changes in various unexpected directions. There's 



a huge Vision Orinda Study now following up on that, 
a big-time science study. 



Now it's 



Henry Peters developed this new method, which was called 
the modified clinical technique (MCT) . I phoned all the 
families to tell them about the findings. I made all the phone 
calls myself. Every time that I got to a father in Orinda, I 
also, ultimately, had to talk to the mother. The fathers were 
of no use whatsoever, and knew it. 



229 



Crawford: It's not their business. 

Blum: It's not their business. So, here's a woman: "You called my 

husband, and he really couldn't tell me any thing- -what is it?" 
So, I'd say, "Your child was examined and we found nothing," 
or, "Your child was examined and there's a possibility of this, 
that, and the other thing; and we'd like the child to go to two 
separate universities--UC Berkeley and Stanfordto be re- 
examined," if that was the case. 

Well, to make a long story short, we got a team to head up 
the study. The expert from Stanford agreed--! was on the 
faculty at Stanford, at that time, at the medical school. I 
went to Ed Maumenee, a famous ophthalmologist. He later left 
to head up the Wilmer Eye Institute at Hopkins; and that's the 
pinnacle. When he left Stanford, he picked one of his 
associates as the participating doctor. Well, that's all 
right. That's the man's name that appears as one of the 
authors of the study. In any case, we proceeded, we got all 
the results together, and on every Thursday night for one year 
--I had all the recordswe sat in the ophthalmologist's office 
in San Francisco, studied the results, and wrote the book. The 
University of California Press published it in 1959, and it was 
a classic. 1 I could go anywhere in the world where there was an 
optometrist and say who I was, and they would bring out the red 
carpet . 

Crawford: That was very exciting. 

Blum: Yes, and what it did was mortify the ophthalmologists because 
it turned out that the optometrists using the MCT, which cost 
fifty cents a head to run, had found everything that was ever 
found on the students at Stanford or at UC Berkeley from 
traditional extensive testing. It was a brilliant, really 
brilliant inexpensive screening. It's of interest that the 
Department of Optometry is just now taking the MCT to China, 
where they will train people to use it and then do all the 
children in China. 

Henry Peters was just a genius at this sort of thing. It 
brought me the Apollo Award in years to come, an annual award 
from the American Optometric Association for a non-optometrist. 
The book was published and the ophthalmologists started 
screaming bloody murder. It was in the code of ethics of the 
AMA that no M.D. shall communicate with optometrists. That was 



'Vision Screening for Elementary Schools: The Orinda Study. Blum, 
Peters, Bettman. UC Press, 1959. 



230 



inserted in the code by request of the ophthalmologists in 
1955, a turf matter, of course. 

Crawford: Is this still going on? 

Blum: Well, no. They got rid of that law a decade later. As soon as 
we were published, we had a second printing. We didn't get a 
dime for it because this was a public service thing. You saw 
it; it was in soft cover. I got a notice from the AMA that I'm 
about to be tried for unethical behavior, consorting with 
optometrists, but they are sending this to the California 
Medical Association because I'm a member here. 

Then I get a letter from the CMA that they're sending it to 
the ACCMA because I'm a member of the Alameda/Contra Costa 
Medical Association, and I will have a trial for being 
unethical, working with optometrists, for figuring out a method 
of testing school kids' eyes the first time it's ever been 
done properly, and a beautiful test, besides. 

So my wife says, "We don't have to put up with this. You 
get on your best suit and go down there and sit through this 
hearing. I'll drive you down, so you're relaxed. If there's 
any crap, you just tell them that we're going to hire a lawyer 
and go the whole way." 

I had a committee of about twenty doctors, headed by a 
urologist, whose son is now a very prominent urologist down the 
Peninsula. They sat me down and they read the charges: 
cooperating with optometrists. The first thing they wanted to 
know was, "How much did they pay you?" Which I don't think was 
a good reflection on physicians to bring that up as the first 
question. I said, "They didn't pay me anything--! 'm a health 
officer." "Well, why did you knuckle under to these rascals?" 
I said, "I'm concerned with the health of the kids." "Why 
didn't you use ophthalmologists?" I said, "Well, the truth of 
the matter is that I asked, and none of them in the East Bay 
wanted to play; but I did get the world's most famous 
ophthalmologist to play--Maumenee, who is now at Hopkins." 
That kind of cooled them off. Then, "How much did you make 
from the book on the royalties?" I said, "Well, it just so 
happens that this is known as a service kind of book. UC Press 
does not pay its authors anything for this kind of book." I 
said, "Look, we ended up figuring out how to do it right, and 
we checked it out all the way around, and all the other tests 
were terrible; we tested them all. They said, "Well, would you 
write all this up? We'll send it on to the AMA." And I 
submitted it shortly after that time, and the case was removed. 



231 



And as I said, this portion of the code of ethics was deleted 
by the AMA a decade later. 

The reason I wanted to get into this study for a moment is 
that this all started as a health officer getting five hundred 
dollars from the county administrator, who is putting his 
blessing on it. It made me very visible to the optometrists 
because I took the heat for ittried for being unethical. Of 
course, I was exonerated, but the optometrists were well aware 
that I had been willing to put my name up front when it was 
known to be a risky thing. 

Crawford: Had you jeopardized your position at Stanford? 

Blum: Not at all, not Stanford, and with their celebrity Dr. Maumenee 
on it. But it is of interest that in the sixties, the UCB 
School of Public Health wouldn't take optometrists. But the 
same university has a school of optometry--the best in the 
world. 

The head of the Health and Welfare Committee of the 
California State Assembly was an optometristGordon Duffy--and 
he was not unaware of what was going on. I worked with him on 
committees, and then one day I was sitting at my desk at UCB, 
and he called, "I'd like to do something for you- -what can I 
do?" I said, "Well, we're working on trying to set up a 
medical school at Berkeley." He said, "Good. I'll have some 
policy analysts work that in to some other piece of 
legislation," and we wrote up the medical school at UC Berkeley 
that's here today and it became law. 



Blum: I'll continue with this stream of events which eventuates in 

the medical school at UCB, known as the Joint Medical Program. 

When I got to UCB the campus under Chancellor Roger Heyns 
was looking at the advisability of creating a medical school in 
the East Bay, which was the largest population aggregate in the 
U.S. without a medical school. 

Bill Reeves and Ned Rogers were on a campus committee 
studying the pros and cons and Ned became the chair. When 
Roger Heyns left, he was replaced by Albert Bowker, who was 
specially interested in a medical school, having just launched 
an unorthodox one at City College of New York. 

The committee met almost weekly for lunch in Bowker 's 
office and chewed over every aspect of the matter. I was 



232 



appointed to it shortly after my arrival and enjoyed every 
minute of the planning for a medical school without walls, 
using primarily local practitioners as faculty and the 
available campus courses for the basic sciences. There was 
such a school at Michigan State just being set up by a former 
dean of the medical school at Stanford. He became one of our 
outside advisors, bringing with him a faculty person in charge 
of their pediatrics and genetics who spent a year here. 

As we got closer to a conclusion, we worked with our two- 
county medical society, ACCMA, won its hearty approval as its 
members would be playing such a key role in teaching. 

However, the president's office at UC was getting a 
powerful barrage against the unorthodox proposal from the other 
medical schools in the system. They didn't want to share any 
funding with another medical school and they hated the proposed 
unorthodox approaches to teaching as well as the offensive 
notion of training primary care or people-oriented physicians. 

A canvass of UC medical school deans showed only one in 
favor. The very antiquated dean at UCLA was away and a friend 
of mine from Hopkins days was acting dean. He called me and I 
helped him compose a very positive letter. 

At that point the president of the university, a well known 
planner by the name of Charles Hitch, sent Bowker a letter 
advising him to forget the medical school. Bowker was a soft- 
spoken man of action, and used few words. At our weekly 
meetings, he rarely spoke, but when he did it was decisive and 
to the point. Bowker raised his hand and asked our committee's 
permission to read a letter from President Hitch which went to 
the effect that it was time to bury the Berkeley Medical 
School. It opened, "Dear Al." 

Bowker then said he would like to read us his reply, which 
was, "Dear Charlie, thought you'd be interested in the 
enclosed." The enclosed was the new state law I had handed him 
a day before which had just been enacted saying that "there 
shall be a medical school at UCB." 

I won't go through the school's ups and down, except to say 
that Robert Biller, now provost at USC and then associate 
professor in public policy, provided the intellectual and 
philosophical framework for the effort. He became the first 
director of Health and Medical Sciences which had five arms an 
undergraduate effort for the pre-health career students, an 
unorthodox breed of intermediate level mental health 
professionals, the unorthodox medical school, a genetics 



233 



counseling program, and a dual degree effort under Dr. Leonard 
Duhl. 

Although I had opted for the undergrad program where some 
four or five thousand pre-med, pre-dental, pre-nurse students 
throve on Shakespeare and chemistry and needed some sense of 
what they were getting into, I was soon detoured into the 
medical school and put in charge of the clinical aspects 
because I was the only M.D. on the committee that knew great 
numbers of local physicians, hospitals, health departments, and 
had also taught in medical schools. 

I became half-time with the medical school and organized 
the medical exposures of the twelve students in the entering 
class, found them practitioner preceptors, organized physical 
diagnosis, hired the clinical professors who opened up the 
program. I found these people with the help of Dr. Norman 
Sweet of UCSF, a student's hero, and Dr. Sheldon Margen of the 
School of Public Health, who had just left private practice in 
Berkeley for a professorship at UCB and had been our family 
doctor (he's the father of the Berkeley Wellness Newsletter). 

Another new president of the UC system forced us into a 
joint venture with UCSF so as to avoid creating a full-fledged, 
four-year medical school in the East Bay. I had my last tangle 
with UCSF over the transfer of our students to UCSF for their 
third and fourth years and thus their M.D. degree. They 
decided that they would not accept our students after all. 
That was a potentially lethal blow. So I went to work and 
called in all my chits. Stanford agreed to take six of the 
twelve, USC one, Harvard one, Rochester one, Hopkins one, and 
at that point UCSF said they were just kidding, they would take 
the whole class, provided they got half the faculty funding, 
which they did. About half of our first class did go to UCSF 
and all of them have from then on. 

Since a partnership with my beloved alma mater, UCSF, was 
not what I had been working for, I left the program in about 
1974 and never touched it again until 1991. 



Business Activities in Contra Costa County if 



Blum: By 1960 I had done quite a few things. I had finished my 

vision study and was writing my book on administration and was 
probably a little tired of Contra Costa at that point, I'm not 
sure. So I started looking around, and I thought other people 



234 



in the health department might be interested in opening a 
really good medical practice. We looked at a walnut orchard in 
Concord and thought that might be a good place for a health 
center. We bought the land inexpensively and then got cold 
feet about going into practice. Subsequently we thought we 
might want to make a shopping center. We couldn't get zoning 
for that, and then we sat there on this sizable investment--! 'd 
involved all my friends and all the doctors in the department, 
and even my secretary. So we created a corporation and we'd 
had a dream of building low-cost housing there and couldn't do 
that for other reasons, primarily financing. We created three 
corporations: a real estate managing group, a real estate 
development group, and a construction company. 

We finally built a mobile home complex. Our one 
businessman partner had an unerring eye for what should be 
bought and what sold. He received 10 percent off the top for 
each purchase and likewise for each sale, a potential gold mine 
for him, but he just couldn't resist helping himself to our 
assets, since he was also our manager for the mobile home park 
and for our construction company. 

Fortunately, he had to go away for a national convention of 
his service club, and I automatically took over the paperwork. 
It was pretty shocking to discover that we hadn't been paying 
our bills and that we owed some $80,000 just to our lumber 
company. I removed all the files from his office, went through 
our finances, and discovered that the missing funds had gone to 
building him a magnificent home. 

Just prior to this rude awakening, our last quarterly board 
meeting had taken on a bizarre set of new rituals. First a 
minister came and gave us a blessing, and then we had a flag to 
salute. The reasons for the appearance of these morally 
edifying rituals was soon evident. Fortunately, I had all this 
partner's shares in these three corporations in my safe deposit 
box and it wasn't too hard to set the accounts straight, and 
divorce our errant partner. 

In addition to learning about partners, we learned a lot 
about real estate zoning, borrowing, naming business 
corporations, and some basic rules of survival. 

One of the socially useful things we tried to do was create 
elderly- friendly low-cost housing. We found an Oakland 
architect who specialized in such work and created a plan for 
three low-cost acres in Concord, which were really a marsh 
between two creeks that were being rerouted. The marsh 
disappeared and became a lovely gentle hill when all the local 



235 



contractors used it as a dump for their unwanted fill. I was 
in Washington frequently and went to see the FHA office that 
also guaranteed loans for elderly housing. All that they 
required was a location three blocks from a shopping center, 
which we were, less than 35 percent coverage of the lot, which 
no developer could afford, and concrete and steel construction 
with elevators for a two-story building for people who were 
currently living in multistory fire traps paying several times 
what we would be charging. 

When I asked the federal loan officer if he was ever 
concerned with creating low-cost safe housing for the elderly, 
he allowed that that was never a consideration in their 
offices. They were concerned with keeping real estate 
interests and contractors happy. We sold the land to a real 
estate developer who had ample funds and built lovely 
apartments with tree-shaded walks, but for better-off people, 
aged or otherwise. 

Another lesser disappointment was my design effort for the 
mobile home park which we called The Trees because it was going 
into an older walnut orchard. We surveyed it and I designed 
the park so that we would spare almost all the trees. In 
Concord's warm climate, that would be quite an asset. What 1 
forgot was that all the utilities which were going underground 
had to get to the unit pads, and inadvertently, we lost about 
half of the remaining trees as a result of placing the 
utilities to the pads. 

I did all this in early mornings before arriving at work in 
the health department, in the evenings, and on weekends. Once 
the new ideas were in place, the only interesting aspects were 
new acquisitions and design of new structures. But the 
nuisance of day-to-day transactions, after they fell on me, 
weren't worth the efforts, and since no one else wanted to take 
over, we began closing out. It took about ten years to get rid 
of the last bits and pieces, but it was all very profitable for 
all the partners and everyone left with a good feeling, 
although it was apparent that we could all have become 
millionaires in that real estate boom if we had stuck it out, 
and if I had continued the managing and entrepreneuring, which 
none of us looked forward to. 

One of the side effects of my business matters was the 
status it earned me among some physicians. Physicians in fee- 
for-service practice (the main form of practice then) were not 
overwhelmed with respect for public health M.D.s whom they 
regard as salaried renegades and traitors, or as physicians 
incapable of making a living in practice. In fact, in the 



236 



western end of the county, I was cordially hated in some 
quarters because we held free well-baby clinics, prenatal 
immunization, birth control, and children's cardiac clinics, 
among others. Scathing letters would go to the medical society 
about my socialistic tendencies, i.e., stealing private 
practice patients. Then I would go to a medical society 
council meeting and explain our work, our duties, the laws we 
were under, and get a grumbling acquiescence. As a result of 
the success of the mobile home park, I was invited to address a 
hospital staff meeting on investing in real estate, although 
the meeting was billed as something about health. 



A House in Berkeley 

[Interview 5: March 29, 1997] ## 



Blum: In the final chapter of this relatively important break in our 
history, we moved to Berkeley. We came here in 1966, and 
somewhere around that time I got a Margaret Sanger Award from 
Planned Parenthood. When we got to Berkeley, we decided to 
build a house and bought a lot. But I couldn't get a building 
permit. We'd bought the land, had a surveyor, architects, 
contracts, everything ready to go; and the city wouldn't sign 
the building permit. 

We fooled around for a while, and finally I thought, "I 
wonder if there's something political about all this." I went 
down to the building department and the building inspector 
wasn't in, although I had made an appointment. 



Blum: I remembered my days in San Diego, Contra Costa, and elsewhere 
--you deal with people who seem to have authority, and maybe 
you just have to play the game better than they do. I said to 
his assistant, "Well, I'll just sit here. I'll clear my 
schedule and I'll be here tomorrow. I know the chief is bound 
to come to his office, and I'll be here." That's the sort of 
treatment that they don't know how to deal with. 

In any case, the assistant inspector who had spoken to me 
was very embarrassed about all of this. He was, clearly, very 
uncomfortable when I couldn't get a permit signed. So, when I 
came the next day, he said, "Come in the office and sit here." 
We sat down and chatted a little bit about things, and he said, 
"You're a famous person, aren't you?" I said, "Me?" He said, 



237 



Crawford: 
Blum: 

Crawford: 
Blum: 



Crawford; 
Blum: 



Crawford: 



Blum: 



"Oh, yes, you." I said, "How would you figure that out? 
Nobody ever told me that before." Well, he said, "Didn't you 
get a Margaret Sanger Award?" I said, "Well, that's true, but 
I wouldn't say that I'm really famous." He said, "Oh, yes. 
That's a very important thing. You know, I wish we had known 
about those things when we got married. We have an awful lot 
of kids." [laughs] He's sitting there, admiring me, and he 
said, "Give me that goddamned permit," and he signs it and 
says, "Go aheadbuild your house." [laughs] 

This is very puzzling, though. What was the basis of their--? 

Of their holding it up? Well, I learned, ultimately, after the 
house was built. It turned out that nobody in the neighborhood 
was in agreement. They just didn't like the house. 

Really? The plan? 

Yes. It was something I did myself, and really very 
conservative, with shingles and two almost flat roofs--you 
could say two matchboxes lying one next to the other, with one 
roof overshooting the other and facing northreally, a very 
attractive house, everybody said. It turns out that a fair 
number of neighbors had Cape Cod houses, and a fair number had 
Spanish houses, and they were seeking a compromise on a Spanish 
Cape Cod. [laughter] 

They didn't come forward and say, "This is what we think"? 

Oh, no. We had a hearing because, I think, we came closer to 
the street by a couple of feet than was allowed, and the issue 
of style never came up. A neighbor told me about the 
reservations years laterone of the neighbors who had lived 
there all of his life in a Cape Cod house. 



That brings you to Berkeley and your house, 
your house? 



Do you still like 



Oh, we love it, yes. I somehow knew Roslyn Lindheim does that 
name mean anything to you? Well, she was a professor of 
architecture, here, and a very unusual person. 

My appointment here for a few years was half-time to the 
Department of City and Regional Planning, half-time to the 
Department of Public Health, so I had a foot in each of those 
places. City and Regional Planning is the sibling of 
Architecture and Landscape Architecture in the Department of 
Environmental Design, so I was on the faculty at the Department 
of Environmental Design here, and I guess I met Roz that way. 



238 



Since we were contemplating building and had bought the 
lot, I asked Roz to come and look at it, and look at my design. 
Then I said, "Roz, would you care to be a consultant on the 
project?" She said, "Well, would you listen to a consultant?" 
I said, "Well, no, probably not." She said, "Well, then what 
do you want to pay one for?" [laughs] 

We became good friends over the years a very interesting 
personpassed away now but she's the one who thought up the 
concept of On Lok. That didn't start from anywhere else. This 
was Roslyn Lindheim. Do you remember the Plane Tree in San 
Franciscothe place where folks could get information about 
health and sickness? It was right near Stanford Medical 
School it was the old medical school library and when 
Stanford became California Pacific Medical Center, Plane Tree 
ended up having a ward in the hospital called the Plane Tree. 
It was a different kind of service where people were treated in 
a very different way. All of this was Roz Lindheim also. 

Crawford: Where was it, exactly? 

Blum: It was a ward in CPMC, but the original little library that the 
public could use which had the technical articles and the not- 
so technical articles was right next door to the old Stanford 
Medical School, which is where CPMC is now located. 

Roz worked for Stone, Maracini and Patterson, the big 
hospital architects. She was one of their head architects, and 
she got to hate hospitals, or to be exact, the process of 
hospitalization. She thought of all the ways of avoiding 
hospitalization, or at least of making it bearable, that was 
the Plane Tree unit, and that's what On Lok was all about 
avoiding hospitalization altogether. 

In any event, Roz was the consultant for our house, and she 
made two suggestions, shorten an overhang and take out a corner 
where the hall entered the living room. 

Then I took my plans to an architect in Walnut Creek; I 
didn't know the engineering; I didn't know the right size of 
windows all the things that make a difference, that make it 
simple to build or complicated. He took my floor plan and the 
side, front, back, views, and he put the plan together. Well, 
it wasn't Spanish and it wasn't Cape Cod. 

Crawford: And it was accepted? 



239 

Blum: Yes. Nobody seemed to want to fight very hard, and it's still 
there. 

Crawford: And you're still in it? 
Blum: Oh, yes. 




Health Officer, Contra Costa County, 1950. 




President, Health and Welfare Council 
of Contra Costa County, 196A-65. 




Teaching at the University of California, 
San Francisco, 1969. 




Opening of the Joint Medical Program at the University of 
California, Berkeley, 1972. 



240 



VII MOVING TO BERKELEY: THE UNIVERSITY AND OTHER INVOLVEMENTS: 
1966-1984 



Joining the University of California Faculty and a Campus 
Revolt 



Crawford: That's grand. And that brings us to Berkeley. 

Blum: I started full-time in Berkeley in '66, and that was an 

auspicious, grim year. And a few years thereafter Mr. Nixon 
had us invade Cambodia. This place really blew up again. 
Students and even faculty. I mean, what's the use of teaching, 
what's the use of learning if we're just going to invade 
countries take out a whole country because we didn't like the 
Vietnamese. We're going to clean out Laos and Cambodia because 
our enemies were using routes through those countries to move 
equipment and supplies and troops; we just extend the war at 
will. This place blew up. We had an official holiday here. 
There were very few classes. 

Crawford: You were familiar with UC as a lecturer. 

Blum: Well, to backtrack, I had come in for one course a semester, or 
sometimes for two semesters a year since 1951, to give some of 
the regular courses in the School of Public Health. 

Crawford: So that you knew the dean and you knew the faculty? 

Blum: Sort of. The dean had a long history of relationships with me, 
as you know. It was Chuck Smith, who was world-famous. He 
discovered and clarified a horrible disease, valley fever or 
coccidioidomycosis. Chuck's name became synonymous with that, 
but he was also the dean at the School of Public Health when I 
first came back to this area after Harvard and from San Diego. 
I came to Contra Costa in 1950, and I thought it would be nice 
to teach somewhere, so I came over to the university, here. 
The School of Public Health at one time was housed in one of 



241 



Crawford: 
Blum: 



the crummy little World War II relics in the glade there near 
the library known as the "Temporaries." 

Ned Rogers, who was the head of administration and a very 
nice person, said they didn't need anybody, but Bill Reeves, 
who now has the office next to me and who soon became the dean 
after Chuck Smith died, thought they could use me, and they had 
a very special use for me teaching epidemiology to students 
who didn't speak much English, or to students who had no 
science background, so that they were presumably incapable of 
handling the material. [laughs] 

They got rid of those students out of the epidemiology 
classes, and gave them to me. I had a great time, because it 
just suited my needs. I knew epidemiology pretty well, 
although I'd never had a course in it. It was a natural kind 
of teaching--it was cause and effect, relationships, 
correlationsall the stuff that came naturally to me. 

You said, when I first talked to you, "I thought this way." 

Yes, so I had a great time with these students, and some of 
them really learned more than they ultimately would have in the 
regular courses. 

This was my relationship with the school, on and off. 
Chuck Smith was called the first dean here; he was really the 
second, it's a long historyit' s in Bill Reeves' oral history. 
But Chuck Smith had sat on the examining boards for me in two 
places, when I applied to Contra Costa for the health 
officership and when I applied to San Mateo. In both cases, he 
saw to it that I was number one on the list. There wasn't any 
question that he knew who I was, so when I showed up around the 
school, he seemed interested in putting me on. He was closer 
to epidemiology than he was to administration. In any event, I 
later moved from that to teaching administration when they had 
some holes in the administration faculty. 



Blum: One of my early teaching successes was with a group of master's 
students learning more about administration. A good many had 
experience and all in all we had a lively two-hour seminar each 
week. It was often a shared session with Al Leonard with whom 
I later wrote a text on administration. The class began at ten 
a.m. and nobody seemed to want to quit at noon. 

In the next year using our same open-ended approach with a 
very comparable group of students, the class was okay, but 



242 



Crawford: 



Blum: 



never was scintillating as in the year before. The third year 
was about like the second one. At one bull session about how 
courses worked and didn't work, I learned that in the first 
year in the eight- to ten-a.m. time slot preceding our ten- to 
twelve-session, Helen Ross, more recently the head of health 
education at San Jose State University, had been doing her 
thing for the same group of students who stayed on in the same 
room for our class. Her thing--how to turn students on and get 
them enthused. But she was no longer there in our second and 
third year repeat. I have always been suspicious that Helen 
Ross was the cause of our first-year success. Perhaps a 
successful class depends heavily on what has happened to the 
students in the hours just prior to getting to one's class, not 
on the giftedness of the instructor in the class. 

f* 

You told me there was nothing for you to do because there 
wasn't much going on in the area of administration. 

Yes, but I'd written that book on administration [Public 
Administration: A Public Health Viewpoint] . I was fairly well 
known to a lot of people. 



Crawford: And there was a Stanford connection, as well? 

Blum: Well, that was another story. That was every Friday afternoon, 
beginning in 1950, when I came back to the Bay Area, right up 
to 1960, when Stanford Medical School left San Francisco and 
went down to the Farm. I kept on for three more years, but 
that was a big commute to Palo Alto and I couldn't keep it up. 
That was teaching straight internal medicine. 

The first week that I came to work at UCB as a professor, I 
got a call from Stanford from then-dean Glaser saying, "Come on 
down and talk about teaching preventive medicine at Stanford." 
I would have loved to do that, because the place where 
preventive medicine is needed is in medical school. Everybody 
who comes to a school of public health has already figured out 
that that's their baby. In medical school, that's not friendly 
territory, but has to be made so. 

I'd had a talk with Glaser about that a few years before. 
He said, "We don't have a professor in that, so we can't do 
preventive medicine now, but I'll call you as soon as it looks 
like we can." So he called me, and I turned him down. I said, 
"I can't leave Berkeley; I just got here." 

Crawford: Would that have been a full-time association? 



243 



Job Offers from Stanford. New York City, and Los Angeles Health 



Blum: Oh, yes. It would be part of the faculty. It's really where I 
wanted to be. Well, that was a wild first week here. I got a 
call from a man who once worked for me and then ran a voluntary 
health agency that had been the backbone- -they and the PTA--of 
our doings in Contra Costa County. He said, "I'm bringing up 
three members of the board of health of Los Angeles County. We 
have the blessing of three supervisors of the five, and we want 
to talk to you about coming to L.A. to head up the health 
department (which had recently combined the city and county 
health departments). I'm representing the voluntary health 
agencies, and we promise you every conceivable support. We 
just want to clean this mess up." It was really a bad scene. 
At the same time, practically at the same moment, I got a call 
from Bob Connery, who was the chief of administration for the 
City of New York, for Mayor Lindsay. Do you remember that 
bright, shining light? 

Crawford: Yes. 

Blum: He was a Space Cadet--this Connery--a professor of political 
science at Duke. That was the kind of people Lindsay brought 
in. He said, "I'd like to make you city health officer of New 
York." He said, "Let's talk about this for a few minutes, and 
I'd like an answer by tomorrow, because it's yours, if you want 
it." 

Crawford: You've already started here? 

Blum: I've started here, and here's Stanford, here's Los Angeles City 
and County and now New York City. 

Crawford: All these things coming through! 
Blum: Yes, and all at the wrong time. 

Crawford: What would you have done if you had still been in Contra Costa 
and all these offers came in? 

Blum: I couldn't go to L.A., because when I talked it over with my 
wife, she said, "Look, you go to L.A. I'll stay here." 
[laughter] The reason I said I would be willing to go to L.A. 
is because it was the last place where you could do something. 
It was the last big city where you could put the pieces 
together. 



244 



Crawford: New York would have just been impossible? 

Blum: Impossible. It went downhill for the four preceding and all 
the following health officers. In everything, the cards were 
stacked. The unions were going this way, business was going 
that way. L.A. was all free-wheeling. It still is. Real 
estate is not in bed with the church, and there isn't any 
church to be in bed with. San Francisco is a different story. 
But in L.A. the movie industry doesn't care much about the 
airplane and manufacturing business or the real estate business 
or agriculture; all of these are free-floating power bases and 
you could work out things with people. 

Crawford: You say the church is in bed with real estate here? 
Blum: That's typical San Francisco. 
Crawford: What are the practical ramifications? 

Blum: Tremendous. I mean, you listen to what the unions and 

Archdiocese has to say because between them, they have all the 
votes. Down in L.A., it's all wide open. When unions or real 
estate or electronics promise to support you, you've got a 
vast, free-floating group that crosses all lines. Ditto for 
the other major interest groups. It really would have been 
fun: the last big chance in the U.S. for running a good major 
city-county health department. 

Crawford: Did it work out? 

Blum: Not very well. They got very, very inadequate peoplejust 

terrible. The new big boss in L.A. is the last health officer 
from Contra Costa, and he might make it. He's a clever guy, a 
young man. 

But that isn't all. This is in the course of maybe two 
weeks time. Then I get a call from the University of Hawaii, 
saying that they need a dean of the School of Public Health and 
the state also needs a state health officer, was I interested? 

So I come trudging home each night with all this wild 
stuff, and I said, "Well, honey, what do you think about going 
to Hawaii?" "Live on an island?" was the response. And you 
could just see in her mind a palm tree and a little beach and 
some sand. She loves it for a vacation, but not to work there. 

New York Citythat was the tough one, because that was big 
bucks and great visibility. She said, "All right, now, what is 
it about New York that would really be so wonderful?" I said, 



245 



"When you get through with that, you are well known and nobody 
can tell fame from infamy there. So however well you do, it 
doesn't make any difference." "And so?" Then I said, "Well, 
then I can get any job I want, anywhere." She said, "Such as?" 
I said, "Well, I can be a prof at UC Berkeley." She said, 
"You've got to be crazy. You are a prof at UC Berkeley." 
[laughter] That was a kind of irrefutable position or 
argument . 

So when it all wound down, the only thing she would have 
put up with would be to go to Stanford, if that really worked 
out. But I'd already committed- -you can't leave Berkeley to go 
to Stanford overnight. 

Chuck Smith obviously wasn't adverse to having me here, 
although I heard from various sources that he was anti-Semitic. 
The truth of the matter is he knew very well that I was Jewish, 
and he got me first place in Contra Costa, where there were 
eighteen or twenty candidates and some very good people with a 
lot more experience than I had; and he got me first place in 
San Mateo. 

He was just a nice guy, a good human being. I have trouble 
believing that he was anti-Semitic, he really went out of his 
way to get me started careerwise. He was still here when I was 
first brought onthat was not as a tenured professor. In any 
event, Bill Reeves got me the tenure position a year or so 
later. In 1967-68 I was half-time full professor at City and 
Regional Planning and half-time here. 

That was a start, but really the start was sidetracked by 
the campus revolt at UC Berkeley. The terrible thing was that 
the School of Public Health students in those days were not 
very socially conscious, and they said, "Oh, well, let's go 
home." So they left, the bulk of them. This was a big issue 
for the country, but not for them. 

Crawford: It's surprising to find indifference here. 



A Joint Masters Program; Department of City and Regional 
Planning and Health Planning: Collaboration with Nathan Glaser 



Blum: Yes, it is, but City and Regional Planning was another story. 
They were wide-eyed and ran nearly all the campus protest 
activities out of Wurster. Practically all the posters were 
made, and all the key student meetings were held there. I sat 



246 



Crawford: 
Blum: 

Crawford: 
Blum: 



Crawford: 



Blum: 



in on hundreds of student and faculty meetings. I tell you, 
that was big business, but I didn't have to make a decision 
about not holding class there was nobody left to hold it for 
in public health. 

And how long was that? 

Oh, it was months several months. The whole semester was 
lost. 

What was the job in environmental design? 

That came about because I was teaching health planning and they 
wanted to keep a relationship between the two departments. In 
fact, I later engineered a joint masters degree with City and 
Regional Planning and Public Health. In three years, a student 
gets two masters degrees one in city and regional planning, 
and one in health planning. It's an ongoing program. It made 
good sense there were a lot of brilliant people in city and 
regional planning, both on the faculty and among the students. 

Environmental design was the school, and this was the 
subset. I guess I taught one class up there in the 1970s, and 
Bill Wheaton, who was head of the department, introduced me to 
the class: "This is Dr. Blum. He's really a public health 
person, a physician." He said, "Now, if you're going to be 
using his book on health planning, that's the best book. Well, 
it's the only book." [laughter] He wasn't kidding anybody. I 
don't think he was overwhelmed with the book, although I was 
quite pleased with it. 



This was Planning for Health [Planning for Health. 
Publications, New York, 1974.) 



Behavioral 



Planning for Health. So, that was kind of fun. At that point, 
Nathan Glazer, the famous sociologist from Harvard of Riesman 
collaboration fame, was here as a professor in city and 
regional planning. It was that kind of a school. They had 
superb people. 

William Wurster was another onethe building's named after 
him- -he was both the dean of architecture here and the dean at 
MIT at the same time for several years. It was a nice show. 
I've mentioned Mrs. Wurster her name was Catherine Bauer was 
on Len Duhl's Space Cadets. She was a wonderful person; a 
sociologist and a housing expert. 

Nathan Glazer and I ended up in the same enclave. City and 
regional planning decided to put together a program called 



247 



"social planning." There wasn't any such curriculum then. So 
Glazer and I teamed up on that, and we actually admitted a 
group of doctoral students to that program. It was really 
meant to be Mel Weber's assignment, but he was on a sabbatical 
in England. He was teaching over there. 

So Glazer and I held the show together, admitted a dozen 
doctoral studentssome became quite famous and I learned that 
part of Glazer 's charm was to let the other guy do the work, 
somehow or other. He was a brilliant man, and as soon as he 
saw an idea, there would be an article springing out, and then 
it was published because he was Nathan Glazer. But it was 
quite a chore for me, especially as he got really fed up here, 
because the university promised him this, and they promised him 
that, and produced nothing. He was supposed to have a decent 
office and a secretaryhe' s kind of a luminary, you know. 
Nothing. So he went back to Harvard. I gave up my part-time 
work at city and regional planning since I had to do a full 
share of committee work for each of the two departments and had 
no time left to do anything useful in either. 

Crawford: What about the rest of the faculty in the School of Public 

Health? I think some other public health officers were brought 
on about the same time. 

Blum: There was Dwight Bissel, but he was never full-time faculty 
here. He was one of the people who competed for my job in 
Contra Costa. He used to teach here, off and on. He was a 
good man--a very good manand he was the City of San Jose 
health officer. But he was filling in for permanent faculty 
that the school didn't have, as I had done earlier. 

Then Al Leonard, who also had taken the exam for Contra 
Costa, took the job that I left in San Diego and then he came 
to be the City of Berkeley health officer. At that time the 
university had a deal with the City of Berkeley that three 
professors in the School of Public Health would also be the 
officials of the health department of the City of Berkeley, so 
that we would have a real, honest- to-God training ground for 
public health students. 

In any case, these people were meant to be both in teaching 
and active in public health duties, but it didn't hold. People 
like myself came in over the top of them as full-time faculty, 
and these people slowly disappeared from the faculty. 

One of the catches to it was that the university doesn't 
honor people who are doing teaching and paid work for cities 
and not devoting themselves to research. It just wasn't in the 



248 



cards that they would get permanent appointments here, even 
though there was an agreement to that effect. It lasted for 
half a dozen years, more or less. 



A First Course in Health Planning. 1967. and New Legislation; 
The 89th Congress, 1966 



Blum: I came here in July, 1966, and the new federal planning law was 
passed in December, 1966, and I decided to offer courses in 
planning in '67. The head in administration was Ned Rogers a 
very lovely Bostonian and just a terrific guy--what you call 
an honest, bright conservative who still thought the Republican 
presidents were tremendous. We could never discuss things like 
presidents, but we could discuss public health, and he wrote 
the first book on human ecology. 

Crawford: And he'd been dean. 

Blum: He had momentarily been dean. He brought in Smith to replace 
himself when he was about to become UC's vice president for 
health. Because he had the temerity to say publicly that 
government should really take over health care, the medical 
people in this world wiped him out, and he couldn't be a 
university vice president. He was a straightforward, proper 
Bostonian, a Beacon Hill-type who believed, and inadvertently 
said, that the only way we're ever going to have a good health 
care system is by the single-payer systemto provide universal 
coverage. Well, that was anathema to organized medicine. 

Crawford: How did they move against him? 

Blum: Politically, they just saw to it that he couldn't be vice 
president for health at UC. 



Blum: So Ned Rogers backed away and said, "Well, Chuck, 1 brought you 
in to be dean, you're dean, and I'll go back to being head of 
administration, a professor of administration." Not too long 
after that I came here, and when Chuck passed away, Bill Reeves 
became the dean. 

Crawford: Talk about the difference in styles. 

Blum: I didn't have that much to do with either of them prior to 

coming on full-time, you see. As I said, Chuck Smith was very, 



249 



very friendly, and he was good about human beings. One of his 
pet students became the health officer of San Mateo County- -Hal 
Chope, after whom they named their county hospital. Chope 
caught coccidioidomycosis as a medical student in Chuck Smith's 
lab at Stanford. It's a horrible disease; there was no 
treatment, and he started going downhill. So Chuck said, 
"Let's just never mind you going through medical school. Let's 
have you take it easy." They sent him on a trip around the 
world. Chuck paid for all of this, as far as I know. 

Crawford: Just felt badly about it? 

Blum: Yes, and I think Chope wound up in South America, where he 

started feeling better. He came back and he was all right, and 
he finished medical school and went into public health. It 
takes a pretty good guy to accept responsibility for such a 
lab-acquired illness. Anybody else would have blamed the 
student for breathing too hard, or something, just wouldn't 
take it upon themselvesChuck did. 

Chope and I were co-partners in crime for many years- -he 
was health officer in San Mateo County and I was in Contra 
Costa. He was a good bit older than I and a lot more 
prominent. In any event, Chuck took a hand in all of these 
things. I'm sure he took a hand in getting him that job in San 
Mateo--which was the best public health job in the States. 

Crawford: I talked to a student of yours from those early years named 
Lucy Johns . 

Blum: Oh, wow. Okay. I was going to tell you about Lucy. 

Crawford: She told me that you loved the climate on campus; that you took 
courses and you were very much a part of the antiwar activism. 

Blum: Lucy Johns was in my first class, and, in fact, one of her 
ideas was in my first book on planning. Unfortunately, I 
didn't notice that when it was published, it said, "Lucy 
Jones, " not Johns. It was one of those nice printer errors. 
Lucy upbraided me once, in recent years for that. She said, 
"You know, I've always held it against you that you didn't give 
me credit for that power configuration." 

Crawford: What was it, specifically? 

Blum: It's a chart describing sources of power in the textbook on 
health planning that was her idea. I said, "What are you 
talking about?" She said, "Well, you didn't really give me 
credit." I said, "Goddammit, let's get a copy of the book." 



250 



So we opened up the book, and I said, "Isn't that your chart." 
"Well, yes." I said, "Well, what does it say?" Then we both 
looked, and it said Lucy Jones. [laughter] 

She had never bothered to really look at that chart. I 
don't know what she thought but, any event, we were always good 
friends. She was in my first class of graduate students, and 
she was a character. Sometimes she would perch up on my desk 
in my office and start giving me a lecture. 

II 

Crawford: You must have had wonderful students. 

Blum: Unbelievable. They were very, very bright; they were young; 
they were not coming here for refurbishing; they were not ex- 
health officers and ex-this and ex-that, coming in for a year 
so they could get a raise or a promotion. These were people 
who thought something could be done and should be done by use 
of planning. The war had pretty well shaken them up. We were 
destroying Johnson's good programs to create an army to kill 
all the Vietnamese a big deal. 1 said, "I've never taught a 
planning course." "Well, start . Let's start." 

Crawford: It sounds as if the students contributed substantially. Lucy 
Johns called your classes a free-for-all. She said you never 
stood up at the top of the class and lectured formally. 

Blum: I might have gotten more respect if I'd have done that, but 
then I probably would have killed the discussion. This way, 
they were on their best behavior to get up there and try to say 
something, so the others couldn't demolish it. 

Crawford: You had more Ph.D. degree students, I think, than anybody on 
the faculty. 

Blum: I probably did. 
Crawford: Were you tough? 

Blum: No, not at all. I'd inherited a good many from other faculty 
who seemed not to care; wouldn't even read their students' 
papers. We had a few such faculty. I got four or five very 
good students who had a faculty member who wouldn't even read 
or criticize their thesis. I remember three or fourat least 
two of whom are now professors that I just took over. I said, 
"Let's change the committee structure, and I'll be your 
chairman, and let's get rid of this knothead that you've got in 
there as your committee chair." 



251 



Crawford: You mean they'd sign off without having looking at the thesis? 

Blum: Well, they might not even sign off. They might not ever do 
anythingit was just horrible. There weren't a lot of such 
people, but there were a couple, and they were in interesting 
slots, so the students were attracted to them. That was kind 
of tragic. 

Crawford: They were there for research instead of teaching? 

Blum: They weren't there for anything. 

Crawford: Just lazy? 

Blum: Lazy was the only word for it. 

Crawford: But a small percentage, let's hope. 

Blum: Yes, but they were agreeable they ' d take any student. But 
then they wouldn't even read a thesis. 

I inherited a lot of ambitious people who came in with an 
anthropologic, sociologic, or economic kind of slant, a lot of 
whom weren't mine. When I retired, I had fourteen people, 
still, in the Ph.D. track. That was fine. That kept me doing 
something for several years. They took three, four, five 
years. Many of them were working full-time as well. 

Crawford: So that's a very rewarding aspect it has to be. 

Blum: Yes, and people don't appreciate that. I heard the old saw 
about faculty who have to publish or perish, but that never 
bothered me as I started out at the top, and within a year or 
two I was tenured. As I've said, I was lucky. 

Crawford: You never felt pressured. 

Blum: Pressured? No. 

Crawford: You published lots after that, obviously. 

Blum: Not a great deal. I should have done a lot more. I've got a 

lot of things I really could have published, but I wasn't quite 
secure about the validity of my observations, for instance, 
after my study of Sweden in 1986. I did more work on Sweden 
than anybody's ever done from this country. I didn't publish 
it because I knew there were a lot of weak spots in what I had 
put together, things that no one in Sweden was prepared to 
argue or defend. It was good enough for me to use as the basis 



252 



Crawford: 
Blum: 



Crawford; 
Blum: 



of lectures and classes, but we weren't drawing absolute 
conclusions, and I was too lazy to do the research on the 
thing, especially knowing that a stranger does see things 
differently, not necessarily correctly or wrongly. 

This was true of my trip to China in 1987. I had just 
finished reading, when you came in, a thesis on health care in 
China. It's exactly what I observed in 1987 as a visiting 
professor at West China University of Medical Sciences in 
Chengdu, but I never wrote a word on it, because I thought that 
although I was there three months, I had pretty superficial 
information. I didn't really document, and of course, neither 
did they. I was just wandering around, looking, talking, and 
as it turns out, as better documentation is emerging, I was 
very much on the right track with my surmises, e.g., that 
useful basic care for the rural 800 million was falling apart. 

Well, this is a masters thesis I am reading, done from the 
literature, but it's exactly what I had discovered. It's as I 
thought it was--one hell of a mess, and it all started just 
about the time we were there. I never published a word on it, 
because I didn't want to badmouth China. I didn't know where 
Deng was taking them. I wasn't about to spend a year or two 
researching that. Besides, I don't speak Chinese, I don't read 
Chinese, and so it would be a lot of second-hand material. I 
just didn't botherbut in my own mind, I saw it very clearly. 
In the Swedish situation I did report about what went on in 
Sweden, and contrasted it with what is going on in the U.S. so 
that American readers would have a baselinebut never 
published it. 

Yes, we have that material. 

I think it was pretty good, but I wasn't that interested in 
publishing. I didn't have to get ahead. I did it for my own 
edification and for the students that I was working with. That 
was good enough, but some of the faculty feel so pressured. 
These are even people who have tenure and the luxury of 
everythingif you can call it luxury, being around here. They 
really weren't interested in students; that's what it all 
boiled down to, they were into research. 

You often hear that. 

The one thing that I could see was that if I gave three hours, 
three times a year which is not a lot to some good doctoral 
student, that's about what it took to help them when they 
needed it on their thesis, I could learn a lot. 



253 



Crawford: Your door is always open, even now. Dr. Reeves told me that. 

Blum: Yes. But that is not expensive. I mean, three hours once in a 
while for somebody digesting the world's literature on a 
subject and doing a study on some aspect of an issue gives you 
the last word delivered to your desk. Nobody's going to do it 
any better. It's usually something new, and if it isn't 
something new, it's a repeat of something old that needs 
repetition. You can't complain that you're losing ground-- 
you're not. 

Crawford: Your gain. 

Blum: Yes, for a few hours, you get what people have spent hundreds 
and even thousands of hours on. It's true that many faculty 
who do work with graduate students only let them work on the 
area that they themselves are working in, and this 
distinguished me--I was willing to have the student work in 
whatever area if it's relevant to the student, even if I'm not 
getting ahead from it. 

Crawford: You'll get better material if it's their real interest they are 
researching and writing about. 

Blum: Well, surely, yes, but these are different ways of looking at 
it. In part, I never had any pressure. My wife and I had 
always said we weren't going to bend to pressure, so we always 
saw to it that we didn't have great debts and we always had 
some money in the bank. We always paid for our houses when we 
walked in the door. We were not born rich, I can assure you, 
or even well-off or even just minimally well-off; we were in 
real trouble economically, but we said, "We're never going to 
be pushed by our debts. So we don't have to accept anything 
from anybody that we don't want to." And that's a great 
relief. Now it does mean that you're stodgy, in one sense, 
that you always want to have a bank account, but I don't find 
that so embarrassing. 

But I learned a lot and I took fourteen or so Ph.D.'s on 
after I retired. 

When I retired from the School of Public Health at the end 
of 1984, there was a huge party--! mean, hundreds of people 
from all over, and there's a picture of me, six months old- -my 
wife had fetched it out- -stark naked, you know. [laughs] 

Crawford: Oh, they loved that. 



254 



Blum: And they blew it up. It was six feet high. I found it the 
other day, or she did, cleaning out my study closet. 

So it was that sort of a thing; my whole career laid out, 
and people wanted to say things. The major speaker was Bill 
Reeves, but Lucy Johns wasn't on the list to say anything, and 
she just worked herself right up to the microphone, and got a 
little hystericalthat's not Lucy's styleabout how I'd saved 
her life, and her career, and a few other things. She was one 
of the protesters in '67, in that first class. Lucy had 
wandered around with some kind of a sign about something or 
other, and lo and behold, had been nailed and, apparently, 
kicked out by Chuck Smith. I don't really remember all this, 
neither does Bill Reeves. 

Crawford: That was the situation on campus? 

Blum: Oh, it was pretty mean, yes. I found out whatever the matter 
was and got her back in. She was probably the best student I 
had. It was just absolutely an amazing planning class, almost 
every one of them became well-known at whatever they were 
doing. 

That was a class that insisted that we teach planning 
because they all came for that purpose, but there was no 
planning program or courses as yet, and it was my first year of 
full-time teaching. So we struck up a deal. There were about 
thirty students who wanted to take planning, and, if each of 
them promised to do a lecture, then I would run the course. I 
agreed to give one lecture too. We had divvied up issues of 
different kinds that none of us knew about, because planning is 
not the public health world. It wasn't then, and it still 
isn' t . 

Crawford: So the demand was coming from the students? 

Blum: Yes. As I said, I was hired as a professor of administration, 
and at that moment they didn't need me in that area. They had 
several good people here, and there was nothing left for me to 
teach, so I was going to sit. I remember coming to the first 
faculty meeting, and they asked, "What do you want to do?" I 
said, "There will be a planning law in a couple of months- - 
maybe I should teach planning." They agreed that it was a good 
idea. They said, "There's nobody here to teach planning, and, 
besides, everybody in public health knows how to plan." Which 
was surely a good joke, as it turned out. So I agreed to do 
it, and I had this first class, which probably was January of 
'67, and Lucy was in that group, along with some other 
unbelievable people. 



255 



Crawford: 
Blum: 

Crawford: 



I had been to a meeting a few months before the course 
started and ran into a man by the name of Mark Blumberg, who 
became chief planner for Kaiser. He was probably the first 
bonafide health planner in the United States. Mark Blumberg- - 
he was a dentist, a physician, and an economist and just a 
tremendous person. He did some of the first technical health 
planning in the U.S., in Hawaii on their health plan, and put 
them way ahead of everybody. Nobody knew what it was that he 
was doing at that time, but it was good, and became a landmark 
approach to one area of planning. 

I think he and I had worked together at that air pollution 
control district that little advisory committee and Mark was 
either part of the staff, or he was on the technical advisory 
board. I left about the time he came on. Maybe he replaced 
me . I don ' t know . 

A few months before my first planning course got underway, 
he and I were at a meeting on manpower, and he gave a spiel 
about what was wrong with the document that had been presented 
to us. I had exactly the same feelings about it, and expressed 
them. After that, he came up to me, and he said, "What the 
hell do you know about planning?" He's that kind of a guy, a 
really big, tall gruff guy. I said, "Oh, enough to be a 
professor of health planning." He had never been a professor, 
and I'm told that he always wanted to be, and that remark was 
the worst kind of beating anybody could have given him. He's a 
very helpful man, as well as a wonderful planner. 

So, since we were getting acquainted the hard way, I said 
to him, "Look, I'm going to start teaching a course on health 
planning. How about you coming over and opening it up, and 
setting us straight. Explain planning to us, because I'm not 
so sure we know what it's about." He did that and came here 
for years. He used to assist, come in, wouldn't take any 
money. He was at Kaiser and couldn't receive money. Mark 
started us off, and then each of the students took a subject; I 
took one, and we explained to one another what these terms and 
concepts were that were central to planning and that we had 
never dealt with in public health. So the course started out 
with a bang. 

What was the thrust of the course? 

Planning health planning- -what it was, how to do it. It ended 
up being a great big book in my hands before it was all done. 



Different kinds of health planning? 
that sort of thing? 



Single payer coverage, 



256 



Blum: No. We were in the world of health planning, not health care. 
My attitude was that you have to plan for health care when you 
fail on the health planning side, that what doctors do is just 
treatment for health failures. 

Health planning really has something to do with "Do you 
have something to eat? Do you have a job? Do you have a roof 
over your head? Do you have rats enjoying it with you, or 
not?" This is what affects health; this is the big game. The 
world is coming back to it, finally. The realities are that 
health is determined primarily by the large environment, 
social, cultural, economic, educational forces in particular. 
So that's what the students were learning. Ultimately many of 
them ended up doing health care planning too. 

Crawford: What was the legislation? 

Blum: Oh, it was the Public Law 89-749--the 89th Congress. 

Crawford: You said that became law just as you were coming on at 
Berkeley. 



A 1968 Planning Grant from the USPHS ; a Program for Minorities 
and Native Americans; Abandoning Our Marvelous Planning Grant 



Blum: Yes. We knew it was going to happen, and nobody in the United 
States or anywhere else knew where or how to start teaching 
about it. So we started right here, and we had a good time. 
We got a huge grantBill Reeves was already dean--and we 
started out educating ourselves. 



Blum: In the School of Public Health we did assemble a team. It was 
very clear where the health problems were they were primarily 
in the poor and dysfunctional neighborhoods. So we started the 
planning program here by bringing in forty or fifty of the 
world's top planners in the summer of 1968 to teach us what 
planning was and how to go about it. 

One of them came from Cleveland, which supposedly had done 
the very best work on health planning. They have a good school 
of planning in Ohio, interestingly enough. I think it's the 
Hoover School at the University of Cincinnati. I remember I 
visited there once. Cleveland had this great study about what 
to do, and if you flip over the pages of the report, the first 



257 



thing you see is where the problems are. The problem areas 
were shown in transparencies, and on the very bottom 
transparency was the census tracts. On the next overlay 
transparency was the average incomes. Then came all the health 
pictures. All the bad health problems in Cleveland, by and 
large, were in a handful of neighborhoods; you could see 
through all these transparencies all were in the same place. 

Cleveland had brought in the greatest minds in public 
health and that was part of this great Cleveland Plan. They 
looked at the study and they said, "Well, we have to have 
better sex education. We have to have more blood testing." 
They looked at the infant death rates, and they said, "We have 
to have more clinics to give earlier prenatal care." All in 
the bad neighborhoods. 

They went through every one of these major health 
deficiencies and came up with all the answers that never have 
worked- -and that was the great Cleveland Plan. We learned how 
incompetent health planners really were and how ignorant public 
health specialists were. 

Crawford: What is the problem with it? 

Blum: The study tells you exactly what's wrong, and that nobody gives 
a damn about the causes. They went through all the traditional 
markers for health and produced all the recommendations that 
don't make that much difference. They acted as though treating 
each of the findings by traditional health care and education 
was going to offset the illiterate, poverty-stricken, 
dysfunctional neighborhoods and families. 

Crawford: Instead of getting to the neighborhoods--. 

Blum: And seeing how you could revive them. But we were educating 

ourselves, and that's when we invited all these people in, and 
it was kind of dispiriting to see how stupid some of the 
renowned experts really were. None of the professional 
planners were making a case for looking at anything 
intelligently. The Cleveland Plan was great tremendous, but 
it was irrelevant. Even heart disease, even cancer, accidents, 
all diseases were excessive in the same neighborhoods, how can 
one overlook the socio-economic cultural setting? 

Well, people are still getting famous for writing about 
that and using those data some to illustrate what is really 
relevant, and some to go back to the old garbage. The United 
States Public Health Service still deals mostly with the old 
garbage even the Robert Wood Johnson Foundation in one of 



258 



their 1997 brochures regurgitates how it's just bad habits that 
are killing Americans. 

II 

Blum: As an aside, there had been practically no minority students 
here before that. Yes, there were people who were black or 
blue or green, but that's because they came from other 
countries to get their schooling here. 

So we started out, and one of the people in that first 
class was an exec from the TB circuit, Elaine Walbrook. She 
was in my first class when I was new here, and she was new as a 
student, but we had become old pals in previous years. Since 
I'd lost track of her in the TB movement, she had gone to work 
for the Paiute Indians in Nevada. She was in the class, and as 
we put the grant together I grabbed her to be part of the staff 
because she was an expert organizer. 

Crawford: This was a U.S. Public Health Service grant in curriculum 
planning? 

Blum: A planning grant. 

Crawford: A hundred and six thousand, something like that? 

Blum: Oh, hell no. It was a million and a half or something like 
that. 

Crawford: For Berkeley? That's astounding. 

Blum: Well, there was no school in the country that was prepared to 
deal with it but Berkeley's School of Public Health. 

Crawford: Those were the salad days? 

Blum: Yes, there was money. Lots of money has been wasted on a lot 
of other things, too. 

Crawford: Was that a multi-year grant? 

Blum: Yes, it was for three years. Elaine had the idea to bring in 

minorities in the summertime for the six-week summer portion of 
the grant program and teach them something about health 
planning. We decided to bring in a lot of black people for the 
first summer, because they were the most numerous around us. 
Then the second year, we would bring in a good number of 
American Indianswho were her buddies and she knew their 
world backwards and forwards. The third year, we would bring 



259 



Crawford: 
Blum: 



in Hispanics--they ' re the most recent immigrants, 
exactly what we did. 



And that ' s 



We had a tremendous experience, and not just because we 
brought in guest lecturers. We started in the spring of '68 
with ourselves and guest artists for us, and by the time we got 
to the summer, we realized that we were hearing nothing new, 
practically. Everything we were going to hear, we'd boned up 
on. In a year I'd read about three hundred books on planning-- 
I really mowed through the field. I discovered that we in 
public health knew nothing about it. The planning that one 
does in administering an organization has little to do with 
community- level planning. It's a different world. 

Define what you mean a little more narrowly, would you? 

Well, if you work inside an organization, you've got the 
organization's objectives, and you've got the rules of the game 
by which it must work, and a set budget with which to do it. 
This is what is wanted from it, so how do we get from here to 



there with the monies we have, 
almost automatic. 



It's internal planning. It's 



Crawford: 
Blum: 



In other words, that's what everybody is getting so famous 
for, guiding their organization, and getting their hundred 
million dollars of bonus for. You're going from here to there, 
but you have to figure out how to do it- -but it's all cut and 
dried when it's within your organization, e.g., make a handsome 
profit. Once you make your plan, whether you were wise or not, 
time will tell. But when we were doing health planning, we 
were planning for whole communities rather than for an 
organization, and we had to take everyone's objectives into 
account, various levels and types of government agencies and 
the whole world of private interests, as well as the 
unexpressed needs and desires of the citizenry whose health is 
to be improved. 

Global. 

Yes, in other words, what is needed here? This is a view that 
can be shared by every citizen, if you want to go that far. 
There is also a special set of constraints, as no two people 
need or want the same things. It's just a different worldand 
it's a fun worldit isn't just internal organizational 
planning. Not everybody understood this, and some people in 
public health never did. 

So we started out teaching ourselves, and within six 
months' time, we had a pretty good understanding of the 



260 



subject. Then we invited in these minority people, along with 
others, for a six- week summer session. We had folks from all 
kinds of out-of-the-way places, such as the Pacific Islands. 
We brought in lots of minority people who ultimately went on to 
graduate school, and a good many for more advanced degrees. 
They had been proposed by their communities generally. 

II 

Blum: Unfortunately, our concern for planning for improved health did 
not focus on how to do more or better medical care, rather on 
how to improve health by working on the socioeconomic and other 
factors that determine health. This scared our funders. At 
the end of the second year they adjourned a spectacular team of 
over a dozen hot-shots of traditional fame. After a day of 
questions and answers down in the then Regents' meeting room on 
the ground floor of this building, they remained totally 
nonplussed, best expressed by one of the visiting geniuses, 
"Why don't you build something useful like planning a health 
center, rather than working on how to prevent the various major 
forms of heart disease?" I lost my cool and suggested that 
we'd rather use our wits and no money than their wits and their 
money, a sort of Shavian take-off. 

As we walked out, someone came up behind me. It was Bill 
Reeves, whom I hadn't seen come in the back door, and he said, 
"I guess you don't really want your grant good for you, keep 
on doing what needs to be done." That was mighty supportive 
from the dean at a bad time. 

We had done the right thing and went on our way. They let 
us spend what remained of the grant. 



Blum: Planning became big time, even without our grant, and Elaine 
Walbrook, because she identified with the Indians, took their 
recruitment on after the big grant was over, and we really 
brought in Native Americans to UCB for years and years and 
years; brought them in first to Public Health and to Social 
Welfare, then to the whole campus. Elaine was the brain behind 
this. 

When you come to our house, you see a lot of Indian things. 
These are gifts from ex-students; people that went through the 
program. They had an interesting time. I remember one lady, 
Sandra Yellowhawk, gave me a beautiful burden basket. She's an 
organizer, down in Peach Springs, of all places that ' s the 
entryway to Havasu Canyon. She was a very quiet, soft-spoken 



261 



persontrained as a nurse. After the first yearit was a 
two-year program she introduced me to her husband and daughter 
one day, and she said, "I know you wouldn't approve of what we 
did, but my daughter and I just went to" what was the name of 
that great big faker who held those horrible meetings and 
taught you how to be a bastard to everybody? 

Crawford: Werner Erhardt est . 

Blum: Werner Erhardt est . She said, "I know you wouldn't approve of 
it, but we went." She never spoke like this before. She said, 
"You know, I don't think my daughter and I ever had a 
conversation before we went to this course, and my husband and 
I surely never did. We just sat there and ate our breakfast, 
and our lunch, and our dinner. We never really conversed with 
one another. Now we do." She joined the graduation committee 
of the School of Public Health, and she got into every single 
thing before the year was over she just blossomed. 

Crawford: She was empowered, as they say. 

Blum: Empowered. And by that reprobate. Well, we had all kinds of 
people, and some did have trouble. We brought in a wonderful 
old medicine man, and he had a bad time because this was so 
foreign, and he was an old man. Many of these people, when 
they went back to their tribes, were resented and pushed out. 
It was like the old story of the Africans going back to 
Liberia: "We don't need you; you're not one of us." So there 
was some of that. 

We had one wonderful guy, since passed away, who was a 
robust Midwest Indian. He was a fighter pilot during World War 
II, and a hereditary chief. Some of the tribes have hereditary 
chiefs, some have elected chiefs, and some don't have chiefs at 
all, like the Navajos. He came through the summer training 
program, and he did very well, though he used to give us a 
rough time. He was a burly, fun kind of character. 

Elaine set up an Indian advisory board for the whole Indian 
recruitment and training program that we ran. All this had 
merged, finally, into just an Indian program, because black 
recruitment and Hispanic took place elsewhere. The advisory 
board was made up of prominent Indian leaders from many walks 
of life, including some of our former summer trainees as well 
as Indian graduates from our school. They advised us on the 
real world, on what we had to teach, and helped get legislation 
and funds relevant to our training and relevant to Indian 
health generally. 



262 



Crawford: 
Blum: 



The hereditary chief came on the board a few years along, 
and as I greeted him he made a little speech to the board for 
my benefit to the effect that I had been so patronizing to the 
Indians in the summer program, and it made him decide to show 
me--he went to Harvard and got an M.B.A., and then went back to 
his tribal chief duties, and here he was on our board, back at 
UCB. He had forgiven me, decided I was all right after all. 

Elaine did so well that we recruited Indians for eight 
other schools of public health, as well as our own. We'd give 
the trainees a summer training here, and then they'd go to 
whatever school they had chosen. We had big grants in order to 
keep going. Elaine did all that single-handed. She knew 
Senator Fred Harris, who was married to a great Indian lady. 
Elaine really knew everybody in the field and on the 
congressional committees. 

Then the Indian Health Service started fighting us. You 
see, we had said we would not train people just to go back to 
the Indian Health Service. There was no way Indians were going 
to get a masters degree here and just qualify for the Indian 
Health Service. You come here as an Indian, you're not going 
out as an Indian- -you 1 re going out as any damn thing you want. 
They couldn't understand that, and they didn't want to put 
money into it. One of the SPH non-Indian graduates, actually, 
ran the IHS program. We fought him tooth and nail in Congress 
and won, year after year. Elaine was hated in some quarters, 
but she did the job and was loved in the Indian community. 

Were they generally successful in their fields? 

I would think so, yes, and we have some wonderful memories of 
some of those people, some of whom I still occasionally see. 

The upshot of all of this was that we won the battle year 
after year of getting the funds for the Indians, in spite of 
the Indian Health Service. Elaine passed away a few years ago 
from cancer, which had limited her for several years, but she 
never quit. She carried the ball on this campus. 

We had social welfare involved, and then we sat down with 
the dean for minority affairs and the folks in engineering; 
some petroleum types. They said they didn't want any Indian 
programs, unless the students could get in on the usual 
admission procedures, and so on. 

Elaine looked at this great professor, and she said, "Where 
do you work? Don't you work with Conoco? Do you know you're 
on Navajo land? Do you realize that they govern this land?" 



263 



She really slapped him around, and, lo and behold, engineering 
decided they could take Indians. Some of the students 
graduated here and then went through law school as well. 

There was another Indian graduate of this school of public 
health years and years agoBlue Spruce. George Blue Spruce 
was an Indian dentist, of which there are very few, and he had 
graduated here and had gone on to be a big shot in the Indian 
Health Service. Such Indians were rare until our program 
kicked in. 

I hadn't been here very long when I got the bug that we 
should have minority students in the department. In Contra 
Costa County, we had worked with all kinds of wonderful 
minorities. There were people who were talented, yet said that 
they could never make it into this university and so on. It 
seemed preposterous, but many of them didn't bother studying in 
school, and I knew that. So I cooked up a deal. 

I wanted nineteen or twenty new student slots, one for each 
programthere were that many programs in the School of Public 
Health, and everybody who had a grant had a program. They were 
departments unto themselves, and it was a mess. 

Crawford: What would have been some of those categories? 

Blum: Oh, there might be maternal and child health, there might be 
nutritionthose are the big ones health education, but then 
there was nursing administration, there was hospital 
administration, there was dental administration, there was 
general administration, there was planning. There were five 
programs, right in that one little enclave of administrative 
thinking, each admitting their own students. 

Crawford: All competing for the same funding? 

Blum: Not quite; there was different funding. The reason they were 
in existence was that each had different specialized funding. 
This was the heyday of the School of Public Health fundings, 
but not too academically healthy. 

Crawford: Why was funding so easy to come by? 

Blum: Well, this was the Johnson era. They were trying to do 

something, trying to change. After all, the U.S. was a pretty 
chronically impoverished place. It may have looked good in San 
Francisco, but it didn't look so good in a lot of other places, 
including the hills of California. Hillbillies were indigenous 
out there, all kinds of them. 



264 



Crawford; 
Blum: 

Crawford: 
Blum: 



Crawford: 
Blum: 
Crawford: 
Blum: 



So I decided to go for a minority training grant. I wrote 
it up and took it around to each of the faculty, and I said, 
"Just put up one slot. Make a provision for one student, one 
minority, and between us, we'll have twenty." Do you know, not 
a single department would give me one slot. 



A student slot? 

A student slot, 
was one. 



Not a single department except mine, so there 



What would it have cost them? 

Nothing, they just weren't about to put up with that kind of 
nonsense. They were going to pick all the best students they 
could get, and had no room for a minority person who might not 
seem up to the grade-based competition. 

So, was this anti-affirmative action? 

Oh, yes, and I realized it wasn't going to get any better. 

How about Dr. Reeves? 

Well, he was the dean, so I took it down to him. I'd never 
talked to him about this, and I didn't know what to expect. I 
knew he was a nice guy, and I knew he liked me because he was 
the one who made me a tenured professor. In those days there 
were no committeesyou just did it. 

He said, "You're going to take in nineteen or twenty people 
because they're black or brown or something, and you're going 
to leave out people with straight A's from Harvard?" I said, 
"I don't expect to leave anybody out who has straight A's from 
Harvard, but it might be good for the school to leave them 
out." We had had some horrible people from those great places. 

I said, "These are the people who come from the ranks of 
the folks who need the services, and we graduate nobody to talk 
to them out there." This is a very basic argument about 
diversification. We had quite a time, and then, without 
batting an eyelashtypical Bill Reeves--he said, "All right. 
What do you want me to sign?" [laughter] 

So he signed the document asking for the assignment of 
nineteen or twenty new student positions in the school, 
positions which are fought over because student slots are the 
basis for getting more facultyit 's all geared to student 
enrollment, you see. 



265 



Then I took this up to the dean of the graduate school, who 
I've mentioned was a fine man by the name of Sanford Elberg. 
Sanford is still around. He used to be faculty at the School 
of Public Health. He was the world's authority on brucellosis. 

He had been one of my instructors in bacteriology; we hit 
it off really well, because I had made a point of being the 
best student in the big course in bacteriology. 

fl 

Blum: He looked at the document and agreed that it was very 

important. He said, "Let's go into the inner office and talk 
about it." Then he gets to the inner office, which was all 
fitted in oak, pulls open the drawer behind him, and brings out 
a big flask of sherry. He pours me a glass and pours himself a 
glass. [laughs] This isn't customary behavior on this campus, 
I'll tell you. 

We start discussing the proposal, and we go through the 
various aspects of it. I wanted these graduate level slots to 
be free of the college B-average requirements, so that the 
students could come in with less than a B average if they met 
certain other criteria. 



Crawford; 
Blum: 



He said, "Well, I'll take it under advisement." I knew it 
was probably like birth control in the health department it 
ain't done. You just don't ever drop the B average for 
minorities, which you do all the time for football players and 
basketball players, artists and others, and, I suspect, 
occasionally for the governor's son or daughter, but I don't 
know that. I have just heard more about this recently. 

I get a letter a week or so later in which Sanford starts 
out by indicating one of the problems with it, and then another 
problem, then another problem, and another. I thought he was 
going to let me downthe usual university stuffand then in 
the very last paragraph he says, "However, this is such an 
important experiment that you are hereby authorized the 
nineteen new positions for graduate students." 

This caused concern amongst the faculty? 

No, no. They didn't mind if they got new slots so long as they 
didn't have to set anyone else aside. They'd take a chance. 



Crawford: They just didn't want to give up their own places? 



266 



Blum: Anything. I mean, real academic pigs. I hate to say it, but 
I'm not impressed with academia's sense of social justice. 

Crawford: Was there a lot of infighting amongst them? 

Blum: Always. Academia is a world of great claims. It's not 
necessarily a world of great performance. My biggest 
disappointment in the university was its pretentiousness. 

But I just took the bull by the horns, and what I did was 
business as usual, I guess. I short-circuited everybody- -went 
to the dean, went to the graduate divisionand got the slots. 

One of the least sympathetic program heads came charging in 
as soon as the new slots were announced, demanding two or three 
of the slots or they would raise a stink about the program. 

At that time, my office was down on the corner where Copy 
Central is now. The planning project was in that building, 
over a Bill's Drugstore. We were upstairs in a real dump, 
sitting in pigeon droppings; the windows were open half the 
time. I said, "Do you see that door right out there? I'm 
asking you to get out of here and never come back through that 
door again. I never want to talk to you. You think you're 
going to blackmail me? Just start right out." 

At that point, I was chairman of the department, and I 
never did talk to this person, a caricature of an academic, 
again for years. We didn't hear any more about blackmail. 



Blum: Going back to minority students, the first class we brought in 
of about twenty or so included a black woman who had very 
mediocre grades a C+ average--f rom some college in the Valley. 
She got through with us, got her masters degree, went on and 
got a Ph.D. in political science at UCB. That's a student who 
didn't have a B average. Political science has got to be one 
of the weightiest departments on this campus. She was a 
wonderful woman, and along the way she even did organizing in 
Botswana. 

We had a lot of interesting people who came in under those 
slots. We didn't count Asians or Jews as minorities; they're 
not a minority in this field. We would be inclined to take in 
an Italian because they're so rarenot anymore, hopefully, but 
they were. 



267 



So we took in these people on our special slots, mostly 
blacks and Hispanics, as it turned out. Through our planning 
grant we had recruited many of these people in the summer 
before to come and look at the university and see what there 
was , and many of them came back in planning or in health 
education. They usually had weak backgrounds in science, so 
that math and statistics and epidemiology would not be their 
first home. They would be going into something like health 
education or administration, which made sense, and had 
infinitely more social emphasis and relevancy for them. 

That girl I mentioned had organized a clinic for a black 
community when she was in high school. So who needs B's--we 
can't get people with A's to do that for a black community. We 
did take in a few minorities with high averages who weren't 
worth a damn, just like whites who had never done anything. 
Book learning isn't where it is it's part of it, but it's not 
everything in this field. 

So, it was very much fun, and the Indian recruitment went 
on and on, and the minority recruitment went on for a long 
time, and is supposedly still going on. We set up a faculty 
committee, yet very few of them would even come to the 
committee meetings. I can name two or three that did. The 
rest of the faculty wouldn't even give the time of day to such 
efforts, which of course gave them very little tangible 
rewards. They were getting ahead; no time to waste. They're 
getting themselves ahead, to be specific. 



Pressure to Publish. Public Administration, and Alex Meiklejohn 



Crawford: 



Blum: 



Crawford; 
Blum: 



How would somebody like that unsympathetic program head be 
tenured in a department like this one? 

Write a book every year, write a paper every week, and usually 
get somebody else to do it, or it's a compendium of opinions. 
I'm not impressed with such garbage. It's easy work and 
doesn't take any brains to do it, but you publish, and it gets 
you in all the best places. 

You said you didn't feel the pressure to publish. 

I didn't, because I came here at the top of the ladder and was 
soon tenured. I wasn't the first year, but I was tenured 
shortly thereafter. I'd already done my vision studythe 



268 



Orinda Vision Studythat was a classic operation. Then the 
book on administration was pretty fancy stuff. It would be 
fancier today, sad to say. Blum and Leonard, 1963, as I 
mentioned. That was Public Administration; A Public Health 
Viewpoint. 

It was dedicated to Alex Meiklejohn because I had really 
understood through him, finally, what public administration was 
about. It has something to do with the country's philosophy, 
its people, and its history. I never understood that when I 
went to Harvard and supposedly learned administration. I 
thought it was something like physics or math, something very 
tangible, teachable, and comprehensible. But administration is 
purely an artifact of a culture, and I commenced to realize why 
administration changed every five or ten yearsbecause the 
culture was changing. Everybody was catching on a piece at a 
time. So the book was devoted to that. 

Alex Meiklejohn lived here in Berkeley, and one day Al and 
I invited him and his wife to our house. We lived in Walnut 
Creek. And Alex, his wife, the Leonards, and we had lunch. 
Marian, my wife, made a very lovely luncheon, and it was a 
beautiful day, and kind of open to the backyard. We had a nice 
place out there. 

At the end of the lunch, we said to Meiklejohn, who was 
approaching ninety, "We have a surprise. Here's a copy of a 
book for you that was dedicated to you." His wife and he were 
sitting side by side on the sofa after lunch, and he said, "My 
dear, isn't that exciting." He was very soft spoken, and spoke 
very little. He was a famous man, and revered in educational 
circles--at Amherst--the leader who started that whole new 
movement in college education. He looked at his dedication; it 
was short and sweet, and then he suddenly looked at his wife 
with consternation, and said, "Oh, my dear, do you remember 
there was another book that was dedicated to me. It was so 
terrible." [laughs] That was Alex Meiklejohn. He wasn't 
going to disguise his sudden remembrance of comparable things 
gone wrong in the past. 

One day his wife invited us to a Bay Area Planned 
Parenthood annual meeting where Gertrude Jones, a world- 
renowned Planned Parenthood gynecologist from the Midwest, was 
going to give the lecture. We all went to Meikle John's house 
for dinner. It was Jones and her husband, and Dr. and Mrs. 
Meiklejohn, and my wife and I, sitting together in their house 
right up here on La Loma in a nice, big comfortable dining 
room. Jones's husband was a corn farmer from Iowa--do you 
remember Khrushchev visiting a corn farm in Iowa? He was the 



269 



Crawford: 
Blum: 



brother of that corn fanner; a husky guy with a big, open face 
--kind of a match for Khrushchev, I'm sure. 

We're eating dinner, and we're getting ready to go to this 
meeting, and he says to Meiklejohn, "Alex, how do you feel 
about all this family planning?" Alex, his eyes twinkling as 
usual, said, "Well, I'll tell youI'm a ninth son." 
[laughter] Wasn't that wonderful? This is a man of few words 
and lots of thought. I thought that was magnificent. 

He wasn't a great proponent of family planning. 

Well, he probably was, but give or take a few kids. [laughs] 



Building a Planning Faculty 



Crawford; 



Blum: 



Good story, 
this point. 



Well, we should talk about the planning faculty at 



I had to build up a planning faculty, I started recruiting 
people. I recruited some very, very interesting people, and 
some of them were tenured appointments; some were not. 

Alan Blackman I found at City and Regional Planning, where 
I taught briefly and got to know most of the faculty. He was a 
fellow who'd gone through Reed College in Oregon, which has a 
peculiar reputation. It is fantastically full of brilliant 
people, and by my standards, full of impractical folks at the 
same time. He was one of their grads, and he couldn't quite 
get organized to get his doctorate, but he was smart, smart, 
and he knew the planning field. So I hired him on the grant 
for the first year, and I'll never forget, he's setting up the 
summer course, and it looks to me like all the big shot guest 
lecturers are lecturing on Sundays. 

I said, "Alan, I don't see this business of putting people 
on Sunday. That doesn't sound like good planning to me." He 
gets his calendar out, and we're looking and comparing the 
dates on this little chart. It turns out he'd gone to a yard 
sale, and he'd bought this beautiful calendar, but it was last 
year's calendar. Somehow I always held this against Reed. I'd 
had dealings with Reed students here before in bacteriology, 
[laughter] 



270 



Crawford; 
Blum: 



We had our problems, and I had to fire him, but he was a 
bright man. I learned a lot from him. Everybody we hired had 
something to teach us. 

I brought in Cy Roseman, who eventually left his tenured 
position heregot sick of it. He was a tenured prof in health 
planning and administration. And Dick Bailey, who retired just 
a year or so ago, was an economist and very useful to us. He 
did a couple of beautiful books based on some research that 
almost fouled his own nest. 

He was applying for tenure, and he did a book on economies 
of scale in health care in which he interviewed, visited, and 
studied the records of a great number of physicians to see how 
much work they really did, how many patients they saw, and 
where the time and effort went; he discovered that groups of 
three or four doctors were the most efficient. Everybody knew 
that was wrong, so when he came up for tenure, folks in the 
economics department said, "This is primary data. Who can be 
so stupid as to waste time getting primary data?" Meaning, you 
went to the source of where it really is, not statistical 
sources or secondary data which always prove that it's more 
economical to have large groups. 

Well, large groups are economical in one sense, they make 
more money per doctor, but that is because they have drugstores 
sell drugs, all sorts of goodies, and that's where they really 
make their killing; but they do less work as doctors. They are 
not more but less efficient at doctoring in larger groups. 

In delivery of care? 

In delivery of care. So we had quite a knock-down, drag-out, 
and I really pulled out all the stops as chairman of the 
Department of Social and Administrative Health Sciences, one of 
the two departments that made up the School of Public Health 
after the smaller programs had been merged, to have him 
redeemed for getting primary data, when any jackass can go get 
secondary data, which, of course, in this case isn't measuring 
effectively at all. It doesn't tell you what you want to know. 
So we won that battle, and he got his tenure. 



Crawford: You were chairman of the Department of Social and 

Administrative Health Sciences, known as Department A. 

Blum: Yes. Under Bill Reeves the faculty divided the school into 
two. Parts of each department, however, couldn't stand one 



271 



another, so it could have been better, but I think that the new 
dean, Pat Buffler, has done better by it recently. 

But public health is always going to be uncomfortable to 
subdivide. It's just like a hospital. You've got a nursing 
division that does work all through all areas, but then you've 
got housekeeping, that does similarly, and you've got pharmacy, 
and then x-ray, run by doctors, other services that serve all 
the departments, as personnel, or [production?] and so on. 

Crawford: Not tidy. 

Blum: It's a three-way matrix. I mean, this way and this way and 

that way. You're constantly stirring around. The only person 
I ever knew who worked that out very well was a man by the name 
of Bob Biller, who went on to be provost at USC. He was in 
political science and was the first head of Health and Medical 
Sciences here, and he had worked this out this matrixthe 
difference in why you go one way one time and another way 
another time; he put some sense into it. But there are always 
problems with organizing public health because there are too 
many disciplines and too many subjects and too many kinds of 
students. 

Crawford: What has Dean Buffler done? 

Blum: She reorganized the school in a new way, in that faculty have 
to establish a home in one or another of five divisions, 
irrespective of what their own background is. These divisions 
are more nearly related to traditional subjects like 
environment, administrative sciences, epidemiology. But if you 
want to do something with AIDS, that wouldn't necessarily be 
just in epidemiology or contagious diseases--it could and 
should include folks from sociology or maternal and child 
health, it is a cross-cutting area of interest. Thus the 
traditional areas are joined together by these various problem 
areasback to Leonard Duhl's old theory that if you had a 
significant problem, no one discipline was going to be able to 
take care of it. This actually sets the stage for urging 
people from different disciplines to get together and work 
together. The work that you do commences to relate you across 
the board, not just in the School of Public Health, but to 
other colleges and other schools. These cross-cutting entities 
may come and go as special problems or issues come into being 
or retreat. 

Crawford: So it encourages a kind of fluidity? 



272 



Blum: Yes, without disrupting the basic departments, which are then 
crosscut by people doing different things. 



Serving on Committees of the Academic Senate 



Crawford: 
Blum: 



Crawford: 
Blum: 



Crawford: 



Blum: 



Was the faculty loaded down with administrative chores? 

Yes, to quite an extent. This university had undertaken to 
have a weak formal administration, and the faculty had to do 
the thinking and much of the administering, which is the 
trademark of this university. 

Is this different from Stanford? 

To a certain extent, yes. There's much more faculty 
involvement in running the UC system. The first great revolt, 
in fact, was here in Berkeley in the twenties, and it was about 
having the faculty run the university. When you do that, 
you've got to undertake to do a lot of things, and the Academic 
Senate is a monstrous bit of machinery. 

When I first came here, I thought I'd better learn 
something about teaching. Having only taught off and on for a 
decade or two elsewhere, I found I knew nothing about teaching. 
So I joined two committees of the Academic Senate; the two most 
preposterous committees, I think, that ever existed. They're 
still here, still doing their good workthe course committee 
and the teaching committee. 

Everybody on the teaching committee, obviously, was headed 
for winning a teaching prize. The only thing they did was give 
out teaching prizes. That bugged me right off, because you 
know that teaching is often a gift. It comes with certain 
personalities . 



Did it come easily to you? 
teacher. 



I know you're a very popular 



Oh, yes. But at the first meeting of the Academic Senate that 
I attended, they announced they're reestablishing the teaching 
committee, and they would give five prizes every year to the 
best teachers. 

They also told us that the last time this committee did its 
work, three years before, and nominated five people, every one 
of those five people were fired that year, and that that was 



273 



very, very unflattering to the university. So they wanted to 
have the committee pick people who wouldn't be fired. In other 
words, the fact that they are superb teachers isn't worth very 
much around here. This is the first lesson I learned after I 
arrived. 

Crawford: How do you measure a teacher's qualities? 

Blum: How do you measure? By a mixture of popularity students 

saying this is a fantastic course, the best course I ever had 
and opinions of other faculty, too. So we picked out five 
people, and cleared each of them with their departments, that 
they weren't to be fired- -how do you like that? 

I started objecting pretty early. There was one fine 
person on the committee, and that's Marian Diamond. She's not 
only a magnificent teacher and researcher, she's a good human 
being. Everybody else there, I'm sure, was bucking for a 
prize, and they all got it, as far as I know, except me, 
because I quit. I couldn't believe what I was hearingthis 
garbage about picking professors to get a prize. 

So I went to the library and got some of the classic books 
on education, most of which were written at Harvard, and 
brought them to the committee, and passed them around. I asked 
them, "Shouldn't we be looking at something like this? I mean, 
rewarding the teacher for being a good teacher is rewarding 
natural talent, and everybody who isn't that good isn't going 
to even bother anymore. That's the message that you're sending 
out skip it. Why can't we look at what teaching's all about 
and try to facilitate better educational processes?" 

When I handed out these books, everybody put them down like 
they were contaminated. They were back to me in thirty 
seconds. So I got a stomach full and walked away from that 
committee shortly thereafter. And then, one or two of the five 
prize-winner teachers that we picked were fired anyway. 

Crawford: What were the firings for? 

Blum: They had come to the end of their promotion time without a 

suitable production of research and publications. You've got 
so many years to make it. But that was a pretentious teaching 
committee-- just an abysmal fraud, at best. 

At the same time, I had a very similar experience in the 
Academic Senate Course Committee. They asked me to review some 
courses. There was a course about health that was being taught 
elsewhere than in the School of Public Health, and it looked 



274 



pretty good to me, so I reported back to the next meeting that 
I was happy to approve this course. Then I approved another 
one, and somebody realized that I was kind of simple. They 
said, "But maybe the School of Public Health doesn't want 
somebody else to teach these health courses." Then I caught 
onthis was a turf protection society. 

Crawford: Against the threat of--? 

Blum: Of some other department taking over, doing something useful in 
your field. So they had to remind me, "Is it okay from the 
School of Public Health standpoint?" I said, "It's a good 
course." They didn't really care if it was a good course or a 
bad course. This was a twenty- five member committee that had 
to approve all courses to be offered on the campus at UC 
Berkeley. 



Blum: Another kind of academic committee work of probably more 

significance goes on at the level of selecting faculty for 
tenure. I played an interesting but shabby role on my first 
plunge into that activity shortly after I received my own 
tenure. I discovered something about why tenured faculty might 
not always be particularly outstanding figures. 

I was asked to represent the School of Public Health on the 
final Academic Senate review committee for each of two School 
of Public Health faculty being considered for the tenured 
associate professorship. Quite by chance one committee met in 
the morning and the second in the afternoon of the same day. I 
boned up on each professor's background and publications so 
that I could participate intelligently. 

Unfortunately, as we met for the first evaluation in the 
morning, there was no announcement of who or what nor was there 
any paperwork to say which faculty was being considered. The 
chair began by asking me to lead off, since I was from the same 
school, to describe the candidate's capabilities and output. 
Being a relative newcomer to the university, I didn't know 
anything about the fields of the other committee members and so 
remained clueless about which professor I was to discuss. I 
was too embarrassed to admit my predicament and set out to 
describe our committee's target, but which one was it? 

I decided to meld and generalize the two totally disparate 
characters from different fields, one in his late thirties, one 
in his late forties. I carried it off quite successfully and 
concluded by saying that this professor had a vigorous, 



275 



youthful approach to his work. A committee member immediately 
wanted to know how come I said youthful, this candidate wasn't 
young at all. I promptly caught on and made a quick recovery 
by saying that he was a new father this very week, which was 
true. Everyone laughed and we went on from there quite 
happily. 

Unfortunately, based on that experience, I have never been 
able to feel secure about the quality of faculty consideration 
about appointments for tenure. 

I saw an interesting kind of discrimination in committee 
work too, based on a "this is how we do it" unconcern. About 
twenty years ago I was on a search committee for two tenured 
faculty positions in the School of Social Work, serving as the 
outside member. There were two male tenured and two female 
non-tenure-track professors from social welfare on the 
committee as the basic decision-making group. Each search 
position had distinctive needs and finally we narrowed down the 
field of candidates to one woman and one man for each slot. In 
each case the candidates were well matched and either would 
have been a good acquisition. 

By the last scheduled meeting of the committee, it was 
clear that we would get a good person whichever way we decided 
for each position. It was also clear to me that the male was 
the only one in each case who would be put forward to the 
chancellor. 

As we opened the last meeting, I couldn't resist asking how 
many tenured women faculty there were in the school. The 
immediate answer was, "None." With no further discussion, the 
two women were selected and shortly became faculty. Even with 
capable non-tenured faculty women on the committee, custom had 
almost carried the day in a field more famed for its women than 
its men leaders and practitioners. 



Thoughts about Teaching and W.C. Fields 



Blum: You asked me about teaching. Although I was almost always 

treated as an interesting speaker and teacher, it is not clear 
that I was really a good teacher, whatever that is. Certainly, 
recorded renditions of various of my talks or lectures leave a 
lot to be desired: repetition, slang, bad grammar, incomplete 
thoughts keep them from being very impressive, and this 
recorded history is no exception. 



276 



Be that as it may, students do tell me that they enjoyed my 
courses, at times when there is no reason for them to say such 
things other than good feelingsan issue to which I shall 
return. 

The most startling of such events of praise occurred one 
day when I was just entering the elevator in Warren Hall for my 
fifth-floor perch. A young man in his thirties happened 
aboard, and immediately said, "You were a good teacher; I 
really enjoyed your courses. You always reminded me of 
someone." I thanked him and as he got off at the third floor 
he turned back with some enthusiasm and blurted out, "I know, 
W.C. Fields." And he was gone down the hall. I didn't really 
have time to acknowledge this compliment, later came home and 
told my wife, who wasn't sure about its implications either. 

Neither of us had ever seen a full-length W.C. Fields 
production and had our doubts, even though the comparison 
seemed to have been made with the best of intentions. 

Within the week we discovered that four W.C. Fields films 
were being presented at a theater in Berkeley. We attended and 
were pretty overwhelmed, not altogether unfavorably. I could 
only assume that the kind of gross exaggeration that I as well 
as W.C. Fields commonly indulged in had its values, both for 
emphasis and amusement. We never did explore the negative 
possibilities of my relationship to W.C. Fields. I can say 
that I had my share of spirited students. 

I think, however, that the many thanks I got from students 
was in good part based on two quite different factors. One was 
my willingness and even enthusiasm for going out on a limb on 
issues of serious disagreement. Whether they liked my stance 
or not, they knew where I stood. 

Of more importance was being available for assisting with 
problems, whether on course materials, concepts, university 
pitfalls and rules, or on more personal matters, such as 
health, family, jobs, whatever. I am sure that the dearth of 
faculty who cared or would give time made someone who was 
willing to help seem quite different and important as faculty. 
Not unlike doctoring, teaching also involves caring about the 
person who presents himself or herself for assistance. 



277 



American Public Health Association Involvements in the 1960s 



Crawford: Before we move on to the seventies, would you talk about some 
of your extra-curricular activities such as APHA? 

Blum: I was once on the road in the 1960s to becoming an official of 
APHA. When I was a health officer, I was on a whole series of 
committees. One of them was chronic disease, which included 
alcoholism, rehabilitation, and a few other things--! was 
chairman of that for several years. Then I found myself on the 
governing council of APHA, which makes the policies. It's a 
big body which meets once or twice a yearI've forgotten 
which. 

I was also on the Technical Development Board. These roles 
aren't on my CV--these are things done in passing. The TDB was 
made up of about eighteen peoplehalf came from California, 
which I found interesting. This was the leadership group where 
the guts of new decisions and policies were made by APHA. We 
would meet a couple of times a year. 

I finally discovered why there were mostly Californians 
thereCalifornia was the only place where government would pay 
expenses for health officers to go to such meetings. [laughs] 
There was a different tradition out here. As I told you, I 
could get my health department to pay. They would send me to 
New York, or wherever the meeting was, and that was fine. And 
APHA was simply too poor to buy our tickets and cover our 
expenses, and we as individuals in public health weren't well 
enough paid to travel to meetings on our own. 

I'll never forget my last meeting at the Technical 
Development Board, which as I said is on the way to the top 
leadership, potentially, if you stay with it. Well, I never 
really liked to be president of anything in the first place. 
It always bothered me to waste my time being president, because 
it involves a lot of ceremonial activities which I can't take, 
or do well. 

We had this tremendous meeting, chaired by the president of 
APHA. The chief staff person was there, and all nine 
Californians. The president's a Calif ornian- -we could just as 
well have the meeting in Berkeley, it would have been cheaper. 

We are debating two big measures about which we're going to 
testify to Congress. TDB is advising the APHA president on 
what to say. 



278 



The first measure was about whether the U.S. Children's 
Bureau should be included in the U.S. Public Health Service 
together with the rest of the public health programs. We 
developed formidable logic about keeping it separate. It was 
an interesting, effective bureau, and trained a lot of good 
people and did a lot of good things. There also were many 
people in the room who had loyalties to the Children's Bureau. 

So this was a partisan measure. Many members of the TDB 
didn't want the Bureau lost by putting it in the Public Health 
Service, feeling that it would be diluted out, and MCH budgets 
might be screwed around with- -they wanted to leave it as a 
separate agency reporting to God, you see. So we developed a 
logic of separateness, and I went along with it. 

Then the next item we had to decide on was whether the 
Environmental Health Services should stand alone or be made a 
part of the USPHS. This time, we all agreed that they should 
be included in the Public Health Service. We developed all the 
exact opposite arguments as to why the Environmental Services 
should be included--a counterlogic, almost word for word, to 
everything we had said for the Children's Bureau. So in one 
case we're going to appeal to keep them separate, and in the 
other case, we're going to fight to include them. I couldn't 
believe my ears. 

I said, "Hey, fellows. Supposing you talk to legislators? 
That's what you're going to Washington to do. And some of the 
same ones are sitting on both committees. You give them all 
the arguments for putting health services together, on one 
hand, and you give them all the arguments for keeping the 
pieces apart on the other? If they've got all their marbles, 
aren't they going to get a little restive?" This thought 
didn't bother anyone. 

And this is the top level of APHA. So I started thinking, 
Oh, the hell with it. I'm not going to stay with this, and I'm 
not going to waste my time fighting it. I know what's behind 
it, and it's probably not going to make any dif ference--this is 
playing both sides of the street, and principle be damned. Of 
course, they lost on both of them. [laughter] 

At the next governing body meeting, again a similar display 
of policy concerns and logics. It's full of "yes for this, but 
no for this." The same grounds are being perverted, just using 
reverse arguments, in item after item. This passes for policy 
making and governance. Well, I'm not a perfectionist, but I'm 
too much of a perfectionist to put up with having irrational 
decision making every inch of the way. So I resigned from the 



279 



TDB, and I resigned from the governing boardand I never said 
a word about making policy. I just figured the hell with it. 

Crawford: They didn't want to know why? 

Blum: Nobody cared that much. Nobody was going to miss me, really. 

Nobody's ever missed, you know. At that point, an aunt of mine 
died, and she was a person I really loved to visit. She lived 
in New York; APHA was in New York then. I thought, Ah, I 
really have no good reason for going to New York anymore. So I 
stopped going to New York and the APHA, and that was that. 

II 

Blum: Getting back to being president of things--! became president 
of the Health and Welfare Council of Contra Costa when I was 
the county health officer, even though I objected, and I 
objected. That was the first time I'd ever been talked into 
being president of any thing- -maybe once before, I hadthe 
president of the American Medical Student's Association at 
UCSF, but there was a purpose to that. Nobody else would take 
it in their right mind [laughter], and yet the job had to be 
filled. 

But I said to these people, "Look, sooner or later you're 
going to come before the board of supervisors, for whom I work, 
and you're going to have an issue, and you're going to ask me 
as president to present it to the board. The board is going to 
say, 'Who the hell are you working for? Us? Or this other 
outfit?' And they're not going to like it. It's already a 
gross conflict of interest on my part, as far as the board's 
concerned, when they see me show up to fight for something that 
they regard as none of my business as their health officer. 
It's the wrong place for me to be, and even more so if it is a 
concern of the health department's. If I want to make a case 
before the board of supervisors for something, I ' 11 do so, but 
as the health officer. 

Well, I finally accepted, and very shortly thereafter we 
had some big deal, and I had to go before the board- -well, it 
was preposterous. So we had to send the vice president, 
[laughter] 

So no more do I ever make that mistake. I'm not president 
of anything. I may be chairman of a committee or something. I 
ran into the same problem when I was chairman of the board at 
Alta Bates, and chairman of the board at HEALS at the same 
time and the two came to blows. So I resigned at Alta Bates. 



280 



Crawford: Your point being that you really could be more influential in a 
different position? 

Blum: Yes. Being chairman sounds good, but I've learned my lessons a 
few times, knowing full well what was going to happen. 
However, there are times when there are no choices. When I 
wanted to run a health department I had to be the health 
officer, and when we wanted to put the Joint Medical Program 
medical school at UCB into shape, I had to be the chair. 
Consultancies are fun, but being the CEO is where the action 
is. 



Advising Governor ReaganGreed is Great; 1967 ti 



Blum: I also worked for Reagan for a very brief time. Newly elected 
Governor Reagan selected a diverse committee of about twenty 
persons, to be chaired by his chief of staff, a successful 
businessman, to tackle the problem of how to reform government 
agencies to get more useful work out of them. I was one of two 
UC Berkeley professors selected; the other was the eminent 
political scientist and public policy expert Aaron Wildavsky. 

We never saw the governor in the two meetings I attended 
before 1 was dropped, but we got the full Reagan flavor- -why 
are government workers so lazy, incompetent, interested only in 
enlarging the scope of their duties, ensuring the security of 
their own future and caring not a whit that their efforts at 
enlarging the role of government was interfering with the 
profits of the timberers, developers, industrialists, farmers 
who might harm a few workers by using pesticides and herbicides 
as they harvested California's green gold. This was the first 
time I began to understand Mr. Reagan's credo, that Greed is 
Great and that greed makes America great. All this could not 
be blamed on incipient Alzheimer's, for this man had come from 
the far left in college on to the presidency of the supposedly 
left-leaning actor's union. But there he became the stool 
pigeon for the FBI, putting the finger on liberal movie 
industry people. 

This was an interesting situation for two Berkeley 
academics who were obviously also government employees, 
probably of the most unproductive kind, and in my case actively 
concerned with planning for health, which could only result in 
some kind of restraints on the earnings of the health and other 
sectors, not a minuscule part of our thriving economy but one 



281 



of its major growth areas, and would lead to restraints on 
other sectors that adversely affected health. 

I was not at liberty to point out that Mr. Reagan's 
diagnosis of the faults he found in the public sector were 
exactly what one would expect from greedy Americans who would 
end up in secure positions and make their greedy mark by making 
themselves more important and by creating an even bigger 
machine of government control, and with more influence for the 
great profit-makers. 

Since my experience with government workers in the health 
and education sectors had introduced me to thousands of persons 
who in fact were satisfied with poor pay and rather looked 
forward to improving the safety, education, and health of the 
people of our country, I felt that Mr. Reagan was becoming a 
pretty atavistic character and would soon be a destructive 
force against health, education, and conservation wherever he 
could. 

In fact, the kinds of people Mr. Reagan brought into the 
state government as he set up new and more powerful entities to 
interfere with the operating departments greatly increased the 
size and cost of state government while its effectivity was 
lessened by slash-and-burn personnel policies, cutting up and 
moving parts of departments like the state health department, 
one of the best in the country, into sites as far apart as 
Sacramento and Berkeley, getting incompetent top-line 
bureaucrats who would hold up any kind of health- improving 
measures that the governor couldn't kill legislatively. Yet 
the times were such that more not less health services and 
education were demanded and authorized, and it took even more 
expansive bureaucracies to hold up and derail new programs. 
Mr. Reagan's efforts to promote profits over everything else 
were actually attended by skyrocketing state costs, obviously 
good practice for what he did as president. 

The only advice I could give was that if Governor Reagan 
would treat government employees as reasonably as normal 
people, he might get them to cooperate in mitigating endless 
bureaucracy, and perhaps see things in a more variegated light, 
one that encouraged the values of production for profit, and 
help the producers see that they too could gain from helping 
with a bit of their profits to create a healthy and educated 
society that could work harder and better. This went over like 
a lead balloon- -government was the enemy and had to be 
destroyed, and I was never invited back. 



282 



Wildavsky was strangely and atypically silent. He was a 
brilliant thinker, an enchanting speaker, a Catskillian summer 
theater type of entertainer. Once when he was asked to address 
a national gathering on policy for health care he asked me for 
a few key references. I gave him three, which made it all too 
clear that health care, expensive as it is, is not what keeps 
us well. He turned a hundred pages into a classic brief speech 
that ended with the oft-quoted comment to the effect that his 
mother's admonishment to use chicken soup and avoid the doctors 
was good policy. 

Wildavsky was opposed to any and all planning, saying that 
planners were too ignorant to understand what the forces really 
were that they were trying to harness. Unfortunately, a 
realistic appraisal of much of planning. Thus, they might do 
more damage than currently existed without planning and 
therefore society was better off to be guided by greed, or the 
market, as we like to describe it. He clearly was on Mr. 
Reagan's side. I called his school of thought "I'm all right, 
Jack," since he and people like him weren't hurting. 

But it was a bit discouraging for him to be labeled as a 
"hog-in-the-trough" state employee. He didn't last on the 
committee either, as he tried to raise the level of the 
discourse of Mr. Reagan's brain-trusters as they led the 
committee to the great new horizons offered by unbridled greed, 
and well-bridled government. 



Planning for Health and Expanding Health Care Horizons, Two 
Textbooks: 1974, 1976 

[Interview 6: April 3, 1997] ft 



Crawford: What about changes at the university after the 1970s? 

Blum: In the late sixties, the campus was very politically alert, and 
social justice was very, very important, but not in the School 
of Public Health. We still had a lot of professionals coming 
because it was "the" thing to do, and if you came to school and 
put in another year and got a masters degree, then you might 
get a salary increase somewhere or be eligible for a better 
position. Really impressive. 

Then, all of a sudden, that kind of person died out. Early 
in the seventies, we started seeing a very different kind of 
student, people who were interested in social justice and who 



283 



felt that health was a good place to work, and who were 
concerned with the terrible inequalities in health, and 
inequalities in all kinds of things that seemed to determine 
how healthy people would be. 

Previous to that, I don't think the faculty was really 
challenged that much. They were the authorities, but people 
who came to school in the seventies certainly didn't agree to 
all of thatnot by a long shot. So it became much more 
interesting, much more exciting. There were all sorts of fun 
people that we had to deal with, and I had some wonderful 
experiences with students here. 

Crawford: Dr. Winkelstein was dean for most of that decade? 

Blum: He was dean most of that time, and he too was concerned with 

such things as social justice, and was very open to any kind of 
reasonable suggestions. Really, the life of a professor at 
Berkeley was never hemmed in. You could do your thing, and 
there were two issues: one, could you manage to get something 
published so that it looked like you were on the ball; and, 
two, could you attract students? 

Crawford: Not unreasonable demands, you felt? 

Blum: No, no. The publishing was relevant, if not carried to 

extremes --assuming you had ideas, and they were worth airing. 
The ability to attract good students was a very positive kind 
of thingnot the sort of thing that the teaching committee was 
interested in, unfortunately, as I mentioned before. 

The other day when I went to a meeting in Sacramento, I ran 
into people who had been students of mine thirty years ago and 
who remembered what had happened and felt very good about it. 
It wasn't, "Oh, here's this poor old guy, wandering around 
Sacramento." There was some enthusiasm. 

Crawford: I have found that to be true in your case. Wouldn't that be 
true of professors who lent themselves to the students? 

Blum: Well, I think that had a lot to do with it. Yes, were you 
there to be sure that the students' interests were covered? 
That might mean covering your own, and, presumably, there was a 
convergence of interest. They wanted what you had to offer, 
and you wanted to do what they were interested in, but it was 
no struggle on the part of either party. So it was a good 
time, and the students improved tremendously. You could hardly 
complain. 



284 



I think that what's worth commenting on, though, about 
those first few years is that as I look back on itand I'm 
really kind of startledis my putting together that first 
textbook in 1974 on the subject of planning for health on a new 
basis, Planning for Health. It wasn't planning for care; it 
was planning for health. Much of what I had to say there 
couldn't have been new. I have long since learned that other 
people have said these things going back for a couple thousand 
years, but the basis of what I had to say, really, is just now 
coming out at WHO, thirty years later. 

There is a WHO document that just came over my desk last 
week; it's about a meeting held at the end of 1995. It takes 
them roughly a year, typically, to develop a document and 
distribute it worldwidethis went worldwide. Almost all the 
things I was concerned with and pushed for are finally here. I 



Thirty years 



feel very good about their getting on the ball, 
later? That's not bad. 

Crawford: What has been the usage of your planning book? 

Blum: Very, very limitedtwo editions. It crops up in odd places. 
A fellow came by here the other day who had never gone to 
school here, but who works in Washington, D.C., and he had a 
book in tow. He said, "Look what I found in the second-hand 
bookstore. I want you to autograph it." [laughs] It was a 
first edition of Planning for Health. 

Crawford: How many editions? 

Blum: Just two. [Second edition: Human Sciences Press, New York, 
1980.] 

Crawford: Is it still used as a textbook? 

Blum: I seriously doubt it. It wasn't heartily received then, 

because it ended up saying you just simply can't look at health 
care as any answer to improving health. Health care is where 
all the money goes, but it doesn't improve health in people 
very much. The real issues are social and economic, and 
cultural and educational; I called all that environmental. 

I remember my big battle with the U.S. Public Health 
Service. To this day, they claim that environment is 18 
percent of the problem, and behavior is 50 or 60 percent. 
Someone named McGinnis put all that together and gave a lecture 
here. My students really took him apart. "How can you say 
such nonsense? The environment is what determines how healthy 
you're going to be." He said that by the environment he only 



285 



Crawford: 
Blum: 

Crawford: 
Blum: 



meant the air and the water and the soil and the accidents on 
the job kind of stuff. Social and economic and educational and 
cultural issues were not assigned to the PHS and thus not in 
their definition of environment, and so he could freely say 
that environment was not a big factor. This was and continues 
to be the position of the USPHS, where he is an assistant 
surgeon general. 

So if you looked at it that way, and got rid of all the 
major causes of good or bad health, then you could say that 
behavior was the remaining, single, largest factor. These 
would be purely behavior; smoking and drinking, dangerous 
driving, and sex. All of this you could bounce back on the 
individual, and most importantly, avoid asking for social 
change . 

The other bit of stupidity in taking that position is that 
there is no such thing as behavior without an environment. The 
environment dictates or creates behavior. How is it that all 
the smoking, practically speaking, occurs in certain places and 
certain groups? How come all the heavy drinking likewise? And 
how come all the promiscuity? These are real problems, they 
occur in certain socio-economic, cultural environments, and 
those are not just god-given behavioral factors. They are 
responses of human beings who seem to experience these 
differences in environment. But changing behavior is the 
garbage that is officially peddled in the United States. Yes, 
it can and does work in some situations, but usually not among 
the people who need to change the most. 

We're not further along the road? 

Not in the United States, but very much in most other 
industrialized countries. 



Were you instrumental in this new work, do you think? 
certainly that was the thrust of your report. 



Because 



It is hard to know. I suppose so. A lot of people picked it 
up. At the identical time that I was doing this work in the 
1970s, the Canadians did the same thingexcept it was 
published by the Canadian government. It was called The La 
Londe Report. I was working for PAHO occasionally at that 
time, and in the PAHO office I met the man who wrote that 
report for La Londe. His name was La Framboise. He had all 
these wonderful charts and pictures, and they were the same 
sort of things that I had. 



286 



Neither of us had ever heard of one another, and we're 
sitting there in New York looking at one another, and it's just 
astounding. They published hundreds of thousands of copies and 
distributed them around the world; the La Londe Report had a 
serious influence, yet was never taken seriously in the U.S. 
because it smacked of social justice. 

La Londe was a gifted and trusted man who was the head of 
health and welfare for the Canadian government, under Trudeau. 
And then, when he got through giving real credibility to the 
health sector, La Londe was shifted over to law, where he also 
did very fine work. He was, apparently, a powerful force. The 
interesting thing is that almost all of the new Canadian era of 
understanding the origins of health were inspired in French 
Canada. 

All of this was based on the work of another committee 
headed by Castonguay and Nepveu. They took about five years to 
develop the theory of health. They covered the philosophy of 
every civilization, practicallyand they came up with the 
notion that health was really based on response to environment. 

Crawford: Does this thinking come from France originally? 

Blum: Not from France, but from French Canadians. And yet it was 
once in France, too, a long, long way backbut with no 
continuity. 

The commission lasted for about five or six years, and 
Castonguay, of all things, was an insurance man, brought from 
the private sector, where he was one of these people who 
measures riskin any event, brilliant. The commission issued 
a seven-volume study, which I once bought and finally gave to 
the library. I'm sure it's been lost since, but the Castonguay 
and Nepveu Report, which resulted in the La Londe kind of 
thinking, was very much a product of these French-Canadians. 

Crawford: What have your Canadian students found their way into? 

Blum: Well, they're almost all in health work of one sort or another. 
The Canadian government, particularly in several of the 
provinces, did lots of wonderful things that I also thought 
needed to be done. They put together health, welfare, and 
mental health, and said, "This is people, this is human 
service. It belongs together." They did that in many 
provinces and did a good job. They're way, way, way ahead of 
us . 



287 



Crawford: 



Blum: 



Crawford; 



Blum: 



Crawford: 
Blum: 



We always hear people saying they will go to Canada when they 
retire to get good health care. 

Well, of course, that's real care--not just medical care. When 
you say health care here, it always means medical care; not 
there. 



You worked on curriculum development, 
into the seventies and eighties? 



How did that develop 



We became aware of the fact that what most people call policy 
was just one more manifestation of planning. Or, at least for 
a planner, you could plan in many places and at many levels, 
and the first area you would probably want to plan for would be 
policywhat is it we want, and after that how are we going to 
get it? 

But then as you plan for this and you plan for that, you 
finally come down to planning for services at the end of the 
line, it's just a continuum. If you don't have any policy, I 
challenge you to come up de novo with services that are 
meaningful, because you don't know with what purposes you are 
carrying them out. 

You're not going to do the policy work successfully unless 
you have some sense of what's involved in this field. So in 
health, I had to start with health. I didn't see how you could 
plan for health if you didn't know what health was or what 
affected it. That was the first statement 1 made to myself. 

Your focus was really policy? 

Well, it was a mixture. I ended up calling myself a professor 
of health policy and planning, because we got into policy in 
fairly short order, thanks to some wonderful students. I told 
you about how the planning course started, with each student 
doing a piece. But the policy course per se involved a pre-med 
student who got an M.P.H. here and who is now at the National 
Institutes of Health, Pamela Gurnick. She just sat down with 
me for the best part of a semester, and we hatched out the 
policy planning course, but it was much her doinga terribly 
bright person. 

We grew into policy, because it became clear you couldn't 
not grow into policy- -you had to do it if anything was to take 
place. 



288 



Crawford: 



Blum: 



In 1976, you published Expanding Health Care Horizons. 
Party Associates, Oakland] 



[Third 



That book originated as an invitation to present up-to-date 
thinking on what health was and what health care might best be. 
Each of three authors was given a week in which to present 
their views. Ivan Illich presented Medical Nemesis, Rick 
Carlson did the End of Medicine, and I presented what health 
care should be doing if it were based on our understanding of 
what caused good and bad health, something a lot different than 
the repair concept of Western medicine. 

Roz Lindheim, an architect whose work in health opened many 
new avenues in health care, appears in several contexts in this 
book because she influenced many of us in many ways, got me 
invited to Cuernavaca to CIDOC, Centre Intercultural de 
Documentation, which was Ivan Illich 1 s own institute and which 
enjoyed the protection of the liberal archbishop of Cuernevaca. 
Illich was a priest who came from Yugoslavia, was trained at 
the Vatican and was reputed to be a protege of Pope John. 

He had written many controversial books, all of which 
sounded a strong anti-organization theme, probably built out of 
his experience and objections to bureaucratic, authoritarian 
organizations like the Catholic Church. As the one-time rector 
of the Catholic University of Puerto Rico, he had strong 
feelings about the limitations of traditional universities and 
CIDOC was his own creation. 

The institute earned its way by teaching Spanish to well- 
off persons needing a rapid and reasonably thorough Spanish 
grounding. But its overriding purpose was to piggy-back high- 
level discussions of all major social issues, as well as 
maintain an elegant library and a place for him to think and 
work. His medieval-style university CIDOC was an unlikely 
mixture of the ultra-technical reception machinery, and a 
freedom to wander, imbibe, and disperse information and ideas 
in an almost market-like intellectual setting. 

When one arrived, one was set down in front of a suitcase- 
sized mechanized monster which took your fifty dollars, took 
your picture and a small ticket you had filled out, and turned 
out a wallet-sized plastic-encased I.D. card that allowed you 
to attend for the rest of the year. That allowed the card 
holder to attend any and all presentations, of which there were 
a dozen or more going on at any one moment. 



289 



It might be medicine one month, a four-hour-a-day series, 
with half presentation, half discussion, history of the 
Philippines which we attended, or philosophy, whatever. 

Illich toured each series at least once a week and gave a 
resume of all the courses that were being presented, truly an 
unbelievable tour de force. We had attendees in ours from 
twenty-three countries, and since presenters were paid 
according to the number of attendees (out of their $50.00 
fees), we were paid more money than it cost us to travel and to 
stay there for a week. 

To prepare myself, I put all my ideas into paradigms, 
chains of logic, summaries, and presented about a hundred 
charts and tables in my week. Given its success with an 
international audience, I did what any respectable professor 
would do: turned it all into a book, Expanding Health Care 
Horizons, a title suggested by a confrere who then denied 
vigorously that he had ever named anything, even though he 
approved of the book. I obtained a contract from Warner, and 
Harry Specht, the dean of the School of Social Work at UC 
Berkeley, was the editor for them. 

Harry had worked under me as the CEO of the Contra Costa 
Health and Welfare Council for the one year I was its 
president, and we enjoyed one another. He went on a sabbatical 
to Europe, injured his back, and lay on the floor of their 
leased van for months while his wife drove, and that was where 
he edited my book. He did a magnificent job sharpening and 
clarifying, never once ruining what I was getting at. 

After all that, Warner was sold, perhaps it became Time- 
Warner, it cancelled its contracts, and here 1 was. I wanted 
the book for my classes. Because it laid out the new look for 
health care that I wanted to use, a pair of former students, 
Helen and Paul Mico, who created a publishing house at that 
moment, Third Party Publishing, took it as their first venture. 
Since they had so few books, they had no budget for 
advertising, so it remained mostly for local consumption. It 
brought all my major themes together and from time to time I 
get asked to sit in on the founding of a health care venture 
based on the premises held forth in that book. 

We had a lot of dealings with Illich while we were there, 
partly fascinated, partly repulsed by this formidably talented, 
educated, and experienced empiricist. Fascinated by the 
searching questions he asked, repulsed by the elitist answers 
he typically gave. 



290 



Wasn't organized education creating a great subclass of 
those who never could get any of it, therefore shouldn't we do 
away with organized schooling? Similarly for medicine, and so 
on. My preface to Expanding Health Care Horizons responds to 
that philosophy rather vigorously. 

Anyhow, we thought he would be good for Berkeley, got him a 
Chancellor's professorship, and he spent a semester in 
presenting a formal course on gender [1982-1983] and holding 
parallel seminars and soirees on various related issues. I did 
all the necessary paperwork and petitioning. Roz was in 
Europe, and I sat back to enjoy what could only become an 
intellectual fracas. 

His class drew 500-700 people for every single lecture. 
The large home he rented with his stipend was busy at all hours 
with truly intellectual forays. This was old-time intellectual 
fare of the highest order. Several UCB women faculty were 
truly indignant over what this maybe celibate priest had to say 
about gender issues, and proceeded to write heated responses in 
book form. 

He has been at Heidelburg the last few years and is, by my 
standards, becoming more respectable or less controversial. 



The Hospital World: Alta Bates and Herrick Hospitals and HEALS 



Blum: At the same time during the seventies, I got pulled into the 
hospital world, which I also loved, even though it was a long 
way from policy planning at the community level. I was asked 
to help with the planning at Alta Bates Hospital, and that's 
because of former students who were now running Alta Bates. 

Crawford: Let's talk about that. 

Blum: In the seventies, I was planning with Alta Bates, and they and 
Herrick were in sort of a death-throes battle for survival. 

One of my co-professors, Dave Starkweather, was the key 
force on the board at Herrick. He didn't want to be the 
chairperson there, because he was wise about that, but he was 
certainly the brain there. I got to be pretty much head of the 
planning at Alta Bates, although they had several full-time 
planners on the staff. They were well-paid people. 



291 



He and I came to a pretty rapid understanding that no way 
could the two hospitals survive in Berkeley. This was in the 
early seventies. It was just ridiculous. They were going to 
have to join together. In 1981 I went onto the board at Alta 
Bates, and ultimately became chairman of the board for a brief 
period- -it was my last year there, at which time the two 
hospitals were, literally, joined, and made into one, which is 
now called Alta Bates. We finally engineered it, and it took a 
long time, until 1984. First, we went through the trustees, 
who were not physicians. The physicians hated one another. 
The administrators hated one another. 

Crawford: Is that surprising? 

Blum: Well, no, you want the business, they want the business, and 

there's not enough businessthat ' s the real issue. Remember, 
at this point, there were new hospitals coming into service in 
Alameda County, Contra Costa County, and so on. In the case of 
Contra Costa, patients that used to come to Berkeley went to 
John Muir, and maybe to Concord, to Mt. Diablo, and maybe to 
Brookside in San Pablo, and then to Doctor's Hospital in 
Pinole. At that time Kaiser was also making huge inroads into 
patient care. 

Crawford: Is Kaiser not a good program? 

Blum: No, that's not the issue. It was making horrible inroads , 
taking customers. 

Crawford: Enormous inroads, but not negative ones? 

Blum: I don't think so. People got at least as much as they had ever 
gottenfor a lot less. 

Crawford: Was this the era of the MBAs, when they came in to administer 
in hospitals? 

Blum: Yes, and, in fact, Starkweather was specialized in hospital 

administration, and I was not. I was interested in health care 
in a broad sense, but I played the narrow hospital game, too. 
That's how you learn what's going on, if you're in it. 

Under his auspices and doing the work, but under my 
chairmanship, we set up the joint masters degree between the 
School of Business and the School of Public Health. With a 
three-year program, a student could get two masters degrees, as 
I've said, and they were typically headed into the Kaisers, the 
Blue Crosses, and the Blue Shields of the medical world. We 
trained a lot of students that waywe're still doing it. 



292 



Dave Starkweather and I were very, very different people, 
and we were interested in very different things. He was very 
much a computer nut, and I could care less--I haven't seen any 
good thinking coming out of a computer. I was interested in 
which way to go on issues, and he was interested in getting 
there. So it was a good match-up. All my students tended to 
take his courses, and his students tended to take my courses, 
but then they pulled apart when it came to a career. They were 
very, very different people, obviously. But it was good for 
the two of us, each in his own department and each in his own 
hospital, and able to exchange. We had adjacent offices, you 
see, in Warren Hall. 

So we got these two hospitals together. One of the big 
battles we had lived through was over emergency services. 
There was a statewide program, which has since somewhat fallen 
to pieces, of having emergency services good ones. There was 
the issue of whether it would it be Alta Bates or Herrick that 
would be the chief emergency servicer in the Berkeley area, and 
remember, emergency generates business. People come in who 
have no intention of coming in, but they're there, and when 
they need hospitalization, you've got them. Often, it's around 
accidents, and in those, there's usually moneythere' s some 
insurance or something, you see. Many people can pay. Well- 
to-do people also get into accidents. 

Anyhow, Herrick was much more dependent on its emergency 
room than Alta Bates. Alta Bates was slowly pushing its way 
in, and they just about displaced Herrick. So here we were, 
with great big meetings going on about how we ought to work 
together and not kill one another, yet there was only room for 
one such service in the area. This is what's known as 
competition in the hospital business, and it means that prices 
go up and up and up for everybody, because everybody is trying 
to do everything without adequate volume. 

So we had this meeting, and I was still chairman of the 
Alta Bates planning group, but not on the board at Alta Bates 
yet; it was early in the eighties. We listened to all the 
competing claims, and it was crystal clear to me that Alta 
Bates was chiseling its way into Herrick 1 s territory. I had 
been appointed as one of the people on the committee, and there 
was the chairman of the Alta Bates board as chair of the 
meeting, a man by the name of Manlove, a very interesting, 
powerful force on the Alta Bates board. 

I listened for an hour or so, and I said, "Well, Mr. 
Chairman, as a member of this committee, I move that we agree 
to give the emergency services to Herrick. That's where it 



293 



started, that's where we all agreed it was to go, 
that we honor that agreement." 



and I suggest 



So it was moved, seconded, and passed with only one or two 
negative votes. It was just so obvious, it had to be that way. 

When I came home, it was on a Friday evening. I said to my 
wife, "We're going to get a phone call shortly, and we're going 
to hear from the chairman of the board of Alta Bates, and I'm 
going to be disengaged from any further work for Alta Bates," 
because I had really, really kicked in that whole profitable 
business, thoroughly and intentionally. I don't believe in 
stealing, even between public institutions. [laughter] 

Sure enough, we're sitting down to dinner, and the phone 
rings, and she says, "A man by the name of Manlove." I said, 
"Hi, Bob, what can I do for you?" He said, "We need you on the 
board of trustees at Alta Bates." [laughter] I said, "Really, 
I hadn't come to that conclusion, myself." Then I said, "Sure. 
I'd love to." Given the occasion, it was a good augury. 

So that's how I got on the board at Alta Bates. It was 
just the exact opposite reaction of what I expected. 

Crawford: They recognized a strong man. 

Blum: It wasn't just that. Their move was foolishness. How much 

chiseling can you do, in the long run, with everyone watching? 

So I stayed on the board, and we had a wonderful era of 
planning. The administrator there, who was very antagonistic 
to Herrick at the time, was a very, very bright guy. He is a 
real big shot around here now, and somebody that I always 
enjoyed working with- -Bob Montgomery. A good planning group 
was just critical to everything he undertook. 

Just about that time things for Alta Bates really settled 
in and became hard--I mean, we had gotten the Medi-Cal decision 
that it was only going to pay so much. I'll never forget the 
trouble we had getting the board to understand that if our 
average cost per day is $900, and Medi-Cal only pays $600, that 
we're really not losing $300 a day if taking in that new 
patient into an otherwise empty bed only costs us $400 a day to 
take care of. Never mind the average cost; the truth of the 
matter is that if this Medi-Cal patient costs us $400 and 
they're giving us $600, we just got through making $200. That 
sort of thing was particularly enjoyable, because I got to know 
a lot more about what I was teaching, in contrast to many 
teachers who had little contact with actual operations. 



294 



Crawford: The real thing. 

Blum: Yes, in contrast to most people who teach and do exhaustive 
research on some arcane issue. They read about it in the 
literature, and this particular set of discoveries showed up at 
least five or six years later in the literature. Well, here 
you're living it right now--I'm representing a hospital and 
going to Sacramento, and arguing about the rates, and trying to 
get a little more money for Alta Bates from the state. 

Crawford: From Medi-Cal? 

Blum: Yes, and it was feasible, and we did get some more. And, at 

the same time, hassling with Herrick and saying, "Come on, come 
on. If we get together, we can all survive." Sure enough, the 
docs were finally amalgamated, and the cardiac group that was 
Herrick and the cardiac group at Alta Bates have gotten along 
famously ever since as one group. They are all part of a 
bigger medical group. 

Crawford: Which is what? 

Blum: Well, it was just a group of heart people that now relate to 

Alta Bates, but they used to relate to two hospitals. Now it's 
a big operation. They couldn't have survived divided. Alta 
Bates had trouble, even after they amalgamated, to really get 
through some of those bad years. The doctors and the hospitals 
slowly learned to work together as both were in danger 
otherwise . 

As soon as we amalgamated the two hospitals, we turned to 
Blue Cross and said, "We want more money for hospitalizing your 
cases . " 



Crawford: 
Blum: 



We suddenly had the control of the local market. There was 
no more Herrick to compete with; there's no immediate 
competition. We could work more cheaply together, but at the 
same time, we didn't have competition. So we could tell Blue 
Cross, "We want more money. Otherwise, you have got to make 
your Berkeley subscribers go to Pill Hill"--well, they may not 
want to go to Pill Hill. 

What's Pill Hill? 

The amalgam, there, of Merritt and Peralta and Providence-- 
that's Pill Hill. That's just five or ten miles away, but 
Berkeley-oriented people don't want to do it. They'll buy some 
other insurance if they want to stay here. Most people don't 
enjoy changing their source of medical care. 



295 



Crawford: You had a good bargaining wedge. 

Blum: All the stuff that isn't supposed to be, you learn. We had 
meetings at seven in the morning practically every day, and, 
then, at noon many a day; and then in the eveningseither 
during dinner or after dinner. 

Crawford: All the while working full-time here. 

Blum: Yes, it was really a wonderful time, and, at one point in the 
seventies, Bob Montgomery and I and a few other people had 
decided we should have our own HMO. If Kaiser got all the 
business, they'd send their subscribers not to us but to 
Kaiser's facilities. So we created HEALS, an HMO, in 1978. 
Before it was all over, I was chairman of that board for some 
years, from 1984 to 1987. My last year on the hospital board 
was the year the merger really sank in, about 1984. Chairman 
of the Board of Trustees-- ' 84. So it was that late. It took 
all those years and years and years of struggling. 

II 

Blum: But to get to HEALS: several physicians at Herrick wanted to do 
something, felt we just had to stop Kaiser's inroads, and the 
administration at Alta Bates felt the same way. This is 
interestingit wasn't the docs at Alta Bates, and it wasn't 
the administration at Herrick. Between us we finally convinced 
each of the organizations to put up some money, and we would 
partner equally in setting up HEALS. The name was suggested by 
a doctor from Herrick. It was a good name. HE and ALS 
represented key letters from Herrick and Alta Bates. 

Crawford: Appropriate acronym. 

Blum: It sounded good. But anyway, nobody put up real money. Alta 
Bates put up something like twenty thousand; and then Herrick 
put up twenty thousand. It is ludicrous. You needed about a 
million and a half, or two million dollars, to get started, and 
today about twenty times that. 

Crawford: What were the ramifications of setting up an HMO? 

Blum: Well, in the first place, you had to have a marketing arm; 
somebody had to sell a service policy to industry or to 
government and other big employers who are the purchasers. It 
was very clear that we could sell it to the two hospitals for 
their employees. If they founded it, they would provide it for 
their own employees, but even they were reluctant to do this, 



296 



Crawford: 
Blum: 



Crawford; 
Blum: 



as HEALS paid them less per patient-hospital day than most 
other HMOs and insurers. 

So we had some customers, but supposing you wanted to come 
to the university to sell HEALS insurance. They're the biggest 
employer around. Well, then one suddenly needs PR; you need a 
whole publicity machine, and you've got to set up the business 
and operations side, so that when you hand out materials, 
you're able to say how you work, what your relationships are, 
how referrals take place, what doctors are used. Before that 
you've got to sign up doctors, and you've got to sign up 
hospitals and set up the machinery to take in the purchasers' 
money, direct patients, pay doctors, on and on. 

More or less the same staff doctors you had? 

Well, remember that the so-called staff doctors didn't work for 
the hospital. They were all in private practice, and many of 
them worked in two or three hospitals. So you had to get them 
to agree to take HEALS subscribers as patients. You had to get 
the hospitals to do so also, and at our prices. 

So first you had to develop the prices; the whole bit, and 
then how much money for drugs? How much could you expect? How 
much could you afford to pay? How about the business side of 
dealing with doctors and sending them their money, and dealing 
with the hospitals and sending them their money, and dealing 
with patients and their problems, and selling memberships? It 
was a tremendous ground-up effort, and essentially done with 
almost no money. 



Was Kaiser an HMO in the strictest sense? 

Always. Yes, it always was, and not for profit, 
out not for profit, too. 



We started 



We ended up hiring a brilliant administrator named Dennis 
McKenna from Kaiser somewhere down in the Los Angeles area. He 
was a young hustler, and we practically lived with him. There 
were four or five of us--me, Montgomery, Manlove, Jerry 
Kaufman, McKenna- -hatching the program at all these stages, and 
then reaching out and finding somebody to do the selling, 
reaching out and grabbing somebody to do the PR, then getting 
business types, section by section, for drugs, medical care, 
hospital care; pulling people in to help work out the 
negotiations with the hospitals. 

We had to negotiate with all the hospitals around, and we 
finally offered our plan in San Francisco, San Mateo, Santa 



297 



Clara, Yolo, Solano, as well as Alameda/Contra Costa counties. 
And then we had to get the medical societies not to obstruct. 
They hated HMOs, because HMOs had meant more Kaiser for some of 
them. Most welcomed HEALS which used only private 
practitioners . 

Crawford: And it meant ceilings, didn't it, on private practice prices? 

Blum: Well, it ultimately wouldat least it would interfere with how 
they charged, right off the bat. The doctors in HEALS were not 
paid on an annual basis, neither per patient nor by salary. 
They earned the money on a fee-for-service basis, and we had to 
negotiate how much they would be paid for every single 
procedure. We had to negotiate: how much for a tonsillectomy , 
an examination of a tonsil, an examination of an eye, a 
cataractwhat does it cost to remove. Well, you'd borrow such 
information from here and you'd borrow from there, and you'd 
add it all up, and how many of these will there be per patient, 
and how much on average for each subscriber? Because that's 
how much you have to charge the purchaser for each employee 
they would insure with us. 

We had some guidelines. One was that we weren't going to 
be much more expensive than Kaiser; we were going to stay 
within, maybe, 10 percent of Kaiser's monthly costs. 

Crawford: Was this easy to do? 

Blum: No. You're starting up, and you have no money; there is no 
reservoir of bucks. 

Crawford: All you have is your physical plant, basically, isn't it? 

Blum: You don't even have a plant. You just rent an office. You pay 
for each service given to each subscriber. If they are taken 
care of in Pill Hill, or here, or there, or elsewherethere 
are pre-negotiated rates at which hospitals are going to take 
care of them. All that has to be negotiated. Everybody's 
giving you a rough time. Everybody's surviving. 

Dennis was a bit of a genius. We were told at that time 
and everybody knew that a plan had to be nationwide. Dennis 
really felt quite differently, and persuaded me, that you had 
to be regionwide, but that it wouldn't be enough just to be in 
a county, that we had to be regionwide because, for example, 
Standard Oil has a plant in Richmond, but its workers go home 
at night to five or six counties. So you've got to be in those 
six places. Region was the issue. 



298 



Crawford: 
Blum: 

Crawford: 
Blum: 



The San Francisco Bay Area was a good, sizeable region; the 
people who started out and tried to go nationalmost of them 
went crazy. Ultimately, HMOs kind of got back to it. 

The doctors didn't trust us; they didn't really look 
forward to an HMO, but many of them did put in twenty- five 
hundred dollars, which would be theirs. They could have taken 
it back out; they got stock, ultimately, for it. 

Originally, it was a not-for-profit plan and there was no 
stock. What we did was withhold on every doctor: he'd done 
various services, and billed for them, and got paid for them, 
but he wouldn't get all of his moneyhe'd get 80 percent and 
the remainder would be held in a pot until we had some cash to 
turn around with. 

When you start out with just a few hundred doctors and four 
or five hospitals, you don't have much volume. That withhold 
is critical; otherwise you can't pay your bills. We were 
always staggering from one hour to the next, paying our bills. 
If a baby was born prematurely, we practically had a board 
meeting over it, because this might cost you thousands of 
dollars a day at Children's Hospital in the East Bay, it would 
cost you the best part of two thousand dollars a day. 

In this case the baby may stay in the hospital for a month, 
two months, three months. We didn't have that kind of money, 
so it was one long hassle. Yes, we could have gotten better 
prices in San Francisco at UCSF, but did you dare ask a parent 
to move their premature infant to San Francisco? 

All these things were quite revealing. We went through a 
thousand things, so we were always negotiating with everybody 
over everything. Originally, because we didn't have too many 
customers, the hospitals wouldn't give us a good price, nor 
would the pharmacists, labs, and x-ray people. 

What was HEALS 1 range? 

Well, we started out in Alameda/Contra Costa, and then moved to 
the whole Bay Area. 

Did you benefit from Kaiser's expertise in this area? 

Well, in the sense that the person we hired to head it up was 
savvy to the Kaiser business operations. 



Crawford: Were they resistant to what you were trying to do? 



299 



Blum: No, it was just a matter of business they 're going their way, 
you're going yours. Kaiser is so big that it's hard to say 
that they were resistant to anything, or cared. Half the docs 
here were ex-Kaiser docs in this area that's how you proved 
that you were a good doctor; you left Kaiser. It's kind of 
interesting; it really tells you that Kaiser must have been 
pretty good in the first place. 

So our own doctors did us no favors, and they still went on 
overdoing, overdoing, over-prescribing. Instead of generic 
drugs, they'd go for trade names. The difference in price 
might be five-fold. 

We had committees of physicians, and the place was run by 
doctors, really, because in the long run, they write the 
prescriptions, they send the hospital the patient. But it 
turns out that it's very hard for a doctor-run organization to 
stick by their guns. In other words, if they see a doctor 
who's wasting procedures or doing unnecessary surgery, it's 
very hard to step over and say, "John, my old friend, you're 
going to have to knock it off. You can't be doing that." And 
they didn't succeed at controlling needless services. We'd 
always, year after year, lose a half a million bucks, one way 
or another. But that's chicken feed because our revenues were 
a hundred million almost overnight. The HMO grew fast. 

Crawford: Who absorbs the loss? 

Blum: You don't. It just stays on the books. Or that 20 percent the 
doctors are supposed to get back? Well, they don't get 
anything back, and that 20 percent is used to make the 
organization solvent. It teaches the doctors just the wrong 
thing, that they had better grab their money and run, because 
they're only going to get 80 percent of what they think they're 
going to get. So there are many kinds of incentives in the 
picture. The withhold worked just the opposite to what it was 
supposed to do, that is, encourage thriftiness so you could get 
it back. 

I remember just a year or two ago I went to see a man whose 
father had been a doctor in my day at HEALS, and he said, "I 
remember your name. You were involved in HEALS?" I said, 
"Yes, I sure was." He said, "The doctors really kind of ruined 
that, didn't they?" 

Well, that's exactly true, by not watching out for 
avoidable costs. Instead of HEALS becoming more and more 
valuable, it was really starting to build up debt. So it was 
sold to QualMed. QualMed became HealthNet, and now HealthNet 



300 



and somebody else are going together, 
monsters, now. 



It's one of the 



The doctors were in a position to make it or break it, and 
they were very casual about breaking it. They didn't see it 
was in their own interest to make it successful. They would 
never get it into their heads that HEALS was detouring patients 
to them who would otherwise have gone to somebody else. For 
instance, the first year HEALS was offered here at UC Berkeley, 
we outsold Kaiser. That's unbelievable. And all those persons 
who shifted to us from Kaiser meant new patients for our 
doctors . 

Crawford: That is unbelievable. Was that the force of your marketing or 
discontent with Kaiser? 

Blum: Well, both. In the first round, you will get the discontented 
people. Secondly, our price was very close to Kaiser's, so 
that the university agreed to pay for it. The patients then 
have the chance to get their own doctor and go to Alta Bates 
and not to Kaiser and not to Kaiser Hospitals and the price to 
them was identically zero. In fact, the university absorbed 
the difference. You didn't have to pay anything for this. 

Crawford: How did you get the university to go with HEALS? 

Blum: It was a bargain. But it took a little talking, I will say. 

Crawford: Did you lobby for it? 

Blum: Not really, because as a faculty person, that wouldn't look too 
good. Dennis McKenna, our chief operatorour gurudid it 
with assistance from other people, but it was obviously the 
thing to do. So HEALS was really a wild success here. 

Crawford: How long was your involvement with it? 

Blum: Quite a long time. In the course of a few years, I became 
chairman of the board, and I was chairman for quite a few 
years. I was chairman from "84 to "87, as I said, and it had 
taken almost a decade to set it up. 

Crawford: People complain because the hospital stays are so short now. I 
think a mastectomy is almost an outpatient procedure. 

Blum: It can be. Well, in those days, the first thing we did was 

compare drug use, compare hospital stays, and so on. The deal 
we had with Alta Bates was paying them so much a day, in the 
hospital. It had nothing to do with how long you stayed, they 



301 



got paid for each day. Now it hardly works that way. Usually, 
the hospital gets paid per case, and the shorter the stay, the 
happier everybody is; but Medicare really started that. But if 
physicians aren't watchful, or don't give a damn, they 
authorize a day more, and in HEALS" time, you start looking at 
more days and days, more drugs and drugs, more procedures and 
procedures. A lot of procedures aren't really necessary. 

The HEALS committees always talked great, but they really 
didn't do that much. When HEALS was sold to QualMed, I got 
sixty-five dollars for my one share. It wasn't one of those 
deals where you sold because the directors made great money. 
Quite the contrary, we made nothing, but QualMed picked us up 
when we were probably losing a half million dollars a year, at 
least. 

The first year QualMed is supposed to have netted ten 
million dollars on the same operation. QualMed took the same 
premiums, same docs, same hospitals, same prices, same drugs; 
and it turned a ten-million-dollar profit. 

Crawford: How? 

Blum: It was now a for-profit venture. It had become a for-profit 
venture in my time for various reasons; really had no choice, 
mostly because it was losing money. QualMed hired three bright 
young docsone for every thirty-five thousand customers (about 
a hundred thousand customers) --and they, not the clerks, 
scrutinized all transactions that amounted to anything. 



Crawford: Smart. 

Blum: Well, those three docs cost QualMed half a million dollars 

between them a year, and they saved ten million. Just their 
presence had already changed the attitude of what doctors were 
going to prescribe, because they knew they'd get called if they 
were prescribing something or doing a procedure that was 
uncalled for. 

Crawford: In front of a peer? 

Blum: That's right, in front of a hot, young peer, who knew as much 
or more than they did, almost for sure. I don't know how 
QualMed operated after that, but that's how they started. I 
stayed on as a consumer after 1987. 

Crawford: The care was good? 



302 



Blum: 

Crawford: 
Blum: 



Just the same care, same docs, same hospital, same everything, 
but the needless crap was gone. 



Crawford; 
Blum: 

Crawford; 
Blum: 



Crawford; 
Blum: 



So, all on balance, a success? 



But 



Totally. I'm sure that QualMed never regretted buying us. 
the point I'm making is that no one doctor, from his 
standpoint, could see that. What he kept overlooking was, 
"Never mind your take-home, you won't have any patients if you 
don't have an organization to compete with Kaiser, because 
everybody is going to Kaiser." That was the way it was. The 
bulk of the patients that weren't county patients were in 
Kaiser, that's that. There were a certain number in Medicare, 
too, of course, and Medi-Cal, but it was Kaiser. If you let 
that go on, you wouldn't have a practice. 

Before HEALS started, at that point, many of the docs that 
we knew had just left private practice and gone to Kaiser. 
Things were that tough. Or, in some cases, had gone to the 
county, because there were hard times, and many people didn't 
have the wherewithal, so they went to the county as patients. 
Well, the doctors had to go somewhere, and they went to county 
or they went to Kaiser, where their patients had gone. 

It seems that Kaiser has very simplified billing procedures. 

When I go to the hospital, you should see the list of crap that 
comes out with the charges. 

Exactly. 

Well, in Kaiser, there's no such nonsense: You're on this ward? 
All right, that's worth eight, nine hundred dollars to the 
internal Kaiser bookkeeping, but the patient never sees that. 
You've been paid for, and you're done. They don't waste their 
time or yours getting your money. 

That's very streamlined, in that sense. 

Very streamlined. So their administration costs are about 3, 4 
percent, and everybody else's plan is probably 15 or 20, you 
see. That's still true, although other plans are commencing to 
catch on. Many have streamlined themselves to the 10 percent 
mark. The little HMO that Contra Costa County runs that was 
starting when I leftwasn't my doing, but it was a good idea- 
runs at 6 or 7 percent. 

For instance, our overhead at HEALS was monstrous when we 
started--it was 25 percent. Of course, there are still big 



303 



insurance companies that run that way. They're taking that 
money out of it, but the point is that the development of one 
ad, or the development of a billing form, if you use it for two 
million customers, is a lot cheaper per customer than using it 
for twenty thousand. Contra Costa County managed to do it for 
twenty thousand persons, and do it almost as cheaply as Kaiser 
with thirty times as many subscribers. 

Well, in HEALS' first year, we were scared to death--! mean 
a 25 percent overhead, but you knew there was no choice. You 
had to negotiate with every single employer. You had to go 
back and convince them to buy our product, that we were here to 
stay. Our doctors and hospitals were known quantities, and 
that helped. 

And the next year it dropped to about 20 percent, and that 
was quite a relief. And then it dropped to about 15 percent, 
and then it dropped to about 12. When you got through the 
newness and the development, and then, secondly, you spread it 
over a hundred thousand customers, not over five thousand, that 
downward shift in overhead costs was exciting. 

Crawford: I've been reading about Alta Bates' new birthing center. How 
did they have the financial resources to develop this? 

Blum: Hospitals have lots and lots of money. Money runs through, 
runs through. On the other hand, even as they have lots of 
money, they could be going broke. Herrick, before they were 
partnered with Alta Bates, spent twenty, thirty million 
building a new hospital. And Alta Bates proceeded to get 
thirty million bucks to do the same sort of thing. They were 
just competing with one another for no purpose. Berkeley 
needed one of the two, but not both. Well, this is where the 
monies go, you see. 

Crawford: So they were always competing? 

Blum: Not since they merged, no more duplication of facilities and 

staffs. When Bob Montgomery left Alta Bates for ten years, he 
was followed by people that were unbelievable. I'll never 
forget; I had a hand in picking them out. We weren't very 
bright. 

In 1983, we had a welcoming party for the new 
administrator. My wife went with me to the fancy little 
soiree, and when we left, she said, "Who was that tall guy?" I 
said, "Well, that's the new administrator." She said, "Oh, no, 
you couldn't have picked him? You're going to die with that 



304 



guy." She did personnel work, years ago, of all places, for 
Kaiser at Walnut Creek when they were new. 

Crawford: Oh, really? For many years? 

Blum: Several years; it was a part-time job, no big deal. She's one 
of those people who sizes up people. She's always said she 
should have been the doctor in the family. She wasn't wrong on 
this guy, either. We got the biggest bluffer you ever saw. 

Crawford: Had he come from this program? 

Blum: No, no, god knows where he came from. He used to say that he 
was a minister's son. He'd been trained, though. 

But he managed to get rid of that thirty million bucks or 
most of itwithout anything to show for it. He was just a big 
operator, and he literally almost killed HEALS. Under his 
initiative, Alta Bates suddenly decided to take it over and own 
it. They came in with some idiotic claim that they owned 87 
percent of it, and they were going to start writing the ticket. 
This was when it was really growing like mad, and looking very 
prosperous . 

We added it all up, and the only thing he had overlooked 
and this is this guy's business trainingwas the fact that the 
docs had never been getting their 20 percent, and that means 
that they had been investing their 20 percent in the plan, and 
their ownership was like 97 percent, if you wanted to get down 
to brass tacks. They owned the whole thing, dollar-wise. So 
here they were and their hospital was trying to steal it. 

So it came to quite an impasse. We were switching to for- 
profit, because if you weren't for-profit, and you needed to 
borrow money, you could only go to the bank, or something 
comparable, and there's only so much you can borrow at the bank 
without being choked to death on 10 percent interest. We 
started converting to for-profit so we could sell stock and 
raise money that way, and Alta Bates wouldn't let us convert. 
Oh, did we have a time with Alta Bates. We hired lawyers, we 
did this, we did that, and we finally got out from under their 
clutches, and then went independent. 

Crawford: What happened to your administrator at HEALS? 

Blum: He was bounced out at the same time. It would be hard to 
defend him, although I sort of did, because he was just 
brilliant about the strategy of the thing about which way to 
turn on the big scene but internally, he was a poor 



305 



administrator. So he had to go, and when I was gone that was 
the end for him. 



Crawford: 
Blum: 



At one point, he discovered that we were double paying for 
x-ray. Every time a patient got x-rayed in Alta Bates, it was 
included in the bill as an extra, but then we'd get separate 
repeat bills from x-ray. It was a half million dollars per 
year, and I don't think it was accidental, because every kind 
of problem we had with Alta Bates was always the same way. 

Well, the idiotic thing is that Alta Bates has now had to 
reproduce HEALS. Alta Bates has a medical group, and they are 
back where they were when they had HEALS--they have a similar 
kind of organization, but now the doctors are mostly per 
capitated. 

Oh, they didn't go with HEALS? 

No, although Alta Bates was the key force in setting it up, 
they tried to steal it, so HEALS went on its own way. We used 
Alta Bates as a hospital, but Alta Bates was no longer in 
HEALS, to speak of. They may have owned a few shares of stock 
because of their original twenty-thousand-dollar investment. 
They were pretty horrible to do business with. They, too, 
couldn't even realize that if they lost HEALS, they'd lose a 
lot of customers to Kaiser. 



Well, anyhow, all this you learn, and when you're teaching, 
it's nice to know what you're doing. 

Crawford: How did this affect your teaching? 

Blum: Oh, it was wonderful. You work longer hours, but you're just 
picking up all sorts of information all the time, and nobody 
else even knows what's going on. Now a lot of people know 
those things, but in those days, where were you going to read 
about it? Five years later, somebody will write an article on 
it, which might or might not be to the point. But you're 
really living it. 

Of course, we were constantly negotiating with other HMOs, 
sharing territory and considering joining forcesso you were 
in everybody's backyard, and you knew all the businesses up and 
down the whole Bay Area, and there were many HMOs in the Bay 
Area. 

Crawford: This was the time when they were being established? 



306 



Blum: Being established, yes. If we weren't in them, we were 

negotiating with them. If we weren't negotiating with them, we 
were surely watching. So we knew all kinds of things. Well, I 
thought it was the difference between knowing what you were 
teaching and just teaching. 

Crawford: You were really training these public policy students, weren't 
you? 

Blum: Oh, yes, at the same time, and many of them went into these 
operations. Part of our training was always something 
practical. When I became the professor of health policy--! 'd 
been in health planning before the mid-seventies--all the 
students had to work in the field while they were going to 
school. This was not as an internshipbut they had to honest- 
to-god pick up a project and run with it as part of class work. 
Thanks to Len Duhl, who had a lot of connections in the state 
legislature, many of our students worked in Sacramento for the 
assembly or the senate or the governor's offices. They were 
full-time students, but as part of our course work they were 
doing projects for the organization that they were assigned to. 
They had fantastic experiences, and many of them ended up 
there. Just the other day I saw several who are still there. 
This was at the state health department. There were at least 
half a dozen at this one meeting. In many cases, their job 
resulted from the project that they had worked on as a student. 

Every so often the students had to report to their 
assembled class. That's how we operated. It would be teams of 
two to five peopleusually three or four and they'd work up 
there, and divvy up the tasks, and I didn't have that much to 
do with it. They did it, and then they'd come back and fill us 
in. We would give them two hours to bring us up to date on 
where their team was, what they were doing. So all of us 
learned all kinds of things about how our state government 
operated and what it was up to. 



307 



VIII INTERNATIONAL FIELD SERVICE: 1969-1981 



Dr. Hilleboe and the World Health Organization 



Crawford: Today we're going to talk about your international work to 
date. How did you get started in field work? 

Blum: I had had a good experience, because planning was new, and I 
was in charge of that program in the School of Public Health 
because nobody else knew what to do with it. It was assumed 
that anybody in public health knew all about planning--! think 
I said that alreadyand it turned out we didn't know anything 
about it. We had only done planning internally inside of 
organizations, which is a very simple matter with a set of 
objectives, usually mandated in law. When you deal with a 
community, whether it be a city or a county or a state or a 
country, the objectives commence to be pretty diffuse, and to 
plan is no small matter. 

Each year, I got out a little textbook. It was 
mimeographed and put out by the Western branch of the American 
Public Health Association. It was done at cost, so whoever 
bought the book paid for whatever it costa couple of dollars 
--but each year it got bigger and bigger and finally ended up 
being my book on health planning. Originally it started out 
with a lot of other contributors because I really hadn't had 
the breadth before. 

By happenstance, there were some real problems at the UCLA 
School of Public Health in the late sixties, and the dean there 
invited me down to live through the problems with them. We 
ended up with a two-day session with a man by the name of 
Herman Hilleboe. He was an assistant surgeon general in the 
U.S. Public Health Service, and he was supposed to have become 
the next surgeon general of the U.S. Public Health Service, if 
and when Dewey became president. 



308 



Crawford: 
Blum: 



Herman Hilleboe was picked up by Governor Rockefeller and 
brought to New York as director of the New York State Health 
Department when Dewey fell by the wayside. He was a sharp, 
smooth article; a very, very bright person. Lester Breslow-- 
who was the dean at UCLA--invited me and Herman Hilleboe to 
spend a couple of days with him, looking at health planning, 
and we just worked from dawn to dusk and argued beyond, and 
Herman Hilleboe could never understand what I was doing, 
because he'd always been an in-house or administration planner. 

He said, "The governor wants this, so you figure out how to 
give him this." But the crux of the matter is that useful 
health planners don't work that way. They have to figure out 
for the governor what it is that the governor should want. If 
you're really a health planner, you have to figure out what a 
society or a legislature or somebody else needs. You don't 
have all the instructions about what you are to do all handed 
down. Typically, the state health officer has a job where it's 
all written down. He's got to be smart enough to make it 
happen. It's quite different to be smart enough to say what 
ought to happen in the first placewho's going to make what 
laws under what circumstances that ' s the job for a health 
planner. In reality, without recognizing the nature of the 
task as being one of health planning, health officers had 
always done this, but without benefit of understanding much 
about planning as a skill. 

Well, Herman Hilleboe could not understand this. He'd been 
so busy all his life in the midst of administrative and 
organizational planning that he thought that was all there was 
to it. Hilleboe was also the key advisor to the director 
general of the World Health Organization, although he didn't 
work for WHO on a regular basis. He left Los Angeles for 
Geneva and his WHO desk when our little meeting was over. 

That's unusual, isn't it? 

No, there were quite a few such people in the history of the 
WHO, but he was the key one in my time. 

So when we finished our meeting in Los Angeles, I gave him 
a copy of the book. I remember it was a nice persimmon color, 
an eight-and-a-half-by-eleven-size paperback. I asked him to 
look at it on the plane--"You may finally understand what I'm 
trying to say." 

Then in a matter of sixty or ninety days, I get a call from 
the World Health Organization to please come and do an 



Crawford: 
Blum: 



Crawford: 
Blum: 



309 



examination of a program of theirs. It was a special 
committee, and we had to publish our recommendations. 

What was the program? 

It was an epidemiologic program, and it was run by a scientist 
who was kind of a maniac, and he kept destroying it. I never 
understood why, because it was a potentially wonderful thing. 
We tried to change it all around and we did, but they couldn't 
make it work with that guy in charge. They had to finally send 
him off somewhere and ended the program. 



Do you remember his name? 

No, it was a nice English name. 
Australia or some place. 



He was from New Zealand or 



So I get this request to be the person who writes up the 
f indings--the rapporteur- -meaning you not only participate but 
you write up all the conclusions. 

Crawford: This was in Rome? 

Blum: No, this was in Geneva at WHO headquarters. I got there, this 
was 1969, and I discovered that there was a message waiting for 
me to please go see Dr. Bennett. I don't know Dr. Bennett, but 
the first thing I see on his desk is my persimmon book. It was 
hardly used anywhere, just for our own use around here, so I 
couldn't believe it. 

He came in and said, "You don't remember me? I used to be 
a student of yours while you were at Stanford." He said, "I 
also worked in your health department. I did an experiment to 
see if the hookworm could propagate and infect people down in 
the Walnut Creek to San Ramon area." 



Then I remembered this kid. He's a tall handsome guy now. 
Here he is, at WHO, one of the bright young men there, and he's 
got my book. I said, "How did you get this book?" He said, 
"Oh, everybody here's got it. You know Herman Hilleboe, Dr. 
Hilleboe? Well, when he came here, this summer, to work, this 
was on his desk. So everybody here figured we had to get one." 
[laughter] 

Hilleboe, I'm sure, had never read it. Hilleboe was still 
there, too. But it was funny because if Hilleboe did 
something, it became sacred at WHO. 

Crawford: Everyone had to have your book. 



310 



Blum: 

Crawford; 
Blum: 



Oh, yes--so that's how I got my start with WHO--through 
disagreeing with Hilleboe, who then took my book and probably 
never looked at it, but left it on his desk. 



That was 1970? 

Yes, it was about 1970. 
friends. 



That was Herman Hilleboe. We became 



Working with WHO in Sri Lanka; 1970 



Blum: Then three or four assignments all occurred at the same time. 

I went to Sri Lanka at their request. That was an interesting, 
fascinating experience. I got there, I think, six weeks after 
Madame Bandaranaike was made prime minister again. It's a 
Commonwealth country, an amazing country. They had better 
literacy than we do and are educated in the British tradition; 
a kind of humanities tradition. They were very expert at 
Shakespeare, but what they really needed were some mechanics 
and some people who could run and build railroads and dams or 
businesses, and they didn't train those kinds of people. 

We got there just a few days after a minor revolt that 
occurred when Mme. Bandaranaike was again elected prime 
minister. It was supposedly brought about by upper-level 
college students who saw no jobs ahead of them. Unemployment 
was rife, yet the people were 98 or 99 percent literate with a 
good humanities-type education. 

Everything seemed very peaceful to us but major changes 
were introduced: all teaching and transactions were to be done 
in either Tamil or Sinhalese. However, the 80 percent dominant 
majority was Sinhalese and this upper-class element who made up 
most of the country's leadership no longer knew much Sinhalese, 
depending entirely on English and were disadvantaged for the 
moment. This turned out not to be practical, but it left a 
sense of the government attempting to be fair. This also 
tended to turn the tide towards the less well-off 17 percent 
who were Tamils and knew Tamil as well as English. 

Then one afternoon, she changed the money, and you couldn't 
get more than something like ninety new dollars for your old 
ones if they were not in usual businesses. So if you had a 
million dollars at home, all that money was valueless. You 
couldn't give it away. Folks that had been hoarding it and 
shipping it out of the country were caught flat-footed. There 



311 



was nothing you could do with the old moneyyou could paper 
the walls. That took a lot of guts. 

Then she appointed all the ministers, who were all new when 
I got there. The minister of health that I worked for, helping 
him plan for his services, was a country general practitioner 
in his thirties from Randy. There are wonderful place names in 
that country- -K-A-N-D-Y. It's hill country, and an old 
Sinhalese stronghold, and very, very beautiful, I must say. 

The first thing he asked me to do was lay out a health 
sector plan. I said, "I want a meeting with all the other 
national department heads or ministers, or the chief officers. 
I would like to hear what you people think your country is all 
about. I have to get some sense of where people want to go. 
I'm willing to give you a sheet with my notions of your 
priorities, because I'm reading your papers like mad, but 
that's just my opinion of what I read." Then I said I wanted 
to get some information on the planning that had been done for 
the physical aspects of the country, and the economics of the 
countryeverything but health. He told me the planning 
department of the national government was in the finance 
department . 

I had just gone to a party the night before; a party in a 
neutral zone, a place where the Poles and the Russians and the 
Koreans and the Chinese could also meet with all the other 
Europeans. I forget whose party it was; maybe Poland's. There 
were people there from every country in the world who were 
working, developing that poor country. 

A Sri Lankan came up and said to me: "I understand that 
you're here to help plan for the health sector. Well, I hope 
you're not one of those idiots who's going to tell us to build 
more beds and more hospitals and train more doctors." I 
wasn't, to be sure. He said, "You know, I've made a tour of 
our hospitals and looked at the records. Do you know that 50 
percent of the cases that are admitted to the two major 
hospitals in this country are there because of contagious 
disease spread by dirty water? That's inexcusable. Why do we 
even need hospitals? Why in the hell don't we clean up the 
water? What's a health department for?" 

This was a planner from the finance ministry, and so I 
realized I wasn't going to have too much trouble with those 
people. He made a lot of sense. 

So I had an entree as of that party, and then the minister 
of health asked me what I wanted to know. I said, "I want 



312 



about twenty items. For example, I want to know what the 
picture was for education by the various grades for 1960, what 
it is right about now, or what it will be in 1980 and probably 
in 1990, because you are getting ready to have one of the 
world's largest irrigation projects." 

The Mahelevi River was being dammed, and they were going to 
irrigate the highlands, and turn it into a Sacramento Valley. 
I don't know if it ever happened. I should go back and find 
out. 



Then I asked for all the water f igures--what proportion of 
the people were going to get clean drinking water, what 
proportion dirty water; what proportion were going to have 
electricity. This is health, you know, it's not just about 
building a hospital. I asked about the roads and the 
transportation. It was a country with good, very cheap 
transportation all over. 

Crawford: The English are responsible for that? 

Blum: I've never been inclined to give the British too much credit 

for anything because of the disastrous things they've done, but 
I guess so. You could say so. Even the big buses around town 
were all two-deckers that couldn't be used anymore in England, 
but a Sri Lankan can fix anything. It's another one of those 
countries with so-called backward people that can do all kinds 
of things if they are allowed to. 

I found out what proportion of the people would be working 
in agriculture, what proportion in other fields. You get down 
to the basics of who is going to be healthy if you start 
unraveling these questions. 

I was invited over to the finance ministry, and they sat me 
down in an auditorium, and they said, "Okay, the first thing 
you want to know is about water." That's the one that scared 
me the most, because that could really wipe the country out 
with dirty water which would be provided for the expected huge 
population coming into the areas to be irrigated from the new 
dam. 

They pulled this big chart across the stage. It had a wood 
frame, and it was about eight feet high, and eight feet wide. 
Here were the charts of water, and the proportions of people 
and usagethe things I'd asked for, they already had it worked 
out. 

Crawford: So they knew about the problem, and they had even analyzed it? 



313 



Blum: Even analyzed it. 

Crawford: There must have been lots of development money at that time. 

Blum: Oh, yes, there was plenty. Well, then they pulled out another 
chart on population, and all by province, so that we could tell 
who was going to lose population, because many people would 
leave to go to this newly irrigated area in the highlands. 

Of course, the reason the highlands were not really already 
inhabited was the historical reality of prior irrigation from 
huge tanks which were hand-built lakes for irrigation. They 
had already irrigated this land a thousand years and more ago, 
and had to abandon it because malaria got so bad. This high 
country is three, four thousand feet up, and they could grow 
everything there, and the heat wasn't so terrific as in the 
lower altitude. It could grow many of the crops we produce in 
our Central Valley: they could have raised fruits and all kinds 
of things like we do here, and that's what they wanted to do. 

So I couldn't believe my eyes as to what I was seeing, 
because the finance ministry had anything and everything I 
wanted, and a hundred things more that I didn't want. We got 
it all down in chart form; I handed it over to the minister of 
health, who was the kind of man that worked about twenty hours 
a day. It was not what you would imagine from a nice, sleepy, 
supposedly tropical country. He was a brilliant fellow. 

Crawford: Who was he? 

Blum: Weratunga, Dr. Weratunga. He was something else--a family 

practitioner. He took one look at these figures, and he said, 
"My god, we're going to have more people in the hospital than 
we have ever had. All this dirty water, and they're all going 
to be drinking it? Something's got to be done." 

You see, there were economists doing the planning, and they 
didn't know or give a damn about health. The health department 
wasn't doing anything; he'd just inherited the job. He looked 
at the projections and saw unmitigated disaster for the whole 
country. The finance guy I had met at the party had seen that 
already. There were already hospitals full of contagious 
diseases . 

Crawford: What were they getting? 

Blum: Well, typhoid, particularly, and dysentery. 

Crawford: They had not had any typhoid prevention? 



314 

Blum: Not really, untreated water keeps it going, and typhoid 

immunization is essentially ineffective. Then, when I started 
visiting the hospitals, I discovered that many of them were 
reinfecting the patients. They'd come in for one thing and 
they'd go out with something else. They didn't have clean 
water in many hospitals. 

So I went back to the finance department, and they said, 
"Those miserable bastards." That's what they called them. 
"They won't even plan for building a water system for each 
hospital. We have been on their trail for years to at least 
have clean water in the hospitals." The money was all set 
aside. "They won't use it. They're all for great new 
inventions and great new doctoring and they send out people 
sick." It was really scandalous. 

Well, then I walked into the middle of some interesting 
planning. The Health Ministry, further on down the ranks, were 
not aware of their incompetence. For example, the hospital 
people in Colombo wanted to import a German laundry; the washer 
peoplethere ' s a word for them, dhobies--were all out in the 
little ditches and creeks, which are potentially full of 
sewage, doing the laundry. But the truth of the matter is if 
it looked clean, they'd just fold it up and send it back. All 
of this was unsupervised. You pay so many cents per sheet or 
per towel or whatever it is, and it all comes back to the 
hospital potentially contaminated-- just horrible. But what the 
hospital wanted to do was import the world's finest laundry. 

I really learned a lot about planning in Sri Lanka. They 
had wonderful planners there, and the upper echelons of 
government were pretty savvy, too. They had a scheme they 
called shadow budgeting, and anything they held really dear was 
given new values. They wanted money for foreign trade, and if 
your department could save on that, whatever it is that you 
wanted to do, the cost was cut on your shadow budget according 
to how much foreign exchange you were saving. 

For instance, instead of a foreign-built laundry, I figured 
out, in a few minutes, what they could do for the dhobies, the 
washer people. They could have built a roof over their heads 
and could have pumped in clean waterthere was clean water in 
their hospital so they didn't have to use the ditch water to 
wash things with. They could have a supervisor there and use 
Clorox/chlorine to sterilize all the laundry; they could have 
had a first-class hand laundry. 

Well, the shadow budget took into account such things as 
the cost for the German machine, about half a million dollars, 



315 



not counting the near impossibility of ever getting it fixed 
once it breaks. 

But if you used dhobies, you got no cost shown on your 
budget for laundry. You got that free because it was a largely 
unemployed group and any budget helping their unemployment got 
credit for that. You could launder the sheets for a fraction 
of the cost by using hand labor, and the government wanted to 
employ those essentially unskilled people, so your budget costs 
were nil. 

The budgetthe country's budgetwas built that way. If 
you had to buy a foreign thing, you got charged double or 
triple because you were using up foreign exchange. If you did 
something that was wanted, like employing the unskilled, it was 
a freebie on your shadow budget. 

This was brilliant, this shadow budget. You want 
somethingyou make it feasible. You don't pay for your 
laundry if you can use the dhobies to do it, but if you want 
the German machine--. The money came out of the finance 
department. You could be taking care of the poor, giving them 
jobs, yet this health ministry was blindly working in the 
opposite direction. They were going to take the jobs away from 
the dhobi and send the money to Germany, and use up foreign 
exchange. 

So on that basis, the health department was persona non 
grata in the finance department- -they were looked upon as 
abysmal idiots. The sheets would cost ten cents apiece with a 
German laundry, and if you had the dhobies do them, they would 
cost a tenth as much. The fact that the government was using 
their own valued principles to juggle the budget was wonderful. 
It's a rare country that does that in a meaningful way. 

It was magnificent planning. Then it turned out, of 
course, that there were big budgets for clean water in the 
hospitals that were never used. This health director was 
appointed just as I got there, and he was losing his mind over 
this, because he could see all this horrible stuff going on, 
and he was stuck with all these fine old employees who did as 
little as possible and never cared. It was a really crummy 
system of management for a remarkably equitable service that 
covered all persons in the country. 

The finance department had an input /output measurement of 
everything that was made in the country or brought in, and 
where it went, what it was used for. I don't know if there's 
another country in the world that really has that. But I went 



316 



Crawford: 



Blum: 



Crawford: 
Blum: 



to the library in the Department of Finance, and I discovered 
that the Colombo hospital could have the chlorine for its 
laundry essentially for free, because industry in Sri Lanka was 
decomposing sea waterthe salt part into sodium, which they 
wanted for something, and the chlorine they had to dump back 
out in the ocean. So it could have been used for free if the 
health department wished to disinfect the hospital laundry 
while it was being done by the dhobies. 

Well, this is what planners do, and finally 1 had my 
meeting with all the ministry people. 

I read that there were members of parliament at this conference 
in Sri Lanka. 

Yes, high level people. I handed them twenty-five or thirty 
highly desired national objectives that I had culled out of the 
newspapers, and one of them was productivity. That was number 
one, as far as I could remember, and number two was something 
else. Number three was respect or care for the elderly, and so 
on. 

I asked them about the list, throwing it out as what the 
foreigner would see in the newspapers as national goals. 
"These are the things you care about. How about it?" They 
said, "Yes, yes, that's a good list." 

I said, "There are some problems here with this list. If I 
plan for the health sector, and if we hold the care for the 
elderly up there very high, as you do, there's not going to be 
as much money for the productivity goal. The productivity 
sector includes people of different ages, and the money has got 
to be spent in different ways for different things, for folks 
in the productive age. How do you feel about that?" Here you 
have two values, and they're competing with one another. 
That's typical of all countries and how their values affect 
planning. 

They decided that the elderly would come first. Principles 
are principles, but values are values, and for them, these came 
first. We went through the list, and a lot of concerns shook 
out. It was fun. At least you got a feel that they were 
responding. I'm planning for them, but am I going to plan for 
productivity or going to plan for the elderly? They had to 
make decisions relevant to their value schema. 

You only have so much? 

A country has only so many available resources. 



317 



Crawford: 

Blum: 



Crawford: 
Blum: 



Crawford: 
Blum: 



It was an interesting, rather equitable country. At that 
time, everybody got a weekly rice ration. It's the only 
country in the world that's ever done that, as far as I know, 
and it bankrupted them. They had to give it up. 

They got into lots of problems over it--it is not a 
communist country; not a socialist countrythey just felt very 
strongly about how things should be. You say, "Why don't you 
just give it to the poor?" They say, "Then we'd have to pick 
out the poor, and make them feel poor." The whole business of 
putting the finger on people for some demeaning reason was 
unacceptable. 

Discriminating. 

Discriminating, yes. I was very impressed with this, yet saw 
that it was high-level politics that had been costing the 
country a bundle of money that was not there to be spent. 

They had kind of overdone the health sector that way, too. 
They had promised everybody health services, so that for the 
average person it was available within minutes all over the 
country. They had equally invested in the educational sector 
and in transportation. 

It was a real priority. Is it still? 

I can't tell you. I don't know. I suspect it is. There are 
things that you can't give up that easily, as Mrs. Margaret 
Thatcher found out. But one of the crazy things is that they 
had so much respect for individuals that they had two systems: 
the ayurvedic system and the Western system of medical care. 
Everybody had a choice or could use both. You go anywhere in 
the country and you come to a free health station, and there 
would be the Western or the ayurvedic--rarely together, though 
--they were usually separate. 



What is the ayurvedic system? 



So 



It came from India. It was longstandingis still there, 
there was the free government program and a private pay 
program, so, potentially, in any one neighborhood, you had four 
kinds of practitioners a public and a private practitioner in 
both Western and ayurvedic medicine. 

It was a needlessly expensive system. I visited Western- 
type clinics with three or four young docs with nothing to do- 
maybe an occasional delivery. Well, that's insanity. You 
wreck the doctors because they're not doing anything. You make 



318 



them kind of unruly because they're feeling neglected and 
wasted. 

II 

Blum: And why should people stop locally for care? For three cents 
they can go down to Colombo to the medical school where there 
is a big hospital, fancy docs, the works. Besides, they get to 
visit and shop in Colombo. The care costs them nothing there 
and it costs them nothing here. 

A planner should take many things into account: how good 
and how cheap the transportation is becomes a factor in health 
care, because folks are, if they're human beings, going to go 
downtown if the fare is three cents and get their medical care, 
even as they continue to live out of town. Well, this is what 
planning is all about, you see. 

Crawford: You really have to know that culture. 

Blum: You've got to know the culture, the practices; you've got to 
know the country. Then you have to explain it to the 
officialdom and the legislators, so they can make the right 
policies . 

So here was the country being undermined by a very generous 
set of policiesvery generous. And a good education-- 
everybody got educated better there than is the case here. 

I sat in on a couple of Commonwealth academic examining 
boards. One was the architectural board, whose members come 
from Britain and hold the exams for the graduating class. 
There's nothing shaky about architecture in Britain, and the 
same way of examining goes on in medicine. This is the 
valuable aspect of being an active Commonwealth country and 
this is reproducing Europe abroad. However, it has no respect 
for the native culture, or for the nation's needs. This is the 
sad part, you see. They could go all through the medical care 
examinations or architecture and never notice that the patients 
in the hospitals were there for contagious diseases that never 
should have been, and that many hospitals did not provide 
potable water to their patients. 

By contrast, seven years later, I was wandering through 
China, and I went to visit a large hospital in Shanghai. The 
pediatrics ward was essentially empty. We asked, "Where are 
your patients?" They said, "Well, we don't really have many 
children patients they 're immunized for this, and this, and 
this." They're better immunized than our children are. That 



319 



was true then; I doubt if it's true now. It's slipping now, 
they're becoming more like us in their quest for a market 
society. 

They said, "What we have here are some thyroid problems, we 
have some tumors, we have this and that, but it doesn't keep 
the wards full anymore. We don't have diphtheria, we don't 
have tetanus, we don't have whooping cough or measles. We just 
don't have the things that used to fill the hospitals up." 

This was looking at the origins of illness in China. 
There, in Sri Lanka, they were just building beds and training 
M.D. 's. 



Crawford: What happened? Did they take notice of your findings? 
were there for about three months? 



You 



Blum: 



Crawford: 



Blum: 



I don't know. I don't think so. Yes, three. I don't think 
anything happened at all. While I was there they gave up on 
mosquito control, and they had the most horrible outbreak of 
malaria the next year. They weren't really listening to 
anybody. This was WHO sending a planner. If I'd have stayed 
with the health ministrybut you've got to be there for a 



couple of years to have an impact, 
in and leave a plan. 



There's no way you can come 



Were you impressed with any of the other development efforts 
that were going on? 

The planning effort, which was interesting, had been instituted 
by a queer combination. An Israeli and an Egyptian set up all 
that wonderful planning that I described for the finance 
department, but at that point, the Sri Lankans kicked out the 
Israelis . 

I, it so happened, had come into the country with some 
Egyptians, and was actually in the Egyptian enclave. They knew 
perfectly well that I was Jewish, but I spent much of my spare 
time with the Egyptians, and the man that I was with was the 
equivalent of the ambassador. He was the head of the trade 
mission there. 

He told me a sad story: "You know, all the Israelis are 
kicked out, and the other day I saw this ad in the paper for 
some second-hand furniture being sold from a home." He said, 
"I went out there to see it, and it was just what I wanted. It 
turned out it was the Israeli planning director's home, and did 
I ever feel awful to even be seen in a situation like that. 
This Israeli is kicked out of the country, so here this 



320 



Egyptian comes in and takes all of his furniture, 
couldn't get out of there fast enough." 



Horrible. I 



These were very alert Egyptians, and it startled me--how 
similar they were to Jews. They were cultured in the same way, 
interested in the arts, social justice, and the whole shebang. 
I fitted right in with them. I don't believe that ever before 
or since have I really become that close to people in such a 
short time. We actually were all in tears when we left. They 
got us a place to live in and did everything for us. I suppose 
we were near-alikes in a foreign culture. 

Crawford: Your wife went, as well? 

Blum: Oh, yes. I never go anywhere without her. 

Crawford: You said, last time when we talked, that there was quite a bit 
of fraudif not fraud, you found a lot of obstacles on these 
assignments? 

Blum: Oh, yes, this one wasn't particularly fraud. It was an old way 
of doing business that nobody ever looked at. Some people 
never did a day's work, but that was typical not just of that 
country, but of many countries including this one. There you 
were up against long-standing things, and if you got hired for 
three months, you knew there was no serious intent for you to 
make significant change. 

Crawford: Really? 

Blum: How could there be? You're talking about undoing hundreds of 

years of the ways a culture operates to produce good education, 
good transport. 

Crawford: Did they tie you up with a counterpart in the field? 

Blum: Yes, there was a chief of planning for the health ministry, and 
he was assigned to planning because he was the worst medical 
officer they had; they just couldn't find a worse one. So I 
had him as my counterpart. He didn't know what we were doing, 
he didn't care, he never came to workhe was a total bum. So 
they unloaded him on me because they didn't want him in surgery 
or obstetrics. 

Crawford: What could the government of Sri Lanka hope for? 

Blum: Well, I don't know what they expected of me. These are always 
the great mysteries. Maybe they could get somebody to do 
something they wanted. 



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Weratunga probably went to work on that potential dirty 
water catastrophe; he was no slouch, but he ended up, in short 
order, leaving the ministry. He became the ambassador to 
Russia. He was a very, very impressive man. 

He was a Sinhalese. The other really impressive man I met 
was a Tamil, the dean of the medical school in Kandy. That was 
the new school. He was also their representative to WHO--a man 
who was on the go. He died of a heart attack as a young man. 

He was a perfectionist, and he pushed the country into 
creating a formulary or list of the kinds of drugs that would 
be allowed into the country and made available. In contrast to 
most free-market countries, you couldn't just ship any old 
drugs into Sri Lanka--he managed to sell this idea of "useful" 
drugs. So they had perhaps a hundred useful drugs imported, 
and other than thatno. The manufacturers had to meet a sort 
of price guide and everything. It was a beautiful job. 

There are almost no other countries like thatNordics 
excepted, but it's not anything I'm used to, for the most part. 
He happened to be an M.D., and a pharmacologist, and the dean 
of a medical school wonderful man. 

I remember we went to visit his home, up in Kandy, a 
beautiful home in beautiful country: everything's green and 
there are all kinds of trees, and the climate is such that you 
have tropical and nontropical weather. 

I said to him he hadn't been dean too long "How did you 
get such a beautiful home." He said, "I was lucky. I was very 
lucky. The man who used to have this home was a professor 
here," he said. It's the kind of place where the grounds come 
right up to the door, and you walk right into the house there 
are no barriers, you know. He said the professor came in and 
went to get one of his favorite books and he pulled out a viper 
along with it." It was just a small thing, but it was 
poisonous they ' re widespread. We even saw them on a cruise in 
the Greek Islands. 

"He went off running," he said, "and he's never been seen 
since. He left the country. So his house was standing here, 
and I took it." [laughter] 

After I'd been there, a Sri Lankan came to visit us here, 
and we took him to dinner in the city. I mentioned this tale 
about the snake- -he also lived in Kandy, he was from the 
university there and he got quite upset with me for being 
derisive about living with all these poisonous snakes. He 



322 



Crawford: 



said, "We have a home in Kandy, and I have little children, and 
my daughter has a pet cobra out in the backyard. You just 
don't interfere with them. It's part of living there." So you 
get another side of how people live. 

One night in Colombo, we went to visit some Canadians 
stationed there, and were living in a magnificent home. They 
had beautiful furniture-- just exquisite, a lot of rich woods 
and things. Then these smooth floors and giant doors, maybe 
fifteen feet across, which slide open, and the house is open to 
the yard. 

Under every seat at this dinner were mosquito coils and 
they were all stinking away so that the smoke was drifting 
around and thus the mosquitos wouldn't eat you. There were 
three or four significant diseases that they carried there. 

The hostess said, "Out there in the backyard"--which is 
just behind where Marian and I are sittingshe said, "the 
little neighborhood girl came over and was looking at the plum 
tree. As she was taking a plum she saw this giant cobra. She 
came running into the house to tell me that we had this giant 
cobra in our backyard." 

So, Marian and I were sitting over a mosquito coil, and of 
course it's getting dark. It is darkin the tropics it gets 
dark fast. We spent the evening hoping that those people 
facing the yard will see anything out in the yard headed our 
way, because we can't. [laughs] 

Did you feel badly that the result of your work was less than 
dramatic? 



Blum: I couldn't. I don't think you're ever asked to take that to 

heart. In fact, you're encouraged to be relaxed about it--just 
like medical care--you can't take every patient too much to 
heart or you'll lose your mind. 

Crawford: Did WHO do follow-ups? 

Blum: I haven't the faintest idea. I doubt it. The WHO regional 
director general was a Sri Lankan. He was a useless bum. 
Nobody had any respect for him, at all. He was the big boss 
for WHO for the whole regionthat part of the world. 

It's an interesting thing: the director general in Geneva 
does not select the assistant director generals for the 
regions. They are voted upon by the countries in the region. 
So you get what you get, and that's that. 



323 



The director generals, who for the most part had been very 
remarkable people, I think, were not necessarily well- 
represented out there in the country. However, the regional 
director was very close to everything we did. He was always 
home, and since he never did anything, I don't think he cared 
whether we ever did anything. 



Blum: I believe that Sri Lanka fascinated me for several quite 

different reasons. It was the tropics with a discrete society 
for 2,000 or more years under three European colonial 
dynasties. It emerged with an educated, proud people, well 
grounded in humane practices, ahead of us in many ways. But in 
retrospect it makes me ill to see how they destroyed themselves 
with essentially no outside help in some twenty-five years. 

The Sinhalese, 80 percent of the population, came from 
northwest India about 2,000 years ago. They are a tall, 
handsome, fairly light-skinned people who were never fully 
conquered and are proud of their heritage. The Tamils, a 
smaller, very dark-skinned group, came about 150 years ago from 
the neighboring Indian province, primarily to work in the 
British tea plantations in the highlands. They ended up being 
to the Sinhalese what blacks are to whites in the U.S. 

When I was there, a very elaborate national birth control 
program was abandoned because the Sinhalese claimed that it was 
going to be genocide for them, the 80 percent majority, because 
the poor Tamils who made up 17 percent of the population 
wouldn't use birth control. They also felt that the Tamils 
weren't worthy people, primarily because they worked too hard. 

A minority is apparently always a minority for some so- 
called good reason. Discrimination was widespread, and the 
Tamils simply revolted, wanting a piece of the country for 
their own. The resulting civil war has shown just how 
determined the Tamils can be, and everything in Sri Lanka is a 
mess. Planning seems to be pointless in the pressure of deep- 
seated prejudices. These are lovely people, proud, self- 
sufficient, yet being wasted by their own unharnessable 
prejudices. 



324 



WHO and a Planning Handbook 



Blum: Also in 1970 I was asked to prepare a draft "on how to plan for 
health" for WHO. I had a few months to prepare it and then 
came to Geneva to present it to an international committee 
whose members would critique it for several days, after which I 
would take it home to rewrite it, and it would (and did) become 
the official guide of WHO on how to plan for health. 

WHO's central offices in Geneva are an impressive sight, 
and the meeting chambers are truly elegant and functional. 
Each speaker is simultaneously translated into English, French, 
Russian, and Spanish, and into other languages when 
participants require it. 

We worked for two hours at a stretch four times a day, 
after getting a sendoff by a WHO spokesperson and by whomever 
was appointed as the chair for the task. 

Criticisms were generally given in a polite but 
understandable way by the participants. Early in the first day 
I received a rather significant criticism by a well-known 
Hungarian planner. Unfortunately, he had found a very weak 
spot in my writing that was contradicted by my main thesis. 
Almost immediately I found myself being defended by various 
members from the Western bloc because the critic was part of 
the Russian bloc. I noted his comments and made use of them, 
but it was clear that my supporters were less interested in the 
significance of the criticisms than in their source. 

That evening I was rounded up for dinner by the Western 
bloc folks in a session free of any Russian bloc people. This 
made the job a lot easier, but probably a bit less rigorous. 

During the three working days, the Russian representative, 
who was a huge, dour, handsome man in charge of training all 
health planners in Russia, and was, 1 was told, the surgeon 
general of the Russian army in World War II only spoke 
occasionally. His contribution was usually translated into the 
same message: "Gentlemen, let us not be so didactic, there is 
no one right way to do things. In my own country we just can't 
use one way of planning for anything." I found this very 
refreshing and wise, and took heed in my rewrite. But 
interestingly enough, our Western bloc dinner group concluded 
that the Russian was so dogmatic and could only see things in 
one light. True, his little speeches were very similar to one 
another, but their intent was obviously to get away from hard 



325 



and fast planning rules that would probably be destructive much 
of the time if applied. 

I learned that Russia was training several thousand health 
planners every year; knowing that they did make big top-down 
plans, I wondered where all the planners could be utilized. At 
a morning tea I asked the Russian translator to ask the Russian 
on our committee what they did with so many planners. Without 
turning to look at me or skip a sip of tea, the Russian planner 
said, "Tell him I'll loan him a thousand planners any time he 
wants them." This more than confirmed my guess that they had 
gone overboard on turning out planners and that the head of 
Russian health planner training was all too aware of that 
reality. 

These were educational events for me and 1 had the good 
fortune to do more such study efforts for WHO in Geneva, in 
Copenhagen, in Santiago, in Washington, D.C., in New Orleans, 
in Gothenberg, and in The Hague. 

At my last such event in The Hague, the participants and 
speakers were to be received by Queen Beatrix at a tea on the 
last day. I came down with food poisoning and couldn't go, my 
wife had to go to uphold our end. The Queen greeted everyone 
at the entry to the palace, in their own language. When my 
wife was introduced, she immediately commiserated with her 
about her sick husband. When the affair broke up, the Queen 
sought her out and extended her best wishes. For truly down- 
to-earth plebeians as my wife and I both are, this encounter 
rather undermined our long-standing antimonarchial biases. 



Assignments in South America with the Pan American Health 
Organization 



Blum: PAHO gave me another assignment, this one a lot more tangible 
and highly relevant to their and my own interests. Dr. John 
Hastings of the University of Toronto who had carried on a 
tremendous study of the desirability and success of combined 
human services was my teammate for examining what the merits 
might be for the success of combining human services in 
Colombia, which had just emerged from its seemingly endless 
savageries, and to us outsiders looked as though it were 
actively drifting towards perpetual disaster. We met with the 
ministers of health and welfare and the dean of the School of 
Public Health and some very wealthy and politically powerful 
business women and, above all, with liberation theologists who 



326 



were risking their lives to help straighten out the country's 
massive injustices. The priests, using their Catholic church's 
authority, were espousing the idea of doing God's work in the 
here and now, not just in the hereafter--an appealing notion. 

We stayed at the exquisite Tecondama Hotel which turned out 
to have its problems. One was our experience as the doorman 
turned us over to the chauffeur of the Ministry of Health car 
taking us to dinner with the minister. The doorman was flanked 
in the bustling street-sidewalk mess of a large hotel by two 
police armed with submachine guns. In the time it took for us 
to cover four feet and get into the car, our chauffeur suddenly 
screamed. Someone had stripped off his wristwatch as he was 
handing us in with his other arm. From that time on we were 
regaled with fearsome tales of how the poor outwitted the more 
affluent. Everyone seemed to enjoy recounting the picaresque 
doings of the growing class of criminals, who were no longer 
necessarily just the poor. 

We got to Cali on invitation of the new medical school 
there whose dean I had met at a PAHO meeting in the U.S. This 
was an interesting city at the center of old estates, large 
blocks of undeveloped land being in individual hands, like our 
Texas. As we entered town we saw vehicles upside down, on 
fire, wheels rotating with tongues of flame. Some young people 
and a few troops occasionally appeared. This was the first day 
of a strike by students at the medical school, a strike that 
spread and finally closed the whole university, a fairly 
liberal enclave, for a year and more. 

In South America, medical students came primarily from 
wealthy families and so a strike, over social causes, is an 
interesting situation in which few student strikers were likely 
to be hurt. 

I was brought to our meeting place, away from campus, and 
we had an afternoon presentation by an American systems 
theorist. He described his introduction of systemic 
relationships to second-year medical students. One issue he 
presented to them involved that of the care of numerous babies 
near death from starvation who came from the nearby hillside 
barrios of Cali. These were families of squatters, mostly 
Indian, coming into the city out of desperation, finding a spot 
on which to rest, one which had no streets, no utilities, no 
buildings, but enough room to start creating something in the 
way of a shelter out of tin cans, cardboard, rock, boards, tar 
paper, logs, whatever. These barrios, horrible as they were, 
allowed people to survive, although often accompanied by 
starvation of babies and children. The city was determined to 



327 



destroy the barrios because Call had been and still was a 
relatively well off city and had no use for the invasion. 
However, a group of communists had fortified the access points 
to the barrio and armed with machine guns stood off the police 
for months and finally years. It was from this hell hole that 
the starving infants came. The planner had asked the students 
to examine the immediate and longterm costs to the university 
and the city of the present medical approach to bringing these 
moribund babies back to health. He also asked them for other 
points at which the infant starvation problem could be 
attacked, and at what costs. Students had soon figured out 
that a feeding program for infants would be much cheaper, would 
spare health, and be better for the community all around. As 
upper-class citizens they didn't hesitate to ask for a hearing 
and were disgusted at finding themselves shunted around. They 
struck the medical school, the strike spread to the university, 
and the issue grew to one of how to redo the barrio and avoid 
future ones. We had arrived at a low point in student morale, 
and thus the civic disruption and burning cars. 

Our narrator seemed somewhat removed from the scene and the 
relationship of his stimulation of the medical students to the 
current riots. From his next presentation he made it clear 
that he was an astute actor and knew how to make things happen, 
but not always how to come up with a happy ending. 

He described a valley with a few hundred people a day or 
two out of Cali that was known for the malnutrition of its 
children. He took a small team of students and they did simple 
arm size measurements and could estimate a near 50 percent 
prevalence of gross malnutrition. This valley was a productive 
one. A few years previously an American team of 
agriculturalists brought in to overcome the malnutrition had 
suggested a simple fertilizer program that would double their 
main crop soybeans, and more than pay for itself. This was 
done. But the U.S.A. planner was still finding 50 percent 
severe malnutrition of the children. 

He and his team determined what the current soybean 
production yield was, estimated what the entire population 
would need in the way of soybeans, a remarkably complete food. 
They discovered that the valley already produced over four 
times as much soybeans as they could possibly use. In fact, 
before the fertilizer program, they had produced over twice as 
much soybeans as they needed. 

The team looked into the origin of excessive food 
production and the coincident malnutrition. It was made clear 
to them that no one would eat soybeans. They were shipped 



328 



mostly to the States for cattle and poultry food. The money 
earned was spent on many things, including expensive polished 
rice. They grew manioc as their preferred food, an indigenous 
food staple with minimal food value. They also invested in 
Coca-cola. 

The team interviewed lots of people and learned that 
soybeans were not considered fit for humans, that the villagers 
had a lovely sweet diet and the kids thrived on it, except that 
they didn't grow properly. 

The team came back with two sizeable growing families of 
white rats, a rarity in this part of the world, and suggested 
an experiment for the main school. One team of children would 
raise one rat family on the diet everyone liked so well, and 
another team would raise the other white rat family on a basic 
soybean diet. The kids loved this hands-on approach, took 
turns taking the animals home on weekends to keep them on their 
diets. 

The Cali team returned in two weeks and everyone gathered 
around to check the animals and weigh them. Naturally, the 
soybean animals were beautiful and the valley diet rats were 
looking runty. However, not everyone trusted the Cali team and 
one of the valley farmers who was taking it all in asked if the 
rat families could have their diets switched. This was beyond 
the dreams of the team and they agreed promptly. The dietary 
switch was made and when the team came back in another two 
weeks, everyone was excited. The previously run-down rat 
family was thriving, and the previously healthy one was looking 
bad on the village diet. 

The entire valley was aroused and the Cali team asked them 
what they could do about their obviously dangerous diet. Since 
they had many times more soybeans than they could eat, they 
could eat them and could still have enough to sell and have 
enough money to buy things they really needed. 

A group of women formed a committee and came up with the 
idea that they had to invent recipes for soybeans that would be 
tasty for the local folk, and that once they found such recipes 
they would write them up, set up a booth at the weekly market, 
hand out samples of the dishes, and sell the recipes for the 
new dishes for a few cents each. 

They asked if they could borrow a hundred dollars to get 
all this done. The team found the money and got it back in 
fairly short order. The entire valley found that soybeans were 



329 



edible in many ways, and could be added to many things so that 
they didn't have to live on just soybeans. 

The Cali team came back a year later and did their arm 
measurements. This time there were less than 20 percent 
measurably malnourished children. 

The lessons I learned from this encounter were quite 
different. In the first place, it wasn't enough to get people 
to look for different ways of intervening in major problems of 
malnutrition. Some people needed little help in solving their 
problem when there were the needed resources available to them. 
In the soybean valley the U.S.A. planner had opened their eyes 
and when he turned the problem back to them, they found a 
simple cultural approach to get needed change. 

In the medical school the solution was not in the hands of 
the victims and would take some major sociopolitical changes 
before anyone would recognize the inefficiency of riots in 
getting problem resolution. Colombia has yet to make that 
break with its history. The U.S.A. planner hadn't helped, 
maybe it was quite beyond help anyhow, but should he have added 
fuel without trying some different approaches? 

A very different set of concerns also emerged for me. The 
planner from the U.S.A. had a very tricky set of roles. Did he 
know that? Was he there to teach the latest in systems 
analysis and planning? As a guest of the university, did he 
have any other obligations to them? As a visiting expert, did 
he have any obligations to PAHO and WHO who arranged for and 
endorsed his visit? To the people who lived in Colombia and 
would pay his bills? To the political leaders who brought him 
in and would receive his plans? To the U.S.A. which he 
represented very tangibly? To the university where he taught? 
To the planning profession? 

He, in one way or another, had assumed or was under an 
obligation, even if unacknowledged, to each. If he checked out 
their verbalized and their unstated desires, which might be 
drastically different, would he have a dozen sets of guiding 
principles on each planning task he undertook? These separate 
interests would probably be in reasonable concurrence on his 
dietary caper. But what would their position be and who could, 
for instance, determine his university, or the U.S.A., or the 
PAHO, or the Cali medical school postures on his medical school 
caper? 

A planner would go mad trying to find out the real and 
proclaimed postures of those to whom he probably had some 



330 



obligations. He would probably go madder trying to reconcile 
those views and finding a posture he could carry out in the 
presence of so many stakeholders to his activities. 

Yet there is a kind of an answer that I adopted for myself. 
First, I would respect my own ideas of social justice and plan 
accordingly. Second, on a given job I would sound out and see 
if I could support the views of those who had the authority to 
engage me. Third, I would apply my social justice biases to 
those whom my planning would affect, if they could not vocalize 
their own views to me or anyone else. 

In my team assignments, I typically took on the tasks of 
meeting the system's clients, its workers, and the citizenry at 
large. To be sure, these were no deep scrutinies, but a step 
in the direction of finding out what was wanted and/or needed 
well below the formal political and professional levels, and 
their reasons for what they wanted or thought they needed. 

In the course of the shortest planning invasion I ever had, 
my "visit" to North Yemen took only a few minutes to see that 
those who would engage and direct me had no intention of 
benefitting anyone other than themselves, and that at the cost 
of harming everyone in their country. An easy decision, don't 
go. 

In Nepal, the situation was much more confusing. Generally 
devoid of evil intentions, the helping guest agencies (everyone 
loves Nepal and working there) were screwed up and helped screw 
up the ministry of health so that it was left directionless, 
thereby harming the people it should serve because of its 
inaction. But I could work here and make sensible 
recommendations that would hurt no Nepalese and might help many 
if carried out. (They weren't.) 

Planning in Utah resulted in giving the citizenry what they 
wanted and what they needed. To be sure, these citizens were 
quite capable of understanding their needs with but little help 
from planners, and were equally capable of making themselves 
heard in the right places. 

Planning for the three Pacific islands was a very mixed bag 
for the islanders, no matter how well informed, they were not 
their own masters. The stateside people, the bureaucrats who 
hired us planners and created the funding rules for the 
islands' activities, seemed minimally informed or concerned 
about what went on in the islands, and launched endless attacks 
of planning. Not much of lasting value came from these 
planning ventures, even though the planners had a free hand in 



331 



carrying out their planning processes, there was no means of 
putting a significant plan into operation. 

My stint as a member of the Technical Advisory Committee on 
"Pan-American Programme for Health Planning" came soon after 
WHO "found" me in PAHO, its American regional entity known as 
the Pan American Health Organization; decided to put me to work 
in 1971. The South American and Caribbean countries had 
organized themselves into the Pan-American Programme for Health 
Planning and had to a great extent developed their own very 
pragmatic bible on how to plan for health. An outside team, on 
which I was clearly the junior member, was assembled, 
predominantly of persons currently working in the U.S., to 
critique and if possible help this group of countries with huge 
problems, irregular resources, and a pretty impressive record 
of spotty but occasionally brilliant plans and programs. The 
presumption of WHO and PAHO that Americans would be helpful, 
and that primarily South Americans would agree to such help, is 
not a credit to anyone's sophistication. 

We flew to Santiago, Chile, as a team. My wife and I, at 
least, had never dreamt of finding such a modern, sophisticated 
Mediterranean type city, not a tribute to our briefing. We 
were put up in a great, old, but modern enough hotel. My wife 
and I didn't know the other team members and were soon 
forgotten in the shuffle. They were all well known 
international figures. We ate a very cautiously chosen dinner, 
avoided iced drinks, water, raw vegetables, uncooked seafood, 
and the like. We could see the other members of the team at a 
nearby table indulging in all the forbidden items that this 
fine hotel offered. 

We retired early as it had been a long flight in tourist 
class and soon went to sleep. About midnight we were awakened 
by a kind of scratching on our door and a rattling of our door 
handle. I opened the door and there on the floor was the 
intellectual standout of our team, Vicente Navarro, of Spanish 
origin, and presently head of the planning efforts at the Johns 
Hopkins School of Public Health. He had gotten violently ill, 
purging at both ends of the G.I. tract, had lost so much fluid 
that he had barely enough blood pressure to drag himself to our 
door. He couldn't rise, sit, stand. 

I hauled him back to his room, got into my portable 
medicinal cabinet, and amply medicated him. 

Next morning no members of our team were visible, and I 
went by myself to the day-long meeting with the South American 
contingent. It turned out that no member of our team was well 



332 



enough to get to the meeting until the third and next-to-last 
day. 

Staying well had earned me a lot of respect, I wasn't one 
of those American novices who got sick as fast as they arrived. 
In fact, there was an element of implied insult that all the 
gringos except the experienced one, me, caught an illness in 
Santiago. 

As our team assembled, they all wanted to know how come 
Marian and I hadn't gotten sick, I told them about their iced 
drinks, raw oysters, and green salads which I saw all of them 
eating at our first meal, as well as the ice water copiously 
drunk. They were quite incensed by my advice, essentially that 
when you go to a non-Western country, you don't do as the 
natives do, and you never drink unpurified water. As experts 
who had been everywhere in the world, they assured me that 
Santiago had a modern purification plant and safe water. I 
suggested a visit to the purification plant, and the only thing 
we learned was that the city was broke and hadn't bought any 
chlorine or purified the water for over two years. 

Two years later when we met at a meeting, Vicente came over 
and thanked us for having "saved his life." Some ten years 
after that, we met him at another meeting and he came over and 
reminisced how he had saved my life in Santiago. So much for 
memory and memoirs. 

The conference presented me with a new view of planning and 
how to measure the true value of what plans have created. In 
most developing countries, it is the training of M.D.'s that is 
the central goal of health planning. M.D.'s do the planning 
too, and come up with an impressive way of measuring the 
outcome of their planning. More M.D.'s mean more lives saved, 
similarly lesser health professionals save lives too, but only 
a fraction as many. Thus the benefits of a health plan can be 
determined in advance without the need for checking resulting 
health improvements. For example, if an M.D. is worth a 
hundred lives saved annually, a nurse perhaps ten, the numbers 
of professionals to be provided gives the figure for lives 
saved even as the plan is being contemplated. Of course, the 
great numbers of M.D.'s who only leave their apartments in the 
best residential enclaves when it is time to attend a social 
affair are not considered. 

Since having an M.D. is a symbol of success and puts one at 
the top of the social ladder in most developing countries, and 
the resources needed to produce them are contributions from the 
national treasury, these are popular plans among the decision 



333 



influencing upper classes whose offspring get the opportunity 
to go to medical school. 

Over the years, South American health sector planning 
seemed to add very little to health status. Of course, things 
of greater import than planning were to happen to these 
countries and their peoples. 

My return assignment to work with this committee, which was 
beginning to examine its work more realistically, was 
interrupted by the advent of Pinochet. Our work center at the 
UN's building in Santiago was no longer a suitable place as 
Pinochet did not encourage such pursuits as planning for 
health, and many Chilean health professionals, as Dr. Allende, 
were disappeared. Some of the Chileans involved were lucky to 
escape and I worked with several of them at WHO in Geneva in 
the next few years. 



A USAID Project in Nepal #// 



Crawford: What was the background of your project in Nepal? 

Blum: That was another story. That was a USAID- financed project 

[U.S. Agency for International Development]. The professor, 
William Griffiths, who sits at this adjacent desk asked me to 
do it. He had a large contract for many, many years to do 
various things like maternal and child health, immunization- 
specific programs, health education in particular--in Nepal. 
Somehow or another, they got to thinking that planning would be 
relevant. 

That was '77, the year I took a big sabbatical. That was 
the year that I wandered around France, Switzerland and Greece, 
and Canada as well. 

Crawford: These were the summer months? 

Blum: Typically, yes. I couldn't get away, otherwise. I went from 
an eleven-month appointment here, originally, to nine months 
early in my career, so I could feel free to be gone. I took 
off much of that year because I had a sabbatical coming as 
well. 

When I got to Nice, I got the mail and there was a request 
to please continue and come on up to Denmark and spend a week 
there for WHO. Again, I was the person who was going to be 
writing things up. 



334 



These were good learning experiences because you worked 
with people from all over the world who were interested in 
planning. You got to learn about planning problems that people 
have and the new approaches that they suggest. 

I got through with that and went clean across Canada. I 
had had many Canadian students. They knew what I had written 
about what they were doing in Canada that they were putting 
together human services, particularly in some provinces. I 
really went to Canada because we had a lot of Canadian students 
at Berkeley. One day an American a physician stood up in a 
class of two hundred people, saying, "I'm going to drop this 
course, because all I hear is that the work that I've taken up 
to do as a doctor is derided, not thought of as very 
important . " 

Well, I don't think I ever derided it, but it wasn't very 
important, that's for sure. Being a physician doesn't do a 
hell of a lot to help the world's health. I was always 
generous, and thought it might be of some 15 percent relevance 
to health, but I doubt it. 

This physician got mad and walked out. That was kind of 
interesting because it taught you that you shouldn't say things 
in certain ways. Then a French-speaking woman spoke. She 
said, "I am a doctor from Quebec, and we do combine human 
services, and we do see a difference, and we do do more than 
just M.D.'s do. That's what health care ought to be all 
about." 

She came down afterwards to say hello--it's a big class of 
two hundred and introduced herself. She was a tiny little 
pediatrician, and then I discovered the whole Canadian 
revolution, which was a fantastic thing. Really, the most 
remarkable turnaround. So that is how I decided to spend a few 
months in Canada. 

It turned out that they were on the same wave length that I 
was, doing the things I was talking aboutbut they were doing 
it. As a result of that, I had a lot of French-speaking 
students for years and years and years, particularly Quebec 
people, but also some from the other provinces. So I decided 
to go look at it on my sabbatical year. After the job for WHO 
in Europe, I did two and a half months in Canada, and that was 
a marvelous experience. 

Then by the time I got back, I'd been lined up to go to 
Nepal. That was just a month's work. So I went, and I was 
with a wonderful public healther--a New Zealander with an 



335 



Australian wife. They had been everywhere and done everything. 
I was to work for him, where he was head of the UC team in 
Nepal working for USAID. 

They were concerned with general health care, although they 
started out with health education in maternal and child health. 
Right away it was clear that they were tangled with somebody or 
other; they were at loggerheads with other foreign agencies 
over how to proceed in providing health care in Nepal. 

Foreign missions were all over the place--WHO, amongst 
others and another USAID team was were selling multiperson 
teams that work as a unit, and were for abandoning the vertical 
schemes they used to have in Nepal. Mosquito control ran from 
the top, and everything else ran from the top. In the field in 
a vertical scheme, the workers were always unaware of other 
specialized health workers working alongside of them. This 
USAID team wanted to put it all together at the bottom and do 
the job with big field teams covering all the health bases. 

Our USAID group was saying, "Do the job with one- or two- 
person teams--a man and wife, something like that, who were not 
experts in everything, but more generalized persons." 

It turns out that our team was looking at northern Nepal 
and the other team was looking at southern Nepal, and nobody 
seemed to really see the difference. Southern Nepal is jammed 
full of people; it's practically like India, and you can have 
teams of all kinds of specialized personnel because you have a 
big population. You have twelve months of the year where you 
can work by means of teams of specialized workers. 

In northern Nepal, you're talking about isolated villages-- 
a hundred, two hundred, three hundred people is a big village, 
and when you get in there for the winter, you can't get out for 
six months and more. Their winterit's kind of an odd season 
--it is interrupted by some good weather, but you're still 
stuck. I mean you can't get around up in the Himalayas for 
months at a time. 

So here these arguments are going on idly in Kathmandu, but 
you need both kinds of approaches. In the southern Terai, you 
can use teams of specialized people, and you don't have to have 
such generalized individuals who will have to live in a small 
village for much of the year and work by themselves as is 
necessary in the Himalayas. The foreign missions lined up with 
one or another of the American teams and the Nepalese were 
simply immobilized, doing neither as a result. 



336 



One evening at dinner after a week in town, my boss said to 
me, "What are you learning?" I said, "It sounds to me like the 
ministry of health is being paralyzed by two views: ours, which 
is partial and focuses on northern Nepal, and the other USAID 
group whose view is certainly partial, talking about the Terai 
and southern Nepal." So we went over and had dinner with the 
chief of the USAID mission. The USAID boss was a urologist. 
He wouldn't know a planner if he fell over one. 

Crawford: That's odd to have a physician as the USAID boss, isn't it? 

Blum: This was for the health planning department. I knew that we 

were having real problems, thanks to his nonleadership . He's a 
very happy, sociable guy--a good man to have in one sense. 

I said, "Nice job that you have here, where you really 
don't have to steal anything or push anything for the USA--it's 
about doing good work, isn't it?" 

He said, "Yes, it's the best job I've ever had. Usually, 
USAID has a lot of tough games to play. You have to sell stuff 
that nobody needs or that nobody wants. Here, you just do 
whatever is right, because we want to be friendly. It's an 
interesting part of the world. The Russians are building a 
road into the country from one direction, the Chinese from 
another, and the Americans, a road off to nowhere." 

I said, "It's very complicated, though, if you don't have 
any specific mission. Have you ever thought about that? It's 
very hard to know what to do when you don't have a mission. 
You know, I'm bumping into the consequences--you' ve got two 
teams here in one area of health, and they're just like this 
[makes striking sound with hands]. They're not working 
together. " 

I said, "Just because there's no mission, it makes it a 
tough job, but it doesn't mean that it's any less important." 
Oh, that was a sad bit of work that evening. He was a nice 
enough guy, and I don't think he quite knew what I was talking 
about. It was clear to me that if you don't care--it's a 
wonderful place to work and they love you--so you screw them up 
by paying no attention to what your technical teams are doing, 
even when they set the health machinery in a blind struggle and 
stop the health ministry from doing anything. 

1 wrote a report, and Bill Griffiths, the titular head, and 
my current roommate, was very startled; apparently he'd never 
had such a substantial report from anybody he'd ever sent to 
Nepal before. 



337 



The obvious thing in northern Nepal was to say, "Look, 
we'll give you one of four or five things in the village. 
We'll give you a teacher if you will build a school and see 
this teacher has something to eat." You see, you just don't 
send them the teacher; you've got to involve the people in it. 
"Or, we'll give you a health mission, or we'll do this, or 
we'll do that." But always with some tasks that the residents 
would have to do to make the work viable and meaningful to 
them. 

The people have to play a role in it. They've got to do 
something. I went up where Hilary had set up his little 
hospital. This was about thirteen, fourteen thousand feet--not 
very far up--you can still get your breath. [laughs] These 
things were kind of nice, but they didn't involve the people 
enough; although the school that he built in Kumjung and this 
hospital were fairly well used, I don't think that people were 
put in the position of supporting them. That was a mistake, as 
far as I'm concerned. People were not helpingthey were 
receiving something. 

Finally I made the recommendation that the multipurpose 
person go up in the highlands, and the multiteam persons go 
down to the lowlands, where there's population to justify it. 
This is a pretty obvious response, but it wasn't obvious to 
them. 

I remember being asked to go to the three chief top dogs of 
policy for the kingthree prominent citizens chosen by the 
king- -who were really above the parliament, above the elected 
body. I visited with them, explained some of these things to 
them that I thought could be done, and they said, "Oh, we 
couldn't do that. We could never do that. The doctors 
wouldn't like it." 

I said, "Do you mean that these several hundred doctors 
sitting in Kathmandu, who never leave town, wouldn't like it? 
Don't you have some obligation to the other ten million 
people?" They said, "Oh, no, no. We worry about the doctors." 

Well, if you are a doctor in Nepal, you came from the noble 
classespart of the king's family, so to speak. 

The king was interesting. He was trained at Harvard in one 
thing or another, and he was in the paper every day- -one day he 
was planting a tree, the next day he was raising a chicken, the 
next day he was doing something elsea real Peace Corps type, 
and it was just fraud. It was just talk, talk, talk, but 



338 



nothing ever happenednothing, and his parade of useful public 
service tasks was just a device to disarm people. 

Crawford: Just the advantaged class getting more so? 

Blum: Making the image good. Of course, now he's got a Communist 

party on his neck, I see. He really had it coming, I must say, 
but I don't know that they're any better than he was. 

It was an interesting experience, and I loved the Nepalese 
people. They're so very sweet and kind. They're just 
remarkably lovely people. Sri Lankans were very different. 
These are at the two ends of India. The Nepalese are very 
polite, and timid, and quiet, and never intrude on you. If you 
get a fast and hard salesman, he's not Nepalese--he ' s an 
Indian; you can just bank on it. 

Down in Sri Lanka they are very proud people. There's this 
old history amongst the Sinhalese, who had never been conquered 
by the British, as I've mentioned. 

I remember in the mornings walking to work. I had an 
office in the health ministry and my wife usually walked uptown 
at noontime so we had lunch together. In the morning, almost 
everyday, I'd meet this interesting beggar, a man who had had 
polio as a child, and who was on his hands and knees. He had 
callouses like horns on his hands. They were about a half inch 
thickgreat , big, mountains of callouses. He'd be rolling 
along, propelling himself on a little kind of skateboard. You 
really have to experience a Sri Lankan beggar to understand 
that they aren't beggars at all. 



This man said, "You're from the United States, 
was wonderful. Did I know President Kennedy?" 



Well, that 



I said no. Well, he didn't assume I did, but as you've 
probably noticed in the Peace Corps, Kennedy had really 
captured everybody's imagination all over the world. You saw 
his picture in the damnedest places. My beggar was familiar 
with news from all over the world. Then as I got to know him, 
I don't know how I had a collection of silver dollars, but I 
gave him a silver dollar every time we met. We discussed the 
world's affairs, he even knew all about our race problems. It 
was like meeting an old friend, and he acted that way; no 
begging relationship. 

II 



339 



Crawford: You've said about all your international work that you felt 
that you didn't go out there in the field and really do the 
work, that you were only the consultant. Do you, in 
retrospect, wish you had? 

Blum: I can say that I had a wonderful time, and I learned all kinds 
of things. But you learn more and better by doing, and, in 
each different situation, there are so many different factors 
that you never thought about. Of course, when you come home, 
you discover that the same factors are all here, except you 
never noticed them, because you were raised among them. 

So consultant assignments are good learning experience. 
But when you take those short consulting missions, unless you 
know that somebody's seriously at work doing something and that 
you're really helping them, don't kid yourself that you will be 
the savior. I've never been on a job as a consultant that I 
haven't run into officials who are fishing for a better 
consultant reportone that they liked better. I've mentioned 
that to you before. Very, very impressive job- -but you're the 
ninth one to undertake it, and maybe yours will be acceptable, 
but they still might go for a tenth study, particularly if they 
find somebody else to pay for it. 

My work in American Samoa in 1984 illustrated this all too 
well. About five people I know have been there one or more 
times each. We used to meet one another in the airport or 
hotels and discover that someone else had just done a critical 
piece which we were not going to be shown. 

To make a dent, you have to be more than a consultant. 
You've got to be willing to work. Some of the people that have 
made the biggest dents are neither presidents nor consultants. 
They're often folks that have gone in to work, and work. You 
can't just say, "Well, I've got my job back in Berkeley." If 
you're going to make a change, you've really got to be there 
where it has to be carried out. 



Crawford: Such as you did in Contra Costa County? 

Blum: Yes. You've got to be there. You've got to be there. That's 
why many planners say they don't want to plan unless they can 
also run what they've planned, because what happens to your 
plan under someone else is often a total perversion. 



340 



Planning in Color Country, Utah ## 



Blum: I was picked up along with a Colorado-based health planner in 
1973-1975 to plan for health and health care facilities and 
services in the southwest part of Utah, known locally as the 
Color Country. This extended from St. George, not too far from 
Las Vegas, to well north of Cedar City. My opinion is that 
this is the most beautiful and colorful scenery I have ever 
seen and that alone was no small inducement to sign up. The 
area includes Cedar Breaks, Zion and Bryce National Parks. 

We were hired by the University of Utah, which is not a 
Mormon entity and probably accounts for their willingness to 
hire planners devoid of cultural awareness about Mormons. They 
were thoughtful enough to provide full-time a brilliant young 
Mormon health planning student who knew who I was from his 
course material. It was a revelation to see how often he had 
to explain how various statements, acts, and events really were 
to be interpreted. Given that Utah citizens are better 
educated than those of any other state and were totally easy to 
understand and amply capable of explaining themselves, it still 
became clear that the two planners would have totally 
floundered without our Mormon-reared assistant who became 
totally integrated into and devoted to the team, whose purpose, 
after all, was to help Utah citizens. 

Neither of the two planners remembered Zane Gray's Riders 
of the Purple Sage. Unfortunately, neither of us had yet heard 
of Stegner, whose books might have given us some clues about 
what Utah people were like and what they might want and how 
they might differ among themselves given their origins and 
religious differences. 

Of all things, the University of Utah Medical School had as 
planning director a nun working with them full time. I knew 
that at that time there was great enthusiasm in the health 
planning world for doing away with all small hospitals, sending 
patients even for great distances to great medical centers, and 
concentrating on use of specialists. Of course, all of this 
could be of great value to the University of Utah medical 
center which hired us if we planned accordingly. I got a 
written contract from the University of Utah that they would 
have no part in writing or influencing the report that we would 
prepare. In this way we would not make any recommendations 
other than what our findings and judgment would come up with. 
And in fact, the university never did interfere with our 
planning or disagree with our findings which amply justified a 
strong emphasis on revitalizing local services rather than 



341 



depending on better air transport and remote expertise to 
compensate for lessening local services. 

The job initially involved visiting the health facilities 
and practitioners in every town in the five-county region, 
meeting with citizen groups, and finally holding an open 
citizen meeting in each town to hear what was really wanted and 
what diversity of opinion there might be. These open meetings 
were my job and I had a well honed but flexible game plan to 
get things out and on the table. It was based on the well 
known Andre Delbecq teaching of just having people write what 
they most wanted to say, post these anonymous desires on a 
wall, and then open up the meeting for discussion. In this way 
neither the moderator nor any local spellbinder or influential 
in the audience got to make an opening speech and thus put 
everyone in a mental rut or framework. This technique was 
usable with simple modifications even in groups not sharing the 
mainstream language. Using this technique people didn't have 
to own up to or defend anything as their name was not on their 
ideas, which were posted. 

The town of Escalante turned out over thirty people, 
including the mayor. The anonymous contributions fell into two 
areas, one full of requests for sanitation, fly control, rabies 
control, and such, and another on learning about health, better 
clinics, better educational goals, and so on. Once up on the 
wall it was clear that indeed there were two very different 
sets of concerns. Of course, one expects homogeneity in Utah. 
The mayor enjoyed my puzzlement, although there was no problem 
with getting approval for both sets of concerns. 

He took over the meeting for a few minutes and pointed out 
to me that the sanitation-minded folks were all newcomers from 
the big cities, some of them commuting weekly to their jobs in 
Los Angeles. They wanted the big city protections they were 
used to even as they wanted the air, space, and country living. 
The Mormon locals who weren't so wealthy or freewheeling wanted 
more capacity to take care of themselves, a very traditional 
help-yourself Mormon touch. They also wanted more professional 
services available to them which could be afforded. They had 
no hospital and aspired to none, wisely since they could in all 
but truly bad weather get to such services in Panguich. 

In Panguich there was a concern with replacing a tiny beat- 
up old hospital and getting at least two new doctors. One of 
the two in practice there was not always sober and told me he 
couldn't do painstaking work any longer. The other was in 
surgery as I came along. He had huge swollen legs from heart 



342 



failure and hadn't felt free to leave town for even a day in 
over ten years. 

The church had wanted to close the hospital, transport 
patients far north to good facilities in Provo, but forgot that 
this would mean closing the appended local nursing home, which 
was too small to stand alone, where people could visit their 
aged family members, would mean the end of some key specialist 
weekly clinics with experts flown in, typically from Los 
Angeles, would do away with the built-in office space for the 
local physician, for the county health department public health 
nurse and for the social worker from the county welfare 
department. All in all, destroy a sort of home-grown and 
successful combined human services operation that was in place. 
It helped people to stay at home, and still provided a local 
place for simple surgery and uncomplicated childbirth. A 
first-class air evacuation was already in operation based in 
Provo for serious emergencies and specialist care. 

We learned that in good part because of Mormon tradition, 
there was a strong desire to do things for oneself, one's 
family and neighbors, and to cooperate in creating and 
maintaining what could be called self-help and community 
undertakings. Given that this was pretty much my own bias, and 
realizing that this didn't have to be sold to the locals who 
might in fact be stronger proponents of this philosophy than I, 
we set about to cooperate. 

Since money for a replacement of the hospital which 
centered this community self-help thrust was in the hands of 
the church, and the church had indicated its interest in 
closing this hospital and its related services and wanted to go 
this route of more centralization than currently existed, we 
examined all the factors. It was of interest that contrary to 
well established wisdom there was no trouble in staffing the 
hospital or other health and welfare services. That help, 
nearly all women, enjoyed being part-time and nearly all were 
rearing families. Service was good and finally, it cost much 
less per hospital day here than in any large Utah facilitya 
critical argument. 

At a meeting with the mayor, chamber of commerce, and 
church hierarchy, who were of course all ordinary citizens, 
since there is no professional Mormon priesthood, we found a 
remarkably solid desire for a small new hospital, and for the 
new doctors who would then come to work there, (and they did). 
The mayor composed a letter and a follow-up set of points for 
discussion with the Mormon church health care leadership in 
Provo. It went something to the effect that they all had 



343 



tithed regularly for years, but would have difficulty seeing 
their way to continuing if the church insisted on neglecting 
their hospital and in fact dismantling it. They had a report 
from an outside expert that pointed out the remarkable 
advantages of having their own small hospital which served as a 
base for all the human services provided in the area. They got 
their new hospital. 

We worked there off and on for over a year, looking at the 
situations, helping people get what they wanted. We got some 
agreements to combine human services in the Color Counties, but 
this suggested the need for a better defined bureaucracy and in 
turn aroused the unwillingness of the people to delegate more 
of their human need tasks to any kind of officialdom. There 
was a remarkable consistency of the Mormon people in this 
desire for self-help and avoidance of a professional priest 
class, and at that time, an intolerance for city managers, 
because people felt that they should be volunteering and doing 
the civic tasks themselves. 

Escalante wanted a physician-staffed clinic and it was 
created by means of a contract until disrupted by the death of 
an airborne M.D. from Page, Arizona. They really wanted, and 
we helped them organize all kinds of emergency and safety 
efforts and the health program entity. The city of St. George 
had very different concerns, as did Cedar City, and these 
larger entities commenced to be more like the cities we knew. 
Even though dominated by Mormons, the unity of concerns was 
being diluted by a growing proportion of non-Mormons and a more 
typical large city way of looking at things. 

As part of the do-it-yourself outlook, we found that the 
junior colleges in the area had strong sociologic concerns and 
all had done and were continuing to keep updated inventories of 
the social makeup of their counties, political, social, and 
belief shifts, as well as health status. This was remarkable. 
Such a concern for what one's people are, how they think and 
feel, was not something I was familiar with elsewhere. 
Although not an ancient culture, this one had many firm tenets 
that they kept in sight. I really had no trouble identifying 
with their self-help or community integrity, outlooks, and 
institutions and enjoyed working there. 

Their failure to consistently adhere to their preachments, 
such as finding church-owned resort property as host to 
striptease nights, which I attended as part of a planning 
conference, made me realize that Mormons were far from being 
resolute about their principles, were pretty much like what I 
expect to find anywhere, but they certainly had principles or 



344 



values that were more communal than any I had encountered in 
this country previously. These principles, which included 
getting a good education, helping others, staying healthy, and 
avoiding the obvious bad health-affecting habits, in fact find 
Utah to have the highest level of education and the best 
longevity statistics among the states. 



A Keynote Speech on Prevention in Paris: 1982. Courtesy of the 
Drug Companies; A Contrast. Consulting for MDI 



Blum: One consulting episode I should mention here: One lovely Monday 
morning in 1982 at my desk in Warren Hall, I received a call 
from a young French woman asking if I would give the opening 
speech at the first-ever nationwide conference on prevention in 
France. She was speaking for an organization I couldn't place. 
I assured her that I wouldn't consider a round trip to Paris to 
talk for an hour and proceeded to give her the names and 
locations of prominent public healthers on the East Coast. She 
thanked me . 

Exactly one week later at the same hour, this lovely French 
voice said, "Monsieur, we have decided that we want you, not 
someone else." I responded that I had told her it was too much 
of a trip to make for a day in Paris. She responded, "But 
Monsieur, why one day? Couldn't you stay for a week or so 
after your speech?" I suddenly woke up, and saw that the whole 
thing occurred during our spring recess. I explained that I 
never traveled without my wife, that I wouldn't want to spend 
my own money on the venture. She allowed that there was no way 
they would let me do so, and we settled on eight days in Paris. 

It turns out that drug companies were footing the bill for 
the conference. The main meetings were for the most eminent 
medical practitioners in France and would be held in the Auto 
Club on the Place Vendome, which shares a building with the 
Hotel Crillon. France had a very bad maternal and child health 
record up until this time, and they were turning it around, 
which they succeeded in doing spectacularly. It also meant 
great expenditures for immunizing materials and this is where 
the drug companies came in. 

The night before we left, we had dinner with Dr. 
Felsovanyi, the physician I had worked with at Hopkins and 
again at Stanford as residents, and with whom I had almost gone 
into practice. My sister-in-law, who was his first patient in 



345 



Palo Alto and whose life he probably saved on her first visit, 
set up the dinner. It came up that we had to leave early 
because of our departure in the early morning for Paris. 
Having been a titled Hungarian at one time, he knew Europe and 
asked where we were staying. When we told him we were being 
put up at the Scribe, he okayed that and when he asked about 
where the meeting was, my wife told him the Triple A. He 
choked on that one but figured out that it was "the" Auto Club. 

It was quite an adventure. The persons who brought us and 
registered us at the Scribe explained that we were to charge 
everything and anything and slipped a small fortune in my coat 
pocket for incidental expenses. In retrospect, for we never 
bothered counting it, there must have been the equivalent of 
the best part of a thousand dollars. 

The meeting was quite an affair, I spoke in English, there 
were no translators, and everyone seemed to enjoy a nap. The 
food was fabulous, the meetings horrible, but a social success 
apparently. 

Our hotel room was lovely. There was a bowl of exotic 
flowers two feet in diameter on a little table, worth a small 
fortune, without doubt. I started sneezing and we put the 
flowers in the vestibule adjacent, and people kept taking 
bouquets out of it for days. 

The day after the meeting was April 1; the Monet home and 
gardens opened on that day and we got on the train at St. 
Lazare and headed off for Giverny, where we got a taxi and had 
the whole place essentially to ourselves because it was the 
first day it opened. Unforgettable, inside and out. 

Later in the day we walked back to town along the river in 
a pleasant daze. The next day we found the Marmottan museum 
and a lot of Monets that we had never seen before. This was 
before the great robbery at this museum. 

One of the nicest professional appointments I ever had was 
as an ethics consultant to a Cincinnati consulting firm called 
Management Design Institute or MDI. 

The partners in the firm were all planners in various 
fields. Each had a religious background, being either a former 
nun, priest, or minister. Their clients were usually 
educational or health care institutions which were run by or 
had been founded by religious orders. What was so remarkable 
about the group as I began attending their two-day quarterly 
board meetings was their expectation that I be present for the 



346 



entirety of each agenda item. These might be plans for 
themselves or their organization's future activities. I was 
exposed to the full flavor of their doings as they went from 
item to item, project by project, their report and then 
discussion of the goals of the projects, of their roles in 
each, the financial stakes for their client and for themselves. 
Most exciting was their expression of what their roles were in 
each and to what degree their personal gains or satisfactions 
were in each job. 

Of course, MDI had to survive economically and they faced 
that issue as well as the members' reimbursement in such an 
open way that I would not have expected to be possible. If it 
became clear that monetary or ego returns were getting high, 
the whole board undertook an examination of how to turn their 
assignment or contract around so that its social or 
humanitarian aspects were once again to be central. I had 
never worked in such an environment and discovered how much 
could be learned by getting back to the basics of human well- 
being by working with the humanitarians. This led me to a 
whole new respect for religious training, particularly since we 
heard little about religion or God. It is worth noting that on 
the first night of each meeting we took several hours to visit 
one of Cincinnati's exciting historical entities and learned 
about it at a lovely and relatedly different dinner following. 

My role was pretty routine, all I had to do was pass 
judgment on the legitimacy of each of their undertakings after 
it had been presented and discussed. How did I get such a job? 
At an atypical presentation on the ethics of health planning 
which I made as a panelist at a Marin County affair, along with 
a group of professional ethicists, there was an MDI partner who 
was shortly in Cincinnati and got me the contract with MDI, at 
that time an unknown entity to me. 

My back gave out toward the end of my first year of working 
with them. I had to have a spinal stenosis cleared out and it 
took about a year to recover my mobility. At that time I was 
asked by Health Access to work on the Petris bill, which aimed 
to provide full health care coverage for everyone in California 
and would realistically cost less for care than the usual and 
current California modes of operating which leave some 6 
million persons with no coverage. 

Given that it was a day's work to get to Cincinnati by air, 
that MDI surely didn't need me, and that I had learned so much 
about honest work, we had a fond farewell. I can only hope 
that such a dream team of planners is still hard at work. It 



347 



was the most impressive group of individuals I ever worked 
with. 

fi 

Crawford: Any place you especially wish you had worked? 

Blum: One of the countries that I might have enjoyed working in was 
Yugoslavia. The Yugoslavs were wonderful to work with. They 
were the best of all, the frankest, the most honest. 

Crawford: Which contingent? 

Blum: All of them. You never knew the difference. When Tito was 

there, it ran. The Yugoslavs I worked with at WHO were people 
away from home. I never worked with them in Yugoslavia. I 
worked with them in Geneva. When you've got one of them on 
your team, you say, "Hey, that's great. We've got a Yugoslav." 
You never knew whether they were Moslem or Serb or Croatian. 
That didn't mean a thing. They were open, frank about 
Yugoslavia or whatever else they were working at, never a word 
of party line, in fact, there seemed to be none. I used to 
debate with them about the unbelievable lack of central control 
in Yugoslavia, each province doing what it wanted, each city, 
each factory. For example, several provinces were into ship 
building, but it was being overdone and not economically 
viable. I raised the issue about some control at the national 
level, but was assured that if decision-making were 
centralized, as in Russia, there would be bigger and better 
disasters . 

When I pointed out a need to redistribute wealth as from 
Croatia to Herzegovina or Macedonia, they felt that would be 
too much meddling. Even when I pointed out that there might be 
some long-term disasters if some provinces became very wealthy, 
and some very poor, especially when this is combined with the 
historic and religious differences among provinces, envy could 
be lighting tinder. They were so allergic to Russia and had 
such faith in their own progress that they didn't take me 
seriously. I might have done useful planning there, but didn't 
fit their perceptions in any way. 



Fieldwork in Three Pacific Islands and Yemen, 1980 it 



Blum: My planning experiences in Saipan were paralleled by my 

experiences in American Samoa and Guam. What is interesting is 



3A8 



that the three islands experienced a tremendously different 
pattern of events for over a hundred years but are now all 
dependent on and dependencies of the U.S. Anyone might assume 
that three semi-autonomous, semi-tropical dependents of the 
U.S. could be governed similarly in principle, with reasonable 
allowance for specific differences called for by the realities 
of their situations. There is perhaps one similarity in our 
pattern of control for all three territories, our profound 
disinterest in their affairs and the ineptness of our attempts 
to help them plan for their needs. The short term, typically 
one-aspect-at-a-time planning grants released stateside suggest 
that no one here has heard of the interrelatedness of the 
economy, education, health, and even history of the resident 
peoples in the territories. And it is the truth that we don't 
believe in the relevance of the interrelationships of key 
forces as being important to planning. But in small island 
societies, the tightness of the relationships between major 
sectors of societal activity stares out at anyone interested in 
making significant changes in settings, each with vastly 
different health problems. 

Looking at planning in Saipan in more detail provides a 
sense of what is so specific about its people and economy and 
what is so typically amorphous about the planning done in it. 
I was one of a team of consultants headed by a very competent 
health planner, my faculty counterpart at the University of 
Hawaii School of Public Health, Bob Mytinger. He knew the 
Pacific scene, assembled good teams, knew how and when to lead 
and when to turn us loose so that we all enjoyed our work 
together. But he didn't write the specs for what was to be 
done, that took place basically in the States, and to a 
secondary degree on the islands. Although the plans were not 
calculated to make great changes, they could be implemented, 
but rarely were planners encouraged to do so. The duration of 
their work was limited, the team restricted by equally limited 
resources. Few major changes can be expected to occur in a 
one- to two-week enterprise. We also knew that other teams 
might be doing a critical piece of the job that was left out of 
our contract. Sometimes we met the planners working on our 
island in Hawaii or the Bay Area in social situations and found 
out about their contribution to the planning for the island in 
the course of gossiping. We might, in fact, be actively 
pulling in opposite directions, because we were each limited to 
considering only one aspect of an issue, and thus not aware of 
the underlying relationships or forces. 

Was this kind of confusion a result of massive astute 
conniving by hidden or sinister forces? Probably not, very 
little on these three islands looked all that sinister or even 



349 



directed in favor of anything, rather it was letting the status 
quo continue, favoring some, hurting others, as fate seemed to 
dictate. 

As we flew into Saipan in 1980, the reminders of World War 
II were all about us, even though its main street was a 
bustling mixture of low buildings and beautiful new high-rise 
Japanese hotels. Saipan (and now all but abandoned neighbor 
island, Tinian, from which we destroyed Hiroshima and Nagasaki) 
still showed ample battle scars. There were burned-out 
Japanese gun emplacements along the shore, sunken planes on the 
water side of the harbor road which were totally visible in the 
clear shallow waters, and hulks of burnt and bombed-out 
American landing craft and tanks in and about the reefs 
guarding the harbor. This road led on up to the cliffs where 
the Japanese, accompanied by many friendly Saipanese, had 
jumped to their deaths as the final American roundup had taken 
place, in good part presumably because of what was anticipated 
if captured by Americans, given the Japanese approach to 
Americans taken prisoner. As we stood among the suicide 
cliffs, busloads of American and of Japanese tourists came up, 
and they eyed one another quite casually as they surveyed one 
of the mean little pockets of history. 

Saipan had been in Japanese hands since World War I as 
payoff for not siding with the Germans. They had made it into 
a most successful sugar plantation, and at the same time had 
turned the native population, long before brutalized by the 
Spanish, into a second-class society which had to work hard, 
were adequately housed and fed, and limited to a few grades of 
schooling. Although their mobility was essentially zero, it 
apparently hadn't been too bad as many Saipanese remained pro- 
Japanese when we attacked in World War II. 

When we got there in 1980, it was economically booming as a 
Japanese extension once more. The U.S. rebuilt health, 
schools, homes, other public facilities, but forgot the docks, 
shipping, or job-producing sector, and thus the Japanese were 
welcomed back. About every eight hours a Nippon 747 would 
deliver about 200 honeymoon couples and take away an equal 
number of slightly (days) older married couples. These seemed 
to be terribly young, almost teenagers, and one wondered if a 
single person showed up at an airplane ticket office, if a 
requisite bride or groom were thrown in as part of the deal. 

We learned more about the honeymoon trade as we lived in 
one of their featured hotels there, and again in Guam and 
Hawaii. If honeymooners could afford more, they went to Guam; 
if still better off, went to Hawaii; and if truly well off, 



350 



went to mainland U.S. and beyond. Because there were more jobs 
than workers, and many Saipanese were on entitlements, a good 
many workers were being brought in from the Philippines by the 
Japanese, along with a fair bit of tuberculosis. 

We settled down in a honeymooners ' hotel, tried the exotic 
drinks, dodged the giant snails which took over the walkways 
during the night, and then delivered ourselves to the Saipanese 
planning department. This island of 20,000 persons, excluding 
honeymooners, had much of the officialdom that one would 
associate with a California county. 

The key Saipanese health planner had been a student of 
mine, no more or less distinguished than many another. His 
first task was to lay out the scope of our work which the 
stateside grant called for, the main concern being for the 
replacement of their temporary postwar hospital. This was the 
largest single source of well-paid permanent jobs in this 
island country, the hotel business using low-paid workers and 
the construction work being relatively short-term. Saipanese 
did get preference for any jobs on the island. 

The dream hospital was envisioned as 150 beds, more 
realistically about sixty beds were needed. But it was the 
envisioned permanent payroll that fixed the matter. 

The chief planner's seccnd task was to impress us with his 
general grasp of the situation. He really did that too, when 
he announced that he had gotten Saipan to adopt San Francisco's 
civil service classification, widely acknowledged to be one of 
the less useful ventures of that sort. Moreover, there were 
almost as many categories in that compendium as there were 
people on Saipan. 

As we got about I took on the task of visiting homes of 
former cases and saw a relatively good state of health. The 
rest of the team worked mostly on the hospital-centered issues. 

One evening we were all invited to a picnic of hospital 
staff at someone's home. It was a beautiful mixture of raw and 
cooked dishes. But one took my fancy, canned tuna, just as we 
know it, brand name and all. I mischievously asked how come 
when you could buy a fresh-caught five-pound tuna down at the 
harbor for $1.00 any day of the week. I got told off in no 
uncertain terms, if canned tuna was good enough for Americans 
it was good enough for Saipanese too. 

So, planning isn't just built up from logic of what is good 
for you, what is available, and what is affordable. It must be 



351 



said these were rather well-educated and reasonably 
sophisticated people to deal with. 

In Saipan the kinds of health issues we confronted were 
basic. There was need for a major medical facility given their 
distance from other facilities, the need for well-trained 
personnel, heavily imports, as Saipanese were not going 
overseas to get health training. The latter was complicated by 
the unwillingness for the so-called Chamarros (Saipanese) to 
take orders from persons of another culture. For example, the 
head nurse, an Anglo from San Jose, California, could not get 
the native mop brigade to do the floors the way she wanted on 
the morning we arrived. Lack of a regular pharmacist meant a 
less than adequate pharmacy or appropriate drug advice. Poor 
administration meant that a single autoclave with no backup had 
been broken for six months and that there was a complete lack 
of sterile supplies other than those that could be boiled or 
soaked in germicide locally. Lack of repairs, possibly based 
on hopes for a new hospital in two or three years, meant that 
as the team and I attended a childbirth in the delivery room, a 
hole in the roof delivered a steady stream of rain water on the 
baby's emerging head. Nothing too awful, but a bit unnerving 
all the same. 

Out in back in a rough-hewn shed was a highly vaunted 
kidney dialysis unit all set up to run, but with no one trained 
to do so. And if there were such a person, they would also 
have to undertake general rodent and insect extermination 
duties as well. 

By contrast, the public health nurses worked out in the 
patients' homes supervising pregnant women, new babies, 
families, elderly, even those with serious disabilities, to 
whom they taught physiotherapy with clever homemade equipment. 
One comfortable nurse took my blood pressure to show a new 
patient what it was all about. 

The dilemmas for planners are obvious. It is a remote 
island, a long way from backup modern facilities. Can they do 
everything, no, not adequately. Can they depend on less than 
daily air traffic to Guam or Hawaii, or should they try to turn 
towards Japan? No good answers, but a series of compromises. 
We agreed to a modest, well-equipped hospital, one that would 
be significant to the island in terms of jobs, able to care for 
most of their illness, but dependent on air transport and 
arrangements overseas for an occasional case. Emphasis was 
placed on the outpatient and home visiting services. 



352 



Looking back, the high point was literally and figuratively 
our lunch at the local skyscraper with its rooftop rotating 
restaurant. It was built by Nauru (a not-so-close neighboring 
island) speculators who had mined away the centuries of bird- 
created fertilizer and were faced with little more than a 
remaining hole in the ocean. They decided that their mined 
riches had to be turned into basic investments, and this space 
needle was one of them. 

We parked the car, took the elevator to the rotating 
restaurant, and some two hours later, when we had wrapped up 
all our farewells, we stood in the lobby to take the elevator 
down. Looking out, it was clear that we were facing the shore 
opposite to the one at which we had parked our car. I nearly 
panicked as I contemplated hiking around the end of the island 
to get back to where we had parked the car. However, sanity 
returned, we descended and found our car where we had left it, 
even if it was on the "opposite" side of the island from where 
I had viewed the other coast up in the space needle. 

Samoa and Guam offered much more complex situations than 
Saipan. But tiny and straightforward as Saipan was by 
comparison, it presents the need for more than sector-by-sector 
planning, which was basically all they could obtain. One might 
say that thanks to Japanese initiative and acceptance there, 
they were filling some critical blanks that drew no concern 
from the U.S. 

My shortest and perhaps sharpest planning venture occurred 
in 1980, preceding by just a few years the merger of North and 
South Yemen. The organization known as the Western Consortium, 
then a research and project haven for UCB professors, got word 
of North Yemen's desire for a total health plan, and recruited 
me for the job. Being Jewish was not an issue in that country 
at that time, if ever. I read up on North Yemen from whence 
came the Queen of Sheba, the major coffee producer of a century 
ago which exported extensively from its harbor at Mocha, 
currently the great producer and exporter of a mild narcotic 
called Qat: a land of resolute sheiks who were required to 
check in their knives and Kalashnikovs at the gates of the 
capital city of Sana when entering. Once in, they might well 
be regaled by public ceremonies at which one or more of the 
many thieves would have a hand amputated. 

This was not an opportunity to be overlooked. I found a 
beautiful art book covering all the areas from urban to remote. 
I further prepared with passports, visas, and general 
background materials. 



353 



The consummation of my planning contract for this $100 
million-plus project was to take place at a dinner staged for 
the half-dozen Yemeni here for the purpose of meeting the 
planner, and to visit the relatively new Stanford University 
Medical School, the piece de resistance of their shopping tour. 
The event of my introduction to their team was scheduled for 
eight p.m. at Maxwell's Plum in Ghirardelli Square on the bay. 
The restaurant was a decidedly poor choice for me as it was a 
decadent mess that had recently replaced the truly inviting 
Senor Pico, a favorite of ours, where we brought guests at 
least for the drinks and the evening bay views in a well-done 
Mexican atmosphere. 

I got to the rendezvous at about six p.m. at the end of my 
day's work. Since I was at least two hours early, I decided to 
improve the ambience with a Scotch and soda. As the pall 
retreated, I started feeling better and ordered a second Scotch 
at around seven and another at eight. The Yemeni were caught 
in the traffic returning from their outing to Stanford and 
arrived about nine p.m. 

At dinner I was seated in the center of the group with the 
director of all their health services on one side and the dean 
of the proposed medical school on the other. They all spoke 
good English and there wasn't much occasion to misunderstand 
one another. 

As we moved into the dinner I asked how they had enjoyed 
Stanford Medical School, and they became quite ecstatic. In 
fact, they had already decided to essentially copy it, lock, 
stock, and barrel for the capital city of Sana. 

When I asked how it would fit in with the needs of North 
Yemen, they saw such a question as irrelevant. It would be 
paid for by international funds and it would be the showplace 
for that part of the world, even more impressive than anything 
in the oil-producing countries of their region. When I pursued 
the issue of how they could subsequently finance the research, 
teaching, and service functions of a Stanford-level medical 
school, they allowed that Allah would no doubt find a way if 
outside funders didn't. I continued by pointing out the 
experiences of other low- income countries which had built 
showplaces and as a result could not even maintain the physical 
plant, had to give up most of the health services throughout 
the nation, gave up most of the preventive public health 
services, all basically to make possible the training of 
M.D.'s, so trained that they could no longer function in their 
own country. These M.D.'s became emigrants, extruded from 
their own country and took all the wealth that had been 



354 



invested in them, to Western countries that didn't need them 
but where they would fit in. 

None of this futuristic speculation found a good reception. 
By about ten o'clock I bid them a pleasant goodbye and they bid 
me good riddance. I later heard that some of these officials 
did prosper magnificently as equipment had to be selected and 
inducements for selection ran high. At least one of the top 
people met his downfall in this lucrative business, but I doubt 
that he lost a hand. 

I concluded that there was a place for fast judgments, or 
else that I had been badly self-trained and had created 
misleading notions that were likely to keep me from being an 
effective planner in a developing country. 



A Fulbright Award in Sweden (1986) and Thoughts about Fieldwork 
II 



Crawford: Where were your ideas best accepted? 

Blum: Oh, I don't know that they ever were--just by scattered people, 
or groups in Canada, Finland, Holland, Sweden. In Finland and 
Holland very flattering books were written in response to my 
book Expanding Health Care Horizons. 

Crawford: Do you go back when you've had those consultancies to see 
results? 

Blum: No, in fact, I might not be remotely welcome. I guess my ideas 
were best accepted in Sweden, where they were least needed. 
Even there, I kept kicking people's shins, because they were 
leaving out some of the critical ingredients. It was a top- 
down situation, again. It seemed to me in Canada to all be 
top-down, except in Quebec. So the top is decent, the top are 
nice folks, but the actual problems are going on at the bottom, 
and you'd better cut them in on it. They were doing better at 
that in Finland, I think, than they were in Sweden, which is 
interesting, because Finland is a rough and tough society. 
There are lots of rowdies, physical violence, not as bad as the 
USA, but not as socially smooth as society in Sweden. 

That visit to Sweden was, perhaps, a high point in my life, 
not because it was a Fulbright, but because I had three months 
to do what they wanted me to do, and I wanted to do it as well. 
That was to introduce my version of how to provide combined 



355 



human services, things that they were already doing in great 
part, but that had some serious problems. 

The University of Gothenberg wrote the Fulbright specs. 
The man who actually wrote them, Harald Swedner, was a Ph.D. 
graduate of the University of Chicago, and his thesis was about 
the unholy nature of the University of Chicago's relationships 
with the ghetto that it was in. It was an alert thesis, I will 
say. He got quite famous for it. 

He had come out here to look me up, because he believed in 
combined human services, which they were just starting in 
Sweden. I asked him to come and spend a quarter with us, 
teaching our graduate students about health planning; I had him 
lecture the planning class a couple of times. He was the head 
of the Department of Social Services at the University of 
Gothenberg, and I remember his lecturing the class about 
working in the ghetto, the many people who needn't be there, 
and the kinds of work he organized and what he did to get them 
out. 

He was full of his work, and one of our students--! 
remember that day very clearlyasked him if any people were 
left in the ghetto after all his work. He said, "Oh, yes. As 
we get one of them onto the ladder on his way out of the 
ghetto, somebody's climbing down another ladder to get into the 
ghetto." [laughter] 

He's making a point that there are human problems that pull 
people down from the highest levels of society. Here we have a 
saying, "It takes three generations from wealth to squalor." 
It's the traditionally accepted thing. Just recently, a DuPont 
murdered his janitor, or somebody. It doesn't take too long 
for all sorts of problems to set in, whatever they're due to-- 
and lack of wealth was not one of the DuPont issues. 

So Harald didn't feel they were going to run out of social 
work, but he thought there was something more you could do 
about it, and that you could help people get out and that more 
could be kept out. Of course, the kids who are born into it 
don't necessarily have to be there. They're kind of stuck 
there by their family, which climbed down the ladder. 

Harald invited me to come, and he wrote the Fulbright specs 
in such a way that it didn't make any difference who else 
applied, it practically had my signature on it. 

Crawford: I never realized it works that way. 



356 



Blum: Well, it depends. If you're being invited for a specific task, 
it can be that way. They even list the person who could do it, 
and in this case they wanted somebody to go through the whole 
background and the nature of health, and how to plan for 
improving it and providing care for it. I had a great time, 
because I essentially redeveloped my theories of health 
planning with the class, a very mature one. They worked 
through it, and it was a good experience. 

Sweden's an interesting, wonderful country. The University 
of Gothenberg is spread all over Gothenberg, because every time 
there's a fine old building that gets shabby, they totally 
rebuild it, and they're very likely to give it to the university. 
So the university's scattered around this city of half a million, 
which has another quarter million around its periphery. 

It's not so big but what the students can easily get from 
one building place to another on fabulous public 
transportation, and it is a diverse and scattered campus, all 
in these wonderful buildings some of which were built for 
them, and some of which were not. There is a world-class 
medical school there too. The scattered campus is common in 
most European cities. 

Crawford: Is society a lot more homogenous than ours? 

Blum: It is, but I'm not sure homogeneity is the key factor any more. 
When you arrive at the Stockholm airport somebody gives you a 
ride into town, and you see cranes all over rebuilding, and 
building new stuff. I mean, it's a beautifully cared-for city. 
It's how a city ought to be. 

We were living in a newly rebuilt area in a new apartment 
house. There were several optionsyou tear buildings down and 
destroy them or you rebuild them, and damn little argument 
about it. They're concerned with who needs housing, so there 
is no waiting until there are great numbers of unemployed or 
anything else there aren't great numbers needing care or 
housing. There are no homeless persons. 

If you're unemployed, you have enough money to rent an 
apartment anyway, because the offset is 85 percent of salary, 
or something like that. So there are vast areas being 
replaced, and there are vast areas that are brand new, and 
there's spotty rebuilding or replacements scattered all through 
the rest of the city where and when needed. 

One of the things you look for in a foreign country is 
"where are your downtrodden; where are your poor people?" And 



357 



the Swedes say, "I'll ask my secretarymaybe she knows where 
there is a ghetto!" [laughter] So you take an hour and go 
visit a center where these "desperately poor" people are living 
often in a new, brick, eight-story building surrounded by 
transportation, always in good, safe housing. 

One of these I was sent to was about ten miles outside of 
Gothenburg, which looks like the suburbs of Washington, D.C. 
They have streetcars and buses that come on an average of every 
few minutes so that their less-than-central location is not too 
much of a handicap. 

We went to a school there, primarily for the poor people of 
this ghetto, with classes for immigrants who don't speak 
Swedish. When immigrants are invited into Sweden they get all 
the services and they are expected to go to school, learn 
Swedish, and become Swedes. They can vote after a couple of 
years and become full citizens in a few more years. 

We visited the high school and saw nine or ten kids in 
classes for non-Swedes--Laotians, Lebanese, Americans --there to 
learn Swedish by total immersion. About mid-morning there was 
a snackbolognas and cheese, drinks. All grammar schools must 
provide a substantial hot meal at mid-day, just to be sure 
children have one good meal. In high schools the hot lunch is 
optional, but in this one serving a ghetto it was totally 
available. Kids were taking as much as they wanted, all free. 

There is an assumption here that there are enough disturbed 
families that may not have the best diet at home. So a very 
liberal food policy is at work for the students. 

The social worker who was assigned to the two total 
immersion classes was only allowed half a day as a school 
social worker and spent the other half-day in another 
environment, so that she wouldn't be so likely to get burned 
out or become too blase about teenagers' problems. 

The morning that she took us to the school she explained 
that she would disappear from her two classes about an hour 
later and then would be back to show us the lunchroom at noon. 
Her special problem to be solved that day was the placement of 
a Salvadoran sixteen-year-old boy refugee who had started doing 
badly in school. 

The reason social workers were assigned to the foreign 
student classes was to enable them to judge progress or 
problems for refugee kids. This boy was a strongly left- 
leaning youngster who lived with his mother, a strongly right- 



358 



leaning artist, and they hated one another. The boy could not 
cope with it and his schoolwork was plummeting. 

At noon our social worker returned, very pleased. She said 
that the boy had met and was going to live in the family of a 
Spanish- speaking Chilean exile who was a teacher at the school. 
The social services would pay all the housing, food, and other 
expenses of the boy, and he would stay in the same school, 
which he liked. 

What was most interesting was the social worker's statement 
that the mother, who was reasonably well off, would object to 
paying any of her son's bills. So the social services would 
spare the boy from all of that, which was now Sweden's problem, 
and they would set about collecting from the mother, and he 
would be involved not at all in this unpleasantness. 

Incidentally, this was a beautifully equipped high school, 
infinitely better set up than anything available here at UCB 
for teaching needs. 

One of the main reasons for my Fulbright was the interest 
in combined human services. In the course of my exposure, we 
went to a leading-edge community a dozen miles out of Lund, and 
its clinic was connected to the university's medical school. 
Quite inadvertently we were introduced to their 
ophthalmologist. He spotted the little ice box we were 
carrying for my wife's anti-glaucoma medication, one that was 
free of a preservative because she had become allergic to the 
various preservatives in such medications. He asked what it 
was and was shocked when I told him, reached to the shelf above 
his desk, and gave us a box of several hundred single doses of 
sterile sealed glass ampules of her medication that contained 
no preservative. He gave us a prescription for another 500, 
which we filled at the village drugstore for a lesser cost than 
her little vial which she had to keep on ice as we traveled. 

There is no such product in the USA because the demand is 
small and profits would be zilch. In Sweden the government 
health services find it possible to produce what is needed, and 
in fact to do so, it partners in all pharmacy activities 
including ownership of drugstores. It is also evident that 
there aren't a million useless remedies for sale, and the 
government covers the major part of prescription costs for all 
citizens. 

The government's concern extends to the use of alcoholthe 
prices are fairly high and access to liquor is through 
government stores which have limited hours and so cut the 



359 



opportunity for casual purchases. Liquor is available with 
foods and entertainment at fairly high costs. The consumption 
of alcohol is about 50 percent of what it is here, hospital 
admissions for acute alcoholism are a fraction of what they are 
here, and the rate of deaths from cirrhosis is about half of 
what it is here. 

Why do Americans always worry about alcoholism being out of 
control in Sweden? Given its socialistic tendencies we like to 
find problems with the system, and because Swedes are so 
concerned about alcoholism, we assume they have a worse problem 
than we do. Certainly not so, but they do plenty to keep the 
problem down, and no one there dreams of taking a drink before 
driving, given the drastic, rapid, and inescapable punishment. 

The Swedes are very serious, very businesslike, and keep 
going economically by competing with the major industrial 
countries. Their wages are high, their social benefits are 
high, they have excellent schools, probably the best housing in 
the world, and provide a complete-coverage health care system, 
with 50 percent more aged persons than we haveaged persons 
are costly. Sweden does not have a lot of natural resources 
except for water power, wood, and iron, so they have to be 
well-educated, efficient, very skilled to keep competitive. 

During our stay, I taught health planning for doctoral 
students at the University of Gothenburg. Half of the students 
were well over forty years of age, much in keeping with a 
widely supported notion that education should never cease. 
Since most of my students were professionals, some already 
having their special training, their source of employment 
encouraged them in going to school, essentially forever, and 
the university cooperated so that my course met for three full 
days every other weekend. The employers covered the one work 
day every two weeks and the students gave up only every other 
Saturday and Sunday. 

Because the Nordic countries do a lot of sharing, one of my 
students commuted from Oslo, one from Copenhagen, as well as 
two from Stockholm, across Sweden. We also had a week-long 
session with guests from Finland as well, covering related 
topics, and during one week I worked in Oslo, lecturing and 
advising and visiting with former students from Berkeley, and 
another week I did likewise in Turku in Finland. 

In Turku I was the guest of a magnificent rehab center for 

victims of injuries incurred at work or elsewhere, and for 
long-term diseases. It was one of two such fabulous centers, 

which were research as well as rehab based. When I visited the 



360 



library in this gorgeous, colorful building, where patients 
stayed for weeks and even months, sometimes with spouses, there 
was quite a surprise. It had all the capabilities we have at 
the university, and an unbelievable public relations section, I 
am sure, because there on top of the pile of books being 
returned for filing was the last edition of my book on 
planning! No one cracked a smile or acknowledged the 
happenstance. 

I recall an interesting field trip that our class took to 
visit an island in the harbor area adjacent to Gothenburg. We 
went to the end of a streetcar line and took a small ferry that 
called at more than a dozen islands. In winter once the ice 
became thick enough, there were power sleds, or helicopters if 
needed, to bring in patients needing intensive care. The visit 
was to a local medical facility that was available twenty-four 
hours a day for an island population of 2,500. The full-time 
doctor was the husband of one of my students. He introduced us 
to his physician assistant, nurse, social worker, secretary, 
and ambulance drivera team that was available twenty-four 
hours a day and with regular office hours mornings and 
afternoons. A replacement doctor would be there if the one 
went away for a day or more. 

I asked him about what bothered him the most in his work, 
and his response was quite unusual. He said this occurrence 
had just happened twice and had left him feeling dissatisfied: 
on the previous Sunday there was a knock on his door, as his 
state-provided house was adjacent to the clinical facilities, 
and a lady asked his pardon, but would he please sign her 
mother's death certificate, and that the ambulance with her 
mother's body was right there for him to see. He said he got 
truly uptight and demanded to know why they hadn't called him 
when she got ill, since he was always there. The lady 
explained that her mother wanted to die at home and that she 
didn't want the doctor because he might intervene in some way. 
Parenthetically, there are no charges for the available 
services. Since Swedish doctors are trained much like our own, 
with a strong interventionist streak, he was not prepared for 
rejection at the point of imminent death. 

This episode wasn't so startling to me, for I had seen the 
same thing in both urban and rural settings in other countries. 
In fact, although I hadn't encountered such behaviors here, I 
suspect that some of the more rural long-settled areas of our 
own country might well exhibit older people with such feelings. 

One more thing that stands out is the basic integrity of 
Swedish people. On a surprise trip to southern Sweden, our 



361 



host ran out of gas. Our first rescuer was a farmer lady just 
returned from town. In her high heels and good dress she took 
out her tractor, hooked us up, and pulled us until we got 
started, because our Volvo needed a tow when we put in some 
spare gas. She knew all this, even put on the tow rope 
herself. We were far from anywhere and ran out of gas once 
more in a small rural community, went to a farmhouse where we 
saw trucks, and were given several gallons. 

We continued until we were almost out of gas again, but 
this time we found the main road and an isolated service 
station and a grocery. No one was around, so we filled our gas 
tank and then went looking for someone to pay. At that moment 
a lady came out of the grocery with her purchases, explained to 
us that the owner of the store and gas station had just taken 
off for the weekend, that we could pay her, and that she was 
locking the grocery store because she was the last customer, 
but that the gas pumps were to stay open in case anyone would 
need gas. 

We also lived through a major government train worker 
strike and discovered that all trains ran with no pickets 
visible, but that conductors simply didn't collect the tickets. 
Lots of people just took a ride around the country for the day 
or two it took to settle the strike costly to the government 
because of the loss of revenue from the on-strike but operating 
government-owned transport. Again, another world from the one 
we came from. 



Teaching Health Planning in Chengdu, China, 1987 



Blum: In 1987, shortly after we returned from Sweden, I was recruited 
by Dr. C. C. Chen to teach a month-long course in health 
planning for a special group of young physicians from various 
parts of China who were emerging as public health leaders. 

Living and teaching in China when not on an organized tour 
or not as a guest of government is quite something. The big 
hotel in Chengdu where we stayed for the month while I taught 
at the university was off-limits to local Chinese, such as my 
revered host, C. C. Chen, and his daughter, who was a professor 
at the medical school. 

Gambling was punishable by death, and so we watched folks 
gamble on the street with police looking over their shoulders. 
The two-tier money scheme, cheap for Chinese, extortionate for 



362 



foreigners, led to black marketing with scores of illegal 
money-changers in the courtyard of our hotel. Two prices for 
taxis, two prices for hotel rooms capitalism a la extortion 
for non-Chinese speakers. Because we then spent two months 
touring China on our own, usually with a chauffeur and local 
guide, we had some wonderful and some gruesome experiences, 
enough of the latter, however, to look forward to "escaping" 
the country finally. 

The teaching experience was the worst I ever had. The 
timing was too close to the end of the Cultural Revolution and 
no student was willing to talk for fear of being quoted out of 
context and thereby perhaps once more being sent down to the 
pig farms. All of my students would fit the elite category and 
many already had been among the elites whom the youth and less 
educated had humiliated and tortured during the Cultural 
Revolution. 

On the first day a very young woman physician did speak up, 
responding to my request for some sense of what goals one could 
plan for in China in 1987. But she was the first and last to 
speak. By the next day the other students had shut her up, 
apparently explaining to her the risks she was taking by 
talking. 

One can't teach planning by lecturing, but I staggered 
along, sometimes waiting fifteen or twenty minutes for a 
response to a question, shaming them into talking a bit. 

Translation made the effort even more complicated. Even 
though I had formally been promised translators who knew the 
planning field, only one of the three was even familiar with 
the concepts. Because most of the students, but not all, were 
proficient in English, the translators were often interrupted 
by the students telling them that they were misinterpreting me. 
About eight hours a day, six days a week, and five weeks 
running, it was a true nightmare. 

At the end of my stint at the university I was asked to 
spend an afternoon with the third-year medical students 
discussing systems of health care. The class was mostly women, 
all spoke excellent English, and all were very young, for in 
China as in Europe, medical students go from demanding high 
school work directly into medical school. This experience was 
enthralling. There was no fear of repression, the students 
were brilliant, free-flowing, responding to my style of asking 
questions and having them provide the answers. I never had a 
better class in the U.S. So, there are hopes. 




Henrik and Marian Blum on assignment for the World Health 
Organization in Sri Lanka, 1977. 




Getting the Sedgwick Award from the American Public Health 
Association, 1985. 




Teaching on a Fulbright in Sweden in 1986. 




Teaching health planning in Chengdu, China, 1987. 




In charge of the Joint Medical Program, University of 
California, Berkeley, 1994. 



363 



IX THE 1980S AND 1990S 

[Interview 7: May 1, 1997] II 
Reviving the Joint Medical Program 



Crawford: Let's begin today with the Joint Medical Program, which you are 
credited with reviving in the last few years. 

Blum: Joyce Lashof was the dean of the School of Public Health in 
1991, an old and dear friend. She had only an indirect 
relationship to the medical school, she was expected to take 
over whenever it got into a mess. That was in 1991. She had 
to replace the then director of the Joint Medical Program (JMP) 
and asked me to come out of retirement. Knowing that it was 
not a career or economic issue for me, but that it would 
reconnect me with an old love, I agreed. Joyce was resigning 
the deanship and presumably JMP would either be dead or have a 
new permanent head within eighteen months. 

When Pat Buffler became the new School of Public Health 
dean in 1992, she made some critical connections at UCSF, which 
also had a new chancellor and a new medical school dean. 
However, she wasn't officially in charge of the Joint Medical 
Programthere had always been a kind of an oddball 
relationship between the two campuses over it. The 
administration in Berkeley never knew what to do with a joint 
medical program and never did anything except complain, and 
they finally decided to dump it into the School of Public 
Health after Pat had helped the program survive the big cuts in 
'91, '92, and '93. It became a division of the School of 
Public Health in 1993. 

The JMP had started in 1972 on the Berkeley campus as part 
of a large Department of Health and Medical Services venture, 
as I mentioned. It accepted twelve students in that year and 
every year since then. 



364 



Pat was anxious to take the chore onshe's an ex-nurse 
with a Ph.D. in epidemiology, and her feeling is that the big 
world, the broad world, is public healththe health of the 
publicand a subset of that is medical care, a feeling I 
share. 



Japan is a classic example of the relevance of that 
thinking. It has one of the poorest medical care programs in 
the world of developed countries, but that has nothing to do 
with their life span or their infant mortality, which is now 
the best in the world. Medical care is not particularly 
relevant to the state of health of a population. 

Crawford: Because of the general well-being and the other services? 

Blum: It's not just services, it's a question of good living 

circumstances where people generally feel secure and positive 
and pretty good, and get a good education. In spite of being 
destroyed, morally, for a moment there in World War II, their 
life has been secure and their rebound spectacular. 

So Pat Buffler bought into the virtue of this program. The 
School of Public Health had been involved in taking care of the 
finances before that and that was something of a joke. As 
interim chair of Health and Medical Sciences and its Joint 
Medical Program (JMP) , I never got a budget, so I could never 
tell where we stood. The fellow who was supposed to do the 
budget was dying; he was always blue in the face because he 
wasn't getting any air he had emphysema but he couldn't stop 
smoking. So I'm sure his brain was as badly oxygenated as his 
face. 

He just couldn't produce the work, and was years behind. 
All I ever saw was an official data sheet once a year from the 
university that had nothing to do with the budget we were 
familiar with, and we'd show a surplus. Little did I know that 
what I was reading happened to be a reflection of the salary 
that I didn't take. I replaced a person that earned a hundred 
and twenty thousand dollars, and I agreed to do it for sixty 
thousand if I didn't have to put in much more than half time. 
And so it turns out that what I kept seeing was the other sixty 
thousand of my salary floating around, so it always looked like 
we were in good shape. [laughter] 

Crawford: That's pretty good. 

Blum: We didn't have any information about what was really going on 
financially. I discovered that no matter what I presented in 
the way of a budget, nobody in the chancellor's office ever 



365 



commented on it. Nobody ever said that we didn't know what we 
were doing, and it was clear that I didn't, ultimatelythat I 
was doing it the wrong way for all three years I was there. 

It wasn't a rational system, and nobody ever looked at it. 
If you've got an irrational method of running a budget, why 
look at it. It tells you nothing. The final issue was, "Is 
there anything left?" Well, half of my salary--my 
predecessor's salary to be exactwas there. So we were doing 
great. 

Of course, I was chintzy. I stopped feeding the students 
pizza--! must have saved at least five hundred dollars. 

Crawford: So the crisis was a budget crisis? 

Blum: Yes. At that point when I came on, the obvious was our reduced 
budget each year, but the superseding crisis was whether we 
were to be shut down. There was a new chancellor at UCSF 
who's now leaving to go to be the dean of Harvard Medical 
School--Joe Martin--a broad gauge man, Canadian in origin. 

The new dean of the UCSF medical school, who was briefly 
the interim chancellor, was Haile Debas--also a good human 
being as well as a famous surgeon, also via Canadawhom, I'm 
sure, Joe Martin had a hand in picking. These were two lovely, 
lovely people, and Canada has a bearing on it, because as I've 
said, their health care is more closely oriented to what people 
need than to what government and doctors need. 

So all of a sudden, the JMP at UCB began being perceived as 
really a wonderful place to train students because our 
students, who spend their last two years at UCSF, do very well 
there and go into primary care practice predominantly. 

I got a few testimonials on what a great place it was from 
folks out in the field who got their doctoral training here. 
It's not because they're great scientists it's because they're 
good doctors . 

Crawford: What do you do with the program? 



366 



Blum: Presently very little, other than that I sit in on master theses 
seminars. There have to be three faculty, two tenured on each 
thesis, and even though I'm retired, I'm legitimate tenured 
faculty, so I also sit on a good many thesis committees. 

Crawford: But you were in charge of resurrecting the program? 

Blum: Yes, but we don't know that that was the cause of our survival 
and renaissance. The new dean had these nice connections over 
there with Joe Martin, and he was willing to listen. So she 
really built the connections. 

Four or five years ago, when I first got re-involved ... 
This was a private letter, from chancellor's office to 
chancellor's office. Everybody saw it, of course. 

Crawford: Very distressing. 

Blum: When I saw the letter, I felt we would win the battle for 

survival of JMP. Because it was so denunciatory of Berkeley I 
had a feeling it was going to get a strong reaction in 
Berkeleyand it did. The Graduate Council asked me to come 
and discuss the letter and a few other things; they were 
mortified. It seemed to be saying, What could you expect of a 
medical school over here? Let the students all take their 
courses in San Francisco and make out like they were here. Let 
them spend a little time here, but they could take all the good 
courses over there. Of course, although unstated, slowly but 
surely, all the faculty positions would be transferred to UCSF. 

So this letter was very helpful to the cause, and the new 
public health dean just went to work. She got a commitment 
from the administration here, who really weren't very sharp, 
that if she could get a letter of support from the dean of the 
medical school in San Francisco, they would continue the 
program. Everybody here knew that was impossible, because UCSF 
had been denouncing it for twenty years, and this most recent 
blast had been the worst yet. [laughs] But she got the 
promise from Joe Martin, the new dean. 

Crawford: And that did it? 

Blum: He wrote back a very positive letter, and the people here were 
astounded. They were truly astounded that you could get a 



367 



letter like this after all these years of getting abusive 
letters about killing the program. 

Crawford: That's one of Dean Buffler's major achievements, really. 

Blum: I wouldn't say major, but as far as this program is concerned 
it was the major breath of life for it. I think I've already 
told you that we had a formal review, and the team that 
reviewed it didn't really care one bit about what they saw, and 
that was a Berkeley team, concerned only with savaging it 
because of budget cuts. They had voted three to two to kill 
the program. 

Berkeley faculty could never catch on that the JMP wasn't a 
threat to the campus 1 budget. The reality is that this program 
is run from the presidential office, part of the so-called 
systemwide budget. But everybody at Berkeley kept thinking 
they would share any savings that they got out of it after they 
had disposed of us. 

Back in the early seventies, maybe late sixties, when Ned 
Rogers was chairman of the committee, we kept running into 
comments such as: "Well, if we let this medical school start 
here, it's like letting the camel's nose under the tent. The 
whole camel is going to be inside, and they'll take all of our 
budget." So the Berkeley campus was anything but enthusiastic 
about seeing it start, and that's why it took state legislation 
to get it going. Pat Buffler's side of it was very specific, 
very personal, and that promise from UCSF that she got 
surprised everybody, including me. 



Blum: While JMP was well on track, the UCB campus under Tien was 
trying to make sizeable cuts beyond 10 percent annual 
decrements to individual departmental budgets. Every 
department and program was examined by a special committee for 
survival. Our committee had one School of Public Health 
faculty, two other Berkeley faculty who dinged us, one 
antediluvian medical school dean from outside, and one 
progressive school of public health dean from outside. After 
months of study under a professor of chemistry from UCB who 
never could understand that we were a medical school, they 
voted three to two to kill us. Tien sent us the report asking 
if we cared to respond. Implications were all too clear, and I 
could see no reason not to respond. 



368 



The response was pretty simple. There were three questions 
we should have been asked but never were. 1) What was the 
original purpose, 2) how successful were we in achieving it, 
and 3) how relevant was the purpose in retrospect? 

The purpose had been to train physicians who would 
specialize in caring for people, not to become specialists in 
organs, diseases, or procedures. 

The success was self-evident. Over 60 percent were in 
primary care, over three times the average proportion produced 
by medical schools in the U.S. up to that time. 

The relevance was spectacular. The major problem in 
medical education twenty years after the founding of the JMP 
was how to teach and produce primary care physicians. The 
major problem in finding physicians to work for HMOs also was 
the need for and the unavailability of such doctors. 

In about two days, I got a reply from Tien authorizing the 
search for an appointment of a permanent chair to replace me. 
For the first time this was going to be a Berkeley enterprise, 
all previous searches had been under the thumb of UCSF and had 
resulted in chairs who were from UCSF and whose positions 
seemed to be more valuable than the incumbents were. Tom 
Boyce, who now heads up JMP, is that new chair and he is a 
remarkably suitable faculty and chair choice. He also has had 
UCSF experience so that he is at home on both campuses, as 
befits the head of a program that educates on both campuses. 



Ronnie London and Maggie Hall 



Blum: When I took on the task of strengthening the JMP in 1991, I 

inherited a small but most remarkable staff. Not since I left 
the health department did I see the kind of devotion and 
concern for doing the work properly and promptly that I found 
here. True, there were complications. Ronnie London was in 
charge of the entire operation and the staff, other than 
Maggie, my secretary. She admitted students, dealt with the 
UCB hierarchy, and the superimposed UCSF one, with its often 
less-than-f riendly regulations, kept the budget fluid, without 
ever being able to get a useful accounting, kept the students 
in line and happy, seeing that they met all the masters degree 
requirements, holding their hands in times of personal 
disaster, financial shortfalls, illness and whatever else, and 
dealt with vendors who often couldn't get their university- 



369 



incurred bills paid because payment was not a function 
allocated to us. In other words, Ronnie had to run the whole 
thing and the prior heads of the program usually contributed 
little more than confusion, they had all been hand-me-downs no 
longer of use at UCSF. 

Ronnie seemed like an embittered person who would be a real 
problem for me, particularly since I knew nothing about the 
academic administration and the bookkeeping in this bastard 
program that had no direct lines to anyone but seemingly to all 
kinds of persons on two campuses. 

I soon learned that Ronnie could explain the realities of 
each situation and that if we tackled them together, some 
longstanding screw-ups could be undone, e.g., summer session 
administration pocketing our summer session earnings year after 
year. 

With her day-to-day knowledge of where our money really 
went, we undertook our own budgeting, previously delegated to 
another department but paid for out of our budget. We set up 
useful encumbrances, cleared them on payment, organized our 
internal expenditures, and put everyone on a budget with 
accountings done regularlyall the things she had been 
desiring to do over the years. She was and is the epitome of 
the ideal worker. She got along with me and almost everyone 
else, helped her staff through personal misfortunes, encouraged 
and helped them to get training when indicated. 

We were moved into abandoned University Hall quarters which 
were not even repainted, but it did get us out of a "temporary" 
shack some fifty years old. The move was not done because we 
deserved something more than twenty years in our rat-harborage, 
but because the "temporary" had to go to make way for the new 
campus underground library. 

Our "new" building, University Hall, had been badly shaken 
by the big earthquake in 1989 and the steel which had been 
overlooked when it was put up in the 1950s was now being put in 
place around the outside to hold the place up. This was going 
on as we moved in and I'll never forget Ronnie leaning out a 
window and handing the window cleaners espresso from our new 
machine in the students' lounge. Sure enough, we got an 
excellent window cleaning job, about the best. 

The staff situation had one complication. My secretary was 
Maggie Hall, who had been my planning program librarian in the 
late 1960s when I first came to Cal. She hadn't worked for me 
in the intervening twenty years. She did not work under Ronnie 



370 



but worked immediately under and for the director. She was 
about the only person whom Ronnie couldn't charm and was 
essentially totally independent of her. Yet, the program was 
tiny and the two key staff reporting to me had to work 
together. With a little push here and there they did. 

Maggie's skills included keeping historical records and she 
did so even when repeatedly discouraged from doing so in a 
program that had many crises. Her efforts at keeping track of 
graduates probably saved the program from an untimely death in 
1993 when she had records to show that 62 percent of the 
graduates were in primary care, which was one of our original 
goals. 

She is a painstaking person, and one of her main 
accomplishments for me was putting out my letters or documents. 
She found the errors of fact, but more importantly, she could 
ask, "What are you trying to say?" Few secretaries can do 
this, and fewer care to bother. Between us I think we did 
pretty well, and to the point. 

Maggie's crowning touch came when we were recruiting for my 
replacement, the first UCB-selected full-time tenured faculty 
for the JMP. There was a monstrous list, which a committeeof 
which I was not a partboiled down to five. Three of them 
were from Harvard, and none of them were really suitable, but 
the committee picked out the most senior and academically 
prestigious one, who was totally irrelevant to an unorthodox 
medical school. 

By this time the JMP was in the School of Public Health. 
The dean called to tell me of the apparent choice and because I 
wasn't in asked Maggie to tell me who was about to be selected. 
I can just hear Maggie asking, "What in the world can this 
person do for the JMP?" 

The dean soon found me and asked what Maggie was talking 
about, and this gave me a wide open opportunity to really 
explain what she was talking about. The dean cancelled the 
search and undertook a new one, through which we obtained the 
current director, who is elegantly qualified and full of energy 
and enthusiasm, illustrating how a good secretary saves a 
school. 

Maggie retired a year or so after I did, and now we both 
volunteer at Lifelong Medical Care, an organization dedicated 
to providing care to poor persons. 



371 



The Over 60 and On Lok Programs and Managed Care ii 



Crawford: Let's move on to Over 60, because that is such a signal 
success . 

Blum: Well, I keep hearing that I founded it--I did not. It was 
founded in the mid-seventies, at least ten years before I 
became affiliated with it. It was well in business by the time 
I got involved. When I retired in 1984, a brilliant ex- 
doctoral student named Meredith Minkler, who is now a professor 
in the school, had greased all the skids and I landed on the 
Over 60 board. I've been active in the planning aspects of the 
organization ever since, and now Meredith is once more active 
too. 

Crawford: I remember that there was an anniversary tribute, wasn't there, 
where you and Lillian Rabinowitz spoke. 

Blum: Lillian was one of the founders, the key founder. Lillian is a 
lady who never recognized the limitations of her power. She 
doesn't have wealth, or anything like that. I used to be 
scared when I saw her come down the hall of the School of 
Public Health because she'd spot me and say, "I've got 
something I need you to do." 

Crawford: Did you know her well? 

Blum: Barely, but she knew who I was and didn't hesitate to try to 
get me to do things. She has no fear. She'll walk in 
anywhere. She had had problems with the geriatric services she 
was getting at Kaiser, which is a pretty big machine. This was 
maybe six, seven years ago, and she kept pushing right up until 
she found me, and it turned out that I knew the head man there. 
So I got an appointment for us, and we sat down on the twenty- 
sixth floorwhich is the place to bewith David Lawrence, and 
she gave him all of her problems. 

That's her style. She'll look for an opening and she won't 
quit until she finds one. She found me, and I could deliver 
her to David Lawrence. Well, the next thing you know, she's on 
a Kaiser patient committee to improve the geriatric services at 
Kaiser, and she's been on it ever since. She keeps working at 
things until whatever is needed happens. She founded several 
other organizations with several other women. They were all 
Gray Panthers. 

Crawford: Yes, she founded the branch out here in 1974. 



372 



Blum: She did. What they did was to found a service which really 

distinguishes Over 60 from all other senior services. You look 
at the whole patient; you don't just look at their lab work or 
their torso. 

Crawford: How workable is it? 

Blum: Totally. It costs less to take care of patients if you pay 
attention to them. The labwork may or may not tell you 
anything, but if you listen to patients you may discover that, 
irrespective of labwork, they're starving to death. Labwork 
might prove it ultimatelyparticularly after they're deadbut 
the issue should be, "What are you going to do about it?" 
Well, medical care wasn't going to do anything about it. The 
issue was starving. 

In other typical cases, the family is going crazy because 
they have a drug addict, or they're being thrown out of their 
home, and they have no place to live but on the street. Where 
does medical care get into any of those situations? 

Crawford: Is Over 60 very much like your multiservice center program? 

Blum: That's right. When I resigned here and retired, the next day I 
went down to Over 60 and they put me on their board, because it 
was the only place I knew ofwith one other exception, On Lok 
--that took care of all the needs of their customers, or tried 
to. If you need a job, they'll try to help you get a job. If 
you need a family, they'll try to help create one out of your 
friends. Whatever it is that's needed the things that really 
have something to do with your health. That's not promoting 
community health as such, but it's looking at the sources of 
what will make any one individual or family survive and be 
reasonably healthy. 

Crawford: It sounds, on the face of it, like it would be very costly. 

Blum: Yes, but by the time you get through finding some food for 
these people, most of the medical costs may disappear. Or 
fixing teeth, if they need teeth and they can't chew and they 
can't swallow and they're on a diet; or podiatry if they can't 
walk because their feet are so gnarled and knotted all of that 
is not very expensive. 

Crawford: Do they provide podiatry? 

Blum: And dentistry, too, but the real issue is the home situation. 

Crawford: Keeping the people independent at home is the focus, isn't it? 



373 



Blum: It really is, and that means Over 60 keeps filling in whatever 
is missing. Sometimes they will find housing for people, all 
sorts of things. They can't overcome the homeless situation by 
themselves, but for their homeless patients, at least, they 
really go all out, and they do accomplish a lot. So there's 
less hospitalization, there's less nursing homes. 

Crawford: These people have Medicare? 

Blum: Most do, a few don't. If they have Medicare, which our elderly 
patients do, Medicare won't, for example, pay for any of the 
looking-in type of home visits, or for transportation. You 
have to get the money for these things, and we are cooking up 
schemes to get money all the time. Sometimes the county will 
give, the city will give, but Medicare pays for little or none 
of the things like housing, legal assistance, supervision, 
counseling, and so on. 

Crawford: I have read that the budget has gone from twenty-nine thousand 
to two million at Over 60. How have you gotten that money? 

Blum: Well, contracts, contracts, and contracts from all levels of 

government, from volunteer organizations and individual gifts. 
Most of the contracts pay for certain enumerated services; only 
a few allow us to do what a patient needshelping somebody get 
a house, for example, or getting a lawyer to get out of some 
kind of crazy entanglement, or getting a little psychiatric or 
psychological assistance. Generally most contracts just don't 
pay for those things, but some of the foundations do just 
exactly that, if only for a few years. The United Way provides 
some general support which can be used for any purpose. 
Individual volunteers are critical in these areas. 

Crawford: Do they have an enormous staff? 

Blum: Well, it's large in one sense, but, on the other hand, there 
are many economies that are achieved. 

it 

Blum: The point I need to make is that the savings to society created 
by Over 60 do not accrue to Over 60, because nobody is paying 
them for savings. If the program were per-capitated, meaning 
Over 60 got so much per person, then any savings they made they 
would get to keep. That would be different, but since they're 
typically only able to bill for servicesthey bill the county, 
they bill the state, and they bill Medicarethey don't get 
anything for the savings which were created by Over 60 "s 



374 



services that can't be classified as medical care, 
instance, we can't get paid for a social worker. 



For 



Crawford: You can't? Who pays the salary of the social workers? 

Blum: We have all sorts of oddball grants and philanthropic 

foundations and gifts. Sometimes the county and the city will 
throw in a pot of money for the homeless or this or that, which 
we can use as we think is advisable. 

If you belong to Kaiser they get your premiums, sick or 
well, they can do anything they want, even though they don't do 
all that much differently. But this is where On Lok shines, 
and accounts for our close relationship, morally, spiritually, 
and intellectually with On Lok. They get paid by the month for 
each of their clients from Medicare and Medi-Cal, and they get 
the equivalent of what it costs to put a person in a nursing 
home, for the only people they can accept are those who are 
eligible for a nursing home under Medi-Cal and Medicare 
stipulations . 

Crawford: So those are rather severely disabled people? 

Blum: Fairly severely. They would be institutionalized, ordinarily. 

Crawford: And they stand upon not institutionalizing? 

Blum: About one in seven of their patients, maybe, gets some 

institutionalization if they are in the hands of On Lok, yet 
all seven out of seven are eligible for it, and On Lok gets the 
money for all seven. So they can use it for whatever the 
person needs, and they do so wisely since only a few ever need 
to go into the nursing home which would otherwise be their 
fate. 

Crawford: So they can decide? 

Blum: On Lok can decide whether it's going to be social work or more 

doctoring, or exercise, or whatever. Of course, they offer social 
work and the transportation and the recreation and a million and 
one thingsdiet and foodand they arrange all of that. 

Crawford: What if they run over? 

Blum: That's their problem; they'll go broke. 

But here is Over 60 doing the same thing with no guaranteed 
flow of money, because these people are not as sick as those 
who would be taken into On Lok. We are at this very moment 



375 



trying to figure out how we can break that barrier. How can we 
take people before they are nursing-home eligible? Why do we 
have to wait until then to try keeping them independent? 
Supposing we started a little sooner to keep them independent? 

Crawford: Your success rate would be greater? 

Blum: Well, it would be greater, but why must society wait until 
people are already cracked up to provide them with relevant 
services? Yet our society will not pay for a full scope of 
needed services until patients are nursing home eligible. 

Crawford: That's what I'm saying, yes. 

Blum: Yes, it's insane as our society does it now. Neglect people, 

save money, and then spend a fortune on putting them in nursing 
homes . 



Crawford; 
Blum: 



Medicare now has contracts with HMOs to take seniors who 
are not cracked up or crocked up. Medicare, in this part of 
the world, pays over five hundred dollars a month per person, 
but these people are not in institutions, whereas On Lok's 
people are certified as on their way to an institution, and 
they get around three thousand dollars a month to do the whole 
works. 

That's what it would cost in a nursing home, whereas a 
Medicare HMO will get five hundred or so dollars a month in 
this part of the world to take care of you, but they try 
awfully hard to find people that are easy to take care of. 
Well, Over 60 doesn't look for people who are easy to take care 
of, traditionally we take the difficult cases. Now Over 60 has 
some patients who are in HMOs and use Over 60 as their basic or 
primary source of care. Over 60 maybe gets thirty dollars a 
month to service such patients. 

That's a big disparity. 

And the HMO gets over five hundred dollars a month for the 
Medicare-eligible, but the HMO does have to pay for 
hospitalization and for nursing home care and for various drugs 
and so on. The point is that when Over 60 does a good thing 
for those HMOs, and keeps their patients out of nursing homes 
or hospitals, none of that rebounds to Over 60 's credit, just 
to the HMOs. They get any gains out of it. So the country 
isn't set up to doing anything very intelligent or very useful 
when it comes to older people or chronically ill people. This 
doesn't just apply to old peopleit applies to any age group- 
same logic. 



376 



Crawford: But On Lok and Over 60 are considered model programs. 

Blum: Yes, but Over 60 could easily die before it gets anybody's 
attention. In the East Bay there is an On Lok replication, 
also founded by Lillian Rabinowitz in 1988. It started as a 
day care center for the elderly. It has become an On Lok 
replication now known as CEI [Center for Elders Independence]. 
I was the first president of that, and what we wanted was to 
see if we couldn't build an On Lok replication that could take 
care of people earlier. Well, the financial blocks are 
absolute. We could not. 

So Over 60 is now negotiating with CEI--the On Lok 
replication--to see if we at Over 60 and CEI can work together 
so closely that we at least cover the early ones and they cover 
the full-blown ones. That's not easy. These are two separate 
worlds of finance. Over 60 has no basic resources to invest, 
and won't get a dime for trying. They can't get On Lok-type 
money, and CEI can't share the On Lok-type money with anybody 
else. 

So that's not going to be an easy marriage, even though the 
present president of CEI is Marty Lynch, who is the CEO of Over 
60. We're very close, because we use the same ideas and tools. 
We're interested in the same goals as CEI, but for a different 
population. But the mechanism for financing is so split up, 
this is for this, and that is for that, and never the twain 
shall meet. 

Crawford: You must have some kind of a track record, because it has been 
in existence for a long time. 

Blum: Yes, it's a moral track record, though. Now that Over 60 is 
working for HMOs--seven of themit's commencing to be 
understood, I believe. It's just started to happen, you see, 
in this past year, 1996. Apparently our patients will be 
better off than the rest of the comparable patients in an HMO. 
It will be less expensive for the HMO to care for them, but 
we're not going to get anything to show for such savings. 
They'll give us another dollar a month, or something. It costs 
a little more than that to do the social work or the home 
visiting kind of additional services that create the 
differences that keep a patient from getting more seriously 
ill. 

Crawford: But you are covering the social work? 

Blum: Oh, yes, yes. I mean, that's the nature of Over 60 's services. 



377 



Crawford: How about the new clinic site? 



Blum: 



Crawford: 
Blum: 



Crawford: 
Blum: 



Crawford: 



Blum: 



Well, we have yet to raise a lot of money. We've raised, 
essentially, two million, and we have another million to go, 
and we are borrowing a couple of million. We will share the 
clinic with CEI, providing many economies for both of us. The 
clinic will have housing attached, run by housing people. We 
will not run it. We have signed up with the housing entity to 
say that if your residents want to use our services, they can, 
but we're not providing services free to these people. We're 
here for support, to be sure. The nonprofit senior housing 
operation we're dealing with will in turn give our clients 
first priority for empty units. So that when one of our 
patients gets into a housing bind, there is some place to put 
them. 

Can you buy that housing for them? 

Since it's HUD-financed housing, they can go in as renters. 
You don't have to buy anything for them. They have to meet HUD 
eligibility in any case. There will be forty such units, and 
people in those units have the option of using Over 60 services 
or not. The way it's set up presently, they are not bound to 
use Over 60, but it's downstairs, which is convenient if they 
like it. They can also belong to any of the seven senior HMOs 
we contract with and use Over 60 as their customary source of 
care. 

Are you pleased with the design of that project? 

Yes, I think it will do something that is rarely done; it puts 
together a lot of different services. The gains to the 
residents should be tremendous they will be able to have 
health care and housing at the same site. 

But it's not for everybody; with forty housing units, how 
far do you go? The clinic can service ten thousand people. 
Presently, the Over 60 "s clinic services maybe four thousand. 
Then there's the issue of can you do it all in one place? 
These are old people, so there's a limit to how useful any one 
site can be for people who have mobility and transport 
limitations. 



And the in-home care? 
itself? 



Is that workable? And does it prove 



Well, it is part of what we do, and if you do a job for your 
patients at their home and have somebody to help with the 
groceries or the cooking or the visiting or checking on 



378 



temperatures, or whateverit ' s a tremendous difference, 
because without that, maybe this person has to be put in a rest 
home or a nursing home. 

Crawford: It's really kind of going back in time in a way, isn't it? 

Blum: Yes. There isn't any doubt about its utility, but many of the 
HMOs at the very same moment are carving out mental health. 
You've got a mental health problem? Well then, you'll get care 
for this from another organization. So your doctor doesn't 
even know where you're going. In Over 60 the same doctors are 
providing or seeing that all the care gets put together. They 
work as a team with social workers, psychologists, mental 
health workers, volunteers all sit down and go over each 
patient's record as needed. They use outside specialists as 
needed, but keep control of the patient. 

Some people don't need a lot of these services, but when 
it's needed, it's critical. The staff spend a half a day a 
week just going over the cases of people they serve in common. 
Sometimes it's just two or three workers, sometimes it's four 
or more. The folks who do the home visiting are often 
critical. Decisions are made about what is to be done, who 
will do what . 

Last year Over 60 joined forces with several other 
Berkeley-based similarly focused clinics serving the poor, 
uninsured, homeless that also serve infants, children, families 
and pregnant women as well as homeless and AIDS patients. The 
name of these combined entities became Lifelong Medical Care in 
1997 and we are currently struggling harder than ever to meet 
the constantly increasing portion of the population that has no 
health care coverage, the typical American health care scene 
after "Welfare Reform" of 1997. 

I visited lots of clinics like this when I was in Canada 
that were doing a lot of exciting things. Of course, 
everybody's covered in Canada, so you don't have to worry about 
the money for it. 

Crawford: Fully covered? 

Blum: Fully covered. They're covered for mental health, and physical 
health, and social needs, up to a pointnot as clearly for the 
social, but it's pretty good, compared to here. 

Crawford: They don't have an enormous homeless problem? 



379 






Blum: 



Crawford : 
Blum: 



Crawford; 
Blum: 



No. And they don't have a folks-without-health care problem. 
Every fourth child in California, every fifth person overall, 
doesn't have any source of care. Well, it's unknown in Canada, 



and that's why I was looking at Canada, 
pieces together. 



They put all the 



I visited one place in Calgary, a clinic that services the 
senior housing, and the same clinic also services young 
families and the community at large. The same bus driver 
brings in families, children, old people. The bus driver on 
occasion is part of the care team that discusses families with 
serious problems. Sometimes it's the bus driver who has a 
critical role. He can tell you that this patient is not able 
to walk up into the bus anymore- -well, this is critical 
information. Such a health center uses less resources than we 
do in the U.S. --much less and provides more meaningful care. 
They actually look at what they're doing, and they put the 
pieces together. On Lok does the same things. 

That's because it's community oriented? 

People oriented. Community oriented also implies doing things 
that make the community healthier, e.g., safety, housing, air 
pollution, jobs, good health education. All services are 
combined in some provinces. The best I know is Manitoba, and 
Quebec to some degree. This was Calgary, which is in Alberta, 
which is not famous for putting things together, but this 
clinic was putting it together. They had the authority to put 
it together. 

To see this Indian bus driver at work, and this was no 
Indian community, this was Calgary, building on his 
relationship to an Indian family. He had information that 
nobody else had. This is what the team had to have to give 
relevant medical care. It was very much cheaper too. Mind 
you--I keep repeating thiswhen care is typically piecemeal, 
as it is in the U.S., we find that 50 percent of prescriptions 
are not taken in a useful manner or not taken at all. 

Is that a fact? 

Yes. About half of that 50 percent are not even purchased, and 
another half are never taken as prescribed--50 percent. So how 
about all the work that went into the examination and the 
history and the x-rays and the tests? They result in a 
prescription that is thrown out half the time, which means that 
we're just wasting medical care money. The issue is how about 
all the work that went into producing that apparently 



380 



irrelevant prescription, and why was it irrelevant to the 
person it was specifically prescribed for? 

Crawford: So they will eventually be back for treatment. Are 
institutions like On Lok and Over 60 rare here? 

Blum: There are a handful of other On Loks now. They are 

replications of On Lok, and there are a handful of other 
organizations that tried to do this, but not very concisely. 
They sort of did it by accident. Remember that one of On Lok's 
founders, the person who had the idea for it, was a hospital 
architect and a professor here at UC Berkeley--Roz Lindheim. 
Before On Lok, she made her career building hospitals and came 
to feel that most patients could be kept out of them, to 
everyone's benefit. 

Roz really hated hospitals. She knew from just visiting 
that that wasn't the right way to treat peopleto put them in 
the hospital. She was strong on educating patients so they 
would understand why they were ill and what it would take to 
get well and stay well and educating the health professions to 
care about and learn about the needs of their patients. 

Crawford: Isn't managed care getting us anywhere? 

Blum: There is no managed care anywhere I know of--it's all managed 

money. Don't get confused by the name. On Lok and Over 60 are 
the exceptions. 

Crawford: Okay, managed money. 

Blum: You see, managed care suggests they're really looking at me or 
you for what we need and what we know. 

Crawford: Nobody's looking at you? 

Blum: Nobody's looking. Managed care is looking at money, and how to 
cut the cost. So, that's it. Nobody checks things such as the 
unfilled prescriptions. It is the research studies that bring 
those things out. 

Crawford: But is that something we can check? 

Blum: Of coursewhat proportion of prescriptions are filled? Before 
you came in, the medical student who was here invited me to 
give the closing speech at their graduation for this year. He 
wants his class to hear about my view of why they are here. He 
is here to do something dif ferent be interested in patients 
not just their lab work or their insurance, but to really 



Crawford: 
Blum: 



Crawford : 

Blum: 



Crawford: 



Blum: 



Crawford: 



Blum: 



381 



listen to them. What makes a real doctor, as far as I'm 
concerned, is the ability to care about people enough to find 
out what's bugging them and thus what they need. 

I think we all feel this- -we 're on our own. 

We're on our own. I know very few exceptions, and some of the 
people that I think are getting the last word in technical 
medical care are getting no care at all. Most doctors are not 
paying attention to patients. They don't relate to them as 
people, they relate to their specific illnesses as though it 
stands apart from the patient. 

But why? They used to, it seems to me. 

Yes, well, they didn't have all this distraction of an endless 
stream of new scientific tests. Maybe that's what you're 
really hinting at. I don't know. I'm used to the distraction, 
but I still like to think about how the patient is doing. 



honor that they want you to speak, because they have 



It is an 
questions 



That's why they're here, but they could get it knocked out of 
them in short order, too. On the other hand, we probably 
couldn't ruin them, because they're highly self-selected as 
persons and for their concern with people. 

It would be an interesting study for one of your students to 
talk to their patients and find out, ten years down the line, 
how they felt about their treatment. 

It should be done. They're working on it. The student who 
asked me to speak wrote the dissertation for his masters thesis 
about the way they were learning here, and its relevance. This 
is the first student that's ever done this--our approach has 
been assumed to be good, because our students do well at UCSF. 
But maybe they would have done well at UCSF, anyway. You see 
what I'm saying? 



A Hypothetical Health Care Study 



Blum: I once drew up a research project for the medical school in 

which I was concerned with, "What are we doing?" I got a lot 
of UC Berkeley researchers together to think about it, but 
nobody wanted to work on that project because everybody wanted 



382 



to work on their own project--! mean, that's UC Berkeley, you 
do your own thing. 

It was to look at a group of students in the Joint Medical 
Program and take a comparable group at UCSF--because there are 
equally good students at UCSF with exactly the same goals in 
mind as those who get in here. You could find a group who say, 
"Yes, I'm concerned with health care for all kinds of people, 
particularly for the disadvantaged people," and so on. Then 
you could see how well both groups did as doctors. This sounds 
simple, but in the first place, how do you match these people? 
You've got to look at their background, the racial situation, 
their economic and social background. 

Crawford: Very difficult, so many variables. 

Blum: That's right. You've got to look at their parents are they 
professionals on and on and on. Then, what kind of schools 
did they go to? You could take a hundred of ours and a hundred 
of UCSF's, but you really have to take several hundred from 
each to get a picture. 

Then, how do you prove how good they are as doctors? How 
well they graduated? Did they get honors at UCSF? That's 
crap. There are solid studies showing that we don't even know 
how to pick medical students and that we don't know how to 
judge them on their way through medical school. Grades don't 
really mean that much. 

The first inklings you start getting about quality is when 
they're residents. Then observers can say, "This person really 
is a good doctor," and their patients are responsive. Some of 
that is diluted by the fact that some of them are very good 
with their hands, they're superlative technicians. There are 
all sorts of things that make a good doctor. So who does the 
judging? The faculty or peers of some sort? Probably peers. 

Probably the point at which you can really judge them is at 
the end of their residency, at which point, historically, there 
are enough studies to show that what other physicians think 
about the resident's capacity as a good doctor is typically 
related to what doctors think of doctors ten years into 
practice. But, again, that has some shakiness. Why doctors 
think of other doctors as being good is a very peculiar thing. 



Blum: Let me give you an example of doctors judging quality of other 
doctors. An aunt of mine living on the Peninsula needed a 



383 



gynecologist and asked me for advice. I called a prominent 
physician friend of mine who had practiced in the area for many 
years for a reference. He recommended an ob-gyn who had not 
too many years previously delivered his two children. My 
aunt's surgery went well and she subsequently asked me to thank 
my friend for the reference. 

When I called him he asked whom he had recommended, and 
when I told him, he exclaimed "That butcher." I said, "Wait a 
minute, he delivered your two children, and three months ago 
you recommended this guy." His response was, "I just went to 
surgery with him on a traffic victim and it was clear to me 
that he was just a butcher." "So, how come you used him for 
your family and referred cases to him if you knew nothing about 
his capabilities?" I wanted to know. "Oh, that was simple, I 
played poker with him for years, a marvelous player, and was he 
ever hot on investing in oil wells," was the answer. 

I think that our judgment of whom to admit to medical 
school is not as ridiculously flawed. But since each 
interviewer uses what are ultimately highly personal criteria 
for judging a candidate's probable future quality as a doctor, 
it is no wonder that qualified interviewers frequently disagree 
thoroughly. Fortunately, no one gets to be an interviewee who 
isn't a high achiever, so no matter which ones get selected, 
they don't do badly, apparently. 

When UCB had a large Ford Foundation grant for placing 
fellows in India, I remember very well writing a rather 
circumscribed letter for one of my students. He was okay, he 
wasn't super. A few weeks later I got an excited call from the 
selection committee asking that I tell him that his acceptance 
had been a mistake. He had been placed on the "do not pass" 
list but that list had become confused with the "do pass" list. 

I refused the honor of so informing him and suggested that 
the persons making the error do the telling. This they 
declined to do, the acceptances stood, and all the do-not-pass 
students went to India. Everyone involved in India and here 
ended up being quite happy with the fellowship candidates and 
their performance in India. Quality can be hard to ascertain. 

** 

Blum: In any case, I gave up on a study. I was not the proper person 
to do it, our medical school was not sure of survival, money 
could not be attracted to do the task here. A request as to 
whether they might be interested was sent to the Robert Wood 
Johnson Foundation, but must have ended up in the wastebasket. 



384 



Now that same organization is putting in ten million 
dollars into each of various medical schools to do all the 
things that we're doing here. It's identicalconcerned with 
students, and so on, so forth. 

Crawford: They are creating programs? 

Blum: Yes, but no clear approach is made for evaluating what really 
results. And the Pew Foundation came up with similar 
recommendations. So, we can say that we're doing what these 
two outfits would do, but it would be good to look back to see 
if it all made any difference in the quality of physicians and 
to the health care delivered. Far from a simple task, however. 

The professor who heads up the JMP now is a researcher, 
which I really wasn't, and is very oriented as to how to make 
academia work, while I'm sort of hostile to academia because I 
regard much of it as puffery. The number of studies that come 
out of a university this size about anything that it has 
contributed to increase the value of their students to society 
is pretty limited. 

Crawford: What has contributed to the value of the students? 

Blum: What have we done to help students to do something of use to 
society? We can tell you what kind of incomes they make. We 
can tell you the high offices they've gotten, but some of those 
incomes and high offices are with some truly horrible 
organizations, not necessarily a credit to a university and 
hardly a help to society. 

Crawford: So you don't feel that you've directed the students very well? 

Blum: That's not the issue. In this university, we don't know, and 
generally seem not to care how well we prepared them to add to 
society's well-being. I doubt if many universities do much 
more. 

Crawford: How about your students? Do they keep in touch? 

Blum: Oh, yes, but that is all anecdotal stuff. The ones that are 

going to keep in touch with me are going to keep in touch with 
me because they and I are on the same wavelength. I'm saying 
there's no concerted attempt to see where anybody has gone or 
where they're going or whether one approach to education is 
better than another in terms of what they contribute to 
society. Medical schools do better at that, by and large, than 
universities. I was going to try to do something with our 



385 



group, here, but the support for it, obviously, was lacking at 
the time, and it's not an easy task. 

Crawford: I see what you're saying. 

Blum: UC Berkeley likes to brag: we've got Nobel scholars. Well, 
that's hardly the issue. 

Crawford: Anybody from your department get a Nobel? 
Blum: Not that I'm aware of. 



Awards and Afterthoughts 



Crawford: You've gotten about all the awards there are to get. You've 
certainly gotten all the public health awards. Let's talk 
about the Sedgwick Award because that's the biggest one, I 
think. 



Blum: In our field, yes. 

Well, I think I mentioned to you that I got another award 
in the same year, maybe six months, nine months earlier, from 
the American Health Planning Association: AHPA. I went East in 
June and received the award. It's not a big organization, but 
it was what there was in health planning, and I received a 
beautiful statuette in the name of one of the key figures a 
young man in the field who perished too young. That was very 
nice, I was very pleased. 

They told me, "We're going to re-present the same award to 
you at APHA in the fall," because many organizations in the 
health field gather when APHA gathers. There are at least a 
dozen organizations that come together with APHA because their 
membership also belongs to APHA. 

Then I got a letter from APHA, saying, "We hope that you 
will accept this award and will be present." I thought, Well, 
that's nice of them, but they're a little behind the times. 
I've already accepted this award from AHPA. and I know they're 
going to present it at APHA, so I never did anything about this 
letter from APHA. 

One day nearly a month later I was cleaning off my desk, 
and I find this letter. I start to read it again, and it says, 
"You have been chosen for the Sedgwick Award." I said, 



386 



"Jesus." I mean, that's not the same award; this is another 
one. I'd better start looking at this. I'd never responded, 
[laughter] It had been there for weeks. So, I thought, Sit 
down slowly, because this doesn't happen very often. This is 
the one people like me don't get. 

Crawford: So, it was a surprise? 

Blum: I read on, and there's a list of all the people that have 

gotten it. I would be at the head table for this but am not 
expected to say anything. I think one can say, "Thank you." 
And would I be willing to wear a tuxedo--it was requested but 
wasn't required. That has never ceased to bug me, that APHA 
should want its highest award to go to someone attired in 
upper-class trappings. 

Crawford: What is that? 

Blum: That it was even suggested that I wear a tux. I'm in the 

American Public Health Association: our goals are not to take 
care of the folks who wear tuxedos. 

Crawford: Good point. 

Blum: Our goals are to take care of folks who can't get enough to 
eat, basically, or health care. So I thought, Oh, I've been 
such a thorn in the side--I was going to say 'pain in the ass' 
--over the years to that organization and others, that I will 
not disrupt them once more. I'll go, and I'll wear a tux--or I 
could go and not wear a tux. I'll think about that. 

I wrote and accepted and got the two awards at that annual 
meeting: one from AHPA, re-presented at APHA; and the Sedgwick. 

One of the people that helped me to get it I just had 
dinner with last night, a Japanese woman. She and one of the 
tallest, handsomest black women I've ever seen came to meet us 
at the airport in a limousine--one of those stretch things--! "d 
hardly ever seen one before. My wife and I get off at Dulles, 
and there it is, picking us up and bringing us into town. I'm 
used to riding three or four abreast in a taxicab or a bus, so 
it was fancy for us. There were no drinks aboard, though it 
was one of those cars that was fitted out for everything. 

Before we left here, I did rent a tux. I said, "Well, I'm 
not going to bug anybody there. I'm being very nice, so I'll 
put up with this, and if I have a speech to make, I'll keep my 
mouth shut about tuxes. I'll be good for the first time in my 
life." 



387 



Crawford: 
Blum: 



[laughter] Why would you change at that point? 



Crawford: 
Blum: 



Crawford: 
Blum: 



Well, I've thought about that 
always creating miseries for 
an award at the State Health 
Award for something or other, 
and said they were so pleased 
that I was somebody who had 
afflicted the comfortable." 
really saying it well. Since 
Stevenson coined that phrase 
president. 



since, I guess because I am 
people. Just the other day, I got 
Department, a Beverly A. Meyers 

and somebody had written a letter 

that I was getting this award, 
comforted the afflicted and 
[laughter] And, you know, that's 

then I've learned that Adlai 
about the time he was running for 



You need that on a plaque somewhere . 

My award is a plaque, and it isn't on there, but I thought that 
was very good. Last night, when I went to a health officer's 
banquet to tell them what being a health officer was all about 
forty, fifty, sixty years ago, they repeated that same comment, 
because the state health officer was there who had given me the 
award the week before. 

But it does get monotonous that you're always a sore thumb, 
and it's easy to be a sore thumb. You don't have to be clever 
to find something serious to gripe about. So I let the tuxedo 
go, but I did inquire, afterwards, of someone on the committee 
that had picked me, "How come? I can think of twenty people 
that really had this medal coming, certainly more than I did? 
I could just go down the list, and find people who have done 
great things." 

He said it wasn't a tough decision. He used to be a health 
officer in California, and I had invited him a few times to 
come here to the school and teach because as I've told you 
there's nobody in the school who knows all about public health 
departments or their works. 

In fact, I brought that up when Dean Buffler was there. I 
said that if any of those people in the audience (who were all 
health officers) thought they were going to learn anything 
about health departments in the School of Public Health, they 
were crazy. There's nothing here. There's not a single 
faculty person who knows anything about a health department. 

What did the dean think of that? Pretty strong comment. 

I don't know what she thought. She was sitting right alongside 
of me. I said they should think of stuffing me when I die and 
putting me in the hall so the school would have somebody who 



388 



had actually been through the mill and knew something about the 
field. [laughter] 

Crawford: Your idea is that these people are too theoretical? 

Blum: They're not just theoretical. They're so limited subject- 
matter-wise, they've never been near a health department. They 
might be able to go and advise someone about an epidemic of 
rabies, or innumerable other health issues, but that doesn't 
have anything to do with doing the job in a health department. 
To be effective you've got to go to the board of supervisors, 
the citizenry, doctors. Running a health department is 
relatively complicated. Nobody here knows anything about that, 
or cares. There were four of us here, in my time, who had ever 
seen a health department. Warren Winkelstein had run the City 
of Buffalo Health Department, I ran Contra Costa County. Bill 
Reeves had innumerable contacts with them statewide. 

Crawford: You didn't say much about Winkelstein as dean. 

Blum: No. We saw eye to eye on many things because we had the same 
background. Then Joyce Lashoff had been a state health 
of f icer--those are the only four. So that students since 
Joyce's retirement may have never seen a health officer. The 
professors around now have rarely been in a health department. 
That tells you something about what is taught, and that was 
part of my message last night. 

Crawford: Is that true with all the schools? 

Blum: True with almost all of them. Just last week I saw an article 
by a professor from someplace or other in the monthly American 
Public Health Association publication saying exactly the same 
thing, that there's no evidence of being able to learn anything 
about public health departments in a school of public health. 
You learn some of the theoretical underpinnings. True, at a 
place like Harvard you can learn a lot about society and the 
causes of illness. 

That's new, though. When I was at Harvard, nobody had ever 
heard of the relationship of social and economic affairs to 
healththey never talked about that. Now Harvard School of 
Public Health has teamed up with WHO, and they have given 
serious consideration about what is necessary to improve 
healthand it isn't just teaching people to stop smoking. 
It's the whole business of economics, culture, education, and 
so on. 

Crawford: That's what they're looking at? 



389 



Blum: They're starting to look at it at Harvard, now. It does my 

heart good. WHO and Harvard have teamed up on a whole new way 
of examining community health, which I, in my textbook on 
planning, started doing. They're putting the whole School of 
Public Health to work on it, and it's exciting. So there's a 
change in the air, but the crux of the matter is that almost 
nobody else in the U.S. is looking at what happens to such 
efforts or attempting to apply the new knowledge. 

it 

Blum: Anyhow, going back to the member of the selection committee, I 
asked him how come I got this award, because we both know that 
there are at least twenty people floating around that we can 
think of that really deserve the Sedgwick by the usual 
standards. 

He said, "Oh, it wasn't hard. I'll tell you, it was a 
cinch. We sat down to have this awards meeting, and somebody 
raised your name, and that was it. It was all settled." 

I said, "How come?" 

He said, "Well, there were a lot of your ex-students, and 
others who had a reason to be interested in the things you were 
doing. They happened to be there, and that was that." 

But really, I had no excuse for getting the award. I guess 
that's the basic thing, but I felt very good about it. I think 
Joyce Lashof had a hand in it, because she was about to be 
president of APHA. I had a feeling that there were enough by- 
accident circumstances that really generated support. 

Crawford: I imagine it was your students. 

Blum: It could have been, yes. That's what this fellow said. 

Crawford: You've gotten many awards, and given some. Today as I was 

coming in, I noticed that the Henrik Blum Award nominations are 
being taken and considered now. 

Blum: Oh, that's from the School of Public Health. There's not much 
to be said about that. One of the founders of that effort was 
Mike MacDonald, who was one of my students. He is now the 
executive director of the Koop Foundation in Washington. 

Crawford: Is that associated with Everett Koop? 



390 



Blum: Yes. He works directly under him. Mike was a communications 
nut and a combination businessman-PR man and wanted to apply 
his knowledge to further the public health. When he was here, 
there weren't too many people who were really willing to listen 
to Mike. I was, and he and I had a few interesting experiences 
in looking at the future of health and health care. 

We tried to set up a course, some years ago, on computer 
literacy. I'm not computer literate, and it means nothing to 
me, because I can always get people to work with me who are. 
But it's a critical tool today for students and practitioners 
of almost every field, certainly public health. 

Well, Mike has ideas and Mike has capacity to do all kinds 
of things. In any event, Mike and I decided that every student 
going through the School of Public Health should be computer 
literate this was fifteen years ago. 

We set up a scheme that was going to cost each student 
fifty dollars, and we got the School of Education to loan us 
their lab, and we got their instructors for free. It was all 
set to roll, but the folks in our division of statistics lost 
their cool. They thought they should control it, and they 
insisted, I guess to Joyce Lashoff , that they were going to do 
it. I mean, let's not have dumbbells like me, who know nothing 
about statistics or computers to get involved. And they killed 
it. So they never had such a course. Fortunately, now all the 
students come in computer literate. 

When Mike graduated, I gave the commencement speech for 
their class. It was a nasty speech to the effect that there 
was more to being a professional than making a good living and 
peddling the crap you learned at school, that you had better 
look at your customers and see what they need. That's being 
professional. You put their needs ahead of yours, otherwise 
you're no professional. 

Mike got the ball rolling on my award and the framed 
picture you saw in the school. It shows a lot of hands of 
different colors and shapesmen and womencrossing hands and 
I think mine are in there at the bottom of it, and Mike's. I 
have a copy of it hanging on my wife's desk at home, but it's 
also been, for years, hanging in the display case in the School 
of Public Health hall when this time of year comes along. 

That picture was related to the award. It was combining of 
hands, interests, and sharing, which Mike learned wasn't 
universally popular. Then Dick Bailey who was an economist I 



391 



brought on the faculty years ago, with some effort- -glued the 
award all together, and each year they've been giving awards to 
a student who matches the committee's notion of my ideals. 
I've never had anything to do with it. They're making a choice 
now, and at the commencement somebody will get that award. I 
don't typically go to commencements if I can avoid it, so I 
won't be giving the award. 

Crawford: Do you know where these students have gone from here? 

Blum: Not really. This pretty well happened about the time I 

retired, and I did know them then, but I no longer do. The 
recipients sometimes come to see me, and sometimes they don't. 
A lot of them don't even know I'm alive. That's not the goal, 
really. Some of the craziest people get that award, as I 
learned. And some marvelous people. [laughter] 

Crawford: Depending on who's doing the deciding? 

Blum: No, they're using the same criteria, and on paper people match 
certain criteria. I ran into one of them on a very extensive 
basis afterwards. It was just as disheartening as could be. 
The person really meant well, but did some awful things, yet 
did a lot of good things, too. Really meant well, but short on 
judgment . 

So you know, I was sorry that I'd met the person. Not that 
it did me any harm, but I would like to have the delusion that 
the awardees were always super, super. [laughter] 



Reflections on a University Career 



Crawford: Any final thoughts you would add? 

Blum: My failure to go along as a happy member of whatever 

environment I was a part of was never much of a secret. Yet I 
was hardly to be classified as an outcast, in part I suspect 
because I wanted the good things for everybody that everybody 
always claimed to be in favor of. The difference was primarily 
that I really wanted them, and when social justice, equity, or 
fairness issues seemed to be getting short shrift, I was 
willing to fight for those who were being shafted. I also did 
at least my share of whatever jobs were necessary as well as 
those required to make the environment a more fair one. 






392 



When I came to the university I again took seriously the 
duties attached to teaching, grievously slighted in many 
quarters in the race for academic prominence. I remember being 
scoffed at for having office hours on at least three days a 
week, literally being told that the incompetent hid under the 
guise of being available to students. In our work with areas 
of social significance it was clearly an advantage to see and 
hear about the world from the perspectives of students who had 
quite as real encounters with realities as anyone else. The 
awareness of and concern for their problems was quite as 
educational for me as my accumulated so-called wisdom was for 
them. 

Again, this approach to teaching marked me off as atypical, 
potentially a trouble maker, and sure enough, I was promptly at 
odds with the image-builders on the faculty, whose proclaimed 
goals often seemed insincere, as they were not even being 
pursued. This brought me up against what I called the 
pretentiousness if not fraudulence of many faculty as well as 
of our institution. 

My distaste for Academic Senate activities, in view of my 
dislike of the gross indirection and hypocrisy which were so 
obvious there, to be sure, interspersed with occasional 
brilliant pieces of work, were, I suspect, hardly noticed by 
anyone but myself, for the vast majority of faculty, for 
whatever reason, were likewise inactive in the Senate. My 
excuses to myself were not new ones. I couldn't survive in 
that organization, it turned my stomach, and if I strove to 
reform it that would be beyond the scope of my capacities or it 
might well be impervious to direct attack anyhow, which I had 
learned from watching the failures of other disgruntled 
characters like myself. 

This brings me to the need to explain my overall 
satisfaction at being at UC Berkeley in spite of my apparent 
numerous dissatisfactions with the institution, all the way 
from my being forced out of my intended engineering career at 
the age of fifteen for lack of a transit, to my decision to 
work hard for the transformation of medical education, with 
some success of my efforts as evidenced by the general switch 
of medical education in line with our rump group's dreams for 
health and medical sciences, begun in 1972 at UC Berkeley. 

I had to learn that the university community is no better 
or worse than any other collection of people. In spite of 
being achievers in arts, letters, and science, there are among 
them plunderers who steal ideas from students. There are 
racists, megalomaniacs, and those who would happily make the 



393 



earth uninhabitable in the course of extending their successes. 
My anticipations instilled in childhood that the academic 
achievers would be noble citizens died hard. But once 
expectations were overcome, I took satisfaction in absorbing 
from and conversing with those who also meant to do good. 

Having been asked hundreds of times by prospective students 
and faculty whether they would be happy if they came to UC 
Berkeley, I nearly always responded favorably, with one big 
proviso. They had to be prepared to work without very tight 
guidelines, they would have to choose their own path, watch out 
for only a few basic requirements, and be their own task 
masters. While no one was going to be looking out for them, 
this is one of the largest academic cafeterias in the world, 
and when they did very well they would even be allowed into the 
kitchen to help concoct some of the offerings, and if 
reasonably successful, might go on to creating original recipes 
and attracting gifted students and confreres to work with. 

When these recipes attracted favorable attention outside 
the campus, students as well as faculty would receive entree 
and support in many forms here and elsewhere. 

I guess the attraction is freedom to do your thing if you 
can do it well, and if you can do your minimal share of scut 
work, i.e., duties which aren't particularly relevant to you or 
your unit but which are required if the institution is to 
provide the needed inf rastructural elements of running a 
university . 

My special interests were always in education and in 
training for professional careers, and at the same time, in 
reforming the health, educational, and health-caring 
institutions. By keeping involved in the health care world, 
taking responsible roles in a community hospital, in 
establishing an HMO, in consulting with people in health 
departments, health care institutions, and universities around 
the world, I could bring from and take to such entities as well 
as bring back to my students what was going on and why, long 
before such information would be in the literature. One could 
hardly complain about participating in such fun at either the 
teaching or doing end of my work spectrum. And when the 
opportunity arose, appropriate students could be placed into 
various operating entities. 

Having also been asked a few hundred times whether I have 
been satisfied with my years of work at the university, it has 
been easy to respond that I was lucky, that I came to the right 
place, one that could put up with me, let me do my thing, and 



394 



accept that in my own way I have been of use to some of the 
university's purposes. In fact, I've had one hell of a good 
time, which includes imagining that I have helped others 
towards a satisfying career in institutions that still call for 
plenty of change. 



A Sweet Finale 



Blum: A sweet finale has just appeared for this narrative in the form 
of a most felicitously phrased teaching award from the 1998 
graduating class of medical students at UCSF. This is one of the 
most satisfying awards I ever received. Students continue to be 
my favorite people. 



Transcribed by Caroline Sears 
Final Typed by Shannon Page 



395 
TAPE GUIDE- -Henrik Blum 



Interview 1: January 23, 1997 

Tape 1, Side A j 

Tape 1, Side B 13 

Tape 2, Side A 27 

Insert from Tape 3, Side A [1-28-97] 27 

Resume Tape 2, Side A 35 

Tape 2, Side B 47 

Interview 2: January 28, 1997 

Tape 3, Side A (beginning moved to page 27) 54 

Tape 3, Side B 57 

Handwritten Insert $Q 

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Resume Tape 3, Side B 68 

Tape A, Side A 78 

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Handwritten Insert gg 

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Tape A, Side B 90 

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Insert from Tape 5, Side A [2-3-97] 101 
Resume Tape A, Side B 



Interview 3: February 3, 1997 

Tape 5, Side A 104 

Handwritten Insert 108 

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Tape 5, Side B U 5 

Tape 6, Side A 122 

Tape 6, Side B 1 35 

Handwritten Insert 14g 

Insert from Tape 7, Side B [3-21-97] 149 

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Interview A: March 21, 1997 

Tape 7, Side A 1 58 

Tape 7, Side B 168 

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396 

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Tape 8, Side A 178 

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Tape 9, Side A 216 

Tape 9, Side B 225 

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Interview 5: March 29, 1997 

Tape 10, Side A (beginning moved to page 203) 236 

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Handwritten Insert 280 

Interview 6: April 3, 1997 [note: tapes 12 and 13 mislabeled] 

Tape 13, Side A 282 

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Tape 12, Side A 307 

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397 

Interview 7: May 1, 1997 
Tape 14, Side A 

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398 



SAMPLE i^DITED PAGE 



255 



sta-ci_S-tics gone ke-rs-erk 



.' So we had a wonderful program. in statistics . $ And many of 
trs were left a 1 one^__nxe.t-Ly -mtrcfru as .J- mentioned v Sarah / 

*=*K^i- 



Bowditch and I. 



, ynn knew th"" s "3t"f f 



didn't waste your 



time._Go_do_some thing else. Thatj was the beauty of Harvard. 



lA^*-**tf^ 

You don't have to do jpK. because it's required. If you don't 



-haue t-o 



-i^, 'don ' t do it. 



Y 



Crawford: So it was a fruitful year? 



Blum: 






Oh, it was a good year in many ways. Theo. I made some 

L 




remarkable acquaintances. We couldn't get any ff&fa&*~~ It was 
right after the war was over. CouT3n'l find a place tu blay^' 
e'd heard that from the previous class about a medical 



student who lived in &* great big old house up in 

'^/ 



It was a three-story mansion built by some old gambler. [tape 



ends ] 




3^L ^<^^^ 



garret, where we 



^_^ CT^^C m/yi. 



y -t~i~ 

/^--tf-^l^A-^r-v^ v 




[End Tape 5, Side 
[Begin Tape 6, Side A] 

Blum: 



SAMPLE INSERTED PAGt 



2^Jfefe,^vS^f' *-^> 



rf&&^*L<JC3l 




APPENDIX 



A Henrik Blum Curriculum Vitae 400 

B University of California Oral History Series List 408 



400 



APPENDIX A 
10/01/94 



CURRICULUM VITAE 



HENRIK L. BLUM, M.D. , M.P.H. 

Born: November 11, 1915 in San Francisco, CA -- No siblings 

Married: Marian H. Ehrich, December 25, 1938 -- No children 



EDUCATION 

Grade and Secondary Schools 
University 

Medical School 

Asst. Physician in Medicine 
Fellow in Medicine 
Public Health 



Napa , California 
University of California 

Berkeley 
University of California 

San Francisco 
Johns Hopkins 
Stanford University 
Harvard University 



1937, B.S. 
Chemistry 
1942, M.D. 

1944-45 
1946-47 
1947-48, M.P.H 



HONORS 

Academic 
Sigma Xi 
Phi Sigma 
Alpha Omega Alpha 
Delta Omega 

Diplomate 



University of California 
University of California 
University of California 
Harvard University 



American Ecarc of Public Health and Preventive Medicine 



1936 
1936 
1942 
1948 

1950 



FACULTY APPOINTMENTS 

Clinical Instructor in Medicine 

Asst. Clinical Professor 

cf- Medicine 

Lecturer in Public Health 
Clinical Professor 

of Public Health 
Professor, Community Health 

Planning 
Chairman, Program in 

Planning and Pol icy 
Coordinator of Clinical Studies 

for Health & Medical Sciences 
Chairman, Department of Social & 

Administrative Health Sciences 
Professor Emeritus 
Member, Joint Faculty Committee 
Chair, Joint Faculty Committee 
I nterim Chair 



Stanford University Medical School 

Palo Alto, CA 
Stanford University Medical School 

Palo Alto, CA 

University of California, Berkeley 
University of California, Berkeley 

University of California, Berkeley 

School of Public Health, 

University of California, Berkeley 
University of California, Berkeley 

University of California, Berkeley 

University of California, Berkeley 
UCB - UCSF Joint Medical Program 
UCB - UCSF Joint Medical Program 
Health and Medical Sciences Program 
University of California, Berkeley 
and UCB-UCSF Joint Medical Program 



1950-57 
1957-65 

1951-66 
1966-68 

1968-85 
1970-84 
1972-73 
1980-82 

1985-present 
1989-90 
1990-91 
1991-94 



401 



OTHER APPOINTMENTS 

Intern 

Assistant Surgeon 
Senior Assistant Surgeon 

Chief Preventive Medical Services 
Health Officer 

Member, Committee on Social & 
Physical Environment Variables 
as Determinants of Mental 
Health 

President 

Member, Technical 
Development Board 

Chairman, Chronic Disease and 
Rehabilitation Committee 

Consultant, Ad Hoc Committee 



Member, Special Grants Review 
Committee 

Member, Special Training Grant 
and Review Committee 

Member 



President 

Member, Board of Directors 
Member, Board of Directors 
Member, Governing Council 

Member, Region IX, Regional 
Advisory Committee 

Member, Scientific Group on 
Research in Epidemiology 
and Communications Science 
(and rapporteur) 

Consultant 
President 

Consultant, Health and 
Welfare Planning 



San Francisco Marine Hospital 1942-43 

U.S. Public Health Service 1943-45 

U.S. Public Health Service 1945-46 

San Diego County Health Department 1948-50 

Contra Costa County, CA 1950-65 

National Institute of Mental 1956-65 
Health, Washington, DC 



California Conference of Local 1960-61 
Health Officers 

American Public Health 1960-64 

Association 

American Public Health 1961-64 

Association 

Community Health Services and 1962-63 
Facilities - Surgeon General 
Washington, D.C. 

National Institute of Mental 1962-64 
Health, Washington, D.C. 

National Institute of Mental 1962-6* 
Health, Washington, D.C. 

Governor's Committee on Children 1964-67 
and Youth in Cal ifornia 

Contra Costa Council of 1964-65 

Community Services 

United Bay Area Crusade 1965-68 

Bay Area Social Planning Council 1965-68 

American Public Health Ass'n 1967-70 

U.S. Public Health Service 1968-70 

World Health Organization 1969 



World Health Organization 1970 
Sri Lan-ka 

Northern California Public 1970-71 
Health Association 

World Health Organization - PAHO 1971 
Colombia 



402 



Member, Technical Advisory 
Committee on Pan-American 
Programme for Health Planning 

Chairman 



Member, External Advisory Group 
on Health Planning, Key 
Problem Area of Health Planning 

Member, WHO Expert Advisory 
Panel on Health Administration 

Member, Board of Trustees 
Chairman, Board of Trustees 
Member and Rapporteur 
Consultant 

Consultant, Health Planning 
Member, Board of Directors 
Chairman, Board of Directors 
Consultant 

Consultant 

Member, Board of Directors 

Member, Board of Directors 

Consultant 

Visiting Professor 

Member ana Consultant, Committee 
oh Evolving Trends Affecting Life 

Member, Board of Directors 
Member, Boara of Directors 



World Health Organization - PAHO 
Chile 

Bay Area Comprehensive Health 
Planning Task Force on Personal 
Health Care Delivery 

Agency for International 
Development 

World Health Organization 

Alta Bates Hospital 
Alta Bates Hospital 
PAHO/WHO Task Force 
U.S. -AID Planning, Nepal 
American Samoa 
HEALS (HMO) Corporation 
HEALS (HMO) Corporation 

Health Care System Analysis 
Northern Marianas 

Health Care Planning, Guam 
Alta Bates Corporation 
Western Consortium 

Health Care Planning 
American Samoa 

West China University of 
Medical Sciences, Chengdu 

California Medical Association 

Over 60 Health Center 

Coalition for Elders Independence 



1971-73 

1971 

1972 

1972-86 

1975-85 

1984-85 

1977-79 

1977 

1979 

1978-87 

1984-87 

1980 

1981 
1981-85 
1982-84 
1984 

1987 
1983-1991 

1985-1991 
1994-present 

1988- 



PROFESSIONAL AFFILIATIONS 

California Public Health Association 
American Public Health Association 
Alameda-Contra Costa Medical Association 
California Medical Association 



403 



AWARDS 

Resolution of Commendation 1984 - California State Assembly 
The Berkeley Citation 1984 - University of California, Berkeley 
The Richard J. Schlesinger Achievement Award 1985 - 

American Health Planning Association 

The Sedgwick Memorial Medal 1985 - American Public Health Association 
The Apollo Award 1986 - American Optometric Association 
Fulbright Scholarship to Sweden, 1986 

Vice President (USA) 1990 - American Public Health Association 
President-Elect and President, Delta Omega, National Public Health Honor 

Society, 1989-1992 

PUBLICATIONS 

Mahoney, J.D., C.J. Ven Slyke, J.C. Cutler and H.L. Blum, "Experimental Goncccocai 
Urethritis in Human Volunteers," American Journal of Syphilis, Gonorrnec, & 
Venereal Disease, 30:1, 1-39, January 1946. 

Blum, H.L. and C. Barnett, "Prognosis in Late Latent Syphilis," Archives of 
International Medicine, 82, 393-409, October 1948. 

Blum, H.L., W. Chiapella and A.W. Lesem, "The 1948 Epidemic of ' Pol iomyel itis in 
San Diego County, California," Stanford Medical Bulletin, 7:4, 169-179, 
November 1949. 

Milmore, B., H. Flanders, H.L. Blum and M. Mills, "Screening Tests for Diabetes 
Detection," California Medicine. 78:1, 37-43, January 1953. 

Josephi, M. and H.L. Blum, "Rural Areas Need School Lunch Program Too," The 
Nation's Schools, 57:3, 100-108, March 1956. 

Blum, H.L. and M. Josephi, The Brentwood School Health Study. Monograph. 

Martinez, California: Contra Costa County Health Department, December 1957, 
pp. 47. 

Graham, B.S., H.L. Blum and T.W. Green, "Immunization Against Tetanus and 
Diphtheria with Special Combined Toxoid," Journal of the American Medical 
Association, 166:13, 1586-1687, March 29, 1958. 

Blum, H.L. and W.A. Ketterer, "A Health Department's Activities in Mental Health," 
Public Health Reports. 78:7, 619-626, July 1958. 

Josephi, M. and H.L. Blum, "School Health Education Can Be Evaluated," 
California's Health, 16:5, 33-40, September 1, 1958. 

Blum, H.L., H.B. Peters and J.W. Bettman, Vision Screening for Elementary 

Schools: The Orinda Study. Berkeley, CA: University of California Press, 
1959, pp. 146. 

H.L. Blum, H.B. Peters, J.W. Bettman, V. Fellows, F. Johnson, "Design and 
Evaluation of a Vision Screening Program for Elementary School Children," 
American Journal of Public Health. 49:12, 1670-1681, December 1959. 



404 



Stadt, Z.M., H.L. Blum, E.E. Barney and E. Fletcher, "Contra Costa County 
Fluoridation Reports," Journal of California State Dental Association and 
Nevada Dental Scoiety, 36:4, April 1960. 

Fletcher, E. and H.L. Blum, "The Pittsburg [California] Study: A Report of 
Information Available in a Local Health Department on a Census Tract Basis," 
Journal of Indian Medical Profession, 7:4, 3196-3200, July 1960. 

Cavender, C. and H.L. Blum, "As Citizens View Us," California's Health, 18:18 
1-2, March 15, 1981. 

Cavender, C. and H.L. Blum, "Listening to Volunteers," Adult Leadership, 10:6, 
163-164 & 188, December 1961. 

Blum, H.L. "A Community Approach to Rehabilitation: Experience in Contra Costa 
County," in Health Education in Medical Care: Needs and Opportunities. 
Reported of a seminar conducted in 1962 by the Health Education Division, 
Berkeley, California: University of California, School of Public Health, 
Health Education Division, 1962, pp. 91-95. 

Blum, H.L., F. Hesse and G. Kent. Childhood Acquisition of Tuberculosis Infection," 
Alameda-Contra Costa Mecial Association Bulletin, 18:5, 26-27, May 1962. 

Cavender, C., H.L. Blum and E. Fletcher, "Neighbor-to-Neighbor Safety Education," 
Public Health Reports. 77:6, 511-517, June 1962. 

Blum, H.L., The Multipurpose Home Visitor: A Family Specialist. A Report to 
WHO of Observations and Elicited Attitudes about the Utilization of Such a 
Home Visitor in Four European Countries. Martinex, CA: Contra Costa County 
Health Department, January 16, 1963. 

Blum, H.L., F. Hesse, G. Kent and D. Lichtenstiger , "A Tuberculin Testing Survey 
of a School-Age Population in Eleven Areas in California," American Review 
of Respiratory Diseases, 87:2, 181-199, February 1963. 

StatJt, Z.M., H.L. Blum, G.W. Kent, E. Fletcher, G. Keyes , and L.A. Frost, "Direct 
Mail Dental Motivation of Parents of Three-Year-Old Children," American 
Journal of Public Health. 53:4, 572-581, April 1963. 

Messenger, M.B., A.E. Bonestell, H.L. Blum,, A.S. Browne, M. Kindley and J. Flett, 
"The Transmission of Hospital Staphylococci by Patients to Household 
Members," The American Journal of Hygiene, 78:3, 310-324, November 1963. 

Blum, H.L. and A.L. Leonard, Public AdministrationA Public Health Viewpoint, 
New York: The Macmillan Co., p. 522, 1963. 

Blum, H.L., and P.F. O'Rourke, "Children of .Families Who Follow the Crops-- 
A Responsibility for Public Health" (editorial), American Journal of Public 
Health, 54:3, 520-521, March 1964. 

Blum, H.L., "Urge National Task Force on Migrant Farm Labor," Public Health 
Reports. 79:3, March 1964. 



405 



Jolly, E., H.L. Blum, G. Keyes , and G. Smith, Experience of Public Health Nurses 
in Obtaining Family Pedigrees," Public Health Reports, 80:1, 41-46, January 1965. 

Jolly, E. and H.L. Blum, "Genetic Counsel ing--A Health Department Service to 
Physicians," California Medicine, 103"5, 330-333, November 1965. 

Blum, H.L., "The Multipurpose Worker-- A Family Specialist," American Journal 
of Public Health, 56:2, 188-190, February 1966. 

Jolly, E. and H.L. Blum, "The Role of Public Health in Genetic Counseling," 
American Journal of Public Health, 55:2, 186-190, February 1966. 

Blum, H.L. and G. Keranen, Control of Chronic Diseases in Man. New York: 
American Public Health Association, p. 192, 1966. 

Blum, H.L., "Research into the Organization of Community Health Service Agencies 
An Administrator's Review," Milbank Memorial Fund Quarterly, 44:3, Part 2, 
52-93, July 1966. 

Stadt, Z.M., H.L. Blum, G.W. Kent, E. Fletcher, G. Keyes, and L.A. Frost, 
Socio-Economic Status and Dental Caries Experience of 3911 Five-Year-Old 
Natives of Contra Costa County, California," Journal of Public Health 
Dentistry, 27:1, 2-6, Winter 1967. 

Blum, H.L., R. Whal , G.M. Lemon, P. Jornlin, and G.W. Kent, "The Multipurpose 
Worker and the Neighborhood Multiservice Center: Initial Experiences and 
Implications of the Rodeo Community Service Center," American Journal of 
Public Health, 58:3, 458-468, March 1968 

Blum, H.L. and Associates, "Notes on Comprehensive Planning for Health," 
San Francisco, CA: American Public Health Association, October 1968. 

Susselman, S. and H.L. Blum, "Origins and Progress of a Mental Health Program," 
in Mental Health and Urban Social Policy, Duhl , L.J. and Leonard, F. (Eds.), 
Jossey-Bass, Inc., 1968. 

Blum, H.L. "The Dimensions of Health Planning and Data Requirements To Acccrrmodate 
Health Goals in Development and Implementation of Physical Planning." Selected 
papers from American Society of Planning Officials National Planning Conference, 
San Francisco, May 4-9, 1968. 

Blum, H.L. and Associates, "Health Planning 1969," San Francisco: Western Regional 
Office, American Public Health Association, 1969. 

Blum, H.L., Eleanor Kunitz-Sully, "What Is Comprehensive Planning for Health?" 
Inquiry VI:2, 3-16, 1969. Reprinted as Chapter 6 in Levey and Lumumba, Health 
Care Administration, Lippincott, 1973. 

Blum, H.L., "Barriers to Manpower Mobility and Utilization," Journal of the American 
Optometric Association, 42:12. November 1971. 

Blum, H.L., "Background Paper." Prepared for the Expert Committee on Training 
National Health Planning, World Health Organization, Geneva, December 1969. 



406 



World Health Organization, "Report of the Scientific Group on Research in 

Epidemiology and Communications Science," October 12-16, 1970. Henri k Blum, 
Rapporteur. 

World Health Organization Expert Committee, "Training in National Health Planning," 
WHO Technical Report Series No. 465, 1970. Henrik L. Blum, Consultant. 

Blum, H.L. ."Purposes of Health Planning." Paper commissioned by the State Office of 
Comprehensive Health Planning. Berkeley, California: School of Public Health, 
University of California, March 1, 1971 (Mimeo). 

Blum, H.L., "A Working Definition of Health for Planners: Merging Concepts." 
Paper commissioned by the State Office of Comprehensive Health Planning. 
Berkeley, California: School of Public Health, University of California, 

May 26, 1971. 

Blum, H.L., "Priority Setting for Problems, Solutions, and Projects by Means of 
Selected Criteria," International Journal of Health Sciences. 2:1, 1972. 

Blum, H.L., "Potentialities of Metropolitan Planning for Human Needs." Proceedings 
of Congress on Environmental Health, American Medical Association. DHEW 
Publication No. HSM 73-10015, 1973. 

Blum, H.L., Planning for Health. New York: Behavioral Publications, 1974, pp. 621. 
Blum, H.L., "Evaluating Health Care," Medical Care, XII, 999-1011, December 1974. 

Blum, H.L., Review article Hilleboe, H.E. _e_t __]_., "Approaches to National health 
Planning/' WHO Public Health Paper No. 46, International Journal of Health 
Services. IV, No. 2, 365-387, 1974 (Sol icitedTT" 

Blum, H.L., "Introduction: An Updated Self-Help Perspective on Our International 
Activities." A solicited introduction to "The Ten Year Health Plan for the 
Americas." American Journal of Public Health, 65:10, 1046-1047, 1975. 

Blum, H.L., ""actors in the Health Care Delivery System Inhibiting Utilization and 
Uhat Can Ee Done About Them," Social Welfare Forum, Columbia University Press, 
1975. 

Blum, H.L., "From a Concept of Health to a National Health Policy," American Journal 
of Health Planning, 1:3-22, July 1976. 

Blum, H.L., Expanding Health Care Horizons. Oakland: Third Party Associates, Inc., 
pp. 217, 1976, 

Blum, H.L., "The Realities of Health and Health Care," in Conditions for Change 
in the Health Care System, WHO-DHEW HRA Publication No. 78-642, 1977. 

Blum, H.L., "Does Health Planning Work Anywhere," American Journal of Health 
Planning, 3:3, 34-47, July 1978. 

Blum, H.L., "Federal-State-Local Relations in Health Care," in Changing National- 
Subnational Relations in Health. Fogarty International Center, Washington, D.C., 
DHEW Publication No. 78-182, 1978. 



407 



Blum, H.L., , Review of Battistela, R.M. and T.G. Rundall. Health Care Policy In a 
Changing Environment. Berkeley: McCutcheon Publishing Corporation, 1978. 
Hospital Forum, Vol. XXII, No. 5, p. 38, July/August 1979. 

Blum, H.L., Review of Hyman, H.H. Health Planning: A Systematic Approach. 
Germantown, MD: Aspen Systems Corp. Inquiry, Vol. XV, pp. 198-9, June 1978. 

Blum, H.L., "Prevention and Public Policy" in Social Factors in Prevention, 
R. C. Jackson, J. Morton, and M. Sierra-Franco (Eds) School of Public 
Health, University of California at Berkeley, 1979. 

Blum, H.L., Health Planning Methods: An International Perspective. WHO-DHEW HRA 
Publication No. 79-14042, 1980. 

Blum, H.L., "Social Perspective on Risk Reduction," Family and Community Health, 
3:1. 41-51, May 1980. Reprinted as Chapter 2 in Promoting Health Through Risk 
Reduction, M.M. Faber and A.M. Reinhardt (Eds.) New York: McMillan, 1982. 

Blum, H.L., Planning for Health, 2nd Edition. New York: Human Sciences Press, 
pp. 462, 1981. 

Blum, H.L., Review of Campbell, Rita Ricardo, The Economics and Politics of Health 
Care. Chapel Hill: University of North Carolina Press, 1981. Hospital Forurr;, 
29-30, March/April 1981. 

Blum, H.L., Expanding Health Care Horizons, 2nd Edition. Oakland: Third Party Press 
Associates, pp. 240, 1983. 

Blum, H.L., Review of Lefkowitz, Bonnie, Health Planning: Lessons for the Future, 
Rockviile, MD: Aspen Systems Corporation. Inquiry, 20:390-393, Winter 1982. 

Blum, H.L., "Health Sector Trends around the World," Mobius, 5:3, 1985. 

Blum, H.L., Review of Handbook of Health Professions Education, Christine H. 
McGuire e_t aj_. , Eds. San Francisco: Jossey-Bass, Inc., 1983. Mobius, 
5:1, 1985. " 

Blum, H.L., "Interview with Henrik L. Blum, M.D., M.P.H." (conducted by Joan R. 
Altekruse), Family and Community Health, 8:4, 76-83, February 1986. 

Blum, H.L., "A Health Planner Meets C. West Churchman," Systems Practice, 1:4, 
357-365, December 1988. 

Blum, H.L. e_t aj_. , "Improving the Public's Health: A Proposal for California." 
California Public Health Association, Berkeley. 59 pp., March 15, 1990. 

McDonald, M.D. and Blum, H.L., "HOT: The Emergence of Health-Oriented 
Telecommunication 'Applications," Healthcare Informatics, 9:11, 62-68, 
November 1992. 

McDonald, M.D. and Blum, H.L., Health in the Information Age: The Emergence of 
Health Oriented Telecommunication Applications. Environmental Science ana Policy 
Institute, 1992, pp. 72. 



APPENDIX B 



408 



March 1999 



INTERVIEWS ON THE HISTORY OF THE UNIVERSITY OF CALIFORNIA 

Documenting the history of the University of California has been a 
responsibility of the Regional Oral History Office since the Office was 
established in 1954. Oral history memoirs with University-related persons 
are listed below. They have been underwritten by the UC Berkeley 
Foundation, the Chancellor's Office, University departments, or by 
extramural funding for special projects. The oral histories, both tapes 
and transcripts, are open to scholarly use in The Bancroft Library. 
Bound, indexed copies of the transcripts are available at cost to 
manuscript libraries. 

UNIVERSITY FACULTY, ADMINISTRATORS, AND REGENTS 

Adams, Frank. Irrigation, Reclamation, and Water Administration. 1956, 
491 pp. 

Amerine, Maynard A. The University of California and the State's Wine 
Industry. 1971, 142 pp. (UC Davis professor.) 

Amerine, Maynard A. Vine Bibliographies and Taste Perception Studies. 
1988, 91 pp. (UC Davis professor.) 

Bierman, Jessie. Maternal and Child Health in Montana, California, the 
U.S. Children's Bureau and WHO, 1926-1967. 1987, 246 pp. 

Bird, Grace. Leader in Junior College Education at Bakersfield and the 
University of California. Two volumes, 1978, 342 pp. 

Birge, Raymond Thayer. Raymond Thayer Barge, Physicist. 1960, 395 pp. 

Blaisdell, Allen C. Foreign Students and the Berkeley International 
House, 1928-1961. 1968, 419 pp. 

Blaisdell, Thomas C., Jr. India and China in the World War I Era; New 
Deal and Marshall Plan; and University of California, Berkeley. 
1991, 373 pp. 

Blum, Henrik. Equity for the Public's Health: Contra Costa Health 

Officer; Professor, UC School of Public Health; WHO Fieldworker. 
1999, 425 pp. 

Bowker, Albert. Sixth Chancellor, l/niversity of California, Berkeley, 
1971-1980; Statistician, and National Leader in the Policies and 
Politics of Higher Education. 1995, 274 pp. 



409 



Brown, Delmer M. (In process.) Professor of Japanese history, 1946- 
1977. 

Chaney, Ralph Works. Paleobotanist, Conservationist. 1960, 277 pp. 

Chao, Yuen Ren. Chinese Linguist, Phonologist, Composer, and Author. 
1977, 242 pp. 

Constance, Lincoln. Versatile Berkeley Botanist: Plant Taxonomy and 
University Governance. 1987, 362 pp. 

Corley, James V. Serving the University in Sacramento. 1969, 143 pp. 
Cross, Ira Brown. Portrait of an Economics Professor. 1967, 128 pp. 

Cruess, William V. A Half Century in Food and Wine Technology. 1967, 
122 pp. 

Davidson, Mary Blossom. The Dean of Women and the Importance of 
Students. 1967, 79 pp. 

Davis, Harmer. Founder of the Institute of Transportation and Traffic 
Engineering. 1997, 173 pp. 

DeMars, Vernon. A Life in Architecture: Indian Dancing, Migrant 

Housing, Telesis, Design for Urban Living, Theater, Teaching. 
1992, 592 pp. 

Dennes, William R. Philosophy and the University Since 1915. 1970, 
162 pp. 

Donnelly, Ruth. The University's Role in Housing Services. 1970, 
129 pp. 

Ebright, Carroll "Ky". California Varsity and Olympics Crew Coach. 
1968, 74 pp. 

Eckbo, Garrett. Landscape Architecture: The Profession in California, 
1935-1940, and Telesis. 1993, 103 pp. 

Elberg, Sanford S. Graduate Education and Microbiology at the 

University of California, Berkeley, 1930-1989. 1990, 269 pp. 

Erdman, Henry E. Agricultural Economics: Teaching, Research, and 

Writing, University of California, Berkeley, 1922-1969. 1971, 
252 pp. 

Esherick, Joseph. An Architectural Practice in the San Francisco Bay 
Area, 1938-1996. 1996, 800 pp. 

Evans, Clinton W. California Athlete, Coach, Administrator, Ambassador. 
1968, 106 pp. 



410 



Foster, Herbert B. The Role of the Engineer's Office in the Development 
of the University of California Campuses. 1960, 134 pp. 

Gardner, David Pierpont. A Life in Higher Education: Fifteenth 

President of the University of California, 1983-1992. 1997, 
810 pp. 

Grether, Ewald T. Dean of the UC Berkeley Schools of Business 

Administration, 1943-1961; Leader in Campus Administration, Public 
Service, and Marketing Studies; and Forever a Teacher. 1993, 
1069 pp. 

Hagar, Ella Barrows. Continuing Memoirs: Family, Community, 

University. (Class of 1919, daughter of University President David 
P. Barrows.) 1974, 272 pp. 

Hamilton, Brutus. Student Athletics and the Voluntary Discipline. 
1967, 50 pp. 

Harding, Sidney T. A Life in Western Water Development. 1967, 524 pp. 

Harris, Joseph P. Professor and Practitioner: Government, Election 
Reform, and the Votomatic . 1983, 155 pp. 

Hays, William Charles. Order, Taste, and Grace in Architecture. 1968, 
241 pp. 

Heller, Elinor Raas. A Volunteer in Politics, in Higher Education, and 
on Governing Boards. Two volumes, 1984, 851 pp. 

Helmholz, A. Carl. Physics and Faculty Governance at the University of 
California Berkeley, 1937-1990. 1993, 387 pp. 

Heyman, Ira Michael. (In process.) Professor of Law and Berkeley 
Chancellor, 1980-1990. 

Heyns, Roger W. Berkeley Chancellor, 1965-1971: The University in a 
Turbulent Society. 1987, 180 pp. 

Hildebrand, Joel H. Chemistry, Education, and the University of 
California. 1962, 196 pp. 

Huff, Elizabeth. Teacher and Founding Curator of the East Asiatic 

Library: from Urbana to Berkeley by Way of Peking. 1977, 278 pp. 

Huntington, Emily. A Career in Consumer Economics and Social Insurance. 
1971, 111 pp. 

Hutchison, Claude B. The College of Agriculture, University of 
California, 1922-1952. 1962, 524 pp. 

Jenny, Hans. Soil Scientist, Teacher, and Scholar. 1989, 364 pp. 



All 



Johnston, Marguerite Kulp, and Joseph R. Mixer. Student Housing, 
Welfare, and the ASUC. 1970, 157 pp. 

Jones, Mary C. Harold S. Jones and Mary C. Jones, Partners in 
Longitudinal Studies. 1983, 154 pp. 

Joslyn, Maynard A. A Technologist Views the California Wine Industry. 
1974, 151 pp. 

Kasimatis, Amandus N. A Career in California Viticulture. 1988, 54 pp. 
(UC Davis professor.) 

Kendrick, James B. Jr. From Plant Pathologist to Vice President for 
Agricultural and Natural Resources, University of California, 
1947-1986. 1989, 392 pp. 

Kingman, Harry L. Citizenship in a Democracy. (Stiles Hall, University 
YMCA.) 1973, 292 pp. 

Roll, Michael J. The Lair of the Bear and the Alumni Association, 1949- 
1993. 1993, 387 pp. 

Kragen, Adrian A. A Law Professor's Career: Teaching, Private Practice, 
and Legislative Representation, 1934 to 1989. 1991, 333 pp. 

Kroeber-Quinn, Theodora. Timeless Woman, Writer and Interpreter of the 
California Indian World. 1982, 453 pp. 

Landreth, Catherine. The Nursery School of the Institute of Child 

Welfare of the University of California, Berkeley. 1983, 51 pp. 

Langelier, Wilfred E. Teaching, Research, and Consultation in Water 
Purification and Sewage Treatment, University of California at 
Berkeley, 1916-1955. 1982, 81 pp. 

Lehman, Benjamin H. Recollections and Reminiscences of Life in the Bay 
Area from 1920 Onward. 1969, 367 pp. 

Lenzen, Victor F. Physics and Philosophy. 1965, 206 pp. 

Leopold, Luna. Hydrology, Geomorphology, and Environmental Policy: U.S. 
Geological Survey, 1950-1972, and the UC Berkeley, 1972-1987. 
1993, 309 pp. 

Lessing, Ferdinand D. Early Years. (Professor of Oriental Languages.) 
1963, 70 pp. 

McGauhey, Percy H. The Sanitary Engineering Research Laboratory: 
Administration, Research, and Consultation, 1950-1972. 1974, 
259 pp. 

McCaskill, June. Herbarium Scientist, University of California, Davis. 
1989, 83 pp. (UC Davis professor.) 



412 



McLaughlin, Donald. Careers in Mining Geology and Management, 
University Governance and Teaching. 1975, 318 pp. 

Merritt, Ralph P. After Me Cometh a Builder, the Recollections of Ralph 
Palmer Merritt. 1962, 137 pp. (UC Rice and Raisin Marketing.) 

Metcalf, Woodbridge. Extension Forester, 1926-1956. 1969, 138 pp. 
Meyer, Karl F. Medical Research and Public Health. 1976, 439 pp. 
Miles, Josephine. Poetry, Teaching, and Scholarship. 1980, 344 pp. 
Mitchell, Lucy Sprague. Pioneering in Education. 1962, 174 pp. 

Morgan, Elmo. Physical Planning and Management: Los Alamos, University 
of Utah, University of California, and AID, 1942-1976. 1992, 
274 pp. 

Neuhaus, Eugen. Reminiscences: Bay Area Art and the University of 
California Art Department. 1961, 48 pp. 

Newell, Pete. UC Berkeley Athletics and a Life in Basketball: Coaching 
Collegiate and Olympic Champions; Managing, Teaching, and 
Consulting in the NBA, 1935-1995. 1997, 470 pp. 

Newman, Frank. Professor of Law, University of California, Berkeley, 

1946-present, Justice, California Supreme Court, 1977-1983. 1994, 
336 pp. (Available through California State Archives.) 

Neylan, John Francis. Politics, Law, and the University of California. 
1962, 319 pp. 

Nyswander, Dorothy B. Professor and Activist for Public Health 
Education in the Americas and Asia. 1994, 318 pp. 

O'Brien, Morrough P. Dean of the College of Engineering, Pioneer in 
Coastal Engineering, and Consultant to General Electric. 1989, 
313 pp. 

Olmo, Harold P. Plant Genetics and New Grape Varieties. 1976, 183 pp. 
(UC Davis professor.) 

Ough, Cornelius. Recollections of an Enologist, University of 
California, Davis, 1950-1990. 1990, 66 pp. 

Pepper, Stephen C. Art and Philosophy at the University of California, 
1919-1962. 1963, 471 pp. 

Pitzer, Kenneth. (In process.) Professor, College of Chemistry. 

Porter, Robert Langley. Physician, Teacher and Guardian of the Public 
Health. 1960, 102 pp. (UC San Francisco professor.) 



413 



Reeves, William. Arbovirologist and Professor, UC Berkeley School of 
Public Health. 1993, 686 pp. 

Revelle, Roger. Oceanography, Population Resources and the World. 
1988. (UC San Diego professor.) (Available through Archives, 
Scripps Institute of Oceanography, University of California, San 
Diego, La Jolla, California 92093.) 

Riasanovsky, Nicholas V. Professor of Russian and European Intellectual 
History, University of California, Berkeley, 1957-1997. 1998, 
310 pp. 

Richardson, Leon J. Berkeley Culture, University of California 

Highlights, and University Extension, 1892-1960. 1962, 2A8 pp. 

Robb , Agnes Roddy. Robert Gordon Sproul and the University of 
California. 1976, 134 pp. 

Rossbach, Charles Edwin. Artist, Mentor, Professor, Writer. 1987, 
157 pp. 

Schnier, Jacques. A Sculptor's Odyssey. 1987, 304 pp. 

Schorske, Carl E. (In process.) Professor, Department of History. 

Scott, Geraldine Knight. A Woman in Landscape Architecture in 
California, 1926-1989. 1990, 235 pp. 

Shields, Peter J. Reminiscences of the Father of the Davis Campus. 
1954, 107 pp. 

Sproul, Ida Wittschen. The President's Wife. 1981, 347 pp. 

Stampp, Kenneth M. Historian of Slavery, the Civil War, and 

Reconstruction, University of California, Berkeley, 1946-1983. 
1998, 310 pp. 

Stern, Milton. The Learning Society: Continuing Education at NYU, 
Michigan, and UC Berkeley, 1946-1991. 1993, 292 pp. 

Stevens, Frank C. Forty Years in the Office of the President, 
University of California, 1905-1945. 1959, 175 pp. 

Stewart, George R. A Little of Myself. (Author and UC Professor of 
English.) 1972, 319 pp. 

Stripp, Fred S. Jr. University Debate Coach, Berkeley Civic Leader, 
and Pastor. 1990, 75 pp. 

Strong, Edward W. Philosopher, Professor, and Berkeley Chancellor, 
1961-1965. 1992, 530 pp. 



414 



Struve, Gleb. (In process.) Professor of Slavic Languages and 
Literature. 

Taylor, Paul Schuster. 

Volume I: Education, Field Research, and Family, 1973, 342 pp. 
Volume II and Volume III: California Water and Agricultural Labor, 
1975, 519 pp. 

Thygeson, Phillips. External Eye Disease and the Proctor Foundation. 
1988, 321 pp. (UC San Francisco professor.) (Available through 
the Foundation of the American Academy of Ophthalmology.) 

Tien, Chang-Lin. (In process.) Berkeley Chancellor, 1990-1997. 
Towle, Katherine A. Administration and Leadership. 1970, 369 pp. 

Townes, Charles H. A Life in Physics: Bell Telephone Laboratories and 
WWII, Columbia University and the Laser, MIT and Government 
Service; California and Research in Astrophysics. 1994, 691 pp. 

Underhill, Robert M. University of California: Lands, Finances, and 
Investments. 1968, 446 pp. 

Vaux, Henry J. Forestry in the Public Interest: Education, Economics, 
State Policy, 1933-1983. 1987, 337 pp. 

Wada, Yori. Working for Youth and Social Justice: The YMCA, the 

University of California, and the Stulsaft Foundation. 1991, 
203 pp. 

Waring, Henry C. Henry C. Waring on University Extension. 1960, 
130 pp. 

Wellman, Harry. Teaching, Research and Administration, University of 
California, 1925-1968. 1976, 259 pp. 

Wessels, Glenn A. Education of an Artist. 1967, 326 pp. 

Westphal, Katherine. Artist and Professor. 1988, 190 pp. (UC Davis 
professor. ) 

Whinnery, John. Researcher and Educator in Electromagnetics, 

Microwaves, and Optoelectronics, 1935-1995; Dean of the College of 
Engineering, UC Berkeley, 1950-1963. 1996, 273 pp. 

Wiegel, Robert L. Coastal Engineering: Research, Consulting, and 
Teaching, 1946-1997. 1997, 327 pp. 

Williams, Arleigh. Dean of Students Arleigh Williams: The Free Speech 
Movement and the Six Years' War, 1964-1970. 1990, 329 pp. 

Williams, Arleigh and Betty H. Neely. Disabled Students' Residence 
Program. 1987, 41 pp. 



415 



Wilson, Garff B. The Invisible Man, or, Public Ceremonies Chairman at 
Berkeley for Thirty-Five Years. 1981, 442 pp. 

Winkler, Albert J. Viti cultural Research at UC Davis, 1921-1971. 1973, 
144 pp. 

Woods, Baldwin M. University of California Extension. 1957, 102 pp. 

Wurster, William Wilson. College of Environmental Design, University of 
California, Campus Planning, and Architectural Practice. 1964, 
339 pp. 

MULTI- INTERVIEWEE PROJECTS 

Blake Estate Oral History Project. 1988, 582 pp. 

Architects landscape architects, gardeners, presidents of UC 
document the history of the UC presidential residence. Includes 
interviews with Mai Arbegast, Igor Blake, Ron and Myra Brocchini, 
Toichi Domoto, Eliot Evans, Tony Hail, Linda Haymaker, Charles 
Hitch, Flo Holmes, Clark and Kay Kerr, Gerry Scott, George and 
Helena Thacher, Walter Vodden, and Norma Wilier. 

Centennial History Project, 1954-1960. 329 pp. 

Includes interviews with George P. Adams, Anson Stiles Blake, 
Walter C. Blasdale, Joel H. Hildebrand, Samuel J. Holmes, Alfred L. 
Kroeber, Ivan M. Linforth, George D. Louderback, Agnes Fay Morgan, 
and William Popper. (Bancroft Library use only.) 

Thomas D. Church, Landscape Architect. Two volumes, 1978, 803 pp. 

Volume I: Includes interviews with Theodore Bernardi, Lucy Butler, 
June Meehan Campbell, Louis De Monte, Walter Doty, Donn Emmons , 
Floyd Gerow, Harriet Henderson, Joseph Rowland, Ruth Jaffe, Burton 
Litton, Germano Milano, Miriam Pierce, George Rockrise, Robert 
Royston, Geraldine Knight Scott, Roger Sturtevant, Francis Violich, 
and Harold Watkin. 

Volume II: Includes interviews with Maggie Baylis, Elizabeth 
Roberts Church, Robert Glasner, Grace Hall, Lawrence Halprin, 
Proctor Mellquist, Everitt Miller, Harry Sanders, Lou Schenone, 
Jack Stafford, Goodwin Steinberg, and Jack Wagstaff. 

Interviews with Dentists. (Dental History Project, University of 

California, San Francisco.) 1969, 1114 pp. Includes interviews 
with Dickson Bell, Reuben L. Blake, Willard C. Fleming, George A. 
Hughes, Leland D. Jones, George F. McGee, C. E. Rutledge, William 
B. Ryder, Jr., Herbert J. Samuels, Joseph Sciutto, William S. 
Smith, Harvey Stallard, George E. Steninger, and Abraham W. Ward. 
(Bancroft Library use only.) 



416 



Julia Morgan Architectural History Project. Two volumes, 1976, 621 pp. 
Volume I: The Work of Walter Steilberg and Julia Morgan, and the 
Department of Architecture, UCB, 1904-1954. 

Includes interviews with Walter T. Steilberg, Robert Ratcliff, 
Evelyn Paine Ratcliff, Norman L. Jensen, John E. Wagstaff, George 
C. Hodges, Edward B. Hussey, and Warren Charles Perry. 

Volume II: Julia Morgan, Her Office, and a House. 

Includes interviews with Mary Grace Barren, Kirk 0. Rowlands, Norma 

Wilier, Quintilla Williams, Catherine Freeman Nimitz, Polly 

Lawrence McNaught, Hettie Belle Marcus, Bjarne Dahl, Bjarne Dahl, 

Jr., Morgan North, Dorothy Wormser Coblentz, and Flora d'llle 

North. 

The Prytaneans: An Oral History of the Prytanean Society and its 
Members. (Order from Prytanean Society.) 
Volume I: 1901-1920, 1970, 307 pp. 
Volume II: 1921-1930, 1977, 313 pp. 
Volume III: 1931-1935, 1990, 343 pp. 

Six Weeks in Spring, 1985: Managing Student Protest at UC Berkeley. 

887 pp. Transcripts of sixteen interviews conducted during July- 
August 1985 documenting events on the UC Berkeley campus in April- 
May 1985 and administration response to student activities 
protesting university policy on investments in South Africa. 
Interviews with: Ira Michael Heyman, chancellor; Watson Laetsch, 
vice chancellor; Roderic Park, vice chancellor; Ronald Wright, vice 
chancellor; Richard Hafner, public affairs officer; John Cummins 
and Michael R. Smith, chancellor's staff; Patrick Hayashi and B. 
Thomas Travers, undergraduate affairs; Mary Jacobs, Hal Reynolds, 
and Michelle Woods, student affairs; Derry Bowles, William Foley, 
Joseph Johnson, and Ellen Stetson, campus police. (Bancroft 
Library use only.) 

Robert Gordon Sproul Oral History Project. Two volumes, 1986, 904 pp. 
Includes interviews with thirty-five persons who knew him well: 
Horace M. Albright, Stuart LeRoy Anderson, Katherine Connick 
Bradley, Franklin M. "Dyke" Brown, Ernest H. Burness, Natalie 
Cohen, Paul A. Dodd, May Dornin, Richard E. Erickson, Walter S. 
Frederick, David P. Gardner, Marion Sproul Goodin, Vernon L. 
Goodin, Louis H. Heilbron, Robert S. Johnson, Clark Kerr, Adrian A. 
Kragen, Mary Blumer Lawrence, Stanley E. McCaffrey, Dean McHenry, 
Donald H. McLaughlin, Kendric Morrish, Marion Morrish, William Penn 
Mott, Jr., Herman Phleger, John B. deC. M. Saunders , Carl W. 
Sharsmith, John A. Sproul, Robert Gordon Sproul, Jr., Wallace 
Sterling, Wakefield Taylor, Robert M. Underbill, Eleanor L. Van 
Horn, Garff B. Wilson, and Pete L. Yzaguirre. 



417 

The University of California during the Presidency of David P. Gardner, 
1983-1992. (In process.) 

Interviews with members of the university community and state 
government officials. 

The Women's Faculty Club of the University of California at Berkeley, 
1919-1982. 1983, 312 pp. 

Includes interviews with Josephine Smith, Margaret Murdock, Agnes 
Robb, May Dornin, Josephine Miles, Gudveig Gordon-Britland, 
Elizabeth Scott, Marian Diamond, Mary Ann Johnson, Eleanor Van 
Horn, and Katherine Van Valer Williams. 



UC BERKELEY BLACK ALUMNI ORAL HISTORY PROJECT 

Broussard, Allen. A California Supreme Court Justice Looks at Law and 
Society, 1969-1996. 1997, 266 pp. 

Ferguson, Lloyd Noel. Increasing Opportunities in Chemistry, 1936-1986. 
1992, 74 pp. 

Gordon, Walter A. Athlete, Officer in Law Enforcement and 

Administration, Governor of the Virgin Islands. Two volumes, 1980, 
621 pp. 

Jackson, Ida. Overcoming Barriers in Education. 1990, 80 pp. 

Patterson, Charles. Working for Civic Unity in Government, Business, 
and Philanthropy. 1994, 220 pp. 

Pittman, Tarea Hall. NAACP Official and Civil Rights Worker. 1974, 
159 pp. 

Poston, Marvin. Making Opportunities in Vision Care. 1989, 90 pp. 

Rice, Emmett J. Education of an Economist: From Fulbright Scholar to 
the Federal Reserve Board, 1951-1979. 1991, 92 pp. 

Rumford, William Byron. Legislator for Fair Employment, Fair Housing, 
and Public Health. 1973, 152 pp. 

Williams, Archie. The Joy of Flying: Olympic Gold, Air Force Colonel, 
and Teacher. 1993, 85 pp. 

Wilson, Lionel. Attorney, Judge, Oakland Mayor. 1992, 104 pp. 



418 



UC BERKELEY CLASS OF 1931 ENDOWMENT SERIES, UNIVERSITY OF CALIFORNIA, 
SOURCE OF COMMUNITY LEADERS (OUTSTANDING ALUMNI) 

Bennett, Mary Woods (class of 1931). A Career in Higher Education: 
Mills College 1935-1974. 1987, 278 pp. 

Bridges, Robert L. (class of 1930). Sixty Years of Legal Advice to 
International Construction Firms; Thelen, Marrin, Johnson and 
Bridges, 1933-1997, 1998, 134 pp. 

Browne, Alan K. (class of 1931). "Mr. Municipal Bond": Bond Investment 
Management, Bank of America, 1929-1971. 1990, 325 pp. 

Coliver, Edith (class of 1943). (In process.) Foreign aid specialist. 

Dettner, Anne Degruchy Low-Beer (class of 1926). A Woman's Place in 
Science and Public Affairs, 1932-1973. 1996, 260 pp. 

Devlin, Marion (class of 1931). Women's News Editor: Vallejo Times- 
Herald, 1931-1978. 1991, 157 pp. 

Hassard, H. Howard (class of 1931). The California Medical Association, 
Medical Insurance, and the Law, 1935-1992. 1993, 228 pp. 

Hedgpeth, Joel (class of 1931). Marine Biologist and Environmentalist: 
Pycnogonids, Progress, and Preserving Bays, Salmon, and Other 
Living Things. 1996, 319 pp. 

Heilbron, Louis (class of 1928). Most of a Century: Law and Public 
Service, 1930s to 1990s. 1995, 397 pp. 

Kay, Harold (class of 1931). A Berkeley Boy's Service to the Medical 
Community of Alameda County, 1935-1994. 1994, 104 pp. 

Kragen, Adrian A. (class of 1931). A Law Professor's Career: Teaching, 
Private Practice, and Legislative Representative, 1934 to 1989. 
1991, 333 pp. 

Peterson, Rudolph (class of 1925). A Career in International Banking 
with the Bank of America, 1936-1970, and the United Nations 
Development Program, 1971-1975. 1994, 408 pp. 

Stripp, Fred S. Jr. (class of 1932). t/niversity Debate Coach, Berkeley 
Civic Leader, and Pastor. 1990, 75 pp. 

Trefethen, Eugene (class of 1930). Kaiser Industries, Trefethen 

Vineyards, the University of California, and Mills College, 1926- 
1997. 1997, 189 pp. 



419 



UC BERKELEY ALUMNI DISCUSS THE UNIVERSITY 

Griffiths, Farnham P. (class of 1906). The University of California and 
the California Bar. 1954, 46 pp. 

Ogg, Robert Danforth (class of 1941). Business and Pleasure: 

Electronics, Anchors, and the University of California. 1989, 
157 pp. 

Olney, Mary McLean (class of 1895). Oakland, Berkeley, and the 
University of California, 1880-1895. 1963, 173 pp. 

Selvin, Herman F. (class of 1924). The University of California and 
California Law and Lawyers, 1920-1978. 1979, 217 pp. 

Shurtleff, Roy L. (class of 1912). The University's Class of 1912, 

Investment Banking, and the Shurtleff Family History. 1982, 69 pp. 

Stewart, Jessie Harris (class of 1914). Memories of Girlhood and the 
University. 1978, 70 pp. 

Witter, Jean C. (class of 1916). The University, the Community, and the 
Lifeblood of Business. 1968, 109 pp. 



DONATED ORAL HISTORY COLLECTION 

Almy, Millie. Reflections of Early Childhood Education: 1934-1994. 
1997, 89 pp. 

Cal Band Oral History Project. An ongoing series of interviews with Cal 
Band members and supporters of Cal spirit groups. (University 
Archives, Bancroft Library use only.) 

Crooks, Afton E. On Balance, One Woman's Life and View of University of 
California Management, 1954-1990: An Oral History Memoir of the 
Life of Afton E. Crooks. 1994, 211 pp. 

Weaver, Harold F. Harold F. Weaver, California Astronomer. 1993, 
165 pp. 



INDEX- -Henrik Blum 



420 



Aboriginals, health care in 

Australia for, 200-202 
Addison, Thomas, 113 
Akimoto, Bertha, 62-63 
Alameda/Contra Costa Medical 

Association, 230, 232 
Alameda County Health Department, 

223 
Alta Bates Hospital 

birthing center, 303 

and Blue Cross, 294 

and HEALS, 304-305 

and Kaiser, 291, 295-296 

and Medi-Cal, 293 
American Health Planning 

Association, 385 
American Medical Association, 

229-230 
American Medical Students 

Association, 77, 279 
American Optometric Association, 

229 
American Public Health 

Association, 277-279, 307 
anti-Semitism, 7 
Apollo Award, 229 
Ariss, Jean, 33, 133 
Arnon, Daniel, 48-49, 52-54, 56 
Atomic Energy Commission (AEC) , 

171 
Australia, health care in, Alice 

Springs and Friendly Farms, 

196-202 
authorship, 184, 267, 282, 324 



Bailey, Dick, 270 

Bauer, Catherine (Mrs. William 

Wurster) , 177 
Bay Area Air Pollution Control 

Legislation, 218-111 
BART (Bay Area Rapid Transit), 

180 



Biller, Robert, 232, 271 
Bissel, Dwight, 247 
Blackman, Alan, 269 
Bloomfield, Arthur, 108, 114 
Blum, Haiman, 11-22, 15, 17, 36- 

39, 42 

Blum, Henrik, Award, 389-391 
Blum, Marian Ehrich, 49, 58-59, 

91, 94 
Blum, Pauline Leplin, 12-19, 26- 

27, 31, 37-44 
Blumberg, Mark, 255 
Bowditch, Sally, 119 
Bowker, Albert, 2, 231 
Boyce, Tom, 368 
Branch, Gerald, 47 
Brown, Pat, 208, 210-212 
Buffler, Patricia, 271, 363-367 



California Conference of Local 

Health Officers, 203 
California Medical Association, 

192 
California State Board of Health, 

288 
California State Department of 

Health, 126, 288 
Calonico, Tony, 60-61 
Canada, health care in, 199, 200, 

286, 334, 328-391 

Castonguav and Nepveu Report. 286 
Chile, health care and planning 

in, 331-333 
China, teaching in Chengdu, 318, 

361-362 

Chope, Hal, 249 
Christian, Winslow, 207 
Churchill, Winston, 1-2 
CIDOC (Centre Intercultural de 

Documentation) , 288 
coccidioidomycosis, 249 



421 



Colombia, health care and planning 
in, 325-329 
liberation theologists, 325- 

326 
soybean production and 

malnutrition, 326-328 
Committee on Social and Physical 
Environment Variables as 
Determinants of Mental Health 
(NIMH), 176-178 
Comrades and Chicken Ranchers, 

15, 20 

Connery, Bob, 243 
Contra Costa County 

civil service, 142, 157, 174 
county hospital, 140-146 
development in, 158-168 
Health Department 

birth control program, 202- 

212 

budgets, 134-136 
crippled children's program, 

212-215 

genetic counseling, 214-215 
mental health program, 144- 

145, 176 
nursing program, 136-137, 

185 

Office of Economic Oppor 
tunity (OEO) funding, 155 
polio immunization program, 

172 
Rodeo Multipurpose Center, 

188 

sanitation, 146-155 
sewage disposal, 138-140, 

158-166, 168-70 
toxic materials, 171, 172 
tuberculosis, testing and 

treatment, 134-135 
Health Maintenance Organization 

(HMO), 143 
Health and Welfare Council, 

279 
Parent-Teachers Association 

(PTA), 136-137, 141 
unions, 141-142, 157 
Cummings, Jack, 138 



Debas, Haile, 365 

Degnan, George, 140-141 

Denmark, health care in, 194-195 

Depression, the, 35 

Duffy, Gordon, 231 

Duhl, Leonard, 135, 176, 216, 306 



East Bay Municipal Utilities 

District (EBMUD) , 167, 168 
Eggeburg, Roger, 204 
Elberg, Sanford, 48, 265 
emergency health services, 292- 

293 
England, health care in, 194-195 



Felsovanyi, Anthony, 344 
Finland, health care and planning 

in, 194-195 
France, health care and planning 

in, 193-194 

Paris conference on prevention, 

344-345 
Fulbright grant, 355 



genetics, 214-215 
Girtman, Louis, 141 
Glazer, Nathan, 246-247 
Glimcher, Melvin, 123-124, 182 
Goldman, Leon, 69 
Goyak, Ivan, 203 
Griffiths, William, 336 
Grigsby, Leah, 39-40 
Gurnick, Pamela, 287 



Hall, Maggie, 368-370 

Harmony Country School, 20, 24 

Harvard University School of 

Public Health, 118-184, 389 

housing at, 122 

Peter Bent Brigham Hospital, 

118 
Hastings, John, 325 



422 



HEALS (QualMed, HealthNet), 295- 

306 

for-profit status of, 301, 304 

funding of, 297-298 

and QualMed, 301 

and Kaiser, 295-303 

and staff doctors, 296-302, 
304 

and territory, 297-298 
health maintenance organizations 

(HMOS), 143, 291, 295-303, 

371, 374 

hepatitis, 95-96, 201, 295-306 
Herrick Hospital, 290-291, 303 
Hilleboe, Herman, 307-310 
Hitch, Charles, 232 
hospitals: Lincoln Hospital, 185- 

187 
housing projects, East St. Louis, 

185 



Kaiser Permanente, 291, 295-303, 

371, 374 

Kark, Sidney, 181 
Krevans, Julius, 365 
Kushner, Tommy, 3-5 



LaLonde Report. 285 

Lashof, Joyce, 363, 388 

Leake, Chauncey, 57, 62 

Leonard, A.L., 185, 247 

leptospirosis , 153 

Leslie, Anne, 172 

Lewis, Gilbert, 54 

Lincoln Hospital (NY), 185-187 

Lindeman, Erich, 181-184 

Lindheim, Roslyn, 237-238, 288, 

290, 380 

London, Ronnie, 368-370 
Luisignian, , 109 



Illich, Ivan, 288-290 
at UC Berkeley, 290 



Jacqueline, Sister, 217-218 
Japan, health care and planning 

in, 364 
Japanese internment camps in World 

War II, 62 
Jewish community (Petaluma), 15- 

17, 21-23 
John F. Kennedy University, 223- 

225 
Johns Hopkins University Medical 

School, 90-98, 112 

development of yellow fever 
vaccine, 96 

faculty appointment, 90 

faculty of, 92 
Johns, Lucy, 249 
Johnson, Robert Wood Foundation, 

383-384 
Jolly, Elizabeth, 212-215 



MacDonald, Mike, 389 
Management Design Institute of 

Cincinnati, consultant to, 

345-347 

Manlove, Robert, 292, 293, 296 
Margen, Sheldon, 233 
Marsh, Earl, 64-65 
Martin, Bill, 149-156 
Martin Joe, 365 
Massachusetts General Hospital, 

182 

Maumenee, Ed, 229 
Mayo Clinic, 72 
McKenna, Dennis, 296-297, 300 
Medicare, 301 

Meiklejohn, Alex, 177, 184, 268 
Meitner, Lisa, 50 
Meyer, K.F., 153-154 
Meyers, Beverly A. Award, 387 
military service, 78-108, 126-127 

ROTC, 72 

Mills, Bill, 28-30 
Monsanto Corporation, 157 
Montgomery, Robert, 293, 296 
Moore, J.E., 90 
Morrison, Harry, 223-225 



423 



Mullan, Fitzhugh, 171 
Muller, Curt, 150 
multipurpose worker programs, 

188-193 
Mytinger, Bob, 348 



Napa High School, 33-35, 44 
Native American health care, 187- 

188 

Navaho medicine men and 

training, 187 
Naffziger, Howard, 66 
National Institute of Mental 

Health (NIMH), 176-178, 186 
Navarro, Vicente, 331, 332 
Nepal, health care and planning 

in, 334-349 

conflicting aid approaches, 

335-336 

Newell, Robert, 70, 111 
New Pisa Restaurant, 147 



O'Connell, Bill, 201 

Orinda Vision Study, 227-231 

American Medical Association, 
charges by, 230 

Maumenee, Ed, 229 

modified clinical techniques, 
228-229 

optometrists vs. 

opthalmalogists, 229-230 

Peters, Henry, 229 
Over 60, 208, 371-381 

clinic, 377 

Coalition for Elders' 

Independence (CEI), 376 

funding, 373 

goals, 372 

Gray Panthers, 371 

HMOs, 375, 380 

housing, 373-377 

in-home care, 377-378 

and Kaiser Permanente, 374 

Lifelong Medical Care, 378 

Medicare and, 373-375 

Minkler, Meredith, 371 



Over 60 (cont "d. ) 

and On Lok, 374-376, 380 

Rabinowitz, Lillian, 371 

Welfare Act of 1997, 378 



Pacific Islands, health care and 

planning in, 330, 347-352 
Pan American Health Organization 
(PAHO), 325-330 
Chile, assignment in, 330-333 
Colombia, assignment in, 325- 

329. 
See also individual country 

listings 
Pan-American Programme for Health 

Planning, 331 
Peace Corps, training volunteers 

for, 197-200 
Petris health bill, 346 
Planned Parenthood, 189 
polio, 127-128 
Poss, Martin, 202, 203 
Price, David, 81, 91 
public health 

administration, 184 
ethics of, 4-11, 69 
field work and teaching in 

Australia, 196-199, 200-202 

Canada, 199-200, 286, 334 

Chile, 331-332 

China, 252, 318, 361-362 

Colombia, 325-329 

Denmark, 194-195 

Finland, 194-195 

France, 193-194 

Nepal, 334-339 

Pacific Islands (Guam, 

Samoa, Saipan) , 347-352 
Sri Lanka, 320-323, 338 
Sweden, 154, 177, 356-361 
Utah, 340-343 
United Kingdom, 194-195 
Yemen, 352-355. 
See also individual country 



Randall, Ollie, 192 



424 



Reeves, William, 231, 241, 250, 

254, 270 
Rockefeller research fellowship, 

104 



sabbatical year, 333, 356-361 
San Francisco Marine Hospital, 

79-82 

Sax, Sidney, 181-182 
School of Public Health (UCB), 

240-275, 363-368, 381-394 
Sedgwick Award, 385, 389 
Shell Chemical Corporation, 53 
Silva, Joe, 167-169 
smallpox, threatened epidemic in 

San Diego, 103-106 
Smith, Chuck, 124 
Space Cadets, 176-180 
Sri Lanka, health care and 

planning in, 310-323 

counterpart program, 320 

culture, 323 

dhobies, 314-316 

hospital politics, 314-316 

results of fieldwork, 322 

typhoid, 316 
St. Mary's College, Moraga, 144- 

145 
Stanford University Medical School 

residency, 110-118, 162 

syphilis research and 

treatment, 110-112 
Starkweather, David, 290-292 
Stout, Perry, 48 

radar projects, 51-53 

soil studies and 

crystallography, 48-49 

X-ray diffraction, 50 
Sweden, health care and planning 

in, 154, 177 

Fulbright program assignment, 
355 

medical programs, 359-360 

Pharmaceuticals, 358 

social programs, 356-361 

University of Gothenburg, 
teaching at, 355-356 



Swedner, Harald, 355 



Tasem, Walt, 92 

Taussig, Helen, 94-95 

teaching, 275-276, 293-294, 305, 

355-356, 391-394 
Teeter, Desmond, 134 
Togasaki, Yoshiye, 64, 119, 136, 

203 
Tosco Oil Company (Tidewater), 

129-130, 156-158 
Tuskegee Study, 4, 5 



United States Agency for 

International Development 
(AID), 334-339. 
See also Nepal 
United States Children's Bureau, 

278 
United States Congress, Public Law 

89-749, 256 

United States Public Health 
Service 

funding from, 190, 258 
military service in, 78-108, 

126-127 
University of California, San 

Francisco, Medical School, 57- 
79, 95 

University of California, 
Berkeley 

chemistry program, 47-48 
Department of City and Regional 

Planning, 245 
engineering program, 45-47 
School of Public Health 

Academic Senate committees, 

272-275 
administration, master's 

program in, 241 
Business School, joint 

master's program, 291 
computer literacy program, 

390 
curriculum, 287 



425 



University of California, 

Berkeley, School of Public 
Health (cont'd.) 

faculty, 251-252, 265-266, 

363-368, 387-388, 392 
genetics, courses in, 215 
Joint Medical Program 
(Health and Medical 
Sciences Program) 

faculty involvement, 

363-368 
goals, 368 
resistance from UC San 

Francisco, 363-367 
staff, 368-380 
minorities programs, 259- 

267 
planning, courses in, 248, 

250, 254, 256, 287 
students, 253-254, 282 
teaching, 275-276, 391-394 
tenure, 274-275 
University of California, Davis 

extension services, 17-18 
University of California, Los 
Angeles, School of Public 
Health, 307 

University of California,