The Alemany Emergency Hospital and Health Center: The Hidden History Behind the New Deal Era Buildings

The Alemany Emergency Hospital and Health Center buildings anchor the corner of Alemany Boulevard and Onondaga Avenue, just one short block from Mission Street, in the heart of the Excelsior District. They are unofficial neighborhood landmarks and are especially meaningful to those who remember when they were operational.

I passed these buildings for ten years and wondered about them. And then last year at the History Expo in the Old Mint, historian Gray Brechin showed me his website about The Living New Deal. There was a map indicating the locations of Works Progress Administration murals. One was at the corner of Alemany and Onondaga. “What in the world is that?” I asked. And that’s how my involvement with this historic landmarking application project to preserve these neighborhood  gems began.

What Are They?

Chances are if you are an old-timer, you used the services provided at 35 and 45 Onondaga. But if you aren’t you probably have no idea what they are or were.

Today, this district remains predominately populated with modest, single-family homes with few architecturally exceptional buildings other than Balboa High School, the Geneva Office Building and Powerhouse, San Miguel School and the Telephone Building.

Alemany-HospitalFunded by a 1928 public bond measure and built in 1933, the Alemany buildings were the final piece of the citywide emergency hospital system to be built, extending the City’s emergency hospital system to cover a growing and underserved area. It was a system which was once nationally known and respected. These buildings are remnants of a noble, and once controversial, effort to provide free and efficient emergency health care to the district.

They were planned and designed by City Architect Charles H. Sawyer who began his career with the city during the hectic rebuilding of San Francisco after the 1906 earthquake and fire. Sawyer also ushered the Bureau of Architecture through the Great Depression. He oversaw the department during a period when innumerable civic buildings were built. Schools and hospitals were his domain. San Francisco’s schools and emergency hospital buildings were once the envy of other cities and earned the respect of professionals across the country. As an administrator, Sawyer was responsible for overseeing the work of the entire department, hiring architects as appropriate. However, there are several buildings for which he himself prepared the plans: the Alemany buildings are two of those and they are significant examples of his work.

Built during a time when the City’s population was continuing to grow, the buildings were funded by voter-approved bond monies. There was overwhelming public support for them, during a period when people faced hard economic times and the City faced a “depression load of indigent sick,” the San Francisco Chronicle reported in 1933. This was during the Great Depression when state and federal monies were being made available to keep people, including artists and writers, employed.


The Alemany Hospital was opened and dedicated on Aug. 16, 1933. During the same period of time, across town, painter Bernard Zakheim was organizing artists to win the first federal Public Works of Art Project grant to create the Coit Tower murals. PWAP was a predecessor of the WPA programs: Works Progress Administration/Work Projects Administration and with this funding, Bernard Zakheim painted the Library mural at Coit Tower.

Later in 1934, he painted the two murals at the Alemany Health Center building, murals which most district residents don’t realize still exist. The murals were titled “Community Spirit” and “Growth”. They were funded by PWAP, under the sponsorship of the State Emergency Relief Administration. The Alemany murals, which depict the neighborhood and a healthcare theme, are important examples of Zakheim’s work and contribute to the overall aesthetic significance of the buildings. “Community Spirit” is intact but in need of conservation. “Growth” has been painted over and would require substantial conservation work to be seen or restored.

The Emergency Hospital System

The five hospitals (in the citywide system) have different problems depending on the zone each is in. Harbor has many serious cases—stevedores who have been injured on the job or waterfront prowlers who have been brawling. Park, especially over the weekends, handles dog bites, tick bites and children who have fallen from swings. Alemany largely handles domestic accidents, but the crew out there will tell you that when they get an auto accident “it’s a lulu.” That’s because the number of boulevards—Bayshore Highway, Alemany Boulevard, Sloat Boulevard and Nineteenth Avenue—allow drivers to get up considerable speed before they smack into each other. (San Francisco City Employees Digest, Sept. 1963)

San Francisco’s Emergency Hospital System is fondly remembered by those old enough to have used it and a surprising historical note to younger people and to those who did not grow up here. Alemany Emergency specifically is remembered by many longtime residents of this stable, working class community which still includes many families who have lived in the neighborhood for three and four generations.


The citywide system was created to address the needs of a quickly growing population and became a professionally respected organization. It was known as “one of the most comprehensive and elaborate public health services of its kind in the United States,” according to “Catastrophes, Epidemics and Neglected Diseases”. Its origins can be traced to the treatment rooms attached to the city’s prison circa 1870s and it evolved into the well-developed system of emergency care “recognized as one of the finest in the United States.”

The history of San Francisco’s free emergency healthcare system features colorful characters and dedicated civil servants, such as Sawyer and, the “Dr. Phil” of his day, the Director of Public Health, Dr. Jacob Geiger. They worked together with elected officials and strategized the political system of the time to accomplish their work. The development and growth of the hospital system, which began in the 19th century with Central, Park, and Harbor hospitals, expanded to include Mission, Potrero, Ocean Beach and finally Alemany.

The system was gradually folded into what eventually became the first complete municipal trauma center at General Hospital. Its financial and political support fluctuated during times of extreme population growth, the Great Depression, the World Wars, the passage of local bond measures, the availability of state and federal funds, and the passage of Proposition 13 in the 1970s. Social changes in health care reform and Medicare/Medicaid laws and the expansion of emergency rooms in private hospitals played a role in the development and changes to the system. Technological improvements in communications systems, like the 911 call system, had broad and sweeping effects. The evolution of the system’s origins is complex and the reasons for the eventual demise of this free health care system are equally complicated. The system was officially disbanded in the summer of 1978 despite organized civic engagement and protest. What remains is the story and several of the original buildings—one of which, the Park Emergency Hospital, has already been designated a San Francisco landmark.

Neighbors Still Remember Using the Services

Many district residents, of varying ages, remember being treated at these buildings. The late Martha Chase attended senior services there for many years before she died just a few years ago. Emily Powell remembers, in 1938, having stitches there after being hit by a car on Mission Street. Betty Castagnola, in her 80s, remembers getting stitches there frequently since she was a “tomboy.” Lydia Marciano, in her 80s, took advantage of the baby wellness program when she was a young mother. Denise Ruggieri, in her 60s, remembers being treated there as a child many times. Rita Gelini, in her 60s, distinctly remembers going there in 1960 for her immunization shot. Nancy Pannous, in her 60s, remembers taking her mother there on Thanksgiving Day to get stitches after she cut herself slicing the turkey. Nancy also remembers going to Harbor Emergency after having her toe stepped on at a high school dance. Delia Kutches, in her 90s, worked at the Alemany as a nurse. Joe Flanders, in his 80s, drove an ambulance out of Alemany and the other emergency hospitals until they closed. Valerie Reichert, in her 60s, remembers being treated at the Park Emergency as a very young child after swallowing nail polish remover.


These buildings represent a time when people, lived, worked, went to school, shopped, and received first aid treatment near home. This was a time when people in the Outer Mission and Excelsior Districts rarely went downtown to shop because Mission Street was a vibrant commercial strip. Downtown was for special events and required white gloves for the ladies.

The Alemany Emergency Hospital and Health Center, as part of the citywide emergency hospital system, is part of San Francisco history. But, on a local level, these buildings played an important role in the lives of our neighbors as well. These emergency hospitals were effective, neighborhood first-aid centers which served the community well before we had innovative technologies like the 911 system and affordable health insurance plans.

The Community’s Social Engagement

Sawyer and Geiger’s dedication to civic buildings and public health were embodied in these two buildings. In the summer of 1978, the threatened closure of the system galvanized the neighbors to organize a protest against the loss of this free emergency healthcare service to the working class residents of the Excelsior and Outer Mission.

In 1978, the newly instituted district elections. Dan White was elected supervisor for the Excelsior/Outer Mission area. He spoke publicly in favor of keeping the Alemany hospital open. District elections were designed to make sure the voices of the neighborhoods were heard downtown and this was the first year of that experiment.

During the previous era of citywide elections, neighborhood organizations collaborated to make sure they were heard at City Hall. Communities of the Outer Mission Organization, one of these groups, were instrumental in organizing the “sit-in” at the Alemany Hospital. Neighbors moved into the building, eating and sleeping there for over a month and a half in the summer of 1978. They attempted to continue offering free first aid and emergency services. They waxed the floors, did the laundry and referred to their effort as “the greatest grassroots movement in San Francisco,” according to a report in the San Francisco Examiner.

This event, while modest and largely forgotten, is in keeping with San Francisco’s heralded tradition of civic engagement. These buildings represent what is perhaps the most important moment of social activism in the Excelsior District’s history which occurred just months before the fatal and fateful shootings at City Hall. The buildings, the murals, the hospital system, and this particular act of social engagement deserve to be acknowledged and remembered.

Last spring, the Historic Preservation Commission members agreed that the application to landmark these two buildings needed more study. The final version of the application was submitted last month. Anyone who is interested in support of this landmarking effort, please e-mail David Hooper at vpulgas@yahoo.com.

Lisa Dunseth is a resident of New Mission Terrace.

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