the Public Health and Marine Hospital Service from 1902 to 1912; (4) the Public Health Service from 1912 to the present time. The transition in 1870 from the unorganized to the organized service was entirely an administrative change resulting_in_increased efficiency, but not involving any material change in function or volume of work. All the other periods represent either a definite broadening of the field of activity or a marked increase in the activity along particular lines.

The Unorganized Marine Hospital Service, 1798 to 1870. The furnishing of medical relief to merchant seamen was one of the earliest of the federal activities that did not relate to the actual operation of the government. The act of July 16, 1798 (Stat. L., 605–606), provided that after September 1, 1798; the master of every American ship arriving from a foreign port should pay to the Collector of Customs the sum of 20 cents a month for each seaman, which amount he was authorized to deduct from the seaman's wages. After September 1, 1798, vessels engaged in coastwise trade could not obtain a new license until payment had been made at the rate of 20 cents a month per seaman for the period covered by the license which had expired. The President was authorized to use the money collected in this manner to provide temporary relief and maintenance for sick and disabled seamen, who were to be placed in hospitals already established; if no hospital was available provision for relief was to be made in such manner as the President should direct. Special provision was made that the money was to be expended in the district where collected.

The President was also authorized to accept cessions of buildings and grounds and donations. The surplus after paying expenses could be used to purchase buildings or grounds and to erect buildings. The President was authorized to appoint directors of the marine hospitals of the United States in various ports at his discretion, who were to hold office during the pleasure of the President. Each director was to

supervise the expenditures in the port to which he was assigned, to provide accommodations and govern the hospital under general instructions of the President, and to render an account quarterly to the Secretary of the Treasury or some other person designated by the President. The directors were to receive no compensation except such as might be incurred in the actual discharge of their duties. The Collectors of Customs appear to have become directors exofficio.1

The act of 1798 referred only to merchant seamen, but on March 2, 1799 (1 Stat. L., 729), a new act was passed authorizing the Secretary of the Navy to deduct twenty cents a month from the pay of naval officers, seamen, and marines, who were made beneficiaries of the marine hospitals. These deductions were transmitted quarterly to the Secretary of the Treasury. This act remained in force until the passage of the act of February 26, 1811 (2 Stat. L., 650), which placed naval hospitals under the superintendence of the Secretary of the Navy and provided that the collection from officers and seamen of the Navy should be paid into a separate fund for the Navy.

It was soon recognized that proper relief could not be given by expending the money entirely within the district in which it was collected, and the act of March 2, 1799 (1 Stat. L., 729), authorized the President to expend the fund within a state adjoining the one in which the money was collected, with the exception of New Hampshire, Massachusetts, and Connecticut. All money collected in these three States was required to be expended within their borders. Three years later these limitations on the expenditures were abolished, and the fund was made a general one to be used throughout the country for the benefit of sick and disabled American seamen.

The first marine hospital operated by the government was the one at Washington Point, Norfolk, purchased in 1800. By 1802 hospitals had been opened at Norfolk, Boston, New131 Cong. 2 Sess., S. Ex. Doc. 14, p. 5.

port, and Charleston.2 The increasing use of the Mississippi River for transporting the lumber and other products of the western territory to market made it desirable to provide hospital facilities at New Orleans, and the act of May 3, 1802 (2 Stat. L., 192), authorized the President "to take such measures as may be expedient" to provide medical assistance at that place if this could be done "with the consent of the government having jurisdiction over the port." At this time France still had possession of the Louisiana Territory, as the treaty ceding this area was signed at Paris on October 31, 1803. The master of every boat or raft going down the Mississippi River was required to pay twenty cents per month for each person employed. The hospital tax was collected at Fort Adams, and no vessel or raft was to be cleared until the tax was paid. An appropriation of $3,000 was made for establishing the hospital, and the President was authorized to appoint a director of the marine hospital at New Orleans whose duties were to be the same as those of directors of marine hospitals in the United States. The act of February 24, 1804 (2 Stat. L., 252), extended the laws relating to sick and disabled seamen to the territory acquired from France.

The act of May 3, 1802, also provided $15,000 for the erection of a hospital in Massachusetts, authorized the admission of foreign seamen to hospitals at the rate of seventyfive cents a day, and allowed the directors of hospitals a commission of one per cent. on the money expended.

The settlement of the Northwest and Louisiana territories. and the development of transportation facilities on the Great Lakes and western rivers brought to the attention of Congress the necessity of establishing hospitals in that region. By the act of March 3, 1837 (5 Stat. L., 189), the President was authorized to purchase sites for not exceeding three hospitals on the Mississippi River, three on the Ohio, and one on Lake Erie. An appropriation of $15,000 was made for the pur

2 Supervising Surgeon General, Marine Hospital Service, Annual Report, 1872, p. 7.

chase of sites, and the President was authorized to call upon the "medical men" of the Army to select suitable locations. The Secretary of War was directed to prepare plans and estimates, which were submitted to Congress in December, 1837.3 Later acts provided funds for the erection of these western hospitals which were built under the direction of the Topographical Bureau of the War Department.*

New hospitals were built at various times, but no important legislation affecting the service was enacted between 1837 and 1870. The act of March 1, 1843 (5 Stat. L., 602), provided that seamen engaged in the coasting trade should be beneficiaries of the service. These seamen were entitled to this service under the original act of July 16, 1798, but for "some cause not apparent the provisions of the act of July 16, 1798, including coasting vessels under the general law, had been suspended, by construction, since the year 1831, and was merely renewed."5 By the act of July 20, 1846, canal boats were exempted from the tax, and the persons employed on them were denied the use of the hospitals. The act of March 3, 1849 (9 Stat. L., 368), carried an appropriation of $1000 to collect facts and information in relation to marine hospitals and the marine hospital fund and to report to Congress what changes were necessary. Dr. George B. Loring, and Dr. T. O. Edwards were appointed to collect the necessary information and their report, made in 1851, reviewed the general history of the service, described existing conditions, and made some recommendations, the most important being that the system should be placed under a chief surgeon. Secretary of the Treasury Chase in 1861 stated that the number of marine hospitals "has been increased far beyond necessity or utility." Subsequently the act of March 1, 1862 (12 Stat. L., 348), authorized the Secretary of the Treasury to rent

4

7

Secretary of War, Annual Report, 1837. pp. 195-203.

31 Cong., 2 Sess., S. Ex. Doc. 14, p. 25.

5 Ibid., p. 3.

• Ibid., p. 30.

Secretary of the Treasury, Annual Report, 1861, p. 27.

marine hospitals to authorities of cities and to contract with hospitals for the medical treatment of seamen. By the act of April 20, 1866 (14 Stat. L., 40), the Secretary of the Treasury was authorized to sell or lease such marine hospital lands and buildings as he deemed advisable, except the hospitals at Portland, Maine, and Cleveland, Ohio; no hospital was to be sold or leased if suitable accommodations could not be obtained. This act was amended by the act of June 27, 1866 (14 Stat. L., 76), which provided that no hospital should be sold or leased if the relief furnished amounted to twenty cases a day.

The tax on seamen was collected continuously from 1798 to 1870 except for the period of one year beginning April 1, 1837. The proceeds of the tax, however, were sufficient for the expenses of the service during only thirty-four of the seventy-three years. During the other years it was necessary to appropriate money from the general funds of the government in order to maintain the service, and from 1841 to 1870 deficiency appropriations were made each year with the exception of 1846 and 1854. In addition, specific appropriations were made for the purchase of sites and the erection of buildings.

During this period medical relief was given in the hospitals operated by the service, in contract hospitals, and in private dwellings under contract with local physicians. Thirty-one hospital projects had been undertaken by the government since the organization of the service, but only nine of these were in use in 1870, seven being operated by the government and two being leased to private parties. Of the remainder, fourteen hospitals had been sold, one transferred to the War Department, one abandoned, one burned, one destroyed by flood and one by hurricane, one injured by earthquake and abandoned, and two unfinished, the completion of one of these being regarded as impracticable. Hospitals had been built at points where there were no patients or not sufficient patients to justify the maintenance of the institutions.