of sanitary reports, contained in the act of April 20, 1878, was the first authority for the publication of the series now known as Public Health Reports. The first number, issued under the title "Bulletin of the Public Health," appeared July 13, 1878.16

Dr. J. M. Woodworth, the first Supervising Surgeon General of the service died on March 14, 1879, and was succeeded by Dr. J. B. Hamilton.

National Board of Health, 1878. The duties and powers relative to quarantine, reports from consular officers, and the distribution of health bulletins conferred on the Marine Hospital Service by the act of April 29, 1878, remained in force only until June 2, 1879, when a law was passed (21 Stat. L., 5) transferring these functions to the National Board of Health which had been created by the act of March 3, 1879 (20 Stat. L., 484). The act of June 2, 1879, which repealed the portions of the act of April 29, 1878, relating to the quarantine and public health functions of Marine Hospital Service, provided that "this act shall not continue in force for a longer period than four years from its date of approval." At the expiration of the four years the repealed sections of the act of April 29, 1878, were revived by the expiration of the repealing statute.17 The duties of the Marine Hospital Service in relation to quarantine were thus again in effect after June 2, 1883.

Personnel System of 1879. The methods of appointment and promotion of the commissioned personnel of the service were further refined by the regulations approved November 10, 1879, which in their basic features are in force at the present time although of course some modifications have been made in the details. The regulations of 1873 had provided that appointments should be made only after passing a technical examination before a board of officers. The regulations of 1879 continued this provision, but in addition specified that

16 For resumé of history of this and other series, see pages 195–197. 17 20 Op. Att. Gen., 467.

original appointments should be made to the lowest grade only-that of assistant surgeon-and fixed the age limits between 21 and 30 years of age.18

A new grade-that of passed assistant surgeon—was established, and it was provided that after three years' service an assistant surgeon should be promoted to the grade of passed assistant surgeon provided he passed a satisfactory examination. Vacancies in the grade of surgeon were to be filled by promotion of passed assistant surgeons in order of seniority, but promotion was made only after the officer had passed an additional examination.19

Development of the Service from 1883 to 1889. After the control of quarantine was restored to the Marine Hospital Service on June 2, 1883, sanitary inspectors were stationed at Habana, Vera Cruz, London, and Liverpool, in order to give notification of the sailing of vessels likely to carry infected passengers or commodities. Habana and Vera Cruz were important centers of yellow fever infection, while London and Liverpool were selected principally by reason of the danger of disease being carried by vessels transporting rags and other similar commodities which were shipped from places where cholera was prevalent, and which were transshipped through English ports.

20

Until 1884 the expenses of the service had been paid from the permanent indefinite appropriation derived from the proceeds of the hospital tax on seamen, supplemented by specific appropriations. The act of June 26, 1884 (23 Stat. L., 57), which took effect July 1, 1884, repealed all acts levying a hospital tax and provided that the expenses of the Marine Hospital Service should be paid from the proceeds of the tonnage tax imposed on vessels from foreign ports entering the United States. The receipts from these duties on tonnage were made a permanent indefinite appropriation for the use of the Marine Hospital Service. In some later years the proceeds of 18 Regulations, 1879, Par. 24-26.

19 Ibid., Par. 30-32.

20 Sup. Surg. Gen., Annual Report, 1883, p. 52.

the tax were insufficient to support the service, and deficiency appropriations were made. The act of June 26, 1884, made no changes in the organization or activities of the service.

As a result of the growth of the service a small laboratory for the manufacture of some preparations had been maintained in Washington as a part of the purveying depot, but no provision was made for systematic laboratory investigations in the field of hygiene until August, 1887, when a bacteriological laboratory was established at the Marine Hospital at New York.21 This laboratory was maintained at New York until 1891, when it was moved to Washington. In 1887 the service resumed the publication of the Weekly Abstract of Sanitary Reports, which had been discontinued in 1879 when quarantine control was vested in the National Board of Health.

The act of August 1, 1888 (25 Stat. L., 355), prescribed specific penalties for trespassing on quarantine reservations as well as penalties for masters or pilots of vessels who might enter any port in violation of the act of April 28, 1878. This law also provided for the establishment of national quarantine stations under the Marine Hospital Service at the mouths of Delaware and Chesapeake Bays, on the Georgia Coast, and at Key West, San Diego, and Port Townsend.

The Secretaries of the Treasury and the Supervising Surgeons General had repeatedly recommended that the rules of the service requiring examination prior to appointment be given the force of law, but not until 1889 did Congress pass a law on this subject. The act of January 4, 1889 (25 Stat. L., 639), provided that all medical officers of the service should be appointed by the President, and be subject to confirmation by the Senate. Prior to this act only the Supervising Surgeon General was appointed by the President. This act provided also that original appointments could be made only to the rank of assistant surgeon and after an examination before a board of medical officers of the service in ac

21 Ibid., 1888, p. 11.

cordance with rules prepared by the Supervising Surgeon General and approved by the Secretary of the Treasury and the President. It provided that an assistant surgeon could be promoted to the grade of passed assistant surgeon after four years' service and after passing a satisfactory examination. An examination was required also in the case of passed assistant surgeons promoted to the rank of surgeon. The President was authorized to nominate all officers already in the service.

The requirements of this act were embodied in the general regulations approved May 20, 1889, which provided also that the Supervising Surgeon General should be selected from the surgeons in the service. 22 These regulations fixed the compensation of surgeons at $2500, passed assistant surgeons at $1800, and assistant surgeons at $1600. Longevity pay at the rate of 10 per cent. of the annual salary for each five years' service was allowed to medical officers above the rank of assistant surgeon, with the limitation that the total longevity pay should not exceed 40 per cent. The beginning of a retirement system was evidenced by the provision that officers on "waiting orders" for more than two months should receive 75 per cent. of the pay of their rank, but there was no method prescribed for placing officers under "waiting orders.” 23

Interstate Control of Diseases, 1890. The first effective measure in the direction of interstate control of disease was the act of March 27, 1890 (26 Stat. L., 31), which provided that whenever he deemed it necessary the President was authorized to cause the Secretary of the Treasury to promulgate necessary rules and regulations to prevent the spread of cholera, yellow fever, smallpox, and plague from one state or territory into another. These regulations were to be prepared by the Supervising Surgeon General of the Marine Hospital Service, and the Secretary of the Treasury was authorized to employ such inspectors as might be necessary to enforce the regulations.

22 Regulations, 1889, Par. 1.

28 Ibid., Par. 24.

Violation of the regulations made in accordance with this act was made a misdemeanor, punishable by fine or imprisonment. It should be noted that this act does not confer general interstate quarantine authority, the diseases for which quarantine may be declared being cholera, yellow fever, smallpox, and plague.

Medical Inspection of Immigrants, 1890 and 1891. The medical inspection of immigrants was added to the duties of the service in the early part of 1890, when this work at New York was made one of its duties, although legislation placing the medical inspection of immigrants at all ports under the control of the service was not passed until March 3, 1891. The first act placing restrictions on the admission of defectives was the law of August 3, 1882 (22 Stat. L., 214), which prohibited the landing of a "lunatic, idiot, or any person unable to take care of himself or herself without becoming a public charge." As in the earlier legislation relating to quarantine, Congress looked to state organizations to furnish the machinery for the administration of the law. The Secretary of the Treasury was charged with the duty of executing the provisions of the act, and "for that purpose" he was given "power to enter into contracts with such state commission, board, or officers as may be designated for that purpose by the governor of any state to take charge of the local affairs of immigration in the ports within said state." These boards examined the immigrants, and Collectors of Customs were required to refuse admission to any immigrants whose entry was prohibited by the law. The Treasury Department was apparently unable to make general provision for the medical inspection of immigrants, as this work appears to have been carried on at New York only.24 In April, 1890, the contract with the Board of State Emigration Commissioners at New York was abrogated, and the Treasury Department undertook the inspection of immigrants at that port, the

24 Sup. Surg. Gen., Annual Report, 1890, p. 62; Annual Report, Secretary of the Treasury, 1890, p. lxxiv.