medical inspection being assigned to the Marine Hospital Service.25

More specific provisions for the control of immigration and the medical inspection of immigrants were contained in the act of March 3, 1891 (26 Stat. L., 1084), which took effect April 1, 1891. This law prohibited the admission, among others, of "idiots, insane persons, persons likely to become a public charge, [and] persons suffering from a loathsome or a dangerous contagious disease." 26 It was provided that medical examinations were to be made by surgeons of the Marine Hospital Service, but if the services of a surgeon of the service could not be obtained without unreasonable delay the inspector could cause the examination to be made by a civil surgeon whose compensation was to be fixed by the Secretary of the Treasury. Medical officers were immediately detailed for inspection of immigrants at the more important ports; at other places the regular officer on duty at the station was available for this service. The inspection work at New York was made by a civil surgeon appointed by the Secretary of the Treasury, as the technical point was raised that the term "surgeon" in the act of March 3, 1891, meant an officer with the rank of surgeon. The Treasury Department maintained that the word surgeon was used in a general sense and meant any surgeon of the service. The district court, however, sustained the point raised, and as there were not sufficient officers of the grade of surgeon available, it was necessary to suspend the inspection work at that port.27 This technical objection appears not to have been raised at other ports, and the New York decision apparently was not used elsewhere to question the authority of the examining surgeons. This situation was remedied by section 8 of the act of March 3, 1893 (27 Stat. L., 570), which pro

25 Ibid., p. 55.

26 As this monograph is devoted solely to the activities of the Public Health Service, the general restrictions on immigration are not discussed.

27 Sup. Sur. Gen., Annual Report, 1891, p. 18.

vided that medical examinations might be made by any medical officer of the Marine Hospital Service detailed by the Secretary of the Treasury.

On June 1, 1891, Dr. J. B. Hamilton resigned as Supervising Surgeon General and was succeeded by Dr. Walter Wyman. In this year the bacteriological laboratory was moved from New York to the Washington headquarters, which had recently been moved to the Butler Building at New Jersey Avenue and C St. S. E.

Quarantine Law of 1893. The necessity of an extension of the powers of the federal government in preventing the introduction of contagious diseases into the country and their spread from one state to another resulted in the passage of the act of February 15, 1893 (27 Stat. L., 449), which is still in force and which gives authority for all existing domestic and maritime quarantine regulations. While this act did not undertake to prohibit states or municipalities from maintaining quarantine stations, it provided that state officers might surrender local stations to the Secretary of the Treasury, who was authorized to receive and pay for them if he considered them necessary to the United States. It would probably have been impossible to pass a law prohibiting states from maintaining quarantine stations, and the best results were probably obtained by allowing the states to surrender their quarantine functions from time to time as they realized the advantages of the national system Gradually the local stations have been surrendered by the states, the last one-at New York-having been acquired in 1921. While the act authorizes the Secretary of the Treasury to pay for the state quarantine stations, this portion of the law is practically of no effect, as he cannot disburse money for this purpose without a specific appropriation by Congress.

This act places upon the Supervising Surgeon General of the Marine Hospital Service the performance of all duties relating to quarantine and quarantine regulations. That officer is specifically directed to examine the quarantine regulations

of all state and municipal boards of health, and to coöperate with and aid the local boards in the enforcement of the regulations. If there are no regulations, or if the local regulations are insufficient, the Secretary of the Treasury is authorized to make additional regulations, which must operate uniformly and in no manner discriminate against any port or place. For the first time provision is made for quarantine regulations to prevent the introduction of contagious diseases other than cholera, yellow fever, smallpox, and plague, from one state or territory or the District of Columbia into another state or territory or the District of Columbia. The rules and regulations for both national and interstate quarantine promulgated by the Secretary of the Treasury are to be enforced by the sanitary authorities of states and municipalities if these officers will undertake this duty, but if the local authorities fail or refuse to enforce the regulations the President is authorized to "execute and enforce the same and adopt such measures as in his judgment shall be necessary to prevent the introduction and spread of such diseases, and may detail or appoint officers for that purpose."

This law provides also that vessels clearing from a foreign port for any port in the United States must obtain a bill of health from a consular officer or from a medical officer detailed for that purpose. The Secretary of the Treasury is authorized to make rules and regulations that must be obobserved by vessels sailing from a foreign port to the United States.

Authority is given for the detail of medical officers to consulates for the purpose of furnishing information and giving bills of health. Consular officers at places to be designated by the Secretary of the Treasury are required to make weekly reports of sanitary conditions. The Secretary of the Treasury is also directed to obtain weekly reports of the sanitary condition of ports and places within the United States, and to publish weekly abstracts of the consular sanitary reports and other pertinent information. Provision is also

made that the Secretary of the Treasury shall "by means of the voluntary coöperation of state and municipal authorities, of public associations, and private persons, procure information relating to the climatic and other conditions affecting the public health."

In order to furnish full protection against the introduction of contagious diseases the President was given authority "to prohibit, in whole or in part, the introduction of persons and property from such countries or places as he shall designate and for such period of time as he may deem necessary."

Regulations of 1897. In 1897 the regulations of the service were again revised and provision was made for increasing the efficiency of the service by dropping assistant surgeons who were unable to pass the examination for promotion. These provided that an assistant surgeon failing in his first examination should be given a second one at the end of the year; if he again failed to pass, it was further provided that he be reported to the Secretary of the Treasury as "not qualified for promotion" and "be requested by the Secretary of the Treasury to tender his resignation." A passed assistant surgeon failing in two examinations was to be placed in the register as "not in line of promotion." These regulations also provided for a retirement system for commissioned officers by placing them under "waiting orders." An officer reported to be unfit to perform his duties by reason of disease, injury, or age could be ordered before a board of officers for examination. If his disability was incurred in line of duty the board was authorized to recommend that he be placed on waiting orders or given special duties of a light character. The pay of an officer placed on waiting orders was fixed at seventy-five per cent. of the salary of his grade. These regulations likewise provided that acting assistant surgeons receiving more than $300 a year should be appointed only after passing an examination prescribed by the Civil Service Commission. Previously these officers had been appointed by the

Secretary of the Treasury on the recommendation of the Supervising Surgeon General.28

Growth of the Service from 1898 to 1901. The SpanishAmerican War in 1898 presented grave problems to the quarantine division because troops were being moved to and from an area which was badly infected with yellow fever. In coöperation with the War Department the Marine Hospital Service assumed charge of the sanitation on transports, and later when the troops were returned to the United States, a national quarantine station under the direction of an officer of the Marine Hospital Service was established at Montauk Point at the request of the Secretary of War.

At the conclusion of hostilities the quarantine laws of the United States were extended to Cuba and Porto Rico by the executive order of January 17, 1899.29 Medical officers of the Marine Hospital Service were immediately detailed to these islands, and quarantine service was organized at the principal ports.

The inspection of immigrants at foreign ports was commenced in 1899 when an assistant surgeon was sent to Naples for this purpose. This officer was detailed under the authority of the quarantine act of February 15, 1893, and he had definite authority only to issue bills of health and to require the sanitary measures specified by the regulations. He was, however, instructed to note, for the benefit of the immigration service, any physical infirmities or defects which might prevent the entry of the immigrant. There was no authority to prevent the embarkation of passengers who were not suffering from a communicable disease, but the transportation of defectives was generally prevented by calling the attention of the steamship company to the fact that the passenger would probably be refused admission under the immigration laws. This plan worked well, although many

28 Regulations, 1897, Par. 17-52.

29 Sup. Surg. Gen., Annual Report, 1899, p. 468.