Reorganization of the Service, 1870 to 1875. This law authorized the Secretary of the Treasury to appoint a supervising surgeon of the Marine Hospital Service at a salary of $2,000 in addition to necessary traveling expenses. The duties of this officer as stated in the law were to supervise under the direction of the Secretary of the Treasury "all matters connected with the Marine Hospital Service, and with the disbursement of the fund for the relief of sick and disabled seamen." In the same act the hospital tax on seamen was increased from twenty to forty cents a month. The proceeds of the tax were to be placed in a separate fund, which was appropriated for the expenses of the Marine Hospital Service, and which was to be "employed under the direction of the Secretary of the Treasury, for the care and relief of sick and disabled seamen employed in registered, enrolled, and licensed vessels of the United States."

The office of supervising surgeon was first filled in April, 1871, by the appointment of Dr. John M. Woodworth, who promptly took steps to reorganize the service on a more efficient basis. The rules governing the service were gradually revised, and the new rules were codified in regulations approved October 1, 1873. Under the new regulations appointments were made to the general service, and not to particular hospitals or stations, the surgeons being transferred from the smaller to the more important stations as vacancies occurred. This feature emphasized the national character of the service, prevented appointments due to local political influence, and gave the general service the benefit of the experience acquired by its officers. More important was the requirement that appointments to the medical staff should be made only after examination by a board of surgeons, the appointment being made by the Secretary of the Treasury on the recommendation of the Supervising Surgeon.12 Compensation of all officers and employees was fixed by the Secretary of

12 Regulations, 1879, Par. 51 and 52.

the Treasury, with the exception of the salary of the Supervising Surgeon, which was fixed by statute.

Supervising Surgeon Woodworth had been a medical officer of the Army, and evidently believing that a military plan of organization gave the best results, he placed the service on what was practically a military basis. Officers were required to wear a regulation uniform when on duty, and the general discipline and administration of the hospitals were modeled on military lines. In their basic features these regulations are in force at the present time, although modifications have been made in details as a result of the creation of additional grades of officers and changed conditions.

The first annual report of the reorganized service was the one for 1872, which reflected the change in general character. The earlier reports contained only statements of receipts and expenditures, while the report for 1872 included detailed medical statistics on cases treated and brief reports on the history of surgical cases. In the report for 1873 was begun the publication of more detailed technical and scientific papers dealing with cases of special interest. These papers continued to be published in the annual reports until 1905, after which articles of this character were issued in separate form.

The next legislation affecting the service was contained in the sundry civil appropriation act of March 3, 1875 (18 Stat. L., 377), in which the head of the service is called the Supervising Surgeon General, and which provided that he should be appointed by the President, subject to confirmation by the Senate. The salary of the office was fixed at $4,000 a year. No change was made in the method of appointing other officers, and they continued to be appointed by the Secretary of the Treasury, who also fixed their compensation. By this act some changes were made in the method of collecting the tax, and the term "seaman," previously undefined, was made to include all persons employed on vessels, in so far as the benefits of the service were concerned. Foreign seamen were allowed to obtain treatment at the hospitals at

rates to be fixed by the Secretary of the Treasury, instead of at the rate of seventy-five cents a day prescribed by the act of May 3, 1802. Seamen on vessels not subject to the hospital tax were to be admitted on the same terms as foreign seamen, and under this provision persons employed on vessels of the Navy, Engineer Corps of the Army, Coast Survey, and Lighthouse Service 13 were given treatment, the expenses being paid by the various services. This law provided also that insane patients of the service should be admitted to the Government Hospital for the Insane, now St. Elizabeth's Hospital, and that the Secretary of the Treasury might lease hospital buildings and use the proceeds for the maintenance of the service.

Quarantine Law of 1878. The first national quarantine law was the act of April 29, 1878 (20 Stat. L., 37), and the medical officers of the Marine Hospital Service were charged with the enforcement of regulations to be promulgated by the Secretary of the Treasury. It is true that Congress had passed quarantine laws in 1796, 1799, 1832, and 1866, but these earlier laws merely extended federal aid in the enforcement of local regulations. By the act of May 27, 1796 (1 Stat. L., 474), the President was authorized to direct revenue officers and officers commanding forts and revenue cutters to aid in the execution of health laws of the states in such

manner as may appear necessary. This law was repealed by the act of February 25, 1799 (1 Stat. L., 621), which provided that any quarantine established by or in conformity with the health laws of any state should be observed by Collectors of Customs and all other officers of the revenue, by masters of revenue cutters, and by military officers as directed by the Secretary of the Treasury. The act of July 13, 1832 (4 Stat. L., 577), gave the Secretary of the Treasury authority for one year to employ additional boats and officers if he deemed the revenue boats and officers insufficient to enforce the quarantine regulations. By the act of May 26,

18 Sup. Surg. Gen., Annual Report, 1875, p. 6.

1866 (14 Stat. L., 357), the Secretary of the Treasury was directed to make quarantine regulations necessary to aid state or municipal authorities in guarding against the introduction of cholera. He was also authorized to direct revenue officers and commanders of revenue cutters to assist in the execution of the quarantine and health laws of the states.

An epidemic of cholera in 1873 focused attention on the subject of quarantine and the Secretary of the Treasury on September 8, 1874, issued a general circular calling attention to the act of February 25, 1799 (R. S. 4792), which for some years had been practically a dead letter. In this circular officers of the Marine Hospital Service and customs officers were directed to inform themselves fully regarding local health laws and regulations, and directed to give prompt assistance in their enforcement.14

All the laws discussed above assumed that quarantine was a local function and that any action of the federal government should be merely for the purpose of assisting state or municipal authorities. The diversity in the regulations and the burden thrown upon foreign commerce by the unreasonable requirements at some ports led to the passage of the act of April 29, 1878 (20 Stat. L., 37), which gave authority to the Supervising Surgeon General of the Marine Hospital Service, subject to the approval of the President, to make rules and regulations governing the detention of vessels having cases of contagious diseases on board or coming from foreign ports at which contagious diseases exist. It was expressly stipulated, however, that these rules and regulations must not "conflict with or impair any sanitary or quarantine laws or regulations of any state or municipal authorities.' This provision might seem to tie the federal regulations definitely to the local rules, but the Attorney General held that the law did not mean that nothing could be done except what was authorized by the state law. "The only limitation is that the federal regulations must not interfere with the state

14 Ibid., p. 16.

laws... Suppose the [quarantine] period named by him [the State health officer] is deemed too short. It is in my opinion clearly competent under the acts of Congress above quoted to prescribe a longer period, both for persons and cargo, the regulations carefully providing that the federal jurisdiction should attach upon the expiration of state action."15

Officers of existing state or municipal quarantine systems were authorized to act as officers of the national quarantine system, and if the quarantine was considered necessary at other ports, the medical officers of the Marine Hospital Service were directed to perform such duties as might be assigned to them by the Supervising Surgeon General.

This act provided also that consular officers in foreign countries should advise the Supervising Surgeon General regarding the appearance of contagious diseases in any foreign port or the departure of any vessel from such a port for the United States. They were also required to report the departure of vessels from such ports to the health officer at the port of destination. In addition consular officers were required to make weekly reports to the Supervising Surgeon General on the sanitary conditions at the ports where they were stationed. The Supervising Surgeon General was required to notify the local authorities at the port of destination regarding the departure of any vessel from an infected port; he was also required to prepare and transmit to the medical officers of the Marine Hospital Service, to Collectors of Customs, and to state and municipal health authorities in the United States, weekly abstracts of the sanitary reports received from consular officers, as well as other pertinent information. The act of March 3, 1879 (20 Stat. L., 402), authorized the expenditure of $5,000 from the permanent appropriations of the Marine Hospital Service for the expense of collecting data for health bulletins.

The provision for the distribution of the weekly abstracts 15 20 Op. Att. Gen., 474.