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.

persons who failed to pass inspection at Naples, went to French ports and embarked for Canada.80

For some time the treatment of leprosy and the segregation of persons afflicted with this disease had been attracting considerable attention and on March 2, 1899, Congress passed an act (30 Stat. L., 976) directing the Supervising Surgeon General of the Marine Hospital Service to appoint a commission of medical officers of the service to investigate the origin and prevalence of leprosy and to report on legislation necessary to prevent the spread of the disease. The expenditure of $5,000 was authorized for this work, to be paid from the appropriation for preventing the spread of epidemic diseases. This commission submitted its report in 1902, and recommended the establishment of a national leprosarium to be maintained by the federal government.31 Provision for a national home for lepers was not made until February 3, 1917 (39 Stat. L., 872), and the institution was not opened until 1920.

For several years the service had been considering the advisability of establishing a establishing a sanitarium for tuberculosis patients, and in 1899 it was decided that the abandoned military reservation at Fort Stanton, New Mexico, was the most suitable site in possession of the government that was not being used for other purposes. The executive order of April 1, 1899, directed that this reservation be turned over to the Marine Hospital Service. The first patient was received at this institution on November 18, 1899, and on June 30, 1900, forty-seven patients were under treatment.

When provision was made for civil governments in Hawaii and the former Spanish Islands the quarantine duties of the Marine Hospital Service were extended to these possessions. The executive order of January 3, 1900, placed the quarantine administration of the Philippine Islands under the Marine Hospital Service and set aside $300,000 from the revenues

30 Ibid., 1899, p. 577; 1900, p. 523. 31 57 Cong., I Sess., S. Doc. 269.

of the islands for that purpose. Section 10 of the act of April 12, 1900 (31 Stat. L., 80), creating a civil government for Porto Rico, and section 97 of the act of April 30, 1900 (31 Stat. L., 160), creating a government for the territory of Hawaii, provided that quarantine stations should be established as directed by the Supervising Surgeon General of the Marine Hospital Service, and that quarantine regulations. should be under the control of the United States Government. The law relating to Hawaii stipulated that the health laws of the island should remain in the jurisdiction of the government of the territory, subject to the quarantine laws and regulations of the United States.

A new building for the hygienic laboratory of the service was provided for in the sundry civil appropriation act approved March 3, 1901 (31 Stat. L., 1137), but the building was not occupied until 1904. This act appropriated $35,000 for the erection of "necessary buildings and quarters for a laboratory for the investigation of infectious and contagious diseases, and matters pertaining to the public health." The wording of this appropriation is significant in that there is recognition of the fact that the Marine Hospital Service was no longer concerned solely with medical treatment of specified beneficiaries, but had become the representative of the federal government in health matters. At first the investigations made in the hygienic laboratory had been entirely in connection with the hospital branch of the service. Gradually they had extended more and more into questions of public health and quarantine, owing mainly to demands made by state and municipal health organizations.32 For many years the results of its work had been published as appendices to the annual report of the Surgeon General, by 1899 the reports had increased to such an extent that it was deemed advisable to issue them in pamphlet form.33

Further authority over quarantine anchorages was con

32 Sup. Surg. Gen., Annual Report, 1897, pp. 716-717.

38 Ibid., 1899, p. 845.

ferred on the Supervising Surgeon General by the act of March 3, 1901 (31 Stat, L., 1086), which also made subject to quarantine regulations any vessel which might arrive within the territorial limits of the United States, but which did not attempt to enter any port. The act of February 15, 1893, applied only to vessels entering United States ports.

In 1902 an appropriation of $250,000 was made for the purchase of the property used for a marine hospital at New York. At the most important port in the country, the hospital had never been housed in a government building. Until 1879 seamen were treated at various hospitals under contract, in that year the use of Bedloes Island was obtained from the War Department, and the hospital was operated at that point for three years, when it became necessary to vacate because of the erection of the Statue of Liberty. After 1882 the hospital was quartered in rented buildings on Staten Island.

In September, 1901, the Surgeon General submitted to the Secretary of the Treasury a plan for organizing a yellow fever institute composed of officers of the service and others specially qualified, who became members by invitation. The object of this organization was "to collect all facts concerning yellow fever, to designate the specific lines of inquiries to be made, and to make them." This institute became a part of the Division of Scientific Research which was organized at the same time.34 The results of the work were published in the series known as "Bulletin of the Yellow Fever Institute."

The Public Health and Marine Hospital Service, 1902 to 1912. The increase in duties of the service resulting from the supervision of quarantine, the medical inspection of immigrants, the prevention of the interstate spread of diseases, and the general investigations in the field of public health made it desirable to change the name of the service and give it more specific statutory powers.

34 Surgeon General, Public Health and Marine Hospital Service. Annual Report, 1902, p. 439.

The Act of July 1, 1902. Four bills relating to the service had been introduced during the first session of the FiftySeventh Congress, and on July 1, 1902, the President approved the act which changed the name of the service to the Public Health and Marine Hospital Service (32 Stat. L., 712). This act also changed the designation of the head of the service to Surgeon General, and fixed his salary at $5,000 a year. The salaries and allowances of the commissioned medical officers were to be the same as provided by existing regulations of the service. Commissioned medical officers detailed in charge of administrative divisions in Washington were to have the rank of assistant surgeons general. The President was authorized to utilize the service in time of war in such manner as would promote the public interest without impairing the efficiency of the service in filling the functions for which it was created. He was also given authority to prescribe regulations governing the administration, discipline, and uniforms of the service.

A definite organization was provided for the Hygienic Laboratory, which had previously been operated under regulations of the service, and which had been doing work in the field of bacteriology and pathology only.35 Provision was made for a director of the laboratory detailed from the corps of commissioned officers of the service. The Surgeon General was authorized to appoint heads of the Divisions of Chemistry, Zoology, and Pharmacology from outside the service at compensations to be fixed by the Surgeon General if commissioned medical officers were not available for this duty. An advisory board of nine persons was created for the purpose of consulting with the Surgeon General relative to the investigations to be undertaken and the methods of conducting the work. This board was made up of the director of the laboratory, five persons skilled in laboratory work in its relation to the public health and not in the regular employ of the government, to be appointed by the Surgeon Gen35 Ibid., 1905, P, 218.