MARINE HOSPITAL SKIJYICK. 



4 4I> 



MARINE HOSPITAL SERVICE. On, of the 



bureaus <>f i he United stales Treasury Department 

 is distinctively an American institution, there be- 

 ing nothing exactly like it in any foreign country. 

 IHs not for the benefit of the navy, but is devoted 

 to care of sick and disabled seamen of the merchant 

 marine. Through the agency of the Boston Marine 

 Society, as early as ITll'J. the attention of Congros 

 was first directed to the needs of this class of citi- 

 zens, whose lives become almost necessarily improvi- 

 dent while spent in the interests of commerce. No 

 decisive action was taken until 1798, when, through 

 the exertions of the Hon. Edward Livingston, of 

 New York, a bill was passed establishing the Ma- 

 rine Hospital Service. Under its provisions a tax 

 of 20 cents a month was placed on the pay of every 

 seaman employed on vessels engaged either in for- 

 eign or coasting trade, and the President of the 

 United States was authorized to use the fund thus 

 derived for the benefit of sick and disabled Amer- 

 ican seamen. Medical treatment, under the direc- 

 tion of the new establishment, was begun in 1799 

 in Boston by providing for the care of patients at 

 local hospitals and the appointment of a physician 

 to look after them. The first marine hospital' owned 

 by the Government was at Washington Point, Nor- 

 folk County, Va., purchased by the United States 

 in 1800. The General Court of Massachusetts au- 

 thorized the erection of a marine hospital at Holmes 

 Holl, now Vineyard Haven. Marthas Vineyard, in 

 1 ?!is. and it was in use for many years. In 1803 the 

 first marine hospital erected by the service was com- 

 pleted, its site being Charlestown. Mass.. for the port 

 of Boston, and it is now standing in the navy yard 

 at that port. 



As first initiated, the service contemplated in- 

 cluding naval officers and seamen tinder its opera- 

 tions, but in 1811 separate hospitals were estab- 

 lished for the navy. As for several years all ex- 

 penses had to be met out of the fund created by 

 the tax on merchant seamen, and the amount col- 

 lected was not sufficient to meet the demands, re- 

 strictions were necessary to limit the expenditures. 

 Chronic and incurable cases were excluded, and in 

 no case was relief allowed for a longer period than 

 four months. Foreign seamen were admitted to 

 United States marine hospitals on certain condi- 

 tions, the rate of charge being 75 cents a day. In 

 1801 the State Department received petitions from 

 New Orleans (which did not then belong to the 

 United States) calling attention to the deplorable 

 conditions existing in that city from the fact that 

 numbers of American citizens, principally boatmen 

 from the Mississippi and its tributaries, arrived 

 each year during the sickly season. The constitu- 

 tions of these robust Western men were enervated by 

 climatic influences on these long flatboat voyages; 

 frequently three out of the five composing a crew 

 died during the trip, and it was not uncommon for 

 the entire crew to perish, leaving the cargo deserted. 

 The survivors, after their employers' markets were 

 made, were left stranded in New Orleans far from 

 home and friends, victims of fever in that low flat 

 country, unable to enter the already crowded Span- 

 ish Poor Hospital, and refused admission to the 

 better class of public houses. Residents of New 

 Orleans urged the United States Government to 

 place a tax on the pay of every boatmen, in order 

 that a sum might be raised to afford accommoda- 

 tions for their sick. It was also recommended that 

 American physicians be sent to look after their wel- 

 fare, as there was added to the general distr. 

 prevalent prejudice against the Spanish doctors. 

 In response to these representations, provision was 

 made for sick and disabled boatmen in local hospi- 

 tals at New Orleans in 1804. but a marine hospital 

 was not erected in that city till 1837. 



VOL. xxxvi. 29 A 



The principle on which the slender funds of the 

 service were administered was to regard them as 

 auxiliary to the provision made for charitable ob- 

 jects by the municipal authorities, and this prin- 

 ciple worked a hardship in the new cities that 

 sprang up on the banks of the Western lakes and 

 rivers. At these places the only bond of community 

 seemed to be the survival of the fittest, and there 

 were few accommodations for the care of sick stran- 

 gers, for the most part boatmen returning from , 

 their commercial expeditions, when left helpless on 

 shore by the steamboats of the Mississippi. The 

 cholera epidemic of 1832 gave a new impetus to the 

 Marine Hospital Service. At the inland ports shock- 

 ing cases occurred of boatmen ill with various dis- 

 eases, huddled promiscuously into one room and 

 almost inhumanly neglected. From such emergen- 

 cies sprang the energy of this beneficent govern- 

 ment institution. The President was authorized to 

 receive donations of personal property and real es- 

 tate to increase the Marine Hospital fund, and each 

 year that a shortage occurred in its accounts Con- 

 gress appropriated a small sum to cover the defi- 

 ciency. The petitions of the lake and river districts 

 began to win attention. The act of 1842 author- 

 ized the purchase of sites for marine hospitals at 

 Cleveland. St. Louis, Pittsburg. Natchez, and other 

 rising towns. The first marine hospital at Chicago 

 was begun in 1848, but it has been far eclipsed by 

 the present fine building designed by A. B. Mulletf, 

 which, when opened for the reception of patients in 

 1873, was pronounced " the finest structure of its 

 kind in the country." During the civil war all the 

 marine hospitals in the country were put to excel- 

 lent use in providing for wounded soldiers, North 

 and South. 



While the good work of the service was ever in- 

 creasing, abuses were also creeping into the system. 

 Politics were perverting its efficiency, dishonest and 

 incompetent administrators were sometimes in- 

 trusted with the management of the most impor- 

 tant hygienic measures, and many of the old hos- 

 pitals gained a bad reputation from simple lack of 

 cleanliness and ventilation. The most proficient 

 surgeons twenty-five years ago regarded fire as the 

 only effective antiseptic, and advocated the burning 

 of all hospital buildings after a definite term of 

 years. To diminish the mischief resulting from 

 misrule, a reorganization of the service was deemed 

 essential, and in 1870 Dr. John S. Billings, surgeon 

 general of the army, was summoned to Washington 

 to assist in this work. The Secretary of the Treas- 

 ury was then authorized to appoint a supervising 

 surgeon at a salary of $2.000, and the late Dr. John 

 M. Woodworth, of Illinois, appointed in 1871. was 

 the first person to fill this office. It was also deter- 

 mined to institute examinations for admission to 

 the service, after passing which the applicants were 

 appointed by the Secretary of the Treasury : and 

 the duties of all employees were strictly defined. 

 Another important change was increasing the tax 

 levied upon each seaman to 40 cents a month, to be 

 collected by the collector of customs at every port, 

 and a system of outdoor dispensary relief was in- 

 augurated in 1872 for distributing medicine. An in- 

 vestigation of the accounts of the service showed that 

 an aggregate of $4.830,994.34 had been appropriated 

 by Congress, contributions by taxation and gift had 

 amounted to $7.096.968.89, and there was a surplus of 

 $288,028.57 to the credit of the Marine Hospital fund. 

 The service was self-supporting and required no 

 further aid by appropriation except for new build- 

 ings. In 1884 the hospital tax was abolished, and 

 in its stead the tonnage tax received from foreign 

 vessels was made available. 



Soon after its reorganization the service began to 

 attract attention abroad, and the conservative Lon- 



