450 



MARINE HOSPITAL SERVICE. 



don medical journals forgot their insular pride and 

 were enthusiastic in according praise to the Amer- 

 ican institution. The " Lancet " even went so far 

 as to say: " Our transatlantic neighbors, ahead of us 

 in many things, are most decidedly in advance of 

 the old country in providing for the care of their 

 sick sailors." and recommended that " a leaf be 

 taken out of the book of the Marine Hospital Serv- 

 ice of the United States " for the improvement of 

 the military hospitals in Great Britain. 



As early as 1851 the service had been extended 

 to San Francisco, under what is known as " the con- 

 tract system," by which patients are farmed out to 

 the lowest bidders (a practice still in operation at 

 small ports) ; and subsequently a building was 

 rented for hospital purposes, but as this was injured 

 by the earthquake of 1868, the contract system was 

 resumed until 1875, when the first marine hospital 

 of the pavilion style of architecture was completed. 

 Prior to that date all the hospitals of the service 

 had been built according to the plan drawn by 

 Robert Mills in the shape of the letter H, the only 

 departure from this model being the building at 

 Detroit, which was laid off in the shape of the 

 letter T. The pavilion hospital was built with 

 long wings connected with the main office by nar- 

 row passageways, the object being to isolate each 

 ward, give increased ventilation and produce bet- 

 ter sanitary conditions. The advantages of this 

 style of architecture over the block hospital has 

 caused much discussion, but a final judgment has 

 been rendered that as good results may be obtained 

 in one as in the other, if they are conducted under 

 proper management. The pavilion style of archi- 

 tecture requires more space and is much more ex- 

 pensive than the older type. There are pavilion 

 hospitals at San Francisco, New Orleans, Memphis, 

 Cincinnati, St. Louis, Baltimore, Evansville, Ind., 

 and Cairo. 111. 



In 1875 the supervising surgeon was made a com- 

 missioned officer, and the title of his office was 

 changed to supervising surgeon general, his salary 

 being increased to $4,000 a year. The same act di- 

 rected the medical officers of the establishment to 

 inform themselves specially as to the local health 

 laws in force at their stations, and to render prompt- 

 ly all the aid in their power to maintain them. 

 This was the first practical exercise of quarantine 

 jurisdiction by marine hospital officers, which has 

 since been developed until the service is recognized 

 as the guardian of the public health of the nation. 

 In 1878 a national quarantine was established by 

 act of Congress which embodied so many of the 

 opinions of the supervising surgeon general relative 

 to preventing the introduction into our country of 

 contagious diseases from foreign ports that it has 

 been called li the Woodworth law." Dr. Wood- 

 worth did not long survive the success of his ener- 

 getic crusade against " the careless and offending 

 people " who imported pestilence. In 1879 he died, 

 and Surgeon John B. Hamilton, who had been tem- 

 porarily in charge of the bureau, was appointed to 

 fill the vacancy. The same year a national board 

 of health was intrusted with the executive author- 

 ity of the national quarantine on account of the 

 yellow-fever scourge ; but at the expiration of four 

 years this important duty reverted permanently to 

 the care of the Marine Hospital Service, and made 

 rapid progress toward a high standard of excel- 

 lence. In 1891 Dr. Hamilton resigned his office. 

 Surgeon Walter Wyman, of Missouri, was appointed 

 to succeed him. The most comprehensive legisla- 

 tion affecting the national quarantine service and 

 the country at large was embodied in the act of 

 Feb. 15, ,1893. Under its provisions officers of the 

 Marino Hospital Service have been detailed to serve 

 in association with the consuls at various foreign 



ports, and to authenticate the regular consular bill 

 of health by a certificate as responsible physicians 

 relative to the sanitary condition of vessels, cargo, 

 crew, and passengers about to depart for the United 

 States. Extensive investigations have been con- 

 ducted by Dr. Wyman in person and by his subor- 

 dinate officers in relation to the cause of yellow 

 fever at Havana, and the strictest vigilance is 

 maintained at all Southern ports that are exposed 

 to the menace of disease from the island of Cuba. 

 Regulations prohibiting shipment of Egyptian rags 

 from infected ports during the outbreak of cholera 

 in 1896 have been rigidly insisted upon, and, in 

 view of the possible danger to the public health of 

 the United States from the prevalence of the bu- 

 bonic plague in India and China, the Marine Hos- 

 pital Service has issued a circular, dated Jan. 18, 

 1897, addressed to all consular officers, masters and 

 owners of vessels, collectors of customs, national, 

 State, and local quarantine officers, and others, call- 

 ing attention to existing quarantine regulations of 

 the Treasury Department, and promulgating addi- 

 tional precautionary measures to be observed vi/., 

 fifteen days' detention of all crews and passengers 

 who have been exposed to the infection, and other 

 requirements relating to cholera. 



At New York, Boston, and New Orleans the 

 maritime quarantines are owned and operated by 

 the State and municipality ; but the Marine II os'- 

 pital Service is required to co-operate with these 

 local authorities in enforcing not only their own 

 rules and regulations, but those of the Secretary of 

 the Treasury. The most harmonious relations exist 

 between the Marine Hospital officers and the local 

 boards of health, and there is a growing sentiment 

 throughout the country in favor of yielding all con- 

 trol of quarantine tothe General Government. Penn- 

 sylvania and North Carolina have set an example by 

 practically surrendering their, functions in this 

 matter, and a similar proposition has been favor- 

 ably discussed in Maine and in Texas. During the 

 past year the Marine Hospital Service acquired en- 

 tire control of the quarantine that guards the port 

 of San Francisco. The quarantine system of the 

 United States is acknowledged to be far superior to 

 that of every other country in one important re- 

 spect, viz., the precautions required to be taken by 

 vessels at foreign ports. The regulations of the 

 Secretary of the Treasury served as a model at the 

 late Sanitary Conference held in Paris for the prep- 

 aration of precautionary restrictions to be imposed 

 upon cholera-bearing pilgrims. The vigilance of 

 the Marine Hospital Service at home is equally un- 

 remitting. By an arrangement with the Immigra- 

 tion Commissioner .at the port of New York, the 

 destination of every immigrant arriving on a vessel 

 that has had contagious disease on board is noted, 

 the health officers for each State interested are 

 warned by telegraph, and the same facts are pub- 

 lished in the weekly pamphlet issued by the bureau, 

 entitled " Public Health Reports." This pamphlet 

 also contains interesting sanitary statistics. Upon : 

 the appearance of an epidemic disease in the United 

 States, information is telegraphed from the Marine 

 Hospital Service to all portions of the region likely 

 to be infected; and where the contagion is threat- 

 ening, officers of the service are sent to represent 

 the Government and enforce the regulations of 

 inland quarantine. A sanitary cordon is estab- 

 lished round the stricken district; detention camps 

 are equipped to segregate the well from the sus- 

 pects, and these again from the sick ; and a system 

 of railroad inspection is inaugurated for the exam- 

 ination of passengers and the disinfecting of bag- 

 gage. Depopulation of the infected district is rec- 

 ognized as a valuable means of controlling the 

 epidemic, and probation camps are opened outside 



