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Public Health

History

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Author:  John Parascandola, Ph.D., copyright, PHS Commissioned Officers Foundation for the Advancement of Public Health; reprinted with permission of Faircount Corp.

The United States Public Health Service traces its origins back to a 1798 “act for the relief of sick and disabled seamen.”  The young American republic was dependent upon the sea for both defense and commercial purposes.  When American merchant ships docked in the country’s ports, questions arose as to how to provide health care for sick or injured seamen and who would pay for this care.   Utilizing a model developed by its former mother country, Great Britain, the new nation created a system to provide care to merchant seamen.  John Adams signed an act of Congress on July 16, 1798 which established a Marine Hospital Fund to be administered by the Treasury Department.  Twenty cents a month was deducted from the pay of each seaman to fund a system of hospitals in major port cities to treat sick and injured seamen.  One can think of this arrangement as the first health insurance scheme and the first HMO in America.   In 1799, seamen of the Treasury Department’s Revenue Marine Division (forerunner of the Coast Guard) were also included in this program.  Officers and men of the Navy were also eligible for care in the marine hospitals from 1799 until 1817, when the Navy began construction of its own hospitals.

The first of the Federal marine hospitals opened in 1799 in a converted former Army barracks on Castle Island in Boston harbor.  The first hospital to be built using funds authorized under the 1798 act was opened in the Charlestown section of Boston in 1804, replacing the temporary facility on Castle Island.  Marine hospitals were eventually opened in other cities along the East Coast, inland waterways, the Great Lakes, and the Gulf and Pacific Coasts.

In the period before the Civil War, the marine hospitals hardly constituted an organized system.  They were inadequately funded, and the choice of sites for hospitals and the appointment of physicians were influenced by political as well as medical reasons.  During the Civil War, the hospitals were taken over by troops on both sides for their own use, and by 1864 only eight of the 27 hospitals listed before the advent of the war were operational.  Concerned about the situation, the Secretary of the Treasury commissioned a study of the marine hospitals in 1869.  The critical report issued as a result of the study led to the passage of reform legislation in the following year.

The reorganization of 1870 transformed the loose network of locally controlled hospitals into a centrally controlled Marine Hospital Service, with its headquarters in Washington, D.C.  In 1871, John Maynard Woodworth was appointed to be the first Supervising Surgeon (a title later changed to Surgeon General) of the Service.  Woodworth had served as a surgeon in the Union Army during the Civil War, and he quickly moved to adopt a military model for his medical staff.  He instituted examinations for applicants and put his physicians in uniform.  Physicians were not appointed to a given hospital, but to the Service as a whole. Woodworth thus created a cadre of mobile, career service physicians who could be assigned and moved as needed to the various marine hospitals.  In 1889, this uniformed services component of the Service was formalized by legislation as the Commissioned Corps.  At first open only to physicians, over the course of the twentieth century the Corps expanded to include dentists, sanitary engineers, pharmacists, nurses, and other health professionals.

In the closing decades of the nineteenth century, the scope of activities of the Marine Hospital also expanded well beyond the care of merchant seamen.  Responsibility for quarantine for certain infectious diseases originally rested with the states, but an 1877 yellow fever epidemic that spread from New Orleans up the Mississippi River served as a reminder that diseases do not respect state borders.  The epidemic resulted in the passage of the National Quarantine Act of 1878, which began a process of transferring responsibility for quarantine from the states to the Federal Government.  Since the Marine Hospital Service already had hospitals and physicians located in many port cities, the Government assigned the Service to administer Federal quarantine.

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©2012 Commissioned Officers Association of the USPHS Inc
Revised 1/17/2012