History(cont.)

Another function that the Federal Government took over from the states in the late nineteenth century, motivated by the dramatic increase in immigration in this period, was the processing of immigrants.  Under the immigration act of 1891, the Marine Hospital Service was assigned the responsibility for the medical inspection of arriving immigrants.  Immigration legislation prohibited the admission of individuals suffering from “loathsome or dangerous contagious diseases,” those who were insane or had serious mental deficiencies, and anyone likely to become a public charge (e.g., owing to a medical disability).  Service physicians at immigration depots such as Ellis Island in New York examined incoming immigrants for medical fitness.  On a busy day at Ellis Island, Service physicians would inspect thousands of immigrants, necessitating that the examinations be brief and superficial.  When an immigrant’s condition aroused concern during this initial inspection, he or she was detained for further, more detailed examination.

The relatively new science of bacteriology and the germ theory of disease were beginning to make their impact felt in the late nineteenth century, and the Marine Hospital Service decided to establish a bacteriological laboratory at the Staten Island hospital in 1887.  Originally concerned mainly with practical problems related to the diagnosis of disease, the laboratory in time began to undertake original biomedical research as well.  The Hygienic Laboratory, as it came to be called, was moved to Washington, D.C. in 1891, and eventually evolved into the National Institutes of Health.

Because of the broadening responsibilities of the Service in the area of public health, its name was changed in 1902 to the Public Health and Marine Hospital Service.  The 1902 law that changed the name of the Service also led to increased cooperation between Federal and state health authorities, including directing the Surgeon General to prepare and distribute to state health officers forms for the uniform compilation of vital statistics.  These statistics were published in the Service’s journal, Public Health Reports.  Another law passed in 1902, the Biologics Control Act, extended the Service’s reach in yet another direction, giving it regulatory authority over the production and sale of vaccines, serums, and other biological products.

Examples of the increasing cooperation of the Service with local health authorities in the early years of the twentieth century include the campaigns against plague in San Francisco and yellow fever in New Orleans.  State and local health officials began to call on the Service more frequently for assistance in dealing with public health problems.  For example, Yakima County, Washington officials turned to the Service for help in combating a typhoid fever epidemic in 1911.  The Service sent a Commissioned Officer to investigate the outbreak, and he identified the cause of the spread of the disease as feces and initiated a campaign for sanitary privies.  This work also marked the beginnings of the Service’s first substantial rural sanitation campaign.  The rural sanitation efforts of the Service in the following years spread to other areas of the country and helped to encourage the establishment of county health departments.

The increasing involvement of the Service in public health activities led to another name change in 1912.  “Marine Hospital” was dropped from its title, and the organization became simply the Public Health Service (PHS).  At the same time, the PHS was given clear legislative authority to “investigate the diseases of man and conditions influencing the propagation and spread thereof, including sanitation and sewage and the pollution either directly or indirectly of the navigable streams and lakes of the United States.”  Thus all types of disease, whatever the cause (including environmental pollution), came within the purview of the PHS.  One important breakthrough in combating disease at about this time was the demonstration by a PHS Officer that pellagra, a disease especially common in the South, was caused by a dietary deficiency.

World War I had a significant impact on the PHS.  Some PHS Commissioned Officers were detailed to the Army and Navy, but most PHS staff members were involved in war-related efforts on the home front. The Service was given the responsibility of working with local health departments to keep the areas around military training camps in the United States free from disease.  The threat of venereal disease (VD) to servicemen and essential war workers was of particular concern to the military, and a Division of Venereal Disease was created in the PHS in 1918 to help control the spread of VD.  The Spanish influenza pandemic that struck the world in that same year led to increased funding and staff for the PHS specifically to fight this disease.  The Service also became more actively involved in industrial hygiene and water pollution activities during the war.

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