When Congress created the U.S. Public Health Service, it recognized the success achieved by the increasingly organized Marine Hospital Service in taking responsibility for protecting the health of U.S. citizens.
When, in 1912, the U.S. Congress passed legislation authorizing the U.S. Public Health Service to investigate the causes of communicable diseases, lawmakers recognized the official transition from the Public Health Service’s origins as an agency of government established with a narrow focus—that is, to provide health care for one small segment of the population—into a government agency responsible for overseeing the general health of the entire citizenry of the United States.
The origins of the U.S. Public Health Service can be traced to sixteenth century England, although hospitals have existed in Europe and Asia since Christians began performing charitable acts around the time of Constantine; they continued throughout the Middle Ages, especially in monasteries. Some monastic orders, such as the Knights Hospitaller, specialized in the care of the sick and injured. Later, after the defeat of the Spanish Armada in 1588, the English established a seaman’s hospital in gratitude for the services of their naval personnel. Throughout much of the American colonial period, the British government collected a nominal sum from its sailors, including those from the colonies, to care for the sick and disabled.
In the early days of the United States, Alexander Hamilton urged a similar program on the grounds that an effective merchant marine was essential to U.S. commerce. In 1798, Congressman Edward Livingston of New York pushed through Congress a measure creating the Marine Hospital Service. The law provided that the Treasury Department would collect twenty cents per month from each merchant seaman to support the establishment of hospitals. The following year, Congress amended the act to include personnel in the navy and Marines. The first temporary U.S. Marine Hospital was established in Boston in 1799, and the first government-owned hospital was built in Norfolk County, Virginia, shortly thereafter. In 1802, Congress broadened the law to cover crews on boats and rafts sailing down the Mississippi River to New Orleans. As the United States expanded westward, Congress in 1837 provided for additional hospitals in the Mississippi River Valley and the Great Lakes region.
During these years, the Treasury Department loosely administered the Marine Hospital Service, but financial responsibility for the hospital rested on local customs collectors. Much of the medical care was provided on a contract basis rather than in hospitals owned or staffed by the government. For example, at times both Bellevue Hospital in New York and Charity Hospital in New Orleans treated individual patients for seventy-five cents per day. Patients in these institutions may have fared better than those treated in private institutions because the contracts were awarded as a form of political patronage. Still, the caliber of service rendered for the first seventy years varied widely from hospital to hospital.
As the century advanced, the Marine Hospital Service began to build more hospitals, but political factors often determined their location. In New Orleans, for example, work was started on a Marine hospital in 1837. After lagging for many years, the project was completed in 1851, at a total cost of $123,000, an enormous sum for those days. Despite the obvious mismanagement of this building contract, funds were appropriated for an even larger hospital in 1885. This one was built in a swamp, and one of the walls sank two feet before the structure was completed. The building, which eventually cost half a million dollars, was never used by the Marine Hospital Service.
Complaints about the marine hospitals led Congress to appoint an investigatory commission in 1849. Seven years later, the commission’s recommendations for standardizing hospital procedures were put into effect. Although some improvement ensued, political interference and a high degree of decentralization still characterized operations. Critics noted that each hospital operated independently. In 1870, Congress remedied this situation by completely reorganizing the Marine Hospital Service, centralizing control in a bureau of the Treasury Department and placing a supervising surgeon at the head. The first officer to hold this position was Dr. John Maynard Woodworth, a Civil War veteran and an exceedingly able individual. The same law also increased the hospital tax to forty cents per month. The monthly charge remained the same until 1884, when it was supplanted by a tonnage tax. In 1906, Congress recognized the expanded sphere of duties for the Hospital Service and replaced the tonnage tax with direct congressional appropriations.
Remarkable gains were made under Woodworth. In 1873, he introduced a personnel system that was, in effect, a civil service system for all employees. By this and other measures, he gradually raised the caliber of the staff and fostered the development of a strong esprit de corps. The next major advance came in 1889, with the creation of a commissioned officer corps, which gave the service a mobile force of highly qualified health experts. Woodworth also provided strong support for the developing public health movement, actively worked for a national quarantine system, and helped draft the first federal quarantine law in 1878. Following the passage of this latter act, the Marine Hospital Service collaborated with state and municipal governments in improving their quarantine agencies. When Congress strengthened the National Quarantine Law in 1893, the Marine Hospital Service began taking over state and local quarantine stations. The takeover was completed in 1921, when the Marine Hospital Service began to run the quarantine facilities of the Port of New York. The Immigration Act of 1891 further broadened the responsibilities of the Marine Hospital Service by requiring its medical officers to examine all immigrants.
Another significant step had been taken in 1887, when Joseph Kinyoun, a physician who had trained in Europe, established a one-room bacteriological laboratory in the Marine Hospital on Staten Island. Four years later, the bacteriological research moved to Washington, D.C., when the Hygienic Laboratory for Bacteriological Research was established there. In 1902, Congress acknowledged the Marine Hospital Service’s changing status by changing the organization’s name to the U.S. Public Health and Marine Hospital Service. In 1912, the name was shortened to the U.S. Public Health Service.
The Public Health Service steadily widened its functions in the twentieth century. Its research laboratories did outstanding work in epidemiology, and the service played an important role in developing state and local health boards. Under the Social Security Act of 1935, the Public Health Service was given responsibility for distributing eight million dollars annually in grants-in-aid for public health purposes. In succeeding years, both the budget of the Public Health Service and the agency’s responsibilities increased dramatically.
By the end of the twentieth century, the Public Health Service had evolved into an agency active in medical research, health education, and disease prevention. As a division of the Department of Health and Human Services headed by the surgeon general, the Public Health Service included the Centers for Disease Control and Prevention, the Health Resources and Services Administration, the Indian Health Service, the National Library of Medicine, the Substance Abuse and Mental Health Services Administration, and the National Institutes of Health. The bacteriological research begun by Kinyoun in the nineteenth century had grown into a medical resource used not only by the United States but also by countries around the world. Researchers at the National Institutes of Health were active in finding the retrovirus associated with acquired immunodeficiency syndrome (AIDS), for example, and researchers at the Centers for Disease Control and Prevention discovered the causes of infections such as Legionnaires’ disease. The Public Health Service also remained active in disease prevention and education efforts, including the creation of educational materials warning young people of the dangers of smoking tobacco and engaging in other risky behaviors.
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Aday, Lu Ann, ed. Reinventing Public Health: Policies and Practices for a Healthy Nation. San Francisco: Jossey-Bass, 2005. Excellent summary of contemporary public health beliefs. Comprehensive analysis includes examination of environmental, economic, and human rights issues related to public health and the Public Health Service. -
Dupree, A. Hunter. Science in the Federal Government: A History of Policies and Activities. Baltimore: The Johns Hopkins University Press, 1986. Lucid, comprehensive history of the relationship between science and government in the United States from 1787 to 1940. The chapter on medicine and public health details the evolution of the Marine Hospital Service, its interactions with other government health agencies, and its emergence as a leader in bacteriological research. -
Gallo, Robert. Virus Hunting. New York: Basic Books, 1991. An informative history of AIDS and the isolation of the virus that proved to be the etiological agent. Gallo, who is probably the most important figure in that endeavor, includes a history of the National Institutes of Health and its evolution within the Public Health Service. -
Mullan, Fitzhugh. Plagues and Politics: The Story of the United States Public Health Service. New York: Basic Books, 1993. A history that focuses specifically on the Public Health Service. -
Pickett, George, and John Hanlon. Public Health: Administration and Practice. 10th ed. St. Louis: Mosby College Publishing, 1998. A useful description of the organization of public health services and programs, with emphasis on implementation, management and patterns of programs, and the role of the environment. -
Ravenel, Mazyck, ed. A Half Century of Public Health. Lynn, Mass.: Nichols Press, 1921. Commemorates the fiftieth anniversary of the American Public Health Association. Provides an excellent description of the nature of public health in the United States during the nineteenth and early twentieth centuries. -
Starr, Paul. The Social Transformation of American Medicine. New York: Basic Books, 1984. Outstanding historical review, describing the evolution of American medicine from the eighteenth century “doctor on horseback” to the twentieth century industry funded by the government. Also discusses the establishment and evolution of government agencies such as the Public Health Service. -
U.S. Department of Health and Human Services. Public Health Service. For a Healthy Nation: Returns on Investment in Public Health. Washington, D.C.: Government Printing Office, 1994. Describes the public benefits possible through increased funding for the Public Health Service. -
Williams, Ralph Chester. The United States Public Health Service, 1798-1950. Washington, D.C.: Commissioned Officers Association of the U.S. Public Health Service, 1951. An outstanding documentary on the history of public health programs and services in the United States. Discusses the Public Health Service from its early inception as the Marine Hospital Service to its later role in disease prevention. -
Wilson, Florence, and Duncan Neuhauser. Health Services in the United States. Cambridge, Mass.: Ballinger, 1985. Originally developed for students in public health, the book provides a concise summary of the health care system in the United States. Describes various agencies, their roles in public health programs, and summaries of the laws they oversee and enforce. Includes charts and “maps” through the bureaucracies.
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