BEFORE THE 
COMMITTEE ON INTERSTATE AND FOREIGN COMMERCE 
- z . / t - i /• ■ 1 * 4.' < 4 \ . < < - . - ■ \ -.-J . A . ; 
OF THE 
HOUSE OF REPRESENTATIVES 
IN THE MATTER OF 
ESTABLISHING A BUREAU OF PUBLIC HEALTH IN THE 
DEPARTMENT OF THE INTERIOR. 
Address, by request, oe the 
S U P E R VISIN G SURGEON- G E N E R A L, 
U. S. Marine-Hospital Service, 
May 18, 1894. 
WASHINGTON r 
GOVERNMENT PRINTING OFFICE. 
1894. ADDRESS OF DR. WALTER WYMAN, SUPERVISING SURGEON- 
GENERAL, U. S. MARINE HOSPITAL SERVICE, MAY 18,1894. 
IN RE A PROPOSED BILL TO ESTABLISH A BUREAU OF PUBLIC 
HEALTH IN THE DEPARTMENT OF THE INTERIOR, ETC. 
Mr. Chairman and Gentlemen of the Committee : On March 
28 you listened to a number of gentlemen distinguished in various 
specialties of medical science, who endeavored to make plain to you 
the great desire of the medical profession of the United States for some 
legislative action looking to the prevention of the introduction of epi- 
demic or contagious diseases into the United States, the suppression 
of contagious diseases within our borders, the diffusion of sanitary 
knowledge, the collection and utilization of mortuary and vital statis- 
tics, and encouragement of State and local health organizations. They 
presented a bill for consideration, through the operations of which they 
hope that this desire of the medical profession may be gratified. 
I will in a few moments refer again and more specifically to the 
declared objects of this bill, and with regard to the same will at the 
present moment only say that I am in hearty sympathy with the desires 
and sentiments of these gentlemen which were so intelligently placed 
before you. These very matters have formed the chief subject of my 
professional thoughts for a number of years, and I have long been a 
student of the problems which they involve, seeking a definite solu- 
tion. 
But I will come at once to the bill which they have presented as 
their solution of these problems, and I propose now to critically exam- 
ine it with a view to determining whether it is a wise and practical 
measure. 
In the discussion March 28 the Academy committee seemed desirous 
of making it appear that the quarantine portion of the bill was not its 
greater portion, that the chief objects of the bill were outside of quar- 
antine matters and related to the establishment of some central bureau 
of advice and information upon the general subjects just mentioned. 
Yet, as pointed out to them at the time by one of your number, nearly 
the whole bill relates to quarantine; in other words, twenty sections 
out of the total twenty-three refer to quarantine matters, the remain- 
ing three (18, 20, and 21) relating to reports to Congress, mail matter, 
postage, appointments and salaries of officers, and estimates of expenses. 
There was no suggestion that the enforcement of quarantine rules and 
regulations should be taken from the Marine-Hospital Service, which 
for so many years has been charged with this work, but the bill con- 
templates that the making of these rules and regulations shall be trans- 
ferred to the new bureau of public health and the commissioner thereof. 2 
And when it was suggested that this was encroaching upon the admin- 
istrative functions of the Marine-Hospital Service and that it might be 
better to leave the making of the quarantine rules and regulations as 
now provided for, the gentlemen of the Academy committee insisted 
that, inasmuch as quarantine rules and regulations are based upon 
scientific knowledge, it would not be compatible with the dignity and 
importance of this proposed new bureau to deprive it of this function. 
As is known to you, under the present law the surgeon-general of 
the Marine-Hospital Service is charged with all the duties pertaining 
to quarantine and quarantine regulations which are provided for in the 
act of February 15, 1893. The regulations must be approved and pro- 
mulgated by the Secretary of the Treasury. To aid me in preparing 
these regulations I called aboard of medical officers of the Marine-Hos- 
pital Service. This board consisted of an ex-surgeon-general of the 
Marine-Hospital Service; a surgeon of the Service who had had charge 
for a long period of the quarantine division in the Bureau; a surgeon 
who had had practical experience in charge of quarantine stations, both 
in the North and in the South; another who was in charge of the med- 
ical department of the Immigration Service at the port of New York, 
giving him an insight into the character and the necessary precautions 
to be taken with regard to immigrants; and still another, who was a 
skilled bacteriologist, a specialist in biological diagnosis, and in charge 
of the scientific laboratory of the service. These gentlemen, with sug- 
gestions from myself, framed the rules and regulations to be observed 
with regard to vessels, passengers, and cargo in foreign ports and on 
the voyage. 
For the quarantine rules to be observed at ports of the United States 
a similar board was called together. All the State and local regula- 
tions had been previously examined, and you will remember that the 
law requires that if any such are found insufficient the Secretary of 
the Treasury shall make additional ones. It was evident that there 
were some which were deficient, and a minimum standard was there- 
fore determined upon, namely, a code of rules which should be required 
at every quarantine station in the United States. A uniform quaran- 
tine code for the maritime ports of the United States had long been the 
desire of quarantine and sanitary officers; for years it had been their 
chief complaint that no uniformity existed, and heretofore all efforts to 
this end, through conventions and otherwise, were futile. For the first 
time in the history of the United States such a code was prepared, 
adopted, and promulgated last season under the law of February 15, 
1893. 
After these rules and regulations for domestic quarantine had been 
prepared by the board I have .just mentioned, and before the adjourn- 
ment of this board, a conference was called by myself of the quaran- 
tine officers of the Atlantic and gulf coasts, representing the cities 
and ports of Portland, Boston, Providence, New Haven, New York, 
New Jersey, Philadelphia, Wilmington, Del., Baltimore, Norfolk, Wil- 
mington, N. C., Charleston, Savannah, Florida, Mobile, New Orleans, 
and Texas. 
This conference was called to order March 16, and remained in ses- 
sion two days, the first day being devoted to a consideration of the 
rules which had been prepared, and discussion thereof, with the under- 
standing that there would be no vote. The second day the rules were 
again read seriatim, discussed, and voted upon. After adjournment of 
the conference the board continued its labors, paying special attention 
to the views expressed in the conference. The rules thus perfected 3 
were then presented by myself to the Secretary ot the Treasury, were 
promulgated by the latter April 4, and a letter inclosing them was sent 
to each maritime quarantine officer, calling attention to the law and to 
the fact that these were minimum requirements, and requesting an 
expression of willingness and ability to execute them, to which satis- 
factory responses were received. 
Now, for the enforcement of these rules for domestic quarantines, the 
following additional regulation was promulgated by the Secretary of 
the Treasury, after its legality had been affirmed by the Attorney- 
General of the United States. The regulation and the instructions in 
accordance therewith have been issued in the following form; 
INSTRUCTIONS TO MEDICAL OFFICERS OF THE MARINE-HOSPITAL 
SERVICE DETAILED TO MAKE INSPECTIONS OF STATE AND LOCAL 
QUARANTINES. 
TREASURY REGULATION. 
* * * 56 * * * 
In the performance of the duties imposed upon him by the act of February 15, 1893, 
the Supervising Surgeon-General of the Marine-Hospital Service shall, from time to 
time, personally or through a duly detailed officer of the Marine-Hospital Service, 
inspect the maritime quarantines of the United States, State and local, as well as 
national, for the purpose of ascertaining whether the quarantine regulations pre- 
scribed by the Secretary of the Treasury have been or are being complied with. The 
Supervising Surgeon-General, or the officer detailed by him as inspector, shall at his 
discretion visit any incoming vessel, or any vessel detained in quarantine, and all 
portions of the quarantine establishment for the above-named purpose and with a 
view to certifying, if need be, that the regulations have been or are being enforced. 
J. G. Carlisle, 
Secretary. 
GENERAL INSTRUCTIONS. 
A. Your inspections will include all ports within your district where vessels are 
allowed to enter and discharge cargo, and ports which may be used as ports of call., 
B. A separate report will be made of each station visited. 
C. Visit every part of the quarantine establishment, and take necessary precau- 
tions to prevent the conveyance of contagious or infectious disease through the 
medium of your own person. 
D. Visit the custom-house for the purpose of ascertaining whether the regulations 
with regard to bills of health and quarantine certificates are being observed; also 
the immigration station for any pertinent information. 
E. Reports of a statistical character and descriptive of the quarantine, called for 
herein, need be made but once in every six months, namely, on the date nearest the 
1st of January and the date nearest the 1st of July; but any changes that have been 
made since the last general report should be immediately recorded. 
In making your report you will follow the special instructions in their qrder, 
referring to each by number. 
SPECIAL INSTRUCTIONS. 
1. Describe the quarantine station, location, buildings, anchorages, etc. Give 
limits of anchorage for noninfected and for infected vessels; facilities for inspection 
of vessels; apparatus for disinfection of vessels and of baggage; facilities for 
removal and treatment of the sick, and for the removal and detention of suspects'; 
mail and telegraph facilities, etc. 
2. Give personnel of the station or port; name of the quarantine officer or officers; 
post-office address; total number of officers and subordinates, etc. 
3. Transmit copies of the laws under which the local quarantine is maintained, 
and copies of the quarantine regulations; and describe the quarantine customs of 
the port as they are carried out. 
Note.-There are sometimes slight, but possibly important, variations from the letter of the local 
regulations in the administration of quarantine. Also local regulations generally allow a wide lati- 
tude to the quarantine officers, and how this latitude is used, i. e., how the quarantine officer interprets 
the spirit of the regulations, is very important. 4 
4. State what quarantine procedures, either under printed regulations or by 
-custom, are enforced at the port, in addition to the requirements of the Treasury 
Department. 
It should also be stated whether there is undue or unnecessary detention or disin- 
fection of vessels. 
5. State whether the inspection is maintained throughout the year or for what 
period, and what treatment of vessels is enforced during the entire year. 
Note.- Many ports on the South Atlantic coast (e. g., Charleston, Savannah, and Fernandina) 
require certain ballasts to be discharged in quarantine without regard to season. 
6. Are vessels from other United States ports inspected? 
7. Describe quarantine procedures in the inspection of vessels, and, if infected, 
the treatment. Give time in quarantine (a) between arrival and commencement 
of disinfection, (6) time occupied by disinfection, and (c) time after completion of 
disinfection of vessels until discharge. 
Note.-Quick or slow handling of a vessel is of more importance commercially than the question 
of fees. The time lost is the vessel's heaviest expense, generally. 
8. What communication is held with vessels in quarantine (and before quarantine 
by pilots, etc.) and how regulated? Is there any intercommunication allowed 
among vessels in quarantine ? 
9. State what will be done with a vessel infected with cholera; second, a vessel 
infected with yellow fever; third, a vessel infected with smallpox (said vessel 
carrying or not carrying immigrants), and what conditions are regarded as giving 
evidence of the vessel's infection in each case. 
10. State whether records are kept at the station of the cases of disease that have 
occurred during the voyage, on arrival, and during detention. 
11. Transmit schedule of quarantine fees, and give other fees and expenses neces- 
sarily and usually attendant on quarantine, as tonnage, ballast, wharfage charges, 
etc. 
12. Make a statement showing the number of vessels arriving at the port during 
the preceding calendar year, by months-(a) from foreign ports; (&) from foreign 
ports in yellow fever latitudes via domestic ports; (c) from domestic ports. Show 
also the character of the commerce carried on by the port, i. e., from what countries 
chiefly the vessels come, and whether in cargo, ballast, or empty. 
13. State results of your visit to (a) the custom-house; (&) the immigration bureau. 
14. State whether in your opinion the quarantine facilities are sufficient to care 
for the shipping entering the port. 
15. Name the quarantine regulations of the Treasury Department which are not 
properly enforced, and state specifically whether the regulations regarding inspec- 
tion and disinfection, and particularly the period of observation after disinfection, 
of vessels are observed. 
16. Mention any facts which in your opinion should be known to the Department, 
bearing directly or indirectly upon the quarantine service, and make such recom- 
mendations as seem proper. 
Walter Wyman, 
Supervising Surgeon-General, Marine-Hospital Service. 
Note.-Report to be written on legal cap paper (on one side only), signed, and inclosed in this blank 
as a cover. 
In conformity with this regulation and the printed instructions, all 
the quarantines of the United States from Maine to the State of Wash- 
ington are subject to periodical inspection under the supervision of the 
Marine-Hospital Bureau. In accordance with this regulation, also, an 
inspection was maintained at the New York quarantine the greater part 
of last season, both to render such aid as might be given and to insist 
upon the enforcement of the Treasury regulations. 
I submit that this method, above described, of making quarantine 
regulations, prepared, as they were, by men of scientific attainments, 
familiar with actual working details at quarantine stations, familiar 
with all matters pertaining to immigrants, and, too, with the compli- 
cated machinery of Governmental methods and associated services in 
Washington, that this method is superior to that suggested in the pro- 
posed bill, namely, by a commissioner of public health in the Interior 
Department, with an advisory council of forty-four members (one from 
each State of the Union), unacquainted with one another, and unfa- 
miliar with Governmental methods and existing branches of the Exec- 5 
utive Departments. Or, if the advisory council is not to assist in 
making these regulations, which seems a matter of doubt under the 
terms of this proposed law, then I submit that the method so success- 
fully adopted is a more practical way of framing regulations than to 
entrust them to one man alone, namely, the commissioner of health, 
an officer of the Interior Department, to be executed by the Secretary 
of the Treasury or the President. 
There are no more experienced men in both the theoretical and prac- 
tical workings of quarantine than are to be found in the medical corps 
of the Marine-Hospital Service. There are scientific investigations 
being constantly made in the laboratory of the Service, which is as well 
supplied with every modern apparatus or instrument as perhaps any 
laboratory in the United States. These investigations relate princi- 
pally to the cause, nature, life history, and prevention of epidemic dis- 
eases; and it may be added that instruction is given m this laboratory 
both to the officers of the Service and to local quarantine officers in 
biological diagnosis of contagious diseases. » 
In framing regulations, the Marine-Hospital Bureau, besides its own 
scientific and practical officers, has the assistance of the law officer of 
the Treasury Department, detailed from the Department of Justice, 
and the benefit of the counsel and advice of the heads of the several 
divisions in the Treasury Department conversant with all the executive 
and legal details which might require consideration, and finally, of the 
Assistant Secretary and the Secretary of the Treasury himself. It is 
difficult to conceive of any question connected with quarantine regula- 
tions which can not be decided properly and promptly by the Marine- 
Hospital Service and the Treasury Department to which it belongs. 
Now, hand in hand with the making of quarantine rules goes their 
execution. I contend that they can be best executed when emanating 
from the same body or service that is charged with their practical 
application. In the proposed scheme of having one Department make 
the rules and another execute them, I can readily see the possibilities 
of clash, the shifting of responsibility from one to the other, and crim- 
ination and recrimination after the resultant disaster. 
Moreover, speaking for the Marine-Hospital Service, to have an out- 
sider make the rules and command us to enforce them would deprive 
the corps of its esprit, than which nothing is more essential for effect- 
ive service. It is this esprit du corps that has gained for the Service 
its successes in the past. 
I will not here dwell upon, but simply refer to, the alacrity with 
which the members of this corps have sprung to their posts of danger 
when ordered, submitting themselves to all kinds of exposure and pri- 
vations in their efforts to speedily check the spread of epidemic disease, 
and facing a death which has come to a number of its officers. 
The proposed law would make the Marine-Hospital Corps simply a 
hewer of wood and a drawer of water, with all the responsibility-the 
terribly responsibility-of a successful enforcement; while the commis- 
sioner of publip health in the Interior Department might simply from 
his office declare what should be done, leaving further responsibility to 
the Marine-Hospital Bureau and its officers. Such a status would 
inevitably destroy the enthusiasm of our officers, an enthusiasm which 
is felt, not only for the character of the work they are doing, but for 
the peculiar service which they themselves by their own efforts have 
made illustrious, and in which they feel a peculiar pride. 
There is another consideration which shows that the proposed arrange- 
ment is impracticable. Certain difficulties might suddenly arise with 6 
regard to the enforcement of quarantine regulations, which might 
require prompt amendment or additions thereto, and for the executive 
force to then be obliged to await the decision of an officer in another 
department would cause delay that might be fatal. For example, as 
matters now stand, if the Surgeon-General is informed that certain 
quarantine regulations are insufficient, and a new regulation is imme- 
diately necessary, he may prepare the same without waiting to explain 
its necessity and convince the commissioner of public health thereof. 
Every epidemic is apt to produce new conditions and to demand some 
variation in suppressive measures, and during the past season instances 
of this kind actually occurred. 
Finally, 1 have to state that the quarantine season is now upon us. 
Amended rules and regulations have been prepared and are before you. 
Cholera has been reported in Belgium, Portugal, and France. The 
return of it is expected in Italy and Germany. It has been in Russia 
and Constantinople all winter, in Tripoli and other places. To disturb 
the present efficient organization at any time is unnecessary, and to 
adopt new procedures now would likely be hazardous. 
It is now necessary to consider this matter from a departmental and 
more general standpoint. The bill proposes to establish in the Depart- 
ment of the Interior, and under the direction and supervision of the 
Secretary thereof, a national bureau of public health, which, with its 
commissioner and, possibly, its advisory council, is to make rules and 
regulations for maritime quarantine. 
Now, maritime quarantine, as its name implies, relates to commerce, 
to vessels and crews, and has intimate relations with the shipping 
laws, the custom^ service, immigrant inspection, etc., all of which are 
regulated by the Treasury Department. What propriety there could 
be in the Department of the Interior having charge of quarantine with 
these surrounding conditions it is difficult to conceive. This bill would 
impose upon the Secretary of the Interior an entirely new kind of work, 
and would make his Department lap over or extend into the Treasury 
Department. In his efforts to carry out this law the Secretary of the 
Interior would find himself surrounded on all sides by the various 
branches of the Treasury Department, into whose jurisdiction lie would 
be constantly intruding. A vessel arrives at quarantine; the customs 
inspectors are interested in that vessel as well as the quarantine offi- 
cers. The Revenue-Cutter Service maybe interested in that vessel for 
violating the navigation laws. The Immigration Service is very much 
interested because it carries immigrants, and so is the Bureau of Navi- 
gation, which looks after the tines and penalties. 
The Inspection Service of Steam Vessels looks to the personnel of the 
pilots, and, if the vessel is of American registry, has supervision of the 
boilers, air space, ventilation, etc., and the Marine-1 lospital Service cares 
for the sick and disabled among the crew. Now, these are all Treasury 
bureaus or divisions, and it sometimes happens that in the exercise of 
their various functions, with regard to this vessel, the different bureaus of 
the Treasury Department may have some misunderstanding. Customs 
authorities have claimed right of precedence over quarantine authori- 
ties in boarding vessels. Immigrant inspectors have claimed the same. 
There are certain precautions to be taken by the customs inspectors 
when a vessel is in quarantine. How necessary, therefore, for all to be 
under one bead. There would be unavoidable clash and maladminis- 
tration, with two heads of large departments of the Government attempt- 
ing to manage subtle affairs upon a big ocean vessel arriving at an 
American seaport. 7 
The very terms of the bill show its incongruity, for while it calls for 
the establishment of this bureau within the Interior Department, under 
the direction and supervision thereof, in several sections of the bill (3, 
9, and 10) the Secretary of the Treasury is directed to perform certain 
functions. 
Moreover, section 17 provides that the commissioner of public health, 
without previous assent from the head of a Department, may request of 
the President a detail of officers from the several offices of the Gov- 
ernment for temporary duty to act under the direction of said bureau 
to carry out the provisions of this act, thus giving the commissioner 
the power to strip any service of its active force or agents, despite other 
need for the same. 
Coming now to the additional expenses incurred by the proposed 
establishment of this bureau, it will be seen (section 1) that there is 
to be a president with $6,000 per annum, an advisory council of one 
from each State, who shall be entitled to actual traveling expenses 
and $5 per diem for subsistence while engaged in the performance of 
their duties; and these duties are to consult with the commissioner of 
public health at the annual or at special meetings. 
Section 20 provides for the appointment of 6 sanitary inspectors, at 
$1,800 per annum, making $10,800 per annum; a chief clerk, at $1,800; 
1 clerk of class 3, at $1,600; 1 clerk of class 2, at $1,400; and 6 clerks, at 
$1,000 per annum; 1 messenger, at $840; and 1 watchman, at $720 per 
annum; making a total of $30,560 per annum for salaries in this bureau. 
I beg. leave now to refer, as I stated that I should do at the begin- 
ning of my address, more specifically to the declared objects of the 
bill, irrespective of quarantine proper. These objects are practically 
the same as were mentioned in the first bill presented by the Academy 
committee, and to which the honorable the Secretary of the Treasury 
objected, and from whose letter to your chairman, of January 3,1 quote 
as follows: 
The bill does not establish a bureau of public health as that term is generally 
understood, or, if it does, then a bureau of public health already practically exists 
in the Marine-Hospital Service, which is now exercising every essential function 
that is provided for by this bill. By a bureau of public health is understood not 
only a quarantine organization, but the establishment of a central bureau having 
control over general sanitation of towns and villages, withppwerto demand systems 
of sewerage, methods of disposal of garbage, water supply; house draining and 
plumbing; ventilation of dwellings, schoolhouses, and other public buildings; the 
examination of.the milk supply; examination of food and of drugs; proper disposal 
of the dead; the enforcement of rules regarding disinfection of dwelling after the 
ordinarily contagious diseases, such as scarlet fever, measles, and diphtheria, and 
other functions too numerous to mention, but all of which may be found set forth 
in the report of any Stat" board of health or of the health department of any large 
city. It is the desire of some sanitarians that such a public-health bureau'should 
be established, but at present all these functions are performed under State or local 
law, and the right, as Well as the propriety, of the General Government undertaking 
so exclusive and minute a field of operation, it is believed, would not be seriously 
considered by Congress at the present time. Nor does the bill call for any such 
establishment, although its title would so indicate, and by reason of this title it 
may receive the indorsement of those who will not look carefully into its provisions. 
Now, from a careful perusal of this new bill, and from the remarks 
made by the gentlemen on March 28, it appears that, quarantine aside, 
what is desired and hoped to be achieved through the instrumentality 
of the bill is as follows, namely: 
Collection of information regarding prevalence of contagious and 
epidemic diseases in this and other countries. 
Publication of information thus obtained in a weekly bulletin. 
Collection and utilization of mortuary and vital statistics. 8 
Uniformity of system in registration of births, marriages, and deaths. 
Suppression of contagious diseases within our own borders. 
Diffusion of sanitary knowledge. 
Encouragement of State and local health organizations. 
Investigation by experimental and other methods of the causes and 
means of prevention of disease. 
Advice and information to be given to the several departments of the 
Government and executives and health authorities of the several States, 
on such questions as may be submitted by them. 
It will be seen that, summarized, the above objects may be stated to 
be gaining and spreading of information and giving advice. 
Now there are two considerations to be taken into account with 
regard to these desired objects: One is, how much can be done under 
the peculiar construction of our Government-in other words, under 
the Constitution of the United States; the other is, how much is being 
done by State governments and existing branches of the General Gov- 
ernment. 
In the addresses which were delivered before you on Wednesday the 
desires of sanitarians and of medical men were forcibly expressed, just 
as though all these desires might as well be gratified as not. But there 
are limitations to the exercise of health prerogatives by the National 
Government, and these limitations find their corresponding privileges 
in the rights and constitutions of the several States. It is impossible for 
us to be guided by precedents set by foreign governments, monarchical 
and even despotic in character. An attempt on the part of the National 
Government to interfere in domestic sanitation, to enforce laws regard- 
ing plumbing, drainage, light, heat, and ventilation of public buildings, 
the placarding of houses containing contagious disease, or imposing 
restraints upon the inhabitants thereof, would meet with violent and 
legally authorized opposition on the part of the citizens of the several 
States and municipalities. Nor does this bill contemplate such action 
on the part of the Government. While Congress may legislate to 
advance the interests of science, still the executive rights which the 
Government has in sanitary matters are derived chiefly from the clause 
of the Constitution giving Congress the power to regulate commerce; 
and in regulating commerce it has the right to strip it of its disease- 
bearing agencies. Moreover, even if the right of minute surveillance 
existed, no example worthy of imitation can be taken from any foreign 
government whose physical conditions so materially differ from our 
own. 
As stated in an address which lies before you,'even- 
History furnishes no models for the construction of any sanitary institution 
adapted to the wants of this nation. Lycurgus, with his Spartan laws, adapted to a 
small and peculiar province, the laws of Moses, the quarantine laws of the fifteenth 
century-none of these furnish a sanitary framework for the United States. What 
nation has such conditions of boundary and magnitude as our own? What can 
England, with its Government on a "tight little isle," and its possessions scattered 
over the earth, what can a nation with such physical conditions teach us? What 
can France, or Spain, each with a territory surpassed by a single one of the United 
States, teach us? Or Germany, with scarcely any seaboard at all? What conditions 
prevail in Russia, Italy, or Turkey, that prevail here? 
We may adopt scientific appliances, we may study technique in foreign lands ami 
observe the application of sanitary principles, but we must be a law entirely unto 
ourselves with regard to our sanitary policy. 
We must study, too, our national organization, and work out a sani- 
tary system in harmony with it- 
Broadly stated, this sanitary policy expects of each State a sanitary autonomy 
whose influence should be appreciated by every individual in every hamlet, however 9 
small, in its domain. It contemplates a State pride in the development of sanitation, 
a self-reliance and an unwillingness to surrender functions or call for aid from the 
General Government excepting after clearest convictious of propriety or necessity. 
As we look to the State for the development of its own educational 
system, so must we look to the State for the education of its people in 
the establishment of sanitary surroundings, and in the matter of per- 
sonal prophylaxis. In point of fact the growth of State and municipal 
health organizations within the last ten years lias been remarkable. 
Of the 44 States, 38 have now State boards of health. 
Before you are the annual health reports of several States-Massa- 
chusetts, Pennsylvania, New York, and New Jersey. These are but 
samples, but within their covers you will find laws, regulations, statistical 
information, the results of scientific investigation into the causes of 
disease, articles upon plumbing, sewerage, water supply, heat, the ven- 
tilation of school houses; in short, all the matters affecting the public 
health. Now, under the proposed bill of health, the National Govern- 
ment would only be advisory to these State boards. The bill does not 
specify the use of any executive force on the part of the General Gov- 
ernment with regard to matters contained within these State health 
reports. Yet, as though to bring the United States into unfortunate 
contrast with England, one of the speakers on March 28 referred to the 
superior sanitary organization of the latter country and the great 
advances made through the agency of the local government board. 
This local government board, however, has more than advisory rights, 
and would never have achieved its success if its powers from the start 
had been limited to advice. 
Much has recently been said regarding internal sanitation and internal 
quarantine, and the necessity of suppressing the ordinarily contagious 
diseases (diphtheria, typhoid fever, tuberculosis, etc.), irrespective of 
the great epidemic diseases, cholera, yellow fever, and small-pox; and 
in the bill under consideration it is provided (section 12): 
That the commissioner of public health shall, under the direction of the Secre- 
tary of the Interior, cooperate with and aid State and municipal health authorities 
in the execution and enforcement of the rules and regulations of such authorities, 
and in the execution and enforcement of the rules and regulations made by the com- 
missioner of public health and approved by the President of the United States, to pre- 
vent the introduction of contagious or infectious diseases into the United States from 
foreign countries, and into one State or Territory or the District of Columbia from 
another State or Territory or the District of Columbia. 
The above is presented as though it were a new provision of law, 
whereas a like provision already exists in section 3 of the act approved 
February 15, 1893. 
Under this act regulations have been made, promulgated, and exe- 
cuted, under the direction of the Secretary of the Treasury, to preVent 
the spread of yellow fever from one State to another, and other regu- 
lations have been prepared to prevent the spread of other contagious 
or infectious diseases. 
As to internal sanitation the proposed bill nowhere provides for it 
specifically. 
Yet the need of internal sanitation has been dwelt upon as though 
the General Government could undertake it and as though this bill 
provided that it should. 
There is one clause of the bill which, if passed, might be so construed 
as to give the proposed bureau local and even domiciliary supervision, 
namely, the clause in section 1 which states that "this bureau shall, 
in general, be the agent of the General Government in taking such 
action as will most effectually protect and promote the health of the 10 
people of the United States." This clause, with a liberal interpretation, 
gives so wide, and at the same time so minute a power, that, as I am 
advised, it would prove not only repugnant to State authorities and 
conflict with State laws, but the functions which might be attempted 
under it would be unconstitutional. I quote, as stating in a general 
way the views I have heard expressed by a number of eminent men on 
this subject, some of them members of Congress, an editorial in the 
New York Times of August 2, 1893: 
The sanitary condition of cities and towns, and the control of the influences 
which affect the health of the people are matters that come very distinctly within 
the police power of the States. Regulations and restrictions for the protection of 
the public health can be best established and administered by State and local 
authorities, and the nearer their administration comes to the people affected the 
better. The subject may be neglected in some States, or they may be slow in 
appreciating its importance and providing for the sanitary well-being of their 
people, but that fact does not impair their authority or transfer it elsewhere. They 
may be dilatory or negligent in many things that the National Government can not 
look after for them. 
When it comes to dealing with contagious diseases brought from other countries 
the matter takes a different aspect. The enforcement of measures for preventing 
their introduction at our seaports or over our borders necessarily involves interfer- 
ence with foreign commerce. Vessels have to be detained, inspected, and disin- 
fected, and passengers and merchandise have to be subject to regulations that con- 
cern the people and the interests of the country regardless of State lines. National 
jurisdiction has here an appropriate field and is alone adequate to its requirements. 
Quarantine regulations affecting communication with foreign countries should be 
national and national only. The same principle may apply in some degree to pro- 
tection against the transmission of infectious diseases from one State to another 
through the agencies employed in interstate traffic, as interference with those agen- 
cies pertains to the regulation of commerce between the several States. But there 
is seldom any occasion for interference in the case of infections originating in this 
country. 
There might be a useful function for a national board of health in the collection 
and diffusion of statistics and information relating to matters that concern the public 
health, and in consulting and advising with State and local authorities. But no 
power or jurisdiction could be exercised by such a board, by whatever name it might 
be called, over those authorities, and it could in no way deal practically with inter- 
nal sanitation. 
Coining now to the second matter for consideration, namely, how 
much is being done by existing branches of the Government service, 
for the purpose of saving time I would refer to the pamphlet before 
you, entitled "Government Aids to Public Health," which, however, 
does not contain an exhaustive statement. 
Concerning the collection of information regarding the prevalence of 
contagious and epidemic diseases in this and other countries, and the 
publication of the information thus obtained in a weekly bulletin, you 
have before you a bound volume of such weekly bulletins for the year 
ending December 31, 1893. This, volume, published by the Marine- 
Hospital Bureau, contains, first, domestic information, viz, abstracts of 
the reports of States and municipalities, special reports concerning 
contagious diseases, mortuary reports from the diffel^nt cities of the 
United States, reports concerning immigration, and reports from the 
Department of Agriculture, showing the temperature and rainfall in 
the various cities from which mortality reports are received; second, 
foreign information, received through the State Department and from 
officers of the Marine-Hospital Service stationed abroad, relating to 
like subjects. 
Concerning the experimental investigation into the causes of dis- 
ease, 1 have to state that such experiments are going on constantly in 
the laboratory of the Marine-Hospital Service, and that special com- 
missions, either under present laws or by special resolution of Con- 11 
gress, may be appointed at any time for this purpose. I have here a 
volume prepared by Dr. Shakespeare, who was specially commissioned 
by the President to visit Europe and India and prepare a report upon 
the prevalence, history, and origin of cholera. His expenses were paid 
from the "epidemic fund," and without special legislation. 
I will further state that, under the auspices of this Bureau, during 
the past year, a commission, consisting of Surgeon Irwin, of the Marine- 
Hospital Service, and Dr. Walter Kempster, an expert visited all por- 
tions of Europe, as well as Egypt and Palestine, in further investiga- 
tion of the prevalence of cholera, its method of introduction into Europe, 
and the special sources of danger to the United States through the 
importation of merchandise from infected countries. 
Passed Assistant Surgeon J. J. Kinyoun was detailed, in 1890, to 
visit Berlin and Paris for the purpose of investigating and familiariz- 
ing himself with the methods of the distinguished Profs. Koch and 
Pasteur. 
Other experts have been employed by the Treasury Department and 
sent to points of danger, their expenses paid out of the "epidemic 
fund." The inspections made by them have embraced the cities of 
Central America and Mexico. 
The annual reports of the Mari ne-Hospital Service contain numerous 
articles upon the cause, life history, and prevention of contagious dis- 
eases; and in further illustration of the scientific work of the Bureau, I 
would invite your attention to the report of the present House Com- 
mittee on Ventilation and Acoustics, just published, containing the 
results of a scientific examination made by an expert officer of the 
Marine-Hospital Service, of the air of the House of Representatives for 
the detection of impurities therein deleterious to health. 
There remains, therefore, of the avowed purposes of the bill to be 
mentioned only statistics regarding marriages, births, and deaths. 
The Census Bureau furnishes much of this information, though it is 
admitted, not as frequently as could be desired. 
I by no means mention the above facts for the purpose of asserting 
that all is being done that is desired, but simply to show the committee 
what is being done, and that with some extension of present organi- 
zation and facilities much more could be done without breaking up 
existing institutions, without disturbing organizations that have 
reached their present degree of efficiency because founded on the neces- 
sities of the Government, and because year by year they have been 
strengthened and improved by intelligent administration and Con- 
gressional action. 
A few words now regarding the organization and scope of the Marine- 
Hospital Service. 
MEDICAL CORPS. 
The medical corps of the Marine-Hospital Service, as will be seen by 
the small blue book before you, consists of a supervising surgeon gen- 
eral, 16 surgeons, 26 passed assistant surgeons, 19 assistant surgeons, 
and 93 acting assistant surgeons, making a total of lol. The regular 
corps, that is to say, all of the above excepting the acting assistant 
surgeons, are appointed by the President after thorough physical and 
professional examination. The acting assistant surgeons are appointed 
by the Secretary of the Treasury, on recommendation of the Supervis- 
ing Surgeon-General, who satisfies himself as to the professional quali- 
fications of the officer. The employment of acting assistant surgeons 12 
in times of emergency for temporary service, and the discontinuance of 
their services when the emergency is over, furnishes an excellent method 
of increasing or contracting the medical corps as occasion requires. 
The acting assistant surgeons are men who have been long in the 
service and are trained in Government routine. When newly appointed 
in emergency they are usually assigned to a marine hospital under the 
observation of the commanding officer and one of the older assistants, 
detailed to meet the emergency. 
I have heard that intimations have been made concerning the youth 
and inexperience of the members of the regular corps, the absurdity of 
which is shown by a table which I have caused to be prepared giving 
the age and date of graduation of every officer of the service. From 
this table it will be seen that the average age of the 16 surgeons is 50 
years, the average age of the 26 passed assistant surgeons is 35 years, 
and of the 19 assistant surgeons, 29 years. 
The medical colleges represented are as follows: 
Medical College of Maine. 
/Western Reserve Medical College. 
Jefferson Medical College, Philadelphia. 
Pennsylvania Medical College. 
Chicago Medical College. 
Rush Medical College. 
University of Georgetown, D. C. r 
University of Michigan. 
Columbia College, Washington, D. C. 
Bellevue Hospital Medical College, New York. 
National Medical College, Washington, D. C. 
University of Pennsylvania. 
University of Maryland. 
College of Physicians and Surgeons, New York. 
College of Physicians and Surgeons, Baltimore. 
College of Physicians and Surgeons, Boston. 
Dartmouth Medical College, New Hampshire. 
McGill College, Montreal, Canada. 
Harvard Medical School, Boston. 
Howard University, Washington, D. C. 
Medical College, South Carolina. s 
Virginia Medical College. 
University of Virginia. 
Miami Medical School, Cincinnati. 
Long Island Medical College, New York". 
St. Louis Medical College. 
It will thus be seen that the members of this corps are fairly repre- 
sentative of the medical profession of the country. Many of them, in 
spite of the fact that they are subject to change of station every four 
years or oftener, have held and are now holding professorships in the 
medical colleges of the cities in which they are stationed. 
Concerning the new admissions to the corps, the law requires that 
they shall be appointed to the grade of assistant surgeon only, and 
provision is made for subsequent promotion. The examination is held 
once or twice a year as occasion requires, and the applicant must pass 
a very severe test, making an average of 80 per cent on all branches. 
The successful candidates are relatively few. For example, this month, 
out of 29 who appeared for examination, only 4 made the required grade. 
These new appointees represent the very best men among the newer 
graduates of the colleges ; but very rarely do they come direct from 
the medical college, most of them having had hospital or private prac- 
tice before seeking admission to the corps. Out of the total 61 medi- 
cal officers, 53 had hospital practice before entering the service, 7 were 
engaged in private practice, and only 2 had neither private practice 
nor hospital service. 13 
There are 19 hospitals owned and operated by the service, and 95 
additional relief stations, where at contract hospitals seamen are 
admitted and treated by acting assistant surgeons. 
DISTRIBUTION AND QUALIFICATIONS OF THE CORPS. 
The officers of the Medical Corps, just mentioned, are stationed in 
every important port on the coast, lakes and rivers, and being trained 
in the execution of Government business, become valuable agents for 
the immediate execution of any sanitary measures which may be 
imposed upon them by telegraph or otherwise from the Bureau. It is 
always possible for the Marine-Hospital Service, in any part of the 
country, on the shortest notice, to have qualified agents at a place of 
danger. There is scarcely an officer of the regular corps who has not 
had actual quarantine experience, and the corps numbers among its 
members men whose names have become national by reason of their 
effective service in various epidemics. The corps embraces a number 
of skilled bacteriologists, also men who have had large practical experi- 
ence in the treatment of yellow fever and other contagious diseases, 
men thoroughly acquainted with all the military duties connected with 
sanitary cordons, detention camps, and with the methods of train and 
vessel inspections, scientific disinfection, etc. The effectiveness of this 
corps is the result of special care exercised to secure within it men 
who, by natural inclination and special education, are fitted for san- 
itary work, and is also the result of long and active experience. 
The Marine-Hospital Service dates as far back as 1798. It was reor- 
ganized and put upon its present basis in 1871. Though established 
for the purpose of caring for sick and disabled seamen of the merchant 
marine of the United States, there have been from time to time other 
responsibilities imposed upon it, growing out of the necessities of other 
branches of the Government with which it is intimately and neces- 
sarily associated. For example, the Revenue-Marine Service, a branch 
of the Treasury Department, relies upon the Marine-Hospital Service 
for the physical examination of its officers and men and their profes- 
sional treatment when sick or disabled. The Life-Saving Service relies 
upon the Marine-Hospital Service for the physical examination of the 
keepers and surfmen. Hundreds of rejections of physically unsound men 
seeking to become surfmen have been made by the officers of the Marine- 
Hospital Service. The Steamboat-Inspection Service, a most important 
branch of the Treasury, relies upon the medical officers of the Marine- 
Hospital Service for a determination as to the ability of the pilots to dis- 
tinguish signal lights, and large numbers of applicants for pilots' license 
are annually rejected by the officers of this service on account of color 
blindness. The Immigration Bureau relies by law upon the Marine- 
Hospital Service for the medical inspection of immigrants. 
Naturally, too, by reason of the intimate association of the Marine- 
Hospital Service, through its sailors, with shipping and commerce, the 
National Government has imposed upon this Service the execution of 
tbe national quarantine laws, to which reference has already been 
made. I will only add here that so far as national quarantine is con- 
cerned, the Service, by tradition and constant activity, save for a 
period of four years, is the natural executor of the same. National 
quarantine received its first executive impulse through the first sur- 
geon-general of the Marine-Hospital Service, Dr. John M. Woodworth, 
in 1878. Both prior and subsequent to this last date the Bureau has 
controlled, wholly or in part, epidemics of yellow fever and of small- 14 
pox; notably yellow fever in 1873,1876,1877,1878,1882,1887,1888,and 
in 1893, the Brunswick epidemic, when it was confined within the cordon 
on lines established by the Service. 
It also took charge of railroad quarantine against smallpox in Canada, 
in 1885, and at Harris Neck, Ga., in 1891, it stamped out the disease. 
It had complete control of the quarantine measures against yellow 
fever in Texas in 1882, and in Florida in 1888. 
THE NATIONAL QUARANTINE STATIONS. 
The Marine-Hospital Service has under its immediate control ten 
national quarantine stations, equipped with modern appliances for dis- 
infection of vessels, hospitals for the care of the sick, and barracks, 
where required, for the detention of suspected immigrants.* These 
stations are so far remote from populous centers as to be seldom visited, 
but their completeness and the scientific care exercised in isolation of 
the sick, the surveillance of those suspected and held under observa- 
tion, the cleansing and disinfection of vessels, has excited the surprise 
and commendation of the few members of Congress who have visited 
one or more of said stations. There is a fleet of thirteen vessels con- 
nected with these stations, three of them being old vessels turned over 
from the Navy for the purpose of receiving and housing people in quar- 
antine. 
COOPERATIVE ASSOCIATIONS. 
Now, referring to the work done by the Marine-Hospital Service for 
other branches of the Government-namely, the Revenue Marine, the 
Life-Saving Service, Seamboat-Inspection Service, and Immigration 
Service-a return service on the part of these branches of the Govern- 
ment adds to the strength and ability of the Marine-Hospital Service for 
quarantine work. For example, the Revenue-Cutter Service, under the 
same Secretary as is the Marine Hospital-Service, may be called upon 
at any time, and frequently is, to assist in quarantine measures through 
the medium of their fleet of vessels. During the past summer revenue 
cuttershave patrolled the Southern coast in aid of the quarantine cor- 
don around Brunswick. They have carried medical officers and sup- 
plies to the Sea Islands, off the coast of South Carolina, in the sanitary 
work demanded of the Marine-Hospital Service by reason of the 
great storm. They have furnished vessels for the Marine-Hospital 
Service repeatedly in New York Harbor, and in fact practically form a 
fleet subject to demand for service at any time in the aid of quarantine. 
During the past summer, when it was feared that the immigrant deten- 
tion camps at Camp Low and at Delaware Breakwater, both under the 
control of the Marine-Hospital Service, might of necessity be occupied 
by immigrants held under observation, an arrangement was made with 
the Revenue-Marine Service for the immediate detail of their enlisted 
and armed men from the several cutters, to form the necessary guards 
around these camps, the places of the enlisted men to be supplied by 
new enlistments on the vessels. 
The Steamboat-Inspection Service, in return for the examination of 
* These stations are located at: Delaware Breakwater; Reedy Island, Delaware 
River; Cape Charles, Virginia; Blackbeard Island, Sapelo Sound, Georgia; Bruns- 
wick, Ga.; Dry Tortugas, Fla.; Ship Island, Gulf of Mexico, off the coast of Missis- 
sippi ; San Diego, Cal.; Angel Island, San Francisco Bay, California ; Port Townsend, 
Wash. 15 
pilots, furnishes experts to examine the hulls, boilers, and machinery of 
the vessels which belong to the Marine-Hospital Service. 
The Life-Saving Service, on request of the Supervising Surgeon- 
General of the Marine-Hospital Service, is required by its superintend- 
ent to watch carefully for all dunnage and other stuff that might float 
ashore from infected vessels, thrown overboard before said vessels 
.reach port; to gather up with rakes such material and burn it. 
The presence of medical officers at the immigrant reception stations 
at the several ports enables the Bureau to. keep fully informed with 
regard to immigrants and their baggage, which constitute so large a 
proportion of the danger in the matter of epidemic importation. 
OPERATIONS OF MARINE-HOSPITAL SERVICE. 
The operations of the Marine-Hospital Service, independent of quar- 
antine, during the fiscal year ended June 30, 1893, may be summarized 
as follows: Total number of sailors treated in the hospitals and dispen- 
saries, 53,317; of which number 14,857 were treated in hospital, the 
remainder being office or dispensary patients. There were 1,353 pilots 
examined for color blindness, of which 48 were rejected. One thou- 
sand and ninety-five surfmen and keepers of the Life-Saving Service 
were examined, of which number 41 were rejected for physical causes. 
Two hundred and seventy-nine seamen of the Revenue Marine were 
examined before shipment as to their physical fitness, and 22 were 
rejected. 
With regard to funds, the quarantine service is maintained by a 
yearly appropriation for the ordinary maintenance of the ten national 
quarantine stations. In addition to this there is what is known as the 
"Epidemic Fund," which is placed at the disposal of the President, to 
be used under his direction in any manner he sees fit, to prevent the 
introduction and spread of epidemic diseases. It is from this fund that 
the expenses of the foreign quarantine and extraordinary precautionary 
measures in this country have been paid. 
The Marine-Hospital establishment, independent of quarantine, is 
maintained by a continuing fund derived from the tax on foreign ton- 
nage. 
In conclusion, referring again to the proposed bill to establish a 
bureau of public health in the Interior Department, etc., which bill, I 
learn, was on the 16th instant introduced in the House, and is now 
House Bill 7106, I beg leave to invite your attention to the letter of the 
Acting Secretary of the Treasury, dated May 17, stating the objections 
thereto on the part of the Treasury Department. The bill seems to 
ignore existing statutes, and effects but little change other than the 
establishment of a new bureau. Quoting from the Secretary's letter: 
The hill in question is largely a reenactment of the act of February 15, 1893, as 
will be seen by a comparison of their respective provisions.