47th Congress 1st Session. HOUSE OF KEPEESENTAT1VES. Keport No. 137. MARINE-HOSPITAL SERVICE. January 31, 1882.—Referred to the House Calendar and ordered to be printed. Mr. Washburn, from tlie Committee on Commerce, submitted the fol- lowing REPORT: [To accompany bill H. R. 72.] The Committee on Commerce, to whom was referred the bill H. B. 72, being “A bill to increase the efficiency of the Marine-Hospital Service,” respectfully submit the accompanying letter of the Supervising Surgeon- General, to accompany u An act to increase the efficiency of the Marine- Hospital Service,” and recommend the passage of the bill: Treasury Department, January 14, 1880. Sir : I have the honor to invite the favorable attention of Congress to the draught of a bill, herewith transmitted, to increase the efficiency of the Marine-Hospital Serv- ice, and to the accompanying letter in explanation thereof from Dr. J. B. Hamilton, Surgeon-General of that .service. It is believed that the enactment of the bill substantially in its present form into a law would place the service upon a better footing without materially increasing its expense. Very respectfully, JOHN SHERMAN, Secretary. Hon. Samuel J. Randall, Speaker of the House of Representatives. Treasury Department, Office Supervising Surgeon-General, United States Marine-Hospital Service, Washington, January 13, 1880. Sir : I have the honor to transmit herewith the draught of a bill to “increase the efficiency of the Marine-Hospital Service,” and to request that, if the draught is in accordance with your views, it be transmitted to Congress. The general object of the bill I assume to be in accordance with the recommendations you have repeatedly made, that statutory provision be made for the appointment of officers and employes of this service. Section 1760, Revised Statutes, prohibits the appointment by the Secretary of any person to any office not authorized by law, or subsequently sanctioned by law. The 2 MARINE-HOSPITAL SERVICE. law has, by implication, subsequently sanctioned the employment or appointment of such officers in the text of several health laws passed in 1878 and 1879. No authority exists, in terms, for the employment or appointment of any person in the Marine- Hospital Service, with the exception of the Supervising Surgeon-General. The various circulars and regulations that have been issued from time to time since 1802, by the Treasury Department, governing these appointments, have been based upon the gen- eral law of 1798, which created the fund, and left all the details of its management to the Secretary of the Treasury. It has been found expedient, as time demonstrated its necessity, that the system of these appointments should be made uniform, and the proposed bill only aims at regu- lating by law what has for several years been the practice of the department. To quote from a report made by Drs. Thomas 0. Edwards, of Lancaster, Ohio, and George B. Loring, who were appointed “ to collect facts and information in relation to marine hospitals and the marine-hospital fund,’'- under the provisions of the act of March 3, 1849: “ This [the marine hospital] is almost the only direct tax laid by the government. The power to lay it has always been granted on account of the highly charitable object in view. * * * As the questionable legality of the taxation is laid aside by common consent, it is only asked that while it is continued it may be ren- dered distinct in all its operations. Once received, its expenditure can only be made with propriety and justice by rendering it the endowment of a system of well-ordered hospitals which shall be devoted to the seamen of the United States, and shall pro- tect them against poverty and almshouses in times of sickness. * * * It should be expressly understood that, let the man go where he will in the Union, in an American vessel, as an American seaman, he will find support provided for him in his disability, temporary, but sufficient to restore him to active service. The great- est defect found by the commission was that the methods of government and internal regulation were not uniform; that the position of the hospital at Mobile was as dis- tinct and diferent from that at Norfolk or New Orleans as if one were a hotel and the other a hospital. In one district the surgeon resides within the limits of the hospital grounds; in anothe. he pursues his private business in the circuit of his city, and an assistant represents him for months in the wards of his hospital. Here the surgeon selects his own steward; there the collector of the district makes the appointment himself. In order that suitable professional information may control the system, and give it such a position as it deserves, it is proposed to place it under the charge of a chief surgeon, who shall have his bureau attached to the Treasury De- partment. The regulations which are to govern the hospitals should emanate from him. * * * “ The knowledge to be obtained at the bureau should be correct and detailed, in all matters relating to the diseases, patients, expenses, management, &c., of the hospitals under his control. And he should regulate the number and position of per- sons employed in these hospitals, in a way most conducive to the development of fine medical institutions, devoted to the physical wants of a large class of men. Placed on this footing there is no system of hospitals that would be more respectable and useful. Laying aside for a moment the benefit which might thus arise to the recip- ients of the bounty, the amount of valuable statistics which might be gathered for the medical profession is almost unbounded. The course which would bring marine hospitals up to the standard which they should maintain, and would carry their re- sults into the pages of science, would at the same time render them doubly useful in the work of relief for which they were founded.” The results thus clearly foretold in this report, made thirty years ago, have been accomplished; the reports of the service are sought after by the medical profession ; the standard of professional requirements necessary to gain admission into the service is high—78 per cent, of all applicants for admission into the corps having been re- jected during the past year; the sailors are satisfied as a body; and the popularity of the officers is evidenced by the steadily increasing number of patients from year to year. But in order to maintain the service at its present high standard of excellence, and to attract to it young men of the highest ability, the methods of appointment and the rates of compensation must be regulated by law. Experience has shown the present system—the one recommended in the bill, and already in practice by the department—to be that best adapted to carry out the pur- pose of the founders of the law, and that most creditable to the government. That the general expenses of the service are diminished rather than increased by the appointment of medical officers is conclusively proven by the following table, taken from the annual report for 1879: MARINE-HOSPITAL SERVICE. COMPARATIVE ECONOMIC EXHIBIT. The followin'! tabular statement will serve to illustrate the results of the reorganization of the Marine-Hospital Service in 1871. (Prior to 1868 no separate records were kept from which the actual cost of the service for each fiscal year can be ascertained.) Operations of the Marine-Hospital Service from July 1, 1867, to June 30, 1879. Fiscal years. Number of places at which relief was furnished. Number of sick and disabled seamen furnished relief. Average cost for each seaman relieved.* 1868 Prior to reorganization: 64 11, 535 11, 356 10, 560 14, 256 13,156 13, 529 14, 364 15, 009 16, 808 15,175 18, 223 20, 922 $37 24 36 98 38 41 31 78 30 12 1869 64 1870 74 1871 After reorganization: 72 1872 81 1873 91 31 22 27 91 27 99 26 25 24 22 20 04 1874 91 1875 94 1876 94 1877 100 1878 210 1879 210 17 93 * This ratio is obtained by dividing the total expenditure by the number of seamen treated. The expenses were slightly increased during the last fiscal year, owing entirely to the larger number of patients, yet the expenditures in the year 1871 reached $483,758.73, and exceeded those of 1879 ($375,164.01) by $108,594.82, while the number of patients was 6,666 less in 1871 than in 1879. In 1874 there were 11 medical officers employed. The following table shows the receipts and expenditures from 1859 to 1878, inclusive. Year. Balance on hand at the beginning of the fis- cal year. Receipts from all sources. Aggregate. Expenditures by warrant. Balance on hand at the close of the fiscal year. Hospital-dues. From sales and leases of prop- erty. Appropriations by Congress to meet esti- mated defi- ciencies. Repayments. Gross. Net. I860 $28,136 97 $173,073 09 $275, 000 00 $1, 257 36 $477, 467 42 $456, 850 46 $455, 593 10 $20, 616 96 1861 20, 616 96 155,172 43 175 000 00 5’ 049 89 355, 839 28 313, 968 02 308, 918 13 4l! 871 26 1862 4l! 871 26 128, 526 97 200, 000 00 374, 964 70 295j 013 88 295! 447 41 79! 950 82 1863 79, 950 82 118, 307 74 200, 000 00 5, 032 48 403; 291 04 203!966 08 198! 933 60 199! 324 96 1864 199’ 324 96 117,824 05 100, 000 00 6' 746 98 423, 895 99 267, 658 82 260, 911 84 156! 237 17 1865 156,237 17 128! 656 30 $1, 356 64 150, 000 00 4, 590 94 440, 841 05 354! 420 40 349, 829 46 86! 420 68 1866 86,420 65 142, 292 81 170, 000 00 25,148 88 423, 862 34 361,107 27 335, 958 39 62,752 07 1867 62, 755 07 159| 021 00 88,129 40 200,000 00 17, 918 29 518, 823 76 440, 052 31 422! 134 02 78' 771 45 1868 78, 771 45 175, 977 15 11, 753 20 250, 000 00 24, 674 52 541,176 32 471, 521 05 446, 846 53 79,655 27 1869 69, 655 27 174, 965 95 16, 784 34 200, 000 00 13, 314 14 474, 719 70 419, 403 37 406, 089 -23 55, 316 33 1870 55,316 33 168,153 70 14, 520 30 200, 000 00 10, 793 87 448,784 20 378, 590 71 367, 796 84 70,192 49 1871 70,192 49 293,592 14 46,264 87 250, 000 00 42, 922 86 702,972 36 526,681 59 483, 758 73 176, 290 77 1872 176, 290 77 319, 823 16 21, 225 11 150, 000 00 25, 782 94 693,121 98 464, 855 08 439,072 14 228, 266 90 1873 228, 266 90 333, 003 03 440 00 125, 000 00 24,141 90 710,851 &3 423, 360 59 399, 218 69 287,491 24 1874 287,491 24 352, 379 98 1,210 00 100, 000 00 8, 643 26 749, 724 48 419, 746 61 411,103 35 329, 977 87 1875 329, 977 87 338, 893 78 6, 010 01 100, 000 00 3, 857 08 778, 738 74 414, 257 69 410, 400 61 364, 481 05 1876 364,481 05 351,129 59 1, 739 58 9, 672 72 727,022 94 456,013 10 446, 340 38 271,009 84 1877 271,009 84 373! 862 28 6, 026 00 8. 604 71 659] 502 83 384, 422 57 375! 817 86 275 080 26 1878 275, 080 26 371,310 09 ], 026 00 8,396 68 655, 813 03 376! 347 00 367, 950 32 279, 466 03 MARINE-HOSPITAL SERVICE. MARINE-HOSPITAL SERVICE. 5 It will be seen from the foregoing table that the expenditures of the year 1879 were less than those of thirteen of the nineteen previous years, and the six years showing a less expenditure, with the single’exception of 1878, were during the war, when com- merce was reduced to a minimum and many American vessels registered and sailed under a foreign dag. The proposed bill, if passed, will not increase the corps to the extent of creating any supernumeraries, and will only allow barely enough officers to fill the places where they are urgently needed. At several of the principal stations, where the daily aver- age of patients on hand ranges from 25 to 60, there is but a single medical officer on duty, and no one to relieve him during sickness or to allow of leave of absence. The writer can state that, during his three years’ service at several different stations, he has never been able to obtain a leave of absence, owing to the impracticability of finding any officer to relieve him, and he has known several instances where officers, having been obliged to leave their station, owing to sickness in the family, or other causes, were compelled to employ a substitute at their own expense. The clerical work required of, and performed by, the medical officers of this service is many times greater than that required of the officers of any other medical service under the government, and as the number of sailors is estimated at 170,000, no other service has an equal number of patients. This service also stands alone in the facility with which the actual expenses may be determined, inasmuch as there is no separate department in which all transportation, under orders, freight and repairs of buildings is accounted for; no department in whose general estimates the pay of the medical corps lies hidden; no department from which the rations are drawn and the patients subsisted; but, on the contrary, all its % figures are open and easily accessible. Section 1 of the proposed bill limits the number of surgeons to thirteen, the number actually in the service at this date. The number of passed assistant and assistant surgeons is limited by the bill to twenty, an apparent increase of three, but a real increase of one, as one assistant surgeon whose resignation was only recently accepted leaves a vacancy still unfilled, and the promotion of one assistant surgeon, vice Sur- geon Ellinwood, resigned, leaves another. For reasons stated above the number of medical officers proposed by the bill is still inadequate to meet the actual needs of the service, but the number of subaltern officers is reduced to twenty, to meet what I conceive to be the wishes of the department. The necessity for the enactment of section 2, which simply prescribes that original appointments shall be made to the grade of assistant surgeon only and that they shall be thoroughly competent, is too obvious to require comment. The same remark is applicable to section 3, which prescribes that three years shall elapse after appointment, in addition to a record of fitness and professional ability, before any assistant surgeon shall be promoted. Section 4 follows as a natural sequence, and is in my opinion calculated to develop that esprit du corps essentially necessary for the maintenance of discipline and efficiency in a civil service. Section 5, fixing the compensation, places it at a rate already authorized by exist- ing regulations. Section 6 allows of the retention in the service of the medical officers now in the service. Section 7 is obviously necessary for the government of mixed boards, as officers of the two services are usually detailed to serve together in the annual inspection of life- saving crews and the examinations for promotion of officers of the revenue marine. Section 8 provides for contracts with private physicians at small ports. It is now the practice to make an appointment of such physician as an acting assistant surgeon, but there is no provision for any liquidated damages to the department in case of a failure to perform the duties of the office, which provision might be inserted in a contract. A case recently occurred where at a small port on Lake Superior a sailor, having dislocated his thigh, was sent by the collector to the nearest physician, who reduced the dislocation. The physician made a charge of $30, was allowed by the fee bill of the county, and was the regular and usual charge. A similar accident happen- ing at a port where there was a contract surgeon would have cost nothing beyond the annual compensation, which in some cases is fixed as low as $100. It is then a measure of economy that this section should be enacted. Section 9 regulates the method of the appointment of hospital stewards, engineers, attendants, and laborers, and as it is simply based on the department regulations, will not change the present conditions except to specifically legalize the appointments. Section 10 covers the appointment of the clerks and other employes in this office. As the Solicitor of the Treasury has decided that there is no provision in law for the appointment of a chief clerk in this office, it was thought proper to provide for the per- formance of the routine office work during the temporary absence of the chief officer of the service, which has been done in section 11. The same section also authorizes H. Rep. 137 2 6 MARINE-HOSPITAL SERVICE. the detail of a steward in the office of the purveyor. This is necessary for the proper examination of the medicines previous to shipment, and a steward has been so em- ployed for the past two years. I am, sir, very respectfully, your obedient servant, JOHN B. HAMILTON, Surgeon-General, U. S. Marim-Hospital Service. Hon. John Sherman, Secretary of the Treasury.