Marine Hospital Service



The Marine Hospital Service had its humble beginnings with an act of the 5th Continental Congress signed into law by President John Adam on July 16, 1798. The Act required the Department of the Treasury to "provide for the relief and maintenance of disabled seamen." This Act lead to the formation of several loosely controlled hospitals at sea and river ports all across the United States, which was officially the Merchant Hospital Fund. The Act specified the revenue for the Hospital Fund to come from the merchant seamen. Merchant seamen that used the early hospital fund hospitals were charged "20 cents per month." This series of hospitals to care for merchant seamen was based on the British practice of establishing hospitals to care for sailors and merchant seamen. The Brithish established their first hospitals in 1588 shortly after their victory over the Spanish Armada. The Marine Hospital Fund was a unique and early mechanism to provide the first publicly-funded health care and disease prevention federal agency in the United States.

Following the Civil War, public outcry and scandal surrounded the Marine Hospital Fund. In 1869, Dr. John Shaw Billings, a prominent Army Surgeon, was appointed to head an investigation of the Marine Hospital Fund. Dr. Billings found the hospital fund to be inadequate and completely unorganized. In 1871, the Marine Hospital Fund was formally reorganized to the Marine Hospital Service, under the direction of Dr.John Maynard Woodworth. Dr. Woodworth was appointed to the Service as “Supervising Surgeon.” Dr. Woodworth reorganized the service into a disciplined organization based on his experience in the Union Army as a Surgeon. Dr. Woodworth required his physicians to be a mobile work force stationed where the service was in need, and he mandated the daily wear uniforms. This eventually lead to the creation of the modern day Public Health Service Commissioned Corps. Dr. Woodworth using Army style heraldy created the Marine Hospital Service fouled anchor and caduceus seal which is used to this day by the Public Health Service. In 1873, Dr. Woodworth’s title was changed to “Supervising Surgeon General.” This title change lead to the modern day office of Surgeon General of the United States.

It was the point of origin for the Public Health Service and the Public Health Service Commissioned Corps of the present day Department of Health and Human Services and current Operating Divisions (OPDIV) and Staffing Divisions that include the National Institutes of Health, the Centers for Disease Control and Prevention, Indian Health Service, and a host of other federal-level health programs. The Marine Hospitals, as their name suggests, were hospitals constructed at key sea and river ports across the nation to provide health care for merchant marine sailors. Aside from the well-being of these sailors, the hospitals provided a key monitoring and gate-keeping function against pathogenic diseases.

As the nation grew, the scope of Marine Hospital Service's scope of duties grew to include quarantine and other national public health functions. In 1902, the Marine Hospital Service was renamed the "Public Health and Marine Hospital Service." In 1912, the name of the service was changed to the Public Health Service to encompass its diverse and changing mission. Over time, the hospitals of the service were also expanded to include research and prevention work as well as the care of patients. Aside from merchant seamen, members of the military, immigrants, Native Americans, and people affected by chronic and epidemic diseases found a source for health care in the PHS and its hospitals.

The hospitals themselves were, by the middle of the 1800s, fairly imposing and architecturally grand structures in many cases. As long as ample federal funding was available for their construction, these hospitals were impressive examples of government-provided health care. The hospitals of the early twentieth century in major port cities such as New Orleans, San Francisco, and Savannah displayed ornate architectural detail and reflected many of the changes sweeping medicine at the time. During the Nixon administration, funding was cut to the PHS hospitals program and many of these institutions closed or were turned over to local public health offices. Eight survived as federal institutions until the early 1980s when further budget cuts put an end to their funding. Some, such as the one in Savannah, Georgia, continued as an outpatient low-income health clinic up to 2003 while others, such as the large hospital in San Francisco on the grounds of the US Army Presidio were diverted other Federal and military uses. In the case of the Presidio, the PHS Hospital was used as a site for language-training for military officers in the late 1980s.

Today, the records for these institutions sit in storage at the National Library of Medicine in Bethesda, Maryland.