Teeasuey Depaetment, 
February 21, 1888. 
Sie : Referring to House bill No. 1526, to prevent the introduction 
of contagious diseases and to establish a Bureau of Health, I transmit 
herewith, for the information of the committee, a brief prepared by 
the Supervising Surgeon-General of the Marine-Hospital Service, giving 
reasons why the bill should not become a law. 
Very respectfully, 
C. S. FAIRCHILD, 
The Honorable Maetin L. Claedy, 
Secretary. 
Chairman Committee on Commerce, Souse of Representatives. Treasury Department, 
Office Supervising Surgeon-General, U. S. M.-H. S., 
February 23, 1888. 
Sir : Referring to the bill (H. R, 1526) and to the report thereon, 498, 
I have the honor to inform you that the bill if passed would change 
the present system of the conduct of national sanitary affairs, and, as I 
shall hereafter point out, such change would not, in my opinion, be con- 
sistent with economy or efficiency. 
It is somewhat singular that the principal law sought to be repealed 
by the operations of the proposed act is not referred to by name. The 
law now in force is as follows : 
An act to prevent the introduction of contagious or infectious diseases into the United 
States. 
Be it enacted by the Senate and Souse of Representatives of the United 
States of America in Congress assembled, That no vessel or vehicle coming 
from any foreign port or country where any contagious or infectious 
disease may exist, and no vessel or vehicle conveying any person or 
persons, merchandise or animals, affected with any infectious or conta- 
gious disease, shall enter any port of the United States or pass the 
boundary line between the United States and any foreign country, con- 
trary to the quarantine laws of any one of said United States, into or 
through the jurisdiction of which said vessel or vehicle may pass, or 
to which it is destined, or except in the manner and subject to the 
regulations to be prescribed as hereinafter provided. 
Sec..2 That whenever any infectious or contagious disease shall 
appear in any foreign port or country, and whenever any vessel shall 
leave any infected foreign port, or, having on board goods or passen- 
gers coming from any place or district infected with cholera or yellow 
fever, shall leave any foreign port, bound for any port in the United 
States, the consular officer, or other representative of the United States 
at or nearest such foreign port shall immediately give information 
thereof to the Supervising Surgeon-General of the Marine-Hospital 
Service, and shall report to him the name, the date of departure, and 
the port of destination of such vessel; and shall also make the same 
report to the health officer of the port of destination in the United States, 
and the consular officers of the United States shall make weekly reports 
to him of the sanitary condition of the ports at which they are respect- 
ively stationed; and the said Surgeon-General of the Marine-Hospital 
Service shall, under the direction of the Secretary of the Treasury, be 
charged with the execution of the provisions of this act, and shall frame 
all needful rules and regulations for that purpose, which rules and reg- 
ulations shall be subject to the approval of the President, but such 
rules and regulations shall not conflict with or impair any sanitary or 
quarantine laws or regulations of any State or municipal authorities 
now existing or which may hereafter be enacted. 
Sec. 3. That it shall be the duty of the medical officers of the Ma- 
rine-Hospital Service and of customs officers to aid in the enforcement 
of the national quarantine rules and regulations established under the 6 
preceding section; but no additional compensation shall be allowed 
said officers by reason of such services as they may be required to per- 
form under this act, except actual and necessary traveling expenses. 
Sec 4. That the Surgeon-General of the Marine-Hospital Service 
shall, upon receipt of information of the departure of any vessel, goods, 
or passengers from infected places to any port in the United States, 
immediately notify the proper State or municipal and United States 
officer or officers at the threatened port of destination of the vessel, and 
shall prepare and transmit to the medical officers of the Marine-Hos- 
pital Service, to collectors of customs, and to the State and municipal 
health authorities of the United States weekly abstracts of the consular 
sanitary reports and other pertinent information received by him. 
Sec. 5. That whenever, at any port of the United States, any State 
or municipal quarantine system may now, or may hereafter exist, the 
officers or agents of such system shall, upon the application of the re- 
spective State or municipal authorities, be authorized and empowered 
to act as officers or agents of the national quarantine system, and shall 
be clothed with all the powers of United States officers for quarantine 
purposes, but shall receive no pay or emoluments from the United States. 
At all other ports where, in the opinion of the Secretary of the Treasury, 
it shall be deemed necessary to establish quarantine, the medical officers 
or other agents of the Marine-Hospital Service shall perform such duties 
in the enforcement of the quarantine rules and regulations as may be 
assigned them by the Surgeon-General of that Service under this act: 
Provided, That there shall be no interference in any manner with any 
quarantine laws or regulations as they now exist or may hereafter be 
adopted under State laws. 
Sec. 6. That all acts or parts of acts inconsistent with this act be, 
and the same are hereby, repealed. 
Approved April 29, 1878. 
Under this law, the operations of which were temporarily suspended 
during the period of four years while the National Board of Health 
quarantine act was in force, the present national sanitary affairs are 
managed, with the addition that the authority for maintaining quaran- 
tine and maritime inspections at points of danger is conferred by the 
various appropriation acts to be hereafter cited. 
The committee having charge of this subject may not have had the 
time to pass in review the various legislative acts passed from time to 
time and which have led up to the present law and those subsequent 
thereto. 
The present system of regulating and controlling the affairs of the 
public health of the nation has been reached only after long experience 
and after repeated and varied legislation. The first law passed by 
Congress which had for its purpose the placing of the control and 
management of the affairs of the public health in the hands of the 
public officers of the Government was passed on the 16th of July, 1798, 
and was entitled “An act for the relief of sick and disabled seamen.’7 
This act simply authorized the President to appoint, in such ports as 
he might think proper, persons to be called directors of the marine 
hospitals for their respective ports, and their duties under the act were 
defined to be mainly to provide for the accommodation of sick and dis- 7 
abled seamen at their respective ports, under such general instructions 
as should be given from time to time by the President of the United 
States for that purpose. (1 Statutes at Large, p. 605.) 
February 25, 1799, Congress passed another act, entitled “An act re- 
specting quarantine and health laws,” which, in substance, placed the 
management of the public health and quarantine service under the con- 
trol of the Secretary of the Treasury. (1 Statutes at Large, p. 619.) 
These acts remained in force without material change until June 29, 
1870, when Congress, which provided that the Secretary of the Treasury 
should from time to time appoint a surgeon to act as supervising sur- 
geon of the Marine-Hospital Service, and also that this supervising sur- 
geon should, under the direction of the Secretary of the Treasury, super- 
vise all matters connected with the Marine-Hospital Service, and the 
disbursement of the fund for the relief of sick and disabled seamen, 
and that he should make monthly reports to the Secretary of the 
Treasury. (Revised Statutes, sec. 4802.) 
On the 3d of March, 1875, Congress amended this act and provided 
that the appointment of the Supervising Surgeon-General of the Marine- 
Hospital Service should be made by the President of the United 
States. (Supplement to Statutes, p. 158, sec. 1.) 
On the 29th of April, 1878, Congress passed another act, conferring 
upon the Surgeon-General of the Marine-Hospital Service, under the 
direction of the Secretary of the Treasury, full power and authority to 
enforce the quarantine laws of the United States, but this act carried 
with it no appropriation. (Supplement to Statutes, p. 313, chap. 66.) 
Thus it will be seen that to this time, and down to the establish- 
ment of the National Board of Health by Congress on the 3d of March, 
1879, the control of the quarantine service and the administration of 
the affairs of the public health, so far as they were directed and con- 
trolled by the Government, by law remained under the control of the 
Secretary of the Treasury. 
At this time, March 3, 1879, the system of the management of the 
affairs of the public health of the United States was radically and en- 
tirely changed. As has been stated, Congress took the control of this 
branch of the administration of the Government out of the hands of 
the Secretary of the Treasury, and placed it under the control of the 
National Board of Health, this Board being created by act of Congress 
of March 3, 1879, and its full powers and duties being conferred upon 
them by that act and by the subsequent act of June 2, 1879. The de- 
bates in Congress show that application had been made to Congress 
from time to time for the establishment of various forms of a national 
board of health, and the placing control of the affairs of the public 
health under a board or an association of gentlemen who, acting in 
connection with and in co-operation with the various State boards of 
public health, and with the various local boards of health in the dif- 
ferent States, were to have the entire management and control, under 
a system to be established by them, of the public health of the nation. 
These debates further show that the question of whether such radical 
change should be made or not was a matter of very serious considera- 
tion by Congress, and it was only after long debate, and after strenu- 
ous effort had been made to secure the passage of the bill, that Congress 
finally consented to take the control of the quarantine service out of 
its then present management, and they only did so, as the act shows, 
with the understanding and under the express provision inserted in the 
law that it should be an experiment. 8 
Sec. 10. This act shall not continue in force for a longer period than four years 
from the date of its approval. 
The act provided— 
The four years terminated June 1, 1883. Prior to this time, how- 
ever, Congress, in obedience to public demand, had taken from the 
National Board of Health the control of the fund appropriated to aid 
in preventing the spread of disease: and in the sundry civil appropri- 
ation bill for the year 1882 it was provided that— 
The President of the United States is hereby authorized, in case of a threatened or 
actual epidemic, to use a sum not exceeding one hundred thousand dollars in aid of 
State and local boards, in his discretion, in preventing and suppressing the spread of 
the same. (Statutes at Large, vol. 22, p. 315.) 
This provision was carried into the appropriation act for 1883, with 
an amendment, by adding the words uand maintaining quarantine at 
points of danger” (Statutes at Large, vol. 22, p. 613), and this language 
has been followed in subsequent appropriation acts. 
The other acts in force it is not important to call to the attention of 
the committee, as they do not affect the question under discussion 
further than to give the committee a reference to the same. 
April 18, 1879, Statutes at Large, vol. 21, p. 49. 
June 14, 1879, Statutes at Large, vol. 21, p. 50. 
June 16, 1880, Statutes at Large, vol. 22, p. 266. 
July 7, 1884, Statutes at luirge, vol. 23, p. 207. 
March 3, 1885, Statutes at Large, vol. 23, p, 496. 
August 4, 1886, Statutes at Large, vol. 24, p. 237. 
March 3, 1887, Statutes at Large, vol. 24. 
The fact that Congress, yielding to the public demand (see debates 
in Congress), had seen fit to take the disposition of the moneys appro- 
priated by them for the years 1882 and 1883 out of the hands of the 
National Board of Health and place it under the control of the Presi- 
dent of the United States, and that he directed it to be used under the 
direction of the Secretary of the Treasury is significant as showing the 
popular feeling regarding the management of this branch of the Service 
by the National Board of Health, and has undoubtedly been the cause 
of this attack upon the Secretary, and the reason for the introduction 
of the present bill. 
Regarding this matter, however, if the President was to be guided 
by the intention of Congress, he had no other course to pursue. 
(Debates in Congress, vol. 14, part 3, 2d session, 17th Congress, p. 3022.) 
The foregoing are the acts which have been passed by Congress from 
time to time on this subject. 
Regarding the pending bill, I submit— 
First. That the laws now in force meet all the requirements of this 
bill; and 
Second. If the bill should become a law, it would have no further 
result than to create positions to be filled by appointment, and involve 
the Government in needless and unnecessary expense. 
Section 1 of the bill is as follows : 
That there shall be established in the Department of the Interior a 
Bureau of Public Health. There shall be appointed from civil life by 9 
the President, by and with the advice and consent of the Senate, a 
Commissioner of Health, who shall be intrusted with the management 
of the Bureau herein established. He shall be paid an annual salary 
of four thousand five hundred dollars. For his use the Secretary of 
the Interior shall provide suitable offices, and, with the approval ot 
the same, he shall employ such assistants and clerks as may be neces- 
sary. 
This section creates a new officer, with a larger salary than that now 
allowed by law to the Supervising Surgeon-General. It directs that new 
offices shall be procured for him, and gives authority for the employ- 
ment of assistants and clerks without limit, and without defining the 
salaries to be paid them. The providing of new offices naturally would 
include office-furniture. The luxurious furniture purchased for the 
National Board of Health, which at last accounts lay in a storage ware- 
house in this city, tells a mute but rather interesting story of the lament- 
able failure and losses attending experiments of this kind. No measure 
can surely be said to be in the interest of economy which is so loosely 
drawn as this in regard to unlimited employment; and if there were 
no other reason for the recommitment of this bill, this alone would be 
sufficient reason. 
That it shall be the duty of the Department of State to obtain from 
the consular officers at foreign ports and places all available information 
in regard to the sanitary condition of such ports and places, and to trans- 
mit the same to the Bureau of Health; and said Bureau shall also obtain, 
through all sources accessible, including State and municipal sanitary 
authorities throughout the United States, weekly reports of the sanitary 
condition of ports and places within the United States; and shall pre- 
pare, publish, and transmit to the medical officers of the Marine- 
Hospital Service, to collectors of customs, and to State and municipal 
health officers and authorities, weekly abstracts of the consular sanitary 
reports and other pertinent information received by said Bureau; and 
shall also, as far as it may be able, by means of the voluntary co-opera- 
tion of State and municipal authorities, of public associations, and 
private persons, procure information relating to climatic and other con- 
ditions affecting the public health ; and shall make an annual report 
of its operations to Congress, with such recommendations as it may 
deem important to the public interests ; and said report, if ordered to 
be printed by Congress, shall be done under the direction of the Bureau. 
That the necessary printing of the Bureau of Public Health shall be 
done at the Government Printing Office, upon the requisition of the 
Commissioner of Health, in the same manner and subject to the same 
provisions as other public printing for the several Departments of the 
Government. 
Section 2 is as follows : 
The principal portion of this section is a transcript of the act of 
April 29, 1878, under which the duty is now performed by the Super- 
vising Surgeon-General. The following is the form on which consular 
officers make their reports for the information of this office. It is a slight 10 
modification of the form formulated by my distinguished predecessor, 
the late Dr. John M. Woodworth. 
Form 1974. 
, 18-. 
To the Honorable The Secretary of State, 
Washington, I). C., United States of America 
In compliance with the act of April 29, 1878, I have the honor to make the follow- 
ing report of contagious diseases, and deaths occurring therefrom, at this place during 
the week ended , 18—, for the information of the Surgeon-General of the Marine- 
Hospital Service: 
Cases. 
Deaths. 
Cases treated in 
hospitals (mili- 
tary, civil, and 
private). 
Deaths in hospitals 
(military, civil, 
and private). 
Cholera 
Yellow fever 
Small-pox 
Typhus fever (or ship fever) 
Enteric (or typhoid) fever 
Scarlet fever 
Diphtheria 
Plague 
Totals 
Total deaths from all causes during the week reported, . 
Population according to census of , 18—, . 
Present officially estimated population, . 
Weekly mean of thermometer, ; weekly mean of barometer, . 
Prevailing diseases, (and other pertinent information). 
Very respectfully, 
, U. 8. . 
Consular officers also make the following report on a form devised 
some years ago by myself: 
Form 1971. 
Abstract of bills of health issued at 
during the week ending 
, 188—. 
No. of bill of health. 
Date. 
Vessel, name, and 
rig. 
Destination. 
Sanitary condition 
of vessel. 
Sanitary condition 
of cargo. 
Sanitary condition 
of crew. 
Sanitary condition 
of passengers. 
Sanitary condition 
of port. 
Remarks. 
(Here state whether vessel 
was at infected docks, num- 
ber of days or hours in port, 
and such other facts as may 
be of importance.) 
Number of deaths from yellow fever at this port during the week ending , . 
Number of deaths from cholera at this port during the week ending , . 
Number of deaths from small-pox at this port during the week ending , . 
I certify, on honor, that the foregoing is a correct report. 
Sanitary Inspector, U. S. Marine-Hospital Service. 
In times of threatened epidemic, when it is deemed necessary to em- 
ploy inspectors where an epidemic exists, and at Havana, from whence 11 
we are continually threatened with yellow fever, the following form is 
used: 
Weekly report of inspection of persons and things at , for the week ending 
—, 188—. 
Date. 
No. and sanitary con- 
dition of persons. 
Condition of baggage. 
Condition of merchan- 
dise. 
Where from. 
Destination. 
Remarks. 
(Here state what action was taken, and such other facts 
as may be of importance.) 
I certify on honor that the above is a correct statement of the number and sanitary condition of 
persons who have passed or attempted to pass through during the week, together with the 
condition of their baggage, merchandise, &c. 
In addition, consular officers are required to report by telegraph 
when a new outbreak of epidemic disease occurs in their respective 
districts, and medical officers proper and acting assistant surgeons are 
stationed at the ports along the coast, interior rivers, and the great 
lakes. It is their duty, under the regulations, to familiarize themselves 
with the local health laws of the place where they happen to be sta- 
tioned, and to promptly report to the local authories and to the De- 
partment at Washington any epidemic which may come to their knowl- 
edge. That is a part of their duties by regulation, and has been for 
years. 
The following paragraphs govern them in this matter (see Regula- 
tions): 
Sanitary Inspector, U. S. M.-H. S. 
Medical officers and acting assistant surgeons of the Marine-Hospital 
Service will inform themselves fully as to the local health laws, and 
the regulations based thereon, and in force at their respective ports and 
stations, and will comply strictly therewith. 
Medical officers and acting assistant surgeons of the Marine-Hospital 
Service are, under the direction of the Supervising Surgeon-General, 
required to observe and to aid in executing the quarantines and other 
restraints established by the health laws of any State, and to report 
forthwith to the said Surgeon-General any important event or fact that 
may come to their knowledge bearing upon the importation, outbreak, 
or spread of cholera, yellow fever, small pox, typhus, or other epidemic 
disease, at or near their respective stations. 
Furthermore, voluntary reports are now furnished by nearly every 
health officer in the United States in exchange for the reports of this 
office. (Although the quarantine service is not directly touched upon 12 
in the bill under consideration, except by implication in another sec- 
tion, it is proper to say that during the quarantine season each year 
the Secretary of the Treasury has directed the cruising cutters of the 
revenue service, our coast guard, to aid the national and local quaran- 
tine officers by promptly sending to quarantine any vessel found with 
infectious disease on board.) Based on this information, weekly ab- 
stracts of the sanitary information thus obtained are now issued by the 
Supervising Surgeon-General, as the law directs, to every quarantine 
and health officer in the United States, so far as the bureau has knowl- 
edge of them, and in every case where immediate information is neces- 
sary for safety of any port such information has been transmitted by 
telegraph. It surely cannot be pretended that the new commissioner 
could have any more authentic sources of information or that he would 
be any more diligent in its transmission. The printing is now provided 
for under the general provisions of law providing for printing for the 
Treasury Department. 
Section 3 of the proposed bill provides— 
That the Commissioner of Health shall, under the direction of the 
Secretary of the Interior, frame rules which, when approved by the 
President and issued by the Department of State, shall serve for the 
instruction of consular officers of the United States and of the medical 
officers serving at any foreign port. In compliance with these rules, 
every master of a vessel destined for a port of the United States shall 
be furnished with a certificate containing a detailed statement of the 
inspection of the vessel, cargo, crew, and passengers, and of the sani- 
tary measures carried out at the expense of the vessel: or if such meas- 
ures are not carried out, instant warning shall be transmitted to the 
Bureau, who shall immediately notify the quarantine authorities of the 
port of destination. 
By request of the State Department, rules have already been framed 
by this Bureau, approved by the Secretary of the Treasury, and adopted 
by the Secretary of State, incorporated in the consular regulations, and 
approved by the President, covering the proposition in this section. 
The proof has been read by the proper officer of the State Department, 
and the volume, I am informed, will soon be ready for issue, and the 
adoption of this bill would require them to be again gone over by a 
person doubtless without the experience in these matters that time and 
practice can alone give, or else appropriated bodily by the new officer. 
Section 4 provides— 
That the bureau of Public Health shall, with the approval of the 
Secretory of the Interior, make investigations, both in the United States 
and, if necessary, in foreign countries, into the nature, origin, and pre- 
vention of contagious and epidemic diseases, as well as the causes and 
conditions of particular outbreaks of disease in the United States, and 13 
shall publish and distribute documents relating to the prevention of 
disease. 
These investigations have beeu constantly going on ever since the 
enactment of the law of 1878 ; every epidemic of yellow fever has been 
investigated by officers of this Service and, with the single exception 
of that of 1878, printed in full in the annual reports of this Service. That 
exception was turned over to the National Board of Health, and has for 
several years lain unprinted, although the most exhaustive investiga- 
tion ever undertaken of a similar epidemic. When the epidemic of 
cholera appeared in Spain, the President of the United States, in obedi- 
ence to the general demand for investigation, sent a well-known medical 
gentleman from Philadelphia to investigate the progress and causes of 
that epidemic, and Congress has authorized the publication of the re- 
port. And still more recently a medical officer of the Army was de- 
tailed to report to the Secretary of the Treasury and to proceed to 
Brazil and Mexico for the purpose of investigation of the method prac- 
ticed in those countries for the alleged prevention of yellow fever by the 
method of inoculation. That investigation was conducted under minute 
instructions prepared by the Supervising Surgeon-General and approved 
by the President. This investigation is now going on, and will at an 
early day be made public. 
Section 5 provides— 
That the President is authorized, when requested by the Bureau of 
Public Health, and when the same can be done without prejudice to 
the public service, to detail officers from the several Departments of 
the Government for temporary duty, to act under the direction of said 
Bureau, to carry out the provisions of this act; and such officers shall 
receive no additional compensation except for actual and necessary 
expenses incurred in the performance of such duties. When a detail 
of suitable officers cannot be made, the Commissioner of Health may 
employ such experts, and foi such time and in such manner as the 
funds at the disposal of the bureau may warrant. 
This confers a power on the President which he already has and has 
repeatedly exercised, as already shown in the comment on the preceding 
section. 
Section 6 is as follows : 
That to defray the expenses incurred in carrying out the provisions 
of this act, the sum of seventy-five thousand dollars, or so much thereof 
as may be necessary, is hereby appropriated, to be disbursed undpr the 
direction of the Secretary of the Interior, on the requisition of the 
Commissioner of Health. 
Section 7 provides— 
That an act entitled “An act to prevent the introduction of conta- 
gious and infectious diseases into the United States, and to establish a 14 
National Board of Health,” approved Marcia third, eighteen hundred 
and seventy-nine, and all other acts and parts of acts conflicting with 
the provisions of this act are hereby repealed. 
So much of this section as provides for the repeal of the act creating 
the National Board of Health is doubtless wise, as that body has neither 
any well-defined duty under the act of March 3, 1879, nor any appro- 
priation available for performing any shadowy duty that might possi- 
bly be found for them. The Board have not held any meeting for sev- 
eral years, but some officer representing them has each year submitted 
an estimate for their annual salaries, which has been disallowed by 
Congress. Suit was recently brought by one of their number, claiming 
to act as secretary, in the Court of Claims, but the case was decided 
adversely. 
Section 8 provides— 
That this act shall take eifect sixty days after its passage, within 
which time the Commissioner of Health shall be appointed, subject to 
the approval of the Secretary of the Interior. 
This section is in apparent conflict with the first section of the bill, 
which provides that the proposed Commissioner of Health shall be ap- 
pointed by the President, by and with the advice and consent of the 
Senate, while the one under consideration says he shall appoint within 
sixty days, “subject to the approval of the Secretary of the Interior”— 
a rather singular limitation to place upon the appointing power. 
Having thus shown the fact that the bill is generally defective in its 
provisions, and that the service sought to be performed by it is already 
in successful operation, little argument would seem to be needed to 
show, not only that the bill should be recommitted for revision, but 
that it ought not to become a law. 
The single branch of investigation not touched upon in my remarks 
upon the bill thus far is that relating to the adulteration of foods, and 
that service is now efficiently performed by the chemist of the Agri- 
cultural Department, by direction of the Commissioner, under authority 
of the appropriation act of March 3, 1887. Futhermore, the various 
examiners of drugs, attached by authority of law to the appraisers’ 
offices at the various custom-houses, may and do examine articles of 
food supply admitted to entry. The one article of tea has been made 
the subject of special legislation. 
I submit that this bill cannot be regarded in any manner as adding 
to the efficiency of the Service; and when its generally loose provisions 
regarding expenditures are considered, it must be viewed, in my opinion, 
as adding materially to the expenses of the public service without 
adequate return.