WA U58* 1884 department. Marine-Hospital Service A_:N~ SWE Tt .SUPERVISING SURGEON-GENERAL * « NATIONAL BOARD OF HEALTF. ZMZ-A-IROjEaC IS, 1884. WASHINGTON: GOVERNMENT PRINTING OVVICB. 1884. !*. J NLM OOlOSflO? E NLM001058072 \4? [Treasury Department. Ci\^ , Marine-Hospital Service. AN S"WE H SUPERVISING SURGEON-GENERAL TO THE NATIONAL BOARD OF HEALTH. JSALJ^TlCm IS, 1884. WASHINGTON: GOVERNMENT PRINTING OFFICE. 1884. 1884- ARMED FORCES MEDICAL LIBRARY WASHINGTON, D. C. sts**-* Tueabuky Department, ) Document No. 557. S Marine-Hospital Service. S remarks. Surgeon-General John B. Hamilton submitted the following re- narks to the Public Health Committee, in reply to the argument of *• e National Board of Health: d. Chairman and Gentlemen of the Committee: n compliance with agreement, I submit the following answer to the i£ omenta or charges filed by Doctor Smart, Dr. Stephen Smith, Mr. ing, and Thomas Simons, esq., all of the National Board of ith, submitted to you on Thursday, March 6, 188»|- it is proper to say at the outset that at a previous meeting of your committee, while a bill to confer certain powers on the National Board of Health, not now exercised, was under consideration, certain members of that Board made general and distinct charges reflecting upon my professional, official, and private character. These charges the committee heard, as they were delivered orally, and on the two subsequent meetings I replied to these charges, aud incidentally took up the whole subject, and alluded to the operations of the Board in a manner which the Board are pleased to call charges against them, and to which they now reply in print, and, by way of rebuttal, accuse me of having made misstatements of fact in that oral argument for the purpose of influencing the committee. I did try to influence the committee, and shall always expect to influence reasonable men by the presentation of facts, but that there has been any misrepresenta- tion or intentional misstatement I deny. I shall now examine the statements submitted, and as in many of the papers the statements are repeated, to save your time and mine, I will consolidate them: statement of : octor smart. It is asserted by Doctor Smart, (page 1,) and insinuated by Mr. Waring and Mr. Simons, that "for a long time past charges have been circulated privately by Doctor Hamilton, and made use of to the detriment of the Board, when its members were not present to reply." This is false, and no proof has been submitted to the committee to sustain it. 4 Doctor Smart further insinuates (page 1) that the public press of the country has been manipulated against the Board. The committee are well aware that no one man can control the public press of this country, and that the journalistic profession make up their own judgment of public men and things, irrespective of any attempt to control. Doctor Smart attempts to explain the condition of the barge " Selden," by stating that she was sound when purchased, (pages 2 and 3,) reiter- ated by Mr. Simons, (pages 49 and 50.) What I said about that craft is as follows: "There was the 'Selden,' an old rotten canal-boat, pur- chased at an expense of $3,000, utterly and absolutely worthless; has been of no service, and is now a total wreck," which I now correct as to figures—$2,500 instead of $3,000. I attach an affidavit of Captain Peddle, who was on this vessel for some time, and a statement of Board-. ing Officer Mulligan. Captain Peddle had left the vessel before sh I was wrecked, and was therefore without prejudice: Noefolk, Va., March 3, 1884. I certify that I had command of the hospital-barge '' Selden '' from the time she was turned over to the Marine-Hospital Service for quarantine duty, and at that time she was in a decidedly unseaworthy condition. I should not have been willing to risk my life in her had I known at the time that she was going beyond Craney Island—that is across the bay. Her timbers were affected with dry-rot, and without the repairs made to her she would have broken up before reaching Linden Island, if she had struck even lightly. Her deck-house would have blown off sooner than it did if it had not been for the repairs made to her by the Marine-Hospital Service. Capt. BENJAMIN PEDDLE. Sworn and subscribed to before me, this 3d day of March, 1884. [seal.] E. W. MASSEY, Deputy Collector. Ctjstom-House, Nokfolk, Va., March 3, 1884. It was my opinion last July that the barge "Selden" was never at any time fit for a hospital barge, more particularly for an open roadstead, and if so exposed would come to grief. I based my opinion from a professional sense as a sailor. The ground tackle was too light, and she had no rudder or steering-gear at all; she was dead flat on the floor, and rolled like a barrel in a sea-way. The '' Selden'' was formerly a canal-barge, for inland navigation. JAS. F. MULLIGAN, Boarding Officer, Norfolk, Va. Dr. Wm. A. Thorn, jr., of Norfolk, in a letter dated January 31,1884, says of this vessel: "At the conference at Old Point, which took place on the 27 th of July, the '"Selden" was ordered to the '' Middle Ground,'' in the Chesapeake Bay—a point about three miles from the nearest shore. Now, the "Selden" was an old worn-out canal-boat, built by Capt. J. L. Roper to convey lumber, and was sold by him for use at the Craney Island quarantine station. She had been housed over, and was in every possible respect unfit for service at the exposed point named.'' When turned over to me she was lying at Norfolk, just above the bridge, in Elizabeth Eiver. As it was in the city limits, she could not be used to receive cases of contagious diseases. I personally inspected her, and, while I thought her unseaworthy, the season was too far ad- 5 vanced to adopt other means, and she was by my direction towed to Willoughby's Cove, a safe anchorage. Even this was considered too near Norfolk, and, as known to a member of your committee, the Nor- folk commercial exchanges, including Portsmouth, protested, and re- quired her removal, as yellow fever was then on a vessel in the bay. Fisherman's Island was selected by the representatives of the cities bor- ■ dering on the bay and its tributaries, as the quarantine station, and she was started to that point, but left on the "Middle Ground" for some days before finally getting her over to smooth water inside Fisher- man's Inlet; but she was too rotten to hold together, and as she had no steering-gear, she swung to her anchor and the wind blew her upon it, and a hole was stove in her bottom. The Board, with that singular lapse of memory that have character- ized them throughout this matter, seem to have forgotten that they paid $1,678.73 for " repairs to' Selden'" immediately after her purchase, which brought up the cost to $4,178.00. In regard to the "Mississippi Sanitary Flotilla," (page 3,) what I stated to the committee was as follows: '' When turned over to me last July, we were obliged to keep men pumping to keep some of the 'fleet' afloat. The Secretary of the Treasury ordered a board of inspection to examine these boats and ascertain their condition. It was considered best for the interest of the Government to sell than to attempt to repair them. Four were sold be- cause they could not be kept afloat except at great expense." I also submitted the following letter from Passed Assistant Surgeon Godfrey: U. S. Marine-Hospital Service, District of the Gulf, Port of New Orleans, Surgeon's Office, August 7, 1883. General : I have the honor to invite your attention to the following facts in regard to the fleet of boats recently brought from Memphis. The sulphur is stored on the hull '' Vansant.'' Most of the barrels will fall to pieces when handled. The hull just men- tioned, I am afraid, from the report of the present superintendent, who has had much experience, will sink when the large steamers begin running. The hospital barges, having never been loaded, float so high that they are full of seams above the water-line, and could not now be loaded until thoroughly calked. It would not be practicable to put all the stores aboard the "Benner." I could store them on the hospital grounds, but it would cost a large sum to do it, owing to the fact that a good portion of the bat- ture is still under water. During a severe storm-in July, several of the stanchions in * the launch '' Sentinel'' were broken. If there is any prospect of using it, I should think it expedient to have them repaired. I have a complete inventory nearly ready, but find there has been little care taken for the preservation of articles. I have ordered a large number of things sent to the laundry, that would otherwise soon be ruined. Verv respectfully, JOHN GODFREY, Pawd Assistant Surgeon. Scrgeon-General Marine-Hospital Service. Doctor Smart says, (page 4:) "Just before this property passed from the hands of the National Board of Health, the board of health of Shelby County taxing district, which includes Memphis, applied for permission to use a portion of it in continuing the inspection system. A more definite 6 proof that this flotilla was not worthless could not well be given, as the Memphis board knew by an experience of three years the character of the floating property and the uses it subserved." This opinion is concurred in by Mr. Simons, (page 50,) who also says that "the Shelby board of health was desirous to obtain the custody and use of a part of this property, which the board submits is better evidence of its worth than the statements of the Surgeon-General." Unfortunately for the force of this fact, as affording satisfactory evi- dence of the value of this craft, that board, after a few days' trial, desired to return the vessel, and did so, preferring to use one of their own selection. Exception was taken by Doctor Smart (page 5) to the statement made by me that " Doctor Verdi was paid $300 for an essay in 1879. The com- mittee will please observe that three and a half pages out of the total eight and a half were quotations, a quotation from an editorial in the London Times being inserted, several columns from the Bureau of Sta- tistics, which is at the rate of $00 a page for the apparent original matter; and what was paid for copying the editorial can be easily figured out." (See Annual Report National Board of Health, 1879, page 159.) Mr. Waring says (page 35) that it is false. Mr. Simons apparently concurs, (page 51.) Now, I submit to the committee that my statement is not at all invalidated, whether Doctor Verdi was paid by the page, by the line, or by the day. That he received $o00, and that the essay was printed as a so-called investigation, are admitted facts A simple inspection of the article will give food for a bitterer commentary on the nature of the "investigation," which is said to have required thirty days for its full fruition, than anything I might say or have said. Doctor Smart, (page 6,) Mr. Waring, (page 35,) and Mr. Simons (pages 46 to 48) take exception to the following statement contained in my oral argument before the committee : '' They bring in evidence that the sanitarians have supported them. On what kind of sop have these sanitarians been fed? Doctor Rauch, secretary of the Illinois State board of health; Doctor Kedzie, president of the board of health of Michigan; Wirt Johnson, secretary of the Mississippi board of health, and others—all have 1 >een in the employ of the National Board of Health, as inspectors, essay-writers, or investigators, and in various other capacities.'' I did not enumerate one-half of the officers of State and local boards of health that have been employed by this Board, and paraded before you as "indorsers." Of course they indorse. I do not say—I have not said, the indorsement was corrupt, but that no weight per se should at- tach thereto. As well might the officers or employes of any service indorse their chief, as for the secretaries of the several boards to in- duce their organizations to puff the National Board. 7 In regard to the appropriation in aid of local boards of health, which appropriation I characterized as follows: "This appropriation in aid of local boards of health is, in its nature, a corruption fund, nothing more. It means whenever a board of health applies for money, that board of health gets the money. They are bound to indorse the hand that feeds them. They cannot help it. That is one oi" the conditions. If that is the policy of this Gov- ernment, a disbursing clerk is all that is necessary to carry out the objects of such an appropriation. If I must draw a check, if a check must be drawn by anybody in favor of a local board of health for so much money, Mr. Kelly could just as well draw the check as to have, from time to time, eleven dignitaries to authorize him to draw it.'' This was in general terms. I am nx>t alone in that opinion, as the debates in Congress will show. There is a constant tendency to get hold of these appropriations by all practicable means, and I say now that it would be a great relief to any executive officer if there were no appropriation of this character. The statement by Mr. Simons (page 47) that I made similar disbursements "in aid of the local board of health of Pensacola" is incorrect. An officer of this Service man- aged the maritime quarantine under my orders without reference to the local board, which, however, was kept fully informed of matters at quarantine, and when the yellow fever broke out at the the navy-yard the cordon was put on, and Captain Guttman, who happened at the time to be president of the Pensacola board of health, was employed, because, as I stated in my oral argument: '' When the yellow fever broke out at the navy-yard, it was necessary to protect that city by precautions other than the maritime quarantine afforded. That was done by means of the cordon sanitaire. The president of the board of health of that city was known to me as an old soldier, a Prussian by birth, who had served several years in the Prussian army, and later in the Confederate army. I knew he was energetic, faith- ful, and thoroughly competent to manage that line. For that reason I gave him charge and full control of the cordon line around the navy-yard. You will see the stations there in checks on the map.'' This man was appointed because of his merits and peculiar fitness, and the result justified the choice. The board was not aided as such; work was directed to be done and paid for accordingly. Moreover, all bills were certified by an officer of the Treasury Department, who was on the spot. I quote the following as showing the custom of the Board in regard to "aiding" State boards, (executive minutes, August 1, 1879:) Explaining to the president of the State board of Kentucky: "Ordered, That the secretary address a communication to Doctor Thompson, president of the State board of Kentucky, inquiring whether the State requires any aid or assistance from the National Board of Health, and also requesting that he suggest the names of two or three men who have had the yellow fever, for appointment as inspectors." Executive minutes, October 23, 1879 : "On motion, the following list of appointees of the State board of health of Tennessee was approved " Here follows a list of 32 names, too many to copy in the limited time at my disposal. Neither has it been the custom of the Marine-Hospi- 8 tal Service to ask indorsements of societies or to appoint persons to represent the Service at such society meetings. The executive min- utes of the National Board of Health show: No. 6, February 8, 1881: "Doctor Bemiss suggested the propriety of directing Dr. R. W. Mitchell and Dr. H. A. Johnson to attend the next meeting of the Sanitary Council of the Mississippi Valley.'' No. 14, April 2, 1881: "Doctor Mitchell stated that he thinks it would be bad policy to have representatives of the National Board of Health at the meeting of the Sanitary Council of the Mississippi Valley, unless there by special invitation.'' The order was then revoked, and a suggestion made— "That a private letter be written to Doctor Johnson, requesting that he take meas- ures to have the whole situation made known to the secretary of the council.'' Notwithstanding this action, it was, on September 5,1881, (No. 25)— " Ordered, That the action of Dr. Stephen Smith, in requesting Dr. J. H. Rauch to attend meeting at Evansville, Ind., be approved, and that the accounts of Doctor . Rauch for services as inspector from April 5 to 24, inclusive, $200, and for travelling expenses, $50, be paid." Doctor Eauch was then an officer of the State board of health of Illinois and of the Mississippi Valley Sanitary Council. Dr. F. W. Eeilly, an employ^ of the Board, was also detailed to attend this meet- ing, with $10 per day and expenses. It is not difficult to understand the reason for the apparent interest in the National Board when the methods of that organization are con- templated. An editorial in the Saint Louis Weekly Medical Eeview of February, since this matter has been brought to public attention, says: '' The charge that Doctor Hamilton is guilty of endeavoring to influence public opin- ion will appear very amusing to those familiar with the peculiar methods of the National Board in that respect. The manner in which the Board has used its employes and the recipients of its drippings to puff itself and decry the Marine Service, is a little too apparent for concealment. Some one has always been at hand at all the meetings of medical and sanitary societies to secure the passage of resolutions bolstering up the Board ; and at least two prominent sanitary associations are '' run'' by its friends, and manipulated in its interests.'' The editor, Dr. Julius S. Wise, who presumably wrote the above editorial, is responsible for these statements, which are, in my opinion, the expression of well-known facts. Doctor Smart proceeds to explain his indorsement of Carson's charges against the management of the Texas quarantine during the yellow- fever epidemic by quoting Doctor Happersett's letter, and from the two papers at Brownsville. It must be remembered that both Doctor Hap- persett and the editors referred to were within the lines of quarantine. "No man e'er felt the halter draw With good opinion of the law.'' At least one of the editors referred to lived in Matamoras, Mexico, and that city being infected, Doctor Murray refused him a pass to go 9 and come at will. There are no privileges in quarantine, a point which this gentleman was forced to appreciate. So far as the opinion of Doctor Happersett, within the line, is concerned, it is only fair to offset that opinion by that of Doctor Ainsworth, (also of the Army,) out of it. It is as follows: [Telegram.] September 20, 1882. "To the Collector of Customs and Health Officer, Corpus Christi, Tex.: We, the com- mittee appointed by the citizens of Laredo, in mass meeting assernbled, do herewith protest against any reduction of the present quarantine guard now acting, under direc- tion of the United States military hospital authorities, between Corpus Christi and Laredo, and ask for their continuance, for the reason that the yellow fever has now passed the limits of Matamoras and Brownsville, and is actually in the town of Mier, Mexico, and a ranch on the Texas side, over one hundred miles above the Brownsville cordon, and sixty miles below this place. Please forward these resolutions to the United States Secretary, by telegraph, at our expense, and oblige J. P. Arthur, health officer, city of Laredo; M. Mulhn, M. D.; C. G. Brewster, chairman committee; F. C. Ains- worth, captain and assistant surgeon, U. S. A., Fort Mcintosh; J. H. King, U. S. M.-H. S." Doctor Smart says that in advance of adverse criticism I gathered supporting signatures from that section. On the contrary, it will be seen, by reference to appendix, (Treasury Document No. 550,) pages 11 to 30, that these documents were in answer to the charges which Doctor Smart says "as a private individual" he endeavored to give "as wide a publicity as-possible," (page 10.) Doctor Smart's custom of doing all such underhanded work as a "private individual" rather than in his official capacity, is, so far as the Board is concerned, generosity beyond compare. Doctor Smart, Mr. Waring, and Mr. Simons (pages 1L, 37, and 49, respectively) refer in no very tender terms to the fact that I read the following letter from the ex-mayor of Pensacola, now collector of customs at that port: Washington, D. C, February 6, 1883. Dear Sir : Your letter of inquiry, under date of the 5th instant, is received. To your first inquiry, relative to the amount received and expended in Pensacola dur- ing the late yellow-fever epidemic, I will say that report there estimates the amount at $75, 000. This,*I think, is overestimated, and, in my judgment, about 350,000 were re- ceived and expended during the epidemic. I think about 345,000 were expended by the board of health. (I ought to say, in explanation, that they were at the time asking contributions from the people of the United States.) To your second inquiry, whether any State funds were received and expended after the epidemic ceased, I have to state that I know of no State fund having been expended. I was informed by the secretary of the State board of health that they received from the National Board of Health about §11,000, and after the close of the epidemic they applied to the National Board for more funds, and received 32,000. This latter amount was divided up amongst the doctors, giving each from 3400 to $500. This was given them in excess of the fee of 850 which they uniformly charged every yellow-fever patient. . To the inquiry as to what means were taken by the surrounding towns to prevent the spread of the epidemic, I will say that the navy-yard, Millview, Ferry Pass, Milton, and Bagdad, and all the towns on the line of the Louisville and Nashville Railroad, from Pensacola to the junction, a distance of forty-four miles, kept up a strict quaran- tine, requiring guards night and day, at a great expense to each town. 10 I was collector of the port and the mayor of the city of Pensacola, and in the latter capacity became the custodian of the funds sent me for the poor and destitute. These funds were separate and distinct from any fund received by the board of health. J. M. TARBLE. Surgeon-General John B. Hamilton, Marine-Hospital Service. I would further state that upon my return from Washington, on the 15th of Septem- ber, I called on the board of health members and tendered them the aid of the Treasury Department for the purpose of protecting the surrounding country from the spread of the yellow fever. This offer was positively refused by the board of health, they alleg- ing that they were obtaining all the funds they needed from private subscriptions and from the National Board of Health, and they would not accept the offer of the Depart- ment. J. M. TARBLE. Mr. Waring says, (page 37:) "He read this letter impressively, and he meant the committee to believe it. He himself knew it to be false." On the contrary, I believe the letter to be substantially true. Mr. Tarble is now collector of customs, and informs me that he can prove his statement regarding the two thousand dollars, by affidavit. As this officer is responsible, I leave further discussion of the matter between Mr. Waring and the collector. Doctor Cabell, in Smart's paper, (page 13,j states that I assumed that I "alone had recognized a constitutional difficulty," &c. I made no such statement, and when Doctor Cabell speaks of 1113' conceit, he simply shows the acerbity of advanced age without its mellowness. I was instructed to report upon the matter, and did so. I only mentioned that letter incidentally in refutation of the general charge of the Board that I was a novice in sanitary matters. Furthermore, there is not a single fact to prove Doctor Cabell's indirect assertion that as one of the results of that sanitary conference that the sanitary condition of ships has improved. The vast number of foul ships that came upon our seaboard last year would seem to show a con- trary state of facts, if, indeed, it were admitted that the conference had any influence at all. ARGUMENT OF DR. STEPHEN SMITH. I now come to the consideration of Dr. Stephen Smith's paper, which is deserving of more attention, because written with more skill, and without those attempts at mud-flinging which constitute the chief characteristic of Doctor Smart's and Mr. Wariug's articles, and with- out the garrulous petulance displayed in Doctor Cabell's letter. The doctor, however, views the matter from the stand-point of the Utopian rather than from that of the political economist or executive expert, and there are solid objections—stubborn facts—in the way of his day-dream theories. In criticising the paper, it would strike one that it was scarcely pertinent to the issue for the doctor to cite the discov- eries of Jenner, Pasteur, and Koch as a reason for the existence of the 11 National Board of Health, for none of these scientists ever had any- thing to do with a quarantine or a board of health. His review of sanitary legislation in this country seems generally correct, except that the fact is omitted that the quarantine act of April 29, 1878, was ample for quarantine purposes, had there been an appropriation to execute it. He says that with the death of Woodworth " all opposition ceased." He might have said that Doctor Woodworth's death was the result of persecution; that he was hounded to his grave by some of the same "sanitarians" who became the temporary beneficiaries of that cessation of opposition. His argument is chiefly directed to show that the laws creating State boards of health were founded in wise public policy. That is admitted, but there is an underlying difference between State and Federal boards, owing to the organic laws of the land and the constitutional limitations of Congress. A national board cannot be empowered by Congress to do the things properly and legitimately falling within the scope of duty of a State board. The English health board, of which Doctor Smith speaks, has no particular executive power. The duty of first reporting and ex- amining the ships during quarantine season is laid upon the officers of the customs. Argument directed against management of sanitary or quarantine matters by a "single head" certainly does not apply so far as the Marine-Hospital Service is concerned, for that officer acts only under the direction of the Secretary of the Treasury, who has also at his command the coast-guard of the United States; a most valuable adjunct to the quarantine service. Doctor Smith claims for the Board, as a result of its policy, (page 23)— "1. The method of securing a good sanitary condition of ships." This is certainly as old as sanitary science itself, and is not due to the Board, for the " method " is simply that of cleanliness. There is nothing new in it. "A clean ship sailing from a clean port" has been for years the theme of maritime sanitarians, as the volumes of the Naval and Marine-Hospital Service Eeports well attest. "2. The projected plan of international notification of the sanitary condition of for- eign ports.'' By reference to the law of April 29, 1878, it will be seen that it con- tains the plan of notification now claimed by the Board as its own. It is further seen that the American Public Association, at a meeting held before there was a National Board, adopted the following resolu- tion: '' That it is the duty of the General Government to invite foreign nations to co-operate with it in the establishment of uniform and effective international quarantine regula- tions.'' 12 Consuls made reports of the sanitary condition of foreign ports on blanks prepared by the Supervising Surgeon-General before there was any National Board to "project a plan." "3. The system of refuge stations for infected vessels bound to ports of ^the United States." Neither is this original with the Board, for they say, (Annual Report National Board of Health, 1882, pages 16 and 18)— "In this dilemma, the Board profited by the experience of other nations having a longer and larger experience in matters of quarantine. Thus, in France and Portugal, vessels subject to quarantine which arrive at ports where quarantine cannot be. under- gone must proceed immediately to quarantine stations ; as, for example, vessels liable to quarantine at Dieppe and other northern ports of France are sent to the quarantine station at Havre, and medical assistance is provided at the public cost. (Sir Sherston Baker ; Laws relating to quarantine, 1879.) '' But the English law was yet more suggestive and significant. By virtue of an act of Parliament, orders in council provide that all vessels not having infectious disease actually on board, but not furnished with clean bills of health, arriving in the United Kingdom, and coming from the Mediterranean or from West Barbary on the Atlantic Ocean, shall perform quarantine in Standgate Creek or Milford Haven, and nowhere else. Then, for actually infected vessels it is provided in the same orders in council as follows: " ' 28. And for the better guarding against the introduction of the plague into the United Kingdom, it is hereby ordered that, in the event of the plague actually appear- ing on board any vessel on her voyage to any port in the United Kingdom, she shall immediately, if to the south of Cape St. Vincent, repair to some lazaretto in the Mediter- ranean, there to perform quarantine, and if to the northward of Cape St. Vincent, she shall immediately repair to Milford Haven, there to perform quarantine.' (Ibid, p. 91.) '' Here, then, was pointed out a practicable method of executing the duties prescribed in the law of June 2, 1879, to the end of preventing the introduction of infectious dis- ease into the United States at a comparatively trifling expense.'' As to the fourth claim of the Board, in regard to steamboats, there has never been a time when they could not be inspected by officers of the Marine-Hospital Service, as the following circular of the board of of health of Louisiana shows: Sanitary and medical inspection in the Mississippi Valley by United States Marine-Hospital Service. Board op Health, State of Louisiana, New Orleans, July 24, 18*2. The following official correspondence and action relating to the inspection service of the Mississippi Valley is published for the information of all parties concerned, and more especially of merchants, steamboatmen, and travellers. JOSEPH JONES, M. D., President Board of Health, State of Louisiana. [Telegram.] Office Board of Health, State of Louisiana, New Orleans, July 19, 18*2. To Surgeon-General Hamilton, U. S. Marine-Hospital Service, Washington, D. C: The welfare of the country will be promoted if the inspection service in the Missis- sippi Valley and throughout the United States should be confided to your department which has facilities for the proper treatment and isolation of infectious and contagious •diseases. % 13 New Orleans is in good sanitary condition, and absolutely free from yellow fever. Annual death-rate per 1,000 white inhabitants, 20.3. * * * JOSEPH JONES. M. D., President Board of Health, State of Louisiana. Treasury Department, , Office of Supervising Surgeon-General, U. S. M.-H. S., Washington, July 20, 1882. Sir : I have the honor to acknowledge the receipt of the despatch of this date, and to enclose to you a copy of an order this day sent Doctor Godfrey, the medical officer in charge of this Service at the port of New Orleans. In this connection, you are informed that a copy of your despatch has been forwarded by the Secretary of the Treasury to the chairman of the Senate Committee on Appro- priations, with the information that the facilities,exist in the Marine-Hospital Service for the proper inspection of vessels proceeding up-river from New Orleans, without any additional appropriation from Congress. I have to further request that you will at any time suggest any method by which this Service may aid the State board of health of Louisiana, so far as the treatment of sailors and persons employed on steamboats is concerned. Very respectfully, JOHN B. HAMILTON, Surgeon-General, U. S. M.-H. S. To Joseph Jones, M. D., President State Board of Health of Louisiana, New Orleans. Treasury Department, Office Supervising Surgeon-General, U. S. M.-H. S., Washington, July 20, 1882. Sir : I enclose for your information a copy of a despatch this day received from Dr. Joseph Jones, president of the board of health of the State of Louisiana, and to inform you that the same has been laid before the Secretary of the Treasury, who directs that you inspect vessels leaving New Orleans for up-river on request of the masters, and furnish a certificate of the result of the same without charge. Doctor Jones has been informed of this action, and also that you will co-operate with him as far as is in your power. Yours, very respectfully, JOHN B. HAMILTON, Surgeon-General 31.-H. S. Passed Assistant Surgeon John Godfrey, U. S. Marine-Hospital Service, New Orleans, La. U. S. Marine-Hospital Service, District of the Gulf, Port of New Orleans, Surgeon's Office, July 24, 1882. To President Board of Health, State of Louisiana : I have the honor to say that hereafter such up-river vessels as desire health inspection can have it done without cost, and obtain certificates of sanitary status of passengers and crew, if the masters thereof will make application at my office, in the custom- house. Assistant Surgeon Armstrong will inspect in person. Very respectfully, JOHN GODFEEY, Passed Assistant Surgeon 31.-H. S. The fifth claim of Doctor Smith for the Board, in regard to the system of vaccination of immigrants, is said to be really due to the health officer of the port of New York, Dr. Win. M. Smith; and, so far as the sixth claim is concerned, namely, "the system of railroad inspections of immigrants," that is an infringement on the rights and duties of State or municipal boards of health, and cannot legitimately fall within the 14 province of agents of the National Board, unless they are at the time clothed with State authority. Far be it from me to detract from the general merit of Doctor Smith's opinion as a sanitarian, but it is somewhat difficult to find out exactly what that opinion is. I am somewhat surprised that Doctor Smith, with that high-toned character I have always thought him to possess, should openly say, when writing to me, as follows— '' Now, my dear doctor, the board has no interests in quarantine which it will not cheerfully resign to you, and, if need be, aid you to obtain. Woodworth and I long enter- tained the opinion that the Marine-Hospital Service should be the head of the quaran- tine system of the United States, and I believe every member of the Board would cheer- fully aid to secure it to your Service. If, in addition, you desire to build up a central health department around the Marine-Hospital Service, there will be no opposition by the board, and I should favor it. Finally, whatever may be your wishes, I wish to suggest that they can be better obtained by a free conference with the Board than by ' fighting.' I can assure you of the most cordial, freindly feeling on the part of the Board as a whole, and I do not believe that there would be any difference of opinion as to the policy which the two Services should jointly pursue. '' Very truly, yours, "STEPHEN SMITH." —that he simply did so as a compromise, as " an attempt at concilia- tion," for I then thought he meant what he said. Does Doctor Smith now mean what he says, or is he at this time trying to conciliate his brethren, now enraged on account of the publication of his letter? MR. WAKING'S CHARGES. Mr. Waring admits that he made his slanderous statements against my professional and private character in order to " lash" me into appear- ance before this committee. After such an unblushing confession, I do not fear that any particular weight will be attached to the charges thus made, but I shall reply to such of them as, if made in good faith by a more scrupulous man, would seem to require an answer. Mr. Waring (page 30) draws a comparison between the personnel of the National Board of Health and the Marine-Hospital Service, which is so unfair that I stop to consider it. He leaves entirely out of the account the fact that the medical officers of this Service are appointed only after a rigid examination into their professional qualifications, and that, as shown in the annual report for 1880. (page 24,) more than 80 per cent, of the whole number of graduates in medicine examined have been rejected or allowed to withdraw after having demonstrated their failure to come up to the standard. He furthermore failed to mention that under the regulations it was the express duty of the medical corps of this Service to inform themselves in all sanitary matters, as the fol- lowing paragraphs from the regulations show: "61. Medical officers and acting assistant surgeous 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.' 15 '' 62. Medical officers and acting assistant surgeons of the Marine-Hospital Service are, under the direction ol'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." He did not say that no officer employed by the National Board of Health has ever been required to pass a professional examination, but such is the fact, nevertheless. I have heretofore showed how these ap- pointments were made, that the whole system of the Board depended upon the cohesive power of public patronage. Mr. Waring says I undertook to "contract with the board of health of Pensacola," &c, (pages 30 and 31.) The facts in regard to that matter are simply these: I was ordered to proceed to Pensacola by the Sec- retary of the Treasury to ascertain the actual condition of the city of Pensacola, to report what sanitary measures should be adopted to pre- vent the recurrence of yellow fever at that place last summer. I made report according to the order, and when the report was submitted the Secretary (after consultation with the President, who under the law had a fund at his disposal, absolutely at his discretion, to use in aid of local boards, "or otherwise,11 as he saw fit) decided what portion of the necessary work would be assumed by the Government and what must be done by the State. That is all there is of it. The measures rec- ommended were carried out almost without exception, some by the Gov- ernment and some by the city of Pensacola and municipal board. They were successful, as the report of the grand jury shows: "In conclusion, the grand jury congratulates the people in those sections of the coun- try which was visited by the yellow fever last summer and fall that a concurrence of the board of health, Sanitary Association of Pensacola, its municipal government, and the United States Marine-Hospital Service gives token that all that human ingenuity and prudence can do will be done to prevent a visitation of that scourge to this country the coming season. " Furthermore, vouchers of the National Board on file at the Treasury Department, under date of September 30, 1879, show that "laborers, drivers, carts, and wagons," for cleaning up the fourth and fifth dis- tricts of New Orleans, were included therein and duly paid by that body, which now -takes exception to the mere statement that such work was necessary at Pensacola. Mr. Waring also points with pleasure to my alleged recommendation of the abandonment of Ship Island as a refuge station, as an instance of injudicious action on my part. I made no such recommendation. I simply predicated my remarks on the well-known proximity of Ship Island to the great watering-places on the Gulf coast and the repeated 16 statements of the Louisiana board of health in regard to the commer- cial disadvantages of that location. Before taking any action, I re. quested the Secretary of the Treasury to detail an officer to act in con- cert with Doctor Murray of this Service in an inspection of the other islands in the Gulf, and before their report was received I personally visited the quarantine at Ship Island. I satisfied myself that the disadvantages of the present quarantine were not overstated in the following reports: Office of Superintendent of Repairs, Custom-House, <&c, New Orleans, July 8, 1883. Sir : I have the honor to enclose a paper tracing of Ship Island, taken from the latest Coast-Survey chart, on which, ih red ink, I have noted the position of property lately transferred to the Marine-Hospital Service. The condition of the buildings at Nos. 1, 2, and 3 is fait, and will answer for this year's use. The plank walk from No. 1 to No. 2, through the sand, should be renewed at once. At No. 4 the wharf tracks and cars are in good condition. The warehouse and small side room (10r by 12/) are so open as to be unfit for disinfect- ing purposes. The boat-house is useless, as it is out of water. For all practical pur- poses of the Hospital Service, except for coal, the wharf and buildings in their cost are so much money uselessly expended. No. 5 is the anchorage of commerce, while No. 6 is the quarantine anchorage. By reference to the sketch, you will see that communication between the quarantine stations Nos. 1, 2, and 3, and quarantine anchorage No. 6, and the wharf and disinfect- ing warehouse, &c., at No. 4 is impossible without risk of communicating with the com- merce fleet, of which, as a rule, there are about six loading with lumber for foreign ports. This commerce need not" be interfered with if No. 4 is abandoned or moved up above No. 1. It is five miles from No. 1 to No. 4 in a direct line—too far for efficient service, even if it did not endanger the fleet of commerce. At Nos. 1, 2, and 3 there is no wharf or other means of getting ashore other than by small boats until they ground, and thence wade ashore. Under such circumstances, efficient service cannot be main- tained. Small boats cannot get into Lagoon at low tide. If the wind is strong from the north, northeast, or northwest to west, no landing can be effected at Nos. 1, 2, and 3, as then they are on the lee-shore, and communication between these places and No. 4, where the wharf is, by the island is impracticable on account of the sand. I respectfully submit, then, for your consideration and that of the Surgeon-General my recommendation that there be constructed at once a suitable landing-wharf for sick at No. 1, and as soon as convenient construct a suitable wharf at a point beyond No. 1, and move the warehouse, boat-house, and coal-bin from No. 4 to the new wharf. Both of these wharves should be built on creosoted piles, which can be procured near by, at Pascagoula. The piles can be planted by the pump of the "Day Dream" by the "water-jet" process, as they cannot be driven in that sand, and the timber for decking, &c, can be delivered at the place for about $10 per thousand. If authorized, I can send a foreman and gang of men down from here who would push the work, when through, go into isolation until released by the surgeon, and then return home. These views of mine meet with the approval of Dr. John Godfrey, passed assistant surgeon Marine-Hospital Service, in charge. I have the honor to remain your most obedient servant, JOHN V\\ GLENN, Superintendent. James G. Hill, Supervising Architect, Washington, D. C. Office of Superintendent of Repairs, Oustom-Housc. •>. Board snugly placed on the committee, I should like to see the man. He would certainly be worth looking at as a rara avis. That the attempt failed is a testimonial to the wisdom of the Speaker. The argument of Mr. Simons would doubtless be a gopd one if the premises were sound, but his premises being unsound, the deductions are illegitimate. Teeascky Department, Office Supi wising Surgeon-General, U. S. M.-H. S., Washington, 3Tarch 11, L*H4. Sib : Referring to the brief submitted by certain members of the National Board of Health, I desire to say that the statement made therein, that I was present at certain meetings of the committee and "approved" the bills referred to, is incorrect. No such action on my part appears upon the face of the evidence submitted. In several instances mentioned, I grant, my name appears in the minutes as present; but, as bills were passed on a majority vote, the record is incomplete as proving that I voted aye, or voted at all. The fact is, but few bills were brought before the committee for its consideration, as the certification of a member of the Board and the secretary's signature were all that the Board required. (See Circular No. 7, par. 7, Regulations of National Board.) Their own record (Appendix D, page 69) shows that I was not present when the $2,000 appropriated for Pensacola, in November, 1W2, was approved. Very respectfully, P. H. BAILHACHE, Surgeon U. S. 3Taiine-Hospital Service. Surgeon-General J. B. Hamilton, U. S. 3Farine-Hospital Service, Washington, D. C. CLOSING STATEMENT. I close my reply by a repetition of what I said orally concerning the facilities of the iSTavy Department for the proper conduct of such sanitary investigations as may be necessary, and of those of the Treasury Department for the management of quarantine, and now claim that the facts show that the National Board of Health is not only unnecessary,but is a mischievous excrescence that should be abol- ished: • Now in regard to the latter part of this letter, wherein I stated the reasons why the quarantine should be placed under the control of the Treasury Department, and further stated that there was abundance of work for the National Board of Health to do out- side of the quarantine proper, that there might be a large field in the nature of sanitary investigations—that there was such a field in which they could be profitably employed. I have now changed my opinion in regard to that matter, and to say that I do not now believe there exists such a field for their operations, for the reason that we now have a bureau, specially equipped by appropriation of Congress, for that very work—I mention the Museum of Hygiene, in the Navy Department. They have in that mu- seum appliances for sanitary investigations, for the investigation of everything affect- ing public health. They have specimens of the sanitary machinery that is in use for the protection and preservation of the public health. That bureau, as I am informed, is fully equipped and ready for work, without any additional expense on the part of the Government. They have the officers now for the accomplishment of that work with- out employing any additional force. '' The Ch a irm ax. Who has charge of that ? "Surgeon-General Hamilton. The Secretary of the Navy." .* * * * * "'.r -* j.-. "I have now to speak of the facilities for the management of quarantine by the Treasury Department. That has been done so well by Surgeon Wyman that I probably need do but little more than refer to it by heads of paragraphs, from 10 to 12. First he mentions collectors of customs. 23 " Mr. Petti iion i;. I would like to have a brief of all documents referred to. Who can think of them with the hurry and bustle that we have got to go through with two weeks from now? " Surgeon-General 1 TAMil/roN. Collectors of customs are first mentioned. The same facilities which the Government has provided to prevent the smuggling of goods are those facilities which are best adapted for the prevention of the introduction of infected goods. That much must be admitted by all. The prevention of the introduction of anything that conies from sea naturally falls under the Customs Service. In England last year, when they had the cholera scare, the first duty was laid on the officers of the customs of ascertaining the condition of goods that were to be imported. Then we have the Revenue-Cutter Service, which is the coast-guard of the United States, with a fleet of vessels which traverses the coast. " Mi-. Pettibone. About how many vessels are in the service? "Surgeon-General Hamilton. Thirty-seven, I think, besides harbor-tugs. They have regular stations, and make such complete patrol of the coast that smuggling is to-day an almost unknown thing, so far as any organized smuggling force is concerned. "In addition, we have the Marine- Hospital Service, with which the members of this committee are doubtless familiar. I have been informed, in relation to this Service and the hospitals, that it was said here that it would be 'atrocious' to put yellow-fever patients in the marine hospitals. I do not know anybody that proposes to put such patients in regular marine hospitals. We never have done so, except by accident—when it could not be helped. Three of our officers have died of yellow fever, for they are usually the first to see the yellow fever. Yellow fever may get into hospitals, but it is the intention, and it has been the practice, to furnish all the hospitals with tents, and the moment any contagious disease occurs in the hospital they are promptly removed to hospital tents, without the walls of the building. That is the best way to treat them. "In addition to the Marine-Hospital Service, we have, too, the Coast Survey, which is also under the direction of the Secretary of the Treasury; and all the commercial bureaus have heretofore been placed under the direction of the Secretary, because there has been no other Department of the Government to which the commercial services could be more properly assigned. "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 stationed, and to promptly report to the local authorities and to the Department at Washington any epidemic which may come to their knowledge. That is a part of their duties by regulation, and has been for years.'' As it may be of interest to the committee to examine the documents made use of in my oral argument, I attach hereto, as an appendix, that argument which, as will be seen, is a report to the Secretary of the Treasury, being Treasury Department Document No. ~>o0. I leave to my counsel, Mr. James Coleman, the task of replying orally to any statements that may be made orally before the committee by the legal member of the National Board. I have also to thank the committee for their patient hearing of the case, and to ask their favorable judgment. Respectfully submitted. JOHN B. HAMILTON, Supervising Surgeon-General U. S. Marine-Hospital Service of the Treasury Department. a*, ed forces Medical librae WASHINGTON, D j I ^ V. / <•■■ NLM001058072