The Public Health Service
Founded in 1798, the Marine Hospital Service originally provided health care for sick and disabled seaman. By the late nineteenth century, the growth of trade, travel and immigration networks had led the Service to expand its mission to include protecting the health of all Americans. To reflect this change, the Marine Hospital Service was renamed the Public Health and Marine Hospital Service in 1902. Ten years later, in 1912, the name was shortened to the Public Health Service (PHS).
Under this new name, the Public Health Service was given clear legislative authority “to investigate the diseases of man and [the] conditions influencing the propagation and spread” of these diseases. All types of illness, regardless of their cause, now fell under the control of the PHS.
Structure of the Public Health Service:
In 1918, the Public Health Service was dominated by the Commissioned Corps, a mobile cadre of uniformed and ranked medical professionals.
To ensure that the PHS attracted the nation’s best physicians, entry requirements were highly competitive. In the late nineteenth century, physicians flocked to join the PHS because it offered job stability and a regular paycheck.
Although commissions in the PHS were originally limited to physicians, the early twentieth century witnessed a gradual expansion of the Commissioned Corps.
In 1918, all commissioned officers were white males. Women and minorities could, however, work in the PHS as civil servants and many did so—as physicians, nurses, biologists, pharmacists and sanitary engineers.
Duties of PHS Officers:
In 1918, there were fewer than 700 commissioned officers in the PHS. Charged with the daunting task of protecting the health of some 106 million Americans, PHS officers were stationed in not only the United States but also abroad.
Because few diseases could be cured, the prevention of disease was central to the PHS mission. Under the leadership of Surgeon General Rupert Blue, the PHS advocated the use of scientific research, domestic and foreign quarantine, marine hospitals and statistics to accomplish this mission.
The spread of disease within the US was a serious concern. However, PHS officers were most concerned about the importation of disease into the United States. To prevent this, ships could be, and often were, quarantined by the PHS. Travelers and immigrants to the United States were also required to undergo a medical exam when entering the country. In 1918 alone, 700,000 immigrants underwent a medical exam at the hands of PHS officers.
Within the United States, PHS officers worked directly with state and local departments of health to track, prevent and arrest epidemics as they emerged. During 1918, PHS officers found themselves battling not only influenza but also polio, typhus, typhoid, smallpox and a range of other diseases.
In 1918, the PHS operated research laboratories stretching from Hamilton, Montana to Washington DC. Scientific researchers at these laboratories ultimately discovered both the causes and cures of diseases ranging from Rocky Mountain Spotted Fever to pellagra.
In accordance with the Service’s original mission, PHS officers also cared for seamen in hospitals from Baltimore, Maryland to Seattle, Washington.
The Public Health Service’s Tools for Fighting Diseases:
By 1918, most PHS officers understood how diseases spread. But without antibiotics, PHS officers were limited in their ability to fight disease.
Quarantine was still the most effective tool for controlling epidemics. But quarantines were difficult to enforce. Additionally, quarantines were often imposed only after an epidemic had emerged.
To assist in this process, the PHS began publishing weekly assessment of the nation’s health in 1878. By 1918, state and local authorities routinely provided Public Health Reports with reports on outbreaks of several different diseases allowing the PHS to track epidemics as they developed. Influenza, however, was not a “reportable” disease at this time.
Along with tracking epidemics, the PHS also actively researched diseases and their causes at the Hygienic Laboratory, the precursor to the National Institutes of Health. Having found vaccines for typhus, typhoid and a range of other diseases, scientists in and outside of the PHS were optimistic about their abilities to control and cure diseases in the future.
The PHS in 1918:
In a nation where federal and state authorities had consistently battled for supremacy, the powers of the Public Health Service were limited. Viewed with suspicion by many state and local authorities, PHS officers often found themselves fighting state and local authorities as well as epidemics—even when they had been called in by these authorities.
Widespread disparities in state law further complicated matters.
Despite these problems, the Public Health Service was widely recognized as providing the nation’s best line of defense against infectious disease. But as influenza spread across the nation in the fall of that year, the limitations of modern medicine became evident.