Finding Aid to the Public Health Service Hospitals Historical Collection, 1895-1982

TABLE OF CONTENTS

Descriptive Summary

Historical Note

Collection Summary

Index Terms

Administrative Information

Restrictions

Series Descriptions

Hospital Division Circulars, Similar Letters, Handbooks, and Manuals, 1905-1962

Hospital and Clinic Files by City, (192?) - 1982

Carville Hansen's Disease Center, 1917-1982

Division of Hospitals' Administrative Documents, 1819; 1921-1982

Medical Care of Seamen, 1942-1982

Oversize Case, 192-; 1944

Historical Note

The origins of the Public Health Service hospital system date to the passage in 1798 of the law creating the Marine Hospital Fund to care for merchant seamen. Clerks in the Treasury Department initially ran the fund, but after 1870 responsibility for the hospitals passed to the Surgeon General of the Marine Hospital Service (later to become the Public Health Service) and its Commissioned Corps. Over the years the PHS's hospital responsibilities were gradually broadened to include groups other than seamen. Beneficiaries were examined and treated at a variety of institutions, ranging from large Marine Hospitals in the major port cities (Boston, Baltimore, and New Orleans, for example) to smaller river and Great Lakes port hospitals to tiny third and fourth class stations like those in Chincoteague, Virginia and La Crosse, Wisconsin. Responsibility for the examination and treatment of entering aliens kept stations both large and small on coasts and borders busy, especially at Ellis Island and San Francisco. After World War I, the Public Health Service hospitals and clinics were also briefly responsible for serving veterans eligible under the Bureau of War Risk Insurance from 1919 until the creation of the Veterans' Hospital system in 1922. Other special classes of beneficiaries included narcotics addicts, treated primarily at the Ft. Worth and Lexington hospitals, and Hansen's Disease (leprosy) sufferers, who came from around the world to the Carville, La. Hansen's Disease Center (formerly the National Leprosarium).

In 1939, the Public Health Service was transferred into the new Federal Security Agency (FSA), where its Hospital Division, still manned primarily by Commissioned Corps officers in its facilities and organizational hierarchy, continued the business of administering the hospital system's work. In 1944 administrators attempted to rationalize the confused and scattered variety of PHS functions and responsibilities through a reorganization. The new organizational plan divided the PHS into four bureaus: the Bureau of State Services, the National Institute of Health (NIH), the Office of Surgeon General, and the Bureau of Medical Services (BMS). The BMS held jurisdiction over the Hospital Division, whose name was changed in 1948 to the Division of Hospitals (DOH).

With the end of the war, the newly-streamlined PHS soon found itself engaged in a long-running, and ultimately losing, battle with budget authorities. The Hoover Commission's reports in 1949 and 1955 evaluated the Public Health Service hospitals and decided that beneficiaries' care could more efficiently and economically be provided elsewhere. These reports and the Bureau of the Budget attack on PHS funding and authority began a thirty-year succession of reports, evaluations, reorganizations, and service changes, sometimes instigated and directed by the PHS, and sometimes from elsewhere in the Executive Branch. Hospital administrators and personnel, local, state, and federal legislators, and interest groups representing beneficiaries and communities would be drawn into the arguments over a declining beneficiary population, the benefits of contract or community-sponsored care, and the appropriate course for the Public Health Service and its hospitals in the twentieth-century American health care system.

The series of PHS reorganizations and hospital expansions, conversions, and closures make the DOH's history an occasionally confusing tale. After a small boom of expansion in the 1930s, some of the PHS hospitals were given more funding to expand and improve in the 1950s; other hospitals were closed or converted into outpatient clinics, which consolidated the work of the now-closed relief stations.

In 1966, the Department of Health, Education, and Welfare (DHEW) (formed from the FSA in 1953) reorganized the PHS. One of the newly created bureaus within the PHS was the Bureau of Health Services; included within the Bureau of Health Services was the Division of Direct Health Services which assumed responsibility for the hospitals and clinics. This new division (not to be confused with the Division of Hospitals and Medical Facilities, which administered Hill-Burton construction rather than hospitals themselves) came into existence in January of 1967. At the same time administration of the narcotics addiction hospitals in Ft. Worth, Texas and Lexington, Kentucky was transferred to the National Institute of Mental Health (NIMH).

The Division of Direct Health Services was short-lived. In the spring of 1968 DHEW Acting Secretary Wilbur Cohen announced another reorganization of DHEW and with it the Public Health Service. The Assistant Secretary for Health and Scientific Affairs was given direct authority over the PHS and the Food and Drug Administration (FDA), and the Surgeon General was made his chief deputy. The PHS structure was then realigned, with some functions transferred to the NIH and all others centralized under the new, massive Health Services and Mental Health Administration (HSMHA). Under HSMHA, responsibility for the eight remaining general hospitals (Baltimore, Boston, Galveston, New Orleans, Norfolk, San Francisco, Seattle, and Staten Island), the Carville National Leprosarium, and several outpatient clinics fell to the new Federal Health Programs Service (FHPS).

HSMHA too was short-lived, abolished in 1973 by DHEW Secretary Caspar Weinberger. Responsibility for the hospitals and clinics was shifted to the new Health Services Administration (HSA). Within the HSA, the Bureau of Medical Services, one of four bureaus involved in the delivery of health services, replaced the FHPS. As a division of the BMS, the Division of Hospitals and Clinics administered Public Health Service hospitals and clinics for the remainder of their lifetimes. In 1981, as part of the Reagan Administration's budget cuts for the Department of Health and Human Services (renamed in 1980), the last of the Public Health Service hospitals and clinics were closed as PHS operations. Of the eight hospitals, five were transferred to community corporations, two to the Department of Defense, and one to the State of Louisiana.

Three histories of the Public Health Service provide useful information about the organizational history and structure of the PHS, DHEW, and the PHS hospitals. Fitzhugh Mullan's Plagues and Politics (New York: Basic Books, 1989), the most recent of the three, gives a good overview of the Service's history and goals up to the present. Bess Furman's A Profile of the United States Public Health Service, 1798-1948 (Washington, D.C.: Government Printing Office, [1960]) and Ralph C. Williams' The United States Public Health Service, 1798-1950 (Washington, D.C.: Commissioned Officers Assoc. of the PHS, 1951) supply background and an introduction to the period documented by this collection. Finally, a number of DHEW publications offer useful information about the organization of the DHEW and the PHS; see especially History, Mission, and Organization of the Public Health Service (July, 1976) and A Common Thread of Service, An Historical Guide to HEW (DHEW Publication No. (OS) 73-45).

Chronology of PHS Hospitals

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Collection Summary

Public Health Service (PHS) hospitals have treated merchant seamen and other PHS beneficiaries since 1798. As part of an evolving network of hospital and clinic care, the hospitals experienced in the twentieth century their greatest expansion and also their demise. The papers in the PHS Hospitals Historical Collection, accumulated over the course of many years, chronicle the activities, administration, and closure of the hospitals, especially since 1950.

Found first in this collection are circulars, similar letters, handbooks, and manuals describing clinic, hospital, and division procedure commencing with the early part of the century. These materials were distributed to individual administrators and facilities by the Division of Hospitals, the organizational unit of the PHS which, through several reorganizations and name changes, oversaw PHS hospital activities.

The majority of documents included in this collection originated in the Division of Hospital's Information Office, which collected historical and current information about the Division's activities, and particularly those of individual facilities. Prominent among these facilities and the subject of a separate series within this collection is the National Hansen's Disease Center in Carville, Louisiana (formerly the National Leprosarium). The Carville facility existed as a leper hospital for over two decades before its administration was assumed by the Public Health Service in 1921. The materials found here were collected by the Division of Hospitals' Information Office and stress Carville's unique legacy and service.

Also prominent in this collection are the many histories, program files, reports, and planning documents compiled by the Division of Hospitals. These materials, detailed in the attached series listing, discuss the history, current status, and future of the Public Health Service hospital system. Similarly, both the history and future of medical care for the largest group of PHS beneficiaries, American seamen, is chronicled by materials in the collection's final series. Together, the documents in these two series show how PHS hospital officials and administrators perceived their mission, facilities, and future, and how the hospital system was presented to its critics and supporters.

Researchers interested in the history of hospitals, health policy, and the Public Health Service should also consult the Library's other Public Health Service collections, to which some materials (general bureau circular series, some general histories of the PHS) not specifically related to the Service's hospitals and clinics have been transferred. Also separated, and individually catalogued, are logbooks from the New Orleans Marine Hospital (1870-1887), the San Francisco Marine Hospital (1916-1936), and the Mobile Marine Hospital (1913-1936).

Individual descriptions of this collection's five series follow, as does a detailed box and folder listing. Folders containing significant numbers of photographs have been noted.

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Restrictions

Restrictions

Collection is not restricted. Contact the Reference Staff for information regarding access. For online customer service, please visit custserv@nlm.nih.gov.

Copyright

Copyright was transferred to the public domain. Contact the Reference Staff for details regarding rights. For online customer service, please visit custserv@nlm.nih.gov.

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Administrative Information

Preferred Citation

United States. Public Health Service. Public Health Service Hospitals Historical Collection. 1895-1982. Located in: Modern Manuscripts Collection, History of Medicine Division, National Library of Medicine, Bethesda, MD; MS C 471.

Provenance

The Collection was transferred from the National Hansen's Disease Center in Carville, Louisiana in 1989 by Lila Davis (through Fitzhugh Mullan).

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Series Descriptions

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