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«U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Program Support Center Human Resources Service Division of Commissioned Personnel 5600 Fishers Lane, ...»

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The PHS Commissioned Corps is composed of more than 6,000 commissioned corps officers. The mission of the Corps is to provide highly-trained and mobile health professionals who carry out programs to promote the health of the Nation, understand and prevent disease and injury, assure safe and effective drugs and medical devices, deliver health service to Federal beneficiaries, and furnish health expertise in time of war or other National or international emergencies. As one of the seven Uniformed Services of the U.S., the commissioned corps is a specialized career system designed to attract, retain, and develop health professionals who may be assigned to Federal, State, or local agencies or international organizations to accomplish its mission.

–  –  –

B. THE DEVELOPING NATION

Since its origin in l798, the Corps has been making important contributions to the health of the Nation.

During its early years, our Nation was just a little strip of settlements along the Atlantic Coast, and had not yet grouped any forces to fight against disease or to protect itself against this invisible killer. But it was to learn.

The young Nation depended, to a large degree, upon the sea for both trade and protection. To encourage expansion of the existing, small merchant marine and to protect ill and injured seamen, the 5th Congress enacted legislation to establish a Marine Hospital Service under the Treasury Department.

For health care, the seamen were to contribute 20 cents a month to finance the hospitals. The first temporary hospital was started in rehabilitated barracks on Castle Island in Boston Harbor in 1799.

In 1801, the Service bought a hospital at Ferry Point (Norfolk), Virginia, and in 1804 completed construction of its first permanent hospital at Charlestown, Boston Harbor.

In 1807, Dr. Benjamin Waterhouse, "Professor of the Theory and Practice of Physics at Harvard," was appointed physician-in-charge of the Charlestown Hospital. He proposed to make it "answer the purpose of medical instruction" as well as "healing and comforting the sick and wounded." During his tenure the Charlestown hospital was used to introduce the active practice of medicine to the medical students at Harvard and so became one of the first teaching hospitals in the United States.

C. WESTWARD HO

During this pioneering era, the frontier pushed westward, across the mountains, over the plains, and up and down rivers. The young Nation faced new and difficult problems on the health front. The westward migration, as well as expanding immigration from foreign countries, brought yellow fever, smallpox, and cholera. These epidemics spread suffering, panic, and death.

Typical of the people's helplessness and terror is the story of the towboat, "John D. Porter." While the yellow fever epidemic was gathering force in New Orleans, the John D. Porter pulled out from that port with a string of barges bound for Pittsburgh. She had passed Vicksburg when she pulled back to bury her engineer and fireman and took on a substitute engineer. He lasted until the boat neared Cairo, Illinois, when he left and made his way home to die. By Cincinnati, there had been four more deaths and the boat was boarded by two physicians of the Marine Hospital Service, who stayed on to care for the sick. The John D. Porter moved on up the river, but near Gallipolis, Ohio, members of the terrified and ailing crew refused to go any further. Meanwhile, on shore, the villagers had lined up to guard their town from the pest ship, but crew members forced their way past them and into the village.

Thirty-one local citizens caught the fever and died. When the John D. Porter finally reached her destination, 23 men had died on board and she had carried death l,000 miles up the river.

Nearly 100 cities and villages suffered during the epidemic, and refugees crowded the trains to the North. Shades were drawn as trains rushed through towns without being allowed to stop, and local citizens stood by with shotguns to enforce their private quarantine. States and localities soon learned to call on the Marine Hospital Service for help in the emergency. The Service responded by setting up yellow fever detention camps and operating disinfecting stations to fumigate postal cars, boxes of mail, and passengers. A half-dozen Service officers died of the fever.

–  –  –

In the face of such recurring health crises, the Nation began to take steps to cope with these problems.

The task was not easy. Often gains were made in spite of minimal support, skeptical public opinion, and other sometimes seemingly insurmountable obstacles.

Following the establishment of the hospitals on the East Coast, a chain of new hospitals began to follow the route of shipping and commerce - down to the mouth of the Mississippi and up inland waterways to St. Louis, Missouri, and Paducah, Kentucky. As seamen and pioneers reached the Pacific Ocean, a hospital was built at San Francisco.

In the War of 1812, the Marine Hospitals cared for wounded American seamen, as well as British prisoners. During the Civil War, the hospitals provided medical care for both North and South.

–  –  –

During these decades, the Service began to develop as a National health force. Outbreaks of smallpox in the North and yellow fever in the South, and an investigation of the Marine Hospital Service, lead to a reorganization of the Service in 1870. A central administration was established, headed by the first Surgeon General, Dr. John N. Woodworth. He reorganized the Service along military lines, provided for uniforms, established entrance examinations, and put tenure and promotion on a merit basis free from politics. Gradually, he abandoned the employment of local physicians, replacing them with medical officers who were admitted only after examination and were subject to assignment wherever required.





By 1878, the Marine Hospital Service had begun to lose its identity as a relief organization only. Public health work was undertaken because of the prevalence of major diseases such as smallpox, yellow fever, cholera, typhus fever, and bubonic plague. To provide further protection, Congress, in 1878, enacted a National law to prevent the introduction of contagious and infectious diseases into the United States, later extending it to prevent spread of disease among the States. In this law were the seeds of the modern health program -- preventive medicine.

In 1889, Congress officially established the commissioned corps along military lines, with titles and pay corresponding to Army and Navy grades.

In attempting to treat contagious disease, it was natural that research should become a significant part of the work of the Service. As a result, a bacteriological laboratory was established in the Staten Island Marine Hospital in 1887 and moved to Washington in 1891 to form the Hygienic Laboratory -forerunner of the National Institutes of Health. A biologics control act, passed in 1902, authorized regulation of the sale of vaccines, serums, and similar biologic products in interstate commerce. At the turn of the century there were other developments that included a tuberculosis sanatorium at Ft.

Stanton, New Mexico. Hansen's Disease in Hawaii led to the establishment of a hospital and laboratory there in 1909, and later the National home for individuals with Hansen's Disease, at the National Hansen's Disease Center in Carville, Louisiana.

The face of the land and the nature of its society were changing, and the concept of public health was changing with them. Within a few years, after the turn of the century, the Nation began its rapid evolution from a rural to an urban civilization. Questions of water supply and pollution, sanitation, and hygiene grew more important as people crowded together in the cities.

-6Commissioned Corps Officer’ Handbook, 1998 s The Service began to see public health as the study of people in their relationship to each other and their environment; the place they lived -- the home, the neighborhood, the city; the place they worked; their water; their food; their air; their sanitary facilities; in short, their total environment.

In 1912, Congress enacted legislation to reorganize the Service and enlarge its powers. It was renamed the Public Health Service. The Act also granted the Service authority for pursuing studies of the "diseases of man and conditions affecting the propagation and spread thereof, including (for the first time) sanitation and sewage and the pollution either directly or indirectly of... navigable streams and lakes." In 1916, Congress appropriated funds for studies in rural sanitation, formally establishing cooperation between the States and Public Health Service.

E. 1917 - 1944

The outbreak of World War I imposed new demands upon the Service. The responsibilities involved medical and surgical aid to sick, wounded, or disabled soldiers or sailors; supervising health conditions around military camps and war plants; draining malarial swamps; disseminating health information;

laboratory operations including research and manufacture of serums and vaccines; controlling venereal disease; and care of veterans.

By Executive Order, President Woodrow Wilson ordered that...

"the Public Health Service shall constitute a part of the military forces of the United States... the Secretary of the Treasury may upon request of the Secretary of War or the Secretary of the Navy detail officers or employees of said Service for duty with the Army or the Navy. All the stations of the Public Health Service are hereby made available for the reception of sick and wounded officers and men or for such other purpose as shall promote the public interest in connection with military operations."

The epidemic of influenza in 1918, which affected more than four million and killed more than l/2 million Americans, further alerted the Nation to the need for a more effective National health force.

Meanwhile, emergency war conditions had convinced Congress that the regular Commissioned Corps of the PHS should be strengthened with a reserve corps. A law authorizing such an auxiliary was passed in 1918.

In the early 1920's approximately 50 hospitals were transferred from the PHS to the newly created Veterans Administration, concentrating all health care and services for veterans in a single agency.

Between the wars, narcotics hospitals were authorized and later established at Lexington, Kentucky, and Fort Worth, Texas. The Service assumed responsibility for medical services in Federal penal institutions. In 1930, the Hygienic Laboratory was renamed the National Institutes of Health.

For expanding responsibilities, the Service found that it needed men and women of other professions to serve with its commissioned medical officers. For this reason, Congress opened officer ranks to sanitary engineers, dentists, pharmacists, and later added scientists, nurses, dietitians, physical therapists, veterinarians, sanitarians, and health services officers.

As advances in public health increased life expectancy, the degenerative diseases of the aged such as arthritis, cancer, and heart disease came to the foreground. In 1937, Congress authorized a National Cancer Institute as part of the National Institutes of Health.

–  –  –

After 14l years in the Treasury Department, the Service, in 1939, became a part of the newly created Federal Security Agency, later to become the Department of Health, Education, and Welfare, and subsequently in 1980, the Department of Health and Human Services.

The United States' entrance into World War II again brought a multitude of new responsibilities to the Service. These entailed detailing physicians, engineers, and nurses to emergency areas, to other Federal agencies, and later to the United Nations Relief and Rehabilitation Administration; improving sanitation facilities in emergency areas; cooperating with States in controlling venereal disease;

cooperating with the Army and Navy concerning inspection ordinance plants and other military industries; and developing methods which reduced poisoning from chemical processes.



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