United States. Public Health Service. Division of Hospitals

The United States Public Health Service, successor to the U.S. Marine Hospital Service (1798-1902) and the U.S. Public Health and Marine Hospital Service (1902-1912) administered the former marine hospitals in addition to many other hospitals and clinics, the last of which were closed in 1981. USPHS Division of Nursing originated in the PHS Office of the Surgeon General from the combination of the Division of Nurse Education and Office of Nursing in the Bureau of Medical Services, in 1946; in 1949 this division was abolished and divided into the Division of Nursing Resources in the Bureau of Medical Services and the Division of Public Health Nursing in the Bureau of State Services. In 1960 these two divisions were consolidated into the Division of Nursing in the Bureau of State Services.

From the description of U.S. Public Health Service Historic Hospitals and Division of Nursing Public Affairs Collection, 1892-1984. (National Library of Medicine). WorldCat record id: 421348622

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).

From the guide to the Public Health Service Hospitals Historical Collection, 1895-1982, (History of Medicine Division. National Library of Medicine)