The Past and Future Office of the Surgeon General

The present-day position of U.S. Surgeon General has its roots in President John Adams' 1798 establishment of the Marine Hospital Fund in response to the 1793 yellow fever outbreak in Philadelphia (1). The Marine Hospital Fund later became the Marine Hospital Service, and its first Supervising Surgeon was appointed in 1871. This position was renamed “Surgeon General” in 1873 when the Office of the Surgeon General was established, and the Marine Hospital Service became the U.S. Public Health Service (PHS) in 1912 (1).

For many years, the Surgeon General headed the PHS and focused on controlling infectious diseases, such as yellow fever, tuberculosis, malaria, and cholera, which was crucial to protect U.S. soldiers who were stationed in places where these infections were endemic and to protect the American public when infected soldiers returned home. However, this focus began to change in 1954 when the U.S. Department of Health, Education, and Welfare (later the U.S. Department of Health and Human Services) was established and given authority over the PHS and, consequently, the Surgeon General, who now reported to the Secretary of the U.S. Department of Health, Education, and Welfare and later to the Assistant Secretary of Health (1). The responsibility for the PHS was eventually returned to the Surgeon General in 1977 when the positions of Assistant Secretary of Health and Surgeon General were combined, with Dr. Julius Richmond serving in both roles (2). Dr. Richmond and I are the only persons who have, to date, served simultaneously as Assistant Secretary of Health and Surgeon General. Although one could argue that these changes have diminished the power of the Surgeon General, I contend that the Office of the Surgeon General has gained credibility and influence with the American people as the reporting structure has evolved.