Surgeon General, U.S.

The U.S. Surgeon General serves as “the nation's doctor,” the chief—and most visible—spokesperson and public advocate on issues of public health and preventive health in the country, appearing regularly in news reports on controversial public health topics. This person is appointed by the U.S. president to a four-year term and confirmed by the U.S. Senate.

The post of U.S. Surgeon General may be well-known to many Americans today—thanks in part to the 1964 surgeon general's report on smoking and health—but the history and role of the surgeon general can be traced back to 1798 when Congress, believing the nation's economic interests were tied to the health and medical conditions of seamen working on commercial ships, established what would become known as the U.S. Marine Hospital Service.

An 1870 reorganization of the loosely knit Marine Hospital Service into a national hospital system resulted in the creation of a Supervising Surgeon—later known as the surgeon general—to administer it. The Marine Hospital Service later became the U.S. Public Health Service.

The role of the U.S. Surgeon General has greatly evolved since John Maynard Woodward was named the first Supervising Surgeon in 1871. Early surgeons general expanded the scope of public health services well beyond the care of the merchant marine, dealing also with broad public health issues, such as infectious diseases and rural sanitation. For example, the term of the second Supervising Surgeon General, John B. Hamilton, was largely framed by the yellow fever and cholera epidemics of 1878 and 1892, respectively, and much of Hamilton's efforts dealt with issues surrounding quarantine, a practice that met with some resistance at least partly because it involved intervention by the federal government. The surgeon general's office has also been actively concerned with media effects issues, such as the influence of exposure to television violence on children.

Because of their visibility and commitment to preventive practices and public health, controversy would not be unknown to the surgeons general, who often found themselves confronting political opposition and public opinion. As early as 1929, [Page 852]Hugh S. Cumming, only the fifth surgeon general, asserted that cigarette smoking caused nervousness and insomnia, followed on June 12, 1957, by Surgeon General Leroy E. Burney, who emphasized his role as an advocate for public health and became the first federal official to declare that smoking causes lung cancer. On January 11, 1964, Burney's successor, Luther L. Terry, issued the first report to receive widespread public and media attention, Smoking and Health: Report of the Advisory Committee to the Surgeon General, a report produced by an alliance of private and public health practitioners and advocates that ultimately led to congressional legislation requiring health warnings on cigarette packs. Surgeon general reports in the decades that followed contributed to the office's anti-tobacco focus, and these efforts continue today.

Cigarette smoking was but one controversial issue undertaken by the surgeons general. For example, Thomas Parran Jr., who served from 1936 to 1948, ignored social taboos and began a campaign against venereal diseases. Parran also was a committed advocate of national health insurance, an issue that has remained controversial for decades. As another example, Leonard A. Scheele, who served from 1948 to 1956, issued a recommendation in 1951—calling on decades of research—that public drinking supplies be fluoridated. The move enhanced the role of the surgeon general as an advocate for public health, but the fluoridation issue nevertheless remained controversial.

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