Anchor & Caduceus: Commissioned Corps of the U.S. Public Health Service

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ANCHOR& CADUCEUS Commissioned Corps of the U.S. Public Health Service

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Pfizer’s US Public Health Group T

hrough collaborations with public health thought leaders in academia, government, business and the nonprofit sector, we are helping to meet the health needs of our nation’s communities by building and stewarding comprehensive solutions to complex public health problems. To assure that medical innovations ultimately improve healthcare for all, our Public Health Group creates and manages pioneering public-private partnership programs and advances cutting-edge public health research.

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ANCHOR& CADUCEUS Commissioned Corps of the U.S. Public Health Service

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ANCHOR& CADUCEUS Commissioned Corps of the U.S. Public Health Service A FAIRCOUNT PUBLICATION European Headquarters 5 Ella Mews, Hampstead London NW3 2NH UK Tel. 44 (0) 20-7428-7000 Fax 44 (0) 20-7284-2118

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Writers John Parascandola, Ph.D., Michael A. Robinson ŠCopyright 2005 Faircount LLC. All rights reserved. Reproduction of editorial content in whole or in part without written permission is prohibited. Faircount LLC. does not assume responsibility for the advertisements, nor any representation made therein, nor the quality or deliverability of the products themselves. Reproduction of articles and photographs, in whole or in part, contained herein is prohibited without expressed written consent of the publisher, with the exception of reprinting for news media use. Printed in the United States of America. Various images and text in this publication in no way are used to imply an endorsement by the Department of Health and Human Services, the U.S. Public Health Service, or the U.S. Government for any claims or representations therein. None of the advertising contained herein implies endorsement by the Department of Health and Human Services, the U.S. Public Health Service, or the U.S. Government of any private entity or enterprise.

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Contents | U.S. Public Health Service

CONTENTS

4 16 20

A Brief History of the U.S. Public Health Service

by John Parascandola, Ph.D.

Selected Public Health Service Highlights & Accomplishments

Medical Forces Ready for Rapid Deployment Officers in the U.S. Public Health Service Commissioned Corps See Frequent Duty

by Michael A. Robinson

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U.S. Public Health Service | History

A Brief History of the

U.S. PUBLIC HEALTH SERVICE

By John Parascandola, Ph.D., Former Public Health Service Historian

The

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The U.S. Public Health Service building in Washington, D.C., completed in 1933.

Island. Marine hospitals were eventually opened in other cities along the East Coast, inland waterways, the Great Lakes, and the Gulf and Pacific Coasts.

In the period before the Civil War, the marine hospitals hardly constituted an organized system. They were inadequately funded, and the choice of sites for hospitals and the appointment of physicians were influenced by political as well as medical considerations. During the Civil War, the

NATIONAL LIBRARY OF MEDICINE PHOTO

United States Public Health Service traces its origins back to a 1798 “act for the relief of sick and disabled seamen.” The young American republic was dependent upon the sea for both defense and commercial purposes. When American merchant ships docked in the country’s ports, questions arose as to how to provide health care for sick or injured seamen and who would pay for this care. Utilizing a model developed by its former mother country, Great Britain, the new nation created a system to provide care to merchant seamen. John Adams signed an act of Congress on July 16, 1798, that established a Marine Hospital Fund to be administered by the Treasury Department. Twenty cents a month was deducted from the pay of each seaman to fund a system of hospitals in major port cities to treat sick and injured seamen. One can think of this arrangement as the first health insurance scheme and the first health maintenance organization (HMO) in America.

In 1799, seamen of the Treasury Department’s Revenue Marine Division (forerunner of the Coast Guard) were also included in this program. Officers and men of the Navy were also eligible for care in the marine hospitals from 1799 until 1817, when the Navy began construction of its own hospitals.

The first of the federal marine hospitals opened in 1799 in a converted former Army barracks on Castle Island in Boston Harbor. The first hospital to be built using funds authorized under the 1798 act was opened in the Charlestown section of Boston in 1804, replacing the temporary facility on Castle

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LIBRARY OF CONGRESS

PHOTOS

History | U.S. Public Health Service

hospitals were taken over by troops on both sides for their own use, and by 1864 only eight of the 27 hospitals listed before the advent of the war were operational. Concerned about the situation, the Secretary of the Treasury commissioned a study of the marine hospitals in 1869. The critical report issued as a result of the study led to the passage of reform legislation in the following year.

The reorganization of 1870 transformed the loose network of locally controlled hospitals into a centrally controlled Marine Hospital Service, with its headquarters in Washington, D.C. In 1871, John Maynard Woodworth was appointed to be the first Supervising Surgeon (a title later changed to Surgeon General) of the Service. Woodworth had served as a surgeon in the Union Army during the Civil War, and he quickly moved to adopt a military model for his medical staff. He instituted examinations for applicants and put his physicians in uniform. Physicians were not appointed to a given hospital, but to the Service as a whole.

Woodworth thus created a cadre of mobile, career service physicians who could be assigned and moved as needed to the various marine hospitals. In 1889, this uniformed services component of the Service was formalized by legislation as the Commissioned Corps. At first open only to physicians, over the course of the 20th century the Corps expanded to include dentists,

Top: A PHS doctor checks on a patient in quarantine. The service was assigned to administer federal quarantines after passage of the National Quarantine Act of 1878. Above: John Maynard Woodworth, first Supervising Surgeon (later Surgeon General) of the Service.

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drexel n univ mass

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We l c o m e t o P h i l a d e l p h i a !

The Drexel University School of Public Health salutes the Public Health Service Commissioned Corps and joins the Corps in the quest to make the world healthier and safer.

For those who want to make a difference in the health of communities and populations, the Drexel University School of Public Health offers exciting learning and research opportunities.

By working collaboratively with community groups, agencies, and populations, we prepare professionals who can effectively address today’s most pressing public health problems.

Marla Gold, M.D. Dean, Drexel University School of Public Health 215.762.4110 • marla.j.gold32@drexel.edu • www.drexel.edu/pubhealth

UMassAmherst online www.umass.edu/nursing www.umass.edu/sphhs

School of NURSING School of PUBLIC HEALTH and HEALTH SCIENCES

Transform Your Life Lauri Kalanges, M.D. was a plastic surgeon in Reno, Nevada, who enrolled in the University’s online Public Health Practice program. “I

liked the fact that the program is part of a leading school of public health at a major university, and that the courses are taught by regular faculty members with doctorates.” After earning her masters in Public Health, Kalanges became director of the Center for Active Aging and Healthy Living. “Being able to take the

The Online MS (in Nursing)/ MPH program

Jennifer Morton, R.N., a nurse with 20 years experience in Eliot, Maine, combined her passion for nursing and interest in public health in the online dual degree program (MS/MPH). “The program is world

renowned for its outstanding quality.

And this dual degree program is one of only a few of its kind in the country.”

The stimulation has been amazing. I’m surrounded by professional people with careers and goals.”

knowledge and skills I gained and apply them to a meaningful program for my community speaks volumes about the program’s quality.”

Online public health program ranked in top three by U.S. News & World Report

Troy Ritter was earning a masters degree in the online Public Health Program while working for the U.S. Public Health Service Commission Corps in Alaska. “Thanks to the

program staff, who called me every few weeks to touch base, I feel like I’m part of the university, even though I’m thousands of miles away.” One of his course projects led to a NEHA Sabbatical Exchange Award that supported a month-long study of sanitation services in remote Arctic villages.

• No residency requirement • Full-time or Part-time

Inspiration UMASSAMHERST

enables students to earn two advanced degrees at once, at considerable savings. The program emphasizes public health leadership by enlisting national public health nurse leaders to provide career coaching, practical applications and leadership mentoring.

Contact Scott Campbell at 413.545.0484 or msmph@nursing.umass.edu

The Online MPH in Public Health Practice program is open to the wide range of professionals working in public health and attracts those seeking to advance a career in public health and health practice.

Contact MaryBeth Lizek at 413.545.4530 or phonline@schoolph.umass.edu

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History | U.S. Public Health Service sanitary engineers, pharmacists, nurses, and other health professionals.

In the closing decades of the 19th century, the scope of activities of the Marine Hospital Service also expanded well beyond the care of merchant seamen.

Responsibility for quarantine for certain infectious diseases originally rested with the states, but an 1877 yellow fever epidemic that spread from New Orleans up the Mississippi River served as a reminder that diseases do not respect state borders. The epidemic resulted in the passage of the National Quarantine Act of 1878, which began a process of transferring responsibility for quarantine from the states to the federal government. Since the Marine Hospital Service already had hospitals and physicians located in many port cities, the government assigned the Service to administer federal quarantine.

Another function that the federal government took over from the states in the late 19th century, motivated by the dramatic increase in immigration in this period, was the processing of immigrants. Under the Immigration Act of 1891, the Marine Hospital Service was assigned the responsibility for the medical inspection of arriving immigrants. Immigration legislation prohibited the admission of individuals suffering from “loathsome or dangerous contagious diseases,� those who were insane or had serious mental deficiencies, and anyone likely to become a public charge (e.g., owing to a medical disability). Service physicians at immigration depots such as Ellis Island in New York examined incoming immigrants for medical fitness. On a busy day at Ellis Island, Service physicians would inspect thousands of immigrants, necessitating that the examinations be brief and superficial.

When an immigrant’s condition aroused concern during this initial inspection, he or she was detained for further, more detailed examination.

The relatively new science of bacteriology and the germ theory of disease were beginning to make their impact felt in the late 19th century, and the Marine Hospital Service decided to establish a bacteriological laboratory at the Staten Island hospital in 1887.

Originally concerned mainly with practical problems related to the diagnosis of disease, the laboratory in time began to undertake original biomedical research as well. The Hygienic Laboratory, as it came to be called, was moved to Washington, D.C., in 1891, and eventually evolved into the National Institutes of Health.

Because of the broadening responsibilities of the Service in the area of public health, its name was changed in 1902 to the Public Health and Marine Hospital Service. The 1902 law that changed the name

Top and above: U.S. inspectors examining eyes of immigrants, Ellis Island, New York. Under the Immigration Act of 1891, the Marine Hospital Service was given responsibility for the medical inspection of arriving immigrants.

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The Hygienic Laboratory, the Marine Hospital Service’s bacteriological lab, eventually evolved into the National Institutes of Health.

Shown here is Dr. Ida A. Bengston, one of the first women employed on its staff. of the Service also led to increased cooperation between federal and state health authorities, including directing the Surgeon General to prepare and distribute to state health officers forms for the uniform compilation of vital statistics. These statistics were published in the Service’s journal, Public Health Reports.

Another law passed in 1902, the Biologics Control Act, extended the Service’s reach in yet another direction, giving it regulatory authority over the production and sale of vaccines, serums, and other biological products.

Examples of the increasing cooperation of the Service with local health authorities in the early years of the 20th century include the campaigns against plague in San Francisco

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and yellow fever in New Orleans. State and local health officials began to call on the Service more frequently for assistance in dealing with public health problems. For example, Yakima County, Wash., officials turned to the Service for help in combating a typhoid fever epidemic in 1911. The Service sent a Commissioned Corps officer to investigate the outbreak, and he identified the cause of the spread of the disease as feces and initiated a campaign for sanitary privies. This work also marked the beginnings of the Service’s first substantial rural sanitation campaign. The rural sanitation efforts of the Service in the following years spread to other areas of the country and helped to encourage the establishment of county health departments.

The increasing involvement of the Service in public health activities led to another name change in 1912. “Marine Hospital” was dropped from its title, and the organization became simply the Public Health Service (PHS). At the same time, the PHS was given clear legislative authority to “investigate the diseases of man and conditions influencing the propagation and spread thereof, including sanitation and sewage and the pollution either directly or indirectly of the navigable streams and lakes of the United States.”

Thus all types of disease, whatever the cause (including environmental pollution), came within the purview of the PHS. One important breakthrough in combating disease at about this time was the demonstration by a PHS officer that pellagra, a disease especially common in the South, was caused by a dietary deficiency.

World War I had a significant impact on the PHS. Some PHS Commissioned Corps officers were detailed to the Army and Navy, but most PHS officers were involved in war-related efforts on the home front. The Service was given the responsibility of working with local health departments to keep the areas around military training camps in the United States free from disease. The threat of venereal disease (VD) to servicemen and essential war workers was of particular concern to the military, and a Division of Venereal Disease was created in the PHS in 1918 to help control the spread of VD. The Spanish influenza pandemic that struck the world in that same year led

PHOTO COURTESY OF CENTERS FOR DISEASE CONTROL AND PREVENTION

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History | U.S. Public Health Service to increased funding and staff for the PHS specifically to fight this disease. The Service also became more actively involved in industrial hygiene and water pollution activities during the war.

When the war ended, the PHS was given the responsibility of caring for all returning veterans, leading to large increases in staff and in the number of hospitals operated by the Service. This situation was short-lived, however, as Congress created an independent Veterans Bureau in 1921, and in the following year the responsibility and resources for the treatment of veterans was transferred from the PHS to the new Bureau.

In the period between the two world wars, the PHS expanded the population to which it provided health care beyond the traditional categories of merchant seamen and the Coast Guard. The PHS assumed responsibility for the care of individuals suffering from leprosy when it converted the state leprosy facility in Carville, La., into a national leprosy hospital. Under the PHS, the hospital at Carville carried out pioneering research on the nature and treatment of leprosy.

In 1928 the Service detailed a Commissioned Corps officer to serve as Director of Health for the Bureau of Indian Affairs of the Department of the Interior and also assigned a number of other officers to the Bureau to provide medical assistance in the field. This cooperative arrangement continued until the PHS eventually took over the responsibility for the health of American Indians and Alaska natives from the Bureau almost 27 years later. Another category of beneficiaries was added to the roster of those served by the PHS in 1930, when the law creating the Federal Bureau of Prisons included provisions for the assignment of PHS officers to supervise and provide medical and psychiatric services in federal prisons.

Although the PHS had always dealt with issues of mental health to some extent in the marine hospitals, and had become more involved with mental health in connection with the medical screening of immigrants, it did not establish a formal organizational unit in this area until 1929. Initially the Division of Mental Hygiene focused largely on questions of substance abuse, as is suggested by the

fact that it was actually called the Division of Narcotics for the first year of its existence. The 1929 law that created the Division also authorized the creation of two PHS hospitals for the treatment of narcotics addicts, and these facilities were opened in Lexington, Ky., and Fort Worth, Texas, in the 1930s.

The PHS became more involved in the broader health concerns of the nation under the New Deal. The Social Security Act of 1935 provided the PHS with funds and the authority to build a system of state and local health departments, something it had already been doing on an informal basis. Under the legislation, the PHS was also able to provide grants to states to stimulate the development of health services, train public health workers, and undertake research on health problems. Although these programs were funded and aided by the federal government, they were run at the state and local level, joining the various governments in a public health partnership.

The threat of venereal disease to servicemen in World War I saw a new division created in the PHS to help control its spread.

When Thomas Parran was appointed Surgeon General in 1936, he embraced these new authorities. He was more of an activist than his predecessor. One of the areas of particular concern to Parran was VD. As Surgeon General, he helped to focus attention on VD as a public health problem rather than emphasizing moral issues. His articles in popular maga-

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jeff univ n pickpoint

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David B. Nash, MD, MBA Dr. Raymond C. and Doris N. Grandon Professor of Health Policy, Chair, Department of Health Policy, Jefferson Medical College, and Richard C. Wender, MD Alumni Professor and Chair, Department of Family Medicine Jefferson Medical College Co-Directors of the Master of Science Program in Public Health, Jefferson College of Graduate Studies invite your inquiries about the

Master of Science Program in

Public Health The MSPH program at Thomas Jefferson University offers • An easily accessible and safe location in CENTER CITY PHILADELPHIA • Conveniently scheduled classes designed to fit the needs of working professionals • A program that you can complete at your own pace in 2 to 4 years • Meaningful thesis research and clerkship programs with opportunities in the community and abroad • The resources of a national medical research center that is part of a regional integrated delivery system with multiple sites • Leadership who steer, direct and educate courses from an academic medical center background For more information, please contact Jennifer Ravelli, MPH at 215-503-0174 or by email at jennifer.ravelli@jefferson.edu, or visit our website at www.jefferson.edu/jcgs.

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LIBRARY OF CONGRESS PHOTO

History | U.S. Public Health Service

A group of native Aleuts in 1938. Ten years earlier, the PHS had detailed the first Commissioned Corps officer to serve as Director of Health for the Bureau of Indian Affairs of the Department of the Interior. In 1955, the PHS assumed full responsibility for the health of American Indians and Alaska Natives. zines and his 1937 book Shadow on the Land helped to break down the taboo against discussion of VD in the media. His efforts were also instrumental in the passage of the National Venereal Disease Control Act of 1938, which provided federal funds to the states through the PHS for VD control programs, as well as supporting research into the prevention and treatment of these diseases.

As a result of a government reorganization in 1939, the PHS was taken out of the Treasury Department and given a new administrative home.

President Franklin D. Roosevelt aligned the PHS with a number of other social service agencies, such as the Social Security Board, in a newly created Federal Security Agency. The reorganization, however, had little effect on the basic functions and operations of the Service.

With the entry of the country into World War II in 1941, some PHS officers were detailed to the military services. The PHS also provided personnel to the United Nations Relief and Rehabilitation

Administration to staff medical care and disease prevention programs in refugee camps in Europe and the Middle East. The Coast Guard was militarized in 1941, and 663 PHS officers, eight of whom were killed in the line of duty, served with the Coast Guard during the war.

A nursing shortage during the war led to the passage of the Nurse Training Act of 1943, which created a PHS-administered program called the Cadet Nurse Corps. The program provided participants with a tuition scholarship and a small monthly stipend while attending a qualified nursing school. In return for this support, the Cadets had to agree to work after graduation in essential nursing services for the duration of the war. To symbolize their commitment to the war effort, the Cadets wore specially-designed uniforms. Over 124,000 nurses (including some 3,000 African Americans) were trained in this program from its origin in 1943 to its termination in 1948. The Cadet Nurse Corps marked the beginning of PHS involvement on a

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Left: Surgeon General Thomas Parran.

Appointed in 1936, Parran was more of an activist than some of his predecessors.

large scale in funding the education of health professionals.

The PHS expanded significantly during World War II, doubling its personnel between 1940 and 1945 to reach a level of 16,000 employees. The war also increased the involvement of the PHS in international affairs, leading to the creation of an Office of International Health Relations. Two legislative acts during this period also had an impact on the PHS. A 1943 law reorganized the Service, consolidating its programs into four subdivisions: the Office of the Surgeon General, the National Institute (later Institutes) of Health, and two new entities, the Bureau of Medical Services and the Bureau of State Services. The 1944 Public Health Service Act codified on an integrated basis all of the authorities of the Service and strengthened the administrative authority of the Surgeon General. The act also allowed the PHS to develop a major postwar program of grants for medical

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research through the National Institutes of Health.

Another PHS legacy of World War II grew out of a wartime program to control malaria in areas around military camps and maneuver areas in the United States.

The PHS-administered Malaria Control in War Areas program, based in Atlanta, expanded its responsibilities over the course of the war to include the control of other communicable diseases such as typhoid fever, dengue, and typhus. By the end of the war, the program had demonstrated its value in the control of infectious disease, so successfully that it was converted in 1946 to the Communicable Disease Center (CDC). The mission of the CDC expanded over the succeeding decades to include areas such as nutrition, chronic disease and occupational and environmental health. To reflect this broader scope, its name was changed in 1970 to the Center for Disease Control. It received its current designation, Centers for Disease Control and Prevention (but retaining the acronym CDC) in 1992.

Two major legislative acts passed just after the war, in 1946, had a significant impact on the PHS. The National Mental Health Act greatly increased the involvement of PHS, which administered the programs established by the law, in the area of mental health. The law supported research on mental illness, provided fellowships and grants for training mental health professionals, and made available to states grants to assist in the establishment of clinics and treatment centers and to fund demonstration projects. It also called for the establishment of a National Institute for Mental Health, which was created as a part of the PHS in 1949.

The other 1946 law that had an influence on the activities of the PHS was the Hospital Survey and Construction Act,

PHOTO COURTESY OF CENTERS FOR DISEASE CONTROL AND PREVENTION

U.S. Public Health Service | History

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History | U.S. Public Health Service more commonly referred to as the Hill-Burton Act. It authorized the PHS to make grants to the states for surveying their hospitals and public health centers, to plan construction of additional facilities, and to assist with construction costs.

In 1953, the Federal Security Agency was elevated to Cabinet status as the Department of Health, Education, and Welfare (DHEW), but this change in status had little direct impact on the PHS at the time. However, the Service did assume several new tasks in the 1950s. For example, it became fully responsible for the health of American Indians and Alaska Natives in 1955, when all Indian health programs of the Bureau of Indian Affairs were transferred to the PHS. A new Division of Indian Health (which later became the Indian Health Service) was established to administer these programs. In 1956, the Armed Forces Medical Library became the National Library of Medicine, which was made a part of the PHS. The PHS continued to expand in the 1960s.

Two agencies that were also housed in DHEW were incorporated into the PHS in this decade. St.

Elizabeths Hospital, which had begun in 1855 as the Government Hospital for the Insane, was brought into PHS in 1967 (although much of its physical plant and programs were transferred to the District of Columbia in 1987). The Food and Drug Administration, whose predecessor organization dates back to 1906, was made a part of the PHS in 1968, thus involving the Service much more heavily in the area of regulation.

The famous Surgeon General’s report Smoking and Health, issued in 1964, undoubtedly made many Americans much more aware not only of the dangers of smoking, but also of the PHS and the Surgeon General. Although not the first statement from a PHS Surgeon General concerning the health effects of smoking, it was an extensive and well-documented report that clearly stated some of the health risks of tobacco. It eventually led to the introduction of the now-familiar Surgeon General’s warnings on cigarette packages.

Interestingly enough, the major health event of the 1960s, the passage of Medicare and Medicaid, had little influence on the PHS. When

LIBRARY OF CONGRESS PHOTO

Below: A malaria hospital in China during World War II. The PHS not only worked to control malaria in areas around U.S. military camps at home, but fought the disease abroad.

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these programs became law in 1965, they were placed elsewhere within DHEW. Many within the PHS saw Medicare and Medicaid as essentially insurance programs with which the Service need not involve itself.

Although its responsibilities had expanded in a number of areas, one field in which the PHS saw its activities circumscribed in this period was environmental health. In the 1960s, water pollution control was moved from the PHS to the department level in DHEW, and was then eventually transferred to the Department of the Interior. The creation of the Environmental Protection Agency (EPA) in 1970 led to the loss of PHS programs in such areas as air pollution and solid waste to the new agency. Although some PHS officers continued to be detailed to EPA to assist it in its work, the Service had lost its role as the leader of the federal environmental movement.

Concerns on the part of some political leaders that the PHS needed to be more responsive to the policies of elected officials and more of a modern political bureaucracy led to a major reorganization of the Service in 1968 that dramatically changed its leadership

The Surgeons General continue to greatly influence public policy with Reports on major public health issues.

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structure. Up through the middle 1960s, the PHS was led almost entirely by career commissioned officers (who represented less than 20 percent of PHS employees by the 1960s). The Surgeon General, although appointed by the president, had always been a career member of the Commissioned Corps. The 1968 reorganization transferred the responsibility for directing the PHS from the Surgeon General to the Assistant Secretary for Health, a political appointee. For the first time, a non-career official became the top official in the PHS. Although the Assistant Secretary for Health could come from the ranks of the Commissioned Corps, this has not typically been the case. In general, beginning in this period, the heads of PHS bureaus or agencies were also increasingly not members of the Commissioned Corps. The Surgeon General was no longer responsible for the management of the PHS but became largely an advisor and spokesperson on public health matters. He or she was no longer necessarily chosen from the Corps, but was often appointed from outside the PHS and then commissioned upon appointment.

A series of further reorganizations over the next three decades continued to reshape the structure, but not the basic functions, of the PHS. Some new programs were added. For example, the National Health Service Corps (NHSC) was created in 1970. Under this program, the PHS sent physicians, nurse practitioners, and other health professionals into clinical practice in areas where there were critical health manpower shortages. Beginning in 1972, the PHS could offer health-professions students scholarships in exchange for a commitment to serve in the NHSC. A decade later, however, the PHS lost the responsibility of caring for a particular group of patients when the health care entitlement for merchant seamen was terminated.

By that time, the provision of health care to seamen represented only a small fraction of the work of the PHS, but nevertheless the closing of the remaining eight marine hospitals and 27 clinics in 1981 represented the end of the activity for which the Service had originally been created.

There has been no lack of challenges for the PHS since that time. Diseases from acquired immune deficiency syndrome (AIDS) to severe acute respiratory syndrome (SARS)

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History | U.S. Public Health Service

From left, then-Surgeon General Joycelyn Elders and former Surgeons General Antonia Novello, C. Everett Koop, Julius Richmond, Paul Ehrlich, Jr., and Jesse Steinfeld testify before Congress in this February 1994 photo.

provide some examples of the health issues that have confronted the Service in recent times. Today the PHS remains a component of the Department of Health and Human Services (DHHS), as DHEW was renamed in 1980. A major reorganization in 1995 once again changed the leadership structure of the PHS. The PHS agencies, by this time numbering eight, no longer reported to the Assistant Secretary for Health, but directly to the Secretary of DHHS. The agencies, now called operating divisions, are as follows: Agency for Healthcare Research and Quality; Agency for Toxic Substances and Disease Registry; Centers for Disease Control and Prevention; Food and Drug Administration; Health Resources and Services Administration; Indian Health Service; National Institutes of Health; Substance Abuse and Mental Health Services Administration. These divisions, together with the Office of Public Health and Science (which is headed by the Assistant Secretary for Health and includes the Surgeon General) and the Department’s regional health administrators, comprise today’s Public Health Service, an organization of about 56,000 employees, including some 6,000

members of the Commissioned Corps (which is led by the Surgeon General).

Suggestions for Further Reading Elizabeth Etheridge, Sentinel for Health: A History of the Centers for Disease Control (Berkeley and Los Angeles: University of California Press, 1992).

Bess Furman, A Profile of the United States Public Health Service, 1798-1948 (Bethesda, MD: National Library of Medicine, 1973).

Victoria Harden, Inventing the NIH: Federal Biomedical Research Policy, 1887-1937 (Baltimore: Johns Hopkins University Press, 1986).

Alan Kraut, Goldberger’s War: The Life and Work of a Public Health Crusader (New York: Hill and Wang, 2003).

Fitzhugh Mullan, Plagues and Politics: The Story of the United States Public Health Service (New York: Basic Books, 1989).

Ralph Williams, The United States Public Health Service, 1798-1950 (Washington, D.C.: Commissioned Officers Association of the United States Public Health Service, 1951).

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U.S. Public Health Service | Highlights& Accomplishments

Selected Public Health Service

HIGHLIGHTS & ACCOMPLISHMENTS 1798 An act for the relief of sick and disabled seamen provides for the establishment of federal marine hospitals (eventually leading to the Marine Hospital Service, forerunner of the Public Health Service).

1807 Dr. Benjamin Waterhouse is appointed physician in charge of the Boston marine hospital, where he is the first to introduce interns (from the Harvard Medical School) into an American hospital.

1870 A reorganization of the hospital system creates the Marine Hospital Service, and the following year John Maynard Woodworth is appointed as the first Supervising Surgeon (later Surgeon General) of the Service.

1878 The first Federal Quarantine Act is passed, initiating the involvement of the Marine Hospital Service in quarantine activities.

1887 The Marine Hospital Service establishes a bacteriological laboratory that becomes involved in research

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and eventually evolves into the National Institutes of Health.

1889 The Service’s Commissioned Corps is formally established by legislation.

1891 Federal immigration legislation assigns responsibility for the medical inspection of immigrants to the Marine Hospital Service.

1902 In recognition of its increasing involvement in public health activities, the name of the Service is changed to the Public Health and Marine Hospital Service.

1911 Commissioned Officer Leslie Lumsden, sent by the Service to Yakima County, Wash., at the request of local officials to study a typhoid outbreak, determines that the disease is being spread

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PHOTO COURTESY OF PHS COMMISSIONED OFFICERS FOUNDATION

PHOTO COURTESY OF CENTERS FOR DISEASE CONTROL AND PREVENTION

Highlights& Accomplishments| U.S. Public Health Service

Above: People in Columbus, Ga., awaiting polio vaccinations in the early days of the National Polio Immunization Program. PHS licensed the first polio vaccine in 1955.

Right: PHS Commissioned Corps Officer Joseph Goldberger discovered that pellagra was a dietary deficiency, and proposed remedies, in 1914. through feces, and initiates a campaign for sanitary privies that launches a nationwide rural sanitation program.

1912 The name of the Service is changed to the Public Health Service (PHS). .

1914 PHS Commissioned Officer Joseph Goldberger announces his view that pellagra is a dietary deficiency disease and can be prevented or cured by the addition of milk, meat, or eggs to the diet.

1918 The Reserve Corps of the PHS Commissioned Corps is created

during the Spanish Influenza Pandemic, originally as a means of coping with the emergency.

1919 The PHS is given the responsibility for providing medical care for all returning veterans of World War I until the creation of the Veterans’ Bureau in 1921.

1921 The PHS takes over the Louisiana Leper Home and turns it into a national hospital for patients with Hansen’s Disease (leprosy).

1930 The PHS is given responsibility for providing health care in federal prisons.

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U.S. Public Health Service | Highlights& Accomplishments

1935 The Social Security Act authorizes the PHS to provide grants to states to stimulate the development of health services, train public health workers, and undertake research on health problems.

1941 PHS Commissioned Officer Guy Faget, Medical Director of the PHS hospital for Hansen’s Disease (leprosy) patients, demonstrates the effectiveness of sulfones against this disease.

1943 PHS Commissioned Officer John Mahoney demonstrates the effectiveness of penicillin in the treatment of syphilis.

1944 The Public Health Service Act codifies all of the authorities of the PHS and allows the Service to develop a major postwar program of grants for research in the biomedical sciences.

1945 President Truman declares the PHS Commissioned Corps to be a military service during wartime emergency, but hundreds of PHS Officers have already been detailed to the various branches of the armed services (including the militarized Coast Guard) throughout World War II, eight of whom lost their lives in the line of duty.

1950 The PHS announces that community clinical trials of water fluoridation that it initiated in 1945 have shown the procedure to be safe and effective in the inhibition of tooth decay.

1954 Federal legislation transfers the responsibility for the health care of American Indians and Alaska Natives from the Bureau of Indian Affairs to the PHS, effective July 1, 1955.

1955 The PHS licenses the first polio vaccine.

Top: PHS scientist Marshall Nirenberg with tools used during the period of genetic code translation. Above: The 1964 Surgeon General’s Report on Smoking and Health.

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1964 PHS issues the landmark Surgeon General’s Report on Smoking and Health.

1968 PHS scientist Marshall Nirenberg is awarded a Nobel Prize for breaking the genetic code.

PHOTOS COURTESY OF THE NATIONAL INSTITUTES OF HEALTH

1953 The PHS becomes part of the newly-created cabinet-level Department of Health, Education, and Welfare (which becomes the Department of Health and Human Services in 1980).

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Highlights& Accomplishments| U.S. Public Health Service

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1970 PHS scientist Julius Axelrod is awarded a Nobel Prize for research on the chemistry of nerve transmission.

1972 PHS scientist Christian Anfinsen is awarded a Nobel Prize for research on ribonuclease.

1976 PHS scientist Carlton Gajdusek is awarded a Nobel Prize for research on slow viruses.

1977 A PHS-led international campaign eradicates smallpox.

1980 The PHS coordinates a successful effort to identify the cause of Toxic Shock Syndrome.

1984 Scientists from PHS and from France identify the HIV virus that causes AIDS.

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1986 Clinical tests conducted by the PHS demonstrate the effectiveness of AZT in the treatment of AIDS patients.

1988 The PHS Surgeon General mails a brochure on “Understanding AIDS” to every household in America.

1990 PHS physicians administer the first gene therapy treatment in a human patient.

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1993 Scientists from the PHS and the United States Army isolate the cause of hantavirus pulmonary syndrome.

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1994 PHS scientist Martin Rodbell is awarded a Nobel Prize for research on G proteins, key components of the communication system that regulates cellular activity.

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1997 The PHS makes its important MEDLINE database available free of charge on the World Wide Web. 2000 The international Human Genome Project consortium, funded by the PHS and others, and the Celera Genomics Corporation announce that they have both completed an initial sequencing of the human genome.

2002 A team of PHS and other scientists develops the first vaccine against Staphylococcus aureus, a major cause of infection and death among hospital patients.

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2004 PHS scientists lead a team which discovers that a single protein, known as mBDNF, appears to be central to the formation of longterm memories.

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U.S. Public Health Service | Readiness

Medical Forces Ready For

RAPID DEPLOYMENT Officers in the U.S. Public Health Service Commissioned Corps See Frequent Duty

By Michael A. Robinson

does a man who grew up hunting deer with a bow, and who became a community pharmacist, end up running an office in a sprawling federal agency with some 6,000 officers ready to respond to a public health emergency on a moment’s notice?

For Rear Adm. John Babb, it was a story of patience and persistence. Oh yeah, and there was that epiphany.

Babb, 58, says he decided to become a pharmacist in the late 1960s in part because his father regaled him with stories about how it was a great profession because you could make lots of money and work short hours. Today, Babb jokes that his father, with whom he still hunts and fishes in the deep outdoors of his native Missouri Ozarks, lied to him on both counts.

No matter. As an Assistant Surgeon General and Director of the Office of Force Readiness and Deployment at the Department of Health and Human Services, Babb still isn’t working short hours or getting rich. But he is having an impact on public health around the globe in a way he could never have dreamed of when he was a pharmacist nearly 20 years ago at Black’s Apothecary in Memphis, Tenn.

“I found out that health care was not just about providing care to a single person, one person at a time, that it was about the public,” Babb said. “It could be about providing care to populations or developing programs for populations rather than filling one prescription at a time.

“Yeah, that’s necessary, and there are wonderful people doing that work. But somebody has got to have the big picture in order to develop a program or a vision for where we need to go.”

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PHOTO COURTESY OF PHS COMMISSIONED OFFICERS FOUNDATION

How

The PHS flag flies aboard the hospital ship USNS Mercy during tsunami relief operations in 2005.

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Readiness| U.S. Public Health Service

The Admiral says this sea change occurred shortly after he took a position with the U.S. Public Health Service Commissioned Corps as the Chief Pharmacist at the Federal Correctional Institution in Memphis in 1989. While there he was able to view a microcosm of public health issues – drug addiction, mental health problems, diabetes, and infectious diseases.

As a result, Babb could observe how a change in inmate health habits could affect not just a home, or a block, or a neighborhood, but an entire population. And he realized that if you multiple by that outcome by a few orders of magnitude, you could have an enormous impact on an entire society.

So, he got his master’s degree in pubic administration from the University of Memphis while working at the prison. Then came a series of promotions within the Federal Bureau of Prisons. In 2000, Babb joined the Office of Emergency Preparedness as the Director of the Commissioned Corps Readiness Force, an all-volunteer program that was a forerunner of today’s mission. He oversees the officers in the PHS Commissioned Corps, whose members perform the actual field work.

“Today, the entire PHS Commissioned Corps – all 6,000 officers – are involved in readiness,” Babb explained. “We’ve kind of redefined our mission to promote, protect, and advance the health and safety of the nation.

And that can be done in two different ways, either working for the agency on your day job or working during a deployment to support public health and medical needs of a distressed population.

“We deploy on a regular basis. We get requests from federal, state, and local governments for natural disasters, for terrorist attacks, to support the Department of Defense whenever there’s conflict, and for national special security events.

“What turns me on are the contributions that our officers make to the country, and even internationally. They’re the ones who do the great things. I’m just the guy in the background.”

No wonder Babb’s office is so busy. PHS Commissioned Corps officers deploy to such varied assignments as responses to the September 11 terrorist attacks, the anthrax attacks in Washington, D.C., Midwest tornadoes, Florida hurricanes, the 2nd Tsunami crisis in Asia, and to the funeral for Ronald Reagan. The list goes on: the National Governor’s Conference, the Major League All Star baseball game, the Republican and Democratic National Conventions, and the shooting earlier this year at the Red Lake Chippewa Tribe’s reservation.

Except for three days, Babb’s forces have remained continuously deployed since late January 2003, including some high-profile overseas assignments. The 6,000 PHS Commissioned Corps officers serve on monthly rosters and are ready to respond to support the mission of the Department of Health and Human Services. The PHS Commissioned Corps is composed of physicians, nurses, pharmacists, dentists, veterinarians, engineers, environmental health officers, scientists, therapists, dietitians, mental health providers, and other public health professionals.

In normal times, they work for the various agencies of the Department of Health and Human Services, as well as such government entities as the Environmental Protection Agency, Department of

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U.S. Public Health Service | Readiness Homeland Security, Department of Agriculture, National Park Service, Federal Bureau of Prisons, etc.

Earlier this year, the Readiness Force deployed officers in support of the U.S. Navy on board the USNS Mercy hospital ship in the Indian Ocean and at Aceh, Indonesia, after the tidal waves that devastated much of the region. Babb says the contingent included several mental health workers, and the crew decided to launch a “Train the Trainer” program.

The idea, he says, was to have the mental health experts instruct local nurses and schoolteachers on how to detect signs of stress, depression, and grief among schoolchildren, many of whom had lost most of their families and friends. In this manner, the deployment helped some 50,000 schoolchildren in the area, Babb says.

“We developed this program so that we would have something there that could be sustained to benefit those kids,” he said. “Once the ship leaves, we can’t provide mental health care anymore. If our impact leaves

with the ship, then we’re not really providing the care that’s needed.”

Meantime, those helping with the tsunami relief found the work was often heart-wrenching. Lt. Cmdr. Ken Harman, a PHS Commissioned Corps medical officer serving aboard the USNS Mercy, provided an account of his stay there – correspondence that was edited and was then approved by Navy officials.

“The hospital walkways are full of people with tragic problems,” Harman wrote. “A young mother approached me yesterday with her 6-year-old son at her side. He was obviously unwell and in pain. She handed me a CT scan of his head. I have no idea where she got it. I looked at the films and saw a depressed skull fracture with an underlying subdural hematoma. We have no neurosurgery capability. All I could do was try to console and sympathize.

“We focus on our victories while we strive to do the most good for the most people. The young boy in my arms, Zurfadli, is 13 years old and can’t possibly weigh more than 50 pounds.

U.S. Public Health Services CAPT Marc S. Traeger, left, reviews medical care charts in April 2005 with the head of Mars Hospital Nias, Dr. Yulianus Mendofa. At the request of the government of Indonesia, the Military Sealift Command (MSC) hospital ship USNS Mercy (T-AH 19) and the MSC combat stores ship USNS Niagara Falls (T-AFS 3) were stationed off the coast of Nias, providing assistance as determined appropriate and necessary with earthquake disaster relief efforts and providing medical assistance to those in need.

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U.S. NAVY PHOTO BY PHOTOGRAPHER’S MATE 2ND CLASS SANDRA M. PALUMBO

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PHOTO COURTESY OF PHS COMMISSIONED OFFICERS FOUNDATION

Readiness| U.S. Public Health Service

PHS officers deployed to Iraq and Afghanistan with U.S. troops.

He has a hemoglobin of 3.8 (one third the normal value) and a spleen the size of a south Alabama watermelon (at least 10 pounds). He is suffering from malaria. Now that we have him on the ship, we will treat his malaria and remove his spleen. When he goes home he will have a chance at a normal life; we made a difference for him.

“The little girl in the wheelchair, Elise, is recovering from a brain abscess she got from tsunami lung. She was in a coma when we got her and had to be cared for on a ventilator. We returned her to the community last week and I was lucky enough to see her with her family a few days ago. She smiled happily when she saw me. The weakness on her right side is improving and I believe that she will walk again.”

For the September 11 terrorist attacks, Babb says some 350 PHS Commissioned Corps officers were deployed to New York, to the site of the plane crash in Pennsylvania, and to Washington, D.C. Of those, 88 were on site at Ground Zero in Manhattan, providing mental health support and clinical help for rescue workers.

“They had all these guys out there that were digging for their bud-

dies, trying to find their buddies in that pile, and so they got hurt,” Babb said.

“The pile was 200 degrees Fahrenheit for a couple of weeks after that attack.

They continued to pour water on the pile for weeks trying to put the fire out.

“The pile was slippery. It was full of jagged steel and glass and men fell and their search dogs had their feet ripped up and people were experiencing all these respiratory problems and eye problems because of all the pollutants in the air. Heart attacks, fatigue, dehydration, you name it. There were a lot of health problems on that pile.”

Having so many doctors, nurses, pharmacists, and mental health workers ready for rapid deployment clearly is in the nation’s interest whether responding overseas or domestically, Babb says. No less an authority on the subject than the highly esteemed journal Science agrees.

In fact, two scientists writing for the publication say the quick reaction during the anthrax attacks in the Washington, D.C., area in late 2001 helped save lives. Babb’s team was in place in just six hours and provided antibiotic prophylaxis to some 37,000 people in six separate venues, Babb

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says. In all, they worked at six locations, including Washington’s central mail station, those at the Departments of State, Health and Human Services, and the Senate Office Building, and the Morgan Mail Building in New York City.

The Centers for Disease Control and Prevention confirmed 11 cases of inhalation anthrax, which killed five people. Based on information about dates of exposure, symptom onset, and the anthrax incubation period, Ron Brookmeyer and Natalie Blades of Johns Hopkins University developed a statistical model to estimate the probable number of anthrax cases prevented by the prophylaxis treatment.

The journal Scientific American noted that in addition to confirming the wisdom of these recent decisions, the study also could influence future public health policy. Brookmeyer was quoted as saying that the finding “demonstrates that earlier intervention and treatment can save lives and must be a critical element of any biodefense strategy.”

In fact, Babb says PHS Commissioned Corps officers frequently train on how to respond to bioterror attacks promptly. Furthermore, that’s one of the reasons his officers often deploy to such special events as State of the Union addresses and presidential inaugurations. Obviously, such events already have heavy security and lots of medical help on hand.

OFFICIAL USMC PHOTO BY 2ND LT. PAUL CABELLON

U.S. Public Health Service | Readiness

Marines with the CBIRF Decontamination Unit wait outside of Dirksen Senate Office Building in Washington. Commissioned Corps officers provided antibiotics to some 37,000 people who might have been affected in the 2001 anthrax attacks.

“We provide preventive medicine services, but we’re also there in case of a mass fatality event,” Babb said. “For literally every national special security event, we have to have a team ready in case something happens. You have all these high-profile people in one place and a lot of publicity. It’s a great opportunity in case bad guys want to strike.”

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