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After a 35-year career as an internationally acclaimed pediatric surgeon, during the 1980s C. Everett Koop turned a federal office with a minimal budget and staff, the office of the U.S. Surgeon General, into the most authoritative platform from which to educate the nation on matters of health promotion, disease prevention, and emerging health threats. Guided by his evangelical Christian faith and his professional commitment to saving the lives of newborns, Koop became an outspoken opponent of abortion and, as such, a favorite of political conservatives; yet the positions he took as U.S. Surgeon General on smoking, domestic violence, disability rights, and, most urgently, AIDS, alienated him from his conservative supporters and demonstrated that the politics of public health in the 1980s followed a long-standing pattern of controversy over government authority and individual liberty.
Charles Everett Koop was born in Brooklyn on October 14, 1916, the only child of a banker and a business manager. He grew up in a three-story brick house in South Brooklyn, surrounded by family: his paternal grandparents resided on the third floor, his maternal grandparents, aunts, uncles, and cousins lived along the same quiet streets nearby. His father did not finish high school, but nonetheless advanced to the position of assistant vice president at one of the nation's largest banks, and regularly visited the New York Public Library to satisfy his love of Shakespeare--and to research answers to his son's frequent questions. As the descendant of Dutch and German immigrants, Koop was a self-proclaimed "oddball" at his public elementary and middle schools, which were located in predominantly Italian, Polish, and Jewish neighborhoods. He played stickball and sandlot baseball with his team, the Conquerors, fished, and ice-skated in Prospect Park, but enjoyed his time with his close-knit family above all else. He toured New York City in the company of his maternal grandfather, a tin smith with his own roofing and ventilation business who once, while on a job, perched the eight-year-old on a ledge near the top of the Woolworth building. Family relationships were the primary early force in molding Koop's character and values. Not until he entered a small private high school, the Flatbush School, did Koop's social circle expand beyond his family to include classmates, the staff of the school newspaper he edited, and his teammates on the school football squad.
Koop's family nurtured his aspiration--expressed as early as age six--to become a surgeon. Both of his grandfathers enjoyed working with their hands--his paternal grandfather was an amateur engraver--and their pride in their manual craftsmanship "shaped my desire to use my own hands as a surgeon," Koop speculated. His mother Helen had assisted during in-home surgeries in their neighborhood by administering anesthesia, a role often left to laymen. Three decades later, Koop's first innovation as a pediatric surgeon was to develop a device that prevented anesthesia overdoses in children.
As a young child Koop was fascinated by the medical instruments and the gentle ministrations of the family physician and the family orthopedist. "The idea of using my mind, then my hands, to heal someone simply fascinated me," he remembered. In order to develop the manual dexterity required of a surgeon, Koop used each hand interchangeably to tie knots or to cut out pictures from magazines. At age fourteen, he sneaked into the viewing gallery in the operating theaters at Columbia University's College of Physicians and Surgeons with the help of a neighborhood friend and student at the College. In the basement of his home, with his mother administering anesthesia, Koop performed operations on rabbits, rats, and stray cats, losing, by his own account, not a single patient. From age sixteen, he volunteered for summer jobs at Mather Memorial Hospital and St. Charles Hospital for Crippled Children near his family's vacation home in Port Washington on Long Island.
In the fall of 1933, Koop left home for Dartmouth College on a football scholarship, majoring in zoology. He developed a life-long affection for the institution, not least because he met there the woman who would be his wife of over six decades, Betty Flanagan. There, he also acquired his nickname, "Chick." He soon decided to forego football after sustaining an eye injury and receiving a warning from the school ophthalmologist that he was endangering his future as a surgeon.
Koop returned to New York City in 1937 to enter Cornell University Medical College. A year later Betty and he married, in defiance of a prevailing prejudice against married students among medical school faculty. Betty, a doctor's daughter herself, was the couple's main breadwinner as a hospital secretary until Koop graduated from medical school in 1941. They eventually had four children, Allen, born in 1944, Norman, born in 1945, David, born in 1947, and Betsy, born in 1951.
In the summer of 1941 Koop took up a year-long internship at the Pennsylvania Hospital in Philadelphia, the city that became his home for the next forty years. In 1942 he began his surgical residency at the University of Pennsylvania Hospital. Taking account both of the demand for surgeons created by World War II and of Koop's natural operating skills, his adviser, Isidor S. Ravdin, allowed him to complete his surgical training in half the allotted nine years. Koop spent days at a time at the hospital. "[M]y happiest hours were those in the operating room," he recalled. "I love surgery because I have an abiding reverence for the human body, reverence for the ways in which its anatomical details allow it to function."
At the end of Koop's residency in 1945 Ravdin suggested that he accept an appointment as the first surgeon-in-chief at Children's Hospital of Philadelphia, an honor for the 29-year-old and a recognition of his surgical skills, but also a challenge at a time when pediatric surgery was not yet a recognized medical specialty. Moreover, like most physicians he had received very little training in pediatrics: only six classes in medical school and none during his abbreviated internship, followed by an occasional operation on a child--but never on a newborn--during his residency. Yet he felt drawn to the field because it promised the opportunity to perform a wide range of surgeries on patients who were particularly vulnerable and underserved by specialized surgeons. He made up for his deficit in pediatric training during a one-year internship with the founders of pediatric surgery in the United States, William E. Ladd and Robert E. Gross, at Children's Hospital in Boston. When he returned to Philadelphia late in 1946, he faced initial resistance from some pediatricians and general surgeons at his new institution who did not agree that the hospital needed a specialist in pediatric surgery. He soon convinced them of his skills, and over the next three decades helped to establish the field of pediatric surgery on the basis that children's bodies are not adult bodies in miniature, but are anatomically and physiologically different and so require special surgical procedures.
This approach allowed Koop to greatly improve the surgical care of children, especially infants. In addition to his invention in anesthesia, Koop made the single most common operation on children, the correction of a hernia, less painful and disfiguring by using a shorter incision and by placing stitches in, not through, the skin. He developed a technique to correct esophageal atresia, a congenital birth defect where the esophagus is detached from the stomach. Over the course of his career he saved nearly 500 such patients. He showed that other once-terminal conditions were correctable, including hydrocephalus--the accumulation of cerebrospinal fluid within the skull--and diaphragmatic hernias, in which the abdominal organs push up into the chest through a hole in the child's diaphragm. In 1977 he gained international attention when he became the first surgeon to separate Siamese twins joined at the heart, and saved the life of one of them. To perform these operations that he pioneered, Koop established the nation's first neonatal surgical intensive care unit in 1956.
Operating on newborns with life-threatening birth defects, spending nights at the bedside of a sick or dying child, and consoling bereaved parents gained Koop acclaim as a pioneering surgeon and empathic healer, and led him to reexamine his Christian faith and the ethical implications of medical procedures, above all abortion and euthanasia. Raised in a church-going family but initially not overtly devout himself, Koop underwent a spiritual awakening in 1948 after he joined the Tenth Presbyterian Church of Philadelphia. "As a person whose training and experience put full faith in science, I came to see an even higher truth. From then on, I saw a coexistence between science and God," he wrote in his autobiography, Koop: The Memoirs of America's Family Doctor, published in 1991. Betty and he found solace in their faith when their son David died in a climbing accident in 1968, a loss they grappled with in a jointly-written book, Sometimes Mountains Move. In the wake of the U.S. Supreme Court's 1973 decision in Roe v. Wade legalizing abortion, Koop began to speak publicly about his fears that abortion devalued human life and would help loosen the moral strictures against the infanticide and euthanasia of other care-dependent members of society, from newborns with birth defects, to persons with disabilities, to the elderly. He expressed his concerns in The Right to Live, The Right to Die, published in 1976, and in Whatever Happened to the Human Race?, a multimedia project, produced in cooperation with the noted theologian Francis Schaeffer in 1978, that included five films and accompanying lectures and seminars.
Through his speeches, publications, and films Koop rose to prominence among anti-abortion activists, and eventually came to the attention of newly-elected president and abortion foe Ronald Reagan, who nominated Koop as U.S. Surgeon General in March 1981. During eight months of controversy and congressional hearings, critics and supporters debated his stance on abortion as well as the question whether Koop, who had devoted his career to treating individual patients, was qualified to address the health needs of the nation as a whole. He was confirmed as U.S. Surgeon General in November 1981.
During his two terms as Surgeon General, Koop made himself the most prominent government spokesman on issues affecting the health of the American public, despite having little statutory authority and a small budget. He infused a renewed sense of confidence and purpose into the Commissioned Corps of the U.S. Public Health Service (PHS), a federal service of public health professionals that the Surgeon General commands and that had been suffering from low morale after the closing of PHS hospitals and the cut-back in personnel in the early 1980s. He examined medical ethics, health care costs, and the problem of the uninsured in a health care system that faced financial challenges at a time of inflation followed by recession in the early 1980s. Koop warned tirelessly against the health hazards of smoking for both active and passive smokers, and launched a campaign for a smoke-free America by the year 2000. He championed the rights of infants with birth defects to receive medical treatment, and the rights of persons with disabilities to have access to public facilities and to employment. He recast issues of law and private morality, namely domestic violence and pornography, as matters of public health, emphasizing their long-term psychological and health effects.
Above all, Koop helped the nation face the most fearsome new pandemic of the century, AIDS. He educated the public on prevention and protection, argued against mandatory testing and quarantine of the infected, and denounced discrimination against AIDS sufferers in schools, the workplace, and housing. He represented the United States at World Health Organization meetings and other international health forums, which during the 1980s became increasingly concerned with the AIDS epidemic. On this and other issues he often surprised supporters and critics alike. He distanced himself from conservatives by declaring that abortion was a moral issue, not one of public health, and thus lay outside the responsibilities of his office. At the same time he found common ground with liberals in stressing the importance of freely available health information, taking on the tobacco industry, and calling for a larger government role in fighting AIDS. Throughout these controversies, Koop saw himself as faithful to the professional principles and religious beliefs that had guided him throughout his career.
Koop resigned in October 1989, a month before the official end of his second term, to become chairman of the National Safe Kids Campaign, an effort to reduce accidents among children, which carried on his final initiative as Surgeon General. During the 1990s Koop continued to speak widely on health care reform, and promoted the use of the Internet for disseminating health information. Koop was widowed in 2007; in 2010, he married Cora Hogue of Philadelphia. Dr. Koop died at the age of 96 on February 25, 2013 at his home in Hanover, New Hampshire.