The reason this lecture is included in the archive is that it goes into the history of the development of the Public Health
Service, the vicissitudes of the formation of the Sanitary Bureau and some of the contributions of Hawaii to public health
that appear no where else in this archive and are hard to find elsewhere as well. It also goes on to honor an individual who
is responsible - in the early days - for a lot of things that came to pass in public health.
This was the 16th Ira Hiscock lecture. I knew seven of the previous presenters personally. Dr. Hiscock was educated in New
England, as was I, and he became fascinated with the potential of public health, as am I, and he left a legacy in public health
that will be long remembered. I hope some day someone can say the same thing about me.
I then launched into the history and the mission of the Public Health Service starting back with President John Adams signing
into law in 1798, the system of "Marine Hospitals" from which we had our origin. I talked about the International
Sanitary Conferences that were held between 1851 and 1874 - mostly concerned with the spread of cholera. The Conferences,
unfortunately, were not successful mainly because too little was known about the etiology and transmission of cholera and
other contagious diseases. And then the United States, at that time, was still sharing George Washington's opinion that
we ought not to become involved in Europe's problems.
I spoke of Dr. John Woodworth, one of my most illustrious predecessors - already in charge, but later to become Surgeon General
and his call for international action, especially against cholera and yellow fever. The United States did take leadership
in the discussions thereafter, and began its long and continued participation in international health cooperation. Eventually,
the Public Health Service was reorganized in 1912, which saw the end of the Marine Hospital Service and the beginning of the
representation in international health circles of the Public Health Service of the United States.
Before that in 1902, the Pan American Sanitary Bureau was organized and by 1924, the members of the Bureau had ratified a
Pan American Sanitary Code, which helped establish uniform public health procedures throughout the Americas. The influence
of the Public Health Service on American Sanitary Bureau was unquestionable and a little known fact is that from its creation
in 1902 until 1936 all the Surgeons General of the Public Health Service were also Directors of the Pan American Sanitary
I then ticked off some of the landmarks of the 20th Century, such as helping South American countries eliminate plague, the
introduction of preventive medicine, the improvement of environmental health and sanitation, the fight against yellow fever
and malaria, and the role the PHS personnel played in developing nursing schools and other professional institutions throughout
the United States.
Here, I turned to Hawaii where we were honoring Dr. Hiscock. In 1912 Frederick E. Trotter was assigned to the then-territory
of Hawaii to take charge of the expanding quarantine station. Dr. Trotter was a member of the Commissioned Corps and an experienced
internationalist, and served in many foreign posts at the Surgeon General's direction. On the day I gave this talk, his
grandson, also named Frederick E. Trotter was there to honor Dr. Hiscock. Although a business man, he was chairman of Governor
Waihee's Pacific Health Promotion and Development Center, an internationally recognized outreach activity.
Then, came World War II, which started in Hawaii on December 7, 1941 and in the midst of that war and in response to the human
cost of war, the biomedical sciences came up with a number of major advances in drugs, antibiotics, surgery, and physical
rehabilitation. Because the United States was virtually untouched by any of the actual fighting of World War II, we were the
only nation equipped and able to lead the world in restoring the health of other societies that had been devastated by war.
As of the time I was speaking, we still had six public health officers assigned to the United States Pacific territories and
another 9 officers assigned to the Freely Associated States in the Pacific. In short, the Public Health Service became the
Health Arm of the United States Foreign Assistance Program.
When the World Health Organization emerged in 1948, it absorbed the role and the staff of the old International Office of
Public Hygiene and took as a constituent member the Pan American Sanitary Bureau, which later became known as the Pan American
In 1945, as World War II was ending, Surgeon General Thomas Parran rose to great heights, because it was he who told the United
States State Department that the draft charter of the United Nations did not adequately provide for the creation of an international
health organization, and with the State Departments approval and encouragement, Dr. Parran became a key figure at the planning
meeting in Paris and it was he and several Public Health Service officers who put forth the proposal that was to become, two
years later, the World Health Organization. So, the PHS, since its beginning has had an active role in world affairs.
One of the greatest public health efforts of all time was the eradication of small pox. This idea was conceived by the Public
Health Service, a ten-year program, which was directed by a PHS officer.
That brought us to the present time and I reminded the audience that since 1982, I was the chief delegate to the World Health
Assembly each year, but did not mention that I also substituted for the Assistant Secretary of Health at Executive Committee
meetings of WHO on several occasions. The World Health Organization eventually espoused the cause of controlling tobacco and
organized the world in the battle against AIDS. Even today, a PHS officer directs the WHOs "expanded program" on immunization;
another directs the very effective Diarrheal Disease Control Program, and the Acute Respiratory Infections Program. Other
PHS officers are detailed to WHO and the Pan American Health Organization, working in control of Malaria and other parasitic
diseases, as well as the prevention of AIDS.
Inasmuch as I was the Director of International Health for the Public Health Service from March 1982 on, I could speak with
personal experience about our bi-lateral health program with 30 nations and our work with the Agency for International Development
where we provided technical expertise for its projects.
The audience was reminded that the Public Health Service was ready to provide - on 24 hours' notice - emergency aid anywhere
in the world, and I gave examples - six huge disasters, all outside the borders of the United States into which we stepped
for health control and future planning.
By predicting that the international cooperative relationships we had forged over the past century would be strengthened,
I thought the United States would make its second and equally significant contribution to world health, and that was helping
other nations build their own long-term biomedical research capacity. We have much to be proud of and much expertise accumulated
at the National Institutes of Health, the Food and Drug Administration, the Centers for Disease Control, and our Alcohol,
Drug Abuse, and Mental Health Administration. I also, predicted that Hawaii would continue to play a major role as the bridge
between the mainland and the Pacific Basin.
I recounted the places I had visited in Hawaii as part of Hawaii's recognition of the 200th Anniversary of the founding
of the Commissioned Corps, being celebrated during 1989 and closed on a personal note with this being my final year as the
13th Surgeon General. I felt I had done as well as I could, but I regretted that I somehow did not do more. But I held high
in my list of memories the times that I spoke with and listened to my colleagues from many other nations - times when we put
aside the barriers of race and culture and nationality and worked together on to improve the health and well-being of the
(There has been omitted from this lecture a number of quotations that had to do with the writings of Ira Hiscock in whose
honor the lecture had been given.)