Plagues and Politics (United States Public Health Service, 1998)


[ Music ] [Narrator:] The Public Health Service, its
people and programs affect the lives of millions of Americans every day. Whether it’s a matter of medical research,
pure food and drugs, contagious diseases, or the delivery of healthcare, the Public Health Service plays a significant role. How the Public Health Service became what
it is today is really the story of public health in America. A story that is still unfolding. Throughout the years, the Public Health Service
has fought its battle in plague-ridden cities and in the corridors of power in Washington. Today’s Public Health Service agencies are
challenged by an ever-changing world, and they respond. The Centers for Disease Control and Prevention
strive to protect citizens from infectious and non-infectious diseases. The Health Resources and Services Administration
supports the training of health professionals and sends them to underserved areas. The National Institutes of Health conduct
basic research on diseases such as AIDS. The Food and Drug Administration hastens the
approval process to bring new drugs to the public. The Substance Abuse and Mental Health Services
Administration provide services for mental, behavioral, and addictive disorders. The health-related concerns connected with
hazardous waste are increasingly important and are the responsibility of the Agency for Toxic Substances and Disease
Registry. A relatively recent addition to the PHS is
the Agency for Healthcare Policy and Research. The Agency strives to assess the effectiveness
of medical care. The Public Health Service also responds to
needy members of the community, providing care to Native Americans through its Indian Health Service. It also assists the elderly, drug addicts,
those with AIDS, and others who might be forgotten. When it started, its mission then as well
was to serve a group that had little access to medical care, merchant seamen. That was in 1798 when an Act of Congress,
signed into law by President John Adams, provided for the government to maintain hospitals for sick or disabled seamen as had traditionally been done in England. [ Whistling and Music ] For its first 80 years or so, what was then
known as the Marine Hospital Fund, was administered by customs inspectors in
the seaports of the new nation. As the United States grew, so did the number
of ports. Marine hospitals and clinics sprouted on the
East Coast as well as the West Coast and up the Mississippi, anywhere there was a waterway in the growing
nation. By 1870, the system needed to be revamped. The reorganization led to the appointment
of the first Surgeon General, John Maynard Woodworth. He had been an Army medical officer in the
Civil War. Woodworth put his officers in uniform, created
a flag, and instituted the military system of appointment by merit. Dr. Woodworth’s reforms were formalized by
law in 1889, when the Commissioned Corps of the U.S. Marine Hospital Service was created. As the Commissioned Corps was expanding during
the closing years of the 19th century, so was biological discovery. The scientific ferment brought changes to
the Marine Hospital Service. It’s Hygienic Laboratory, started in 1887,
was a pioneer in biomedical research. It manufactured biologicals and trained scientists from state health departments in the techniques of producing them. Years later, it became the National Institutes
of Health, the heart of American medical research. In the latter part of the 19th century, the
Marine Hospital Service was given another major responsibility, boarding vessels arriving at U.S. ports to
check passengers and crews for infectious diseases. This task had originally been handled by the
states, but as immigration mushroomed, the responsibility was transferred to the
federal government. At all ports of entry, the Marine Hospital
Service was in charge of inspection of arriving immigrants, including the most important of them of all,
Ellis Island. The Service pioneered the line. It was an efficient way to check for immigrants
with disease, blindness, and mental deficiencies, anyone
who might become a public charge. More than 12 million immigrants, as many as
5,000 a day at times, passed through Ellis Island. under the examining hands and watchful eyes
of the Marine Hospital Service. In 1902, the service was renamed. It became the Public Health and Marine Hospital
Service. In 1912, as legislation increased its scope
of activities, its name was simplified to the Public Health Service. In the early 1900s, the Service led the fight
in investigating dozens of diseases and developing treatments for them. The service battled trachoma, a serious, contagious
eye disease that can cause blindness. Commissioned Corps doctor John McMullen took
his team to the rural hills and hollows of Kentucky. He established a hospital and 11 field clinics. McMullen and his team taught personal hygiene
to local residents to stem the spread of the inflammation. Within 10 years, the incidence of trachoma
cases was drastically reduced. The PHS marshalled its energies in Montana’s
Bitterroot Valley to combat Rocky Spotted Fever.Mountain The disease was carried by ticks on livestock
and other animals. PHS doctor Thomas McClintick, was sent to
Montana to find a way to control the disease. As he searched for a cure he became infected
with the disease and died. Dr. McClintick was one of five PHS officers
who died from Rocky Mountain Spotted Fever. A vaccine to combat the disease was ultimately
developed. One of the most perplexing diseases of the
time was pellagra; 5,000 people a year were dying from it in the early years of the century. PHS physician scientist Joseph Goldberger
carefully studied the disease, visiting the orphanages and prisons where
pellagra struck most often. Most doctors believed the disease resulted
from infection. Convinced of his own theories, Goldberger
and his wife had themselves injected with the blood of those who had the disease. His findings were startling; poor diet, not
infection, caused pellagra. Soon pellagra was conquered by inexpensive
dietary supplements. The Corps pioneered treatment of tuberculosis and bubonic plague control at risk to their own safety. Officers fought the battles in the laboratories
and in the communities as well. In San Francisco and other cities, the officers worked to vanquish the culprits in bubonic plague, rats and ground squirrels and their fleas. Energetic cleanup campaigns over the years
led to the control of the dreaded plague. Venereal disease, particularly at the time
of World War I, was a major concern. [ Music ] The Service developed tests and public education
campaigns and ran research centers like this one in Arkansas. Workers took on child health as a responsibility
too. PHS personnel traveled throughout the countryside
of America examining and inoculating youngsters against
diseases such as typhoid. And then there was the matter of keeping vital
statistics. Early work in biostatistics kept staffers
busy. This was the personal computer of the ’20s. The compilation and interpretation of statistics
relating to health and disease involved the PHS then as now. At the center of PHS work in the ’20s and
’30s was disease control and rural sanitation. Many an officer’s attention was occupied with
privies. There were the good ones, the bad ones, and
the worst ones. Along with evaluating privies, the Service
designed, built, and distributed toilets. The bottom line was good outhouses, worthy
of the approval of the Public Health Service, like this one, bearing the PHS seal. During those years, the Service successfully
battled with dozens of infectious diseases including malaria, typhus, yellow fever, and hookworm. During the ’20s and ’30s, the Marine Hospitals
remained the core of the Public Health Service. The hospitals employed the majority of PHS
personnel and served as a training ground for physicians, dentists, and other clinicians. As the ’30s wore on and the nation struggled
its way out of the depression, the Public Health Service became part of the cure. The Social Security Act of 1935 was landmark
legislation, providing the PHS with the authority to make grants to help develop and improve
state and local health departments. [Dr. Parran:] One of the most significant
events in public health that has occurred in our lifetime… [Narrator:] The Surgeon General at the time,
Dr. Thomas Parran, was an ardent publicist for the health causes of the day. He made syphilis prevention one of the mainstays
of his mission. His outspokenness on the subject led to more
public attention to venereal disease and its prevention. His conservative predecessor, Surgeon General
Hugh S. Cumming, had served four terms in the position and generally opposed PHS assistance in local
health matters. In 1936, President Franklin D. Roosevelt relieved
Cumming as Surgeon General and appointed Parran, the long-time public health officer. The essence of FDR’s New Deal resonated with
Parran’s considerably broader view of public health. During the Roosevelt administration, 55 acres
in then-rural Bethesda, Maryland became the new home of what had originally
been the Hygienic Laboratory. [FDR:] The National Institute of Health speaks
the universal language of humanitarianism. [Narrator:] In 1930, the laboratory’s name
had been changed to the National Institute of Health. The move to Bethesda prepared the NIH for
its period of rapid growth in the post-war years. [FDR:] Recognized no limits. [Narrator:] 1941 saw the country’s entry into
World War II. Public Health Service officers served in several
different branches of the armed forces. Many were assigned to the Coast Guard and
did everything form making sea-borne house calls while on convoy patrol, to supporting amphibious landings. Perhaps one of the most fundamental changes
brought about by the war was in nursing. The strain of wear on the country’s health
care system made it clear that something had to be done to increase the supply of nurses. The answer was the Cadet Nurse Corps, which
was formed to meet the need. Women enrolled in nursing schools and received
a free education. They were paid a salary by the PHS and were
obligated to perform military or federal service in return for their education. Eight-five percent of the nurses graduated
in the years 1943 to ’46 were in the Cadet Nurse Corps. The quality of nursing education was changed
forever. As a result of PHS policy and funding, nursing
schools were no longer in the shadow of hospitals, which had previously been their sole sponsors. It was a tremendous boost to the profession. The PHS’s most important legacy from World
War II was the Atlanta-based Malaria Control in War Areas Program, often referred to as the MCWA. Malaria control was a major activity in the
American South and the Caribbean during the war. At the end of the war it became clear that
the MCWA had developed an important role in infectious disease, research, and control. So it was continued, providing practical applications
in public health research techniques to problems such as Typhus control. The agency remained at its Atlanta base and
was renamed the Communicable Disease Center and later, as we know it today, the Centers for Disease
Control and Prevention. With a greatly expanded role, CDC handles
everything from highly toxic viruses to quarantine expertise for the space program. Along with the valuable work of the CDC, PHS
dentists like H. Trendley Dean were making major contributions to the nation’s health. In the 1940s, 95 percent of the population
suffered from tooth decay. But in some parts of the country, people had
low levels of decay, though their teeth were mottled and pitted. PHS researchers in the field and the labs
were the prime detectives in solving the case. NIH dentists determined that the teeth were
mottled because of elevated levels of fluoride in drinking water and that fluoride led to
a reduction in tooth decay. In 1945, Grand Rapids, Michigan was the first
city to test this proposition. At 4 p.m. on January 25th, 1945, Grand Rapids
began adding fluoride to its water supply. Schoolchildren actively participated. The results were astounding. Fluoride in the water reduced dental caries
by as much as 60 percent. Fluoridation became the principal public health
strategy in the prevention of tooth decay. Since the early 1900s, dental and medical
care for Native Americans had been provided by PHS personnel on loan to the Indian Field Service. But in 1954, an act of Congress transferred
formal responsibility for the health of American Indians to the Public Health Service. It was the hope that a program administered by health professionals could improve the health of Indians. That proved to be the case. By 1960, Native American infant mortality
had declined by almost 25 percent, and the death rate from tuberculosis by almost 50 percent. Today, that program is an agency of the PHS,
the Indian Health Service. Public health physicians also serve the needs
of another, often forgotten, sector of the population, prison inmates. Since 1930, PHS officers have worked with
the Bureau of Prisons, its facilities and hospitals. Environmental health issues surfaced in the
’40s. In steel towns like Donora, Pennsylvania,
smog made 6,000 people ill and killed another 120. Along with air pollution, concerns about water
pollution were mounting as well. Radiation in the atmosphere from nuclear testing was apparent. The PHS began to study radiation and its biological
effects. Environmental health concerns have stayed
on the scene, growing in prominence. Within the CDC, public health teams deal with
toxic substances, and since the ’70s, the National Institute for Occupational Safety and Health has dealt with a myriad of industrial and environmental issues. Post-war development in biomedical research
paid rich dividends and led to Nobel Prize honors for dozens of
investigators supported by NIH grants. Four NIH scientists have been Nobel Laureates:
Marshall Nirenberg for breaking the genetic code. Julius Axelrod for his work on the central
nervous system, Christian Anfinsen won a chemistry prize for
work on amino acids, and Carlton Gajdusek for isolating a virus
fatal among natives of New Guinea. As reflected in Dr. Gajdusek’s work, international health had become an area of importance for the PHS, one with notable successes. The CDC, for instance, provided leadership
with a global campaign that resulted in the conquest of smallpox. In 1967, Surgeon General William Stewart had
pledged PHS personnel to the World Health Organization campaign against smallpox. More than 300 PHS physicians, scientists,
and public health workers, led by the CDC’s Dr. D.A. Henderson, went all over the globe to fight the battle
and they won. By 1977, smallpox had been eradicated throughout
the world. In the 1960s, reorganization brought new programs
to the PHS fold. One of the most significant was the Food and Drug Administration, which had been an independent agency since its inception in 1906. Its original responsibility was for the protection
of the American consumer against adulterated or mislabeled food and drugs. [ Music ] Today the agency sets standards in the areas
of food, drugs, cosmetics, radiation, health, and medical devices. The agency has labored to expedite and improve
the approval process for new drugs. Reorganization in the early 1970s established
the PHS in its essential form of today. One of those changes was bringing programs
for mental and addictive disorders together into one agency. Today, the Substance Abuse and Mental Health
Services administration administers prevention and treatment programs in these areas, while research activities in mental health
and substance abuse are carried out by the National Institutes of Health. During the 1970s, the PHS became heavily involved
in the delivery of health services to poor, isolated populations. The Community Health Center Program supported
more than 800 health centers throughout the country and provided medical care workers to these
communities through the National Health Corps. Service These programs remain a vital part of the
Public Health Service today as the needs of the medically underserved continue to grow. The Health Resources and Services Administration
supports both state and community efforts to serve those who are less fortunate and provides health
care practitioners to staff those systems. The organization continues to support the
education of health professionals through scholarships and training programs. To assure the quality and effectiveness of
health services, the Agency for Health Care Policy and Research has been established. It sponsors health services and medical outcomes research toward the goals of improving the practice, organization, financing, and delivery of health care services. The PHS has led the national and global battle
against HIV and AIDS, carrying out primary research on the virus
and sponsoring prevention and treatment programs throughout the country. All of the agencies of the PHS are engaged
in this monumental public health campaign. The Public Health Service is made up of both
civil service and Commissioned Corps members. In addition to staffing the agencies of the
PHS, the Commissioned Corps provides clinical and scientific personnel for the Bureau of Prisons, the Coast Guard, the Environmental Protection Agency, and the National Oceanographic Atmospheric Administration. In the 1980s, Surgeon General C. Everett Koop
captured the public eye, bringing visibility to health issues with
his outspoken reports on AIDS and smoking. Today, the Public Health Service is part of
the Department of Health and Human Services, and the heads of its agencies, now called
operating divisions, report to the Secretary of Health and Human Services. The Assistant Secretary for Health and the
Surgeon General advise the Secretary on health policy and programs. The operating divisions of the Public Health
Service provide clinical care while protecting the consumer through regulation of food, drug,
and medical devices. The service also continues to conduct biomedical
and behavioral and health services research throughout the United States and around the
world. The PHS maintains its tradition of public
health campaigning with its Healthy People program to promote health awareness and public action
throughout the United States. And the service continues its scientific and
public education battle against the epidemic of disease caused by tobacco. [ Music ] With a wealth of achievements and a proud
history, the Public Health Service protects and advances the health of the American people. It does so with its special blend of science
and government, tradition and topicality, public service and
personal commitment. Its work continues to respond to the ever-changing
mandates of science, the dictates of government, and the needs
of the people. [ Music ] This videotape is based on the book Plagues and Politics: The Story of the United States Public Health Service, written by Dr. Fitzhugh Mullan.

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