United States Public Health Service

The Public Health Service Act of 1944 structured the "United States Public Health Service" (PHS), founded 1798, as the primary division of the U.S. Department of Health, Education and Welfare (HEW), (which was established in 1953), which later became the United States Department of Health and Human Services in 1979-1980, (when the Education agencies were separated into their own U.S. Department of Education). The Office of the Surgeon General was created in 1871. The PHS comprises all Agency Divisions of Health and Human Services and the Commissioned Corps. The Assistant Secretary for Health (ASH) oversees the PHS and the United States Public Health Service, Commissioned Corps.

Agencies
Agencies within the Public Health Service
 * Agency for Healthcare Research and Quality (AHRQ)
 * Agency for Toxic Substances and Disease Registry (ATSDR)
 * Centers for Disease Control and Prevention (CDC)
 * Food and Drug Administration (FDA)
 * Health Resources and Services Administration (HRSA)
 * Indian Health Service (IHS)
 * National Institutes of Health (NIH)
 * Substance Abuse and Mental Health Services Administration (SAMHSA)

United States Public Health Service Commissioned Corps
The United States Public Health Service Commissioned Corps (PHSCC) employs more than 6,000 public health professionals for the purpose of delivering public health promotion and disease prevention programs and advancing public health science. Members of the Commissioned Corps often serve on the frontlines in the fight against disease and poor health conditions.

As one of the United States seven uniformed services, the PHS Commissioned Corps fills public health leadership and service roles within federal government agencies and programs. The PHS Commissioned Corps includes officers drawn from many professions, including environmental and occupational health, medicine, nursing, dentistry, pharmacy, psychology, social work, hospital administration, health record administration, nutrition, engineering, science, veterinary, health information technology, and other health-related occupations.

Officers of the Corps wear uniforms similar to those of the United States Navy with special PHSCC insignia, and the Corps uses the same commissioned officer ranks as the U.S. Navy, the U.S. Coast Guard, and the Commissioned Officer Corps of the National Oceanic and Atmospheric Administration from ensign to admiral, uniformed services pay grades O-1 through O-10 respectively.

Mission
The mission of the U.S. Public Health Service Commissioned Corps is to protect, promote, and advance the health and safety of the United States. According to the PHSCC, this mission is achieved through rapid and effective response to public health needs, leadership and excellence in public health practices, and advancement of public health science.

History
The origins of the Public Health Service can be traced to the passage, by the 5th Congress of the United States, of "An Act for the Relief of Sick and Disabled Seamen" in 1798. The earliest Marine Hospitals created to care for the seamen were located along the East Coast, at the harbors of the major port cities, with Boston being the site of the first such facility, followed later by others including in the Baltimore vicinity at Curtis Bay. Later they were also established during the 1830's and 1840's along inland waterways, the Great Lakes, and the Gulf of Mexico. By the 1850's to the Pacific Coasts as the country expanded westward. Funding for the hospitals was provided by a mandatory tax of about 1% of the wages of all maritime sailors.

A reorganization in 1870 converted the loose network of locally controlled hospitals into a centrally controlled Marine Hospital Service, with its headquarters in Washington, D.C. The position of Supervising Surgeon (later titled the Surgeon General) was created to administer the Service, and John Maynard Woodworth, (1837-1879), was appointed as the first incumbent in 1871. He moved quickly to reform the system and adopted a military model for his medical staff, instituting examinations for applicants and putting his physicians in uniforms. Woodworth created a cadre of mobile, career service physicians who could be assigned as needed to the various Marine Hospitals. The commissioned officer corps (now known as the Commissioned Corps of the U.S. Public Health Service or the Public Health Service, Commissioned Corps) was established by legislation in 1889, and signed by 22nd/24th President Grover Cleveland. At first open only to physicians, over the course of the 20th Century, the Corps expanded to include veterinarians, dentists, physician assistants, sanitary engineers, pharmacists, nurses, environmental health officers, scientists, and other types of  health professionals.

The scope of activities of the Marine Hospital Service also began to expand well beyond the care of merchant seamen in the closing decades of the nineteenth century, beginning with the control of infectious disease. Quarantine was originally a State function rather than Federal, but the National Quarantine Act of 1878 vested quarantine authority to the Marine Hospital Service and the National Board of Health. The National Board was not reauthorized by Congress in 1883 and its powers reverted to the Marine Hospital Service. Over the next half a century, the Marine Hospital Service increasingly took over quarantine functions from State authorities.

As immigration increased dramatically in the late 19th Century, the Federal Government also took over the processing of immigrants from the States, beginning in 1891. The Marine Hospital Service was assigned the responsibility for the medical inspection of arriving immigrants at sites such as Ellis Island in New York Harbor. Commissioned officers played a major role in fulfilling the Service's commitment to prevent disease from entering the country.

Because of the broadening responsibilities of the Service, its name was changed in 1902 to the "Public Health and Marine Hospital Service", and again in 1912 to just the "Public Health Service", as the emphasis and decommissioning of the various old Marine Hospitals began. The Service continued to expand its public health activities as the Nation entered the 20th Century, with the PHS's Commissioned Corps leading the way. As the century progressed, PHS commissioned officers served their country by controlling the spread of contagious diseases such as smallpox and yellow fever, conducting important biomedical research, regulating the food and drug supply, providing health care to underserved groups, supplying medical assistance in the aftermath of disasters, and in numerous other ways.

Today the mission of the Commissioned Corps of the PHS is "Protecting, promoting, and advancing the health and safety of the Nation."

Tuskegee Study of Untreated Syphilis in the Black Male
In 1932, the Public Health Service, working with the Tuskegee Institute in Tuskegee, Alabama, began a study to record the natural history of syphilis in hopes of justifying treatment programs for blacks. It was called the "Tuskegee Study of Untreated Syphilis in the Negro Male".

The study initially involved 600 black men – 399 with syphilis, 201 who did not have the disease. The study was conducted without the benefit of patients' informed consent. Researchers told the men they were being treated for "bad blood," a local term referring to several ailments, including syphilis, anemia, and fatigue. In truth, they did not receive the proper treatment needed to cure their illness. In exchange for taking part in the study, the men received free medical exams, free meals, and burial insurance. Although originally projected to last 6 months, the study actually went on for 40 years. It has been called "arguably the most 'infamous' biomedical research study in U.S. history."

Syphilis Studies in Guatemala
A USPHS physician who took part in the 1932-1972 Tuskegee program, John Charles Cutler, was in charge of the U.S. government's syphilis experiments in Guatemala, in which in the Central American Republic of Guatemala, Guatemalan prisoners, soldiers, orphaned children, and others were deliberately infected with syphilis and other sexually-transmitted diseases from 1946-1948, (coincidentally at a time of civil unrest and turmoil in the country including later alleged CIA involvement by 1954 in a coup de etat) in order to scientifically study the disease, in a project funded by a grant from the National Institutes of Health of the United States in Bethesda, Maryland.

Secretary of State Hillary Clinton apologized to the Republic of Guatemala for this program in 2010, in light of the now serious ethical lapses in moral judgement which occurred, even just 60 years ago.

Emergency response since 1999
Commissioned Corps emergency response teams are managed by the Office of the Surgeon General. They are trained and equipped to respond to public health crises and national emergencies, such as natural disasters, disease outbreaks, or terrorist attacks. The teams are multidisciplinary and are capable of responding to domestic and international humanitarian missions. Officers have responded to many such emergencies in the past, including:


 * 1999 - Hospital center at Fort Dix, New Jersey, for Kosovo Refugees
 * 2001 - September 11 attacks
 * 2001 - 2001 anthrax attacks
 * 2004 - 2004 Indian Ocean earthquake and tsunami
 * 2005 - Hurricane Katrina
 * 2005 - Hurricane Rita
 * 2006 - 2006 Hawaii earthquake
 * 2007 - Medicine Contamination in Panama
 * 2008 - Hurricane Gustav
 * 2008 - Hurricane Ike
 * 2009 - 2009 Samoa earthquake
 * 2010 - 2010 Haiti earthquake
 * 2010 - Deepwater Horizon oil spill
 * 2011 - 2011 Japan Tsunami and Earthquake
 * 2012 - Hurricane Sandy - New York/New Jersey coastal areas

Notes and references
"This article is based on the public domain text History of the Commissioned Corps, PHS"