A Straight Dope Classic from Cecil's Storehouse of Human Knowledge

Why does the U.S. surgeon general wear a uniform?

August 26, 1994

Dear Cecil:

Why does the United States Surgeon General appear in a military uniform? Have they always done so? Is it because they are leading the nation's battle against disease, smokers, and ill health in general?

Cecil replies:

The surgeon general wears a uniform because the organization of which she is the chief, the U.S. Public Health Service, is a uniformed service. So are mail carriers, you may say, but the postmaster general doesn't get to dress like Horatio Hornblower. The difference is that the PHS began as the Marine Hospital Service, which was organized along military lines in 1870 to minister to merchant sailors. The members were (and still are) given military-style commissions and naval-style ranks, the idea being that they were a mobile force ready to be thrown into the fray wherever germs raised their ugly little heads. One supposes the fact that MHS doctors often served alongside regular military personnel (e.g., in military camps during wars) and sometimes had to order them around also argued for ranks and uniforms. The Marine Hospital Service was reorganized as the Public Health Service in 1912 and transferred to what is now the Department of Health and Human Services, but the military trappings remain.

Some PHS officers today do lead a semimilitary-type existence, serving tours of duty on Indian reservations or in prisons and the like. But many others are longtime medical researchers at federal labs who joined the PHS rather than the civil service mainly because of the attractive retirement benefits. (You can leave with a nice pension after just 20 years.) Uniforms had fallen into disuse until C. Everett Koop was appointed surgeon general by Ronald Reagan. Koop conceived of his post as a bully pulpit and thought the uniform (the SG is the equivalent of a three-star admiral and has a similar uniform) would get people to take him more seriously. Instead, at least at the outset, it got them to take him for an airline steward, and Koop good-naturedly hoisted a few bags into the overhead bins for fellow passengers.

Eventually, though, Koop's considerable personal presence enabled him to put the uniform thing over, so much so that he decided all commissioned PHS personnel should start wearing them. This rankled the troops and the current SG, Joycelyn Elders, has not insisted that they be worn. But she puts one on herself when she makes official appearances and one gathers they are seen more commonly on PHS officers than they used to be. The whole thing may incline us civilian scoffers to make jokes about swords and epaulets and crossed-hypodermic insignias. But Koop and Elders have spoken out forcefully on public health issues like AIDS and smoking, and if uniforms help get the message across, why not?

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