Luther Terry was the Surgeon General of the United States during the Kennedy Administration and the first part of the Johnson Administration, from 1961 to 1965. Terry changed the nature of the office, which until that time was obscure enough so that many Americans did not know there was such a post. Since Terry's time, and specifically because of one important action he took, the office of Surgeon General has been more prominent, taking the lead in public health issues and ruffling feathers in many American industries. Terry issued his report on smoking and its dangers in 1964, leading to the greater prominence of anti-tobacco forces, the warnings on cigarette packages, the banning of cigarette ads on television and radio, and recently court and legislative actions taken against the tobacco industry after decades of resistance.
Terry's action in issuing the report on smoking is much better known than Terry himself, as Patton and Barron note when they writes,
Before 1964, when Luther Terry issued his famous report on smoking, few people knew that there was such a thing as the United States Surgeon General, and fewer still knew his name. Today everyone knows of the Surgeon General, but who can name the one behind the Surgeon General's report? (Patton and Barron 90).
There has been a Surgeon General with that title since 1871. Congress had established the U.S. Marine Hospital Service in 1798, and that was the predecessor of today's U.S. Public Health Service. The purpose was to provide health care to sick and injured merchant seamen. The Marine Hospital Service was reorganized in 1870 as a national hospital system with centralized administration under a medical officer, the Supervising Surgeon, later change to the Surgeon General ("History of the Office of the Surgeon General"). The service became the Public Health Service in 1912 and was made part of the Department of Health, Education and Welfare in 1953. Luther L. Terry became Surgeon General in 1961. His research specialty had been hypertension, a problem clearly linked to smoking. Terry joined the Public Health Service in 1941, when he was in his early thirties, and he would end his career in 1982 as a professor of medicine at the University of Pennsylvania. He clearly changed the office:
After Terry, the Surgeon General became a character on the political stage, and such successors as C. Everett Koop in the 1980s and Joycelyn Elders in the 1990s frequently took the center of it in debates about issues ranging from abortion to drug legalization (Patton and Barron 90).
For most of its history, the office of Surgeon General was noncontroversial. That would change with Luther L. Terry and his smoking report and recommendations, though interestingly Terry was not the first Surgeon General to address this question. Surgeon General Hugh Cumming in 1929 stated that "cigarettes tended to cause nervousness, insomnia, and other ill effects in women" and "warned that smoking could lower the 'physical tone' of the nation" (Parascandola 440). Cumming's challenge to smoking was rather weak. It was directed only at women smokers, for one thing, for it was generally accepted at the time that women are more susceptible than men to certain injuries to the nervous system. Cumming was a smoker himself, and the reason he spoke out at all may have been because of an aggressive advertising campaign aimed at women and young people. Cumming's attack did not have any significant consequences, and indeed, his view was typical for physicians in the 1920s, holding that smoking was not a significant health threat for most people (Parascandola 440-441).
This view wold begin to change over the next several decades, beginning in the 1930s as cases of lung cancer began to increase. Dr. William McNally of Rush Medical College suggested in 1932 that cigarette smoking was an important factor in these cases, and the medical literature began to reflect this view. The idea was not yet widely accepted, however, and many physicians noted that a "statistical correlation between an increase in cigarette smoking and an increase in lung cancer does not prove that there is a causal connection" (Parascandola 441). Critics argued that other factors, including increasing atmospheric pollution from automobile exhausts, might also explain the rise in the incidence of cancer (Parascandola 441).
Research continued, and antismoking groups took up then argument. There had been an antismoking campaign for some time, spearheaded by the American Cancer Society in the early 1960s. A Gallup poll conducted in 1962 showed that only 38% of those responding believed that smoking caused lung cancer. The Federal Drug Administration (FDA) used the 1960 Federal Hazardous Substances Labeling Act to decide whether substances suspected of being toxic, irritating, corrosive, flammable, strongly-sensitizing, or pressure-generating should be regulated, and at the time the FDA refused to find cigarettes hazardous in any of these ways. The American Cancer Society joined with the American Heart Association, the National Tuberculosis Association, and the American Public Health Association to write a letter to President Kennedy to form a national commission on smoking. Kennedy sent the letter to Health, Education, and Welfare Secretary Abraham Ribicoff, who, under pressure, arranged a meeting four months later with these groups and Luther L. Terry. He agreed to consider the commission on smoking but did nothing immediate (Kluger 222).
Senator Maurine Neuberger introduced the resolution to establish this commission even though she was certain it would not pass in congress, and nothing was done for two months. When a reporter asked President Kennedy what he intended to do about smoking and health, Kennedy put off answering. The White House then asked the Public Health Service what it was doing about the issue, and two weeks later, Terry announced that he would create a blue-ribbon advisory committee to examine the issue and make recommendations. This was not the kind of commission Senator Neuberger had intended, but her resolution helped get things going (Wagner 124-125).
Members of this committee were carefully chosen, for the Surgeon General knew that the issuance of such a report would have a significant impact on the public. He also wanted more power to fight smoking. The committee was not supposed to create a new scientific study of the issue but was rather meant to review the existing evidence. The way the ten members were chosen suggests that Terry wanted to influence public opinion. The commission included scientific and professional people, and Terry asked the tobacco industry, health groups, federal agencies, and professional associations to help by selecting names from a list of 150 scientists. Those chosen were paid a consultant fee and then set to work with a large staff to assist. There was one surprising reaction as soon as the commission was chosen. Leroy Collins was president of the National Association of Broadcasters, representing an industry that gained much from cigarette advertising. He called on the industry to take "corrective action" to stop certain kinds of commercials directed at children (Wagner 126-129).
The report was released on January 11, 1964 at a press conference held behind closed doors in the State Department auditorium. This was a Saturday, chosen to minimize the effects of the report on the stock market and to be certain there was coverage in the Sunday newspapers:
All of the approximately 200 reporters attending were required to remain for the entire session. Each was given a copy of the final report and allowed to study it for about an hour. Reporters were then permitted to question the Surgeon General and the committee members about the report. Finally the doors were opened and the reporters raced out to file their stories. Surgeon General Luther Terry later recalled: "The report hit the country like a bombshell. It was front page news and the lead story on every radio and television station in the United States and many abroad." That report is now viewed, and justly so, as a milestone in the campaign against tobacco in this country (Parascandola 90).
The document, now referred to as the first Surgeon General's Report on Smoking and Health, was based on an analysis of more than 7,000 articles relating to smoking and disease in the biomedical literature. The Advisory Committee then concluded that cigarette smoking is a cause of lung cancer and laryngeal cancer in men, a probable cause of lung cancer in women, and the most important cause of chronic bronchitis, and the committee further stated, "Cigarette smoking is a health hazard of sufficient importance in the United States to warrant appropriate remedial action" ("History of the 1964 Surgeon General's Report on Smoking and Health").
The issuance of this report created an opportunity for other federal agencies to take action. The Federal Trade Commission (FTC) report and now wanted to regulate tobacco. Within one week after the report was issued, the FTC began holding public hearings on a proposed trade regulation that would require warnings on cigarette packages and advertising. This proposal was supported by some and bitterly fought by the tobacco industry. As part of its strategy,…