C. Everett Koop, MD, FACS, former U.S. Surgeon General, renowned pediatric surgeon, and public health advocate

Dr. Koop

On February 25, America and the world lost a great humanitarian, C. Everett Koop, MD, FACS, who died peacefully at age 96 in Hanover, NH. His entire life had been directed toward helping others, most recently founding the Koop Institute at Dartmouth College’s Geisel School of Medicine in Hanover.

Born an only child in Brooklyn, NY, on October 14, 1916, Dr. Koop’s earliest aspirations were to become a physician, indeed a surgeon. A neighbor’s son who was a medical student at Columbia allowed him to be an observer in their operating room galleries. From that experience, Dr. Koop learned rudiments of simple surgical procedures, which he performed on stray animals with his mother, a social worker, administering ether anesthesia.

In 1933 at age 16, he matriculated at Dartmouth College as a premedical student in zoology, choosing to take a fourth undergraduate year, instead of enrolling in Dartmouth’s then two-year medical school. In 1938 he married Elizabeth (Betty) Flanagan, a student at Vassar College whom he had met while at Dartmouth, and in 1941, Dr. Koop was awarded his MD degree from Cornell University Medical School, New York, NY.

Dr. Koop started his surgical residency training at the University of Pennsylvania in Philadelphia under Isidor S. Ravdin, MD, FACS. On December 8, 1941, while hospitalized with an acute duodenal ulcer, in the turmoil of the day after Pearl Harbor, he learned that Dr. Ravdin would soon depart from the university to serve in the Army Medical Corps. Dr. Ravdin told Dr. Koop that he would declare him to be essential to the university for the duration of the war. A tibial nonunion and the duodenal ulcer disqualified Dr. Koop from active duty. He spent the war years in surgical training at the University of Pennsylvania, where he conducted research into plasma substitutes.

At the end of World War II, Dr. Koop was planning for a future in cancer surgery. However, Providence presented an opportunity that he had not considered, namely pediatric surgery. There being no reliable coverage of pediatric surgical problems at the University of Pennsylvania, Dr. Ravdin again turned to Dr. Koop to fill that need. After an introductory stay at Children’s Hospital of Philadelphia (CHOP) he was sent to Children’s Hospital in Boston, MA, for a postgraduate stint with William E. Ladd, MD, FACS, and Robert E. Gross, MD, FACS.

Pioneer pediatric surgeon

In 1947, at age 31, Dr. Koop returned to Philadelphia. He said the other physicians at CHOP needed time to adapt to a surgeon being in charge of pediatric surgical patients. He established a world-renowned training program, and his own 35-year career in pediatric surgery as surgeon-in-chief. By 1951, he had trained 38 pediatric surgical fellows, many of whom relocated to other hospitals that by then had recognized the need for this emerging specialty. Although Dr. Koop trained in many types of surgery during the war years, he recognized the need for full-time surgeons in pediatric general surgery, urology, cardiac surgery, plastic surgery, ophthalmology, otolaryngology, orthopaedics, and neurosurgery and recruited excellent individuals to run each of those units in the department of surgery.

Dr. Koop with President Ronald Reagan on his appointment as Surgeon General.

Children’s surgery was a recognized specialty in Europe before it was established in America. Dr. Koop became the founding editor of the Journal of Pediatric Surgery in 1964. He also served as the surgical editor for the Journal of Clinical Pediatrics, as a member of the editorial board of Zeitschrift für Kinderchirurgie, and as an editorial consultant for the Japanese Journal of Pediatric Surgery and Medicine.

He established America’s first neonatal intensive care unit in collaboration with the anesthesia department of CHOP. In 1968, Stanley Dudrick, MD, FACS, then a surgical resident at the University of Pennsylvania Hospital, demonstrated the feasibility of long-term parenteral alimentation in an infant with massive loss of intestine. That modality has saved thousands of lives since then in patients of all ages.

Dr. Koop was author or coauthor of more than 230 articles and books on surgery, medical ethics, and health policy. He was awarded 41 honorary doctorates and multiple prestigious awards, including the William E. Ladd Medal of the American Academy of Pediatrics and the Denis Browne Medal of the British Association of Pediatric Surgeons to mark outstanding contributions to pediatric surgery. He was awarded the Medal of the Legion of Honor by France in 1980 and honorary memberships in the Royal College of Surgeons of England in 1982, the Royal College of Physicians and Surgeons of Glasgow in 1987, the Royal College of Surgeons of Edinburgh in 2009, and the Royal College of Medicine in 1997. Dr. Koop was a member of the American Surgical Association, the Society of University Surgeons, and served in 1971 as the second president of the American Pediatric Surgical Association.

Dr. Koop as U.S. Surgeon General.

U.S. Surgeon General

As his unique surgical career was coming to a close, Dr. Koop began another full-time career that was destined to save millions of lives worldwide. President Ronald Reagan appointed him to serve as the nation’s 13th Surgeon General and Director of the Office of International Health on November 17, 1981. His confirmation was not immediately forthcoming when proposed by the President, for he spoke passionately about various public heal

h issues, such as the addictive and carcinogenic hazards of tobacco, which inspired vehement denials from the tobacco industry. In 1982, he wrote “The Surgeon General’s Report on Smoking and Health,” which led to marked reduction in the number of places where smoking was allowed and therefore a significant decrease in the number of people exposed to secondhand smoke. As Surgeon General, he was in charge of the 6,000-member U.S. Public Health Service Commissioned Corps, and advised the President and the public on health matters, such as smoking, diet and nutrition, immunization, and disease prevention.

In 1986, the President requested that Dr. Koop prepare a report on Acquired Immune Deficiency Syndrome (AIDS). David Baltimore, MD, chairman of the National Academy of Sciences, lauded Koop as a hero, as the one person in the Reagan Administration who was acting positively and practically in confronting this dreaded new disease—even to the point of advocating use of condoms, a measure seldom discussed in those times. In 1995, President Clinton awarded Dr. Koop the Presidential Medal of Freedom, America’s highest civilian honor. His lasting legacy as Surgeon General was to use medical evidence, not politics, to give thoroughly honest information on health care.

Dr. Koop and his wife Betty with (left to right:) Betsy, Norman, David, and Allen on the occasion of Dr. Koop’s first honorary degree, as Doctor of Laws from Eastern Baptist College.

Return to his roots

In 1992, Dr. Koop and Elizabeth returned to Hanover. Betty died in 2007. The Koops had previously lost one of their three sons, David Charles, who perished while mountain climbing. On April 1, 2010, Dr. Koop married a longstanding church friend, Cora Hogue, in the Tenth Presbyterian Church in Philadelphia, PA. My wife and I were pleased to be there for that happy occasion.

The final chapter for “Chick” (a nickname given to him as an undergraduate at Dartmouth) was the founding of the C. Everett Koop Institute at Dartmouth’s Geisel School of Medicine. Dr. Koop created the institute as a way to shape medical school curricula to provide students not only with scientific knowledge, but also to instill Hippocratic principles, such as dedication to the patient, the family, and the community. His leadership led to founding the Dartmouth Center on Addiction, Recovery, and Education, which emphasizes tobacco as a powerful and dangerous scourge across the globe. The C. Everett Koop Institute is a collaborative partnership of educators, scholars, researchers, students, and practicing physicians designed to address critical new health care issues. After serving nearly four decades as a pioneer in pediatric surgery, Dr. Koop shifted his focus seamlessly to improving the health of millions of people of all ages worldwide.

A beautiful memorial service of praise and thanksgiving for the life and spirit of Charles Everett Koop took place at the First Congregational Church of Woodstock, VT, on March 9. His son, the Reverend Norman A. Koop, led the service with all Koop family members taking an active part in the service. A large contingent of uniformed U.S. Public Health Service personnel were in attendance, along with some of Dr. Koop’s trainees.

Dr. Koop is survived by two sons, Allen and Norman; his daughter, Elizabeth Thompson; his wife Cora; and eight grandchildren.

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