C Everett Koop, known as 'America's doctor', was by far the most influential surgeon general in US history. An imposing figure, standing six foot one in his gold-braided dark blue vice admiral's uniform (the rank of the surgeon general), he effectively used his strong personality to advocate for the health of the US public. Koop was born on 14 October 1916 in Brooklyn, New York, the only child of John Edward Koop, a banker and a descendent of 17th century Dutch settlers, and Helen Koop née Apel. His paternal grandparents, cousins and uncles all lived in the same street. Koop's interest in medicine was triggered by watching a family doctor. He practised tying knots, cutting sutures and doing some vivisection on animals in his neighborhood, while his mother gave anaesthesia. He attended Flatbush School and Dartmouth College, where he played football. He then went to Cornell University medical school in Manhattan, where he met and married Elizabeth Flanagan of New Britain, Connecticut, a Vassar student. He completed his residency in general surgery at the University of Pennsylvania under the revered figure of IS Ravdin. Among other skills, Ravdin was known for having a good eye for young talent. On the completion of Koop's residency in surgery, he was offered the position of founding chair of surgery at the Children's Hospital of Philadelphia. He served in that role for 35 years. During that time, he and his colleagues performed thousands of operations to correct birth defects in premature babies. They performed 475 operations alone for oesophageal atresia, a condition which previously had been fatal. He introduced the transposition method for producing gastrointestinal tract continuity between the oesophagus and stomach, and it became a standard procedure. He also did early work on separating conjoined twins. In 1981 he was nominated for the role of surgeon general by President Ronald Reagan. He served from 1982 and, by the time he demitted office in 1989, he had become a household name. During his tenure he defended the rights of children, issued emphatic warnings about the dangers of smoking and prodded the US government into an aggressive posture against AIDS. In the early 1980s, the rights of infants with congenital defects surfaced as an issue. It eventually came before the federal courts, where two cases pitted the rights of parents to withhold treatment for a child who was severely impaired against available medical care. The courts sided with the parents. Koop spoke out against the parents' decision in both cases, noting that the medical and legal establishment had a duty to protect citizens against collective discrimination, regardless of their state of health or age. He alleged that the government's authority to override the rights of parents had been established in truancy law, child abuse legislation and immunisation law. When Koop became surgeon general, 33% of Americans smoked; when he left office it had dropped to 24%, with 40 states and many counties having restricted smoking in public places. Anti-smoking campaigns by private groups like the American Lung Association and the American Heart Association had accelerated. Koop had a major role in educating Americans about AIDS. He believed the nation was slow in facing the virus, which first appeared about the time he became surgeon general. He extolled efforts to identify the HIV virus that causes the disease, and the blood test and research which allowed detection. Koop pushed the government into advocating condom use and public AIDS education and treatments. He was undoubtedly influential in George W Bush's initiative to provide AIDS care and detection in Africa, considered one of the most important achievements of the 43rd President. Koop always believed he had failed to persuade either Reagan or his successor President George HW Bush to make healthcare available to more Americans. He was also disappointed at the lack of influence of the office of surgeon general, a fact he lamented in a later testimony before Congress. Koop was personally opposed to abortion, but believed that a public office such as the surgeon general's should not make policy decisions based on moral grounds. He declared - to the disappointment of the White House - that the evidence did not support the contention that abortions were essentially unsafe. In taking that position he later said he was naïve. In an interview in 1996, he said he did not speak out on abortion because he thought his job was to deal with factual issues like hazards of smoking, not moral issues. Abortion, he argued, presented little health hazard to women. It was a moral and religious matter, not a health issue. Many liberals opposed his nomination, but came to praise him; and the many conservatives who had supported him came, in time, to vilify him. When Koop stepped down as surgeon general in 1989, the *New York Times* noted that: 'throughout, he has put medical integrity above personal judgments and has been indeed the nation's first Doctor'. He was the recipient of many honorary degrees, fellowships and awards around the world, including the French medal of the Légion d'honneur in 1980 and the honorary fellowship of the Royal College of Surgeons in 1982. In his later years, Koop established an internet company providing health information on the web (www.drkoop.com), and the C Everett Koop Institute at Dartmouth College, founded in 1992. Koop was strong in his Presbyterian faith and credited this with helping him and his wife cope with the death of their 19-year-old son David, who was killed in 1968 when a cliff gave way while he was mountain climbing in New Hampshire. Koop and his wife wrote about the loss of a child in *Sometimes mountains move* (Wheaton, Ill, Tyndale House Publishers), published in 1979. Koop died on 25 February 2013 at the age of 96. He was survived by his second wife, Cora Hogue, whom he married in 2010, by his three children, Allen, Norman and Elizabeth Thompson, and by eight grandchildren.