most of its functions, including the phs, were transferred to the newly formed department of health, education and welfare. in 1955 the division of indian health was established upon transfer of these functions from the bureau of indian affairs in the department of the interior. reorganization era main article: u.s. public health service reorganizations of 1966–1973 between 1966 and 1973, a series of reorganizations and realignments led to the end of the bureau structure. the reorganization by 1968 replaced phs's old bureau structure with two new operating agencies: the health services and mental health administration (hsmha) and the consumer protection and environmental health service (cpehs), with nih remaining independent and less affected by the organization. in 1968, the position of assistant secretary for health was created, supplanting the surgeon general as the top leader of the public health service, although the surgeon general was retained in a subordinate role. also in 1968, the food and drug administration, which traced its origins to 1862, became part of the phs. the goal of the reorganizations was to coordinate the previously fragmented divisions to provide a holistic approach to large, overarching problems. additionally, a second wave of hospital closings during 1965–1970 closed the three remaining general hospitals at inland locations along the mississippi river and great lakes, as well as the 19th-century savannah hospital. in addition, st. elizabeths hospital and the psychiatric hospitals at lexington and fort worth were transferred to other agencies, and the galveston hospital was replaced with one acquired by phs in nearby nassau bay. this left eight general hospitals plus the national leprosarium in the system. the new agencies came to be seen as unwieldy and bureaucratic, and they would turn out to be short-lived. cpehs was broken up in 1970, as much of it was transferred out of phs to form the core of the new environmental protection agency. around the same time, the national institute for occupational safety and health was created out of the former division of industrial hygiene by the occupational safety and health act of 1970. hsmha was broken up into four successor agencies in 1973. modern period since 1973, phs has encompassed between six and nine operating agencies anchored by nih, fda, and cdc. the organizational changes since 1973 have been: creation of the agency for toxic substances and disease registry in 1980 merging of the health resources administration and health services administration into the health resources and services administration (hrsa) in 1982 the indian health service being split from hrsa in 1988 the agency for health care policy and research being split from the office of the assistant secretary for health in 1989 breakup of the alcohol, drug abuse, and mental health administration in 1992, with its research functions returning to the national institutes of health, and its services components becoming the substance abuse and mental health services administration the phs hospital system had been the target of efforts to close the entire system since the mid-1970s. as the result of pressure from the reagan administration, the phs hospital system was abolished in 1981, with the last eight hospitals transferred to other organizations: five to non-governmental entities, two to the department of defense, and one to the state of louisiana. phs would however continue to operate the national leprosarium until 1999. in 1995, supervision of the agencies within phs was shifted from the assistant secretary for health to report directly to the secretary of health and human services, eliminating phs as an administrative level in the organizational hierarchy, although the agencies and offices are still legally designated as part of phs. 21st century formation of the office of global affairs from two components within the office of the secretary and office of the assistant secretary for health in 2002 creation of the office of public health emergency preparedness in 2002, which later became the administration for strategic preparedness and response activities public health worker sara josephine baker, m.d. established many programs to help the poor in new york city keep their infants healthy, leading teams of nurses into the crowded neighborhoods of hell's kitchen and teaching mothers how to dress, feed, and bathe their babies. another key pioneer of public health in the u.s. was lillian wald, who founded the henry street settlement house in new york. the visiting nurse service of new york was a significant organization for bringing health care to the urban poor. in the area of environmental protection and public health, a public health service 1969 community water survey that looked at more than a thousand drinking water systems across the united states drew two important conclusions that supported a growing demand for stronger protections that were adopted in the 1974 safe drinking water act. the survey concluded, first, that the state supervision programs were very uneven and often lax, and, second, that the bacteriological quality of the water, particularly among small systems, was of concern. the 1963 clean air act gave the public health service in the department of health, education, and welfare the authority to take abatement action against industries if it could be demonstrated that they were polluting across state lines, or if a governor requested. some of these actions involved the ohio river valley, new york, and new jersey. the service also began monitoring air pollution. the 1967 clean air act redirected attention to larger air quality control regions. controversies tuskegee study of untreated syphilis in the negro 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 titled 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 six months, the study actually went on for 40 years. penicillin—which can be used to treat syphilis—was discovered in the 1940s. however, the study continued and treatment was never given to the subjects. because of this, 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 to 1948, 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 serious ethical lapses in moral judgement which occurred.