[4] Effective October 1, 1893, the supervising surgeon general wore gold epaulettes in place of shoulder straps.
[6] The rank structure was further revised with effect from July 1, 1896:[7] By Act of Congress, on July 1, 1902, the Marine Hospital Service became the United States Public Health and Marine Hospital Service.
The sleeve rank insignia were also altered to match those worn by Navy officers, with shoulder loops replacing straps.
The 1944 Act further established the grade of director, to rank equivalent with a colonel or Navy captain, along with the one-star graded post of deputy surgeon general, also elevating assistant surgeon generals to one-star rank.
[11] Public Law 89-288 was enacted on October 22, 1965, elevating the grade of surgeon general to three-star rank.