Former Surgeon General Julius Richmond

Julius B. Richmond, 91, the first director of Head Start and a former U.S. surgeon general who spent four decades campaigning against cigarette smoking, died July 27 at his home in Brookline, Mass. He had cancer.

Dr. Richmond, a pediatrician and child development specialist, was in 1965 one of the original founders and the first director of Head Start, the federal effort to improve education and health of poor and at-risk children. He also organized and ran a program that opened federally funded neighborhood health-care centers during the 1960s.

Appointed surgeon general and assistant secretary of health in the old Department of Health, Education and Welfare in 1977, Dr. Richmond promoted anti-smoking, preventive health-care and public health policy campaigns.

"There may be more famous surgeons general, but there was none more dedicated, tenacious or courageous," said Joseph A. Califano Jr., former HEW secretary, from a vacation in Italy. "He was with me all the way on the [anti-]smoking campaign. . . . He wasn't sensitive about what people would think of him. And he cared about public health."

His work leading up to Head Start was inspired by the U.S. Supreme Court's 1954 ruling that desegregated public schools, Brown v. Board of Education. Dr. Richmond and a colleague at what is now the State University of New York Upstate Medical University set out to document how poverty threatened the psychosocial development of young children.

According to a 1981 oral history, Dr. Richmond said he and SUNY colleague Bettye Caldwell noticed that all children seemed to develop at the same pace in their first year of life, but poor children's advancement lagged as they started using language and exploring their surroundings.

With early intervention in a stimulating environment, Dr. Richmond and Caldwell found the decline could be prevented.

Dr. Richmond's work caught the eye of Sargent Shriver, who was appointed to lead the new Office of Economic Opportunity in 1964. Recruited to the OEO, Dr. Richmond used demonstration grants to launch Head Start in 1965 and enrolled 500,000 children in 2,700 communities within six months.

The work was not without its moments of danger in those racially segregated times.

Visiting the Child Development Group of Mississippi, a program under attack because it predominantly served black children, in the late summer of 1965, Dr. Richmond noted that his entourage was followed from town to town by "rednecks," and volunteers had to stand as armed guards at night for their buildings.

"It was really a tense situation," he said, according to author Kay Mills's history of Head Start, "Something Better for My Children" (1998). "One of the most beautiful programs we saw had been operating out of a wonderful little black church [in Valewood, Miss.,] and it was burned down the day after we visited the place."

In 1967, Dr. Richmond returned to SUNY to become dean of its medical faculty in Syracuse. In 1971, he moved to Harvard Medical School, where he held professorships in child psychiatry and human development, and in preventive and social medicine.