COMMENCEMENT ADDRESS

BY

C, EVERETT KOOP, M.D,
  SURGEON GENERAL
U,S, PUBLIC HEALTH SERVICE

         AND

DEPUTY ASSISTANT SECRETARY FOR HEALTH
2, DEPARTMENT OF HEALTH AND HUMAN SERVICES

PRESENTED TO THE 1985 GRADUATING CLASS OF
   ROCKVILLE (MD,) HIGH SCHOOL
AT CONSTITUTION HALL, WASHINGTON, DA
       JUNE IO, 1985


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MEMBERS OF THE GRADUATING CLASS OF 1985,,,PRINCIPAL DEBALSO, ,,PARENTS
  AND FAMILY OF THE GRADUATES, #BOTHER HONORED GUESTS, ,,AND FRIENDS:

   I'M VERY PLEASED TO BE YOUR COMMENCEMENT SPEAKER THIS EVENING,
I'LL CONFESS TO YOU THAT I WAS BOTH SURPRISED AND DELIGHTED WHEN I
RECEIVED THE INVITATION LAST MARCH FROM YOUR SENIOR CLASS PRESIDENT,
MR, GUCKES, YOUR CLASS SPONSOR, MR. HAGY, AND PRINCIPAL DEBALSO, IT
WAS A VERY FINE LETTER, ,,ESPECIALLY THE LINE THAT SAID, "WE BELIEVE

THE ROCKVILLE HIGH SCHOOL STUDENTS, STAFF, AND COMMUNITY WILL BENEFIT
BY YOUR PRESENCE AT THE COMMENCEMENT," I REALLY LIKED THE SOUND OF

THAT, IT HAD A NICE RING,

   BUT WAS THAT THE INNOCENCE OF YOUTH? WAS THAT BELIEF, ,,OR JUST

HOPE?

   I DON'T KNOW, BUT IT WAS SO DIRECT AND SO CORDIAL AND SO

OPTIMISTIC -- THE KIND OF LANGUAGE MOST ADULTS HAVE SINCE FORGOTTEN

HOW TO WRITE -- THAT I SAID, "ABSOUTELY YES, I'D LOVE TO COME JOIN
THE FESTIVITIES ON THE NIGHT OF JUNE THE 10~~~"


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  AND THEN, LITTLE BY LITTLE, I BEGAN TO SENSE ANOTHER IDEA TAKE
SHAPE, AND THIS WAS THE IDEA THAT BEGAN TO DOMINATE MY THOUGHTS:

LIKE SO MANY OTHER PEOPLE IN WASHINGTON, I'VE COME HERE FROM
"SOMEPLACE ELSE",, , I PLANNED TO BE HERE ONLY "FOR THE
DURATION", a a I DIDN'T REALLY SEE MYSELF AS BEING INVOLVED IN THE
LIFE OF THIS COMMUNITY,

AND A LITTLE VOICE INSIDE ME SAID THAT THAT JUST WASN'T RIGHT,  I
N LIVE HERE NOW, ,,THIS Is MY HOMEwAND YOU ARE MY NEIGHBORS AND
THIS REALLY IS MY COMMUNITY, YOUR JOY AND PRIDE AND EXCITEMENT ON
SUCH AN EVENING AS THIS OUGHT TO BE MY JOY AND PRIDE AND
EXCITEMENT AS WELL, AND I CAN HONESTLY SAY THAT IT IS,


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  SO I AM HERE THIS EVENING AS, YES, THE SURGEON GENERAL OF THE
US, PUBLIC HEALTH SERVICE, AND, YES, I AM HERE AS THE GOVERNMENT'S
"CHIEF MEDICAL SPOKESMAN/' AS YOUR LETTER PHRASED IT,

  BUT I'M ALSO HERE AS A VERY PROUD NEIGHBORmPROUD OF YOUR
ACCOMPLISHMENTS AT ROCKVILLE HIGH SCHOOL AND ALSO PROUD OF YOUR
ATTITUDE OF HOPE AND OPTIMISM ABOUT THE FUTURE,  I'M TRULY PROUD TO BE
INVOLVED IN THIS TRADITIONAL CEREMONY -- THIS "RITE OF PASSAGE," AS IT
WERE -- THROUGH WHICH YOU MOVE INTO YOUR ADULT YEARS AS AMERICANS
WORKING,,,STUDYINGu,AND GROWING OLD IN A DEMANDING BUT ALWAYS
FASCINATING WORLD,

-

  MY MESSAGE WILL NOT BE LONG THIS EVENING, BECAUSE I'M GOING TO
LIMIT IT TO JUST THAT CHALLENGE OF MOVING AHEAD -- WITH OPTIMISM -- IN
TODAY'S WORLD,


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  AS YOU KNOW ALREADY, OR AS YOU SURELY SUSPECT, IT'S NOT AN EASY
WORLD THAT YOU'RE INHERITING, FRANKLY, IT'S NOT AN EASY PLACE FOR ANJ
OF US, NO MATTER HOW OLD OR YOUNG WE ARE,

  THE DAILY PAPER AND THE TJ, EVENING NEWS GIVE US, EACH DAY, A
THOUSAND REASONS TO BE EMBARRASSED, IF NOT DOWNRIGHT DISCOURAGED, WITH
THE CONDUCT OF MANKIND,

  IS THERE SOME METHOD WE MIGHT ADOPT TO HELP EACH OF US FIGHT OFF
SUCH DISCOURAGEMENT? YES, I THINK THERE IS AND I WANT TO SHARE IT
WITH YOU TONIGHT, IT'S NOT A SECRET PARTICULARLY, YET I DON'T THINK
PEOPLE TALK ABOUT IT AS MUCH AS THEY SHOULD,

  THE FIRST PART OF THE MESSAGE IS THE ESSENTIAL PART, AND IT
STARTS DEEP WITHIN OURSELVES, EACH ONE OF US, FORM TIME TO TIME, CAN
BE CONFUSED ABOUT A LOT OF THINGS IN THIS WORLD -- LEBANON AND THE
SPACE SHUTTLE, TAX REFORM AND LONG DISTANCE PHONE SERVICE -- BUT WE
MUST NEVER ALLOW OURSELVES TO BECOME CONFUSED ABOUT, ,,OURSELVES:


WHO I AM,,,

WHAT I STAND FOR,, ,

WHAT I CARE ABOUT, ,,

AND WHO I CARE ABOUT,

  THESE ARE QUESTIONS THAT EACH OF US HAS TO ANSWER,, aAND EACH OF
US MUST ALSO BE ABLE TO LIVE WITH THE ANSWER,

  YOU ASKED ME TO COME HERE TONIGHT TO ADDRESS YOU AS YOUR
COUNTRY'S "CHIEF MEDICAL SPOKESMAN? AND THAT'S WHAT I'M DOING,
BELIEVE IT OR NOT,


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  AFTER ALL THE YEARS OF WONDER DRUGS AND "CAT" SCANNERS AND LASER
SURGERY AND VACCINES, WE NOW REALIZE THAT THE ESSENTIAL ELEMENT IN
PUBLIC HEALTH -- AND THE KEY FACTOR IN SUCCESSFUL MEDICAL PRACTICE --
IS SIMPLY THE WAY EACH INDIVIDUAL VALUES HER OR HIS OWN LIFE, ,,HOW YOU
PROCESS YOUR OWN EXPERIENCEwAND HOW THAT HELPS GIVE YOU A BETTER
LOOK AT YOUR OWN FUTURE,

LET ME GIVE YOU JUST TWO LITTLE ILLUSTRATIONS,

  FIRST, AS MOST OF YOU KNOW, WHEN I'M NOT IN MY OFFICE UP IN THE
PARKLAWN BUILDING, I'M OUT IN THE WAREHOUSE STAMPING THOSE LITTLE
WARNINGS ON MILLIONS OF PACKAGES OF CIGARETTES, HONESTLY, IT'S
GRUELING WORK, AND EVERY NOW AND THEN, I'VE GOT TO GO OUT AND STAMP A
BILLBOARD AND I REALLY HATE TO DO THAT,


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  BUT THOSE LITTLE MESSAGES HARDLY DO JUSTICE TO THE SCIENTIFIC
RECORD BUILT BY MEDICAL RESEARCHERS OVER THE PAST 25 YEARS, THAT
RECORD CLEARLY PROVES BEYOND ANY REASONABLE DOUBT THAT SMOKING
CIGARETTES IS ASSOCIATED WITH -- AND CAUSES -- THE THREE MAJOR KILLER
DISEASES IN AMERICA: HEART DISEASE, CANCER, AND STROKE,

  THIS YEAR, WE ESTIMATE THAT OVER 350,000 AMERICANS WILL DIE UP TO
20 YEARS "BEFORE THEIR TIME" BECAUSE OF A DISEASE CAUSED BY -- OR
AAGRAVATED BY -- CIGARETTE SMOKING,

     EVERY INFORMED PERSON KNOWS THIS IS TRUE, EVEN THE PEOPLE WHO
  RUN THE R,J, REYNOLDS TOBACCO COMPANY KNOW THIS, I READ IN THE
..-
  NEWSPAPERS THAT THEY'RE ABOUT TO BUY THE NABISCO COMPANY AND I
  PERSONALLY THINK THEY'RE DOING IT BECAUSE THE R,J, REYNOLDS TOBACCO
  COMPANY KNOWS THAT THERE'S A BIG FUTURE IN COOKIES,,,BUT THERE'S JUST
   NO FUTURE IN CIGARETTES,


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  NEVERTHELESS, ABOUT A THIRD OF ALL AMERICANS OVER THE AGE OF 20
STILL SMOKE CIGARETTES,,,ABOUT 50 MILLION OF THEM, NEARLY ALL OF THEM
ARE HIGH SCHOOL GRADUATES WHO READmAND WHO LISTENwAND WHO MAY EVEN
HAVE A PASSING KNOWLEDGE OF THE SCIENTIFIC METHOD, THEY'VE BEEN
EXPOSED TO A GREAT DEAL OF HEALTH RISK INFORMATION CONCERNING
CIGARETTES,

AND YET, THEY CONTINUE TO SMOKE,

  WE HAVE NO VACCINE TO PREVENT THIS, WE HAVE NO TERRIFIC
TECHNOLOGY,, ,NO LASER SURGERYmNOTHING, THE BEST WE CAN OFFER ARE
SOME TRAINING COURSES AND SOME SUBSTITUTES TO GET A SMOKER THROUGH THE
WITHDRAWAL PERIOD, THERE'S NO MAGIC TO ANY OF IT,

  THIS PROBLEM IS CLEARLY RELATED TO EACH PERSON'S OWN SENSE OF
SELF, IN FACT, MOST OF THE NEW AND SERIOUS RESEARCH IN SMOKING THESE
DAYS IS NOT ONLY BIOMEDICAL,,,IT'S ALSO BIOBEHAVIORAL,


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  KNOWING THE SERIOUS HEALTH RISKS INVOLVED, SOME PEOPLE STILL
SMOKE PROBABLY BECAUSE THEY HAVEN'T YET COME TO TERMS WITH THEIR OWN
PERSONAL WORTH, THEY HAVEN'T YET DEALT SERIOUSLY WITH THEIR OWN

LIFETIME PRIORITIES.

  IN OTHER WORDS, THE NEGATIVE HEALTH BEHAVIOR AMONG SMOKERS DOES
SEEM TO REFLECT A DESIRE ON THEIR PART -- FOR WHATEVER REASONS -- TO
IGNORE OR TO DISBELIEVE THE AVAILABLE SCIENTIFIC DATA ON THE HEALTH
RISKS INVOLVED, BUT I WOULD SUGGEST THAT SUCH BEHAVIOR MAY HAVE
ANOTHER BASIS AS WELL,

  I THINK MANY SMOKERS WOULD ALSO LIKE TO SIDE-STEP THOSE REALLY
TOUGH QUESTIONS OF PERSONAL VALUE,,,THE ONES THAT CHALLENGE THEM TO
THINK ABOUT WHO THEY ARE,, #WHAT THEY STAND FOR,, BAND WHO AND WHAT THEY
CARE ABOUT, THEY'RE UNCOMFORTBALE QUESTIONS TO FACE, YET THEY SEEM TO
LIE AT THE HEART OF THE WAY EACH OF US DECIDES HOW WE'RE GOING TO TAKE
CARE OF OUR OWN HEALTH AND THE HEALTH OF THE PEOPLE WE LOVE,


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  SO I'M ASKING EACH OF YOU HERE TONIGHT -- REGARDLESS OF YOUR AGE,
WHETHER YOU'RE THE STUDENT OR THE PARENT, THE TEACHER OR THE PRINCIPAL
-- I'M ASKING EACH OF YOU TO TAKE THE FIRST AND MOST EFFECTIVE STEP TO
INSURE A LIFE OF GOOD HEALTH AND WELL-BEING, AND THAT STEP IS SIMPLY

THIS:

RECOGNIZE THAT YOUR LIFE HAS VALUEmTHAT IT IS IRREPLACEABLE,,,
THAT IT OUGHT NOT TO BE DRASTICALLY SHORTENED THROUGH RISKY, LIFE-
THREATENING BEHAVIOR, ,,AND THAT SUCH A RECOGNITION ON YOUR PART
MEANS YOU DO STAND FOR SOMETHING POSITIVE AND YOU CARE ABOUT
SOMETHING POSITIVE: AND THAT'S YOU,

IF EACH OF YOU WOULD DO THAT, IT WOULD DO WONDERS FOR THE OVERALL
HEALTH STATUS OF OUR SOCIETY AND, FRANKLY, IT WOULD ALSO MAKE LIFE A

WHOLE LOT EASIER FOR THE SURGEON GENERAL OF THE UNITED STATES


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  I SAID I HAD TWO EXAMPLES RELATING HEALTH AND HUMAN BEHAVIOR.
SMOKING AND HEALTH WAS THE FIRST ONE, HERE'S THE SECOND, IT INVOLVES
YOU AS A PERSON -- AND ALSO HOW YOU AFFECT OTHERS,

  NO, I'M NOT GOING TO TALK ABOUT DRUNK DRIVING, I COULDwIT'S
EXTREMELY IMPORTANT, ,,BUT I'M SURE YOU ALL KNOW WHAT I'D SAY AND I
HOPE YOU WOULD ALL AGREE: WHEN IT COMES TO DRUNK DRIVING -- DON'T,

  INSTEAD, I'M GOING TO TALK ABOUT PREGNANCY, CHILDBIRTH, AND
PARENTING, AS WE EXPERIENCE THAT CONSTELLATION OF HUMAN LIFE-CYCLE
EVENTS, WE REVEAL EXACTLY WHO WE ARE AND WHAT WE STAND FOR, BUT WE
ALSO PROFOUNDLY INFLUENCE A SECOND HUMAN LIFE,

   I REALIZE THAT FOR MOST OF YOU THE IDEA OF PREGNANCY AND
CHILDBIRTH IS FURTHEST FROM YOUR MIND, YOU MAY BE HEADING FOR
COLLEGE, FOR VOCATIONAL OR CAREER TRAININGmYOU MAY BE ABOUT TO ENTER
THE BUSINESS WORLD,, ,OR WHATEVER, THAT'S FINE,


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  BUT EVERY WOMAN IN THIS AUDIENCE BETWEEN 16 AND 44 HAS THE
POTENTIAL TO BEAR CHILDREN, IF YOU HAVEN'T ALREADY, AND AS FOR THE
YOUNG WOMEN OF THE CLASSS OF '85, OUR STATISTICIANS INDICATE THAT
NEARLY 70 PERCENT OF YOU WILL HAVE ONE OR MORE CHILDREN WITHIN THE
NEXT 20 YEARS,

  SO, WHILE THIS SUBJECT MAY NOT BE IMMINENT, IT IS CERTAINLY
PERTINENT,

  THE SINGLE MOST IMPORTANT CONTRIBUTION TO A SUCCESSFUL PREGNANCY
AND DELIVERY IS EARLY AND CONSISTENT PRENATAL CARE, EVERY YEAR, OF
THE 3 AND A HALF MILLION BABIES BORN IN THIS COUNTRY, A CERTAIN SMALL
PERCENTAGE ARE HANDICAPPED OR INJURED IN SOME WAY, ONE CAUSE OF THESE
PROBLEMS IS GENETIC, AND WE'RE STILL TRYING TO LEARN ABOUT THAT,


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  BUT THE NEXT MOST FREQUENT CAUSE IS THE BEHAVIOR OF THE
MOTHERmTHE FACT THAT SHE DOES NOT BEGIN WITHIN THE FIRST MONTH OF
HER PREGNANCY TO GET ROUTINE, PROFESSIONAL, PRENATAL CARE, AS A
RESULT, SOME PROBLEMS THAT DEVELOP DURING THE PREGNANCY TERM --
PROBLEMS THAT CAN BE CORRECTED SIMPLY THROUGH DIET OR MEDICATION, FOR
EXAMPLE -- ARE NOT CAUGHT AND BOTH THE MOTHER AND HER BABY SUFFER THE
CONSEQUENCES FOR THE REST OF BOTH THEIR LIVES

  MANY ADULT DISEASE CONDITIONS OF THE NERVOUS SYSTEM, THE
DIGESTIVE SYSTEM, THE HEART, OR THE IMMUNE SYSTEM, FOR EXAMPLE, SEEM
TO HAVE BEGUN BEFORE CHILDBIRTH,

-

  THESE CONDITIONS MAY NOT BE FATAL, BUT THEY CAN DEPRIVE THE
INDIVIDUAL -- WHETHER STILL A BABY, A STUDENT, YOUNG ADULT, OR OLDER
WORKING ADULT -- OF THE KIND OF FULL AND HEALTHY LIFE EACH ONE
DESERVES,


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HEALTHY MOTHERS AND HEALTHY BABIES MAKE A HEALTHY SOCIETY,  IT'S

JUST THAT SIMPLE, THE KEY TO THIS, OF COURSE, IS SOMEHOW TO GUARANTEE
THAT THEY WILL, INDEED, BE HEALTHY,

  FROM ALL THE RESEARCH THAT'S BEEN DONE SO FAR, WE NOW CONCLUDE
THAT ANY GUARANTEE FOR THE BABY DEPENDS ON WHETHER OR NOT THE NEW
MOTHER-TO-BE SIGNS ON FOR ROUTINE PRENATAL CARE AS SOON AS SHE KNOWS
SHE'S PREGNANT,  IF SHE FEELS GOOD ABOUT HERSELF AND CARES ABOUT
HERSELF AND THE BABY THAT'S ON THE WAY, SHE'LL SIGN ON,

AND, GENTLEMEN, THE SAME PRINCIPLES APPLY TO YOU,

-

  FOR CENTURIES, MEDICINE HAS PAID VERY LITTLE ATTENTION TO THE
ROLE OF THE FATHER DURING PREGNANCY, HE'S BEEN AN OBJECT OF MUCH
HUMOR, BUT THAT'S ABOUT IT,


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  BUT IT IS NOW FAIRLY CLEAR THAT THE FATHER'S ATTITUDE TOWARD
PREGNANCY AND CHILDBIRTH CAN BE CRUCIAL TO THE MOTHER'S DECISION TO
GET GOOD PRENATAL CARE,

  THIS INFORMATION, BY THE WAY, IS NEITHER "ANTI-FEMINIST" OR "PRO-
FEMINIST,"  IT'S JUST THAT NEW PARENTS ARE MUCH BETTER PARENTS IF THEY
WORK AT PARENTING TOGETHER,

  THE WAY EACH FATHER AND MOTHER FUNCTIONS AT THIS TIME IS PROBABLY
THE MOST IMPORTANT PARTNERSHIP EVENT IN HUMAN HISTORY, TALKING THINGS
THROUGH TOGETHER, HELPING EACH OTHER EMOTIONALLY AND PHYSICALLY,
SHARING CONCERNS, ASKING QUESTIONS TOGETHER AND OBTAINING ANSWERS,,
ALL THESE ARE ACTIVITIES WHICH THE FATHER NOT ONLY SHARES BUT OFTEN
WILL INITIATE,

  WHERE THAT KIND OF PARTNERSHIP HAS EXISTED FROM THE BEGINNING OF
A PREGNANCY, WE ARE NOW LED TO EXPECT A MUCH HIGHER PERCENTAGE OF
DISTRESS-FREE DELIVERIES AND NORMAL, HEALTHY BABIES,


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  WHERE THE FATHER IS ABSENT OR UNINVOLVED -- WHERE HE IS, FOR

EXAMPLE, UNSURE OF HIMSELF AND OF HIS ROLE AND UNABLE TO DECLARE WHO

AND WHAT HE REALLY CARES ABOUT -- IN THOSE CIRCUMSTANCES WE TEND TO

SEE PREGNANT WOMEN UNDER STRESS, HIGHER HEALTH RISKS FOR THEM AND

THEIR BABIES, AND MORE TROUBLESOME DELIVERIES,

   IT SEEMS SO OBVIOUS TO US NOW, BUT WE'RE JUST BEGINNING TO UNDER-
STAND THE FULL SIGNIFICANCE OF THE IDEA IN TRADITIONAL BIOMEDICAL AND
BIOBEHAVIORAL TERMS:

THAT IS, GOOD FATHERING IS EVERY BIT AS CRUCIAL TO MATERNAL,

_.   INFANT, AND CHILD HEALTH AS GOOD MOTHERING IS,

  THERE WAS A TIME IN THIS COUNTRY -- AND IT WASN'T SO LONG AGO --
THAT WE INVESTED GREAT AMOUNTS OF THE TAXPAYER'S MONEY INTO HOSPITALS
AND CLINICS AND NURSING HOMES. IT WAS AN IMPORTANT EFFORT, BUT IT WAS
NOT THE VITAL EFFORT,


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  NEXT, WE POURED A GREAT DEAL OF MONEY INTO SCHOOLS OF MEDICINE
AND NURSING AND PROVIDED FUNDS TO COVER TUITION AND LABORATORY FEES
FOR STUDENTS, THIS WAS IMPORTANT, ALSO, BUT I'M NOT SURE THAT IT WAS
THE VITAL ELEMENT IN AMERICAN HEALTH,CARE EITHER,

  NO, I'M BEGINNING TO THINK -- ALONG WITH MANY HUNDREDS OF MY
COLLEAGUES -- THAT THE FUTURE GOOD HEALTH IN OUR SOCIETY CAN NEVER
RELY PURELY ON OUTSIDE INFLUENCES, SUCH AS FACILITIES AND PROFESSIONAL
HELP,

  INSTEAD IT MUST BE GROUNDED IN THE HEALTHFUL BEHAVIOR,,,THE
THOUGHTFUL, CAREFUL ATTITUDES,,,AND THE PERSONAL HUMAN INVESTMENT OF

INTEREST AND CARE AND VALUE IN ONE'S OWN HEALTH AND WELL-BEING,

  WHEN THAT BECOMES UNIVERSALLY TRUE, THAN BEHAVIORS SUCH AS
SMOKING WILL NO LONGER THREATEN THE LIVES OF OUR CITIZENS,


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  AND IT WILL BE AT SUCH A TIME THAT WE'LL BE ABLE TO SEE EVEN
GREATER ADVANCES IN INFANT AND CHILD HEALTH, THANKS TO RESPONSIBLE
ATTITUDES ON THE PART OF BOTH FATHERS AND MOTHERS,

   I THINK WE'RE HEADING IN THAT DIRECTION AND, WITH THE HELP OF
EVERYONE HERE THIS EVENING, YOUNG AND OLD ALIKE, WE'LL MAKE IT,

  NOW, I WANT TO SINCERELY WISH EACH MEMBER OF THE CLASS OF 1985 OF
ROCKVILLE HIGH SCHOOL THE VERY BEST THAT THE YEARS AHEAD MAY BRING,,,
THAT YOUR JOYS BE SHARED BY YOUR FAMILIES AND FRIENDS, ,,AND THAT
AMERICA CONTINUES TO BE AS GOOD TO YOU AS I KNOW YOU WILL BE TO

AMERICA,

THANK YOU,

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