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About Epidemiology

Historical Beginnings of the Epidemiology Section

The following is an account of the beginning of the APHA Epidemiology Section as recounted by E. S. Godfrey, Jr., MD. It is taken from "As I Recall It. The background and beginnings of the American Epidemiological Society”, The Yale Journal of Biology and Medicine. Volume 46, Number 1, February 1973.

“As I said before, one could hardly read the Transactions of the London Epidemiological Society without wishing for a similar institution in America. At least I know one person who couldn't. My first opportunity to broach the subject to a presumably sympathetic ear came about quite by chance. I think it was in the summer of 1920. Doctor Emerson probably will not remember the occasion. I happened to be in Washington and had a little time to spare. I had heard that a West Point classmate who, like me, had been "found deficient" in mathematics and studied medicine, was with the Veterans Administration. I called him up and was invited to come over and have a talk. After we had rehashed our trials and tribulations as plebes and brought ourselves up to date on where we were and how we got there, he asked if I wouldn't like to meet his chief, Dr. Haven Emerson. I said I would, very much.”

“We were cordially received and were shortly engaged in an interesting chat during which I suggested either an epidemiological society or as I think more probable, an epidemiology section of the American Public Health Association. No fire was started. Either the tinder was damp or the flame was feeble. It is highly probable that Doctor Emerson saw the practical difficulties which I did not come to appreciate until some 6 or 7 years later.”

“The next effort, so far as I am aware, came at the American Public Health Association meeting in New York City in 1921 when I approached George T. Palmer on the subject. I cannot remember what impulse led me to him unless he had been writing of some of the war camp epidemics ( 1). You may recall that his name appears, along with Henry Vaughan's as a collaborator in Victor Vaughan's book previously referred to. I am sure that I was quite unaware of this association or that the book was contemplated at that time. George, while not enthusiastic, did suggest that perhaps a session of the Vital Statistics Section devoted to epidemiology might be arranged for the following year. I believe he was that Section's secretary at the time. I think I undertook to get the speakers and had no difficulty at all in persuading Frost, Haven Emerson and Chesley to prepare papers and George made good by giving them a place at an afternoon session of the Cleveland meeting (2). The attendance was good but hardly noteworthy. The discussion was rather pointless. The one clear recollection I have of it is that it added a new word to my vocabulary, one which I have already used in this paper. Dr. Louis Harris, soon to become Health Commissioner of New York City, but who was then and had been for several years the Director of Communicable Disease Control, accused us epidemiologists of being "esoteric."

“After I had found out what the word meant and considered calmly and dispassionately the evident lack of enthusiastic reception, I had to admit that Frost's and Emerson's papers were perhaps beyond the grasp of the hoi polloi. At any rate, epidemiology was not just statistics any more than it was just laboratory or just administration, although it partook in some part, large or small, of each of these. Although I am sure, and events proved that there was a latent consciousness of epidemiology as an entity, as something akin to ecology or bionomics, as a methodology if not a science, as a something apprehended but eluding satisfactory definition, this consciousness lacked expression.”

“The discouraging results of the Cleveland meeting made it seem unlikely that any better ones would be obtained by a single session in the laboratory or administration sections. At any rate no one felt like peddling a prospective program to the program committee year after year hoping to find a taker. So the matter was allowed to slumber until some occasion afforded an opportunity to organize a section. The opportunity came at the Buffalo meeting of the American Public Health Association in 1926.”

“The health officers of a number of the larger cities both in the United States and Canada were becoming restive as members of the American Public Health Association and the section on Administration. This section included besides health officers of all sorts of jurisdictions, many subordinates below the deputy level and members of the staffs of the Public Health Service, universities, insurance companies and other nonofficial agencies. These nonofficial members, the Public Health Service officers and to some extent, the state health officers, and their subordinate personnel, seemed to be more apt in expression, contribute more in the way of papers and discussion, have greater representation on committees and on the Governing Council. This matter of representation was much the issue and argued with about as much sense as is to be found in some of the "issues" causing riots today. A few leaders of moderate ability found enough support among the small fry to be able to threaten to withdraw from the Association. They did actually proceed to form an independent organization, the International Health Officers' Association, which after an undistinguished existence of some 15 years, died of inanition.”

“The threat of withdrawal was a cause of real concern to the officers and Governing Council of the American Public Health Association ­ so much so that the latter voted to discontinue the Section on Administration and create a Health Officers' Section. It also accepted a provision in the by­laws of the new section that only Health Officers and their immediate deputies should be eligible for affiliation with it. They thereby extruded a considerable number of members and Fellows of the Association became unattached, and I think more than a corresponding fraction of the brains of its former makeup.”

“This was the opportunity. Dr. Don Griswold who was at the time, I think, Director of the Communicable Disease Division of the Iowa State Health Department recognized it. He called me up and we talked the matter over in the lobby of the Statler Hotel. We agreed to approach Haven Emerson on the subject and get him to help press for the establishment of an Epidemiological Section before the Governing Council of which both he and Griswold were members. The most they were able to obtain at that time was the promise of a special session on epidemiology "under the auspices of a special Committee," at the next annual meeting. This was unfortunate since it forestalled active recruiting among the disaffiliated of the former Section on Administration. However, it was a rule apparently then as now, that applicants for the establishment of new sections must demonstrate their ability to put on worthwhile programs and discussions, attract a sufficient audience, and present evidence of a sufficient initial and potential future membership.”

“Doctors Griswold, Emerson and myself, and no doubt others, undertook to find suitable papers, drum up attendance and pledge future members of the section. Doctor Emerson undertook to act as unofficial secretary, dressing up the program and wangling a spot on the Association program that would not encounter too much competition among our potential recruits. In these he was very successful and we had excellent attendance and discussions at each of the two special sessions we had to hold before final approval came through at the Chicago meeting in 1928.”

“One paper given at the Chicago session stands out in my memory probably because I induced its author to present it there. It was by Dr. Clifford Hervey, one of our District State Health Officers, and it was notable as being the first instance, so far as I am aware, of a well­defined outbreak of typhoid fever transmitted per rectum (31). It involved the peregrinations of one and later two Harris Drip cans among a group of surgical patients in an upstate New York hospital. It was published in the American Public Health Association Journal the following year.”

“Another paper describing some of the homely devices of shoe leather epidemiology described among other things the obtaining of information in connection with a milk­borne outbreak of typhoid (4). A large fraction of the cases occurred in a summer boarding house which ostensibly got its milk from another source. It involved a certain regional knowledge and a shrewd approach in questioning the manager of the boarding house. This paper was given by Dr. F. W. Laidlaw, another of our District State Health Officers, at the meeting in 1929. Perhaps because it was considered too pedestrian or for other reasons at which I can only guess, it was not approved for publication and hence lost to posterity.”

“Except for the details of organization, this about winds up the story of the Epidemiology Section which started first but finished second. The Executive Board appointed Griswold, Chairman; Godfrey, Vice­Chairman and Emerson, Secretary (5). We were also reelected to serve in 1930, ostensibly in order to provide stability during the first year's shakedown and to confirm the Executive Board's judgment in appointing us.”

“I note in the 1951 report of the Chairman of the Executive Board of the American Public Health Association that we had but 32 members the following September 1 (1930). I think a large share of these came from the district officers of the New York State Health Department and the central office staffs of that Department and that of Massachusetts. It was also heavily weighted with Fellows as distinguished from Members.”

“The recruiting difficulty came in tearing loose from old affiliations with the Laboratory and Vital Statistics Sections some who should belong. Frost was a particularly difficult subject. He felt obligated to the Laboratory Section since he had been affiliated with it ever since he had been a member and had served on many of its important committees and recently as Chairman. I think Allen Freeman had much to do with making him see that he had a higher duty.”

“In an aside, from Godfrey's 1952 story for the moment, it was apparently due to his efforts that the Epidemiology Section of the American Public Health Association was established in 1929 with an invited membership of seven fellows and one member of the APHA. By the next year, according to Dr. Godfrey's account, this membership had increased to 32 and from that time forward the Section has continued to flourish. By the early 1950s its membership boasted 166 APHA fellows and 480 members, which far outnumbered the AES of that date.”

“With the launching of this Section of the APHA it might have seemed that Dr. Godfrey had achieved his purpose, but the Epidemiology Section of the APHA has served a more technical purpose than the AES It has been a forum for the presentation of work done and methods developed by professional epidemiologists, many of whom were in the service of official health agencies. There was little that was esoteric about it. Its interests were in the collection and utilization of data on morbidity and mortality; in the planning for epidemiological services at the state and local level; and the selection and training of personnel for these services.”

“Similarly, it has fallen to the lot of this Section to prepare and revise periodically a manual on the Control of Communicable Disease in Man, which has been kept up as a guidebook containing the latest authoritative directions on control measures of infectious diseases in the United States. In the latter endeavor it has had several rivals, notably the Red Book prepared by the American Academy of Pediatrics' Committee on Infectious Diseases.”

“Godfrey had expended much time and effort in his desire to aid the epidemiological interests of health officers, and on his overall wish to put epidemiology on the map in this country. It was with the APHA where his ambitions first lay. In 1927, he at last succeeded in promoting a meeting in Baltimore and in enlisting the support of Dr. John A. Farrell of the Rockefeller Foundation. Dr. Farrell seems to have been singularly generous in promoting the cause of epidemiology. Dr. Wilson G. Smillie, who was one of the earliest members of the AES, recently wrote to me, that at a meeting, held in Baltimore, "Dr. Farrell paid our expenses" (Dr. Smillie was on the staff of the Rockefeller Foundation at the time) (6). And, at a subsequent meeting, "Again Dr. Farrell met all expenses." After all this display of enthusiasm he was disappointed in not being elected to membership in the AES, for it was decided he was not "an epidemiologist."

“In recalling this meeting some 20 years later, Dr. Farrell said (7): In May 1927, about 60 scientists, assembled in Baltimore to formulate plans for the development and enlargement of epidemiological services throughout the United States. They described the field, recommended plans for the development of epidemiological services in state and local health organizations, for the collection and utilization of morbidity data, for the study of epidemics, and for the selection and training of personnel for these services. At that time only a few state health departments had divisions of epidemiology which were supplying services of the caliber recommended by the conference. A recent review of the situation shows that the epidemiological services of these states have more than quadrupled in extent in the years since 1927. Most of the states now have creditable divisions of epidemiology.”

“At this point, and again in 1942, Dr. Farrell was inclined to merge the two fields of: (a) preventive medicine, and (a) epidemiology. While lauding advances made since the turn of the century in preventive medicine, in his examination of the status of epidemiology, he maintained that progress in this subject had been due to an increase of financial support, which had only recently become available for both field and bench work. According to Farrell, epidemiology, even in 1942, was restricted to infectious disease with one exception ­ the nutritional and deficiency diseases.”