7H
A N N i V t . H A P Y ISSUE
VOL.!
Harvard Public Health Review ")f science and education are the brain and nervous system of civitization, heaith is the heart."
F r e J g r / c ^ 71 G ^ ^ e s , i^^MgMf^/ w a g i n g o/^
Evolution of a Global Leader
ALUMNI COUNCIL OFFICERS
DEAN'S COUNCIL
M y r o n Allukian, Jr., M.p.H'67
Barrie M . Damson John H. Foster O. Milton Gossett Vincent L. Gregory, Jr. John H. McArthur Richard L. Menschel Paul G. Rogers Daniel I. Sargent Martin E. Segal Eliot I. Snider Frank Stanton Ladislaus von H o f f m a n Robert C. Waggoner William S. Woodside
DEAN
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.Secretary
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REGIONAL REPRESENTATIVE
Francisco J . Ramos-Gomez, M.P.H'90 Christopher T. Spina, M.r.H'pi
Susan S. Paresky EDITOR
Kevin J . Sottak WRITERS
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Anne Hubbard
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Harvard Public Health Review 75TH A N N I V E R S A R Y !SSUE
VOL. t
Departments From the Dean
1922-1938: Exptoration and innovation 4
Richard Pearson Strong and the Age of the Explorer-Scientist
iz
Cecil Kent Drinker: Dean, 1 9 3 5 - 1 9 4 2 .
15
Gordon Fair: Across the River
18
Alice Hamilton: Adversary of the Poisonous Trades
24
Breathing Easy: The Invention of the Iron Lung
3i
A Partner, N o t a Patron: The Rockefeller Foundation
35
Women and Children First: Harold Coe Stuart, Martha M a y Eliot, and the Development of the Department of Maternal and Child Health
1939-1953: War and independence 41
In the Trenches The Harvard-Red Cross Field Hospital Unit
55
James Stevens Simmons: Dean, 1 9 4 6 - 1 9 5 4
58
First in Food: Fredrick J . Stare and the Department of Nutrition
65
Hugh Rodman Leavell
67
Flying High: Ross McFarland and the Birth of Aerospace Medicine
1954-1971: Expansion and Giobaiization Taming the Summer Scourge John Crayton Snyder: Dean, 1 9 5 4 - 1 9 7 1 Jane Worcester Home Away from Home: Henry Lee Shattuck International House Shifting Gears: Epidemiology's Mid-Century Renaissance M y Year at the Harvard School of Public Health
From the Dean
^
T GIVES ME GREAT PLEASURE to present the first of
] two special issues of the H ^ r t w J
HM^
) R g ^ e w published in conjunction with the School's 75th Anniversary. This issue covers the years 192.Z to 1 9 7 1 , a period in which public health in the United States emerged as a mature enterprise drawing on the full range of analytic, scientific, and policy disciplines. In these pages you will read about some of the remarkable people, events, and discoveries that shaped the development of the School and, indeed, the field of public health. Public health research and training at Harvard actually dates to the last decade of the nineteenth century, when University President Charles William Eliot allocated space at the nowdefunct Bussey Institution to house the Commonwealth's vaccine production laboratories. In 1 9 0 9 , the nation's first Department of Preventive Medicine and Hygiene was established at Harvard Medical School under the direction of Milton J. Rosenau, and two years later, Harvard established a Department of Sanitary Engineering led by George Chandler Whipple. Rosenau and Whipple subsequently joined forces with Massachusetts Institute of Technology's renowned sanitary engineer William T. Sedgwick to launch the Harvard-MIT School for Health Officers, the nation's first professional public health training program and the forerunner to the Harvard School of Public Health. It is impossible in so few pages to tell the full story of an institution as broad in scope, rich in history, and diverse in talent as the School of Public Health. For every faculty member or graduate mentioned here, there are many more who have made critical contributions to the field and whose achievements bring added luster to the School. As dean, I extend congratulations and my profound respect to all who have been a part of the success of this institution over the yearsâ&#x20AC;&#x201D;alumni, faculty, staff, and benefactors. I also wish to acknowledge the support of the five university presidents who have presided during the School's first 75 years: Abbott Lawrence Lowell, James Bryant Conant, Nathan Pusey, Derek Bok, and Neil L. Rudenstine. Most importantly, I salute my six predecessors as dean of the School of Public Healthâ&#x20AC;&#x201D;David Linn Edsall; Cecil Kent Drinker; Edward Godfrey Huber, D.P.H.'n; James Stevens Simmons, s.D.'^c); John Crayton Snyder; and Howard H. Hiatt. They nurtured the School's success, imprinted it with their vision, and guided its evolution into a global leader. /V^wcy V fwc&dvg, De<3??
Exp!oration and tnnovation
HE YEAR is 192.2. Warren G. Harding is in the White House, Prohibition reigns, and on Broadway, T^p Zz'cg/eM FoH^s starring Wiil Rogers sets the tone for the "Roaring Twenties." Although heart disease has recently overtaken tuberculosis as America's ieading cause of death, infectious diseases are stiH the world's killers eiite. Vaccines for polio, measles, diphtheria, and rubella are still decades away, and the memory of the 1 9 1 8 influenza pandemic that claimed some 22 million lives is still fresh in the public's mind. In the fall of 1 9 2 2 in Boston, the first class of men and women begin classes at the newly launched Harvard School of Public Health. The successor to the eight-year-old Harvard-MiT School for Health Officers, the School shares a dean, administrative structure, and, for the first year, classroom and laboratory space with Harvard Medical School. Over the next decade and a half, the School will emerge as a leading research and training center in the fields of sanitary engineering, tropical medicine, and industrial hygiene, laying the groundwork for three quarters of a century of achievements in public health at home and abroad.
ng and the EFORE THE J E T PLANE m a d e it
possible to traverse continents overnight, explorer-scientists such as Richard Pearson Strong covered ^
-OHm****^
thousands of miles by boat, train,
and even foot to study tropical diseases that few Westerners would recognize. Between 1 9 1 3 and 1 9 3 8 , Strong led five overseas scientific expeditions to Africa and Central and South America, including the 192.6-192.7 Harvard African Expedition that crisscrossed the remote interior of Liberia then cut 3,500 miles across central Africa to end at Mombasa, Kenya. The expeditions formed the backbone of Strong's impressive 2.5-year career at Harvard. When he was named the university's first profes-
1922 The Harvard School of Public Health is founded. David
U.S. mortality rate from tuberculosis falls to 97 per
Linn Edsall is dean. With a budget of $162,800, the
100,000, down from 202 in 1900, while the death
new School boasts 13 departments and 16 students.
rate from heart disease reaches 155 per 100,000, up
Women are admitted, but not eligible for degrees.
from 123 in 1900.
Tuition and expenses for the year are $300.
sor of tropica] medicine in 1 9 1 3 , he initially hoped to
too long, no trouble too great to take and watch over a
establish a Harvard-affiliated school devoted entirely to
patient," according to an anonymous biographical sketch
tropical medicine, along the lines of those that had recently
written in 1 9 3 3 . Even in retirement, Strong was relentless,
been established in Europe and Great Britain. Instead, he
teaching classes in tropical medicine at the U.S. Army
settled in to lead a department in the newly founded School
Medical College during World War II and revising to the
of Public Health, throwing his considerable energy behind
point of rewriting Edward R. Stitt's 1,747-page DMgwosM,
building up an area of research that remains strong to this
Pre^eMf/ow <3%J Treafwew? o/^ Tropzcaf D/sMses, one of
day. In 192.6, Strong joined forces with renowned tick-
the primary reference books of the time.
borne disease researcher Ernest Tyzzer to form the Depart-
Four years after his death, at a ceremony marking
ment of Comparative Pathology and Tropical Medicine.
the Belgian government's $2.0,000 gift to endow a chair
The department's members included Lemuel R. Cleveland,
in Strong's name at the School, Shattuck, his long-time
an expert on insect-borne protozoa; Jack Sandground, a
colleague and fellow traveler paid tribute to Strong's steely
round-worm expert who would accompany Strong on
resolve: "When Richard undertook a task, he carried it
several of his expeditions; A. Watson Sellards, a yellow
through with all his strength and was never deterred by
fever expert; and Clinical Professor of Tropical Medicine
difficulties. In the field, he was a stoic."
George Cheever Shattuck. Traveling, researching, and publishing at a preter-
The son of a U.S. Army colonel, Strong was educated at the best schools: Hopkins Grammar School as a prep
natural pace, Strong packed several lifetimes worth of
school student; Yale University as an undergraduate; and
achievements into a single career, accumulating an encyclo-
Johns Hopkins Medical School, where, in 1 8 9 7 , he
Age of the Exptorer-Scientist pedic knowledge of tropical diseases while making a
graduated with the first medical school class. Early on
specialty of onchocerciasis, or river blindness. In a time
he demonstrated an interest in tropical medicine—his
before Medline databases made it relatively easy to put
undergraduate thesis at Yale was on cholera. Following
such scholarship on display, Strong wrote dozens of papers
medical school, he joined the Army and was sent to
clarifying where and why onchocerciasis was prevalent,
Manila to establish research laboratories during the
including Onc^ocercMs/s, a 2.34-page report of his
Spanish-American War. Strong resigned from the Army
investigaton of the disease in Central America. Sandwiched between his Conradian journeys were Strong's World War I heroics, which included a stunningly
a couple of years later, but would spend a total of 1 4 years in the Philippines doing tropical medicine research. That Strong would be drawn to tropical medicine is
successful effort to control a typhus outbreak in Serbia
easy to understand. The European powers had conquered
and an investigation of the cause of "trench fever" among
and carved up Africa in the 1880s. Colonial-era govern-
British and French troops, for which he was decorated
ments had a keen interest in keeping their colonists and
by the American, British, and French governments. In
the labor supply—the native populations—healthy. The
what little spare time he had, Strong apparently also acted
American acquisition of the Philippines, Puerto Rico, and
as personal physician for many of his friends, displaying
Guam after the Spanish-American War created similar
"meticulous care and unselfish devotion. N o hours were
imperial interests and impulses in this country. At about
U.S. life expectancy at birth is less than 60 years and infant mortality is 76 per 1,000 births.
Mo^ froM^/e w g ^^ 7 ^^OM^gfS C O W W g
we^ ^ r o M g ^ / r o w
â&#x20AC;&#x201D; Richard Pearson Strong, diary of the 1926-1927 Harvard African Expedition
the same time, Louis Pasteur's discoveries had launched
immunologic reactions to diseases; and Charles Brues,
the germ theory of disease and the bacteriological era in
a zoologist. On his longest and most arduous sojourn, the
medical research. European and American scientists were
192.6-192.7 Harvard African Expedition, Strong was
eager to go out into the world with their microscopes and
accompanied by two zoologists, a botanist, and a photo-
discover new disease-causing microorganisms. Where
grapher in addition to Harvard colleagues Shattuck,
better to go than to the tropics, with its exotic diseases
yellow-fever researcher (and future Nobel Prize-winner)
(at least to Westerners) and alarming epidemics?
M a x Theiler, and Belgian-born Joseph Bequaert, an entomologist who would later become the
When Strong was a teenager, Patrick
curator of insects at the Harvard Museum
Manson, sometimes called the father of
of Comparative Zoology.
Western tropical medicine, was developing his theory that mosquitoes spread
While some of Strong's expedi-
malaria. When Strong was in prep school, Theobald Smith (who would
tions were broadly investigatory, ^
others focused on specific diseases.
become an influential figure in the
The 1 9 1 3 South American expedi-
early years of tropical medicine at
tion, for example, was organized
Harvard) and Fred Kilborne
to investigate Oroya fever and
discovered that a tick spread Texas
V<??*7*Mg<3
two anemia-
cattle fever. The year that Strong
and fever-producing diseases that
graduated from medical school,
in their later stages sometimes were
Ronald Ross dissected dapple-
mistaken for smallpox. On that
winged Anopheles mosquitoes and
expedition, co-sponsored by the
identified the parasite that causes
United Fruit Company, Strong and his
malaria.
^
colleagues spent most of their time studying hospitalized patients and those
Strong, already specializing in
who had died from the diseases. They
tropical medicine, clearly fell under the spell Pejfsow Sfrowg
of expeditionary research. In his first year at Harvard he led an expedition through Colombia,
1872-^94$
Ecuador, and Peru, and from then on Strong was almost always on the moveâ&#x20AC;&#x201D;so much so that teaching
studied blood, conducted autopsies, and performed any number of histological studies. Dozens of attempts also were made to inoculate
a menagerie of animals with the diseases, with
assignments had to be re-shuffled during his long absences.
mixed results. They succeeded with VefrMgi? PefM^MM^,
His colleague, Shattuck, kept pace, leading three expedi-
but not with Oroya fever.
tions to the Yucatan Peninsula in
1 9 3 0 , and 1 9 3 1 .
Strong's expeditions were multi-disciplinary long
Strong did have some success in identifying the cause of Oroya fever. In his report on the expedition, he charac-
before the word entered the academic lexicon. The first
terized it as "essentially a parasite of the red-blood cell"
expedition to South America, for example, included Strong;
and classified it as falling somewhere between a bacterium '
Tyzzer, the parasitologist; Sellards, whose expertise was in
and a protozoan. It would be 1 3 years before Japanese-
1923 The School moves into newly renovated Infants'
Alice Hamilton leads a
Hospital building at 55 Shattuck Street in Boston,
faculty survey of health
which will serve as headquarters for the next 30
conditions at the
years.
General Electric Plant in Schenectady, New York.
American bacteriolo-
more people are at
gist Hideo Noguchi
work at the planta-
^^GU^EMALA^
would succeed at
tion and in the
cutturing the organ-
coffee Held, where
ism, providing the
they are exposed to
cruciai evidence that
the bites" of the
Oroya fever and
black fly.
VeTYMga PgfWMfTM
Strong also
were the same
conducted an
disease. In another
experiment on two
experiment reminis-
coffee plantations
cent of Ross's and
to see if removing
Reed's earlier work
the nodules that
on malaria and
formed in the most
yellow fever, Strong
seriously infected
arranged to have
people would lower
mosquitoes feed on
the rate of infection.
a patient sick with
Strong believedâ&#x20AC;&#x201D;
Oroya fever. Later he dissected the mosqui-
Map
c;'rc<2
jre^M M^ere owc^ocersM.SM was preM/e?!f.
correctlyâ&#x20AC;&#x201D;that infected humans
toes, looking for the parasite in its gut, which might
were the reservoir of the disease, and he was able to show
indicate that mosquitoes spread the disease. But no
a lower rate of infection in both people and flies in areas
parasites were found, and sand-flies were later proved
where nodules had been removed. Asserting that nodule
to be the vector.
removal is simple, safe, and fast, Strong argued that
Strong's 1 9 3 1 expedition to Guatemala and 1 9 3 4
onchocerciasis could be controlled if doctors would
expedition to the Belgian Congo were targeted at the little-
routinely remove nodules from patients in areas where
known disease onchocerciasis. The disease first had been
the disease is endemic.
described in the Western medical literature in 1 9 1 5 in
Perhaps the key finding that came out of the
Guatemala, where it apparently became a concern of
Guatemala expedition was made by Jack Sandground, an
coffee plantation owners. But because it tends to affect
assistant professor of tropical heiminthology in Strong's
only people who live and work in heavily infested areas,
department. Essentially, Sandground settled a taxonomic
onchocerciasis was not considered to be much of a health
dispute, proving that there was no difference between
threat to white colonists.
what had been previously identified as distinct species of
The Guatemala expedition was primarily epidemio-
the onchocerciasis parasite.
logic and ecological. In Owc^oce^cMSM, his report on that expedition, Strong devotes dozens of pages to the details
- y
of the black fly habitat and breeding cycles. He also care-
'
fully observed the coffee plantation workers and drew the connection between disease rates and the workers' sea-
NTERNATIONAL TRAVEL OF ANY KIND c o u l d b e
arduous in the first half of the century, but Strong's 1 9 3 4 expedition to the Belgian Congo, his last,
undertaken when Strong was 62 years old, was a grueling
sonal schedule: "The only seasonal influence that appears
ordeal. Again accompanied by a team of scientists, he set
to be definite...is that at the time of the year the coffee is
out to study onchocerciasis in a set of villages apparently
ripe and collected and prepared for use or export, many
untouched by European colonial or missionary
Hans Zinsser succeeds
Tetanus toxoid devel-
President Harding dies in office and is succeeded by
Harold C. Ernst as
oped by Gaston Ramon
Vice President Calvin Coolidge.
Professor and Chair of
of the Pasteur Institute.
the Departments of Bacteriology and Immunology.
in the understanding of the ecology
j crMc/ CMC f o
influences. Just reaching the coast of Africa required a 16-day ocean
OT2
voyage. Once there, Strong and his
ro<3& i C<372 MSS
730 0^767* w o r e <3pf MWO?
colleagues spent another week
fo
traveling by trains, autos, and—
T ^ e SM72
according to a newspaper account of
C<3777g OMf 6<37*fy <3726?
the seven-month expedition—"boats
/z<?fC(?/y. B y ^M^r^er p<3s;
with native paddlers." Even for the
J
well-traveled Strong, this destination
sM&ic/z/y s o Jy'xzy 7 z ^ s coTMpeffe^ ^o
was impressively remote.
S^op <372 J
" T h e experiences encountered
JcWTZ /o7*
/ g w 772 7 72M^S. OTZg COM/J
in this region, isolated from civiliza-
infection rates were so high—among people and black flies—Strong left Africa believing that the only w a y to control the disease was to eradicate the breeding ground of the fly—a strategy subsequently adopted by international health organizations and African governments until the late 1980s. Strong's disease-specific expeditions were, in spirit and intent,
tion, were entirely unique and perhaps could not be encountered in
narrowly scientific investigations.
p s T z e f m f w g /o7*c<?
any other part of the world," he
Fo72g
wrote in his report on the expedition,
7*<3yS <373^
The seventh Hamilton Rice Expedition in 192.5, which went up the Amazon and Negro rivers of South
published this time as a supplement to the Awen'c^w /oMrw^f o/^
of the disease in Africa. Because the
As
^OM7*S 2^07T 072 <3776?
72007Z M7<3S Strong organized a make-shift
07?g /e//
laboratory in a mud-walled hut and
^<?<f077z<? <3
then went about diagnosing and
<3? /WZCS Jes/re ^ysf^WcY?/
America, and the 1 9 Z 6 - 1 9 2 . 7 Harvard African Expedition were more like adventures, imbued with a sense of the fantastic and occasionally a hint of foreboding. Strong and his colleagues collected and recorded
treating onchocerciasis. In contrast to <372<^ ^O T'epfCSS <3 SC7-M772
the roughly 40 percent infection rate
information on almost everything they saw and experienced, from
he had seen among Guatemalans, he gradually recognized that nearly
/ o f e s ? <3f
every inhabitant of these African villages was infected with the para-
S M ^ O^
— Strong diary.
site. The lab that Strong set up was
Harvard African Expedition
tribal customs to the parasites found in wild game, all of which was later documented in beautifully illustrated, encyclopedia-sized books published
swamped each day with hundreds of
by Harvard University Press. They
people seeking help for their failing
also brought back hundreds of animal and botanical specimens.
eyesight. "This large number of patients, closely huddled together upon the ground, sitting in the open usually with
TRONG'S VIVID, FIRSTHAND OBSERVATIONS of the
no shelter from the rays of the sun, would patiently wait
Harvard African Expedition were recorded in a 32.0-
their turns for treatment, often throughout the entire day,
page diary, now part of the rare book collection of
and only return to their homes as darkness approached,"
Harvard's Countway Library. The main objective of the
wrote Strong.
expedition was to explore the interior sections of Liberia,
Strong's expedition to the Congo provided important
where Strong's friend, industrialist Harvey Firestone, had
proof about how grave a problem onchocerciasis was in
recently taken out a 99-year lease on a million acres of
Africa. He and his colleagues also filled in important gaps
land to grow rubber trees. For more than four months,
1924 Cecil and Katherine Drinker and William B. Castle conduct first comprehensive investigation of radium poisoning among watch dial painters in Orange, New Jersey.
T o w e ^ y /^r
mosf ^f^mc^we
o / L / ^ e r M ^re ^er
f ^ e w o ^ e /eefs n e a r e r ^o H&a^e?? wore
/oyes^s W
j ^ y w ^ e ^ e efse
^e^M^/M/ /ores^s. f ^ e coM^^ry
7
^ei/er ^ e e n
eOMM^ry. — Strong diary. Harvard African Expedition
Strong and his coHeagues slogged through Liberia's hilly,
the tail, which is the usual custom for the first elephant in
stream-laced interior. Wielding his microscope like a
camp," he wrote.
weapon, Strong studied everything: human blood, snake blood, horse spleen. The maps are unrehabte, so they have
},] 1 2 3 4 EXPEDITION to the Belgian Congo was
to depend on compasses. Strong writes in frustration that
Strong's last adventure. After he retired in July
it is impossible to "travel in a straight line" to any village
1 9 3 8 , Ernest Tyzzer, who accompanied Strong on
in Liberia. On one foray, when some streams are too deep
his first expedition to Central America, succeeded him as
and wide to cross, Strong describes how he and his
head of the Department of Tropical Medicine. At the
coHeagues climbed "twenty to thirty feet into the trees
urging of George C. Shattuck, money was raised from
which grew along the banks and then descended by
former students and the Belgian government for a Richard
dropping down from hanging branches on the other side."
Pearson Strong Professorship. In 1 9 3 9 , Strong's long-time
Strong was very sick much of the time, and his diary
colleague, A. Watson Sellards—a fellow Johns Hopkins
chronicles his stoic efforts at self-diagnosis—he thinks it is
graduate who first worked with Strong in the Philip-
dengue fever, then malaria—and self-treatment with large
pines—was named the first Richard Pearson Strong
doses of quinine that affected his vision and left him nearly
Associate Professor of Tropical Medicine. Strong's life as
deaf. As he battles sickness, sweltering weather, and
an emeritus professor was full of awards, honors, and
adversity, Strong displays discipline, determination, and
tributes. Later, at age 72, he came out of retirement to
remarkable endurance. In just one day he travels miles to a
teach tropical medicine at the Army Medical School in
small village called Binda, examines a boy with yaws and
Washington, D.C. He died in Boston on July 4, 1948, after
another person with leprosy. He draws blood from a
a long battle with cancer.
poisonous snake and from a horse.Then he comes back to
Strong's scientific legacy is somewhat mixed.
the base camp and dresses the ulcerous sore of the chief's
Although a
wife. "So you see I had a busy day," he writes, "and not
Strong to the legendary Walter Reed, Strong himself was
time to think."
circumspect about his career. In November 1 9 3 6 , in an
Posf obituary favorably compared
address to the American Academy of Tropical Medicine,
After exploring Liberia, Strong and his coHeagues proceeded across Africa, traveling up the Congo River and
Strong modestly noted that "many of us have not attained
through Africa's lake district—present-day Burundi and
that measure of success in research that we have sought"
Rwanda. Much of the travel was by boat and train. In the
and made a plea for the "inner satisfaction" that can come
diary, Strong writes with some lyricism about the beauty
through scientific research. Strong is generally credited
of the Congo and the lake district, camping under fig trees,
with discovering the bacterium that causes Oroya fever,
and swimming at sunset. He also describes the party's
although he tends to be overshadowed by Noguchi, who
attempts at lion and elephant hunting. Strong doesn't have
cultured the bacteria and showed that it also caused
any luck with lions, but he does shoot an elephant. "At
V<?7*?*Mg% P e r w M M .
dinner my face was not rubbed with elephant's blood from
In conjunction with the U.S. Department of Agriculture'sBureau of Chemistry,faculty in the Department of Industrial Hygiene study potential health hazards of zinc foil wrappers for food.
S3
HSPH epidemiologist W. Lloyd Aycock shows that polio occurs most often during early spring and summer.
Onchocerciasis Richard Pearson Strong brought onchocerciasis to the world's attention 70 years ago.Yet until recently, it has languished as
hW ^^ ^^WBra^
a neglected disease, partly because it primarily affects people in the world's poorest regions. A 1992 article in the
Journal of Infectious Disease described -4T onchocerciasis as a disease that occurs "au bout de la pisteâ&#x20AC;&#x201D;at the end of the road and beyond." Today a graduate of the School, Donald Hopkins, M.P.H/70, is a leader in the world-wide effort to control onchocerciasis, or river blindness, which affects an estimated 400,000 in equatorial Africa and Latin America and is the fourth-leading cause of blindness worldwide. The disease is caused by infection with Onchocerca i/o/vu/tvs worms and spread by pesky Simulium black flies. The flies pick up the larval form of the worm, or microfilariae, when they bite an infected person. The parasite develops over the course of a
His greatest contributions to pubiic health stem from
week to the stage infectious to humans. When the fly bites the next person, it transmits the larvae, which mature to adult worms that can live up to 12 years in a person. The females, which can grow as long as 10 inches, mate with males, and produce huge numbers of microfilariae. Some but not all of the adult worms coil up in bunches and produce unslightly nodules that are the most visible feature of the disease. "One or two black fly bites are not enough to cause disease," said Hopkins in a recent interview. "Hundreds of infectious bites are usually necessary to get enough fertile female worms into the body that will, in turn, result in high numbers of microfilariae. The casual visitor
j
to an area with blackflies might be annoyed by fly bites but is not really at risk of getting onchocerciasis or going blind. You need to live in the affected area for years to be at risk. This is a disease of poor
^
rural people." Strong believed that the best way to control onchocerciasis would be to remove the nodulesâ&#x20AC;&#x201D;a favored form of onchocerciasis control for decades in Central America. Frank Richards, deputy director of the Atlanta-based Carter Center's Global 2000 River Blindness Program headed by Hopkins, said nodulectomy "makes complete biological sense" but has not been rigorously tested. Until fairly recently, another
of the white man's burden in the tropics is the constant
his onchocerciasis research. Although Strong was not the
menace of tropical diseases" and goes on to say that
first to observe and describe onchocerciasis, he made
"science is doing one of its greatest service to mankind
valuable contributions to understanding its natural history
in overcoming conditions which made life in the tropics
and transmission. Some histories credit Strong with
almost impossible for white men and dangerous and
discovering that black flies spread the parasite that causes
enervating even to natives...." Racism was endemic to the
the disease, although in his own writings, and much
era and culture, and Strong was a product of his time.
to his credit, Strong says that Donald B. Blacklock was
Nonetheless, it is hard for any contemporary reader not
actually the hrst to identify black flies as the vector.
to cringe when reading a Strong report that describes
More crippling to Strong's historical legacy from a
the Kru people of Liberia as "negroid, thick and sturdy
contemporary standpoint, however, is the racist outlook
and unattractive" or, in another report, the claim that
that pervades so much of his scientific writing. In fact,
the indigenous people in Guatemala are "on the whole...
many contemporary historians argue that the whole
rather a listless indolent people...." A disastrous incident in the Philipines nearly un-
enterprise of tropical medicine was animated by imperialist objectives and racist attitudes. The article announcing
hinged Strong's early career. In 1 9 0 6 , as head of the
Strong's appointment to the Harvard faculty in 1 9 1 3 in
Bureau of Laboratories, Strong tested a cholera vaccine on
the university's alumni bulletin states that "no small part
2.4 Filipino inmates of Bilibid Prison. The vaccine had been
1924 Tropical Medicine Professor Richard Pearson Strong
George Chandler Whipple, Gordon McKay Professor
leads the Hamilton Rice Seventh Expedition of South
of Sanitary Engineering and one of the founders of
America up the Amazon and Negro Rio rivers.
the Harvard-MIT School for Health Officers, dies at age 59.
strategy for controlling onchocerciasis centered on stamping out the black flies. The World Bank, the World Health Organization, and other groups have poured millions of dollars into aerial insectide spraying programs over the past 30 years. The spraying programs have reduced transmission significantly in some places. But, notes Richards, spraying can be ineffective in thickly forested areas because the insecticide can't reach the breeding sites. Moreover, once the spraying stops, the flies can come back. Now those involved in onchocerciasis control are pinning their hopes on a drug called ivermectin. Originally developed by Merck & Co. as a veterinary drug, used among other things to stave off heartworm disease in dogs, the drug was found through routine screening—subsequently confirmed by extensive testing—to work against onchocerciasis. A single dose annually kills the worm's microfilariae and prevents release of new microfilariae from the adult female worm. In an infected person, this can mean prevention of onchocerciasis^ worst results—visual damage and skin disease. Ivermectin may also help to curtail transmission—with fewer microfilariae circulating in a person's body, the biting black flies are not as likely to pick up the infectious organism. In 1987, Merck moved to make the drug available worldwide for free.
Hopkins, a veteran of the successful campaigns to eliminate smallpox and Guinea worm disease, stresses that the goal with onchocerciasis is control, not eradication. He said there hasn't been any reliable measurement of the number of people who have benefited so far. Instead, he measures progress in terms of the number of people who have received ivermectin—60 million in the eight-year period between 1988 and 1996. One of ivermectin's virtues is that it is a relatively simple drug to distribute and administer. But in some of the countries where it is most needed, notably Liberia and Sudan, warfare and internecine conflicts have gotten in the way of all health services, including ivermectin distribution. Even in more peaceful places there are obstacles. "Some of the villages most affected by river blindnesses are the hardest to reach," notes Richards. Ivermectin is in such demand in some countries that health officials have had to contend with theft and a growing black market. Said Hopkins," Part of the challenge of all this is to develop sustainable distribution programs." Still, onchocerciasis is one disease that health officials believe they have on the run. Says Richards, "The outlook is very bright." PW
accidently contaminated by plague, and the subsequent
chair John David, the current Richard Pearson Strong
death of 1 3 prisoners caused an uproar. An investigating
Professor of Tropical Public Health, who investigates
committee accused Strong of criminal negligence, and
debilitating tropical diseases that affect millions of the
Strong was said to have been driven "pretty near crazy"
world's least fortunate people.
by the episode. The charges were eventually dropped,
The dedication to
Ep/JgTwo/ogy, a book co-
but the Bilibid Prison vaccine deaths are the Achilles heel
authored by Brigadier General James Stevens Simmons,
of Strong's biography, a weak spot that attracted the
S.D.'^^, chief of the army's Preventive Medicine Program
attention and harsh judgment of medical historians.
and future dean of the School, acknowledges Strong's
Perhaps, as a current faculty member pointed out
"untiring and productive labors in this field since
recently, Strong's best and most durable legacy is the
1899...have contributed richly to the health of our troops,
School's continued success in tropical medicine and
to the sanitary improvement of the tropics and to the
tropical public health. Strong was a world-class scientist
future welfare of mankind."
and leader in public health; he set a high standard by
A brief editorial in the
H e m / J four days after
combining research in the laboratory and in the field.
Strong's death may have summarized him best: the writer
He exuded a truly extraordinary sense of curiosity and
noted that while politicians and statesmen steal headlines,
scientific adventure—an excitement and drive for scientific
it was "the day-to-day plodding of specialists like Strong
discovery that continues today in the work of department
who keep broadening the usable areas of the globe." Peter Wehrwein
Seth M. Fitchet, a 1921 graduate of Harvard Medical School, is the first and only recipient of the bachelor of public health degree from the School of Public Health.
^ ^ ^ ^ ^ ^ ^ ^ ^ ^
Agroupofsixcardiolo-
^ ^ H T ^ ^ ^ H
gists in New York City founds the American HeartAssociation.
Dean, 1935-1942
Ceci! Kent Drinker ^
AMES STEELE, a master of public health degree
] candidate, had been at the School only a few months when his young wife, Aina, was hospitalized with tuberculosis. Student health insurance at the time didn't cover health care for spouses, and Steele's fellowship barely paid for rent and food. The doctor's bills were quickly adding up, and Steele was on the verge of leaving the School when help arrived unexpectedly, in the person of Cecil Kent Drinker. "Dean Drinker saw me through my travails," Steele, M.p.H.'^z, later wrote in a personal memoir of his career. "He assured me that money would be available from his personal account to pay the doctors and sanitarium bills."
1925 Under the direction of Kenneth Bla.ckfan, physician-
On the recommendation of Dean Edsall, Harvard
in-chief at Children's Hospital, HSPH faculty members
President Abbott Lawrence Lowell approves a
Philip Drinker and Constantin Yaglou, right, construct
$100,000 addition to the Antitoxin and Vaccine
the first "air-conditioned nursery" for premature
t
infants.
M ^ !
Laboratory at Forest Hills, Boston.
Drinker was nearing the end of his seven-year tenure as dean when he came to Steele's aid. By year's end, he would resign his administrative post to return to his research on respiratory physiology. But the incident speaks volumes about the taciturn Drinker's generosity of spirit, commitment to students, and the degree to which his life had become entwined with the institution at which he spent the majority of his career. Born in 1 8 8 7 , the third son of a Quaker family, Drinker completed his undergraduate degree at Haverford College and his medical training at the University of Pennsylvania, where he finished first in his class, earning four of the university's five merit awards. He then journeyed to Boston to start a residency at the Peter Bent Brigham Hospital. While in medical school, Drinker was engaged to Katherine Rotan, a recent graduate of Bryn Mawr College and aspiring scientist who would become his wife and life-long collaborator in the laboratory. During the couple's long courtship, they dutifully wrote messages to each other in their personal journals at the close of each day, exchanging journals when they met to catch up on the day-to-day details of each other's lives. Cecil's last journal entry, written shortly after they married, reads: " N o w we are settled in our apartment near the School, both of us studying medicine and more truly happy and contented than we have
been in our lives. It passes all the dreams." As if to underscore the couple's shared commitment to their scientific careers, one of Drinker's aunts gave them a wedding gift of $500 to support their research. In 1 9 1 6 , Drinker joined the faculty of Harvard Medical School's physiology department, and two years later, when department chair Walter Bradford Cannon was called into active military service, Drinker was made acting head of the department. His willingness to step in on short notice and his remarkable energy—he shouldered the full teaching load with only two student assistants-—led to a rapid rise in the faculty. When the Division of Industrial Hygiene was launched as a semi-independent unit of the university, Drinker was selected to direct the effort. nn
ROUND THAT TIME, D r i n k e r ,
# % working with Medical ^ ^ School Dean David Linn Edsall, published his first important paper, a study of manganese poisoning in steel mill workers. Drinker, who specialized in respiratory dynamics, suspected that the worker's symptoms—languor, muscular tremors, and a "peculiar, slapping gait"—resulted from the absorption of manganese dust through the lungs and gastrointestinal tract. In 192.2., the Division of Industrial Hygiene was incorporated into the newly established Harvard School of Public Health, and it quickly became one of the School's strongest areas. By 192.3, Drinker was a full professor
The Scopes "Monkey Trial" prosecution of a Tennessee school teacher for flouting state's law prohibiting the teaching of evolution pits former three-time Democratic presidential candidate William Jennings Bryan, right, against Chicago attorney Clarence Darrow.
and chair of the Department of Applied Physiology with an additional appointment in industrial hygiene. His dual appointments and the recruitment of Drinker's younger brother, Philip, created strong links between the departments of industrial hygiene and physiology. George Cheever Shattuck, clinical professor of tropical medicine, would later write that "in their earliest days, the departments (of physiology and industrial hygiene) were hardly separable, joined as they were by their smallness, by the family ties of Cecil, Katherine, and Philip Drinker, and by their singleness of interest in the new and developing science of preventive medicine for industry." In January of 192.3, Drinker was part of a team of faculty comprising Alice Hamilton, Roger Irving Lee, Edwin B. Wilson, Wade Wright, and brother Philip that surveyed the health of workers in General Electric's Schenectady plant. The following year, Drinker gained national prominence for his investigation of radium poisoning among women who painted luminous watch and clock dials. The study, now regarded as a classic in the field, revealed that the common practice of "pointing up"—running the paint brush between the lips to get a smooth point—led to the ingestion of minute quantities of radioactive radium that were incorporated into
14 so o^' ^
the facial bones, causing necrosis of the jaw. Katherine Drinker and William B. Castle collaborated on the study, which also identified the atmosphere in the factories as a source of exposure.
and a firm grounding in the basic sciences. Drinker's tenure also brought a broadening in the School's curriculum to include lectures in sociology and a course in medical writing taught by Katherine Drinker.
The New Jersey-based U.S. Radium Corporation, which had hired Drinker to do the initial study, first dismissed the findings as preliminary, then asked him to conduct further tests. The results were the same. Drinker eventually published his findings in the JoMrfM/ o/Tw^MS-
Most importantly, Drinker helped steer the School through the Great Depression and the tumultuous early years of World War II, a period that severely strained the School's financial and intellectual resources. But the stress of his responsibilities coupled with deteriorating health (partly due to a long struggle with alcohol) forced Drinker to resign his deanship in 1942.. However, he continued to teach and research at the School for another five years, retiring in 1 9 4 7 . In retirement, Drinkerâ&#x20AC;&#x201D;who, like his brother, had inherited an artisan's genesâ&#x20AC;&#x201D;built laboratories in his homes in Brookline and Falmouth, Massachusetts, where he worked on photographing capillary circulation in living frogs.
Hygz'gwe, and several years later, Drinker and fellow faculty member Alice Hamilton were key witnesses in a law suit against the company that was one of the first to award damages to employees injured through their jobs. Drinker went on to publish important research on the health effects of heat, humidity, and carbon monoxide poisoning and on the role of lymph and capillary circulation in infection. During World War II, as a member of the National Research Council Committee on Aviation Medicine, he collaborated with colleague Leslie Silverman to develop high-altitude breathing equipment that became the prototype for oxygen masks worn by U.S. bomber and fighter pilots. The pair also worked out breathing requirements for protective gas masks for the Army's Chemical Warfare Service.
XeMfDw?^?; iSSy-i^yd
rn HH rn ITH E D S A L L ' S RETIREMENT
m n n H in 1 9 3 5 , the 48-year-old W W Drinker added a new role to his repertoire, becoming the School's first full-time dean. (Edsall had divided his time between the medical school and School of Public Health.) A meticulous organizer with an eye for detail and a reserved, almost formal demeanor, Drinker brought stability to the rapidly growing institution. His term as dean compassed significant changes for the School, including expansion of enrollment from 50 to 9$ students a year, the admission of women as candidates for degrees, and the raising of admission criteriaâ&#x20AC;&#x201D;to require that all candidates possess a minimum of a bachelor's degree
In 1 9 5 6 , Drinker's wife and longtime colleague, Katherine, succumbed to leukemia; Cecil, apparently crushed by this loss, died several weeks later. After his death, Drinker's colleague Stanley Cobb, compared Drinker's skills to those of an artist. "In the laboratory, it was incredible to watch him," said Cobb. "He could do anything with those hands. He was miles ahead of the rest of us." MarceHa J. Bernard
1926 Richard Pearson Strong
Professor ofVital Statistics Edwin B.Wilson assists
leads Harvard African
the Massachusetts Department of Health in the
Expedition through
design of punch cards and data collection for patient
Liberia and across sub-
records in state mental health facilities.
Saharan Africa.
GORDON FA)R N A RECENT TRIP TO PARIS, Peter R o g e r s , a p r o f e s s o r of city
^^ H
H
^^
and regional planning in Harvard's Division of Engineering and Applied Sciences, was having a drink at an outdoor cafe when he struck up a conversation with a man who turned out
^^^^^^^
to be a former top-ranking health official in Colombia. When
Rogers mentioned that he was a professor at Harvard, the man exclaimed, "You're from Harvard. Well, you must know Gordon Fair!" The association between Harvard and Gordon Fair is just as strong for
Across the River
hundreds of other health officials and sanitary engineers around the world. For almost half a century, Fair taught sanitary engineering at Harvard, beginning with his appointment in 1 9 1 9 to the Harvard-MIT School for Health Officers, and ending in 1 9 6 5 , five years before his death. Fair was an entertaining, erudite teacher who treated a lecture as a performance to be perfected. But his influence on sanitary engineering went far beyond the classroom. According to Rogers, Fair deserves a lion's share of the credit for the mid-century sea change in sanitary engineering, when what had been a field dependent largely on received wisdom, empirical experience, and trial-by-error became one based on science, equations, and formulae. Rogers notes that engineering precedes science; it is easier to build something than to figure out how and why it works. Fair's accomplishment was not inventing new sanitary engineering systems, but identifying the principles
A^cwe
Pro/e^^o^ E^M/^rJ Moore,
L. C^awg, aw J GorJoM o/^e Dep^r^wewf EMgweerwg, wAw^ ^ejJ^Mar^re^ w Pzerce
that would make a system work the w a y it was supposed to. " H e was the first person to put sanitary engineering on a scientific basis," says Rogers, w h o was Fair's teaching assistant in the early 1 9 6 0 s and succeeded him as Gordon M c K a y Professor of Environmental Engineering.
Assistant Professor
U.S. biologist Hermann
Gordon Fair named
Joseph Mulier discovers
head of the School's
that x-rays produce
Department of Sanitary
genetic mutations.
Engineering.
16 ^ sh ^
Fair earned a world-wide audience for his methods with the publication in 1 9 5 4 of Wafer $M/?p/y ^wJ W^sfcwfVfer Aiming for much more than just a textbook, Fair and his co-author, John C. Geyer, a Johns Hopkins professor, produced a "great synthetic w o r k " that effectively codified sanitary engineering, says Rogers. Fair's younger son, Lansing Fair, recalls his father saying that the textbooks he had used as a student only had two formulae. " N o w we have over 1 , 6 0 0 , " Fair remembers his father saying, "and they ail mean something." Revised editions of Fair and Geyer's book are still in print, and while environmental engineering, as the field is now called, has moved on since Fair's day (the underlying chemistry is much more complex), Rogers say that a sewage system built today based on principles outlined in W^fer ^Mpp/y "would work perfectly." Water, of course, sustains human life. But under some circumstances— such as rapid urbanization—water can also snatch life away, spreading cholera, dysentery, typhoid fever, and a host of other diseases. Sanitary engineering emerged in the mid-ipth century as England and the United States industrialized and urbanized and pioneers such as John Snow exposed the dire health consequences of a contaminated water supply and its close corollary, poor sewage removal and treatment. During this so-called Great Sanitary Awakening, sanitary engineering and public
health were as interwoven as epidemiology and public health are today, a fact reflected in the joint HarvardMassachusetts Institute of Technology origins of the School and the focus on sanitary engineering of two of that institutions three founders, William Sedgwick and George C. Whipple. —1 AiR's CAREER straddled this 1 early linking of sanitary JL engineering with public health and the eventual separation of the two fields. A South African native educated in the best technical schools in Germany, Fair earned a bachelor of science degree in 1 9 1 6 conferred jointly by Harvard and M!T, which, at that time, shared engineering courses. Three years later, he received his first faculty appointment as an instructor of sanitary engineering. Historian Jean Curran, author of FoMMJers; H^rtwd* o/^ PM^/zc says that from the outset, Fair's duties were centered in Harvard's School of Engineering in Cambridge (later changed to division status by President James Bryant Conant). For most of his career, Fair had offices in Pierce Hall, one of the grand, old red-brick buildings on Oxford Street. Fair's geographical and institutional separation from the School was symptomatic of the gradual parting of the ways between mainstream public health and sanitary engineering. The break up was partly the result of sanitary engineering's success, at least in Europe and the United States. As water supplies became cleaner and sewage removal
1927 Philip Drinker invents the Drinker respirator, which will become known as the "iron lung."
William A. Hinton, director of the state Wasserman Laboratory and instructor at the medical school and School of Public Health, invents the Hinton Test, making possible widespread diagnosis and treatment of syphilis.
and treatment more effective, sanitary engineering became much more about engineering. Meanwhile, academic public health in this country became more concerned with chronic disease and the microbiological aspects of infectious disease. This schism was accentuated at Harvard by the strong and conflicting views of Whipple and David Linn Edsall, the dean of the medical school and first dean of the School. According to Curran (who based his account on interviews with Fair), Whipple wanted to build the School of Public Health where the business school now stands, with strong links to the university's Department of Government and other Cambridge programs. Edsall and his successor as dean, Cecil K. Drinker, saw public health as linked to medicine and gave the School the Boston and Longwood Campus focus it has today. Fair strove to bridge the gap. He was dean of the engineering school for several years and served as master of the college's Dunster House from 1948 to i960. But Fair also had strong ties to the School of Public Health as head of the School's sanitary engineering department. He taught at the School, and many of his Pierce Hall colleagues were on the School's faculty. Lansing Fair remembers "tall, gangly" Philip Drinker being a dinner guest on occasion. And Fair and his students were regularly featured in the School's A/M7MM; and viewed, de facto, as part of the School. In the early 1960s, Fair even went as far as uprooting himself
first scientists to draw attention to the pollution problems in Lake Michigan. He was also one of the driving forces behind the Harvard Water Program of the mid-1950s, which took a then-novel, interdisciplinary, systems analysis approach to the resource management of water. Everything from hydroelectric power to recreational swimming was in the program's purview, and some of the program's ideas were used in the Indus River Basin in Pakistan, where thousands of acres of farmland were going out of production because of the increased salinity of the water.
GorJoH M.
/row /e/2,
from his long-time Pierce Hall environs to a first-floor office in the School's Building One. DMpos<3/ is unmistakably an engineer's book, full of discussions and equations on hydraulics, wave action, and intake velocities, but Fair's understanding of the public health roots of sanitary engineering are evident. Fair also was the author of the chapters on sewage and refuse disposal for Pret/eMfwe MeJ/cwe PM^&r H&3M7, the encyclopedic volume originally edited by Professor of Epidemiology and Preventive Medicine Milton J . Rosenau, one of the founders of the Harvard-MIT school. And when he was invited to
FoMw^^ow M<?/arM
give the prestigious Chadwick Public Lecture in 1 9 5 9 in London, Fair didn't talk about hydraulics. He talked about the public health risks and benefits of fluoridation, atmospheric pollution, and ionizing radiation, which he grouped under the heading "microchemical challenge." Fair's career predated the beginnings of a popular environmental movement and the era of tougher environmental regulation. The first Earth Day was in April 1 9 7 0 and the landmark Clean Water Act that forced better sewage treatment nationwide was passed in 1972. (though Rogers notes that Fair's textbook would have been on the shelf of almost anyone w h o designed one of those new systems or improved treatment plants). Fair, however, was one of the
The execution of accused murderers Nicola Sacco and Bartolomeo Vanzetti at Massachusetts' Dedham prison sparks nationwide protests. Fifty years later, Sacco and Vanzetti are exonerated.
As a Department of the Interior official, future faculty member Roger Revelle also worked on the Indus River Basin project. Rogers says the broad-based approach to water management taken by Fair and the Harvard Water Program influences Army Corps of Engineering thinking to this day. Today, water pollution is an ascendant area of interdisciplinary research and discussion at the School, with Associate Professor Tim Ford and others leading the way. Recent international outbreaks of cholera and a renewed focus on infectious diseases are putting sanitation back on the public health agenda. "Worldwide, many health problems are still caused by bad sanitation," noted Rogers. " H o w many people die of diarrhea each yearâ&#x20AC;&#x201D;seven million? What is needed still, in many places around the world, is low-cost sanitation." Peter Wehrwein
HH y
^^
^
X /^L/ V
v
HEN A L I C E H A M I L T O N SET OUT in 1 9 1 5 to i n v e s t i g a t e t h e
health of peopie working in munitions factories, World War I was raging in Europe, and the United States arms industry was running at fuH tilt. In the frantic effort to produce vast
quantities of explosives, worker safety barely registered as an afterthought. A pacifist who openly opposed the war—a view common among the social reformers of the day—Hamilton had her work cut out for her. Just finding the factories was a challenge. "If there was anyone in Washington who knew where explosives were being produced and loaded...he kept the secret," Hamilton would later write in her wonderfully engaging autobiography, Exp/onng Dangerous Th?Jes. But showing the kind of nerve, determination, and ingenuity that characterized her long career and life—she would live to age 101—Hamilton plunged ahead. When she went to New Jersey to conduct her investigation, she kept a lookout for "canaries," the nickname for men tainted yellow by working with picric acid, a chemical commonly used in making explosives. She also scanned the skies for the telltale yellow or orange plumes of a munitions plant, which, she later wrote, was "like the pillar of cloud by day that guided the children of Israel. I would hear vaguely of a nitrating plant in the New Jersey marshes and I would spot the orange fumes and make my way to them." At about the same time, another future member of the School's faculty, Philip Drinker, was also involved in a war-related effort, analyzing the methods
1927 The Rockefeller foundation approves a second
Charles Lindbergh
endowment grant of $1,090,000 to the School to be
completes first non-
added to its original H ,785,000 gift.
stop solo trans-Atlantic flight.
used to make the silk, linen, and cotton fabric that formed
The decade from 1 9 1 0 to 1 9 2 0 is generally viewed
the outer skin of airplanes. Hamilton and Drinker embody
as the time when occupational health emerged as a main-
two different impulses and traditions in workplace health
stream concern in the United States. Muckraking journalists
research, and perhaps even more broadly, public health.
and government investigations were beginning to cast a
Drinker, trained as a chemical engineer, fits intoâ&#x20AC;&#x201D;and helped
light on the underside of the country's industrial prowess.
defineâ&#x20AC;&#x201D;the field of industrial hygiene, which focuses on
In 1 9 1 1 , the deadly fire at the Triangle Shirtwaist Co.
engineering solutions in the workplace (see story page 24).
in New York City, which killed 1 4 6 people, shocked the
Hamilton, on the other hand, was the prototypical held
nation, exposing how wretched and unsafe working con-
investigatorâ&#x20AC;&#x201D;a self-described explorer of the nation's
ditions could be. Unlike England and many industrialized
largely unregulated factories and workplaces who hts best
countries in Europe, the United States had few labor laws
into the tradition of occupational health and epidemiology.
and little research had been done here in occupational
While Hamilton necessarily became an expert on several
disease. Hamilton's writings are peppered with references
industrial processes, her eye was generally on the worker
to the yawning gap between European and American
and on disease. Hamilton was also intensely political,
worker protection and research.
progressive, and even radical. She opposed American involvement in World War I, protested the 192.7 execution of Sacco and Vanzetti, voted for Socialist Party candidate Norman Thomas in 1 9 3 2 , and was pro-union and a feminist throughout her life. Her circle of friends included Jane Addams, Felix Frankfurter, and other members of the intelligentsia.
Jazz
star-
Harvard's involvement in industrial hygiene and occupational health dates back to the School's predecessor institution, the Harvard-M!T School for Health Officers. The first curriculum covered occupational accidents, industrial poisonings, and the effects of ventilation on tuberculosis. In 1 9 1 8 Professor Emeritus Frederick Shattuck raised
Birth control pioneer
ring A! Jolson, is the
Margaret Sanger
first talking picture and
organizes the first
will popularize the
World Population
talkies.
Conference.
20 ^ ^ ^
$ 1 2 5 , 0 0 0 from a number of New England industrialists to establish a Division of Industrial Hygiene at Harvard Medical School. Led by physiologist and future dean Cecil K. Drinker, the division was one of the institutional seeds for the founding of the School in 192.2. Additionally, the School's first dean, David Linn Edsall, had an abiding interest in industrial medicine and actively promoted the area. Edsall, who had established an industrial disease clinic at Massachusetts General Hospital before World War I, is credited with recruiting Hamilton to Harvard, despite the fact that she would be breaking the university's gender barrier. Other key people in the formative years of industrial hygiene and occupational health at the School included Gordon Fair, best known for his work in sanitary engineering but initially recruited to the School as an expert on vital statistics and industrial sanitation; Louis Agassiz Shaw, who was a key assistant to the Drinker brothers; and, a few years later, Constantin P. Yaglou, who did groundbreaking research on workplace air temperatures. ^H**^
PIDEMIOLOGY HAS BEEN
H^i H '
analogized frequently to detective work; in the case # of Alice Hamilton and other early occupational health researchers, the comparison rings true. Often going on little more than intuition and anecdote, these investigators used their eyes, ears, and common sense to ferret out horrendous working conditions. Hamilton,
in particular, worked tirelessly not only to inspect factories but also to track down workers in their homes and communities. This early brand of "shoeleather epidemiology" was successful partly because the exposures to hazardous substances were so high and the health consequences so grievous, notes Professor Richard Monson, a contemporary epidemiologist at the School who has specialized in occupational health. The conditions in factories in the first decades of the twentieth century often were so bad that workers were literally being poisoned, sometimes getting sick right on the job or just a few hours later. Hamilton became interested in what she called "industrial diseases" while living in Jane Addams' Hull House in Chicago. "Living in a working-class quarter, coming in contact with laborers and their wives, I could not fail to hear tales of the dangers that workingmen faced," she wrote in D^MgeroM.s TraJes. She first made her mark in 1 9 1 0 , working for the governor of Illinois' Occupational Disease Commission. The commission divided up the known poisons, and Hamilton was assigned lead. The exposures that Hamilton was dealing with were so high that it wasn't uncommon for workers to have terrifying neurological symptoms—comas, convulsions, "lead palsy." Combing through hospital records, interviewing labor leaders, and talking to apothecaries (who played a major role in healthcare in working-class districts), Hamilton and her assistants were.
in effect, conducting case studies without the controls. They identified as many lead poisoning cases as possible, then went to the factories where sick people worked and studied how and why the worker might be exposed to lead. The work involved poking around in some of the most obscure nooks and crannies of industrialized Chicago: " I was put on the trail of new lead trades, some of which I had never thought of—for instance, making freight-car seals, coffin 'trim,' and decalcomania papers for pottery decoration," Hamilton wrote in Dangerous The sense of excitement she conveys is exhilarating. "It was pioneering exploration of an unknown field," wrote Hamilton. " N o young doctor nowadays can hope for work as exciting and rewarding." ^
^
AMILTON WOULD GO o n
to do a larger national [ study—she called them M H "surveys"—of lead poisoning for the federal government, and then, during World War I, to investigate the munitions industry. A major theme in her research—as well as in Drinker's—was that dust and poor ventilation were the major causes of occupational disease. While employers had tried to shift the blame for lead poisoning to their workers' poor handwashing habits, Hamilton's research put the onus back on the employer by showing that the air in some factories was so full of lead dust that workers got sick simply by breathing. "There can be no intelligent control of lead danger
1928 Wilson G. Smillie appointed the first full-time
Scottish bacteriologist
professor of public health administration. Smillie
Alexander Fleming
would introduce use of the case teaching method
discovers penicillin.
for students in the department.
GroMp porffYHf
Hoo^erS ResMrc^ CowTwMee ow ^ocM/ TrewJs
in industry unless it is based on the principle of keeping the air dear from dust and fumes," she wrote in DaMgeroMS TraJes. Despite her alarm at some of the working conditions she saw and her strong pro-worker beliefs, Hamilton favored a discreet, almost decorous approach to changing factory conditions. This may have been due partly to the lack of legal or statutory recourse at the time, and partly to her personality and the constraints imposed on women of her era. Colleagues described Hamilton as an extraordinarily gentle person, and Barbara Sicherman, an insightful editor of a collection of Hamilton's letters, comments on Hamilton's "dread of conflict" and a temperament "predisposed to work by persuasion rather than confrontation." Hamilton's approach is captured vividly in D^MgeroMX when she describes a 1 9 1 1 inspection of a factory. "It was a dreadful place," she wrote, "old, dusty with the dust of years, no attempt at any control of
the obvious dangers, just hopelessly bad." And Hamilton was even more upset when she saw the contrast with the gleaming horse stables, "where great dappled gray horses were standing on a clean, brick floor, eating from clean mangers and rubbed down till their coats shone." Back in her hotel room, Hamilton wrote that she was tempted right then and there to expose the situation in a muckraking article for McC/Mre's magazine, which was then famous for its influential exposes. But on "soberer reflection I gave it up," she wrote in her autobiography. "The result would be only a temporary flurry, no lasting reform, and it would make any further work on my part impossible." NSTEAD, SHE VISITS the o w n e r ,
but doesn't have the heart to tell him about the horrible conH , ditions in his factory. " I could no more have told him what his plant really was like than I could have told him his beloved child was a criminal," Hamilton wrote. Eventually she meets
Hawz/^ow, ceM^y; o ^ e r s wof
with the person who is in charge of the day-to-day operation of the plant and, at his request, gives him a written report. Hamilton wrote: "He accepted my written report and at once began to follow its recommendations. That place was radically reformed, at the price of one single interview." Sicherman has written that after Hamilton came to Harvard her career took a turn away from "pioneer investigator to that of codifier, troubleshooter and consultant." Hamilton was, after all, $0 years old when she was appointed assistant professor, and she had lost the connection to one of the primary sponsors of her research, the federal Labor Department, during the Harding Administration. But the pace and range of her work while at the School was still remarkable. She investigated mercury poisoning in the felt hat industry. In 1 9 2 $ , when the introduction of lead into gasoline was a bitterly contested issue, pitting public and occupational health experts and advocates against
Hypobaric-hyperbaric pressure chamber installed at
Investigators at the
Herbert Hoover elected
School. James H. Rand, Jr., president of the Remington
State Antitoxin and
president of the United States.
Rand Coporation, pays for the $30,000, 31-foot-long
Vaccine Laboratory
cylindrical chamber, which is used for high altitude
develop a placental
and diver decompression studies.
extract that is a precursor to immune serum globulin.
of individual cases. But in these steel towns, and in the soft-coal towns of Illinois, my inquiry as to mental symptoms or palsy in men who had been gassed (by carbon monoxide) aroused only puzzled surprise."
/wfenor o/^ we^/ /i^c^ory o/t^e ear/y ipoos. industry, Hamiiton took a strong stand against ieaded gasoline. " N o lead industry has ever, even under the strictest control, lost all its dangers," Hamilton said at a conference organized by the surgeon general. Three years later, she successfully pushed for a similar conference on radium poisoning. In 192.9, Hamilton's landmark /w^MS^M/ Tb%;'cofogy textbook was published. An advocate of birth control since her Hull House days, Hamilton was connected to numerous birth control organizations. In 1 9 3 0 , President Herbert Hoover named her a member of the Research Committee on Social Trends, a blue-ribbon group that was charged with doing social science
1929 In an effort to balance the number of international and U.S. students at the School, The Rockefeller Foundation agrees to fund two training fellowships specifically for U.S. physicians.
surveys on virtually every aspect of American life. Even as late as 1940, when she was 7 1 years old, Hamilton was involved in a study of workers with silicosis. But in the later stages of her career, Hamilton also started to run into the limits of her mode of research, which was based on industrial hazards so flagrant that the diseases they caused were readily apparent. Now, partly because of her efforts, the exposures were lower, the substances less hazardous, and the effects more likely to be seen in the long-term. In D<3MgeroMS TMJes, she wrote: "When 1 had gone into a lead-smelting town and inquired about lead colic or palsy, or 'lead fits,' everyone knew what I meant and many could tell me
In 1 9 3 7 , in what Hamilton calls her "last detailed study of a poisonous trade," she set out to document psychosis-producing carbon disulfide poisoning in the "artificial silk" or rayon industry. Eventually, by her account, the industry changed its way of making rayon so workers were not exposed to hazardous fumes. But Hamilton writes about the many roadblocks and setbacks along the way, and she ends on a somewhat cryptic note of relief rather than triumph: "The story of this investigation is all too recent history to recite in detail, for it is not a pretty history and it was curiously bound up with a not very creditable political situation." Almost 60 years later, on July 1 1 , 1995, the U.S. government recognized Hamilton's pioneering achievements by issuing a 5 5-cent postage stamp bearing her likeness. The stamp was unveiled at the School, and, while the legend identifies her broadly as a "social reformer," to the many professionals who followed in her footsteps, she is best remembered as the intrepid public health pioneer who revolutionized understanding of workplace health. Peter Wehrwein
Dean Edsall tells the president of the University of Western Ontario that, in his opinion, the trend is away from independent schools of public health and toward coordination with medical schools.
Persistent Peri! Lead has one of the longest, most insidious histories of any industrial public health hazard. It's been postulated that the Romans unwittingly poisoned themselves into decline and fall through the ubiquitous use of lead in plumbing and containers. In the mid-18th century, Devonshire, England, was gripped by a decades-long epidemic of "colic" until George Baker discovered that the cider in the country was being contaminated with lead from a particular kind of millstone. Alice Hamilton started the tradition of lead poisoning research in the United States at the beginning of the century, and today, there is a temptation to list lead poisoning prevention and control among public health's triumphs, at least in the industrialized world. After all, many fewer people are exposed to lead at work, and even among those who are exposed, the exposure levels are a fraction of what they were in Hamilton's day. "If you go into a lead industry today, you are not going to see the overt symptoms of lead poisoning that Alice Hamilton saw," says Aaron Sussel, a lead expert for the National Institute of Occupational Safety and Health (NIOSH). "You may find workers who are lead poisoned, but it will be at much lower levels and with much subtler effects." following the gradual phasing out of leaded gasoline and lead paint over the past several decades, lead exposure among Americans in general has also declined. One of the government's best gauges of population-based health, the National Health and Nutrition Examination Survey, found an average blood level of 17 micrograms per deciliter in 1976-1980. When the same kind of survey was done in 1989-91, the average blood lead level was just three micrograms per deciliter. "That is a huge drop!" says Associate Professor Joel Schwartz, who, as an EPA scientist in the 1970s, did some groundbreaking studies linking blood lead levels to leaded gasoline. Still, pockets of dangerously high lead exposure persist. Poor people—particularly
children—living in older, substandard housing are at risk because of aging lead paint. Lead poisoning remains one of the leading examples of how environmental contamination disproportionately affects minorities. And while there are fewer "dangerous trades" than in Hamilton's day, lead exposure is still a significant problem among construction workers and other people who work around older structures, according to Sussel. Ironically, one of the most dangerous contemporary occupational exposures came about in reaction to widespread concern about the potential dangers associated with scraping old paint from bridges, water towers, or other steel structures. The resulting "solution"—containing the paint chips and dust by enclosing the work area—spared the public at the expense of workers, says Sussel. At the same time, more sophisticated and sensitive studies have revealed that even very low lead exposures may have neurological and health consequences. As recently as the early 1970s, a safe blood lead level was considered 25 micrograms per deciliter; now the threshold has been lowered to 10 micrograms per deciliter. Schwartz, who inveighs against the "toxicological fallacy" that everything has a safety threshold, notes that 10 micrograms is still 500 to 1,000 times what might be considered the natural background level found in preindustrial societies and environments. At the School, Schwartz is working on various cost-benefits studies of lead and lead-screening. Associate Professor Howard Hu is one of the leading lead researchers in the country. Hu has conducted several studies that involve using K-X-ray fluorescence to measure lead levels in bone, research that has hundreds of implications and applications. One intriguing possibility proposed by Hu is that menopausal women, who lose massive amounts of bone tissue, effectively experience a gradual, low-level lead poisoning as lead leaves the skeleton. "What Alice Hamilton seemed to have a knack for is finding the classic occupational health problems," notes Sussel, who works in a building named for Alice Hamilton and sees her portrait in the lobby every day he goes to work. "They just don't go away. Even 50 or 60 years later, they still exist." PW
Samuel Albert Levine of
U.S. stock market crash
Harvard Medical School
on October 29 marks
notes the first link
the beginning of the
between hypertension
Great Depression.
and fatal heart disease.
T WAS AN ODD-LOOKtNG contrap-
tionâ&#x20AC;&#x201D;a cylindrical, sheet-metal tank with a small aperture at one end and vacuum-cleaner hoses sticking out of the back. According to at least one eyewitness, it could be heard running from half a mile away. Its inventor, a tall, young man with a thick shock of dark hair and a strong jaw line, rolled the machine into the hospital room of its first patient, an eight-year-old girl suffering from respiratory paralysis due to polio. Within seconds of being inserted in the machine, the girl began to breathe normally. A few minutes later, she asked for ice cream. Philip Drinker, an assistant professor in the Department of Ventilation and Illumination at the emerging Harvard School of Public Health, was the bold young engineer whose breathing apparatus was undergoing its first clinical trial on that day in 1 9 2 8 at Children's Hospital.
As news about this amazing machine spread, orders came in from hospitals around the country; the patent was transferred to Warren E. Collins, Inc., which would eventually build 3,000 Drinker respirators.
The article describing the Drinker's successful experiment, "Use of a New Apparatus for the Prolonged Administration of Artificial Respiration," which Drinker wrote with colleague Charles F. McKhann, appeared on M a y 1 8 , 192.9, in the AssOCMif?'oM (JAMA).
Drinker would spend his entire professional life around machines, specifically, machines that made and measured dust. But it would be this particular one, the "Drinker respirator," which later became known as the iron lung, for which he is most remembered. In 1932. a polio epidemic swept the northeastern United States and the New York Consolidated Gas Company, which subsidized Drinker's research and held the patent on his invention, commissioned Warren E. Collins, Inc., of Boston to begin manufacture of the Drinker respirator.
According to Drinker's sister, Catherine, Drinker conceived the idea of using his respirator on polio victims after responding to an emergency call from Kenneth D. Blackfan, physician-in-chief at Children's Hospital, about a drop in temperature in one of the hospital's air-conditioned rooms for premature infants, (see sidebar page 2.8). Walking through the wards of Children's Hospital, Drinker was horrified by the sight of children in polio-induced respiratory paralysis. "He could not forget the small blue faces, the terrible gasping for air," wrote Catherine in her memoir, F<3?w7y
Breathing Easy T h e o f
t n v e n t i o n
t h e
! r o n
L u n g
1930 Assistant Professor Harold Coe Stuart launches the
Mahatma Gandhi leads a 165-mile march to India's
First analog computer
landmark Longitudinal Child Growth and Develop-
western coast as part of an ongoing campaign of civil
developed.
ment Study, the first major study of the growth and
disobedience to protest British rule.
development of the healthy child.
For the next two decades, until the development of an effective vaccine, the Drinker respirator, modified over time, would be a lifesaver for thousands of polio victims. Yet the concept behind its design, said Drinker, was "simple." As an engineer, Drinker approached the body's respiratory machinery with the same mindset he would any other mechanical device. The principle behind the respirator was to alternate negative and positive air pressure inside the tank "in a manner that seems to be physiologically normal," wrote Drinker and Louis Shaw, a physiologist, in a 1 9 3 8 article describing the respirator's evolution. Negative pressure inside
the tank induced respiration by forcing the expansion of the diaphragm and the thorax. Allowing the air inside the tank to return to atmospheric pressure caused the expiration. The Drinker respirator grew from a device called a plethysmograph that Philip's brother Cecil had built. A paralyzed cat placed inside the plethysmograph could be kept breathing by using a hand-held syringe to vary the air pressure inside the box. Philip believed the same principles could be applied to induce human respiration. Since 1 9 2 6 , Philip had been working under the auspices of the Rockefeller Foundation to
fMwgs
develop better methods of resuscitation. The New York Consolidated Gas Company was particularly interested in this research because they were looking for a device that could save people injured in gas leaks and by electric shock. Drinker assured them a human-sized model of the cat-breathing device could do just that, and he began construction. He started with a wooden crate, and then had the sheet metal tank built
1931 U.S. infant mortality
New York City's Empire
rate stands at 61 per
State Building opens.
/Mecf ewtzre warJs orJer t o M c t w : s o^parafy^'c
1,000 live births.
* J
26 pc
to his specification in the Harvard machine shop. The rubber collar for the patient's neck created a great deal of consternation for the respirator's inventors; it had to be snug enough to create an airtight seal, but ioose enough not to cause strangulation. Older brother Cecil, in fact, had responded to a tetter from Philip asking for his advice on the problem by saying the entire project was insotvable because any collar tight enough to prevent air from leaking would interfere with blood flow to the brain. Luckily for the thousands whose lives were saved
Parents respiratory Stress afMe to JroMWMg, car^ow 77!07!0x;Je pozsoMmg, an J wafMra/ gas /ea^s were a/so treated
by the iron lung, Cecil's letter wasn't received until after Philip had found a ring that worked. The optimal diameter for the rubber collar was based on data on shirt collar sizes provided by the Cluett Peabody Company. The optimal diameter of the head hole came from information provided by the Knox Hat Company. "It seemed impossible to obtain data of this sort from medical sources," wrote Drinker and Shaw. Calculations of how much negative pressure was needed to induce inhalation were based on a set of experiments that drew on the emergency life-saving skills of firefighters from the Consolidated Gas Company of Boston. Emergency workers were asked to apply pressure to a scale as
t^e /roM /MMg.
they would to the chest of someone in need of resuscitation. Another Boston manufacturing company specializing in the production of respiratory equipment, J.H. Emerson, Co., would eventually devise a simplified, less expensive respirator by replacing Drinker's blowers with bellows and substituting a leather diaphragm for Drinker's motor and vacuum cleaner hose. (It's actually the Emerson respirator, not the original Drinker respirator, that is on display at the National Museum of Health and Medicine.) "Incidentally, I don't know the origin of the horrible name 'iron lung,'" wrote James L. Wilson several years later. Wilson was one of several physicians who attended the iron lung's first patient until she died.
1932 To reduce expenses, the Administrative Boards of the
U.S. unemployment
Medical School and School of Public Health propose
reaches 15 million, and
shortening employee vacation allowances from one
34 million Americans
month to three weeks, but the measure meets with
have no income.
strong disapproval.
Outside the lab, Drinker was a dedicated woodworker who passed down his skillful turns of a saw and lathe to his son, Philip A. Drinker, who in turn taught his daughter, Elizabeth. Today, Elizabeth is a successful furniture maker in Maine, while Philip is one of only a few craftsmen in the world who makes hand-tooled alpenhoms, the long curved horns used by herdsmen in the Alps.
OM^ o/^expenwew^ OM CJ^ cow wi^ coHeagMe LoMM
"I think some reporter first used it." However it came to be, the term iron lung became synonymous with the Drinker respirator, both in the clinical and lay lexicon. Philip Drinker became famous virtually overnight, but it was an uncomfortable fame, one perhaps he even felt he didn't deserve. "As time passed, Phil began to look on what he called 'all this fuss about the respirator' as out of focus," wrote his sister Catherine. "He said that in forty years' work at the School of Public Health the 'damn machine' was only one thing, and it just happened. If I'd been a physiologist instead of an engineer it wouldn't have happened. I'd have thought it impossible.'"
]
Warren E.Collins, Inc.,
Franklin Delano
H
NLIKE HIS BROTHER, C E C I L ,
who was organized and liked everything planned, t H Philip Drinker "banged ^ ^ ^ ^ along, enjoying life as it came," wrote Catherine in E^wz'/y Por&wY. "In college he was known as the noisiest man on campus" who wanted his classmates to like him more than he wanted to be successful, she added. Drinker's initial ambition was to be a mining engineer, but when his father told him such an occupation would require him to follow the mining trade all over the globe, Philip chose chemical engineering instead.
of Boston, begins to
Roosevelt wins first of
manufacture the iron
four presidential
lung.
elections.
In his professional career, the senior Drinker seems to have been brash, forthright, and sincere. He was a specialist in ventilation systems, who often served as a subject in his experiments, recording his own inhalations of the worst of toxic environments. (He was the first test subject to get inside the respirator.) In his quest to understand and prevent lung disease in industrial workers, he was often at the forefront of the emerging field of industrial hygiene. Much of his research was conducted in a laboratory in the basement of the old Infants' Hospital building, where the fledgling School of Public Health was housed. A 1 9 1 4 article that Drinker wrote about the laboratory includes seven photographic illustrations, two diagrams, one chart, and a complete floor plan, and it speaks volumes about Drinker's mechanical ingenuity and inventiveness. The hospital's kitchen was transformed into a chemical laboratory. The laundry was changed into a room for studying "smokes, fumes, and dusts." And the hospital's dumbwaiter provided ventilation for a hulking, 9-foot by 1 1 - f o o t by i$-foot "gas chamber." The ceilings in all the rooms were
28 oc ?! ^ ^
painted in white and the walls yellowâ&#x20AC;&#x201D;except in the "illumination laboratory" where all the walls and furniture were painted black, so as not to interfere with the light-sensitive equipment used to study vision and the optical properties of smokes and fumes. ^ ^ ^ ^
VER T H E NEXT t w o
#
^ decades, Drinker and his H colleagues conducted an A n amazing, occasionally ^ ^ ^ ^ amusing, array of experiments in this subterranean laboratory. Their interests were eclectic, though the value of proper ventilation was the recurring theme. The approach was to break down an industrial process or potential hazardous exposure to its most testable elements, run an experiment, and make copious measurements. A typical example is a 1 9 3 8 study on the ventilation of motion picture projection booths. There was apparently concern about toxic gases emitted by the hot, carbon arcs used in movie projectors. Rather than conduct a survey of motion picture booth operators, Drinker recreated the conditions of a projection booth in his lab. He then took temperature and gas measurements from a variety of spots in the room. Despite the elegance and rigor of the experimentâ&#x20AC;&#x201D;or perhaps because of itâ&#x20AC;&#x201D;the results were not dramatic. If the projector's lamp was properly ventilated, there
was " n o sensible escape into the r o o m " of nitrogen tetroxide, Drinker concluded in an article in T/?g JoMrfM/ o/Tn^MsfrM/ Hyg/ewe 7bx;co/ogy.
Comfort Zone
In similar studies, Drinker sought out the laborer's demons of the day: silica, lead, dust, magnesium, and metal fumes. He went into coal mines and shipyards, cotton textile mills, and smelting and refining foundries. He studied the fine bits of metal inhaled by welders and the dust created by pneumatic stonecutting tools. He strove to determine "permissible standards of dustiness" in the workplace.
At the same time Philip Drinker was working to mechanically mimic human respiration, another experiment in engineering at the School of Public Health was trying to reduce the high death rate of premature infants. Like the development of the iron lung, the experiment would involve a unique symbiosis between physicians at Children's Hospital and engineers in the School's Department of Illumination and Ventilation, in an effort to use technology to correct a failure of human physiology.
In 1932. Drinker devised a less expensive apparatus for measuring dusts, fumes, and smokes in the air than the costly laboratory-sized electric precipitators by attaching a rheostat to an $8 "luminous tube transformer" used for operating neon signs. Two years later, Drinker and colleague Willis G. Hazard published a paper describing a more efficient machine to record dust, for which they received a patent in 1 9 3 7 .
Kenneth D. Blackfan, physician-in-chief at Children's Hospital, recognized that premature infants were dying when their body temperatures fluctuated, and believed their inability to regulate their body temperature accelerated their demise. With very little body fat to conserve heat, a relatively large skin surface from which heat is eliminated, and an immature nervous system that could not produce shivering, crying, or other heatproducing exercise, premature infants easily became hypothermic. Conversely, the premature infant's immature sweat glands lacked the ability to cool their bodies effectively when the external temperature rose, resulting in hyperthermia. These extremes could exhaust the infant's energy reserves and leave it vulnerable to respiratory and other infections.
Drinker's other inventions included devices to measure air quality in shipyards and, working with his brother Cecil, the prototypes for the L - 1 2 , A-9, and A - 1 0 oxygen masks used during World War II for highaltitude bombing. He also designed a solarium on the southern side of the roof of Infants' Hospital in which babies born in winter could be lain in the sunlight to soak in the ultraviolet rays that would prevent rickets.
Blackfan sought Drinker's assistance on solving the problem, and Drinker set about designing a room in which the air tempera-
1933 Influenza virus isolated.
James Bryant Conant succeeds A. Lawrence Lowell as president of Harvard University.
I
Prohibition repealed.
ture could be tightly controlled, thus doing the delicate work of heat regulation for the infants. Three rooms were built in Childrens' Hospital for the care of premature infants, and Constantin P. Yaglou, a young instructor in the Department of Industrial Hygiene, was put in charge of them. Yaglou, who had earned a master's degree in mechanical engineering from Cornell University, had come to the School in 1925 after a four-year stint in Pittsburgh at the Research Laboratory of the American Society of Heating and Ventilating Engineers. While
there, he worked on establishing a temperature index and "comfort zone" that outlined the air conditions required to maintain thermal equilibrium between a person and their environment with the least physiologic effort. Yaglou would adapt these basic principles linking the ratios of air movement, temperature, and humidity to human comfort levels to the tiny infants in Blackfan's care. The three rooms, called "conditioned nurseries," were supported by an elaborate ventilation system housed in the basement of the hospital that had the capacity to produce T^e co/^'TiowJ ??Mr.sen<?s Jw^opfc? Dnn^er. <j??J CoMSfawfW %g/()M Mwe /oz'grMMfMrs fo wot^en; w/jMf
25 changes of air an hour to adequately control the rooms' temperature and humidity. Each room could be heated to a maximum of 110°F and cooled to 75°F—circulating air was cooled in the summer by a spray of cold water and warmed in the winter by heating elements. As the air circulated through the room, it drew in the heat from the warm walls, glass, lights and the room's occupants, while its humidity was reduced. Yaglou was assigned to monitor and manage the rooms, and for seven years he and Blackfan conducted carefully controlled experiments in which infants' responses to heat and cold were observed as the temperatures and humidity levels were raised and lowered. The investigators developed a detailed table of their observations, creating a sort of comfort zone for premature infants, and in November of 1933, Yaglou and Blackfan's classic article, "The Premature Infant: A Study of the Effects of Atmospheric Conditions on Growth and on Development," appeared in the ^men'can Jot/ma/ of P/seases /n Oi/V&en.The principles described in Yaglou and Blackfan's paper were widely adopted and would lay the groundwork for the development of smaller, infant-sized rooms, or incubators, that allowed for the temperature control to be adapted to individual needs. TR
1934 Report of the Visiting Committee to the School of
Severe drought
3,900 people die of
Public Health decries the nation's "pitifully small"
unleashes dust storms
malaria in the Southern
number of trained public health personnel relative
in Kansas, Texas,
states of the United
to its need.
Colorado, and Oklahoma
States.
that destroy 300 million acres of farmland.
Indeed, in developing the iron lung, Drinker was continuing a pattern he had shown in his work with dust control systems and ventilation machines: fine-tuning, adapting, and altering machines to try to make them better and more effective. Drinker himself maintained that his only claim of discovery was to measure the precise pressure changes needed to induce respiration. But the iron lung, and its inventor, became famous because of its immediate impact on the treatment of polio patients. The dreadful symptoms of respiratory paralysis were all immediately relieved once the patient was inserted into the respirator. "...before I realized what was happening...I was in the huge cylinder with only my head sticking out Such comfort! I was no longer struggling to breathe and the whole thing seemed simply wonderful. So wonderful that I cannot remember a night before, or since, of such sheer comfort," writes Regina Woods in her book, /row fMstJe frow LM?2g. The iron lung was also used to treat patients with other acute forms of respiratory distress, including those suffering from carbon monoxide poisoning, electric shock, drowning, morphine poisoning, and, as the New York Consolidated Gas Company had hoped, victims of gas leaks. The respirator was used in at least one instance noted in the medical literature to save the life of a woman who had attempted suicide by sticking her head in a gas oven.
Drinker also devised an emergency respirator "to tide someone over for a day or a week until a respirator could be provided." The pictures of the emergency respirator resemble a 4-H project: a wooden box that looks like a packing crate with a hole cut in the middle surrounded by a coarsely cut strip of rubber ("made from the inner tube of a moderate-sized car") and a hose from a hand-sized vacuum cleaner ("costing about $ 1 $ at any department store or electrical shop.") Over the years, adaptations were made to the iron lung: A trip to the dock slip on Atlantic Avenue inspired James Wilson to suggest adding portholes to allow nurses and physicians to wash and administer medications to the patient inside. Wilson also wanted the respirator designed so that it could tilt, allowing different positioning of the patient to drain mucus and reduce bed sores. Mirrors were added to increase patients' views, and warning bells and red alarm lights signaled a fall in pressure. t ^ ^ H H ODAY, the iron lung has all but disappeared from the clinical landscape as vaccination has nearly eradicated polio and intubation has become the common form of artificial respiration. For generations of Americans born after â&#x20AC;&#x201D;the year the Salk vaccine became widely availableâ&#x20AC;&#x201D;images of stricken children in iron lungs lined up in polio wards are historical curiosities. True to Drinker's legacy, however, the School's Department of Environmental Health continues to do pioneering work on the problems of respiration and ventilation.
Associate Professor Robert Banzett is working on increasing comfort levels for people who are intubated and devising mechanics that enable them to talk more easily. Professor Jeffrey Fredberg is a pioneer in high frequency ventilation, the future of artificial respiration. And Department Chair Joseph Brain, Cecil K. and Philip Drinker Professor of Physiology, studies the lung's response to inhaled gases, dusts, and microbes at a level that would have astounded and delighted Drinker. Brain, who was stricken with polio during the last great epidemic of 1 9 5 5 but was spared the disease's paralyzing effects, says that the collaboration between Philip, the engineer, and Cecil, the physiologist, is still "the essence" of much of the Department's current work. "These are the ideas upon which the School was founded," he adds. "For me Philip and Cecil always represent that collaboration." Drinker, who never completely understood the fuss over his "damned machine," was ultimately happy to see it become obsolete. The development and widespread use of polio vaccine in the mid-19 $os, made possible by a trio of Drinker's Harvard colleagues, would ultimately make paralytic polio a rarity (see story page 74). In a 1 9 5 9 address to the American Academy of Occupational Medicine, Drinker said, "I have the vast satisfaction of seeing [the iron lungj rapidly being relegated to a respected place in the museum because of advances in medicine." Terri L. Rutter
1935 David L. Edsall (left) retires as dean
Alcoholics Anonymous
of the School and is succeeded by Professor
founded in New York,
of Physiology Cecil K. Drinker.
A Partner Not a Patron HE ROOTS OF PUBLIC HEALTH
in the United States stretch back to the colonial era, when Boston silversmith Paul Revere was named head of the city's Board of Health. But the modern public health movement more or less dates from the turn of the century, with the rise of the social reform movement and the establishment of formal schools for training public health professionals. Officially the claim of being the nation's first school of public health belongs to the Johns Hopkins School of Hygiene and Public Health, which opened its doors in 1 9 1 8 . But five years earlier, the Harvard-MIT School for Health Officers—the forerunner of the Harvard School of Public Health—admitted its first class of eight students, making it the first formally organized training program for public health professionals in the country. To some degree, however, both Hopkins and Harvard were following the lead of another institution that got its start in 1 9 1 3 . That was the year that Standard Oil magnate John D. Rockefeller set aside the princely sum of $ 3 $ million to establish The
Rockefeller Foundation. By 1 9 1 9 Rockefeller had added another $ 1 4 0 million to The Foundation's endowment. Over the next three decades, The Foundation would pour millions of dollars into projects related to world health, agriculture, education, and peace and underwrite the
President Roosevelt signs the Social Security Act, which provides an economic safety net for unemployed and retired Americans.
i
K my to.. .Mse wowey /oy t^e good/ o/my /eMow ??M7!." —John D. Rockefeller, founder of The Rockefeller Foundation.
32 oo ?
establishment of schools of public health at Hopkins, Harvard, and numerous other universities around the country and world. Rockefeller's interest in promoting health may have stemmed from his close acquaintance with fellow philanthropist Frederick T. Gates, a thundering Baptist preacher with a longstanding interest in the sciences. At the very first meeting of The Foundation's Board of Trustees, Gates, who would become Rockefeller's principal philanthropic adviser, declared that disease was "the root of all human ills" and that "if science and education are the brain and nervous system of civilization, health is the heart. It is the organ that pushes the vital fluid to every part of the social organism." Rockefeller's first foray into public health was a 1909 hookworm eradication campaign in the rural South led by Wickliffe Rose and conducted under the auspices of the Rockefeller Sanitary Commission. A Southernborn philosophy teacher with a reputation as a "sloganeer," Rose would later coin the phrase "a partner, but not a patron"â&#x20AC;&#x201D;a concept integral to The Foundation's philanthropic activities. Under Rose's guidance, the Rockefeller Sanitary Commission tackled one disease after anotherâ&#x20AC;&#x201D; from hookworm to malaria to typhus. The experience led Rose to recognize that the greatest impediment to improved health in America was not lack of money or knowledge, but a dearth of trained public health professionals. At his instigation, The Foundation's General Education
Hcrtw^ PresMfeMf A&^ott Lgwewce LoM'g// ZM^^MWe?!^/ 27! MWTMMg /or
Sc^oo/ o/^
Board, under Gates's direction, began reviewing locations to establish a school of public health in the United States. Despite the best efforts of Harvard President Abbott Lawrence Lowell and Medical School Dean David Linn Edsall to direct funding toward the establishment of a program at Harvard, the award for the first school of public health went to Hopkins, partly because of its southern location, which made it a better laboratory for many of the public health scourges of the day, and partly because of Rose's close ties with Hopkins' William H. Welch. ^
^
ARVARD CONTINUED its
^ ^
discussions with Foundation H President George E. Vincent, however, and in July 192.1, Vincent announced an award of $ 1 . 1 6 million in endowment, $500,000 to cover
the costs of renovating and equipping space for the new program, and an additional $25,000 a year for five years to help cover the operating costs of a reorganized School of Public Health at Harvard. Over the next three decades, The Foundation would grant the School more than $4.7 million. Much of this went to build up the School's general endowment, renovate and expand its physical plant, and cover day-to-day operating expenses. But Foundation funds also supported student fellowships and a range of innovative research projects and centers, including Harold Coe Stuart's Longitudinal Growth Study, the launching of the Department of Nutrition, establishment of a center to study the health effects of radiation, and creation of the Harvard Center for Population Studies. But, in keeping with The Foundation's philosophy of partnership rather than patronage, the Rockefeller influence extended beyond financial support to include a continuous flow of faculty, students, and knowledge. Over the School's first half century, its relationship with The Rockefeller Foundation and the closely affiliated Rockefeller Institute for Medical Sciences was characterized by nearly continuous exchange and collaboration. Indeed, a partial list of faculty who migrated between the three institutions includes some of the most influential figures in the history of the School and the modern field of public health. The primary conduit for faculty exchange was The Foundation's International Health Division (iHD).
1935 International High Altitude Expedition to the Chilean
Milton J. Rosenau, one
Andes examines the effects of altitude change on
of the founders of the
human behavior. Future faculty member Ross A.
School of Public Health,
McFarland is a member of the expedition.
retires from the faculty.
An outgrowth of the Rockefeller Sanitary Commission, the IHD spearheaded The Foundation's work on malaria, yellow fever, typhus, influenza, tuberculosis, and other infectious diseases. The legendary Frederick Fuller Russell, developer of the "triple typhoid vaccine" and tHD's influential director from 192.3 to 1 9 3 3 , would join the School's faculty as professor of preventive medicine and epidemiology in the mid-i<?30s, filling the void left by the retirement of Milton J. Rosenau. Russell taught at the School from 1 9 3 5 to 1 9 3 8 , when he ceded the post to John Everett Gordon, but he would later rejoin the faculty to teach epidemiology during World War II. Another important figure who would come to the School through the IHD was John Crayton Snyder, who would serve as dean of the School from 1 9 5 4 to 1 9 7 1 (see article page 82). In 1 9 3 9 , seeking to avert another devastating typhus epidemic in wartorn Europe, Wilbur Sawyer, the director of the IHD, asked Professor Hans Zinsser to train an individual in all aspects of typhus control. Zinsser selected Snyder, whose subsequent work for the IHD and the U.S. Typhus Commission in Mexico, Spain, Italy, Egypt, Iran, and Germany led to his appointment at the School in 1946,
as head of the new department of microbiology. That same year, two other members of the IHD staff, Hugo Muench and Hugh Leavell, also joined the School as heads of the Departments of Biostatistics and Public Health Practice, completing the reorganization of the HSPH as an independent entity in the university. Fredrick J. Stare, founder of the School's Department of Nutrition, did a three-year post-doctoral fellowship in The Foundation's IHD in England, Hungary, and Switzerland before joining the School. The Foundation would later fund the creation of the nutrition department and also provide a travel grant that enabled Stare to study nutritional programs around the country. Another legendary Rockefeller figure, tuberculosis researcher and antibiotics pioneer Rene Dubos, professor of pathology at the Rockefeller Institute
T/?g PoMMf^atz'ow's Wi'fM/ grant wc/M^ecf Syoo.ooo to rewoMte awJ e<?M;p y j S^attMe^ Street, serfe as t^e Sc%?oo?'s %?o?we /or 40 years.
German pharmacologist Gerhard Domagk discovers antibacterial sulfa drugs, which will revolutionize treatment of infectious diseases.
in the 1930s, was named the George Fabyan Professor of Comparative Pathology and Tropical Medicine at the School in 1 9 4 2 . The flow of personnel between the School and Rockefeller entities was by no means a one-way affair: in 1 9 3 8 faculty member and future Nobel Laureate M a x Theiler left the School's Department of Tropical Medicine to join the laboratories of the Rockefeller Institute in New York, where he would become part of the team that developed the yellow fever vaccine. Theiler's research at the Institute built on his work at the School from 1 9 2 3 to 1 9 3 7 . During World War II, at The Foundation's request, Dean Cecil K. Drinker agreed to let Harold Coe Stuart serve as a clinician on The Foundation's Health Commission to Europe. Stuart was dispatched to southern France to study the nutritional and health
needs of the area's children and later returned with the American Red Cross to implement the commission's recommendations. Students also benefited from The Foundation's largesse. From the outset, The Foundation funded fellowships for international students, contributing greatly to the School's reputation as a global center for public health education and research. So strong was the international influence, however, that in the late 192.0s, an effort was made to encourage more doctors from the United States to enroll. Among those who benefited from The Foundation's support were future faculty members Stanley Cobb, who later developed the School's first industrial psychiatry course, and Thomas Weller. Welter, who worked in the malaria laboratory of Mark F. Boyd, the first recipient of a certificate from the Harvard-MIT School for Health Officers, would later share the Nobel Prize for his polio virus research and serve as chair of the Department of Tropical Public Health for 27 years (see article page 74). Vlado A. Getting, D.p.H.'40, founding editor of the H a r t w J PMM;c He^M? AfMfWMz also enjoyed the support of The Foundation while he was a student at the School. Getting would go on to serve as health commissioner of Massachusetts from 1943 to 1953, clinical professor of public health practice at
the school and interim head of the Department of Epidemiology during World War II, and chair of the Department of Community Health Services at the University of Michigan School of Public Health. ^ ^ ^
URINGTHE1950SAND
1960s,
^
with the dramatic success of infectious disease control programs (in large measure due to research and programs funded by The Foundation) and the widespread availability of health care in the industrialized world, The Foundation turned its attention to the problem of an exploding world population. In 1963, Foundation President J. George Harrar declared, "The problem of numbers [of people] must be faced and decisions must be made which are in the best interests of humanity.... [Uncontrolled population increase can only lead to chaos, and thoughtful leaders everywhere are giving serious attention to ways by which to brake the velocity of human reproduction." At the instigation of Dean Snyder, The Foundation supported a pilot project at the School to explore practical methods of slowing and reducing population growth. This effort evolved into the Harvard Center for Population Studies (now known as the Harvard Center for Population and Development Studies). To lead the new center, Snyder picked Roger Revelle, a scientist of broad vision who is credited with developing the theory of global warming.
1936 Ann Hoague Stewart and Hester Balch Curtis are the first women to receive the M.P.H. degree, 15 years
Harvard University celebrates 300th
after the School's faculty recommended to Harvard
anniversary,
officials that women be admitted as candidates for the master and doctor of public health degrees.
Continuing the reciprocal association the School and The Foundation have enjoyed for more than 70 years, in January 1997, center director Lincoln C. Chen, Taro Takemi Professor of International Health, will take a twoyear leave of absence to assume the position of vice president for The Rockefeller Foundation. In recent years, The Foundation has committed more than $ 1 million to support faculty in the departments of Tropical Public Health and Population and International Health, to fund workshops for public health leaders from around the world to discuss new and emerging diseases, and to explore innovative A I D S research focused on women in the developing world. The Foundation also continues its support for promising students in public health. The long, fruitful partnership between the School and The Foundation has fundamentally shaped the School's character and success. For more than 7$ years, The Foundation's creative philanthropy in combination with the School's strengths in the classroom and held have been a formidable force to advance the public's health in the United States and around the world. Marceita J. Bernard
HE WINTER OF
1 9 3 0 was a harsh one for most Americans, and spring brought little relief. More than 8 million adults were unemployed, and those who did work earned little more than $ 1 6 a week. Lines formed outside of soup kitchens and destitute people reduced to begging lined the streets in many cities, as the nation entered the heart of the Great Depression. While despairing men and women held out hats to passersby or lost hope (in 1 9 3 1 alone, some 2.1,000 Americans committed suicide), the nation's children also paid a heavy toll. In 1 9 3 1 , the U.S. infant mortality rate stood at 61 deaths for every 1,000 live births, and it would not decline significantly for the next few years. The previous year, President Herbert Hoover, seeking "to hnd out what is being done for children, what should be done, and how to do it," had T^e Great Depression &roMg/?f despair an^ poverty to MMtoM MMW^ers o/wMt^ers aw^ cMJrew.
Women and ChiMren First Harotd Coe Stuart, !V!artha May E!iot, and the Devetopment of the Department of Materna! and Chi!d Heatth
Spanish Civil War
British Broadcasting
HSPH nutritionist Bertha Burke publishes "Daily Diet
begins.
System sets up the
During Pregnancy." More than 100,000 copies of the
world's first television
pamphlet will be distributed to pregnant women over
system.
the next two decades.
35
^ ^ ^
initiated the third White House Conference on Children, focusing on chitd health and protection. A result of the conference was the launching of several nationwide longitudinal studies to identify factors that interfere with normal growth and development and to determine how health professionals could prevent these ill effects. That same year, two pioneers in children's healthâ&#x20AC;&#x201D;one a researcher, the other an adept and dynamic administratorâ&#x20AC;&#x201D;were each working to address children's health problems resulting from increased poverty due to the Depression. Both were trained in pediatrics and in public health. One worked in Washington, D.C. the other in Boston, but they were linked by their compassion for and commitment to children. Their collaboration over the next 2.5 years would influence the care and health of mothers and children into the current decade. The catalyst that would bring together Harold Coe Stuart, the pediatrician-researcher, and Martha May Eliot, the pediatrician-administrator, was the Social Security Act of 1 9 3 5, part of President Franklin D. Roosevelt's New Deal answer to the Depression. Specifically their collaboration would center around Title V of the Act, which secured federal funds to develop state-level programs for the care of mothers and children. Discretionary funds, called training grants, were earmarked for training physicians, dentists, and other health professionals in the basic principles of public health. The funds were
administered by an office within the Department of Labor called the Children's Bureau, where Eliot had worked since 192.4. As she rose through the Bureau's ranks, eventually reaching the level of chief, she would use her position to direct a share of the Bureau's training grants toward Stuart and the Harvard School of Public Health. Stuart, in turn, would be a driving force behind the development of the first Department of Maternal and Child Health in the country. Together, they would chart the future of maternal and child health. ) N 1 9 3 0 in Boston's Roxbury neighborhood, Stuart embarked on an innovative study looking at factors that influenced the development of children. Tall, erudite, possessed of a gentle, goodnatured disposition, Stuart had recently been appointed assistant professor in child hygiene at the School of Public Health. A graduate of Columbia's College of Physicians
V^/cafMM exawHMes <7 c M J w 19J4. and Surgeons, he had trained at the renowned University Children's Clinic in Vienna under Bela Schick, who developed the method for testing children for immunity to diphtheria. Stuart had arrived in Boston in 192.2., as head of the outpatient department and allergy clinic at Children's Hospital, where he began to notice how allergies to food and other environmental factors could affect a child's growth pattern. He also saw how allergic responses could change as a child grew. Beginning in 1 9 2 8 , he also oversaw the well-child clinic of the Boston Health Department. Although somewhat shy, Stuart was an energetic lecturer and advocate on behalf of children. At a 1 9 3 3 meeting of the New England Pediatric Society, Stuart stated: "It is inconceivable that a Society such as this should approach the problem of health service from any other stand-
1937 HSPH Alumni Associa-
The School raises admission requirements for all
tion meets for the first
training programs: from now on, a bachelor's degree
time in New York City.
and preparation in the basic sciences are prerequisite for the Certificate in Public Health, while a medical degree is required for both the master and doctor of public health degrees.
point than that of meeting the needs of children in the best possible way." The landmark Longitudinal Growth Study would embody Stuart's broad vision of child health. Based at the Children's Medical Center, the study tracked the growth and development of 3 1 4 infants born of 2.16 mothers from Boston's predominantly Irish, middle-class Roxbury neighborhood. Beginning in pregnancy, mothers were interviewed at length about their home environments, eating patterns, and general health. Over the next two decades, these children and parents regularly returned to the Children's Medical Center to be interviewed and examined by pediatricians, nutritionists, social workers, anthropologists, dentists, psychologists, and psychiatrists. The defining feature of the study was its focus on healthy development rather than pediatric disease. N o comprehensive study of normal childhood growth development had ever been conducted. Stuart questioned how one could understand childhood disease if there was no basic understanding of health for purposes of comparisonâ&#x20AC;&#x201D;a point emphasized at the 1 9 3 0 White House Conference. "Pediatricians interested in research have been so preoccupied with the study of disease that they have not contributed as much as might have been anticipated to studies of normal development," wrote Stuart in an analysis of some early results of the study. "It is surprising how little is really known about the effects of disease on growth, in view of the attention given to sick children."
He advocated that physicians, school health programs, and parents take regular measurements of a child's height, weight, chest-circumference, hip-width, and girth, stressing that diversion from a normal growth pattern might suggest underlying disease. Among other things, the study provided the basis for the development of reference growth charts, now regularly used by pediatricians and other health professionals to track child development. Another important finding came out of a study led by Bertha Burke, the department's nutritionist. Published in 1 9 4 3 , the study provided some of the first information about how mothers' diets affected their newborns. Through detailed food questionnaires and diet surveys, she investigated the relationship between maternal nutrition and the health
of newborns. Only 14 percent of the mothers enrolled in the study ate diets that were considered excellentâ&#x20AC;&#x201D; a daily caloric intake between 2,800 and 2,200â&#x20AC;&#x201D;and that included enough of the what investigators called "important" foods: meat, vegetables, dairy. Forty percent of the mothers were found to be malnourished, and a higher proportion of their babies were born premature, stillborn, or "functionally immature." The maternal nutrition study reflected Stuart's belief that all aspects of a child's environment affected his or her growth and development. At a time when social workers focused more on the quantity of light and the cleanliness of the floors in a home, Stuart asked his investigators to evaluate family relationships and parenting skills. Stuart interviewed fathers and encouraged them to be a part of the
HaroM Coe S&Mrf
presents Jata co//ecfeJ z'w
Growth StM^y.
National Foundation on Infantile Paralysis, which focuses mainly on polio, founded.
Degrees of Change 38 sc
^
Martha May Eliot's behind-the-scenes influence not only helped create a department at the Harvard School of Public Health, it profoundly changed the makeup of the School's student body. It was Eliot's sponsorship of student Hester Balch Curtis, a pediatrician whom she had met while they were both at Yale, that broke a 15-year deadlock between the School and the University's Board of Overseers over the issue of granting degrees to women. Although women had been training at the School since 1915, when it was the Harvard-MIT School for Health Officers, they were allowed only to earn certificates of public health, not degrees. At the launching of the Harvard School of Public Health, in 1922, the faculty had unanimously but equivocally approved accepting women as non-degree candidates,
child's upbringing. Burke's maternal nutrition study even included an analysis of how much of the weekly household income was spent on food. Professor Emerita IsabelIc Valadian, M.p.H.'53, studied under Stuart and went on to chair the Department from 1 9 7 3 to 1 9 9 1 . Valadian says that Stuart developed an understanding of child "wellness" long before it became a mainstream concept of medicine. "Dr. Stuart had great vision," says Valadian. " H e was ahead of his time." At 6'2." tall, Stuart towered over the children he studied (and most of his colleagues), but, says Valadian, in his interactions with children, he
"until such time as women can be admitted in all equality with men" throughout Harvard. In a letter to Rockefeller Foundation President George Vincent, Medical School and School of Public Health Dean David Linn Edsall indicated that he did not "know of any noteworthy person connected with Harvard University who desires to make Harvard... a coeducational institution." In 1924, women were permitted to register as "special students" and earn a doctorate in hygiene through Radcliffe College, but they were still denied the master and doctor of public health degrees. This status quo prevailed until Curtis' arrival in 1936. The maternal and child health training grants provided by Title V of the 1935 Social Security Act presumed that women would be allowed to earn degrees. This financial incentive, combined with Dean Cecil K. Drinker's and the faculty's unanimous support, finally
tipped the balance, and, in 1936, the Corporation and Board of Overseers approved the awarding of master and doctor of public health degrees to women. (Harvard's Graduate School of Education was the first of the university's professional schools to grant women degrees, beginning in 1921. The School of Public Health was second, followed by the medical school in 1949). At the 1936 commencement, Curtis and physician Ann Hoague Stewart were the first women to receive the M.PH. Stewart had finished her coursework two years earlier and had successfully petitioned the Administrative Board to complete the coursework for a master's degree in public health, in the event that women were ever allowed to earn degrees. TR
always brought himself to their eyelevel. She recalls a time when Stuart, noting the downcast look of one of the boys enrolled in his study, spent about a half-hour sitting on the steps outside the clinic with the boy, listening as he talked of a problem at home.
and Biostatistics Chair Robert Reed, began conducting 10-year follow-ups on 12.6 of the study's original 1 3 4 subjects to track their growth and development into maturity. Valadian's research culminated in the publication in 1 9 7 7 of Growth <3?!J
"The reason the Longitudinal Growth Study was so successful was his commitment to the children," says Valadian. " H e was very, very kind."
Fro??! CoMcep^o?? M^fMnYy. Building on Stuart's belief that a focus on disease overshadowed education in the fundamentals of child health, the book is an innovative-self-guided instruction manual on the human systems, filled with quizzes, charts, and graphs outlining the decades of data that come from the growth study.
In 1 9 6 5 , when the study's participants were all in their 30s, Valadian and her colleagues in the department, including nutritionist Johanna Dwyer, s.D.'69, now director of the Frances Stern Nutrition Center at the N e w England Medical Center,
1937 Amelia Earhart's plane
Diabetics treated for
is lost over the Pacific.
the first time with insulin.
M
H W H ARTHA M A Y
ELIOT arrived at the Children's Bureau in 192.4 when the organization was still coordinating its agenda for the future of advocacy work for chitdren. "These were days of e x p i r ing possibihties, days of questioning, days of refreshing advice...days of great satisfaction," Eliot later wrote of her early days there. The Bureau was born through the lobbying efforts of a stalwart collective of women's organizations, including the National Consumers' League, the Women's Trade Union League, the YWCA, the Female Benevolent Society, and the Female Moral Reform Society. Initially drawn together out of concern for the "lapses of morality" in their communities caused by prostitution and alcohol, these women were also concerned about public health issues such as clean food and pure milk, industrial pollution, and child labor. One of the Bureau's first concerns was dealing with the nation's astonishing rates of infant and maternal mortality. In 1 9 1 5 , the first year the Bureau compiled figures, for every 1,000 live births, six mothers died and 1 0 0 babies didn't live through their first year. The Bureau had always had a strong investigative arm, and under Eliot's influence, it began looking at social factors such as the effect of mothers going off to work and leaving their "latchkey children" behind. Eliot was particularly interested in the development of "healthy personalities" in children, believing, as she wrote in 1949, that "...if we are to change the attitudes of the rank and file of citizens toward
world security and peace, sooner or later we must launch a preventive mental-health service for parents and children which will have as vast proportions as the present-day program to prevent physical disease in infancy and childhood." In her capacity as director, Eliot controlled the distribution of Title V funds for children's health programs, and she specifically wanted to use them to build and support a fullHedged department dedicated to the research and teaching of maternal and child health principles within a school of public health. Although a portion of funds appropriated from the Bureau had always been earmarked for training physicians, dentists, and nurses in public health, the Conference on Better Care for Mothers and Children, held in January 1 9 3 8 , convinced Eliot that the Bureau needed to do even more. "We have the knowledge and skills in this country to protect the health and growth of our children,"
wrote Eliot a few years later in the /oM7*72%/ o^PeJMfWcs. "What we lack is the plan and resources to train sufficient physicians, nurses, and other professional and administrative personnel " Initially, she approached Johns Hopkins, her medical school alma mater; but when Hopkins eschewed her offer, she contacted Harvard. Stuart and his coHeagues were eager to accept her proposal. Until that point, the School's Department of Child Hygiene had not strayed much from the original focus of its first chairman, Richard Smith. Although Smith, a pediatrician, went outside his field to gather lecturers in nursing and public health law as it related to children, maternal health, and obstetrical care, the department focused primarily on traditional child hygiene, which included children's nutritional needs, inspections of school buildings to assess their cleanliness, and the administration of vaccines and other measures to control com-
May E/z'ot
coHeagMes Joe Lester Granger CoM/erewce o /
SocM/ Workers
1938 The Whittier Street Community Health Center in
Assistant Professor and future Nobel Laureate Max
Boston, under the direction of George Kahn, becomes
Theiler leaves the School for the Rockefeller Institute,
an affiliated training center for the School.
where he will be part of the team that develops the yellow fever vaccine.
40 cc ? ^
municable disease. Smith paid particular attention to children with special needs; his courses included visits to the Florence Crittenton Home for illegitimate children and to the Judge Baker Foundation for retarded children. At Stuart's instigation, in 1 9 3 8 a subdivision of maternal and obstetrical teaching was created in the department. The next year, lectures emphasizing the protection of the mother as well as the fetus were integrated, and in 1 9 4 0 , Samuel B. Kirkwood, the first instructor in obstetrics and maternal health to come to the department, began teaching an advanced seminar on clinical and administrative problems in the field. A good foundation had thus been laid for Eliot to see the department's potential to fulfill her plan. In 1 9 4 4 , the department was officially renamed the Department of Maternal and Child Health, and Stuart was named as its head. With the name change came a corresponding shift in the kinds of courses offered. Attention was paid to normal pregnancy and labor, delivery, and the diet and hygiene of pregnancy. Also included were discussions on abortions, stillbirths, and neonatal deaths and interrelations between maternal and fetal health. Among the stipulations of the training grants was the requirement that the department count among its faculty a physician, a nurse, a social worker, and a nutritionist. Burke, a nutritionist, had been working with Stuart since the beginning of the
Longitudinal Growth Study, and so was already well established in the department. In 1 9 4 6 , Elizabeth Prince Rice was recruited from her position as director of medical social work in N e w Haven. A public health nurse and a medical care specialist, who held appointments in the Department of Public Health Practice, rounded out the bill. Beyond funding the faculty, the Bureau provided stipends for studentsâ&#x20AC;&#x201D;those who were married received extra, those with children received even more. In fact, until the mid-1960s, the Bureau's training grants were the primary source of support for the Department. "The Bureau funded everything," says Valadian. "Eliot had the attitude that no deserving student should be denied." Although federal reorganizations since the late 1960s have resulted in a shifting of responsibility for the administration of Title V funds, the department has enjoyed a continuous line of government funding since its inception.
s ^ ^
TUART AND
E n o T ' s efforts to advance the health and well being of children reached a fitting culimination in 1 9 5 7 , when Eliot succeeded Stuart as chair of the department. Eliot stayed only three years before retiring. She was replaced by William Schmidt, who strengthened the department's focus on social and community aspects of child development. In 1 9 6 4 , Stuart was awarded the Martha M a y Eliot Award of the American Public Health Association for his leadership in maternal and child health.
1938 Cancer becomes the
The Munich Agreement signed by Neville Chamberlain
second-leading cause
and other European leaders forces Czechoslovakia to
of death in the U.S., a
surrender the Sudetenland to Adolf Hitler's Nazi
position it will hold for
Germany.
the rest of the century.
In the 80 years since the birth of the Children's Bureau and the 75 years since the launching of the School, the health of mothers and children has improved dramatically in the United States. Today children rarely die from measles or diphtheria, and the rate of maternal deaths related to pregnancy and child birth has also dropped significantly. And yet there are still many obstacles to optimal child development, and in seeking to resolve them, the department's research and training follows Stuart's example of adapting to meet children's health challenges at eye-level. Marie C. McCormick, the Sumner and Esther Feldberg Professor of Maternal and Child Health and the current chair of the department, is studying the physical and psychological functioning of the growing numbers of lowbirthweight infants born in the nation's hospitals. Other department faculty are trying to resolve persistently high rates of infant mortality, especially among minorities, and the longstanding problem of youth violence and anti-social behavior. "The health of mothers and children cannot be taken for granted," says McCormick. "Enhancing their well being needs continued inquiry into and teaching about the factors influencing normal cognitive, social, and physical development." Terri L. Rutter
War and
ESPiTE PRESIDENT RoosEVELT's New Deal policies, America's H decade-long economic depression has left nearly 40 percent of ^ ^ ^ families below the federal poverty line. T^e Grapes o/ Wrat^, John Steinbeck's 1939 novel describing the struggles of migrant workers in Depression-era America, is an overnight bestseller. Only 2.0 years after the carnage of the Somme, Europe once again plummets toward war. World War II claims some 55 million lives and launches the atomic age. It also serves as a proving ground for public health methods, as preventive medicine and disease control programs slash mortality rates from disease among U.S. troops. Hundreds of Harvard School of Public Health graduates and faculty contribute to this triumph, both on the homefront through warrelated research and training, and on the battlegrounds of Europe and the South Pacific. In 1946 the School gains administrative independence within Harvard University. Over the coming decade, the School will be at the center of a mid-century renaissance in the health sciences, as new methods are developed to quell disease and extend and improve life.
Trenches
1939 Faculty in the Division of Industrial Hygiene assist in
Rockefeller Institute's
the rescue of crew of the U.S. Navy submarine Jqua/us,
Rene Dubos, who will
which has foundered in 200-foot-deep waters off
later briefly join the
Portsmouth, New Hampshire.
School's faculty, isolates first broad-spectrum antibiotics.
HE OUTBREAK of W o r l d W a r
II marked a turning point for both the field of public health and the Harvard School of Public Health. The all-out mobilization for war, coupled with a concerted effort to control the infectious diseases that had ravaged armies in wars past, catapulted public health professionals to a new level of prominence and importance. To much acclaim, they rose to the occasion. Yet the war years were trying times for the School, sapping it both of students and faculty. The steady climb in enrollment during the first two decades of the School's existence suddenly reversed itself, and by 1942. the number of students had dropped to an all-time low. Only 1 1 students were awarded degrees at the 1 9 4 3 commencement, down from 48 just two years earlier. American students were so scarce that school officials toyed with the idea of allowing foreign students to write their final exams in their native languages.
J
6 MO
e x c e p t ^fop^c^/ %/cers...
Abraham Perley '39
professor of pediatrics and child health, was released from the Department of Child Hygiene to study the impact of food shortages on French children for a Rockefeller Foundation health commission. He later returned under the auspices of the American Red Cross to establish a program to care for the malnourished children and was captured and interned by the Nazis and didn't return to the School until March 1 9 4 4 .
agawst m/ect;oMS A'sease awowg fA'e troops.
Other faculty who left for warrelated duties included Edward W. Moore, a chemist in the Department of Sanitary Engineering, who was assigned to a project for the British Army; Fredrick J. Stare, chair of the new Department of Nutrition; Elliott S.A. Robinson, director of the Division of Biologic Laboratories; and Arthur P. Long, the division's assistant director. The shortage of faculty severely strained the School's educational programs. In EonnJers; Hart^zrJ Sc/wo/ o/ fM&^c .S'c^oo/, Jean Curran, the School's first historian, reports that by 1943 the School's child hygiene department was so depleted of faculty that a student, Stuart Stevenson, taught courses the
The School also was losing faculty at an alarming rate. Epidemiology Department Chair John Everett Gordon was given a leave of absence in 1 9 4 0 to set up a communicable disease program for the British War Office (see article page 49). Gordon took with him John R. Mote, a young assistant professor in the department. A year later Harold Coe Stuart,
TAe 3c^?oo/'s /acM/ty a w j g r a d a t e s were
OT! t%7e /ro?!t
jMnwg WorM War N
as t^e 7Mz/;'tary wage^ a preewptwe i*aft/e
Or
HSPH enrotlment reaches 95 (47 degree candidates,
The insecticidal
46 special students, and 2 certificate candidates). By
properties of DDT are
1943, however, enrollment will be cut in half.
discovered.
last four months of the school year. Two alumni, Vlado Getting, D.RH.'4o, and Helen Roberts, M.P.H.'44, were recruited to shore up the epidemiology department. According to Curran, the strain of keeping the School running during the war contributed to the retirement of Dean Cecil Kent Drinker and the subsequent appointment of Edward Godfrey Huber. Formerly the province of social reformers, public healthâ&#x20AC;&#x201D;particularly as it pertained to sanitation and control of infectious diseasesâ&#x20AC;&#x201D; became a matter of military necessity during World War II. Military bases and facilities, springing into existence virtually overnight, needed clean water supplies and proper sewage disposal. Memories of the heavy toll the 1 9 1 8 influenza epidemic had taken on civilians and soldiers at the close of World War I was still fresh in people's minds. Venereal disease was a centuries-old problem for armies made up primarily of young men. The health of civilian populations, especially refugees, was also a concern, partly for humanitarian
44 ^ H ^ H
reasons and partly for fear that epidemics that started in the general population could spread to soldiers. During the war, Harvard and other schools of public health were pressed into service as ad hoc public health training grounds for military personnel. In 1 9 4 5 , for example, the School was asked to give 63 N a v y and Army officers a rough-and-ready, two-month course in disease preven-
tion and public health. The School's Department of Sanitary Engineering churned out sanitary engineers at a record rate through a specialized Army Training Program, which consisted of two, 12-week terms. In the November 1 9 4 4 edition of the HartwJ HeaM? AJM^MZ jBMHe^M, Gordon Fair, head of the department, wrote that some 60 men had passed through this program in
the first year. The School also moved to bolster its instruction in venereal disease control, hiring Walter Clarke, executive director of the American Social Hygiene Association, to teach courses. Of course, the School was very much tied to the war effort through one of its prominent graduates and future deans, Brigadier General James Stevens Simmons, s . D / 3 9 (see article page $5). As head of the Preventive Medicine Service of the Army's Office of the Surgeon General, Simmons was the top public health official in the armed services. A strong advocate for building up the ranks of the military's health specialists, Simmons would boast of having trained 30,000 officers and enlisted men in various public health specialties by mid-1944. The lead article in the very first edition of the School's A/Mww/ BM/Zetzw in M a y 1 9 4 4 was written by Simmons and was confidently titled, "Preventive Medicine: The Key to Victory and World Recovery." The same issue of the Bulletin also lists six alumni and one faculty member as working for Simmons in the Preventive Medicine Service. The armed services had a voracious appetite for people with public health training. The first issue of the BMf&fw boasted of the School having 1 1 5 alumni in the Army, 2.7 in the Navy, two in the Coast Guard, 3 5 in the U.S. Public Health Service, and 2 in
SoM/ers parage w HarMrJ
1940 Epidemiology Department Chair John Gordon granted
Hans Zinsser, legendary head of the Department of
a leave of absence to organize the Harvard-Red Cross
Bacteriology whose work spurred vaccines for typhus
Field Hospital Unit in Great Britain. He will not return
and Rocky Mountain spotted fever, dies of leukemia.
to the School until after the war.
non-military service abroad. By the end of the war, the School's tally showed a total of 3 3 3 in either military or government service, 1 6 5 from the School of Public Health and 168 from the Department of Sanitary Engineering. Four alumni—Arthur Washburn '37; Huron L. Vaughan '38; James H. Stephens '38; and Leonid S. Snegireff —were awarded Bronze Stars. Five others—Paul Russell '2.9; Francis Carroll '39; Virgil Cornell '39; Granville Larimore '42; and Gaylord Anderson '42—were awarded Legion of Merit Awards. Professor John Gordon would, among a passel of other honors, receive the Army's Distinguished Service Medal.
Y THE TIME the first issue of the A/M7MW; was published in M a y 1944, World War II was nearing its close. D-Day was a month away, and the Germans would be pushed out of France and Belgium by September. In the Pacific, it would be another eight months before U.S. Marines would win the pivotal battle on the tiny island of Iwo Jima.
Assistant Professor Harold Coe Stuart joins The
The School retroactively
U.S. adult per capita
Rockefeller Health Commission in southern France to
awards 33 master of
consumption of
study the nutritional and health needs of children in
public health degrees
cigarettes reaches
the war-torn region.
to holders of the
1,976, an almost
certificate of public
40-fold increase since
health.
1900.
Yet the pages of these early issues of the BMffetw provide a glimpse into the wartime experiences of HSPH alumni. Bits and pieces of news and personal observations are scattered throughout the alumni notes. Full letters, some of them quite long and detailed, were published under the
heading "News from the Front." Together, they create a picture, albeit impressionistic and fragmented, of what World War II was like for a handful of Harvard-trained public health professionals. Much of what the School's graduates in uniform did during the war involved basic sanitation—making sure that the troops and military bases had clean water, disease-free food, and proper sewage disposal. Infectious disease control was also often part of the sanitation assignment. Bernard Blum's experience at Oak Ridge, Tennessee, is a prime example. When Oak Ridge was chosen as the place to manufacture the fuel for the
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Jack Pratt '40 atomic bombs it went from being an obscure, sleepy village of 19,000 to a bustling town of 78,000. Blum '38, was put in charge of keeping the inhabitants of the secret"atomic city" healthy. "The town was seething with construction. The mud was unbelievable," Blum wrote in a remembrance published in the BM/L?f;'M in November 1 9 4 5 . "It was obvious that environmental sanitation was a major job which deserved the highest priority." J.A. Logan sounded incredibly busy when he wrote to Gordon Fair from Brazil: "We have completed three hospitals and have a considerable number of health centers in various stages of completion; the privy program is going full blast, and promises to be the biggest thing of its kind in the world. We are just getting started with our water supplies, our malaria control program, while operating, still needs more orientation." Writing to Professor Fair from New Guinea, Jack Pratt '40 said "Our biggest bugaboo to health is fungus infection, which sooner or later seems to hit practically all of the men." A lieutenant with the Twelth Naval
1941 Japanese planes attack U.S. naval base at Pearl Harbor. The United States enters World War II.
Construction Regiment, Pratt would later write from the Philippines of surviving an attack by the Japanese air force. "We had a merry-go-round of alerts, raids, strafings, paratroop landings, fleet actions and other amenities of war.. .Things have settled down now. We are out of the mud and improving facilities. A shower, a cold drink and a change to dry clothing constitute the acme of desire. Nearly everything else is tolerable with these things." As Pratt's experience illustrates, a degree in public health did not immunize one from combat. Michael Doyle '37, in the midst of his fourth campaign, felt "as though his profession were that of arms rather than sanitary engineering," said a note in the May 1944 BM^e^'w. "His work has been of all kinds, from assault to heavy construction and has included water supply and sewage disposal." "Personally, I have been very fortunate," reported Abraham Perley '39 in the November 1944 BM^^M. "Although I've been in actual combat, I have no scars, physical or mental, except perhaps those of tropical ulcers, which now and then have a tendency
to break down. Thus far, even malaria has spared me. And if I am lucky, I may even get home soon on 'Rotation.' After more than two years overseas, home and family should feel to me mightily good." The same issue of the BMjfe^M soberly reports that three alumni in the service had been killed: Paul Seaman '42, a lieutenant in the Air Force; Howard Shaw '38, an infantry captain; and Francis Vetch, Jr., '40 a lieutenant in the Air Force. Vetch's death struck a chord with a fellow alumni: "Francis was a good friend of all his classmates and was looked upon as a leader and a good student by all of us," wrote a classmate, Loren R. Heiple. "The loss of men of his caliber is a tragic price for the greed of war." Not every death was in the line of duty. The reports that in November 1944, Fridgeir Olason, who had just earned his doctorate in public health, was killed along with his wife and three children when the passenger ship that was taking them home to Iceland was sunk by a German submarine.
^
^
LONG WITH TRAUMA AND
^ ^ ^ ^ tragedy, the war also pro^ T ^ H L vided some alumni with opportunities for new experiences. In a captivating letter from Egypt, Stuart Stevenson '44, a member of the field staff of The Rockefeller Foundation, describes an elaborate meal at the end of Ramadan: "The Pasha in his beautiful white silk robes broke the fast first by taking a glass of apricot juice, then every one began drinking water and all sorts of fruit juices. Then we had a feast which lasted three hours with about 1 5 courses. After that a reception was held at the local officials' club. As we walked in the band began to play and we were led to a special head table. It was on the lawn, with hundreds present, with
colored electric lights hanging from the palm trees like dates." J.A. Logan in Brazil observed: "The Grande Hotel is still doing business on the strand and the sidewalk cafe in front is still crowded with Americans drinking gin-tonicas and Brazilians drinking suarana. I have been staying here since I arrived and the place hasn't lost its novelty yet..." The exigencies of war also gave rise to moments of lightheadedness that occasionally show through in the BMHe^M's letters and notes. The November 1944 alumni notes record that Nicholas Leone '41 spent 1 0 days on a boat in the English Channel. "He is getting some interesting shots with his movie camera," the notes say, "and plans to entitle the him,
'From a Bath to a Meai in a Hetmet.'" Granviile Larimore, chief of venerea! disease education for the Army's Surgeon Genera! Office, begins his tetter "Greetings from Holiywood," and he tetls how he is in the middle of cutting, dubbing, and editing a venereal disease prevention movie called "Pick-Up." (It is a fair bet that the take-home message from "PickUp" was don't!) Loyalty to the School and the bonhomie among classmates also are abundantly evident in the BM/fetw's wartime letters and notes. Fairly typical is Arthur Washburn's ' 3 7 , letter, published in May 1944. "Major Charles Gill and Lt. Col. Shields of our class are in this area and I get to see them once in awhile. We are going to have a get together one of these times soon and drink a toast to all of you and to the School." ^
N ADDITION To the carnage ] caused by bullets, bombs, and ) death camps, World War II unleashed a wave of refugees that numbered in the millions. A large contingent of HSPH alumni were involved in refugee health programs through the United Nations Relief and Rehabilitation Administration (uNRRA), one of the predecessors to the World Health Organization. Female graduates of the School seemed to have played an especially important role in UNRRA. Ruth
Cecil Drinker, Constantin Yaglou, and Leslie Silverman
The newly organized Department of Public Health
begin studies that lead to development of basic
Practice introduces a course in public speaking and
design criteria for gas masks for the U.S. Army Chemi-
"radio technique" to help prepare future health
cal Corps.
officers in clear and effective presentation.
47 ^ ^ o\
48 ^ ^ ^
Parmelee, a 1942. graduate, w a s one of just two UNRRA w o r k e r s assigned to an 8,ooo-person refugee c a m p in w h a t w a s then called Palestine. Without adequate staff, equipment, or supplies, Parmelee w a s facing a public health disaster w h e n she came to the c a m p in J a n u a r y 1 9 4 4 . I n an article for the BM/Zefw she described h o w the refugees were "alive w i t h lice." Scabies—a mite-borne infection— w a s prevalent a n d t y p h o i d cases h a d occurred " b u t there w a s not a hypodermic syringe in the c a m p for giving i n o c u l a t i o n s . . . . " Epidemics of measles and w h o o p i n g cough broke out before a proper quarantine area could be established. Eventually, by her account, Parmelee persuaded British officials a n d others to provide supplies and staff, a n d the situation w a s brought under control. M a r g a r e t Varley '44, wrote several letters to the BM/Jefw about her experiences in Greece. Initially she seems daunted. I n a letter published in M a y '4$ she wrote that she was in a "queer position—the only A m e r i c a n w o m e n in northern Greece at the present time. It w a s thrilling at first, but at this point I crave feminine society." But in a tetter published six months later, Varley has clearly hit stride a n d the sense of pride she has in her achievements is infectious, even 50 years later:
ever have a semblance of community again." T h e Institute of H y g i e n e , where A n w a s assistant director, MO w a s " b u r n e d a n d blasted," said A n in his letter, published in N o v e m b e r 1943Jozef Lubczynski, a 192.5 graduate of the M a r g a r e t Varley '44 S c h o o l and a doctor in the Polish A r m y , wrote f r o m L o n d o n : " F o r two months, I was alone with "Before the w a r we lived a quiet life. m y G r e e k g i r l s — n o medical officer. I D u r i n g G e r m a n occupation at the w a s the health division, w i t h typhus, time of the fall of Warsaw, m y wife diphtheria and meningitis very prevaw a s forced to a b a n d o n the city. O u r lent. I set up a medical warehouse, home w a s burned and property lost. w i t h drug and m i l k distribution and M y wife is living in some rural supplied food, drugs a n d improvised district outside the city. I have no supplies to eight hospitals. I w o r k e d news f r o m her." 15 hours a day a n d no Sundays off for two months. I w a s o n the road a Perhaps the most poignant letter great deal of the time (in a truck, no w a s written by K a r e l U r b a n e k , a jeeps). It was pioneer w o r k . But even1 9 2 4 graduate of the School, o n his tually I got a medical officer, a sanireturn to his native C z e c h o s l o v a k i a . tary engineer, t w o Y a n k e e nurse U r b a n e k provides few details because, assistants a n d two Greek W a r Relief as he wrote, " m y experiences gained medical teams. It's a fine set-up." during the past years are not pleasant, 'Tor
77%OM%?S.,
A s the w a r w i n d s d o w n , the BMj/efw's a l u m n i notes began to fill up w i t h news about medals being awarded and plans for after discharge. But the wartime accounts of some foreign a l u m n i in war-ravaged countries also started to trickle in. T h e stories are grim, the anguish concealed by a thin layer of propriety. T h o m a s A n '39, writes about the ruination in M a n i l a and h o w "it w i l l take quite some time before it w i l l
so that I do not like even to recollect them
Responding to war-time stringencies, Dean Cecil
Harold Coe Stuart
Cecil Drinker resigns as dean. Edward G. Huber,
Drinker calls for a School-wide survey of possible waste
captured by German
D.P.H.'25 (left), head of the Department of Public
in the use of steam, electricity, and refrigeration.
army in France and
Health Administration, appointed acting dean.
" T h e reality is namely worse than one can describe, and the facts are too repugnant to be believable for anyone w h o did not live them through. O n the other h a n d , " he continued, "the recollections of m y H a r v a r d days belong to the most joyous events of m y life." Peter Wehrwein
1942
interned at BadenBaden for 16 months.
71he HarvardRed Cross F/e/d Hosp/fa/(/n/t ^ ^ ^eM^fmg m w y
^ M O ^ e M ^ 7 r e w e w ^ e r e J ^o c o t t e r Mp^ m my W^eM ^
w m p p m g
w y
^e// ^ r o ^ e /oose.
John Everett Gordon, director of the Harvard-Red Cross Field Hospital Unit December 3 , 1 9 4 1 .
F
IFTEEN MINUTES a f t e r
arriving in London in August 1940, Professor John E. Gordon was caught in his first bomb-
ing raid. As director of the American Red Cross-Harvard Field Hospital Unit, Gordon had gone to aid the British Ministry of Health in its efforts to keep the beleaguered royal forces free of disease as they faced the advancing Nazi army. With barely enough time to feel the English mist on his face, Gordon experienced firsthand the destruction of war. When some of the shock had worn off, he walked through the rubble created by the blast to the first-aid station, where his head wound was treated and he was given a cup of tea to calm him. Gordon recovered from his harrowing introduction to war. A mere seven months laterâ&#x20AC;&#x201D;Gordon would eventually spend six years aiding the war effortâ&#x20AC;&#x201D;he calmly
Re^ Cross MMrses f^e /yosp^f, 0^67266? ?M .SepfeTM^er J <741
Fredrick J. Stare joins
Ernest E.Tyzzer retires
HSPH tuition rises to
the School as assistant
from faculty and is
$400 a year.
professor and chair of
succeeded by Rene
the newly created
Dubos of the
Department of Nutrition.
Rockefeller Institute.
50
^ X
reported that "the progress of the war has been most uneventful. There has scarcely been a respectable air raid in London for weeks "He had, however, gotten quite his fill of the English mist and rain at that point: "All of the members of the unit are looking for raincoats," he wrote. The American Red Cross-Harvard Field Hospital Unit grew out of a series of meetings called by Harvard University President James B. Conant at the outbreak of war in 1 9 3 9 . Harvard Medical School Dean Sidney Burwell, Gordon, and Charles Wilder, professor of preventive medicine and epidemiology, and other faculty came together to discuss how to help Britain in her greatest time of need. In a letter to the British Ministry of Health, President Conant offered the university's medical and public health services to Great Britain. For the School, which was already depleted by war-related efforts, this was a big sacrifice. Gordon had only two years previously accepted a position at the School as professor of preventive medicine and epidemiology and was heading the Department of Epidemiology. The British Ministry of Health "gratefully accepted the] gencroujH offer" and "cordially i n v i l g d f ^ ^ ^ H Dr. Gordon to England. He was uniquely qualified to accept. Gordon earned a PH.nnRrnrgYTH from the University of Chicago and an M.D. from Rush Medical College i ^ H 192.5. His experience with commuTR** cable diseases began immediately, with his going first to the Chicago Municipal Contagious Disease
Hospital followed by service as medical director of the Herman Keefer Hospital for Contagious Diseases in Detroit. Gordon's experience tracking epidemics began even earlier. After having just graduated from college, where he studied bacteriology and epidemiology, he went into World War I army camps to track influenza and meningitis epidemics. Afterwards, while on an assignment from The Rockefeller Foundation, he embarked on a three-year stint to study scarlet fever epidemics in Romania. He earned a reputation as an intrepid shoe-leather epidemiologist by swabbing the throats of all the children in the village where he was working each week, comprehensively tracking the course of the disease. While in Romania, recovering from a bout of influenza, he received a letter asking him to join the School. The missive almost went undelivered because his secretary, believing that "nothing of importance" was in that day's mail, had decided not to deliver it to him. Gordon's seemingly life-long quest for adventure was well captured by student who wrote about him after lis death: "It used to be surprising Avho knew only his sedate demeanor in Boston to learn that, when in a new held situation, he /ith boyish enthusiasm." ie approached the rigors of war with the same enthusiasm: "I am having the time of my life," he wrote in a letter to colleague Sidney Burwell. "Rarely have I had so many intriguing problems, such a diversity of experience, and such satisfactorily complete days."
1943 As chief of preventive medicine services in the office of the U.S. Surgeon General, Brigadier General James Stevens Simmons, S.D.'39, completes 40,000-mile, around-the-world tour of military public health facilities.
g
^ ^ ^ ^ ^
^^^ ^^^
O R D O N ' S ARRIVAL in
England in the spring of 1 9 4 0 coincided with the beginning of
the Battle of Britain, in which royal forces fought against Hitler's encroaching army. Poland had fallen the year before. Belgium and Holland had just been cut off from their allies, and France had acquiesced after the Nazis marched unopposed down the Champs Elysees. The British Isles stood alone to absorb the full force of the Luftwaffe's bombing machines. After nearly four months of bombing, with both Germany and England suffering heavy losses to their air forces and an enormous toll in English civilian casualties, Hitler postponed the assault on England "until further notice" and turned his attention toward Egypt. The Americans' presence couldn't have been more timely or welcome. When newly inaugurated Prime Minister Winston Churchill declared that "the British Empire and the United States will have to be somewhat mixed up together in some of their affairs for mutual and general advantage," he was referring to the battlefield. Yet with more and more people displaced by the bombing and crammed into air raid shelters, conditions for disease were ubiquitous. Gordon's team of epidemicfighting forces, which included John Mote, then an assistant professor in epidemiology, were prepared to face their opposition. Among their first responsibilities was to inspect air raid shelters; expecting the worst, they surprisingly found nothing.
GorJoM n g ^ renews
R e J Cross sta/jf.
" W h y no major outbreaks of communicable disease have occurred under shelter conditions is, of course, just as stimulating a problem as the attempt to find the cause of an existing outbreak," Gordon wrote in a communique back to the states about the held unit's progress. September 2.1, 1 9 4 1 , was the official opening of the American Red Cross-Harvard Field Hospital Unit centered in the southern village of Salisbury, Wiltshire. It was a village under transformation as its tiny streets teemed over with R.A.F and army officers, and new enterprises like Woolworth's settled in beside old bookstores and bootmakers. The 404-foot spiral of the 13th-century
Cathedral "could be seen for miles around," wrote Gordon, and a very English restaurant called the Haunch of Venison served delicious food in a dining room with sagging floors up a "narrow winding stairway." Gordon's collaboration with the American Red Cross built on a relationship Harvard and the relief organization had initiated during World War I. For the World War II effort, the American Red Cross provided financial backing and arranged for the construction of the Harvard Field Hospital. The 2.2. buildings that made up the hospital and laboratory were constructed from prefabricated units made in the United States, purchased and shipped overseas by
the Red Cross. The 100-bed facility was staffed by 85 Americans: 65 nurses, 1 0 epidemiologists, and 1 0 lab technicians. It was quite an operation, and it received a great deal of attention. " M o s t every important news agency in Britain has reported on the Unit and sent photographers to the site in order to make a pictured record of the Hospital," read a line in a monthly newsletter Gordon wrote to send back to the States about the Unit's progress. Notices appeared in the M^Mc^aster GtMrJMM, the EowJoM T/wes, PzrtMre Posf, the L<3Mcet, and over the radio. The lads from the United States were even featured in a Paramount News Reel.
Due to war-time
To improve American eating habits, U.S. Department
demands on personnel,
of Agriculture issues a pamphlet that introduces
oniy11degreesare
concept of basic seven food groups.
conferred at H5PH commencement.
Despite being in the middle of a war zone, the English held fast to their sense of hospitality and extended a long, gracious arm to the Americans. Evoking a scene from the musical O/wey; in which even orphans know proper British cordialness, Gordon quotes an expression he heard frequently: "We want you to consider yourself a member of the family here." It was a sentiment echoed by Sir Wilson Jameson, chief medical officer of the British Ministry of Health, when he wrote: "The staff of the Unit have come to be regarded not as a group of workers from America but more as part of the general public health staff of the country." Gordon and the Unit's objective was "to conserve military manpower through the application of appropriate disease preventive measures." The plan was that the Harvard Field Hospital would not only treat patients,
but, in conjunction with its attached laboratory, would also be a center for research into communicable diseases. Obviously both sides of the Atlantic would profit by this arrangement: England gained a needed adjunct to her incredibly drained medical resources, and research in preventive medicine being done at the School would be enhanced by the information gained. A mobile unit, which Gordon referred to as a "freelance" unit, was organized to respond to sudden outbreaks of typhus, influenza and other epidemics wherever they struck. The freelancers soon got their chance to go to work with an outbreak of paratyphoid fever in Bristol, which had been heavily bombed and whose local hospital was stressed beyond its capabilities. Gordon's mobile team responded immediately to the problem and, as Sir Wilson
Jameson wrote in a letter to Burwell, the situation was "brought rapidly under control." Gordon's mobile team also responded to outbreaks of jaundice in Northern Ireland and other areas; several cases of trichinosis in northern England; mumps and meningitis in London and Wales; and typhoid fever in Devonshire. " I could go on multiplying instances of the manner in which this excellent unit is rendering us invaluable help," Jameson wrote to Burwell. Surveying the health of the civilian population was just one of the Unit's major objectives. In the same way a reconnaissance team attached to an army unit surveys a future battlefield for lurking hazards, Gordon organized his own units to search for signs of communicable disease in advance of troops moving into an area. "The health of a command is influenced strongly by the environment in which
Gordon fWg^ f/?e ^eM ^ospzta/s 22
1944 First issue of the
University-wide com-
While traveling to Mexico under the auspices of The
Hart/arcf PuN/c Hea/f/?
mittee appointed by
Rockefeller Foundation, nutrition department Chair
/S/u/nn/ Bu//ef/n pub-
Harvard President
Fred Stare's plane crashes. After providing emergency
lished. Vlado Getting,
Coriant recommends
care to the victims, Stare and others walk away from
D.P.H.'40, is editor.
independence for the
the crash site, return to the airport, and take the next
School of Public Health.
plane to Mexico City.
it Ends itself," wrote Gordon. Disease among civilians whether hostile or friendly, will cross over to infect troops w h o come into the area. History gives credence to Gordon's concern.
a Punjab summer to studies of diarrhea in the Arctic reflected his pioneering spirit."
Indeed until the 2.0th century, infectious diseases took a greater toll during war than did opposing armies. "During the American Revolution, the War of 1812., the Mexican War, and the Civil War, our armies were weakened by infectious diseases, and at times the mortality from this cause alone was appalling," wrote James Stevens Simmons, s.o.'39, dean of the School of
And then nothing happened. N o major epidemic threatened the Allied forces. In fact, according to statistics Gordon compiled after the war, if battle-related mortality is excluded, World War II was the first conflict in which accidental trauma, such as vehicular accidents, drowning, falls, athletic
Public Health from 1 9 4 6 to 1 9 5 4 , in the M a y 1 9 4 4 issue of the H ^ r t w J PM&^'c A/M7M7M The threat of influenza especially created uneasy fidgeting among the soldiers, and not without good reason. The great flu epidemic of 1 9 1 8 , sparked in part by World War I, killed nearly 40 million people worldwide and troops fighting the war paid their tremendous dues to this lethal virus as outbreaks among the allied forces took a heavy toll. Yet the allies' health was in experienced hands. Gordon prepared his Unit for anything, but that was to be expected from a man about whom a former student was once said: "His pride in being able to move easily from held work in the i2.o°F heat of
Russian-born U.S. biochemist Selman Waksman
illnesses, and general sanitation. He warned against drinking locally produced milk, which might be a vector for tuberculosis and other bacteria. Unit members inspected mess halls to ensure that food was clean and rations adequate.
The standard operating procedure included instructions for how to prepare for and prevent everything from respiratory diseases such as scarlet fever, diphtheria, and tuberculosis to insect-borne diseasesâ&#x20AC;&#x201D; malaria being the most feared, particularly among troops returning from the East. Gordon was particularly attentive to nutrition, digestive
The D-Day landing in
isolates streptomycin, an antibiotic (a term he coined)
Normandy, France, by
which will later be used to treat tuberculosis, typhoid,
Allied forces is a
and pneumonia.
turning point in the war against Nazi Germany.
injuries, and even suicides replaced non-battle-related disease as a major cause of death. Soon after the United States entered the war, Major-General Dwight D. Eisenhower was sent to London as Commander of the American forces in the European theater. In July, British and American troops joined together to launch Operation Torch, and the American Red CrossHarvard Field Hospital was incorporated into the U.S. Army. On July 7, Gordon was commissioned in the U.S. Army as chief of the Division of Preventive Medicine, USAFBI (United States of America Forces of the British Isles). In the early summer of 1 9 4 3 , plans were drawn up for an assault on the west coast and an invasion of France.
Troops began arriving from throughout the European theater to prepare for the upcoming invasion. Malaria, " a disease of such rarity in Great Britain," said Gordon, "as to be almost a curiosity," became the most important health problem as troops, as he wrote, "seeded with this infection" came from Africa and Italy, particularly Sicily. Also, an outbreak of influenza required much attention but caused no deaths. The two major health problems that confronted the Unit among the Allied forces were trench foot, which while not a communicable disease was certainly preventable, and venereal disease. The latter absorbed considerable attention and resources, and it appears, taxed the Unit's patience: "the control of venereal disease, which even in those early days of American occupation, gave evidence of being all the problem that had been anticipated," wrote Gordon. It was a problem throughout the war. From February 1944 onward, all attention focused on the upcoming invasion of Normandy. In March, all ground and air force units were vaccinated against typhoid, smallpox, typhus fever, and tetanus, and proper sanitation was stressed in lectures as a personal responsibility of every troop member—"no more, no less," wrote Gordon. Field unit officers under Gordon's command inspected
troops' food and water and instructed them on insect and louse control, waste disposal, and general hygiene. After the Normandy invasion, the Unit's Division of Preventive Medicine, under Gordon's direction, was relocated to northern France in order to be closer to the conflict, eventually establishing headquarters in Paris. As the war raged on, Gordon reported that civilian public health—especially typhus control—once again took precedence. On March 2.1, 1 9 4 5 , General Patton's Third Army swept through Germany on its way to Berlin, marking the beginning of the end of the war in Europe. But the war's end did not bring an end to Gordon's efforts. "Overshadowing all else were the health problems of the millions of displaced persons wandering over Europe," Gordon wrote in a subsequent history of preventive medicine in the European theater. After a brief stint in the Pacific theater of operations, Gordon returned to the School, civilian life, and the teaching of preventive medicine in 1946. But his war years continued to influence his work for the remainder of his very long career.
the British and the Americans. According to a U.S. Army history, Pre^eMtwe MeJzcwe ??z WorM Wi^r 77."The Anglo-American coalition in World War II, one of the closest and most effective in the history of wars, served as a solid basis from which the successful public health activity of Civil Affairs and Military Government grew from its early beginnings in 1940 to the end of the war in 1 9 4 5 . " V-E day was a shared victory for British and American forces; that these fighting men were relatively free of disease was a tribute to Gordon, Harvard, and the British Ministry of Health. Some years later, while working in the Middle East as a consultant to the World Health Organization, Gordon would draw on his wartime experiences and look to public health as a unifying language that all nations, regardless of political differences could speak: "We may not be able to agree on bombs but thank God we can all agree on better control of typhus." Terri L. Rutter
Beyond circumventing major disease outbreaks, the American Red Cross-Harvard Field Hospital Unit proved the efficacy of public health, particularly in times of war, and helped strengthen the alliance between
1945 Rockefeller Foundation approves additional grant
President Franklin
of $1,000,000 over 10 years to support the School's
Roosevelt suffers a fatal
transition to an independent Harvard faculty.
stroke and is succeeded by Vice President Harry S. Truman.
Donald Hornig witnesses the first successful atomic bomb test at Los Alamos, New Mexico. Hornig, who helped develop the bomb's triggering device, will later chair the School's Department of Environmental Health.
Dean, 1946-1954
ROWING UP IN rural North Carolina, *
on the cusp of the twentieth century, James Stevens Simmons played the usual
.
boyhood gamesâ&#x20AC;&#x201D;climbing trees, pretending to be a soldier or doctor, and
diagnosing the ailments of his friends. When his playmates tired of the games, Steve, as he was called, would collect butterflies and other specimens for his growing natural history museum. Years later, as chief of preventive medicine in the office of the U.S. Surgeon General during World War II, Brigadier General Simmons would successfully merge the roles of physician, soldier, and scientist that his childhood games foreshadowed. In an extraordinary 30-year career, Simmons traveled around the world, moving from the field to the laboratory to the hospital; studying malaria, dengue, and other tropical scourges; and developing a preventive medicine program that safeguarded the health of the more than $ million men and women who served the United States in World War II. Along the way, he earned four Health in 1939) and a trophy case full of honors and decorations, including the U.S. Army's Distinguished Service Medal; the Sedgwick Memorial Medal, the American Public Health Association's highest honor; and the Walter Reed Medal of the American Society of Tropical Medicine. Following his success in World War II Simmons returned to Boston to lead the newly independent Harvard School of Public Health, serving as dean from 1 9 4 6 - 1 9 5 4 .
James Stevens Simmons
i
contribute to the security of man's position as an intelligent, peaceful, and civilized animal." Gregarious and energetic, Simmons could often be found sitting in on classes and chatting with students in the hall. The general with the piercing eyes who drew salutes on the battlefield was known to his HSPH colleagues as "Steve." As one former colleague later said, "Steve Simmons made you feel as though the gleam in that eye was meant expressly and intimately for you."
Deaw AfMwoTM wee^s
s^M^ew^s
Taking over from Acting Dean Edward G. Huber, D.p.H.'z^ Simmons inherited an institution depleted by the war. Graduates and faculty members had left in large numbers to serve their country on the battlefields of Europe and the South Pacific. Many who remained focused their work and research on the public health aspects of the war. Simmons faced the daunting task of rebuilding a faculty that had fallen to 1 0 full-time and 3 part-time members and a student body that had shrunk to fewer than 50 students each year. The School's financial resources, diminished by the crash of the stock market in 1 9 2 9 , were further stretched by the renovation of the School's new home in the former
1946
HarMr^ Sc^ooJ
Hea/^,
Huntington Hospital. There was an immediate need to broaden the School's base of financial support. ^""""S
IMMONS APPROACHED t h e
School's administration with the same determination and g elan with which he had worked to protect America's fighting forces. His introductory talk to the class of 1 9 4 7 , (85 members strong) had the forceful ring of a general's pre-battle address to his troops: "[EJveryone respects the integrity of the unselfish men and women of every nation who are devoting their lives to the humane profession of public health. I congratulate you on your decision to join this important profession at the present critical time, for never in the history of the world has public health had such an opportunity to
In 1949, Simmons presented to the President of Harvard and the Board of Overseers a comprehensive 10-year plan for growth that addressed the School's financial needs. The plan called for an active fund-raising effort to be driven by faculty and volunteers, which would focus on increasing the School's endowment and raising funds for current use. Simmons was particularly adept at winning endowment support from America's rapidly growing foundation community. He also began a more active outreach program to the School's alumni, meeting annually with the Alumni Association to report on the progress and achievements of the School, encourage alumni involvement, and request their support (he was the first dean to seek financial support from alumni). Simmons' 10-year plan included elevating tropical public health from the status of a division within the Department of Epidemiology to a department in its own right. (The Department of Tropical Medicine
The School of Public Health becomes independent
John Crayton Snyder is appointed to head the new
Faculty unanimously
of Harvard Medical School with an annual operating
Department of Public Health Bacteriology. James L.
approves the addition
budget of $285,000. Brigadier General James Stevens
Whittenberger joins physiology faculty, beginning
of the degrees of
Simmons is named dean.
34-year career at Harvard.
master and doctor of science.
had been incorporated into the medicai schooi when the two faculties split in 1946.) Simmons' service in the armed forces—particularly in the Philippines and the Panama Canal Zone—had sparked a life-long interest in malaria, yellow fever, dengue fever, and other tropical public health scourges. While earning his degree from the School, Simmons worked with George Cheever Shattuck, clinical professor of tropical medicine, who would become a lifelong friend and colleague; and Simmons' doctoral thesis on malaria control was based on research he had completed while stationed in the Panama Canal Zone in 1 9 3 5 and 1 9 3 6 . As dean, Simmons would work with Shattuck to rally the friends, colleagues, and former students of tropical medicine pioneer Richard Pearson Strong and establish an endowed memorial fund in support of a professorship to honor Strong—the first named professorship at the School. Beyond his administrative duties, Simmons, who perhaps better than any other public health leader of his era knew the national value of a healthy citizenry, used his reputation and position to push for an expanded national commitment to train public health professionals. Ironically, after the great public health advances that had been spurred on by the two World Wars, the nation found itself unable to fill many public health positions at the local, state, or federal level. Studies estimated that the nation's public health training programs would have to produce
2,300 graduates annually from 1 9 5 0 until i 9 6 0 to meet these needs—a figure far beyond the capacity of the nation's nine accredited schools of public health. ^
^
hp %<}
—
UST AS W E U N I T E D a
H ^
few years ago," wrote Simmons in 1 9 5 3 , "to
meet the health hazards H of war, we can and must unite to meet the hazards of peace. We must build up the nation's health in order to ensure its future strength and security, and we must work for an improvement of world health in the hope of ensuring a lasting world peace." Simmons became an outspoken advocate for governmental support of public health education, addressing Congress on the national need for trained public health professionals on several occasions. "We who are responsible for the future of American public health must recognize this challenge, initiate sound plans to meet the national need for training, and see that training is properly financed," he said in 1 9 5 1 . In his three terms as president of the Association of Schools of Public Health Simmons also called upon the nation's 76 schools of medicine to place increased emphasis on preventive medicine, which he believed was the best way to keep the American public strong, diminish the effects of the diseases of old age, and control escalating health-care costs, which had already begun to trouble many.
academic institutions in Asia that would permit collaborative research and faculty exchanges. Unfortunately, Simmons did not live to see this dream realized. In the summer of 1 9 5 4 , while returning with his wife, Blanche, from a visit to North Carolina to see their daughter and new grandson, Simmons suffered a fatal heart attack at age 64. When the faculty and students gathered to begin the 1 9 5 4 - 1 9 5 5 academic year, the Honorable Robert F. Bradford, chairman of the Visiting Committee, summed up the importance of Simmons' leadership in shaping the School's future: "Steve Simmons needs no epitaph. He left this School a rare and rich legacy. He left a living portrait, not of a man alone, but of an institution, a tradition, and an ideal." A fitting memorial for a man who worked so hard to secure the School's future, the James Stevens Simmons Professorship, held first by Simmons' friend and colleague James L. Whittenberger and today by John B. Little, was established at the School in 1 9 5 7 as a result of a fund-raising effort spearheaded by Simmons' long-time friend and colleague, Shattuck. Marceita J. Bernard
Simmons also hoped to create what he described as a "bridge of health" between the School and
Gordon Fair, Gordon McKay Professor and head of
Communicable Disease Center (CDC) is established
the Department of Sanitary Engineering at the School,
as a field station of the U.S. Public Health Service in
is appointed dean of Harvard's School of Engineering.
the Atlanta, Georgia, offices of the defunct Office of Malaria Control in War Areas.
HH^H
REDRtCK J . STARE w a s
changing planes at New York's LaGuardia airport, en route from St. Louis to Boston, when he heard the news. The Japanese air force had just bombed the U.S. naval base at Pearl Harbor, precipitating America's entry mto World War II. Stare, a recent medical school graduate with a PH.D. in biochemistry, continued on to Boston, where he was scheduled to meet with Cecil Kent Drinker, dean of the Harvard School of Public Health, and A. Baird Hastings, head of the Department of Biochemistry at Harvard Medical School, to discuss starting a Department of Nutrition at Harvard. (At the time, the two schools shared administrations, and nutrition courses for both medical and public health students were taught through Baird's department.)
First m Food Fredrick J. Stare and the Department of Nutrition
1947 School introduces a series of 24 "Saturday Morning
Professor Emerita Alice Hamilton becomes the first
Health Forums." Speakers the first year include Dean
woman to receive the Lasker Award from the Albert
Simmons, Martha May Eliot, Alice Hamilton, Ross
and Mary Lasker Foundation for her contributions to
McFarland, Red Cross Chairman Basil O'Connor, and
the prevention of occupational disease.
Johns Hopkins luminary Abel Wolman. The collected lectures will later be published as P u M c Mea/f/; Wor/d Today.
f/w
Six months later, Stare was back at Harvard as
Harvard, and it would have a great impact on the direc-
assistant professor of nutrition and chair of the fledgling
tion the department would take during his 34 years as its
Department of Nutritionâ&#x20AC;&#x201D;the first such department in a
chair.
medical or public health school in the world. Under Stare's leadership, the department quickly emerged as a leading
The United States' entry into World War II would prove to be a boon for scientific research, as the Depart-
center of research into the myriad ways nutrition affects
ment of Defense generously subsidized research to aid the
health, uncovering vital clues about the links between
Allied effort. Stare and his departmental colleagues won
cholesterol and atherosclerosis, clarifying the health benefits
grants to study parenteral nutrition and how nutritional
and hazards of proteins and fats, shaping understanding
status affects malaria. These grants, along with funding
of a well-balanced diet, and spearheading the campaign to
from The Rockefeller Foundation, helped jump-start the
teach schoolchildren the value of good nutritional habits.
nascent department's research program. After the war,
Stare himself would become a resounding, oft-quoted, and sometimes controversial public voice on issues of food and diet.
Stare's close ties to the ^ r ^ T H E
BASIC
y o U R ^ ^
ENRICHED ORWIOLE MEAT. FOUOW. FtSH, EGGS. LEGUMES GRAIN BREAD. HOUR. CEREALS. AND PW^O
food industry would prove invaluable in acquiring new funds to sustain the burgeoning department's growth. An
Ironically, the man picked to head this enter-
adept fund-raiser, Stare
prise says he had never even
cultivated contacts with
heard of Harvard until he
executives in the food industry, who welcomed
got to college. A selfdescribed "simple country boy from the Midwest," Stare was born and raised
the opportunity to fund
PRUIT5. INCLUDING CITRUS; VEGETABLES. INCLUDING GREEN LEAITANDYELMW
research that would lend insight into food and nutrients. Within two
in Wisconsin, the nation's dairy capital. His father was
decades, Stare's depart-
president of a major canning
ment moved from bor-
company, with strong busi-
rowed space in the medical
ness ties throughout the
school to its own building
food industry. He earned his
on Huntington Avenue. By
PH.D. from the University of Wisconsin's School of
^ W F C T Y O U R H E M n ^ PROTECTIVE tXPRS,
1 9 7 0 , the department included 1 8 0 professional and support staff, with five
Agriculture, birthplace of the country's earliest research on nutritional elements and
departmental endowment funds and an annual budget of
health in animals. Experiments conducted on calves at
$4 million.
Wisconsin in the early 1900s revealed that essential elements in foods contributed to growth and development. One of the investigators on these studies, E.V. McCollum, went on to discover vitamins A and B. Stare's foundation in food and nutrition had been well laid by the time he arrived at
"Fred was an empire builder," says former colleague Mark Hegsted, one of the department's original members. A biochemist, Hegsted had followed Stare to Harvard from Wisconsin; he would go on to publish over 400 papers, many of them dealing with protein, responses to malnutrition,
At the request of the governor of New York, the
Ross McFarland joins
India gains
nutrition department begins state-wide nutrition
the School's Department
independence from
survey looking at the impact of rising food prices and
of Industrial Hygiene.
Great Britain.
possible food shortages.
and the effects of calcium intake on osteoporosis. As World War II wound to a close, Stare, Hegsted, and their departmental colleagues turned their attention to two nutritional issues of growing public concern: obesity and coronary artery disease. The department's challenge was great, for just as its cholesterol and obesity studies were taking off, the suspected culprits in these diseases were gaining a foothold in the American diet. Fueled by the postwar economic boom, eating out became a favorite American pastime, and the foods consumed were far from the nutritionist's guide to healthful eating. Beginning in the late 1 9 4 0 ' s , McDonald's restaurants and Baskin-Robbins ice cream stands began popping up around the
country, heralding the dawn of the fast-food franchise. Food companies also began filling supermarket shelves with prepared and processed foods, such as canned meats and fatand sugar-loaded snacks. The department's shift toward the dietary underpinnings of disease marked a transition from what Hegsted calls the "golden age of nutrition"â&#x20AC;&#x201D;the period during the 1 9 1 0 s and 1 9 2 0 s when chemists throughout the United States and Europe rushed to discover the essential vitamins and minerals that staved off disease, such as Vitamin C for scurvy, thiamin for beriberi, and niacin for pellagra. In the postwar era, for largely unexplained reasons, deficiency diseases all but disappeared in the United States and
Europe, and many academics wondered if nutrition studies had dried up. It was a wary time for nutritionists, says Hegsted. "I've always wondered if our department had been delayed four or five years, whether Harvard would have accepted it," he says. But even as deficiency diseases disappeared, the perils of the nation's growing indulgence in fats and sweets were becoming increasingly clear. By 1 9 5 0 , the U.S. mortality rate from heart disease, already the leading cause of death, had passed 300 per 100,000-â&#x20AC;&#x201D;nearly twice the 1 9 2 0 death rate. For American men, the heart disease death rate was over 400 per 1 0 0 , 0 0 0 . But the causes of coronary artery disease remained largely a
gM J Co//MgMg m 1940^. ResMrc^? on <2MZ?7M/s proM'JeJ c/MM
?!Mtne7!f5.
1948 The Stirling County Study, the first large-scale study of the impact of social factors on mental health, begins under the direction of Alexander Leighton. Leighton will later chair the Department of Behavioral Sciences.
United Nations establishes World Health Organization headquartered in Geneva, Switzerland, and the U.N. General Assembly adopts the Universal Declaration of Human Rights.
medical mystery. (President Franklin Delano Roosevelt's physicians, for example, expressed surprise when he dropped dead of a stroke in 1 9 4 5 , despite Roosevelt's long history of dangerously high blood pressure.) A breakthrough came in 1 9 5 3 , with publication of University of Minnesota physiologist Ancel Keys' landmark study showing a correlation between heart disease rates and diets high in animal fat. The study launched a wave of research into the metabolism of fat and the role of blood lipids in the development of atherosclerosis. Between 1 9 5 3 and 1 9 7 0 , department researchers published more than 400 original studies and scholarly reviews on obesity and the relationship between atherosclerosis and cardiovascular disease. The research ranged from metabolic experiments using animals, such as the 1 9 3 9 article, "Mucopolysaccarides and experimental atherosclerosis in rabbits," to a cohort study published in 1 9 6 6 by Hegsted and others that showed the definitive link between dietary fat and serum cholesterol levels. Stare also recruited faculty whose skills reflected this new focus, including cardiologist Bernard Lown (see sidebar page 64) and Yaletrained physiologist Jean Mayer. Mayer, who joined in 1 9 5 0 , would spearhead research into clinical aspects of obesity and the physiologic effects of food regulation during the
!
next quarter century. He would go on to serve as special consultant in nutrition to President Richard Nixon and chair of the White House Conference on Food, Nutrition, and Health in 1969. He left the department in 1 9 7 6 to become president of Tufts University.
H ^H^^
a similar column, called "Food for Thought." In 1 9 5 5 , in an attempt to make the government's io-year-old national nutrition guidelines more accessible and easier to adhere to, Stare's group compressed the government's Basic Seven food groups into the Basic Four. The following year, these guidelines were adopted by the U.S. Department of Agriculture (usDA). The nutrition department's Basic Four depicted a shield of four quadrants of equal size, each containing a different food group. "Protect your health with protective foods," reads the legend under the Basic Four shield. It proposed daily consumption of two or more servings of meat, two servings of fruits and vegetables, four or more servings of grains, and two or more servings of dairy foods.
Thick fog of air pollution kills 22 and hospitalizes
The Framingham Heart
thousands in small, western Pennsylvania city of
Study, the first large-
Donora, a high-profile event signaling dire health
scale longitudinal
consequences of dirty air.
study of cardiovascular
^ ^ ^ ^
ESEARCH, ALTHOUGH THE
mainstay of the department, was only part of the nutrition story. From the ^ outset, Stare also sought to get the word out that, as he once put it, "good nutrition means good food, consumed in variety and in such quantities as to make its maximum contribution to health and well being." Beginning in 1 9 4 5 , Stare wrote a twice-weekly syndicated newspaper column, "Food and Your Health," that provided practical nutritional information for the general public. Mayer later penned
disease, begins.
62 ^ ^ ^ y
The Basic Four wouid be the standard dietary guideline for the next 20 years, guiding the eating habits of two generations of Americans. But as eating habits and nutritional knowledge evolved, new dietary prescriptions were advanced. In 1 9 7 6 , the Basic Four was replaced by the federal Dietary Guidelines for Americans, and more recently the guidelines gave way to the uSDA's modified food pyramid. In each instance, department faculty or graduates played a role, extending the department's history of trying to provide clear nutritional advice to the public based on the best current knowledge. In the 1 9 7 0 s , Hegsted and department graduate Chris Hitt, M.H.s.'7$, helped map out the Dietary Guidelines for Americans, Hegsted as a member of the USDA and Hitt serving on the Senate Select Committee on Nutrition and Human Needs. The guidelines, with its recommendations to reduce meat consumption and increase intake of fruits and vegetables, would turn out to be, in Hitt's words, " a radical departure" from the Basic Four. The guidelines in turn provided a framework for the usDA's current modified food pyramid, which presents grains, fruits, and vegetables as the "base" of a healthy diet and tapers upward to foods that should be eaten infrequently, such as fats and sweets. Two years ago, Walter C. Willett, Stare's successor as department chair, unveiled his Mediterranean Diet pyramid, a modification of the USDA's
pyramid that proposed further reductions in consumption of some foods, especially red meat. Stare also shaped American eating habits in more subtle, behind-thescenes ways. That we have an alternative to skim and whole milk is because Stare suggested to a milk company executive to add more protein to skim milk, resulting in the creation of 1 percent milk. And Stare claims that the basic recipe for the ultimate dieter's breakfast, Special K cereal, was written on a piece of scrap paper during a meeting with the president of the Kellogg Company. ^ ^ ^
TARE'S OUTSPOKENNESS
^L ^^^^ ^
and no-nonsense views on nutrition brought him headto-head with many alternative diet proponents, or what he called "food faddists"—a term first used in 192.2. by the University of Wisconsin's McCullom to describe vegetarians. Stare's battle with food faddists began in 1 9 5 9 , when he was sued by the Boston Nutrition Society for libel. That case would mark the beginning of Stare's confrontation with those who would profess to have found the next "miracle food," and he continues to be frustrated by the specious quest for the perfect food or diet. "There's still a bunch of nonsense in food fads," says Stare today. Because of his high public profile, he regularly received—and responded to—queries from concerned individuals. A collection of this " f a n mail," published in 1 9 8 2 under the title,
1949 Dean Simmons is
School introduces courses in "Human Ecology"
Donald L.Augustine is
awarded the Legion of
and "The Public Health Aspects of Atomic Energy."
appointed head of the
Honor by the French
The latter attracts a larger class than any other
Department of Tropical
government.
subject offered.
Public Health.
Dear Dr. ^Mre; ^^OMM J Eaf?, runs the gamut from hopeful inquiries about foods that may cause or alleviate gout, arthritis, memory loss, diverticulitis, and cancer to outright attacks on Stare's nutritional views. "Dear Dr. Stare," began one irate letter. " Y o u r statements regarding foods are disturbing and appalling to me Don't you realize that man is a fruit eater...not constructed to eat flesh foods?" A letter signed by "an enraged housewife" decried the hazards of "hot dogs, sugared cereals, and colas" and admonished Stare to "tell the truth about good healthful foods." With characteristic candor and good humor, Stare answered his correspondents and critics, always proffering a moderate, commonsense approach to eating. In response to a question about the food value of Scotch whiskey, Stare concluded, "Remember, food (including drink) is meant to be enjoyed, not feared, overconsumed, or misunderstood." As an antidote to " f o o d faddism" and nutritional quackery, Stare counseled sound nutrition education in the nation's elementary, secondary, and, especially, medical schools. " O f all the environmental factors affecting health in present-day civilization in this country, none is more important than nutrition. Yet in most medical schools, organized instruction in nutrition is sadly neglected, despite 'lip service' to the contrary," wrote Stare in a 1948 article stressing the importance of training future physicians in public health nutrition.
And in a 1 9 8 6 in article titled "Nutrition Education in America: From Day One" Stare wrote: "We are a nation of nutritionally naive consumers, currently wasting billions of dollars each year on diet fads and nutrition nonsense. The only means for overcoming our wide-scale nutritional ignorance is by developing and conducting a comprehensive nutrition education program."
investigators who are doing some form of research in nutrition throughout the School of Public Health, the medical school, faculty of arts and sciences, and affiliated hospitals of Harvard.
H N THE 3 0 YEARS THAT STARE
] led the Department of Nutrition, ] the contours of the nation's ] nutritional landscape changed ) dramatically. When Stare arrived at Harvard, there were 2.5 to 30 known essential human nutrients; today, there are 45 to 50. The understanding of the relationship between dietary and serum cholesterol has improved dramatically. By the mid-1970s, when Stare retired, mortality from heart disease was in the midst of a long decline from its mid-century peak. On the other hand, despite a half century of education and information about the perils of overindulgence, Americans continue to get fatter. In 1942., when Stare arrived at Harvard, under 1 $ percent of Americans were obese. Today, over 33 percent of the nation tips the scales at zo percent or more over their ideal weight, the clinical definition of obesity.
Mar^ HegsfeJ, owe o / ^ e ong;?M/ % recew? ?MM?c Hea/^ Ro%7?& progr%7M. "It's the sad story of nutrition," says Hegsted. "There are more fat people now than there ever were." "People eat because eating is a pleasure of life," says Stare. "There's not much interest in nutrition." Obesity is just one of the many areas of research brought together under an umbrella program established by Stare in 1 9 8 4 called the Harvard Human Nutrition Program, H2.NP. Stare, in retirement, was looking for a way to strengthen the teaching of nutrition throughout Harvard. Today, under the direction of Clifford Lo, the program is working to link together the 100-plus
The department's long tradition of national leadership in nutrition research is carried forward by Willett, the Fredrick John Stare Professor of Nutrition and Epidemiology. Like his faculty namesake, Willett is a smalltown Midwesterner who is unafraid of speaking his mind on food issues. Willett recently decried the introduction of olestra, the fat substitute recently made available to the makers of snack foods; his research exposed margarine's harmful side effects; and he has also touted the benefits of olive oil and other staples of a Mediterranean diet. It was this kind of strong public advocacy that Stare had in mind in 1962. when he addressed the annual meeting of the Harvard Medical Alumni Association: "I have always felt that professors in our schools of medicine and public health, and other leaders in the health professions, are falling down on the job if they don't speak out clearly and emphatically on health quackery and nonsense, be it food faddism, antifluoridation, propaganda, or 'cancer cures.'" Terri L. Rutter
Reviving Current Some of the most unlikely research to emerge from the Department of Nutrition, but which would have significant impact in clinical treatment of heart disease, was conducted by a young cardiologist named Bernard Lown and his group of researchers. Because the department was doing so much work on atherosclerosis, Stare determined that they should bring on board "an honest-to-goodness cardiologist." After he had been recommended several times by colleagues, including Paul Dudley White, the legendary heart physician at Massachusetts General Hospital, Lown was brought on board in 1958. At the time, Lown was primarily interested in sudden cardiac death. "I knew nothing about nutrition," he says. But Stare's group was interested in cardiac disease, and so was Lown.
Pro/essor Ewer/tMy Be7'7MrJ Low?!
"The way Fred ran the show, it was the ultimate Protestant reformation. Every believer or communicator operated in his or her own unique way," says Lown about his unlikely but ultimately compatible presence in the department. "There was no sense of this is what the
department was doing, so this is what everybody should be doing. It was free-flowing." Lown does admit, however, to speaking a very different language than the department's biochemists. Lown had been looking for support for his idea to apply electric current directly to the stilled heart, literally jump-starting it back to life. But because he had no engineering knowledge, he kept being turned down. "I didn't know AC from DC," he says.
Finally, Lown talked to Stare, who listened. "He said don't worry about it; do the work," says Lown. To develop the idea, Stare supported the Lown group with $100,000 per yearâ&#x20AC;&#x201D;at that time "an enormous amount of money." And what Lown developed would forever change the treatment of cardiac arrest. In 1958, a patient of Lown suffered from a recurrent arrhythmia. Lown had resuscitated the patient several times using drugs; finally though, the poor man was dying, and Lown had run out of resources. Desperate for a solution, Lown thought about the work of Paul Zoll, a cardiologist at the Beth Israel Hospital who had shown some success eliciting a heartbeat from a heart attack victim by applying alternating current directly to the heart. Believing he had nothing left to lose, Lown took Zoll's idea and applied alternating current to the man's heart. It worked. "The fellow reverted miraculously," says Lown. "From a dying person, here was a live person, ready to go." Lown later learned, however, that alternating current was actually very injurious and potentially lethal to the heart, so he began looking for a safer way to use electricity to correct rhythm disruptions in the heart. "That was a real challenge," says Lown, "to develop a device that could do this that was absolutely safe." He met the challenge with the development of the DC defibrillator, which started a "revolution" in cardiac care. Use of the defibrillator is now part of routine care for the emergency treatment of myocardial infarctions. However improbable the end result of Lown's research, even more surprising was the actual laboratory in which it was designed. "Elegant research doesn't need elegant space," says Lown. "Elegant ideas result in elegant research." Although plans for a new building had been approved, new space wouldn't be ready for occupation for another four years, in 1962. So, Stare gave Lown a room behind an "ancient" Coke machine in the old Huntington Hospital to set up his lab. "Well, the room behind the Coke machine was the old rat room," says Lown. Before any work could begin, he and his colleagues had to remove the rat cages. Then they built a loft to add an additional layer of space. Once the lab was up and running, it operated on three levels: people working in the loft, on ground level, and one person lying on the floor to do an experiment. "It looked bizarre," says Lown, "but, it worked."
1950 Marvarcf PtAb//<r MeaM] /t/umn/ Bu//ef/n introduces "Pappy Says...," a column written by faculty member Hugo Muench, whose humorous, mildly irreverent observations on public health and the School will appear regularly for the next four years.
Hugh LeaveH /\n
/nnovat/ve
t e a c h e r - a d m /n /stra t o r c/eve/op5 a mu/t/d/sc/p//'ned a p p r o a c h to pub/zc hea/t/i pract/ce ^
N JANUARY 1 9 3 7 , rain swelled the Ohio River along
Public Health. Leavell succeeded the late Edward Godfrey
! its Kentucky edge to breaking point. Finally the
Huber, D.P.H.'z^, who had chaired the department since
! southern bank yielded, and water Hooded into the
1 9 3 8 , when it was still the Department of Public Health
) streets of Kentucky's largest city, Louisville. Civil
Administration. The department's redesignation in 1940
and government personnel from the U.S. Public Health
coincided with a broadening in the scope of instruction
Service, Army Medical Corps, and Navy, along with Red
that corresponded to new realities in public health.
Cross nurses and doctors from around the country
"Our department has the great responsibility of
descended on the city to restore order and help dry it out.
dealing with the application of what is taught in other
Food and clothing were delivered by airplane, and over
departments of the School," wrote Leavell in 1 9 5 1 in
2.00,000 people received typhoid vaccines in an effort
the H a r t w J
to prevent an epidemic in the outbreak-ripe conditions.
Hea/f^? A/M77in? BM/Zetw.
In his teaching, Leavell was influenced by the
Coordination of all the players in this enormous
emerging field of "social medicine," which held that the
rescue project fell to Louisville's public health director,
social environment was as essential to keeping a person
Hugh Rodman Leavell. A local boy made good, Leavell
well, or rehabilitating a sick individual, as was physical
had been in private practice in Louisville since graduating
health. Leavell proposed that integrating the social sciences
from Harvard Medical School in 1 9 3 0 . He also chaired
into public health would expand and enhance the benefits
the Department of Public Health at the University of
of the physical and biological sciences. This attention to
Louisville and acted as the city's part-time public health
what in today's age of holistic medicine is called "attend-
director, presiding over a successful campaign to wipe
ing to the whole person," permeated all aspects of
out diphtheria. (In 1 9 3 3 , Louisville experienced the fourth
Leavell's work.
highest death rate in the country from diphtheria.) Leavell's hands-on experience would prove invalu-
Using as his guide the definition of health developed by the World Health Organization in 1946â&#x20AC;&#x201D;a state of
able when he returned to Harvard in 1946 as head of the
"complete physical, mental, and social well being"â&#x20AC;&#x201D;
Department of Public Health Practice at the School of
Leavell incorporated a team concept for public health
In a letter to President Harry S.Truman, Dean
School sponsors the first annual Industrial Tropical
Simmons urges passage of a bill for federal aid to
Health Conference, attended by representatives of
medical and public health schools that the House
American Cyanamid, Coca Cola, Firestone Tire and
Commerce Committee has tabled.
Rubber, United Fruit, and other leading international companies.
practice. He drew his faculty from a variety of disciplines, each concerned with a different aspect of a person's well-being: Elizabeth Prince Rice was a social worker in the Department of Maternal and Child Health who taught a course on social work in health agencies; Margaret Varley, M.P.H.'44, taught a course on public health nursing; and James Dunning addressed dental public health practice. The department even offered a course in veterinary public health practice taught by Raymond Fagan. In the classroom, Leavell employed a variety of nontraditional teaching techniques that were ahead of their time, including the casebased method; field teaching studies in partnership with community agencies; problem-solving focused on real life issues and programs; and vigorous student participation in all aspects of curriculum development, program planning, and implementation. In cooperation with the Departments of Biostatistics, Maternal and Child Health, and Tropical Public Health, Leavell created joint courses to augment his department's offerings. "What an innovative, inspiring, imaginative and stimulating teacher he was, always ready to try the untested," wrote his former students upon his death in 1 9 7 6 . Leavell also incorporated the development of sound administration methods into his multi-leveled approach. His own administrative skills were called "a precious attribute fundamentally grounded on
an unusual grasp of human relationships," in the citation for the Lemuel Shattuck Award, which he received in 1 9 6 1 from the Massachusetts Public Health Association. It was one of two prestigious awards with which he would be honored; he also accepted the Elisabeth Severance Prentiss Award in 1963 for outstanding achievements in the field of public health. In 1948, Leavell's ideas were given a real-life laboratory with the establishment of the Wellesley Human Relations Service. Soon after the end of World War II, veterans around the country settled into government subsidized housing communities called Victory Villages. One of these was situated on the outskirts of Wellesley, an affluent, predominantly white, Protestant suburb of Boston. The veterans, who were an ethnically and culturally diverse group, required a range of health services, and the town's leaders, seeking to avoid a clash of cultures, approached Leavell for help in coordinating their care. Leavell had recently recruited psychiatrist Erich Lindemann from the Massachusetts General Hospital to direct the department's mental health programs. As director of outpatient psychiatric services at Mass General, Lindemann had been studying how physical illness affects mental health, specifically the psychology of burn victims from the 1942. Cocoanut Grove fire in Boston.
and the school systems and medical practitioners. The center served as a field site and research laboratory for the School's students, while also providing mental health services to city residents. Today, the Wellesley Human Relations Service is still in existence, although its research and teaching components were phased out as federal funding was stopped. The Service now operates entirely as an independent clinical practice. Leavell's broad-based approach to public health "embraced all relevant disciplines, all levels of practice and all parts of the world," wrote his former students. Leavell traveled throughout Asia, India, and Central and South America, surveying public health measures being applied in these regions, believing that both host and visitor would benefit from mutual learning and understanding. Upon his retirement in 1 9 6 3 , Leavell returned to India on a Ford Foundation fellowship to serve as a consultant and adviser to the director of the Indian Government's Institute of Public Health Administration and Education in New Delhi. "He was a man of vision," wrote Dean John Crayton Snyder about Leavell upon his retirement. " M a n y men are endowed with unique talents in special fields of interest, but few have applied their abilities to such a wide range of activities." Terri L. Rutter
At the Wellesley Human Relations Service, Leavell and Lindemann coordinated the efforts of community organizations, such as the churches
1950 Physiologist Jean Mayer, who will pioneer under-
Communist forces
British epidemiologists
standing of regulation of food intake and metabolic
from North Korea
Richard Doll and
obesity, joins the Department of Nutrition.
^ g s
invade South Korea,
Bradford Hill show first
trig!)
precipitating the
evidence of link
Korean War.
between lung cancer and smoking.
Ftying High
Ross McFariand and the Birth of Aerospace Medicine A
MONG THE HUNDREDS OF THOUSANDS
of documents in the iate
Ross Armstrong McFarland's archives, encompassing journal reprints, jL
j L . copies of talks and speeches, notes, and correspondence, is one slip
of paper that speaks voiumes about McFarland's piace in aviation history. It is a teiegram from this century's most famous female aviator, Amelia Earhart, dated March 3, 1 9 3 7 , four months before her plane disappeared, that reads: "On contemplated world Right am wondering if there is anything I can check of possible value your (sic) research work
"
"Dear Miss Earhart," responded McFariand, then a member of the Harvard Fatigue Laboratory. " I am of the opinion...that if you are going to be taking many long hops that you would find oxygen of considerable value in reserving your strength and in keeping fit
It could also be used in emergency
situations and for headaches or when you feel exhausted due to prolonged flights."
U.S. life expectancy at
Infant mortality rate is
birth is 68.2 years, an
29.2 out of 1,000 live
increase of about 20
births, half the 1931
years since 1900.
rate.
Emily quickly learned his
McFarland's informed opinions, particularly on the effects of
arcane language of altitude and cabin
attitude change and oxygen depriva-
pressure. Soon after their marriage,
tion on pilot performance, helped
she fainted during a Right. The crew
breathe life into the burgeoning field
was ready to administer oxygen, but
of aviation medicine. Long before
Ross intervened, saying it was
frequent-flyer miles and low-budget
incorrect cabin pressure that caused
airlines made air travel for most
her to faint. This incident prompted
people as commonplace as breakfast
the McFarland's preHight visits to the
cereal, McFarland was working to
pilot. "And now," says Emily, " I
make the airplane environment
always ask what the cabin pressure is."
healthy and safe for everyone, from
After earning his PH.D. in
the cockpit to the rear of the cabin.
psychology from Harvard, McFarland spent a year at Trinity College in
"He was a pioneer on the level
England, where he conducted his Rrst
of Orville Wright," says Daniel Spoor, M.p.H.'66, one of McFarland's
studies on how human behavior was
students, who collectively became
affected by lack of oxygen and other
known as "Ross's boys." Spoor
environmental changes, using as his
would go on to direct the recovery
Abator
subjects pilots from the Royal Air
missions of Apollo 7 and 8 and, later,
McFar/ana!'s many /?yer /WeMcfs a w J coffeagMes.
the astronaut clinic and lunar lab of
Ear^art was among
Apollo 1 1 . Born in 1 9 0 1 in Missouri, McFarland would come
Force. After leaving Trinity in 192.9, McFarland did some postgraduate
study at Columbia University in the Department of Psychology at the College of Physicians and Surgeons.
of age just as the modern age of aviation was taking Right.
There, he investigated the ways in which the central
He was two years old when the Wright brothers made
nervous system is dependent upon a normal supply of
their historic flight across the dunes of Kitty Hawk, North
oxygen, glucose, and organic elements.
Carolina. And he was completing his PH.D. in psychology
His research led to the development of "nomograms"
at Harvard when another aviation pioneer, Charles
from which the combined effects of altitude and other
Lindbergh, accomplished the Rrst non-stop solo transat-
variables such as carbon monoxide levels could be pre-
lantic Right in 192.7. McFarland would later become
cisely estimated and predicted. These Rndings led to
friends with Lindbergh, as he would with hundreds of
regulations for the use of oxygen by pilots in civil aviation
pilots throughout his career.
and by military pilots during night combat.
"He loved to Hy," says Emily McFarland, M.p.H.'56,
As aviation technology advanced, it quickly reached
of her late husband. "We always went into the cockpit to
a point where the capabilities of aircraft exceeded the
talk to the pilot."
physical limitations of the men who Rew. As he would later
Ross and Emily married in 1 9 5 0 when he was 49
write in the paper, "Human Problems Associated with
years old. It was his Rrst marriage, her second, her Rrst
High-Speed and High-Altitude Flight": "Altitudes so high
husband having died a year earlier. Emily says she hesi-
that human life is no longer possible may now be reached
tated about marrying such a long-time bachelor, but she
within a few minutes, and the full range of tolerable
adds with a smile, "Ross was very convincing."
temperature is met within a single Right."
1951 At the government's urging, the School stages a
Dean Simmons under-
CDC establishes the
World population
six-week training program for 50 U.S. Public Health
takes seven-week
Epidemic Intelligence
surpasses 2.5 billion.
Service officers who will be sent to Southeast Asia to
inspection tour of
Service.
fight malaria, trachoma, and other diseases that
Japan and Korea for
threaten the region'spolitical stability.
the Office of the U.S. Surgeon General.
Such rapid altitude changes, McFarland discovered,
for legibility at extremes of speed and studied the size of
cause a drop in the avaiiabie oxygen to the pilot. When
gauges to determine whether they could be used easily.
this happens, the pilot behaves as if intoxicated: his
He recognized that the eye's ability to adjust from light
attention fluctuates, his calculations become unreliable,
to dark conditionsâ&#x20AC;&#x201D;a characteristic he called the "dark
and his judgment becomes faulty. He may become fa-
adaptation"â&#x20AC;&#x201D;was impaired by lack of oxygen, which
tigued, or experience sleepiness, headache, and breathless-
might disrupt a pilot's ability to read his instruments.
ness, all of which ultimately affect his ability to fly,
He also stressed the need for an emergency supply of
increasing the chances of failure or accident.
oxygen in the cockpit to enable a pilot to survive sudden
Armed with his research on the effects of anoxia,
drops in cabin pressure. In fact, McFarland's studies on
along with a broader interest in the relationship between
cabin pressure are responsible for the familiar warning
man and machine, McFarland delved head first into trying
now made at the beginning of every commercial passenger
to understand the reasons for pilot error and the relation-
flight: "In the unlikely event of a drop in cabin pressure,
ship between pilot physiology and the physical demands of
please..."
flight. Over his nearly 40-year career, McFarland produced numerous studies, articles, and lectures showing that pilot error could be reduced if the plane was better adapted to the pilot and the pilot was better suited to the job. He
CFARLAND BEGAN STUDYING t h e e f f e c t s of
! ^
/ H
altitude changes in 193 5, as a member of the
J L V -HL International High Altitude Expedition to the
advocated for converging the knowledge and perspectives
Chilean Andes. Hiking along this South American range,
of engineers, physicians, psychologists, physiologists, and
with peaks reaching over 2.1,500 feet, McFarland and his
anthropologists to address the problems of airline safety.
colleagues studied the effects of altitude change on each
In the process, he revolutionized the held of aviation and
other and on the Andean people living in the mountains.
helped create a new held of study that he called "human
(This expedition also sparked McFarland's lifelong love of
factors" research, which attempted to understand the
mountaineering.)
relationship between people and the machines they
Two years later, McFarland joined the Harvard Fatigue Laboratory based at Harvard Business School, which was investigating how people functioned under different
operate in the belief that by adapting machines to human limitations one can improve an individual's performance. "One of the most important ways of improving flight safety and combat efficiency is to design equipment in terms of human capability," he wrote in his classic textbook, HM77MM Factors
TrdiTMporf^z'oM. "Unless
aircraft are designed around the characteristics of airmen, it is hardly fair to attribute so many accidents to human failure as is usually the case." "He laid out the basic human factors in civil aviation," says Stanley Mohler, a former colleague of McFarland who is now the director of the only civil aviation residency medical program in the world at Wright State University in Dayton, Ohio. To this end, McFarland looked at the size and illumination of the print on airplane instrument panels
1952 T h o m a s R . A . Davis, class of 1953, sets sail in his
HSPH tuition rises to
48-foot ketch M/rufromNewZealand en route to
$770 a year. The class
Boston. Davis's wife, Lydia; sons, John and Timothy;
of 1952 numbers 121,
and two cats will accompany him on the 11,000-mile
42 of whom are
voyage.
women.
I
occupational situations and work stresses. Research on the health of industrial workers conducted at the lab included studies on fatigue and work efficiency among Mississippi sharecroppers, examinations of the physiological changes that occur under temperature extremes in the workplace, and the sources of energy and heat dissipation in muscle tissue in steel mill workers. McFarland and his Fatigue Lab associates produced 61 reports on topics ranging from pilot response to anoxia to sensory and motor responses during acclimatization to the health effects of prolonged exposure to high altitudes. In 1937â&#x20AC;&#x201D;the year Amelia Earhart's plane was lost over the Pacific Ocean and Soviet aviator V.P. Chkalov flew non-stop over the North Poleâ&#x20AC;&#x201D;Pan American Airlines hired McFarland as a consultant to study pilot fatigue on long flights by its new fleet of Flying
Clipper Ships. At Pan American, McFarland established the Health Security Program, which eventually grew into a full-fledged medical program for pilots. The program laid the foundation for commercial pilot fitness and established a more comprehensive examination for pilot selection. "He was the first scientist to study pilot fatigue," says Mohler. In 1940, at the request of the U.S. Navy, McFarland initiated, with Ashton Graybiel, the 1,000 Aviators Study, which resulted in the development of better tests for the selection of fighter pilots. During World War II, McFarland continued his studies on military pilots as a civilian operations analyst with the 1 3 th Air Force in the Solomon Island Campaign. In 1946, he published HM??MM Factors w At'r Transport Dest'gw, one of the first textbooks on the new
discipline of human factors, which would evolve into the modern field of ergonomics. In 1 9 4 7 , McFarland joined the Harvard School of Public Health as a member of the Department of Industrial Hygiene, where he expanded his research to include highway transportation safety. He also applied his concepts of human factors to the design of automobiles and 18-wheel trucks. Six years later, the Advisory Board for Medical Specialties and the Council on Medical Education and Hospitals of the American Medical Association authorized certification of properly qualified specialists in aviation medicine. McFarland's time had finally arrived. In the 1 9 5 4 - 1 9 5 5 academic year, the School began offering a series of seminars to students enrolled for the master of public health or master of industrial
AstrowgMt G/eww prepared /or f^e ceMtn'/Mge t e s t .
Gradates o/ Mcfar/an^'s prograw were
se/ect;wg awj test/wg t/?e /i'rst seven wen ^nown
as t^e MercMry AstroTMMts.
U.S. polio epidemic strikes 50,000 people, killing
Four-day smog in
John D. Rockefeller, Jr.,
3,300. Jonas Salk begins testing a vaccine using
London leaves 4,703
founds The Population
tissue culture methods developed four years earlier
people dead, three-
Council.
at Harvard.
times the city's usual mortality rate.
health degrees wishing to obtain credit toward certihcation in the field of aviation medicine. "W" N 1 9 5 7 , T H E D A N I E L A N D
Florence Guggenheim J L Foundation gave the School $2.50,000 to establish the HarvardGuggenheim Center for Aviation Health and Safety. (While the Guggenheims are known primarily for their philanthropy in arts and literature, funding aerospace studies was not so out of line for them. In 192.6, the first liquid-fuel rocket was launched by physicist Robert H. Goddard, and five years later, his research was financed by Harry Guggenheim.) McFariand, who was then associate professor of industrial hygiene, was named technical director of the center, and in 1 9 6 2 , he was named the Daniel and Florence Guggenheim Professor of Aerospace Health and Safety. The year after the center was opened, the first U.S.-built commercial jet, the Boeing 707, went into service, marking the beginning of the commercial jet age. By the end of 1 9 5 9 , 63 percent of passengers crossing the Atlantic flew rather than taking an ocean liner. In an article for the P ^ M c H ^ M ? A/M7W7M PzJ/e^M, McFariand wrote that the center would unify the basic research in a growing jet age, while serving as a clearing house for technical information on aviation health and safety. By the time the center was established, 37 flight surgeons from the U.S. military and the Royal Canadian Air Force had already completed advanced training in aerospace
medicine through McFarland's seminars. Almost zoo more of "Ross's boys" would follow before McFarland's retirement in 1972.. "He was very much the gentleman professor," says Clarence Jernigan, M . P . H . ' 6 6 , the only physician sent by N A S A to attend McFarland's course. "He had genuine interest in each of us as individuals," concurs Royce Moser, Jr., M . p . H . ' 6 $ . Moser describes the practice of aerospace medicine he learned from McFariand as finely tuned primary care and preventive medicine with special attention to problems affecting the flier: "You're looking for subtle things. For example, a simple faint in the average person may not be something to worry about. But in a pilot, it's cause for an extensive evaluation. " A flier has several million dollars invested in him, particularly those who fly military aircraft," Moser continues. "You can't afford to miss something that jeopardizes that investment." McFarland's wealth of knowledge on the physiologic limitations of fliers also earned him a role in the burgeoning space race. Following the infamous explosion in 1967 during the launch test of the first manned Apollo flight—the three astronauts on board were killed—McFariand began consulting for N A S A . McFariand "laid the groundwork for understanding altitude physiology, which is important for spacecraft environment control systems," says Jernigan. Upon finishing McFarland's program, Jernigan returned to N A S A with what he had learned about the human physiological parameters of
nitrogen tolerance—nitrogen, when added to oxygen, reduces its flammability—to redesign the launch atmosphere for the post-fire space system. McFarland's investigative hand reached to subjects affecting the entire field of flight. He studied the safety of the passenger cabin environment, including the possibilities for the spread of infectious agents. He was interested in the hazards experienced by crop-dusting flyers. Another area that McFariand was interested in was natural aging, specifically how aging affected the pilot's ability to fly. In the military, an old pilot is in his late forties or early fifties, says Cpt. John Baggett, director of the Special Studies Section of the Air Force. By then, a pilot has usually made rank and isn't flying anymore. Yet in the civilian world, the Federal Aviation Administration has set the flight ceiling at age 60. McFariand was interested in a person's physiological age over his chronological age. "In the case of all productive workers, the important variable to consider is not chronological but rather functional age or the ability to perform required duties efficiently and safely," McFariand wrote in his last paper—an analysis of the employment of older workers. McFariand retired from the faculty of public health in 1972.. He died four years later. Many of Ross's boys have gone on to impressive careers, a couple even making their way into contemporary pop culture. Among them was Charles (Chuck) Berry, M . P . H . ' $ 6 , medical director of N A S A
1953 HSPH Department of Nutrition is featured in the first
J. Howard Mueller, head of the Department of
Nathan Marsh Pusey
broadcast of 77)6 fncf/ess fronf/er, a new NBC radio
Bacteriology, dies. His research helped make possible
succeeds James Bryant
improved immunizing toxoids for diphtheria and
Conant as President of
tetanus.
Harvard University.
program hosted by actor Raymond Massey.
71 ^ ? ^
I
from the time the first astronauts were chosen in the [ate 1 9 5 0 s to 1975s when the U.S. spaceship Apollo docked with the u.s.s.R.'s Soyuz. He also trained Kenneth Cooper, M.p.H.'6i, famous as the father of aerobics.
Royce Mose?; Jr.,
M.P.H.'6j, awj C^MC^ Berry, M.p.H.'j6, Ew;7y McFar/awJ, M.p.H.'j6,at tbe groMwJ-brea^mg cere?7!07!y/brt%7e Ross A. McFar/awJ
MemorM/ Laboratory tbe Department 0/EwMr07!77!e7!ta/ Hea/tb 1992.
What McFarland's former students recall most warmly about their time at the School are the many dinner parties and luncheons that the McFarlands frequently hosted at their home on Mt. Auburn Street in Cambridge. The McFarlands were generous hosts, and Emily brought together the boys in Ross's program with their wide and eclectic circle of friends. In the summertime, Emity, who is a past president of the Cambridge Plant and Garden Club, tended lovingly to her luscious Engtish country garden at McFarland's summer home in Dublin, N e w Hampshire. A grand estate, the house boasts 12. bathrooms, an expansive lawn, and a dreamy view of the take. Walking through the neat rows of ferns during a recent visit (the home is now owned by an acquaintance of Emily's, but she is always welcome), Emity points out her favorite flowers. She directs a visitor to peer inside the windows of a smalt cottage at the edge of the garden. "We used to call this 'Ross's tavern,'" she says. Occasionally, Ross's boys would excuse themselves from the gracious mixed company and sherry in the garden during the couple's annual summer picnic and retreat into the tavern.
Scientists James Watson and Francis Crick describe the double-helical structure of DNA.
The enthusiasm "Ross's boys" displayed for their studies had a great impact on Emily, and she eventually decided to pursue a degree in public health for herself. She says that while Ross was initially reticent about the idea, his students were more encouraging, eventually winning him over. In 1 9 5 6 , Emily graduated with an M . p . H . in Health Education and Community Organization. Emily was an early member of the Foundation for Child Development, which was founded by Eleanor Roosevelt. What has kept Emily's place in the hearts and minds of Ross's boys were her graduation gifts: Emily wrote individual poems for each of them, accompanied by an iltustration of a 19th century hot air balloon. (Emily has had several of her poems published in various publications and
Physiologist Ancel Keys shows the correlation between coronary heart disease and diets high in animal fats.
newspapers.) In 1 9 9 2 , Ross's boys memorialized their mentor by establishing the Ross A. McFarland Memorial Laboratory in the Department of Environmental Health. Emily pauses in her stroll through the garden and crosses her arms. She is a tall woman; in pictures of her and Ross together she is nearly as tall as he. She glances quietly at the flowers, and beyond at the wide body of water. " R o s s gave everything he had to the School," she says. "His research and his work were his life." Terri L. Rutter
HE S U M M E R OF 1 9 5 4
brings the televised spectacle of Senator
Joseph McCarthy's hearings on un-American activities, deepening U.S. concern about communist expansion in Southeast Asia, and the launch of the brilliantly successful nationwide polio immunization campaign. The American Zeitgeist combines patriotic fervor and Cold War anxiety with an almost limitless faith in the ability of government and technology to resolve societal ills. By 1 9 6 7 , U.S. Surgeon General William H. Stewart boldly predicts imminent victory over all infectious diseases. Under Dean John Crayton Snyder, the Harvard School of Public Health rides this wave of public confidence and federal funding to new levels of prominence and success, adding faculty, buildings, and departments. By 1 9 7 0 , the School's enrollment has reached 1 7 0 , more than 10-times the enrollment when the School was founded, and graduates occupy key positions in the Centers for Disease Control, World Health Organization, and in governments worldwide.
Expansion and Gtobatization
Taming the Summer Scourge
1954 Mass testing of polio
Thomas Weller, John F. Enders, and Frederick C. Robbins
James L. Whittenberger, chair of the Department
vaccines begins, using
awarded the Nobel Prize for research that enabled the
of Physiology, develops a "sit-up respirator" for
the "killed virus"
development of the polio vaccine.
emphysema sufferers. The invention is featured in
version developed by Jonas Salk.
Mewstvee/r, 7/Ye, and on C 8 S television.
^
T WAS M A R C H 3 0 , 1 9 4 8 . T o the
! relief of Boston baseball fans, ] Ted Williams was back in the ! Red Sox line-up for an exhibition game. Massachusetts lawmakers were debating a bill that would make it legal to disseminate information about birth control. Around the country, worried Democrats were talking about abandoning the increasingly unpopular president, Harry Truman, and mounting a draft-Eisenhower movement. A gusty, south wind was finally shaking the resolve of a late-spring, Boston cold spell. Thirty-two-yearold Thomas Weller was working in the second-floor lab in the old Carnegie Building. Affiliated with Children's Hospital, the lab had been set up a year earlier by Weller and John F. Enders, a brilliant, unorthodox scientist who had left his job in the bacteriologic department at Harvard Medical School to set up this lab. Because he came from a wealthy family, Enders had been cast by his rivals as being a bit of a dilettante. Weller remembers the lab as having old soapstone sinks and a decidedly grim view of a power plant. The windows had to be kept shut for fear of contamination, but smoke from the power plant would still occasionally seep in. In the summer, the temperatures inside the lab could be sweltering.
Mass po/;'o yaccwafwM, w a J e poss/Me
research at f^e Matiow cowtyMgr owe JreaJ
^efpe^ f^g wost
Yet some exciting events were beginning to happen. Enders and Weller had set up the lab to grow and isolate disease-causing viruses in the same way as a previous generation of scientistsâ&#x20AC;&#x201D;Louis Pasteur and Edward Kochâ&#x20AC;&#x201D;-had launched the bacteriological age of medicine by growing and isolating disease-causing bacteria in nutrient media. Earlier that month, Weller had had some gratifying success in growing mumps virus in tissue culture for the first time. N o w he was working on his pet project, trying to grow varicella, or the chicken pox virus. " I wanted to get embryonic skin and muscle tissue for the varicella work, thinking that if there is skin in the culture, maybe the virus would grow in it," says Weller. Faded memory has obscured why and at whose initiative Weller took the next step. But regardless of vagaries of distributing credit, Weller made medical history by opening the freezer on that March day, removing some mouse brain infected with the Lansing strain of the polio virus, and putting it in tissue culture flasks left over from his varicella experiment. There was no eureka moment, says Weller, just painstaking caution. Some days later, Weller recalls that he "took the fluid, injected it in the brains of some laboratory mice, and starting six days later they became paralyzed. Then you repeat it two or three times before you accept the results that it wasn't a fluke." It was, indeed, no fluke. In a wonderful example of scientific serendipity, Weller and his colleagues had shown for the first time that polio virus could be grown in test tube-like
conditions in tissue that was neither brain nor nerve cells. It was an experiment that would change the fundamental understanding of polio. Previous researchers had only been able to grow the virus in nervous tissue. Since polio resulted in paralysis it seemed as though this was, fundamentally, a nervous system disease. Weller and his colleague's experiment showed otherwise, by definitely demonstrating that polio virus grew in other types of tissue. And soon other experiments would show that polio virus first multiplied in the throat and the lining of the intestine before migrating into the blood and then the nervous system. The successful propagation of polio virus in tissue culture would prove to be the key to the successful development of a polio vaccine. And for the nascent held of virology, this and related experiments by Enders, Weller, and Frederick Robbins would help lay the groundwork for practical, test-tube study of viruses using tissue culture. Weller himself went on to be the first person to grow and isolate a number of other important viruses, including varicella (at last), rubella, and some of the cytomegaloviruses. The work on rubella virus and the cytomegaloviruses, agents that cause fetal damage and cerebral palsy, was recognized in 1963 with the receipt by Weller of the Ledlie Prize, Harvard's highest faculty award that is given every two years to the faculty member who has made the most valuable contribution for the benefit of mankind. Six years later, the significance of that March 1948 experiment was
Dean Simmons suffers a heart attack while on a
Harvard physicians, including Joseph Murray who
U.S. Supreme Court
global tour. He dies several months later on the way
would eventually win the Nobel Prize, perform first
unanimously rules that
home from a family vacation. John Crayton Snyder
successful kidney transplant at Peter Bent Brigham
racial segregation of
is appointed Dean.
Hospital in Boston.
public schools is illegal in landmark civil rights case, Brown v. Board of
heralded around the world when WeHer, Enders, and Robbins went to Stockholm to receive the Nobel Prize for medicine and physiology. For the 3 6-year-old WeHer, the fame of being a Nobel Laureate was both an honor and a burden.
award,' but I obtained it on my own merits." Weller's one-third share of the 1 9 5 4 prize was worth about $12.,000. A father of four children, WeHer told Bosfo?? G/o^e that he would use the money to help pay for his children's education. In truth, he says now, there wasn't all that much left over after he paid for plane fare to Sweden and for clothes appropriate to the ceremony for himself and his wife, Kathleen.
^ ^ ^ ABILITY, Weller seems to ^ ^ ^ ^ have been ideally suited for a distinguished career in science. He was born and raised in Ann Arbor, Michigan, where his father was chairman of the pathology department at the University of Michigan medical school. Weller's first scientific passions were ornithology and parasitology, and he has said the happiest times of his life were the
Nutrition department researchers publish a paper
Dean Snyder and a
USDA survey finds that
recommending revising the USDA's basic food groups
team of HSPH faculty
10percentofU.S.
from seven to fourâ&#x20AC;&#x201D;breads, grains, and cereals;
complete a four-week
families live on nutri-
meat, fish, and poultry; fruits and vegetables; and
trip to the Middle East
tionally poor diets,
dairy products. A year later, the USDA releases its own
to study trachoma.
down from a decade
A remembrance of Weller written by Eli Chernin, a former colleague in the Department of Tropical Public Health, describes Weller as "subdued" the day he answered the call from Sweden. Chernin wrote: "As his TPH (Tropical Public Health) coHeagues gathered aroundâ&#x20AC;&#x201D;none of us had seen a Nobelist before, Weller slumped into a chair and remarked to no one in particular, in his quiet uninHected voice, 'Now, I guess we'll have to show them it wasn't a Hash in the pan.'" Even today, WeHer seems wary of the Nobel Prize being the laurel, and the label, that obscures the rest of his work. In a recent interview, WeHer stressed that his July 1 9 5 4 appointment as Richard Pearson Strong Professor of Tropical Public Health and chair of the Department of Tropical Public Health actually predated the announcement of the Nobel Prize by a few months. "I was very pleased that [my appointment] came through before the Nobel Prize," he said. "Post-Nobel, it might be said that 'he got it because he got the
^ ^ ^
Y CIRCUMSTANCE AND
No/?e/ L<!M?*eatM /0/777 E E n J e r s
Hosp/ta/ /Moratory.
1955
Basic Four.
ago.
summers he spent working at the University of Michigan Biological Station in northern Michigan. But to a young man living in the iater years of the Depression, a career in science looked a whole lot less secure than a career in medicine. A practical, down-to-earth person, Weller says, " I selected Harvard because, as I remember, tuition was $400 a year whereas at Hopkins it was more. I didn't even apply to Hopkins." It was during a medical school summer vacation that Weller had his first taste of tropical public health. As a Rockefeller Foundation fellow, he worked in various malaria control programs in Florida. Malaria was a major public health problem in the 1 9 3 0 s in the South. A b o u t 3 , 9 0 0
people died of malaria in 1 3 southern states in 1934, and U.S. health officials at the time estimated a million people were infected with the mosquitoborne disease. A few years later, while in the Army during World War II, Weller also worked in malaria control overseas. Though he never earned a public health degree, Weller has all the zeal of a convert when it comes to the field. "I became completely convinced that there is a public health ethic that will never be taught properly in medical school," says Weller. " A physician has to take care of the individual patient to the best of his ability and financial resources. But a public health worker has to take care of a sick community." Weller also had the drive and curiosity of a researcher. "I was trained as a pediatrician," he says. "And at
that time, the viruses that cause the common pediatric diseases had not been isolated. It was still a mystery. There was a challenge right at our doorstep that would have tremendous benefit to mankind if it could be solved." The fact that polio was caused by a virus was old news by the time Weller came on the scene. Viruses, in general, had been first characterized as transmissible, disease-causing agents back in the 1890s. Karl Landsteiner, an Austrian researcher, is credited with first identifying the polio virus in 1908. But the scientific understanding of viruses was full of gaps. Even though many diseases, such as chicken pox, were considered viral, the causative viruses had not been isolated. In the case of polio, this patchy comprehension led to all kinds of theories about how the disease was spread. For example, Milton Rosenau, who was to become the School's first professor of preventive medicine and epidemiology, proposed in 1912. that polio was spread by the house fly. Decades later, Lloyd Aycock, an associate professor under Rosenau, flirted with the idea that polio was a milkborne disease. These debates and misconceptions were fed by the relatively primitive methods for growing and maintaining viruses. Whereas bacteria will grow easily in warm, nutrition-laden gels and fluids, viruses need living tissue to grow and reproduce. For researchers working in the early part of this century, that meant first identifying the best source of virus from a patient, collecting the virus from an
1956 A rain-collecting device on the roof of Harvard's
Professor James L. Whittenberger and Assistant
Gordon McKay Laboratory is used to measure radio-
Professor Benjamin G. Ferris, Jr., travel to Argentina as
active fallout from an atomic cloud over Boston.
physiology consultants during a three-month polio
Analysis by faculty in the School's Department of
epidemic.
Industrial Hygiene shows that the "small additional exposure to radiation" from atomic weapons testing programs "does not constitute a health hazard."
infected person, inoculating an animal with it, and then keeping it alive by transferring, or "passing," it from animal to animal. Using live animals, particularly monkeys, to study and produce viruses was expensive to the point of being impractical. Says Weller, "With polio there were certain strains that had been adapted to grow in mice. But the great majority of strains would only go into monkeys. A rhesus monkey cost around $30. And to titrate a specimen of polio virus, you might need 80 monkeys. So that became unrealistic." Just getting enough virus to isolate and study was also critical. In addition, before vaccines could be developed against many viral diseases, researchers had to figure out how to mass produce virus so it could be rendered into a formâ&#x20AC;&#x201D;either dead or weakenedâ&#x20AC;&#x201D;that wouldn't cause illness but would still be close enough to the real thing to spur a lasting immunological response. ^ ^ ^
TARTING IN THE LATE 1 9 2 0 S ,
^ ^ ^ ^ scientists experimented with ^ ^ ^ "tissue culture," which consisted of living tissue floating in a nutrient-rich fluid. Scientists had their own recipes for this fluid. Horse sera was one key ingredient in Welter's brew. "We had a good rapport with the state lab [in Jamaica Plain]," he explains. "They had a stable of horses that they were immunizing to make tetanus and diphtheria antitoxin. They had one horse that had good cellgrowing sera so that was sort of set aside for our use."
I
Choice of tissue varied, but human fetal tissue was often used because embryonic tissue grows easier and faster than mature cells. The fact that Weller and other tissue-culture researchers were using tissues from spontaneous miscarriages or abortions—the term used then was "interruptions"—was a sensitive, potentially explosive, subject. Even now, Weller is circumspect about discussing the matter, but he notes that neither he nor his colleagues hid anything when they wrote up their findings: "Read the article. The facts are all there." Indeed, the January 2.8, 1949, article in describing the research that won the Nobel Prize states plainly that "tissue from embryos of 1 . 5 to 4.5 months as well as from a premature infant of 7 months gestation were used." Later in 1949 Weller published a paper indicating that polio viruses also would grow in foreskin tissue cells culled from routine circumcisions. And a few years later, the virus produced for the first large-scale testing of the polio vaccine in 1 9 3 4 was grown in cultures of cells from monkey kidneys. But getting a tissue culture to work wasn't just a matter of finding the right ingredients. It was also figuring out how best to " c o o k " the recipe. Here, too, Weller was an innovator. The common practice in virology labs was to remove the bits of infected tissue every couple of days and and transfer them to new cultures. But knowing that he was working with a slow-growing virus, Weller maintained the virus-infected tissue and instead changed the nutrient-rich
fluid in which it was growing. All of this was done using the simplest of lab equipment—tiny 2.5-milliliter glass flasks. Later Weller and others got good results using "roller tubes," which involved putting the cultures horizontally into a large, slowly rotating wheel. HHHHHj
HE GUIDING HAND OF
FORTUNE was working in two remarkable ways on H March 30, 1948, when Weller removed a bit of polio-infected mouse brain from the freezer to start the history-making experiment. First, because Weller was focused on chicken pox, which seemed to flourish best in skin tissue, the available tissue cultures were of non-nervous tissue. Second, the kind of polio virus that grew in mice, the so-called Lansing strain, did not have a strict affinity for nervous tissue. Twelve years earlier, Albert Sabin and a colleague had successfully grown polio virus in tissue cultures, but the strain at their disposal would only grow in nervous tissue. Welter's description of the Nobel Prize-experiment is muted by personal modesty and plain-spoken matter-of-factness. But the fact is that the significance of growing polio virus in non-nervous tissue culture was not immediately apparent to many. The article in 3c;'s7!<re was only two pages long, had six references, and was sandwiched in between two long-forgotten articles. "It was a short, preliminary report," says Weller. In his definitive history of polio research, Yale professor John Paul described how he was not impressed when he
heard about the experiment while visiting John Enders at his summer house in Waterford, Connecticut. "I was stupidly unaware of the implications that this finding held," Paul wrote in A HVsfory "At least, it did not appear to me as an electrifying piece of news." Weller says Enders deserves credit for recognizing that the results were, in fact, a very big deal: " I think Dr. Enders saw the significance sooner than we did." Part of the reason for the delayed recognition of the importance of the tissue culture experiment was that
1957 Martha May Eliot
The Daniel and Florence Guggenhiem Foundation
succeeds Harold Coe
gives a $250,000 grant to establish the Harvard-
Stuart as chair of the
Guggenheim Center for Aviation Health and Safety
Department of Mater-
at the School.
nal and Child Health.
The standard virology textbook by Rhodes and Van Rooyen calls the demonstration of cytopathic changes in cell culture the "most striking aspect" of WeHer and his colleagues experiments. John Paul, who depended on Weller for much of his account of the tissue culture experiments, makes much the same point. He wrote that the demonstration of "specific injury that could be readily recognized under the high power of the light microscope" made possible "quantitative determinations as to how much polio virus existed in a given culture; to a way in which neutralization tests could be performed in vitro, and to countless other advances." Paul continued, "And, wonderful to say, came the realization that at long last monkeys, which had been so essential in the poliomyelitis laboratory, could be replaced by tissue cultures..."
Weller, meanwhile, went on to become a tissue culture researcher and a virus and parasite hunter par excellence. For 2.3 years, he had one, continuous grant from the National Institutes of Health simply titled, "The Use of Tissue Culture to Study Human Pathogens." But even as Weller was making history by finding the breakthrough recipe for culturing the polio virus, the held was changing. Instead of scrounging for vintage horse sera and embryonic tissue, researchers were starting to use cancer cells that, due to their genetic malfunctions could, theoretically, grow forever. N o w various genetic engineering techniques, including polymerase chain reaction (PCR), are used to track down and identify viruses. Contemporary researchers have foresaken the techniques for home-brewing tissue culture media mastered by WeHer and the scientists of his day.
the full signihcance woutd only emerge with another batch of experiments. Yes, it was signihciant that polio virus could be grown in non-nervous tissue. But in subsequent work, WeHer, Enders, and Robbins would also show that polio virus growing in cells resulted in countable, microscopically visible "cytopathic" changes in infected tissue.
"The real importance of tissue culture is that you always have a source of the infectious agents," notes Sam Telford m , a parasitologist at the School. "Instead of having to wait for a person to become infected, you just go to your incubator, pull out a tube, and voila! you have what you need." Weller said the possibility of developing a polio vaccine was discussed by people in Enders' lab, but it was decided that "it wasn't our kettle of hsh." Jonas Salk and Albert Sabin would go on to have a bitter, lifelong rivalry over who deserved credit for successfully developing the best vaccine, but there is no doubt that the tissue culture experiments performed by WeHer and his colleagues laid the groundwork for the vaccine.
Professor Hugh R.
In an article in the Ma/vard PuM/'c Hea/f/? /)/umn/
Congress establishes
Leavell returns from a
8u//ef/n, Jerome Peterson, M.P.H.'39, identifies 26
the National Cancer
one-year sabbatical in
HSPH alumni working with the World Health
Institute.
India during which he
Organization.
severa/ ^OMsawcf peop/g cowfrac^eJ po/?'o /row; /wproper/y prepared f a c c w e MO^ s^op f^e pM^^ /or
served as a consultant on health to the Ford Foundation.
"We made our own medium and everything," says WeHer, with just a hint of nostalgia. " N o w people buy the cell culture, they buy the media, they buy the works. Nobody spends time washing glassware and starting cultures." Peter Wehrwein
:
Potio In Wallace Stegner's novel Cross/ng fo ^a/e^y, a young woman contracts polio during a weekend camping trip. The narrator describes finding her "on her back, her parted lips enameled with fever, her breath coming hoarsely through her mouth. She heard me, and her eyes opened, but after the first wincing look they closed. I was not sure she recognized me; and when I put my hand on her forehead to feel how hot she was, she rolled her head away and cried out with pain." Throughout the 1920s, 1930s, and 1940s, the nation experienced nearly annual polio epidemics, affecting tens, perhaps hundreds, of thousands of people and leaving some 10,000 victims paralyzed. By 1962, however, after vaccines became widely available, the annual caseload dropped to 465, and over the next few years, the United States averaged a mere 40 to 50 cases a year. Today, with the exception of the rare vaccine-related case, polio has all but been eradicated from the developed world; although it remains a problem in the developing world. Poliovirus belongs to the enterovirus family, which includes Coxsackie, meningitis, and hepatitis A. Enteroviruses infect the intestinal tract. The most common form of polio, called abortive poliomyelitis, resembles, and is no more worrisome than, a common cold. A small percentage of cases of abortive polio are accompanied by stiffness and even a moderate, temporary paralysis. In paralytic polio, the most serious form of the disease, the virus causes lesions along the central nervous system that cause paralysis of the large muscles of the legs and, less frequently, the arms. Muscles of the respiratory system can
also be affected, making breathing impossible. Respirators can sustain breathing in these otherwise terminal cases; sometimes until the muscles heal themselves and other times, permanently. In a particularly serious manifestation of the paralytic form called bulbar polio, the cranial nerves, which control the action of the pharynx and the vocal cords, are affected. In these cases, the paralyzed throat muscles restrict patients' ability to swallow or clear secretions from their mouths, resulting in drowning or asphyxia. It took a while following the introduction of the iron lung for physicians to realize that it was useless in treating cases of bulbar polio. Severity of paralysis varies considerably from case to case. Infants and young children suffer more serious polio manifestations while older children tend to be less severely affected. Adults, such as Franklin Delano Roosevelt, who was stricken in 1921 at the age of 39, are severely affected, often resulting in paralysis or death. During the 1940s, children and fearful parents called polio the "summertime scourge." Swimming holes, pools, and ponds, were closed during polio epidemics, as water was popularly believed to be a route of transmission. Contaminated milk was also implicatedâ&#x20AC;&#x201D;a theory most strongly supported by the epidemiologist W. Lloyd Aycock, who before coming to the School's Department of Preventive Medicine and Hygiene was director of the Poliomyelitis Research Laboratory of the Vermont State Board of Health. The earliest suspected description of a case of polio, according to John Paul's in M/'sfory of Po//o, is etched on a stone slab from the Egyptian Eighteenth Dynasty (1580-1350 B.C.). It depicts
a man, most likely a priest, with one normal leg and "a withered and shortened left leg, with his foot held in the typical equines position characteristic of flaccid paralysis." According to Paul, cases of what were most likely polio, or "infant paralysis" as it was also called, appear in medical records from the early eighteenth century. What seems to be the first large-scale polio epidemic occurred in 1894 in Rutland, Vermont, a small town 125 miles north of Boston. Dr. Charles S. Caverly, the state's public health officer, reported 132 cases. According to Paul, it was the largest number of cases of polio ever reported at one time anywhere in the world. But it was the 1916 epidemic, which touched 28 out of every 100,000 inhabitants of the northeastern United States, that marked polio's emergence as one of the most feared and destructive infectious diseases. Over the next half century, the nation would experience nearly annual full-scale assaults. Polio virus is transmitted through the oralfecal route, which opens a panoply of possibilities for infection: handshaking, sharing tableware, biting one's nails, food contamination, or any other means where hands come close to the mouth. Ironically, improved sanitation due to public health measures may have inadvertently fostered polio's rise. One commonly held theory is that before the turn of the century improvements in sanitation, infants were regularly exposed to polio virus and developed lifelong immunity. (Aycock believed that infants and children were infected several times throughout their early years, and this repeated infection created antigenicity.) Knowledge of how to treat the paralytic polio patient came about slowly; for the patients,
1958 Brian MacMahon,
Tropical disease researcher Eli Chernin discovers that
A $500,000 grant from The Rockefeller Foundation
S.M.H/53, succeeds
streptomycin inhibits growth and reproduction of
funds a Division of Environmental Hygiene at the
John Gordon as chair
snails that carry the tropical disease schistosomiasis.
of the Department of Epidemiology.
School to study problems associated with "peacetime uses of nuclear energy."
Today, thanks to successful vaccination programs, polio's former power to inspire fear has been greatly diminished. In 1988, the World Health Organization resolved to accomplish global potio eradication, and since then, rates of wild-type virus have declined international^ by 82 percent, aided by massive efforts like the one in China in which 83 million children were vaccinated in a single day, and in India, where 88 million children received vaccinations. To date, 145 coun-tries in the world are polio-free, according to the WHO.
recovery was often titled with pain, fear, and humiliation. Legs were covered in plaster casts, or tightly strapped into braces, making them rigid enough to support weight. Pervasive in treatment strategies throughout the 1930s and 1940s was the idea that the patient had to will him or herself to get well. In Stegner's novel, the polio patient recounts trying to walk again: "Some parts of the therapy were alt right, but some were so rough and callous they almost killed me. They'd put you on a treadmill, for instance, with rails to hold on to, and you were supposed to try to walk. There was a nurse behind you with a hand on your belt, but she never kept you from falling. They were careless, they didn't hang on tight.Weal) felt. I found out later they did that on purpose, to harden your wilt. Unless you'd grit your teeth and take any amount of punishment and failure and still go on trying, they knew you'd never improve." Roosevelt was a major force behind the establishment of the Nationat Foundation on Infantile Paralysis in 1937, an organization dedicated to advocacy for polio victims. Roosevelt's law partner from his pre-political days, Basil O'Connor, used his connections with leaders in business and politics to lead the organization into national prominence. It
conducted training programs and produced brochures for physicians and nurses about the intricacies of making a poliomyelitis diagnosis and the use of the iron lung. In 1938, Roosevelt launched a nationwide fund-raising campaign by calting on Americans to donate their dimes to fund these training centers. Comedian Eddie Cantor called Roosevelt's appeal the "March of Dimes"; in 1979, the Foundation officially adopted the moniker.
Yet despite this success, polio has not been erased from the public health lexicon. In parts of the Indian subcontinent and in Central and Western Africa, polio continues to be a significant health problem. Even the United States, despite the early and wide acceptance of vaccination, has not been entirelyspared. In1971,22 unvaccinated people in Texas contracted paratytic polio. In Holland, a religious community that eschews vaccination suffers periodic epidemics; one in 1978 affected 110 people, 79 of whom were left paralyzed.
1959 Thomas 0. Nevison, Jr.,
Associate Professor Elizabeth Prince Rice completes
Cuban revolutionary
Alaska and Hawaii
class of 1959, is medi-
three-month, around-the-world tour of health and
Fidel Castro ousts
become the 49th and
cal officer on an expe-
welfare programs in Asia and the Middle East.
Fulgencio Batista.
50th U.S. states.
dition to the summit of Hidden Peak, second highest of Kashmir's Karakorum Range.
John Crayton
Dean ^ ^
^
1954-1971 S A YOUNG MAN,
Snyder
John Crayton Snyder wanted
Snyder was extremely kind and considerate at a time when
to be a surgeon just like his father. But a talent
the prevailing American attitude toward Chinese—
for research, a bout of scarlet fever, and a great
especially during the Korean War—was cool, if not hostile.
^ ^ scientist's deathbed plea to Snyder all worked
"He was always trying to be very protective of me and
to change the would-be surgeon's plans. Instead of perform-
my wife," said Chang, who remembers Snyder personally
ing operations, Snyder wound up presiding as dean of the
intervening to help him and his wife with various passport
School of Public Health for 1 7 years, leaving behind a legacy
and immigration issues. Associate Professor Grace Wyshak,
of new facilities, academic centers, faculty expansion, and
s.M.H.'^6,
overall educational excellence that imprinted the School with
"gentleman." "You had the feeling," she says, "that he
much of its present-day character and personality.
was upright, civil."
Friends and former colleagues invariably use the
says Snyder always struck her as being a
Snyder was born in 1 9 1 0 in Salt Lake City, but,
words "formal" and "proper" in describing Snyder. Then
surprising for those times and that place, he did not grow
a junior faculty member who viewed Snyder mainly from
up in a Mormon—or even particularly religious—house-
a distance, Professor John Little, in the Department of
hold. His grandfather had disavowed Mormonism after
Cancer Biology, remembers Snyder as someone who com-
defying Brigham Young's orders to undertake a third, year-
manded respect and "had dignity and a certain stern
long mission away from his family. His father, Crayton
countenance." Alexander Leighton, brought to the School
Snyder, became a successful surgeon. Snyder still remem-
by Snyder to head up a newly created behavioral sciences
bers his father's response when a patient scolded him for
department in the 1960s, describes him as a "very clear
being on rounds Sunday morning instead of at church:
thinker" and "very devoted" to the School. Robert Chang,
"I am in my church, all the time, wherever I am."
a retired professor of medical microbiology at the Univer-
The family moved to Pasadena, California, when
sity of California at Davis, came to the School in 1 9 5 0 as
Snyder was a boy, because Salt Lake City's high altitude was
one of Snyder's first graduate students and stayed to work
unhealthy for his brother who developed congestive heart
under him for the next 18 years. As a scientist, says Chang,
failure due to rheumatic fever. Crayton Snyder was a busy
Snyder was careful and conservative. As a mentor, he adds,
surgeon by his son's account, beloved by patients and
1960 Henry Lee Shattuck International House opens as a residence for foreign students.
William M. Schmidt succeeds Martha May Eliot as chair of the Department of Maternal and Child Health.
fp/dem/'o/og/'c Mef/?<x&, a textbook that ushers in the era of chronic disease epidemiology, is published. Brian MacMahon and two faculty members, Johannes Ipsen, and Thomas F. Pugh are co-authors.
Snyder remembers working for him as an emotionally
studious about keeping up-to-date with the latest research and techniques. They were the kind of paternal footsteps
draining experienceâ&#x20AC;&#x201D;any mix-up or dead-end loomed
that attract willing followers. Says Snyder, " A t an early age,
twice as large with Zinsser's death just around the corner.
I decided I was going to be a surgeon."
Snyder recalls the promise that Zinsser extracted from him in late August 1940, before he left for Hamilton, Montana,
That was still the plan after Snyder graduated from Harvard Medical School in 1 9 3 5 , but then, somewhat
to work at a Public Health Service lab there. Zinsser
gradually, his career started to take a different path. While
clasped Snyder on the shoulder and made him promise to
an intern on the surgical service at the Massachusetts
continue to work on the disease until "typhus is licked."
General Hospital, Snyder contracted scarlet fever and was
Zinsser died on September 2., 1 9 4 0 .
quarantined for six weeks in Boston City Hospital. Caused by bacteria, scarlet fever causes nausea and vomiting, as
HOUGH IT WOULD TAKE t h e d e v e l o p m e n t of
well as the reddish rash that gives the disease its name.
broad-spectrum antibiotics after World War II
Largely controlled now by antibiotics, it was a significant
to "lick" typhus, the work Snyder and others did
health threat through-out the 1940s, killing from 4,000 to
during the war sharply contained a disease that
6,000 Americans each year. Snyder went home to California
in previous wars had raged with epidemic ferocity. Snyder
to complete his recovery, and when he returned to Boston
served with The Rockefeller Foundation in Spain and with
and the Massachusetts General Hospital, it was as a research fellow. Snyder said it was during his stint at Mass General that the idea of a career in research, rather than surgery, took hold. His knack for it was evident. Snyder successfully developed and designed a hrst-of-its-kind machine for measuring the cardiac output of unconscious patients and published his work in an article in the /oMHM/ o^
^ ^ ^
HORTLY THEREAFTER,
Snyder
was
recruited
by
the
famed bacteriologist Hans Zinsser to join the ^ ^ ^
International Health Division of The Rockefeller Foundation, where he assisted Zinsser in his
research on louse-borne typhus, a disease of special concern during wartime (see sidebar page 84). Zinsser, who taught courses at both Harvard Medical School and the School of Public Health, was a charismatic, inspiring professor. Years later, former students would describe his lectures as the most brilliant they had ever heard. Zinsser was also a first-class researcher, who had done ground-breaking work on syphilis, rheumatic fever, and tuberculin reactions. Unfortunately by the time Snyder joined him, Zinsser
^egaw
pM^f/c AeaM? career zM^es^'ga^mg
was also a dying man, slowly succumbing to leukemia.
Construction begins on nutrition laboratories (now Building II). School's endowment has grown to $8.7 million.
[
John F. Kennedy elected president of the United
I
States.
Indonesia launches 10-year, WHO-sponsored malaria eradication campaign.
^acfer/a/
Typhus Typhus has stalked people through some of the darkest chapters of history, particularly in Europe. It raged during theThirty Years War. It plagued Napoleon's catastrophic 1812 invasion of Russia. During World War I, typhus swept through Russia and Eastern Europe, infecting 30 million people and killing one of every ten it infected. And during World War II, typhus struck heavily in the Nazi concentration camps.
bacterium called R/'c^eHs/'aproi/i/azeAvV. Lice become infected with R/'dreHs/'aprowaze/r/Vwhen they feed on an infected person and die after 10 to 14 days. But before they die, they feed at least three times a day and spread the bacteria to others through their feces. Because louse bites itch, the bacteria-laden feces usually enter the bodies of unsuspecting typhus victims when they scratch the bites.
Now typhus ranks as one of the world's lesser health threats because, under the right conditions, it can be successfully controlled by delousing methods and treated with broadspectrum antibiotics. But before the post-World War II boom in antibiotic development, curbing typhus was one of the great, ongoing dramas of health research and action. Some of the key figures in that drama were affiliated with HSPH, notably Richard Pearson Strong, George Shattuck, A. Watson Sellards, Hans Zinsser, and John C. Snyder.
Hippocrates used the word typhus, which in Greek means smoky or hazy, to describe the confused state of mind associated with a fever, and for centuries, two distinct diseases, typhus and typhoid fever (caused by ia/mone//a fyp/?/) were lumped together. The fever, headache, and muscle pain associated with typhus are not unusual and could be associated with any number of fever-inducing diseases. Typhus bacteria infect endothelial cells, but beyond that, they are not very discriminating, so several organs, including the brain and the heart, may be damaged. The result is a scrambled set of symptoms ranging from renal failure to myocarditis. Left untreated, typhus is a vicious disease with a case-mortality rate of up to 70 percent.
A relatively mild form of typhus lives in rats and is spread by fleas, but the more dangerous form of the disease—and the variety that wreaks such havoc in times of war and hardship—is spread by lice. Called either epidemic or louse-borne typhus (other names include classic typhus, jail fever, and tarbardillo), the infectious agent of this form of typhus is a
tend to be more common in times of war or famine. That was exactly the situation in Serbia in 1915 when Strong, Shattuck, Sellards and Zinsser were sent there by The Rockefeller Foundation as members of the American Red Cross Sanitary Commission. All three scientists were members of what was to become the School's Department of Tropical Medicine, while Zinsser was later to teach bacteriology and immunology at the School. According to Strong's account of the trip in Typ/ws few/* tv;'f/; Par&'cu/ar Reference fo fhe Serb/an fp;'dem;'c, a typhus epidemic started among Austrian soldiers held prisoner by the Serbians and then spread to the civilian population, many of them refugees. About 150,000 people died in the epidemic, and, at its height, as many as 9,000 were falling ill each day. Shattuck, Sellards, and Zinsser set up a make-shift lab in a Serbian hospital to examine tissue and blood samples from dead
Behind the predilection typhus has for human misery and strife is the fact that the conditions that typhus-transmitting lice enjoy—crowded, unclean, with few chances for people to wash themselves or their clothes—
the U.S. Typhus Commission in Egypt, Italy, and Germany.
During the war, Snyder helped design the studies
It was while working in Egypt that Snyder Hgured out
that proved the effectiveness of Herald Cox's anti-typhus
that one effective way to control lice was to dust the seams
vaccine, and, while at the School, he was involved in the
of clothing with talcum powder laced with DDT. Toxicity
research that proved people harbor the typhus bacteria long
tests were conducted to make sure the powder was safe.
after they recover from the disease. It was working on
DDT was a critical piece in typhus control efforts and
typhus that fully converted Snyder, the former would-be
worked especially well in limiting an outbreak in Naples
surgeon, to the public health viewpoint. He realized that
in 1 2 4 3 - 1 9 4 4 . "It was improper use, primarily in agricul-
while one doctor and potent drugs might cure a typhus
ture, that gave DDT—rightly so—its bad name," Snyder
patient one person at a time, it made more sense to have
notes. It was also discovered later that lice develop resistance
three or four public health workers prevent the epidemics
to the insecticide.
1961 Industrial hygiene Chair Philip Drinker, biostatistics
James L. Goddard,
Chair Hugo Muench, and tropical public health
M.P.H/55,appointed
Bernard Lown and
Professor Donald Augustine retire from the faculty.
head of the CDC, the
graduate H. Jack Geiger,
first of five successive
found Physicians for
alumni who will head
Social responsibility
the agency.
Faculty member
and living typhus victims. Strong, meanwhile, mounted what was in effect a mass debusing campaign that was a logistical masterpiece; an observer described the Strong-led efforts as "miraculous." It was understood that the lice that spread typhus could be killed by high heat, so Strong hastily organized delousing centers in "factories, ware-houses and breweries, and wherever facilities for obtaining steam were available." He converted railroad cars into mobile "sanitary trains." Clothes were hung in an air-tight refrigerator car for steaming. Meanwhile, in another railcar, people showered and were sprayed with kerosene ("an additional precaution for killing the vermin," wrote Strong) before putting back on their disinfested clothes. The Serbian epidemic slackened off during the summer, a pattern common to typhus outbreaks since warmer weather eases overcrowded living conditions. But Strong's efforts were credited with keeping typhus from coming back in epidemic proportions. After the war, Zinsser continued to do research on and write about typhus. In 1934, he correctly hypothesized that Brill's disease was, in fact, not a separate disease but a form of typhus that reemerged in people who had had typhus years before. Zinsser's 1935 book /?afi,
A/'ce and M'sfory is a parody—albeit a serious one—of heroic biographies with "the life history of typhus fever" as its subject. Before he died, Zinsser urged Snyder to keep doing research on the louse-borne disease. Given the experience with typhus during World War I and during European wars in general—it made sense that military officials would make typhus prevention a priority during World War II. All Allied troops were given the typhus vaccine developed in 1937 by Herald Cox. And in 1942, President Roosevelt appointed a special commission to control and research typhus. Snyder worked for that commission throughout much of the war. His research helped establish that DDT was an effective delousing chemical. Dusting clothes with a DDT-laced powder became the standard way for staving off typhus outbreaks during the war (the problem of DDT-resistant lice emerged several years later). In 1945, Snyder spent 54 harrowing days with the U.S. forces liberating the Nazi concentration camps. Snyder was in charge of making sure the advancing troops were properly trained and equipped to detouse the camp prisoners. Given the ripe conditions for typhus in the camps, it was often a scramble with lifeand-death consequences. Snyder was among those who liberated Dachau. His valiant efforts
before they occurred. "The patient becomes the community, the state, or the nation," he says.
(which included an all-night trip to Paris) to get anti-typhus supplies and medical personnel to Dachau helped curb the typhus epidemic there. Typhus outbreaks also occurred in civilian populations in North Africa, Yugoslavia and Italy during World War II. But among the Allied troops, anti-typhus efforts were a remarkable success. There were no deaths from typhus among U.S. military personnel and all told, only 104 cases during the entire war. Since 1950, and the discovery of tetracycline and other broad-spectrum antibiotics, typhus has receded somewhat as a major health threat, particularly in the developed world. But it has far from disappeared. Andean countries, particularly Bolivia, and the Himalayan regions of Asia continue to be plagued by typhus. And in Ethiopia, a country that has contended with famine and civil war for years, typhus has again demonstrated its taste for human misery, afflicting thousands of people, especially in refugee camps. PW
Well, Snyder thought, "if I put myself to sleep, think what I might do to students!" He decided his lectures would have to be a little less "encyclopedic."
^ ^
FTER THE WAR, in 1 9 4 6 , Snyder was appointed
latest information on infectious diseases and bacteriology.
Health Bacteriology. As a teacher, he prepared
Because of the risk of infection, laboratory work was
^ ^ meticulously, writing out his lectures in long-
*.
Snyder tailored his course to give physicians the
to head the School's new Department of Public
notoriously dangerous, and one of the issues Snyder stressed
hand and then practicing his delivery into a dictaphone.
was lab safety. (Snyder had contracted typhus during a
One night, he recalls, he fell asleep while listening to the
laboratory experiment in Spain, an experience that he hoped
recording. One of his children came in and woke him up
no one else would have.) Photographs of Snyder lecturing
saying, "Daddy, daddy, wake up. Your speech is over."
show him dressed in a surgical-type gown. Snyder says he
1962 First manned
Dedication of the Nutrition Building (now Building II)
spaceflights by Russian
and Building I. The latter, only four stories high, will
and U.5. astronauts.
grow to its current 14 stories over the next decade.
was trying to set a very visible, good example for his
students were about 30 to 40 percent of the class, distin-
students. Improving the School's labs so they were safer to
guished people in their own right, and they were forced to
work in was one of Snyder's pet projects, and he says he
find housing in miserable places," Snyder told Robin Henig,
was constantly pressing university officials for changes.
author of T^e Peop/e's PfMM?.- A Me77!Oz?* o/^PMM;'c He^M?
Occasionally, he would win small victories, such as getting
H<37*ZA3?-J, a recently published history of the School.
hard-to-clean wood tabletops in laboratories replaced with easy-to-sterilize stainless steel. Snyder was named dean in October 1 9 5 4 , a few months after the sudden death of Dean James Stevens Simmons. It was a heady era when American faith in health
that endowing profes-
^ ^ ^
NYDER DECIDED INITIALLY
^^^
sorships would be among his top priorities. When
^^^
he pitched the idea at a faculty meeting early in his deanship, however, the response he remembers
and medical scienceâ&#x20AC;&#x201D;and science more generallyâ&#x20AC;&#x201D;was
was: "Where are we all going to work?" Facilities as well
sky-high. The country was euphoric about the successful
as professorships would have to be a top priority, Snyder
completion of a large-scale trial of the Salk polio vaccine
decided. At that time, the School was housed in two
that summer, and the School was basking in the reflected
converted hospital buildings: the former Infants' Hospital
glory of Professor Thomas Welter's shared Nobel Prize for
at 5 5 Shattuck Street, which is now part of Children's
research that made the vaccine possible. But financially, the
Hospital, and the old, brick Huntington Hospital facing
School was on shaky ground. Because of a 10-year
the avenue of the same name, which was demolished to
Rockefeller Foundation grant, Dean Simmons had managed
make room for the School's new buildings. During his
to expand the School, adding new departments and hiring
17-year term as dean, Snyder would not only oversee a
new professors. But the grant was running out. Only nine
quadrupling of the School's endowment, but also a building
professors had tenure and only one professorship was
program unmatched in the School's history. In physical
endowed. Student housing was also a problem. "Foreign
terms, most of what is now thought of as the School of
tA!
Prow j<?6o fo J 9 7 1 , .Swy^er
otw a
^M/Mwg
1962 Nobel Laureate Thomas Weller, chair of the Department of Tropical Public Health, and colleague Frank Neva isolate the rubella virus.
In separate studies, Weller discovers that mental retardation and cerebral palsy are common consequences of prenatal infection with cytomegalovirus.
HSPH tuition has nearly doubled in the last decade, reaching $1,400 a year. Enrollment hovers between 100 and 120 students.
Public Healthâ&#x20AC;&#x201D;Buildings I and II, the Kresge Building,
of chronic diseases that was beginning to take root was
and Shattuck Houseâ&#x20AC;&#x201D;is a legacy from Snyder's deanship.
gathering momentum, but controlling and preventing
Still, fund-raising was not his forte. Snyder almost
infectious diseases still remained the pivotal mission of
reHexively pushes the credit on to coHeagues such as
much of public health. Building on his work in typhus and
Fredrick ). Stare and WeHer. Synder rose to the occasion,
picking up a project initiated by Dean Simmons, Snyder
however, when money was needed to complete the Health
was a key figure in the joint Harvard-Aramco Trachoma
Sciences buildings. In his interview with Henig, Snyder
Research Program to control trachoma in the Middle East
described his personal, whirlwind tour of corporate
and elsewhere. Trachoma, a bacterial disease spread by
America during the summer of 1966 after King Faisal of
Hies as well as by contaminated hands and towels, is the
Saudi Arabia had premised his gift on how much money
main cause of blindness in the hot, sandy regions of Africa
the School could raise "from the great American industries
and Asia. Working with WeHer and Professor Roger Nichols,
currently working in Saudi Arabia."
Snyder also established the Center for the Prevention of
Regardless of how credit is distributed, the achieve-
Infectious Diseases near the end of his deanship, in 1970.
ments during Snyder's deanship are extraordinary: the School's physical plant was transformed from provisional, antiquated former hospitals to three modern buildings; the faculty doubled in size; and the number of tenured faculty grew from 9 to
Endowed professorships grew from
only one to a dozen. During much of Snyder's deanship, WeHer was the
^ ^ ^
UT SNYDER WAS NOT AFRAID to break new intel-
lectual ground. In 1962, he created the Department ^ ^ ^ of Behavioral Sciences (which evolved into the ^ ^ ^ ^ current Department of Health and Social Behavior). That same year, he founded the Department of Demography and Human Ecology (now the Department of Population
academic anchor of the School, and Snyder describes
and International Health) and a year later, the university-
WeHer as being his "trusted adviser." The shift to the study
wide Center for Population Studies (now the Harvard
The Department of Demography and Human Ecology,
The Kresge Center for Environmental Health is formed
later renamed the Department of Population Sciences,
under the direction of Professor James Whittenberger
established under the temporary direction of Dean
to unify and advance the school'swork in environ-
Snyder.
mental health.
Center for Population and Development Studies). The
While he, like many other Americans, came to believe that
latter was, in many ways, Snyder's crowning achievement:
the Vietnam War was a terrible mistake, he did not have
it gave the study of the inter-relationships between demog-
any sympathy for the "storm-the-gates" tactics of some of
raphy and health a permanent, high-profile academic
the student protesters. He was offended by the "don't-
home. Though the thinking about population has changed
trust-anyone-over-30" attitude and the rampant "establish-
since the founding of the center over 30 years ago, Snyder's
ment" bashing. And Snyder still speaks with emotion about
vision of an institution that will "draw upon the resources
the Harvard student strike in 1969 during which some
of the university as a whole" and "search for answers to
protesters took over University Hall in Harvard Yard.
the very complex population questions facing our scientists
"Anyone who tried so hard to get buildings for students
and political leaders" has been fulfilled.
to study in and then finds that they want to trash them—
Snyder was motivated to found the center partly by
that is an offense to my memory," says Snyder, while
a sense of ethics. He had come to believe that public health
noting that some of the demonstrators were not students.
researchers and officials had a responsibility to address
After the protests he took his first and only sabbatical,
explosive population growth because successful disease
and in June 1 9 7 1 , Snyder resigned to return to academic
prevention and vaccination programs were in part respon-
activities, ending a deanship that spanned over one-fifth
sible for falling mortality rates. In a lecture at Riverside
of the School's history.
Church in New York City in 1 9 5 9 , Snyder asked, "should
Snyder stayed active, serving as the medical director
the profession of public health concern itself with rapidly
of the Center for Population Studies and holding a profes-
increasing populations, particularly in those areas where
sorship in population and public health. Working with
health measures are being introduced with such profound
Hilton Salhanick, Frederick Lee Hisaw Professor of
effects? M y answer is yes."
Reproductive Physiology, Snyder designed field trials of a drug that reduced the important pregnancy hormone,
^ ^
^
s DEAN, Snyder enjoyed a good rapport with
progesterone, that he and Salhanick had hoped would make
students, hosting dinners and Christmas parties
for a more effective contraceptive. Snyder was also an
at his home. In the early 1960s, he traveled
adviser to University Associates for International Health,
for three months, visiting recent graduates to
an organization focused on developing health programs
see if the School's curriculum was, in fact, relevant to practical public health work. Snyder took a special interest
in the Middle East. Snyder guided the School through a building boom and
in Shattuck International House (see story page 91), some-
great faculty expansion. The School's main auditorium—
times arranging afternoon concerts of classical music. He
the educational hub of the institution in many ways—aptly
and his wife Virginia—known to everyone by her nickname
bears his name. But Snyder says what he hopes his deanship
Ginty—helped organize and equip a play area for young
will be most remembered for did not happen anywhere
children in Shattuck House.
inside School walls. " I guess the thing that I am proudest
But in the later part of the 1960s, Snyder became dismayed at a particular segment of the younger generation—or at least how it manifested itself at Harvard.
of is what the students did—and are doing—in various parts of the world," he says. Peter Wehrwein
1962 Associate Professor Carl Taylor, D.P.H/53, and family
Longtime faculty mem-
drive from London to India's Punjab, where Taylor will
ber Jane Worcester,
Spring is published. The
spend a year studying internships in Indian medical
D.P.H.'47, promoted to
book warns of environ-
colleges. The 8,000-mile trip takes them through
professor of biostatistics
mental consequences
Istanbul, Ankara, Tabriz,Teheran, Kabul, and the Kyber
and epidemiology.
of DDT and ignites
Pass.
Rachel Carson's 5</enf
public concern about dangers of pesticides.
jane Worcester
HEN BIOSTATISTICIAN JANE WORCESTER b e g a n
"vital statistics" as the held of biostatistics was then
her 46-year career at the Harvard School of
called, and by 1 9 3 4 she had co-authored her first paper
Public Health, Herbert Hoover was president,
with department Chair Edwin Bidwell Wilson. In all
a hrst-class stamp cost 2. cents, and a "computer" was a
Worcester published 68 papers. Wilson, a brilliant statisti-
person, usually a woman, who did the computational
cian with eclectic interests who came to the School after
drudge-work that machines do today. Beginning as one of
an early career oriented toward mathematics and physics,
those human calculators, Worcester blazed a path to success
was co-author on 2.7 of those papers. Other faculty lumi-
that eventually led her to an appointment as chair of the
nariesâ&#x20AC;&#x201D;including Nutrition Department Chair Fredrick J.
Department of Biostatistics. Along the way, she earned a
Stare, Epidemiology Department Chair Brian MacMahon,
doctorate in epidemiology, collaborated with some of the
and Professor of Environmental Epidemiology Ben Ferrisâ&#x20AC;&#x201D;
School's leading faculty, made significant contributions to
would later join the roster of Worcester's co-authors.
research on chronic diseases, and had a profound impact on the life of the School and its students. Worcester arrived at the School in 1 9 3 1 , one of a
Yvonne Bishop, s.M.'6i, a colleague of Worcester for 2.0 years, says Worcester's frequent appearances as a second author reflected the heavy demand for her advice
number of Smith College graduates recruited for their
and input and Worcester's conviction that valid medical
strong training in statistics. She quickly showed a flair for
research needed to be grounded in statistics. In the 1960s
1963 School's endowment
Rand pressure chamber
Nobel Laureate John F.
Thomas Weller
reaches $11.5 million,
used to treat President
Enders, former head
awarded Harvard's
with six endowed
Kennedy's infant son,
of the Department of
George Ledlie Prize by
professorships, up from
who is suffering from
Bacteriology, produces
Harvard President
$8.7 million in 1960.
hyaline membrane
first successful measles
Nathan Pusey.
disease.
and 1 9 7 0 s , for example, Worcester worked closely with MacMahon's epidemiology department as it pioneered the epidemiologic study of chronic disease. As a scholar, Worcester's strength lay not in virtuoso theorizing but in sound, critical thinking and healthy skepticism. In a 1 9 6 6 article for N e w EwgfawJ /oMrfM/ Worcester implored researchers to take statistical analysis into account before they begin a study—a plea that biostatisticians still voice today. In the same article, Worcester warns against going overboard with statistical analysis, dredging data for answers to questions not originally considered and jumping recklessly from association to cause-and-effect conclusions. "The test of significance, at best, suggests an association; it does not distinguish between cause and effect," she wrote. Worcester's skepticism extended to the field's emerging love affair with electronic computing, which permitted complex computational functions at the push of a few buttons. Robert Hoover, s.M.H.'70, D.E.R'76, director of the biostatistics and epidemiology program at the National Cancer Institute, says, "Jane taught that you needed to know what assumptions were being made by the statistical techniques you were using. Because
they are all based on some assumptions." In 1 9 7 4 , Worcester succeeded Robert B. Reed as chair of the Department of Biostatistics. At the time, the department was a fraction of the size it is today—it would be several years before only the advent of large-scale clinical trials research would spur the department's expansion into one of the larger HSPH departments. Teaching absorbed much of the faculty's time. All the students in the School were required to take an introductory biostatistics class—still a requirement for today's students—for which Worcester designed much of the course material, conscientiously revising and updating it, says Bishop. The department also functioned as a kind of universitywide statistical resource: any member of the faculty could tap the department for statistical advice. ^ ^ ^
^ ^ ^
ORMER STUDENTS r e m e m b e r
Worcester fondly as a captivating lecturer and "archetypal mentor." Bishop, who knew Worcester well, says she was first and foremost a teacher who trained students to think "statistically, which meant to think logically." N a n Laird, Henry Pickering Walcott Professor of Biostatistics and current chair of the biostatistics department, whose career at the School overlapped briefly with Worcester's, remembers her as having a wonderfully acerbic wit and sense
of humor. Another former student and colleague, James Warram, s.D.'88, says Worcester was extremely careful with her words. "If you went into her office, and she didn't want to answer you, you would just get silence." Worcester could also be exceptionally warm. Bishop recalls that Worcester was a person of especially good taste and manners and an extraordinarily supportive friend and colleague. "She would do anything to help anybody," says Bishop, who says she benefited tremendously from Worcester's guidance and friendship. Worcester was particularly good at helping women and non-M.D. students break down the "only male" and "only M.D." barriers that exisited at the School at that time, says Bishop. "She had a phrase that she used to counter all fears and anxieties: 'You can do it,' pronounced very firmly." Worcester retired in 1 9 7 7 and moved to Cape Cod. She died on October 8, 1 9 8 9 , in Falmouth at the age of 88. Peter Wehrwein
1963 Despite the recent report by U.S. Surgeon General
President Kennedy
U.S. civil rights leader
assassinated in Dallas,
Martin Luther King, Jr.,
Luther L. Terry linking smoking to lung cancer and
Texas. Seventeen
leads march on Wash-
other diseases, annual U.S. cigarette consumption
international students
ington and delivers
peaks at 524 billion—4,345 cigarettes for every
and numerous alumni
"I have a d r e a m . . . "
American adult.
wire Dean Snyder their
speech.
sympathies.
Home Away from Home Henry Lee Shattuck tnternationa) House
An acfwe soc;aJ
was a Mfa/ part o/Tntematzona/ House's ear/y SMcress.
A
Jty
^
S S O O N AS S H E A R R I V E D a t
Henry Lee Shattuck Internationa! House on a warm autumn day in i960, Virginia R. Hannon, s.D.H.'68, knew she had made the right decision. "It was lively," said Hannon. "There were children everywhere and four or five languages being spoken—all at once. The smells of spices and cooking foods drifted out of the apartments. It was electrifying." In the 1 9 5 0 s and 1960s, as today, one-third of the students at the Harvard School of Public Health came from outside of the United States. Unfamiliarity with Boston and discriminatory rental practices led many of them to over-priced, ill-kept, outof-the-way apartments, where students' spouses and children lived in virtual isolation. To counter these difficulties and help create an atmosphere that would embrace the School's international students, Dean John C. Snyder launched a fund-raising effort headed by his friend Henry Lee Shattuck, a well-known Boston financier, Harvard College alumnus, and former treasurer of Harvard College. Shattuck— the twin brother of George C. Shattuck, legendary clinical professor of tropical medicine at the School for more than three decades—committed a large share of the more than $300,000 needed to purchase and renovate three adjoining apartment buildings in Boston's nearby Fenway neighborhood. Shattuck was joined in the effort to bring an international residence into existence by George
1964 Renowned oceanographer Roger Revelle is named Richard Saltonstal! Professor of Population Policy and director of the Harvard Center for Population Studies.
Harold Coe Stuart receives the Martha May Eliot Award from the American Public Health Association.
President Lyndon Johnson signs landmark Medicare/MedicaidAct, which will take effect the following year.
Gulf of Tonkin Resolution marks escalation of U.S. war effort in Vietnam.
^
?
Boston pMaM^rop/s^ Hewry Lee f/acz'ng page; spearbeaJeJ fbe /MnJ-raMZMg ^rwe fo pMrcbase an J rewcwate ^ e
aw J 207 Par^ Drwe ^ a t becawe /nferMa^owa/ HoMse.
Gund, Charles F. Wilinsky, A . M . Sonnabend, the Edsall family and the Littauer Foundation. In July i 9 6 0 , the king and queen of Thailand paid a visit to the residence, which was in the process of being renovated. The King's late father, Prince Mahidol, was the first Thai student to attend the School. A brief ceremony was held under a canopy in front of the building. Two months later, residents from more than 20 countries entered the flower!ined walkway of Henry Lee Shattuck House and were greeted by Professor and Mrs. Philip Drinker, who served as the house's resident faculty family for the first year. Since then, Shattuck House has been a home away from home for more than 3,500 of the School's 6,000 graduates. Hannon, a graduate of Spelman College, was one of the 1 4 1 people
who called Shattuck House home in its first year. She was delighted to find that her apartment had gleaming hardwood floors and bay windows and was furnished down to pots, pans, and utensils, and that the House included music rooms, a library, and a play room for children. "The biggest factor in choosing to live in Shattuck House," said Hannon, " w a s that I wanted to live in an international setting. It was a marvelous opportunity to learn about other cultures and traditions." An active social life quickly became a defining characteristic of Shattuck House, as residents hosted parties, most having an international flair, in the common areas on the ground floor. According to Hannon, there were holiday celebrations from around the world, cooking classes, and all-night study sessions. The Snyders, with the enthusiastic parti-
cipation of the faculty wives, hosted annual Saturday picnic luncheons in early October, arranging for residents to travel by bus from the Shattuck House to sites in Dublin, N e w Hampshire, where some of the students had their first view of the fall colors in N e w England, and a few even had a swim in Dublin Pond. Abdul Rahman Al-Awadi, M.p.H.'6$, who came to Shattuck House in September 1 9 6 4 , remembers fondly the feeling of community that greeted him. Al-Awadi attributes a lot of the house's spirit at the time to Director-in-Residence Margaret Dale Penrose, the widow of Dr. Stephen B.L. Penrose, president of the American University in Beirut, Lebanon. From 1 9 6 2 until her retirement in 1 9 7 8 , she helped to organize social gatherings that featured exotic dishes and native garb. She stayed at the
1965 Article in the Ma/vard PuN/'c /Vea/f/! /S/t/mn/ Bu//ef/n
The Department of
Countway Library
by Alfred K. Neumann, M.P.H/60, and Samuel G.
Behavioral Sciences is
dedicated.fr/Ma,a
McClellan, M.P.H.'61, states that "public health
established under the
memorial to John F.
workers can and must play a vital role in the struggle
direction of Professor
Kennedy given by
to nurture, encourage, and safeguard the equal
Alexander H.Leighton.
Swedish businessman
human rights of all men."
Johan Throne-Hoist, unveiled at the School.
house to cook Thanksgiving Dinner, and heiped newly arrived students to become more familiar with American styles of cooking and dress. Al-Awadi recalls in particular the special birthday celebrations for the children and an end-of-the year party where people taught traditional folk dances from their countries to their neighborsâ&#x20AC;&#x201D;the precursor to International Night. " I think that my experience at the School was enhanced by living at Shattuck House," said Al-Awadi. "Living there was a unique opportunity to gain understanding of other cultures, especially because the year that I was there the residents were particularly diverse. Being a part of such a close community is an experience that I have savored." Riitta-Liisa Kolehmainen-Aitken, D.p.H.'yy, who lived in Shattuck House in the 1970s, says the residence's extraordinary sense of community among the residents was particularly important for the students' spouses, most of whom were women who stayed at home during the day. Despite their cultural differences, they formed a tight-knit group. They would shop together and look after each other's children. "Without the community of Shattuck House, many of these women would have been very isolated, alone, perhaps for the hrst time in their lives, in a large foreign city," she says.
was stricken with pneumonia. One of the chi ldren had brought the disease home from school, and it spread because everyone was trying to help out the child's family by bringing food and taking care of the children. " N o one complained, though," said Hannon. "That's just the kind of place it was. It was a real community." Two of Shattuck House's more colorful characters were Fletcher and Marie Napier, the residence's on-site managers. According to Kolehmainen-Aitken, the Napiers were more like surrogate parents or grandparents to many of the residents. They were the ones who knew whose heart was breaking, who was going with whom, and who was having trouble with classes or was worried about his family back home. It was Fletcher who in the mid-1970s decided to turn the vacant lot adja-
Of course, in such a tightly knit community, more than just advice was shared. Hannon remembers that during her second winter, nearly everyone on her floor, including herself,
Ernst Tyzzer and Roger Irving Lee (left), both present at the first meeting of the School in 1922, die. Lee, acting dean when the School opened, was known as the "father of the School of Public Health."
cent to the building into a playground. He cleared the lot, completed the landscaping, and built the playground equipment himself. Fletcher later became known for shocking some of the residents newly arrived in the states when he took to wearing a headband with a feather in his shoulder-length hair. He and Marie were elected honorary members of the class of 1978. Dan Beaudoin, who assumed responsibility for Shattuck House after Fletcher's untimely death in 1989, vividly recalls the arrival of Clement Malau, M.p.H.'95, a native of Papua New Guinea. "Clement came to the door, and I started to help him up the stairs with his bags. The hrst thing that Clement told me about himself was that his grandfather had been a head hunter. Clement immediately had my full attention," recalls Beaudoin. During his time at Shattuck House, Malau was one of four students who initiated a weekly cultural exchange that took place on Saturdays. Each weekend, representatives from a different country would set up in the house's community area on the ground floor and talk about their country, show pictures, demonstrate traditional music or dances, and finish up with a traditional meal. Beaudoin recalls curry dishes that made his eyes water and learningâ&#x20AC;&#x201D;through harsh experienceâ&#x20AC;&#x201D;that people from some cultures prefer to drink soured milk. Henry Lee Shattuck International House remains in the memory of its residents as a place of community and exchange, an integral part of their
Surgeon General's warning appears on cigarette packages.
World population reaches 3.3 billion.
experience at the School, and it continues to provide a welcome and supportive home for students today. "When some of the students drop by my office in the late fall, fearing that they are not smart enough or quick enough to keep up with their studies, or they are missing their families who are thousands of miles away, I tell them the same thing Dan
did, ' N o one's left since I've been here.' Sometimes that's all it takes," said Kate Vitkosky, who now oversees the house. "That and the support and companionship of about 70 other people having the same fears and doubts. This is the real strength of Shattuck House." MarceHa J. Bernard
Recent res^e^s o/fwfeTTM^ofMf HoMse.
1966 David J. Sencer, M.P.H.'58, succeeds James Goddard
Alonzo S. Yerby, M.P.H/48, former commissioner of
as head of the CDC. That year, the CDC launches the
hospitals for New York City and a member of President
smallpox eradication programs.
Johnson's National Advisory Commission on Health Manpower, named professor and chair of the Department of Health Services Administration.
HSPH f a c u i t y d r i v e e p i d e m i o i o g y ' s m i d - c e n t u r y s w i t c h to t h e s t u d y of chronic d i s e a s e s .
S H t F U N G G E A RS % HB S HEN N O E L W E I S S CAME t o
the School in 1968 as a M W new M.D., he was ready to immerse himself in the the study of health-care systems. When he left three years later, he had a doctorate in epidemiology and a new set of career plans. "The bottom line is that, as far as I am concerned,! got the best epidemiology education in the world available at that time," says Weiss, now professor of epidemiology at the University of Washington School of Public Health.
Since the School's founding, epidemiology has been one of its undeniable strengths. But in 1 9 5 8 , with the appointment of Brian M a c M a h o n as department chair, the department became a powerhouse of epidemiology scholarship and education. During the 3 1 years that M a c M a h o n served as department chair, i z o students earned their doctorates in epidemiology at the School; many, like Weiss, went on to have distinguished and influential academic and research
Powerful personalities, some brilliant thinkers, and a steady flow of government training grants all spurred the department's rise to prominence. More fundamentally, however, M a c M a h o n and his colleagues played a pivotal role in the discipline's mid-century shift in focus from infectious to chronic disease. Since the nineteenth century, when John Snow discovered that drinkers of London's Southwark and Vauxhall Company's water had a higher risk of cholera than customers of other water companies, epidemiology's
National Institutes of Health and 10 U.S. corporations
Industrial hygiene
WHO assembly calls
give $1.2 million to construct and equip a primate
chair Leslie Silverman,
for intensified effort to
research facility in the Department of Nutrition.
who helped devise
eradicate smallpox.
safety procedures and standards for nuclear reactors, dies.
:
forte had been the study of infectious disease outbreaks. M a c M a h o n and his colleagues argued that epidemiologists also needed to study the distribution and determinants of chronic diseases, such as heart disease and cancer, which, since the 192.0s, had become the industrialized world's leading killers. Ep;Je7w'o/og3C M e ^ o J s , the i 9 6 0 textbook that M a c M a h o n wrote with two other members of the School's epidemiology department, Thomas F. Pugh and Johannes Ipsen, eloquently made the case and developed a vocabulary for this shift. " I can describe MacMahon's role in bringing about the [epidemiologic] transitionâ&#x20AC;&#x201D;he was probably the most important single individual," says Philip Cole, M.p.H.'67, D.p.H.'yo, a former student and professor at the School w h o is now at the University of Alabama at Birmingham. M a c M a h o n built the "premier chronic disease epidemiology department in the country," says Thomas M a c k , M.p.H.'69, a professor of preventive medicine at University of Southern California School of Medicine. Drawing a starting line for something as gradual as epidemiology's shift from infectious to chronic diseases is difficult; the exact beginning of an idea is almost always nebulous. Some historians credit Wade Hampton Frost, the hrst chair of the epidemiology department at Johns Hopkins, with laying the foundation for modern epidemiology. In an interview for Peop/e's H e a / ^ , a recently published history of the School, M a c M a h o n marked
1900
Leading causes of death. United States Pneumonia/Influenza
11.8%*
Tubercutosis
11.2%
Heart Disease
9.4%
Stroke
7.6%
Diarrhea/Enteritis
6.3%
Nephritis
5.9%
Cancer
4.5%
Accidents
4.2%
Diphtheria
1.9%
Other
37.2%
'percent of total deaths
" H H H
H
0%
the classic 1 9 5 0 British study of lung cancer and smoking by Richard Doll and Bradford Hill as epidemiology's major turning point. In the same interview, M a c M a h o n also credits John Everett Gordon, his predecessor as chair of the epidemiology department, with being "one of the hrst and more persistent" to assert that epidemiologic techniques could be applied to non-infectious diseases. Gordon published a series of papers on the epidemiology of everything from suicide to post-partum depression, noted M a c M a h o n . However, he added, as "an infectious disease person," Gordon lacked the training to carry out these ideas. In 1 9 4 9 , at a meeting of the epidemiology section of the American Public Health Association, Gordon commented that although "the main direction of effort in epidemiology is still toward
10%
20%
30%
40%
communicable diseases...it becomes increasingly evident that a limitation of activities to the infections is no longer warranted." HEN M A C M A H O N LEFT the
State University of N e w W W York's Downstate Medical Center in Brooklyn to chair the School's epidemiology department, he had his work cut out for him. Although not an imposing physical presence, the British-born MacMahon impressed students and colleagues with his lucid thinking and penetrating analysis. Weiss remembers M a c M a h o n as " a brilliant classroom teacher" who was a master at weaving in illustrative examples. Robert Hoover, s.M.H.'yo, D.P.H.'y6, recalls how M a c M a h o n would quickly bring some avant-garde presentation down to earth with an incisive ques-
1967 The Program in Law,
Elizabeth Prince Rice,
South African surgeon
U.S. population passes
Public Health, and
associate professor
Christiaan Barnard
200 million, having
Medicine established
emerita, receives the
performs first success-
doubled in only 50
under the direction of
APHA's Martha May
ful heart transplant.
years.
William J. Curran,
Eliot Award.
S.M.H.'58.
1960
Leading causes of death. United States Heart Disease
37.6%*
Cancer
16.5%
Stroke
8.7%
Pneumonia/tnfluenza
3.6%
â&#x20AC;&#x201D; <
Car Accidents
2.9%
Diabetes
1.7%
H "
Suicide
1.3%
H
Chronic Liver disease
1.2%
Chronic Lung disease
1.1%
Other
25.4%
< 10%
tion: " H e would ask, 'But exactly who were the cases and who were the controls?' And there woutd be this sitence. And more often than not the guy wouldn't know. They had become overty infatuated with process." James Warram, S.M.H.'66, S.D.'88, who was on the faculty for eight years in the 1960s and eariy 1 9 7 0 s , recalts the time he showed MacMahon a draft of a paper: " H e came down to my office. He was disgusted with the paper and it showed on his face and he sort of threw it down on my desk. It spitted att over the floor." M a c M a h o n was embarrassed, and Warram surprised. But Warram, now an epidemiotogist at the Joslin Diabetes Center in Boston and an adjunct professor at the School, says he valued getting MacMahon's honest opinion.
20%
30%
40%
But MacMahon did not throw his intellectual weight around. Quite the opposite, according to Hoover, director of the biostatistics and epidemiology program at the National Cancer Institute. "I have never met a more honest scientist in my entire life than Brianâ&#x20AC;&#x201D;intellectualty honest and otherwise. And with that comes humility," he says. Mack of u s e , said M a c M a h o n "suffered fools gladlyâ&#x20AC;&#x201D; better than almost anyone I have ever known. But there was also never any doubt about what he thought about their w o r k . " Warram agrees: " H e was direct, but atso very kind." MacMahon's department boasted a number of prominent epidemiologists. Professor George Hutchison was a strong, precise thinker who, says Warram, complemented MacMahon, functioning as a kind of epidemiologic parliamentarian,
checking facts and making sure that alt the rules were followed. "George's bibliography is quite short," notes Hoover, "but every one of his papers was an absotute masterpiece." Jane Worcester, who served as chair of the biostatistics department, was another stalwart (see profile page 89). And Finnish-born Olti Miettinen was a formidable scholar and personality, known for his combative debating style. Warram fondly recalls the joint "epi-biostat" lunches as one of the best parts of his experience at the School. Though classes were taught in 5 5 Shattuck Street, the faculty offices for the two departments were in the old Huntington Hospital building, or " N o . 1 Shattuck Street," a graceful otd building that Warram remembers as having big windows and fireplaces in the rooms. The lunches, held in a second-floor room that looked out onto Huntington Avenue, were fun, exciting, and, surprisingly, never intimidating, given the high standards of the company. " Y o u could say dumb things and not have to worry about that. You woutd be forgiven," Warram says. That accepting attitude reflected the sense of familiarity bred by a much smaller institution. Warram's 1 9 6 6 graduating ctass had only 83 students compared to the ^oo-person class sizes of today. "These people [the senior faculty], knew each of us. They knew our foibles and our strengths. They were very supportive," he says. "One of the remarkable things about the School was having access to these luminaries," notes Hoover.
1968 U.S. measles cases drop
HSPH graduates Gretchen, S.M.H/66, and Warren,
U.S. civil rights leader
Television coverage of
to 22,000 from 400,000
D.P.H/67, Berggren establish a Department of
Martin Luther King, Jr.
Tet Offensive in Vietnam
in 1962 a s a r e s u l t o f
Community Health at the Albert Schweitzer Hospital
is assassinated.
begins turning U.S.
Enders vaccine.
in Deschapelles, Haiti. For the next two decades, the
public opinion against
Berggrens will work to lower deaths from tetanus,
the Vietnam War.
tuberculosis, diarrhea, and malnutrition.
The shift from infectious to chronic disease epidemiology did not occur because a few influential epidemiologists willed it into existence. To a large extent, it was the only rational reaction to the changing profile of the causes of mortality in Europe and the United States during the first half of this century. Gordon made this clear in his 1 9 4 9 address to the APHA's epidemiology section. In 1 9 0 0 in the United States, five of the ten leading causes of death were infectious diseases, he said. By 1 9 4 8 , only two—pneumonia and influenza (seventh) and tuberculosis (eighth)— were in the top ten. Applying epidemiologic methods to chronic diseases created all sorts of new, knotty problems, both practical and theoretical, for epidemiologists. As M a c M a h o n pointed out in a lecture several years ago, infectious disease epidemics usually happened over a matter of hours, days, or weeks. "The current epidemics of lung cancer and cardiovascular disease, among others," he said, "have taught us that the time scale of epidemics may rather be measured in years or decades." Ideas about the natural history of epidemics also had to change. Whereas a previous generation of epidemiologists had been trained to think of epidemics in terms of the triad of host, agent, and environment, " M a c M a h o n changed that to person, place, and time," says Cole. "The important distinction is that he put time into the picture." Infectious disease-oriented epidemiologists were used to thinking in terms of attack rates, notes Cole.
1969 In an article in the January Ma/vard Pt/N/'c Wea/f/! /t/Hmn/ Bu//ef/n, Assistant Professors Joseph Brain, S.D.Hyg.'66, and David Leith report on an expedition to the Bering Sea to study the respiratory systems of arctic marine mammals aboard the floating laboratory
/S/p/M
Fro?M n g ^ f ; P o w e r E p ^ e T w w / o g y D e p ^ r ^ w e w f C ^ w s D w ^ Y W o s T n c ^ o p o M ^ o s , s . M . ' 6 S , aw^BrMw MacMa^ow, s.M.'jj,
cMrrewi
If 80 percent of the people w h o ate the potato salad at a picnic got sick, the food poisoning attack rate among the potato-salad eaters was 80. That rate would have been set in contrast to the attack rate among non-potato salad eaters, say, 5 percent. Time is not terribly problematic because the symptoms of food poisoning will invariably show up in a day or two, or not at all. But with chronic diseases, the time frame of observation is critical. Cancer and heart disease develop years, perhaps even decades, after the disease-inducing exposures. Cut short the observation period, and you'll miss the epidemic. Moreover, the exposures themselves—smoking, poor diet, lack of exercise—are experienced over years.
Dedication of Health Sciences Laboratories. Since 1960, over 90,000 square feet of space has been added to the School.
A/exawJerM.
D.p.H.'Si.
In Me^oJs, M a c M a h o n stresses incidence rates— the number of new cases of a disease in a population over a specified period of time—over attack rates. An attack rate is, of course, a kind of incidence rate, but it only implies the time element that becomes an explicit variable in MacMahon's equations. Because it captures how quickly people are becoming ill, the incidence rate offers the best clues to causal factors, argued M a c M a h o n and his co-authors. "Where the problem is epidemiologic, the rate of choice is incidence," they wrote. But M a c M a h o n also realized that putting time into the equation could distort observations. H o w diseases are classified changes over the years,
The Department of Industrial Hygiene is redesignated the Department of Environmental Health Sciences, with Associate Professor Dade Moelier as chair.
carefully compare those people with similar but cancer-free subjects, the so-called controls. "The case-control study really revived epidemiology," says use's Mack.
for example. Better, cheaper, or more available diagnostic equipment and tests can create "epidemics of diagnosis." MacMahon makes some suggestions for how to deal with these kinds of issues, many of which come under the general heading of "bias," but there are no pat answers. Contemporary epidemiologists still struggle with how to design the unbiased study. Ultimately, chronic disease epidemiology required a much more sophisticated way of observing diseases that were relatively diffuse and slow-moving. The case-control study, for example, allowed researchers to assemble a group of, say, several hundred lung cancer cases and then
NCi's Hoover notes that the advent of the chronic disease case-control study was, in part, a matter of going back to the future. Whereas by the 1950s, infectious disease epidemiology had become increasingly mechanistic—a matter of probing blood and tissue for the culpable microorganism—the case-control study brought back many of the classic epidemiologic issues: picking a representative sample, correct classification of cases, and perhaps above all, finding suitable controls. Part of the reason MacMahon and others at Harvard were so talented at the "new" chronic disease epidemiology, says Hoover, is that they were so well-grounded in these classic issues. "They viewed epidemiology as intellectual process, a way of thinking and understanding health and disease, and if you understood the basic principles and methods, you could apply it to anything," he says. ^
ACMAHON'S ELOQUENCE w a s
also exceptional in a held in t 8 which clunky, dry expression is the rule. Says Mack; "Brian's language doesn't get hung up on the punctilious subtleties. You don't have to read something 2.4 times to understand what he is saying. One of MacMahon's most felicitous phrases was "web of causation" to describe multiple, interacting causes of disease. In Met^oJs, MacMahon used the web
metaphor to extend the then-prevailing concept of a "chain of causation." MacMahon wrote that each component—or [ink—generates a myriad of effects, not all of them necessarily reiated to the disease of interest. Moreover, each component is itself "the result of a complex genealogy of antecedents." Together, he wrote, the "whole genealogy might be thought of more appropriately as a web, which in its complexity and origins lies quite beyond our understanding." Noel Weiss says he still uses the web of causation idea in his classes, and the phrase entered epidemiology's lexicon. As a researcher, MacMahon practiced what he preached, working primarily on breast cancer and its relationship to endogenous hormones. He has said the choice was partly because "it looked like an easy problem" and partly because he hoped epidemiology would have the same success explaining breast cancer in women as it did in explaining lung cancer in men. MacMahon did ground-breaking research showing the influential role of reproductive experience in breast cancer. His studies revealed that breast-cancer risk varied with the age at which a woman first menstruated and gave birth. Recently, epidemiology's shift in focus has had to be reconsidered. The growing attention to chronic disease epidemiology accompanied a deepening neglect of infectious diseases. In her best-selling book, Cow/Mg P/%gMg, f o r m e r HSPH j o u r n a l i s m
fellow Laurie Garrett gave a scathing account of misplaced confidence
Twenty-second World
Huntington Building at
U.S. Astronaut Neil
Harvard students
Health Assembly held in
1 Shattuck Street is
Armstrong is the first
occupy administrative
razed to make room for
man to walk on the
buildings in Cambridge
the Kresge Education-
moon.
to protest war in
Boston.
Facilities.
Vietnam.
I ^t-
among top U.S. public heaith ofhcials in the 1960s regarding the apparent victory over infectious diseases. "It was part of the euphoria of molecular reductionism that you believed if you hnd a disease, you can find a molecule to control it," says Richard Levins, the John Rock Professor of Population Science at the School and a member of the Working Group on New and Emergent Diseases. While conceding that health researchers must be prepared for the emergence of epidemics such as AIDS, Dimitrios Trichopoulos, Vincent L. Gregory Professor of Cancer Prevention and Epidemiology and former chair of the epidemiology department, believes that, in general, the shift to chronic disease epidemiology has been beneficial. A close friend and former student of MacMahon who coauthored the most recent edition of /og/c Mcf^oJs, Trichopoulos, s.M.'68, chaired the epidemiology department from 1989 until 1996. He says mortality rates from cancer and heart disease in the United States, Europe, and an increasing number of socalled devel-oping countries, justifies concerted researchâ&#x20AC;&#x201D;epidemiologic and otherwiseâ&#x20AC;&#x201D;into these chief causes of death. Moreover, this research has paid off in millions of lives saved and extended, says Trichopoulos. The identihcation of smoking as the cause of lung cancer
has paid huge health dividends as smoking rates have dropped. Trichopoulos predicts that cancerrelated dietary hndings should also start to pay off as new guidelines emphasizing fruit and vegetable consumption are promulgated. As for heart disease, Trichopoulos says credit for the four-decade decline in U.S. mortality rates can probably be evenly split between epidemiologists' identihcation of risk factors and the
medical community's development of new drugs and operations such as coronary bypass. As Noel Weiss points out, all the rigor developed in chronic disease epidemiology over the past 40 years benehts not just investigators in heart disease and cancer, but anyone who wants to do a well-designed study of an infectious disease. It is the science of epidemiology, in general, that has advanced, not just one aspect of it. "The fact is that the more laborintensive, held-study, going-toremote-parts-of the-world, kind of research is still going on. People are still researching AIDS in Africa and other major infectious diseases. There are people investigating outbreaks in the U.S. all the time. It is just that now, compared to decades ago, we are using epidemiology not just to deal with the outbreaks but also to study the cause of more endemic diseases." Peter Wehrwein
1970 Article in the Harvard PuN/c Wea/f/7 /S/umn; 6u//efm
founders.' Haryarcf
by Donald Hopkins, M.P.H.'70, and Leonard Glass,
Sdtoo/ofPuM'c/VM/f/],
M.P.H.'70, calls attention to low minority enrollment
by Professor Jean A.
at the School; only 3.6 percent of U.S. students are
Curran, describes the
minorities.
School's evolution from 1909 to 1946.
Professor of Nutrition Jean Mayer appointed Special Consultant to President Richard Nixon.
+)
T i ! T A
0\ :
1' i
4! Y i 1 I ) Y T
My Year at the Harvard School of Public Health Adapted from an unpubtished memoir written in 1987 by veterinarian Mitton Werrin, who earned his M.P.H. at the Schoo) during the 1955-56 schoo! year. Werrin went on to a successfut career as an epidemiotogist with the Phitadetphia Heatth Department. He died on
A ^ t the appointed time, I took my last took at the worid I had known and entered the beautiful Greek Revival building at $$ Shattuck Street. The targe foyer was filled with men, women, and children, along with alt their worldly possessions. The room was in chaos, the noise overwhelming. Everyone was trying to register. 1 noticed quickly that many people wore strange but colorful clothing. I heard strange accents and languages. Everyone seemed to be just as bewildered as I. To those in chargeâ&#x20AC;&#x201D;faculty wives, school secretaries, and the formidable Mrs. Margaret Barnabyâ&#x20AC;&#x201D;this was
March 8, 1995.
an annual state of affairs. Once the volunteers started to work, the chaos and turmoil were overcome. I hied the relevant papers and received numerous instructions and papers in turn. A few days later, at a student reception,
1970 U.S. Occupational Safety and Health Act (OSHA) signed by President Richard Nixon.
U.S. life expectancy at birth is 70.9years and infant mortality is 20 per 1,000 live births.
102 s' y
we were greeted cordially by the faculty, many of whom were worldfamous scientists. I shook the hands of Nathan Pusey, president of Harvard University, and Dean John Snyder. It was my first opportunity to meet some of my classmates, who came from all corners of the world. Soon classes started. The first six weeks were devoted to a series of lectures by the heads of each major departmentâ&#x20AC;&#x201D;epidemiology, nutrition, sanitary engineering, and the rest. We attended lectures by social workers, public health nurses, public health educators, and maternal and child health aides. Each group explained in detail what they were striving for and how they provided assistance to the public. Before entering the School, I had only a faint idea of what these people were doing, so their lectures were a complete revelation. Professor of Human Nutrition Fredrick Stare and his staff gave a
series of interesting lectures on nutrition, with emphasis on nutritional diseases common in many parts of the world: kwashiorkor and the many enteric diseases which led in turn to all sorts of exotic deficiency conditions. I learned the value of nutritional surveys, in which careful evaluation could point out deficiencies in the diet of a whole community. Some things never seem to change. The lectures were global in scope; it was not uncommon to study a disease found in some isolated area of the Orient, presented by a professor who had just returned from the affected area with all sorts of data that had been collected on the spot. One of the most important series of lectures was given by Dr. Gerald Caplan, an expert on psychosocial problems that beset large groups of people. The students listened intently as he lectured on the mourning process, on the mental and sometimes physical problems that hospitalized
children suffer, and on children's conduct upon separation or loss of a parent. The entire class was required to attend the lectures given by Dr. Benjamin Paul, a social anthropologist, who introduced us to the new field of ecology. From the very start I sensed that I would have trouble with biostatistics, but fortunately I wasn't the only one. Most of my classmates had the same premonition. At the start of my studies in epidemiology, Department Chair Dr. John Gordon asked me to write a term paper on any subject I chose. He seemed delighted when I told him I would like to write about industrial anthrax in Philadelphia. As computers for data processing were unknown then, I had to write, compile, make charts and graphs, edit the material, and punch out the whole thing on a rickety, secondhand, portable typewriter. Once I got started, everything went smoothly, and I started to enjoy the arrangement. A few weeks after classes started, we elected class officers. Committees were chosen and plans were made for a series of class dances, a Christmas party, and a spring clambake. Plans were made to publish the class yearbook. One school tradition was a series of presentations at gatherings called student forums. Here the foreign students gave talks about their countries. Foods native to their countries were served and native costumes were worn. Occasionally, a diplomat would attend and give an oration on the virtues of his country. On India night, the class was introduced to future Indian
HSPH
1971 Derek Bok succeeds
Britain's Royal College of Physicians declares
President Richard Nixon
Nathan Marsh Pusey as
cigarette smoking a hazard on par with the great
signs the National
President of Harvard
nineteenth century epidemic diseases typhus and
Cancer Act, beginning
University.
cholera.
the "war on cancer."
Ep/dew/o^ogy E. Gordon
JeaJs aw A JMwce
Prime Minister Indira Ghandi, who gave an impassioned speech about the beauties and cultural heritage of her country. The forums were very popular, and gave an insight into the health situation in each country. What made Harvard different from other institutions of learning? As soon as classes started I noticed that the relationship between faculty and students was that of a close-knit family. The faculty emphasized that they learned more from the students than by any other means; thus they treated us as equals. The faculty was never condescending. They were always available, ready to assist and understand our problems. One day I entered the office of Dr. John Enders, world renowned researcher on the
polio virus, and asked a question about the virus. He took the time to answer and then gave me a list of articles on the problem. Another factor that made Harvard different was the socialization between the faculty and students. Some of my fondest memories are of the get-togethers at our teachers' homes. We would sit around a table, drink wine, eat cheese, and chat for hours about our experiences. I was amazed at the stories related by the foreign students, who told about their problems in the administration of health in their countries. The final semester was rapidly coming to an end. The last few weeks were hectic as the day of comprehensive exams approached. All social
festivities came to a halt as everyone concentrated on the final struggle. I was still afraid of statistics and thus gave this course the most attention. After ail the exams were completed, the students gathered around to discuss their answers to this or that question. The excitement bordered on mass hysteria; all we could do now was wait and hope. After we loafed around for two days, the grades were posted. I had passed every course. That night I packed my books and belongings, said farewell to my landlady, and took the plane back to Philadelphia. I would return in two weeks for the graduation exercises.
D e a n J o h n Snyder resigns to devote time to popula-
Time-line photo credits: AP/Wide World: pages 31,54,90. Archive Photos: pages 19,40,45,46, 50, 53,
tion problems a n d prevention of infectious disease. Richard H D a a a v serves as actina dean ^ H -
61, 72,83,91,96,97. Brown Brothers: pages 13,20. Corbis-Bettmann: pages 18,24,25,47. Courtesy of Harvard Archives: pages 28,71. The Francis A. Countway Library of Medicine, Boston: pages 10,12, 1 4 , 1 6 , 3 0 , 3 2 , 4 8 , 7 4 , 7 7 , 7 8 , 9 3 , 9 4 . Franklin D Roosevelt Library: page 27. Giraudon/Art Resource, NY O 1997 Estate of Pablo Picasso/Artists Rights Society (ARS), New York: page 35. Harvard News Office:
Alumni
H A R V A R D S C H O O L OF P U B L I C H E A L T H
Day
S A T U R D A Y , A P R I L 2.6, 1 9 9 7
J
& 6 7 7 H U N T I N G T O N AVENUE
#
1 0 : 3 0 A M TO 7 : 0 0 P M
iB O S T O N ,
MA
Dean's Alumni Luncheon and Presentation of the Alumni Awards of Merit Policy, Politics, and Science: Perspectives on the Future of Public Health MoJer<2for G. Timothy Johnson, MPH'76; Medical Editor, ABC N e w s Presenters Walter C. Willett, MPH'73, DPH'8o Chairman the Department Kenneth H.ofCooper, MPH'62. of Nutrition, HSPH Founder and President, the Cooper Aerobics Center Maxine D. Hayes, MPH'77 President, Association of Maternal and Child Health Programs Barry S. Levy, MPH'70 President, American Public Health Association Roundtable Discussions Topics Managed Care Tobacco Nutrition Ethics
Leonard Kirschner, MPH'68
Dileep Bal, MPH'71, Greg Connolly, MPH'78 Johanna T. Dwyer, S M ' 6 5 , S D ' 6 9
Troyen A. Brennan Carla Obermeyer, SM'8$, SD'88, Rachel C. Snow, SD'
International Health
HIV, Health and Human Rights
Jonathan Mann, MPH'8o
Community Health/Maternal and Child Health
Isabelle Valadian, M P H ' 5 3 Jane Gardner, SM'78, SD'3
Environmental Health Violence Prevention Injury Prevention
Joseph Brain, SM'63, SD'66
Deborah Prothrow-Stith
David Hemenway
Cocktail Reception to follow
For ;??/br?7Mf;'o7!
Poo/e <3? 6 1 7 j} j i - 0 1 6 0 or
Gateway to
World Health: -199
KEYNOTE
SPEAKERS
BARRY BLOOM, P H D
GRO HARLEM BRUNDTLAND,MD,
MPH
Powder FwM^ Af/ymter o^JVorn^y WILLIAM FOEGE, M D ,
MPH
PP^/f^ Po/zcy, Confer Ccwter CYNTHIA
McKlNNEY
L/ S. R^fejeMt^'pe,
Dz'ytWf, GfOT^M
FREDERICK MoSTELLER, PHD, D S c
KENNETH OLDEN, PHD
Dwcto^
Apri! 2 7 - 2 9 , 1997 Coptey Ptaza Hotet, Boston
iw^'fMfM o^EMPxrowwe?!^/
JOHN ROWE, M D
Aft (New Tor^) &/700/ PywM^Mt, A f t -S^Mz Afe^'ca;/ PPojy^a/
Join us for a searching took at major THE
pubiic heaith issues and research led by eminent facutty m e m b e r s from
PRESENTATtONS
Infectious-disease control Heaith impacts of gender, class, and race Nutrition, exercise, and longevity Links between heaith and human rights
ce nter s worl dwide. /Sf s n
Influence of public attitudes on health policy and politics
NS FOR
INTERNATIONAL
NIGHT
Harvard S c h o o l of Public Health
Challenges to multiculturalism and its implications f o r pubiic health Molecular markers of disease N e w and resurgent infectious diseases
one/ ALUMNI
Internationa) environmental threats
Economics of health care DAY
Apr;'/ 26, 7997
R e f o r m of health systems worldwide
Harvard S c h o o l of Public Health Enrolment packets u^W be ma</ed on J a t w a r y 1. (f you bat^e questions about the symposium, w'sit the Schoo/'s Wor/d Wc/e Web s<te Bet^eWy Freeman, ^'rector o ^ p u M c a ^ a < r s , at 6 1 7 4 3 2 - 3 8 6 3 ; b^*eeman@sph.harvar<ie&<. For m/brniatfon obout Afumn/ Day, contact Susan Pooie at 6 1 7 3 3 1 - 0 1 6 0 ; spoofe@spb.bar^ard.edu.
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