Veterinary Public Health and Alexander D. Langmuir

James H. Steele 1 and Myron G. Schultz" Downloaded from https://academic.oup.com/aje/article/144/Supplement_8/S47/110320 by guest on 01 October 2021 Alexander Duncan Langmuir was recruited by the ignorance-let's exploit it!" Thus, the Veterinary Pub late Joseph Mountin, as I (1. H. S.) was after World lic Health unit was established in Mountin's office in War II, with the challenge to explore new areas that the Bureau of State Services at the National Institutes related to public health. Mountin was a leader who of Health, late in 1945. The charges were to investi gained fame by challenging the old order and antici gate and develop a control program for the animal pating future needs (1). He foresaw the need for an diseases that are of public health significance, to assist agency such as the Communicable Disease Center the states in the establishment of Veterinary Public (now the Centers for Disease Control and Prevention Health programs, and to serve as a consultant in other (CDC)) to service the states. Public Health Service activities as they relate to ani In 1942, the Office of Malaria Control in War Areas mal diseases (3). This was the first time that Veteri was established by the Public Health Service in At nary Public Health was so recognized as a separate lanta, Georgia, to devise methods to reduce the inci entity in a public health organization table. In 1947, dence of malaria in our troops. This office also coop the Veterinary Public Health activities were moved to erated actively with the states in an intensive campaign Atlanta in the new CDC under the late Raymond A. to control malaria throughout the South where it was Vonderlehr. endemic. On January 1, 1946, following the war, a Justin Andrews, who was Deputy Director of the disease investigation and training center, the CDC, CDC at the time, was encouraged to find an epidemi replaced the Office of Malaria Control in War Areas. ologist who could provide leadership and develop a The establishment of the CDC was the fulfillment of trained corps of epidemiologists as the threat of the Mountin's foresight. He believed that the Public Cold War grew after the Iron Curtain dropped across Health Service should have a field office that could Europe and biologic warfare became a concern to provide state health agencies with the technical help of public health leaders. Andrews helped Mountin find consultants with highly specialized knowledge and the right man in Langmuir, then Assistant Professor at skills, and it came to be. The Johns Hopkins University School of Hygiene and Mountin's challenge to me (1. H. S.) in 1945 was Public Health and a colleague of Andrews. succinct: "What are you veterinarians going to do for When Langmuir arrived in the spring of 1949, he public health now that the war is over?" Further ques asked probing questions about the Veterinary Public tioning by Mountin led to an order from him that I Health program. He was frank in stating that his only should prepare a list of zoonotic/animal diseases that contact with veterinarians had been in the New York affect human health. The resulting chart (2) inevitably State Health Department where they were milk sani led Mountin to ask what control measures could be put tarians. He was interested in learning about animal into effect. It was apparent that the epidemiology of diseases and their public health significance. He was most zoonotic diseases was not known, and control given the zoonoses chart, and he quizzed me (J. H. S.) was not understood. Mountin summarized the situa periodically about diseases that caught his attention. tion by saying, "It appears that we have a lot of One of Langmuir's early impacts on Veterinary Public Health was his visit to the CDC Rabies Inves Accepted for publication April 9, 1996. Abbreviations: CDC, Centers for Disease Control and Prevention; tigation Laboratory in Montgomery, Alabama. The EIS, Epidemic Intelligence Service. laboratory had been built by the Rockefeller Founda 1 University of Texas, Houston, School of Public Health, Houston, tion in the late 1930s to investigate the efficacy of TX. 2 Adjunct Professor of Epidemiology, Rollins School of Public rabies immunization in the prevention of rabies in Health, Emory University, Atlanta, GA. human beings, as well as dogs, under L. T. Webster, Reprint requests to Dr. James H. Steele, University of Texas, Houston, School of Public Health, 1200 Herman Pressler, P. O. Box Charles Leach, and Harald Johnson, all renowned 20186, Houston, TX 77225. medical scientists of the Rockefeller Foundation. They

847 848 Steele and Schultz concluded from their work that the old Semple vaccine disagreement arose. It was in 1952 at a biological from the early 1900s was not effective. warfare review conference for the Public Health Langmuir liked what he saw concerning the ap Service at Fort Detrick, Maryland. There had been proach to the rabies problem. An epidemiologic ap Canadian-American joint investigations of animal dis proach to rabies outbreaks consisted of enumerating eases as possible biological warfare agents from 1942 dog populations and census tracts, developing spot to 1950 at Gross Isle, Quebec, Canada (rinderpest, foot maps, calculating disease rates and vaccination rates, and mouth disease, hog cholera, avian influenza); En and preparing charts showing the effectiveness of dog gland (anthrax, brucellosis); and the United States control and vaccination (4). Langmuir provided active (brucellosis, glanders, tularemia, etc.). All of these are

support to the rabies control program. Many of the animal diseases, but not all are zoonoses. The veteri Downloaded from https://academic.oup.com/aje/article/144/Supplement_8/S47/110320 by guest on 01 October 2021 data gathered by Ernest Tierkel, Robert Kissling, and nary authorities of the participating countries all be Martha Edson were to appear in the WorId Health lieved in the tried and proven control measures of Organization Expert Committee reports on rabies from identification, isolation, and destruction. Langmuir the 1950s (5) through 1984 (6). challenged this concept of control by quoting William The Veterinary Public Health division interested Farr, the famous English medical statistician who had Langmuir. He was always raising challenging ques analyzed the 1860s epizootic of rinderpest that had tions on zoonotic diseases. Sometime after he was swept across Europe following the Crimean War appointed head of the Epidemiology Branch, he vis (1858-1859). Farr, in his analysis, concluded that ited the Rocky Mountain Laboratory and observed there was no need for the slaughter of affected cattle the Q fever investigations in California in order to herds, as the epizootic had peaked by the time the be better informed about the activities of zoonoses. slaughter was instituted.' I (J. H. S.) had never read Langmuir encouraged the focus on rabies, brucellosis, Farr's review but objected on the basis that some leptospirosis, and salmonellosis, as well as Q fever. animals would recover and become carriers. Langmuir The Q fever investigations were integrated with the countered that there was no evidence that an acute National Institutes of Health under Robert Huebner, disease such as rinderpest, with relatively high mor who asked CDCNeterinary Public Health to collabo tality, would have carrier-survivors. At the time, the rate and assign a veterinary officer to the southern carrier state had not been proven, but subsequently the California project. This request had not been cleared carrier state was recognized. Rinderpest is a viral with the California Health Department, with resulting disease (10) that is related serologically to canine confusion and criticism. VonderIehr and Langmuir distemper and human measles. Langmuir and I had to defuse a stormy situation. (J. H. S.) had a fine time at this conference defending The Q fever investigations continued for a number our positions with the assembly of Public Health Ser of years, including studies of the effectiveness of milk vice and US Army officers, foreign scientists, and pasteurization at the University of California College agriculture officials in attendance. of Veterinary Medicine at Davis, California. Other Late in 1953, at the American Public Health Asso studies, which were undertaken as a biologic warfare ciation meeting in New York, Langmuir invited me defense strategy (7), included the role of vaccination (J. H. S.) to attend the editorial review of the forth of dairy cows. These investigations were strongly sup coming American Public Health Association Hand ported by Langmuir. book chaired by the distinguished public health pro Later in 1951, Andrews, then Director of the CDC, fessional, Haven Emmerson, the former New York reorganized the Center. Veterinary Public Health was City Commissioner of Health, and then Professor of merged with epidemiology (8). There was concern that Public Health, Columbia University School of Public Veterinary Public Health would be lost in the expand Health. Langmuir was very generous in his introduc ing Epidemic Intelligence Service (EIS) training pro tion of me (J.H. S.) and why he felt I could contribute. gram. Langmuir was busy recruiting his first class of This was the beginning of more than 40 years as a EIS officers and teaching assistants. Veterinary Public member of the editorial board, representing the Con Health provided him with several epidemiologic case ference of Public Health Veterinarians, first under studies that were used in the short training session that John Gordon's (1955-1965) editorship, and then incoming EIS officers attended. It was enlightening to under A. B. Benenson's editorship (1965-1995). meet these bright young medical (EIS) officers who asked interesting questions and, in tum, expanded our 3 Farr's law: "Subsidence is a property of all zymotic diseases." knowledge of zoonotic diseases in humans. The gradually diminishing increase of incidence in an epidemic disease, by virtue of which the epidemic curve first ascends rapidly, Langmuir supported Veterinary Public Health in then more slowly to a maximum, with a descent more rapid than the most situations, but there was one instance where ascent (9, p. 840).

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Langmuir opened the door that provided the opportu inars. Langmuir would occasionally participate to em nity to include the zoonoses that were not then in phasize the importance of teaching epidemiology. cluded and to correct and add new information. The Sometimes disease outbreaks disrupted the scheduled zoonoses remain an important part of the contents of conference, as in 1953, when western equine enceph the Handbook, and a veterinarian remains on the edi alitis exploded in Central Valley in southern Califor torial board-part of Langmuir's legacy to veterinary nia. Langmuir ordered all veterinary officers to Cali public health (11). fornia for epidemic aid. Thousands of horses were In 1953, Langmuir told me (1. H. S.) to find some examined and vaccinated. This was a successful oper competent veterinarians to bring into the EIS training ational integration of the medical, veterinary, and

program that year. It was a hurry-up recruitment that entomologic resources of the CDC. Downloaded from https://academic.oup.com/aje/article/144/Supplement_8/S47/110320 by guest on 01 October 2021 began in the spring when many new graduates were Demonstration of the CDC resources was enlight already committed to other activities. Nevertheless, an ening to both critics and supporters. Veterinary med outstanding group was assembled. The veterinarians ical schools became interested in teaching epidemiol that were recruited to the EIS were trained alongside ogy. As more graduates expressed interest in public EIS physicians. They worked well in all areas of health careers, recruitment became easier despite the epidemiology on both animal disease and non-animal end of the Korean War and the draft. disease problems. This was the beginning of a new Although the responsibility for milk, meat, and sphere of opportunity for veterinarians in public poultry inspection programs did not belong to the health, as attested to by their past and present contri CDC, the CDC did make valuable contributions to butions. The 1994-1995 EIS Directory shows that them. Clean milk and pasteurization programs were veterinarians are the second largest professional group successful, though some modifications had to be made to qualify as EIS officers and are now integrated into because of Q fever. The CDC Veterinary Public all activities of the Public Health Service, state health Health studies showed that a slightly higher tempera departments, agricultural agencies, colleges and uni ture of 145°F (63°C), an increase from 143°F (62°C), versities, other countries, and international organiza for 30 minutes was necessary. Veterinary Public tions. Positions included are assistant surgeon generals Health also recommended that all Grade A milk be in the Public Health Service; administrators of the US produced by Brucella-free herds (13). This raised ob Department of Agriculture and of the Animal and jections, but it ultimately came to be accepted. Poultry Plant Inspection Service; deans, associate deans, and inspection at the time was voluntary. The CDC be professors in universities; and researchers in industry lieved that there should be government inspection of and universities. all poultry. An epizootic of ornithosis from turkeys to In the 1950s, salmonellosis emerged as a problem in humans in Texas brought national attention to the fact poultry and pigs (12). The Institute of American Poul that there was no government-required inspection. try Industries challenged the epidemiologic finding Within a year or two, the poultry industry was ready to that poultry were a vehicle of human salmonellosis. accept a national poultry (chicken, turkey, duck, geese, Langmuir suggested that a national surveillance activ and other edible birds) inspection program, for which ity be organized. Eli Friedman and Philip Brachman Veterinary Public Health had demonstrated the need. did so and generated data that further affirmed that In 1959 -1961, the late Senator Hubert Humphrey salmonellosis was, and remains, a major public health had the US Senate Committee on Government Oper problem. Mildred Galton, a Florida bacteriologist, ations prepare a report, "Veterinary Medical Science demonstrated how extensive Salmonella bacteria were and Human Health" (14). Previously, this committee in Florida. When she joined the CDC, her laboratory had published other reports on health research to became the Veterinary Public Health laboratory, and which Langmuir had contributed. she trained many EIS officers in laboratory procedures As international stability returned after World War for salmonellosis. She also trained state veterinarians II and the Korean War, more foreign public health and foreign scientists. All contributed to developing veterinarians came to the CDC to work in its different the concepts and practice of epidemiology, surveil laboratories, and others came to learn epidemiology, lance, and disease control that Langmuir espoused. surveillance, and program development. Langmuir With the support of Langmuir and Andrews, Veter welcomed them to the program. Also, CDC staff mem inary Public Health seminars were held at the CDC, bers helped in developing Veterinary Public Health beginning in 1951, for state public health veterinari programs in the Pan American Health Organization ans, teachers, industrial consultants, and practitioners. and the World Health Organization, and they contrib The epidemiology and control of the emerging zoono uted to many Expert Committee meetings in Geneva, ses, especially rabies, were the attractions of the sem- Switzerland, Washington, and elsewhere. The Pan

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American Health Organization Veterinary Public the Surgeon General, 1956. 2. Steele JH. Animal health and the public health. In: Proceed Health program contributed a great deal to interna ings of the 51st Annual Meeting of the US Livestock Sanitary tional public health. All ofthe directors of the program Association, Chicago, Illinois, November 1947. Chicago, IL: were recruited, assisted, and encouraged in their op US Livestock Sanitary Association, 1948:140-5. erations by the CDC Veterinary Public Health pro 3. Williams RC. The United States Public Health Service, vet erinarians. Bethesda, MD: Commissioned Officers Associa gram. These same concepts that stressed epidemiol tion, 1951:543-5, 703, 708. ogy, surveillance, and evaluation were also 4. Tierkel ES. Control of urban rabies. In: Baer GM, ed. The incorporated into the US Department of Agriculture's natural history of rabies. Vol II. New York, NY: Academic Press, 1975:189-201. Animal and Plant Health Inspection Service by EIS 5. WHO Expert Committee on Rabies. Report on the first ses veterinary disciples of Langmuir, most notably James sion. Geneva, Switzerland: World Health Organization, 1950. Downloaded from https://academic.oup.com/aje/article/144/Supplement_8/S47/110320 by guest on 01 October 2021 Glosser, Administrator ofthe Animal and Plant Health (WHO technical report series no. 28). Inspection Service during the 1980s. 6. WHO Expert Committee on Rabies. Seventh report. Geneva, Switzerland: World Health Organization, 1984. (WHO tech Today, 50 years after the Mountin challenge, it is nical report series no. 709). clear that Langmuir's philosophy of surveillance and 7. Stoenner H. Q fever. In: Steele JH, ed. CRC handbook series epidemiology has been fully incorporated into the in zoonoses. Section A: bacterial, rickettsial, and mycotic control and prevention of disease, both domestically diseases. Vol II. Boca Raton, FL: CRC Press, 1980:337-49. 8. Steele JH. Veterinary public health activities of Public Health and in the international Veterinary Public Health pro Service. Mil Surg 1951;108:486-90. grams he helped to foster. Langmuir shared his knowl 9. Dorland's illustrated medical dictionary. 25th ed. Philadel edge and enthusiasm for epidemiology and surveil phia, PA: WB Saunders Company, 1974. 10. Schwabe CWo Economic toll of animal disease. In: Veterinary lance and for the control of disease throughout the medicine and human health. 3rd ed. Baltimore, MD: Williams world. His contributions live on through the monu & Wilkins, 1984. mental and continuing improvement that they have 11. Benenson AS, ed. Control of communicable diseases in man. brought to the health of both humans and animals and 15th ed. Washington, DC: American Public Health Associa tion, 1990. by making the world a better place for all creatures 12. Steele JH. Veterinary public health. In: Brandly CA, Jungherr great and small. EL, eds. Advances in veterinary science. Vol I. New York, NY: Academic Press, 1953:329-405. 13. Report of the WHOIFAO Expert Group on Brucellosis. Ge neva, Switzerland: World Health Organization, 1951. REFERENCES 14. Veterinary medical science and human health. In: Govern mental organizations. Prepared for the Committee on Govern 1. Selected papers of Joseph W. Mountin, M.D. Biographical ment Operations, United States Senate, Washington, DC, Au notes. Washington, DC: US Public Health Service, Office of gust 10, 1961.

Am J Epidemiol Vol. 144, No.8 (Suppl), 1996