American Journal of EPIDEMIOLOGY Volume 136 Copyright © 1992 by The Johns Hopkins University Number 8 School of Hygiene and Public Health October 15,1992 Sponsored by the Society for Epidemiologic Research SPECIAL SOCIETY FOR EPIDEMIOLOGIC RESEARCH (SER) ISSUE: Downloaded from PAPERS PRESENTED AT THE 25TH ANNUAL MEETING OF THE SER, MINNEAPOLIS, MINNESOTA, JUNE 9-12, 1992 INVITED ADDRESSES http://aje.oxfordjournals.org/ The Society for Epidemiologic Research (SER) and the Future of Epidemiology at Oxford University Press for SER Members on April 15, 2014 Milton Terris1 I appreciate very much this opportunity SOCIAL MEDICINE IN GREAT BRITAIN to help celebrate the 25th Anniversary of the In that same year, 1943, John A. Ryle, Society for Epidemiologic Research (SER). the Regius Professor of Medicine at Cam- I think it will be useful to present the histor- bridge, resigned his position to become the ical background to the Society's formation first Professor of Social Medicine in Great as a necessary prelude for discussing SER Britain, accepting the Chair which had just and the future of epidemiology. been established at Oxford University. This I was a student in 1943 at the Johns dramatic event signalized the leap from in- Hopkins School of Hygiene and Public fectious disease to noninfectious disease ep- Health, where Wade Hampton Frost had idemiology. As Ryle stated, "Public health served as the first Professor of Epidemiology. ... has been largely preoccupied with the Frost had defined epidemiology as "the sci- communicable diseases, their causes, distri- ence of the mass-phenomena of infectious bution, and prevention. Social medicine is diseases" (1), and the epidemiology courses concerned with all diseases of prevalence, at Hopkins were limited entirely to infec- including rheumatic heart disease, peptic ul- tious diseases. We studied Panum on Mea- cer, the chronic rheumatic diseases, cardio- sles (2) and Snow on Cholera (3), but the vascular disease, cancer, the psychoneu- great American classic of epidemiology, roses, and accidental injuries—which also Goldberger on Pellagra (4), was not men- have their epidemiologies and their correla- tioned. tions with social and occupational condi- tions and must eventually be considered to Received for publication June 19, 1992. be in greater or less degree preventable" (5). 1 Editor, Journal of Public Health Policy, 208 Mead- The British movement toward social medi- owood Drive, South Burlington, VT 05403. cine which Ryle symbolized was essentially This paper was presented as an Invited Address at the 25th Annual Meeting of the Society for Epidemiologic a movement toward noninfectious disease Research, Minneapolis, MN, June 9-12, 1992. epidemiology. 909 910 Terris The connecting link between infectious eminent epidemiologists, including Milton and noninfectious disease epidemiology in J. Rosenau, author of the first comprehen- Great Britain was Major Greenwood, Pro- sive American textbook on public health fessor of Epidemiology and Vital Statistics (14), who was Director of the Hygienic Lab- at the London School of Hygiene; President oratory from 1899 to 1909, then Professor of the Royal Statistical Society; primary au- of Preventive Medicine at Harvard Medical thor, with Bradford Hill, Topley, and Wil- School, Professor of Epidemiology at the son, of the pioneering work on the Experi- Harvard School of Public Health, and fi- mental Epidemiology (6) of infectious dis- nally Dean of the University of North eases; and author of Epidemiology and Carolina School of Public Health; and Wade Downloaded from Crowd Diseases, An Introduction to the Hampton Frost, who was assigned by the Study of Epidemiology, the first textbook to US Public Health Service to the Johns Hop- include cancer in its scope (7). kins School of Hygiene and Public Health Major Greenwood combined the two dis- in 1919 to develop the first university de- http://aje.oxfordjournals.org/ ciplines, epidemiology and biostatistics, in partment of epidemiology (15). his own person. The tradition of interdisci- The Hygienic Laboratory did not limit plinary collaboration at the London School itself to infectious diseases. One of its offi- of Hygiene was carried forward by Green- cers, Dr. Joseph Goldberger, solved the wood's colleagues, the epidemiologist Rich- problem of pellagra through investigations ard Doll and the statistician A. Bradford conducted from 1914 to 1930; these stand Hill. In 1950, Doll and Hill shared honors with John Snow's work on cholera as a with two American groups, Wynder and classic of epidemiologic research (4). In at Oxford University Press for SER Members on April 15, 2014 Graham, and Levin, Goldstein, and Ger- 1931, a year after the Hygienic Laboratory hardt, in publishing the results of the first was renamed the National Institute of major retrospective studies linking cigarette Health, Dr. H. Trendley Dean began his smoking and lung cancer (8-10). And it was important epidemiologic studies of fluorine Doll and Hill who carried out the first pro- and dental caries; these culminated in the spective study confirming this relation (II- Grand Rapids-Muskegon fluoridation ex- 13). They and their colleagues at the London periment conducted by the US Public School of Hygiene—including Donald Reid, Health Service. And, beginning in 1910, the Peter Armitage, and Jerry Morris—provided Service carried out numerous studies in oc- the most important center for the develop- cupational epidemiology, including investi- ment of noninfectious disease epidemiology gations of silicosis, lead poisoning, industrial in Great Britain. dermatoses, radiation, pneumoconiosis, and mercury poisoning (15). PUBLIC HEALTH IN THE UNITED After World War II, there was further STATES expansion of federal leadership in epidemi- ologic research. The Communicable Disease Research in noninfectious disease epide- Center was founded in 1946 by conversion miology in Great Britain developed primar- of the wartime agency for Malaria Control ily as an academic discipline. This was quite in War Areas; it is now the Centers for different from the situation in the United Disease Control, which is concerned with a States, where epidemiologic research had de- wide variety of infectious and noninfectious veloped primarily as a function of federal, diseases. Perhaps one of the most important state, and local health departments. In 1891, federal actions was the establishment of a the Hygienic Laboratory was organized by statistical unit in the National Cancer Insti- the US Public Health Service (then the tute under the leadership of a sociologist, Marine Hospital Service), and rapidly be- Harold Dorn. This unit, which included came the focal point for epidemiologic re- such outstanding statisticians as Jerome search in the United States. It was the train- Cornfield and Nathan Mantel, made major ing ground for many of the country's most contributions to the methodology of nonin- SER and the Future of Epidemiology 911 fectious disease epidemiology; it became, in Departments in cancer epidemiology; and a sense, the statistical nerve-center of the the Ohio State Health Department in the entire movement. During this period, also, epidemiology of occupational diseases. And the Framingham studies were begun by the local health departments in New York National Heart Institute. These turned out City, Chicago, and Los Angeles produced to be perhaps the most important investiga- important findings in the epidemiology of tions ever carried out in the field of cardio- cardiovascular disease. vascular epidemiology; they opened up an entirely new area of public health, pointing Downloaded from the way toward the conquest of the pan- ORIGINS OF THE SOCIETY FOR demic of coronary heart disease. EPIDEMIOLOGIC RESEARCH A number of the more advanced state The role of epidemiology in achieving ma- health departments also played important jor scientific breakthroughs received na- roles in the development of noninfectious tional and international attention in the dec- http://aje.oxfordjournals.org/ disease epidemiology. The people of Mas- ades following World War II. Funds were sachusetts, for example, alarmed by the made available for epidemiologic training growing problem of cancer and other and research. In the schools of public health, chronic diseases, "had demanded with in- the replacement of the infectious disease- creasing insistence that action be taken, and oriented chairs of epidemiology with repre- through a legislative resolve passed in 1926 sentatives of the new approach—a process the Massachusetts Department of Public which took several decades to complete— Health was committed to a program of can- was begun at Harvard in 1958 with the at Oxford University Press for SER Members on April 15, 2014 cer control" (16). George H. Bigelow and appointment of Brian MacMahon, an im- Herbert L. Lombard of that Department port from England who had been a fellow in carried out intensive investigations, both de- social medicine with Thomas McKeown in scriptive and analytic, of cancer epidemiol- Birmingham. The first textbooks of epide- ogy. Their pioneering work, Cancer and miology based primarily on noninfectious Other Chronic Diseases in Massachusetts, disease appeared: Morris's Uses of Epide- published in 1933, includes one of the first miology (18) in Great Britain in 1957, and case-control studies to demonstrate the re- MacMahon, Pugh, and Ipsen's Epidemio- lation of tobacco use to cancer of the buccal logic Methods (19) in the United States in cavity (16). This study was later extended to 1960. include lung cancer, for which the same Young people flocked to the field, re- relation was reported in 1945 (17). It was sponding to the increased opportunities for these findings that prompted Morton Levin training and research and to the excitement and his colleagues in the Division of Cancer of the rapidly growing list of accomplish- Control of the New York State Department ments of this new area of epidemiology. The of Health to undertake their landmark study professional epidemiologists were joined by of the relation of tobacco to lung and other pathologists, physiologists, chemists, intern- cancers, which, published in 1950 in the ists, and other specialists.