Alexander D. Langmuir

CHANGING CONCEPTS OF AIRBORNE INFECTION OF ACUTE CONTAGIOUS DISEASES: A RECONSIDERATION OF CLASSIC EPIDEMIOLOGIC THEORIES

During the past 15 years, major programs have been launched against three so-called contagious diseases: smallpox, measles, and rubella. The results in terms of achievement of expected goals have varied in the extreme. The global eradication of smallpox within a decade rivals President Kennedy’s inaugural boast in 1960, “We will go to the moon in ten years.” The decline in measles incidence in the U S A . has been substantial but the stated goal of early eradication remains elusive. The rubella program was born in controversy and remains subject to constant reevaluation. The “best and the brightest” epidemiologists participated in the decisions to embark on these programs and have continued to carry them out. Their successes, failures, and haunting uncertainties can clearly be ascribed to the adequacy, or perhaps more correctly the inadequacy, of their understanding of the epidemiology of these diseases. More specifically successes can be attributed to flexibility to accept new information making preconceived attitudes obsolete. Central to the control of all three diseases is the understanding of the theory of contact and airborne infection and its corollary: herd immunity. In the present paper I will endeavor 1. To recall the prevailing attitudes among epidemiologists at the time these programs were started; 2. to reexamine the scientific validity of some of the theories that we so blithely accepted at the time; and 3. to appraise what we think we have learned from our vivid experiences during the past 15 years.

The surveillance of poliomyelitis in the United States in 1955

The role of the Public Health Service in the poliomyelitis problems of 1955 may be grouped into three main activities: (1) the licensing of products and producers and the clearance of vaccines; (2) the administration of federal grant-in-aid funds and of the voluntary interstate program for the distribution of vaccine; and (3) the surveillance of the disease and the field evaluation of the safety and effectiveness of vaccines. The present report will be limited to the surveillance activities. The National Poliomyelitis Surveillance Program was created by the Surgeon General of the Public Health Service on April 28, 1955, immediately after the recognition that cases of poliomyelitis were occurring in association with vaccine manufactured by Cutter Laboratories. The purpose of the program

The Epidemiology of Influenza

Although unpredictable, influenza outbreaks are known to occur in three patterns: pandemics every 30 to 40 years, with high excess mortality; epidemics much more frequently, with lower excess mortality; and usually mild sporadic outbreaks. The possibility of a swine-flu pandemic this winter, resembling that of 1918-20, is the result of a unique deviation in the epidemiology of this fascinating disease.

Outbreak of unusual form of pneumonia at Camp Gruber, Oklahoma, in 1944: Follow-up studies implicating histoplasma capsulatum as the etiologic agentm☆

Abstract An epidemic of disseminated pulmonary disease which occurred at Camp Gruber, Oklahoma, in 1944, following common exposure in an abandoned storm cellar, is reviewed. On the basis of the results of the comprehensive followup study reported here and certain other data which have accumulated in the literature since the occurrence of the epidemic, it is concluded that the outbreak was due to H. capsulatum. This is the first epidemic finally proved to have been caused by histoplasmosis.

The Contribution of the Survey Method to Epidemiology

MY remarks will be confined largely to the simple morbidity surveys conducted by trained, but non-medical, investigators who interview a sample of the general population. More complex surveys, utilizing professional personnel or laboratory diagnostic techniques, I shall class as special studies. I accept a broad definition of epidemiology as the science concerned with understanding the factors related to the occurrence and distribution of disease in the population. Epidemiology must consider both the sick and the well in their relation to each other and to their environment. The morbidity survey is a particularly useful epidemiological tool in that data on both the sick and the well are obtained concurrently. The problems arising from underreporting of cases, from arbitrary classifications of causes of death, and from unknown shifts of population between census years are largely eliminated. Morbidity surveys are of. special value in the study of the acute respiratory group of diseases and the chronic illnesses, for which routine sources of data are grossly inadequate or nonexistent. The survey method, however, is not restricted to these two groups