Better Know An Epidemiologist/History of Epidemiology is an ongoing feature where Mr Epidemiology pays tribute to people and studies who have set the stage for his generation of epidemiologists. All of the articles are listed here.
Epidemiology is a relatively new field. While John Snow made his breakthrough in the 1850s, even as recently as World War 2, there was no central epidemiology agency. However, with the start of the Korean War, the threat of biological warfare loomed. As a result, the government recognized the need for an organization who would track and monitor disease outbreaks.
Enter Alexander Langmuir.
Alexander Langmuir was born on the 12th of September 1910, in Santa Monica, California, and received his MD from Cornell in 1935. He then received his MPH from Johns Hopkins in 1940.
Following World War 2, Langmuir recognized the need for a national body of Epidemiologists. He spearheaded the creation of the Epidemic Intelligence Service (EIS), based in the CDC’s offices in Atlanta.Using the Korean War to provide the political will, and the FBI as a template, he argued for a disease-centric agency that was proactive rather than reactive. This language and thinking formed a fundamental part of the EIS, from naming EIS workers “officers,” to the name of the organization itself.
In order to encourage people to join the EIS, Langmuir negotiated for time spent with the EIS to count towards conscription, which was still active in the US at this time. As you can imagine, many young doctors viewed this as a much more favourable alternative to going overseas to fight. While initially EIS officers were almost exclusively physicians, they are now from a range of backgrounds, including physicians, statisticians, veterinarians and others. They are characterized by their willingness to go into outbreak areas, interviewing those affected and collecting samples for analysis and tackling the problem at a grassroots level. They describe their style as “shoe leather epidemiology,” and this is captured in the EIS logo.
I won’t cover the achievements of the EIS here – that will be the subject of a future post. They have a lengthy list of accomplishments, including eradicating smallpox, preventing disease outbreaks, reducing deaths from cholera among other things. And this was done under the tutelage and direction of Alexander Langmuir.
For example, when Langmuir started the EIS, one of the main public health issues of the day was malaria. However, due to a lack of precision surrounding the case definition of malaria, CDC epidemiologists spent a lot of time working with this disease, not knowing whether it was actually malaria or not. Langmuir insisted that all suspected cases of malaria were confirmed through blood smears. This led to a decrease in the “prevalence” of malaria, freeing up epidemiologists for other activities (prevalence in quotations since the prevalence didn’t actually decrease, just how they defined malaria).
Langmuir also designed the training program for EIS officers. Based heavily on his background as a physician, he ensured that new officers were on the front line, but monitored by more experienced officers, a process inspired by his experience as a medical resident. But even then, the sight of new EIS officers reading books and papers to learn everything about the outbreak they were going to investigate was commonplace. For an excellent history of the EIS, take a read of “Inside the Outbreaks: The Elite Medical Detectives of the Epidemic Intelligence Service” by Mark Pendergrast.
Langmuir’s influence is still felt throughout the field epidemiology community. The graduates of the EIS program that he helped develop have gone on to be leaders and have also set up similar programs across the world. Indeed, Canada’s own Field Epidemiology program is based on the EIS model.
Following his death in 1993, the American Journal of Epidemiology ran an issue dedicated to him. You can access the articles for free here: http://aje.oxfordjournals.org/content/144/Supplement_8.toc
And no, he wasn’t a skin doctor 😉
No authors listed (1996). A tribute to Alexander D. Langmuir. American journal of epidemiology, 144 (8 Suppl) PMID: 8928703
Brachman PS (1996). Alexander Duncan Langmuir. American journal of epidemiology, 144 (8 Suppl) PMID: 8857846
Schaffner, W., & LaForce, F. (1996). Training Field Epidemiologists: Alexander D. Langmuir and the Epidemic Intelligence Service American Journal of Epidemiology, 144 (Supplement 8) DOI: 10.1093/aje/144.Supplement_8.S16