Snippets from the Past: 70 Years Ago in the Journal

George W. Comstock

From the Department of Epidemiology, School of Hygiene and Public Health, The Johns Hopkins University, Baltimore, MD.


    INTRODUCTION
 TOP
 INTRODUCTION
 REFERENCES
 
Vital statistics of the American Journal of Hygiene in 1930 continued the trend set in 1929. The 79 papers tended to be long (18 pages in length on average). The great majority, 53, dealt with parasites ranging in size from tapeworms to viruses. Among the 60 first authors for whom full names were given, 13 were recognizably female.

In the January issue for 1930 were two papers by Edgar Sydenstricker and Rollo H. Britten (1Go, 2Go) on the frequency of abnormalities among 100,924 White male life insurance policy holders who had accepted a physical examination provided by the Life Extension Institute. Sydenstricker, trained as a political economist, had been selected by the US Public Health Service to be its first public health statistician in 1915 (3Go). An early assignment was to work with Joseph Goldberger in his study of pellagra in seven South Carolina mill villages. Here Sydenstricker's training as an economist led him to associate pellagra with economic conditions and also with diet when the findings were analyzed quantitatively rather than qualitatively (4Go, 5Go). In the 1920s, after a period of collaboration with Wade Hampton Frost on the epidemiology of influenza, he concentrated on what became his lifelong interest, the causes of human illnesses and disabilities. After his survey of illness among the textile mill workers and their families, he founded the Hagerstown Morbidity Studies in which for the first time a representative sample of families was interviewed periodically to record all their illnesses (6Go).

His two papers (1Go, 2Go) in this 1930 issue of the Journal continue and expand on the findings of the Hagerstown Morbidity Surveys. Although the population of life insurance policy holders was highly selected, it was large enough to minimize sampling errors and was based on medical examinations standardized to some extent by instructions from a central office. The frequencies of the most common abnormalities are shown in table 1. The age range of the examined population was from 20 to over 70 years. Its median age was 30.4 years compared with the median age of 32.6 years for US White males in the same age range in the 1920 Census. The 90th percentile for the two populations was 44.1 and 57.2 years, respectively. In spite of this difference, age adjustment to the 1920 US population made very little difference in the frequency of the detected impairments.


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TABLE 1. "Frequency of certain impairments among 100,924 native adult male life insurance policy holders upon medical examinations through the Life Extension Institute"*

 
The second of these two papers by Sydenstricker and Britten (2Go) dealt with the prevalence of various abnormalities by age. The authors pointed out that, while the absolute prevalences were not generalizable because of the selected population, the trends by age were likely to be applicable to most populations in similarly industrialized countries. (A similar phenomenon with respect to results by different examiners was mistakenly thought to have been discovered by an investigator who had only recently read Sydenstricker and Britten's paper (Go).)

R. A. Bolt, Director of the Cleveland Child Health Association, provided a careful review of the problems involved in attempting to validate the phrase, "Public health is purchasable" (8Go, p. 606). After deciding that infant mortality was likely to be a good indicator of community health and one also likely to be responsive to changes in public health practice, he examined data from the 99 cities with populations of more than 70,000 in 1923. The correlation coefficient of the infant mortality rates and official public health expenditures was only +0.045. Correlations with expenditures for maternal and child health and for school hygiene were also very low (-0.025 and -0.134) but were at least negative in sign. Bolt discussed possible reasons for such poor agreement, concluding that a major difficulty in this area was obtaining an appropriate accounting of expenditures by other agencies, notably voluntary organizations. A corollary of his findings was that health officers had very little control over expenditures for the improvement of infant and child health.

In a long paper (36 pages), Gafafer (9Go) reviewed speculations as to the causes of the well-known association of infant diarrhea and enteritis with changes in the weather, notably during the summer months. After an extensive correlational analysis of the situation in the "Inner Ring" of London for a 52-year-period, he demonstrated a definite direct association of temperature and humidity with infant deaths from diarrhea and enteritis and found no association with movement of air or rainfall. Unfortunately, his findings cast no light on the opposing views that heat and humidity operated by encouraging bacterial growth in the environment, especially in food and water, or by adverse effects on infant physiology.

Northwest River was a Hudson's Bay Company trading post located in the interior of Labrador (10Go). During the long winters, it was completely isolated except for rare deliveries of mail by dog team. In February 1928, the mail carrier was exposed to influenza when he picked up the mail from a village about 100 miles distant, became ill a day's journey from Northwest River, and had typical influenza on arrival. Two days later, a villager fell sick, and by the last case in mid-May, 121 of the 167 residents had developed a respiratory illness, 90 clearly influenzal in nature. The disease was most common and severe in older adults, sparing most of the children under the age of 15 years. There was no evidence of increasing virulence in spite of the rapid spread. A month after the last case, the virus appeared to be absent from the village since none of a visiting band of presumably susceptible Indians were affected.

A very long (60 pages!) and largely narrative report by Eugene Opie and E. Joyce Isaacs on tuberculosis in Jamaica was introduced by the statement, "The widespread occurrence of tuberculosis among the black population of the West Indies has long been known but there is little accurate knowledge concerning its prevalence, character and mode of spread" (11Go, p. 1). Their investigation, supported by the Rockefeller Foundation and the Henry Phipps Institute in Philadelphia, was hampered by an almost complete lack of health statistics. As a consequence, their report consisted of case reports and elementary analyses of a series of family histories. A noteworthy finding was the marked peak in tuberculosis deaths among young adults, somewhat greater for females than for males. This finding is reminiscent of tuberculosis mortality statistics in the United States in 1920. At that time, a peak of mortality among persons in their 20s was present for most states, was more noticeable among females, and was markedly greater among non-Whites (12Go). By 1940, this young adult peak had almost disappeared for Whites and had become much less prominent for non-Whites.

Another striking characteristic of tuberculosis among Jamaican Blacks was the high proportion of acute, severe tuberculosis cases. Compared with White tuberculosis cases in Philadelphia, Jamaican Blacks had highly bacilliferous sputum, and their disease was often fatal within a few months. Living quarters were extremely crowded, household contacts had an unusually high risk of developing tuberculosis, and it was not rare for whole families to be wiped out by tuberculosis within a few years. Older American phthisiologists will recall similar situations in the rural South that persisted into the 1940s. Although poor resistance to tuberculosis was often attributed to some genetic characteristic of Blacks, this does not seem to be the case. A comparison of clinical findings of tuberculosis cases in Maryland in 1970 showed essentially no differences between Blacks and Whites (G. W. Comstock, unpublished data).

By 1930, it had been well established that animals fed milk alone developed anemia, and that this could be prevented by the addition of iron and copper. J. Ernestine Becker and E. V. McCollum, then the dean of American nutritionists, set out to see if these two supplements were sufficient to support normal reproduction (13Go). A basic diet of milk powder and dextrinized starch, with the addition of ferric citrate and copper sulfate or of dried cooked liver (rich in iron and copper), not only maintained rats in apparent good health but allowed normal reproduction for at least four subsequent generations.

Two papers (14Go, 15Go) from the Department of Agricultural Chemistry, Ohio State University, reported on possible toxic effects of tartrate or sodium aluminum sulfate baking powders. Feeding rats a diet containing 2 percent of either type of baking powder produced no evidence of adverse effects on the digestibility of food, growth rate, longevity, reproduction, or macroscopic appearance of the internal organs of rats, the major test animal for human nutrition. Microscopic examinations of the kidneys were done with special care in view of the 1929 report by Seibert and Wells (16Go) of toxic effects of aluminum salts on the kidneys of rabbits. However, even in doses many times greater than that found in bakery products, there was no evidence of harm to rats from either form of baking powder. (The Seibert of the above reference is Florence B. Seibert, noted for her later production of a large batch of purified protein derivative of tuberculin (PPD-S) that until recently was used as the international standard. The "S" in PPD-S stands for "standard" (17Go, 18Go)).

While the term, "sick building syndrome," had not yet been invented in 1930, there had been interest in school ventilation since early in the 20th century. The New York State Commission on Ventilation was appointed in 1913 and made its first report in 1923. It was reconstituted as the New York Commission on Ventilation in 1926. Two papers in volume 12 are its first major reports (19Go, 20Go). Both dealt with respiratory illnesses in Syracuse schoolchildren. The frequency of respiratory illnesses was found to be highly dependent on the demographic characteristics of the pupils. Older male children were less likely to be absentees as were children of foreign-born parents. Judging which absences were due to respiratory conditions was found to be subjective, so that comparisons between schools based on different observers were not reliable. There was some indication that ventilation dependent on windows and gravity exhaust was more favorable than more modern fan-assisted ventilation systems. (Did this have to do with increased air leakage in older buildings?) Slight differences in temperature had no demonstrable effect. Decreasing air flow from 30 cubic feet per pupil per room to 15 cubic feet per pupil was associated with only a slight, nonsignificant increase in respiratory illnesses. Then, as now, identifying a specific cause for building-associated complaints could be exceedingly difficult.


    NOTES
 
Correspondence to Dr. George W. Comstock, Box 2067, Hagerstown, MD 21742-2067 (e-mail: gcomstock{at}mindspring.com).


    REFERENCES
 TOP
 INTRODUCTION
 REFERENCES
 

  1. Sydenstricker E, Britten RH. The physical impairments of adult life. General results of a statistical study of medical examinations by the Life Extension Institute of 100,924 white male life insurance policy holders since 1921. Am J Hyg 1930;11:73–94.
  2. Sydenstricker E, Britten RH. The physical impairments of adult life. Prevalence at different ages, based on medical examinations by the Life Extension Institute of 100,924 white male life insurance policy holders since 1921. Am J Hyg 1930;11:95–135.
  3. Wiehl DG. Edgar Sydenstricker: a memoir. In: Kasius RV, ed. The challenge of facts. Selected public health papers of Edgar Sydenstricker. New York, NY: Prodist, 1974:3–17.
  4. Terris M. Introduction. In: Terris M, ed. Goldberger on pellagra. Baton Rouge, LA: Louisiana State University Press, 1964:15.
  5. Goldberger J, Wheeler GA, Sydenstricker E. A study of the relation of diet to pellagra incidence in seven textile-mill communities of South Carolina in 1916. Public Health Rep 1920;35:648–713.
  6. Sydenstricker E. A study of illness in a general population group. Hagerstown Morbidity Studies no. I: the method of study and general results. Public Health Rep 1926;41:2069–88.
  7. Comstock GW. Reducing the effect of measurement variation. Am J Epidemiol 1981;114:784–5.[ISI][Medline]
  8. Bolt RA. Municipal expenditures for public health in cities of the United States of 70,000 population and over for the year 1923 in relation to their infant mortality rates. Am J Hyg 1930;11:601–18.
  9. Gafafer WM. Infant diarrhea and enteritis and climate, London, 1876–1927. Am J Hyg 1930;11:535–75.
  10. Smillie WG. An epidemic of influenza in an isolated community--Northwest River, Labrador. Am J Hyg 1930;11:392–8.
  11. Opie EL, Isaacs EJ. Tuberculosis in Jamaica. Am J Hyg 1930;12:1–61.
  12. Division of Public Health Methods, National Institute of Health; Tuberculosis Control Section, States Relations Division, US Public Health Service; Medical Research Committee, National Tuberculosis Association. Tuberculosis in the United States: graphic presentation. Vol 1. Mortality statistics for states and geographic divisions by age, sex, and race. 1943.
  13. Becker JE, McCollum EV. The nature of dietary deficiencies of milk. Am J Hyg 1930;12:503–10.
  14. Lyman JF, Scott E. Effects of the ingestion of tartrate or sodium aluminum sulfate baking powders upon growth, reproduction and kidney structure in the rat. Am J Hyg 1930;12:271–82.
  15. Kraft RM. The effects of the habitual use of tartrate and aluminum baking powders upon the utilization of food in the rat. Am J Hyg 1930;12:283–7.
  16. Seibert FB, Wells HG. The effect of aluminum on mammalian blood and tissues. Arch Pathol 1929;8:230–62.
  17. Seibert FB, Glenn JT. Tuberculin purified protein derivative. Preparation and analyses of a large quantity for standard. Am Rev Tuberc 1941;44:9–25.
  18. Seibert FB. Pebbles on the hill of a scientist. St. Petersburg, FL: St. Petersburg Printing Company, 1968:76.
  19. Cole R, Kimball DD, Lee FS, et al. A study of ventilation and respiratory illness in Syracuse schools; with an analysis of factors affecting criteria used. Am J Hyg 1930;12:196–214.
  20. Cole R, Kimball DD, Lee FS, et al. A study of ventilation and respiratory illness in Syracuse schools; rate of air flow and room temperature in relation to health of school children. Am J Hyg 1930;12:215–37.
Received for publication September 7, 2000. Accepted for publication September 18, 2000.





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