Founders of epidemiology and thier contributions

The document is a foundation to epidemiology. It describes at least well known contributes to epidemiology.More preciously,the article entails the details of the epidemiologists. Spelling errors may persist and your feedback may be submitted to the email address attached.

1. FOUNDERS OF EPIDEMIOLOGY AND THIER CONTRIBUTIONS

AUTHOR: SHAREEF NGUNGUNI 1
EMAIL: [email protected]
Contents
INTRODUCTION ................................................................................................ 2
DISCUSSION OF KEY PLAYERS ................................................................... 2
1. HIPPOCRATES (460-377 B.C) .............................................................. 2
2. JAMES LIND (1716-1794) ....................................................................................................... 3
3. EDWARD JENNER (1749-1843) ............................................................................................ 3
4. IGNAS SEMMELWEIS(1840s)............................................................................................... 3
5. MARY AND GEORGE SOPER .............................................................................................. 4
6. JOHN GRAUNT (1620-1674) .................................................................................................. 4
7. LEMUEL SHATTUCK (1850) ................................................................................................ 5
8. THOMAS SYDENHAM ........................................................................................................... 5
9. JOHN SNOW ............................................................................................................................ 5
10. BERNARDINO RAMAZZINI(1633 -1714) ......................................................................... 6
11. EDGAR SYDENSTRICKER (EARLY 1900s) ................................................................... 7
12. WILLIAM FARR ................................................................................................................. 7
13. FROLENCE NIGHTINGALE ............................................................................................ 7
CONCLUSION ..................................................................................................................................... 8
REFERENCES ...................................................................................................................................... 8

2. FOUNDERS OF EPIDEMIOLOGY AND THIER CONTRIBUTIONS

AUTHOR: SHAREEF NGUNGUNI 2
EMAIL: [email protected]
INTRODUCTION
According to Friis and Sellers (2009), Epidemiology refers to the study of
diseases in populations. It is concerned with the distribution and
determinants of health and diseases, morbidity, injuries, disability, and
mortality in populations. Epidemiology examines disease occurrence
among population groups, not individuals. Epidemiology is an
interdisciplinary field that draws from biostatistics and the social and behavioural sciences, as
well as from
the medically related fields of toxicology, pathology, virology, genetics, microbiology, and
clinical medicine.
Looking at ancient and classical literature, as well as traditional African practices, disease
was thought to originate from the actions of Deities and spirits. To become sick or die
prematurely was seen as mediated by demons or angels of death. The sufferer must have been
under their influence through sin or a spell. The solution was to consult a prophet, priest or
medium of the deity or spiritual healers to divine, appease, atone or cast away these evil
powers (Kumar et al 2005). The field of epidemiology has been contributed by several key
players who wanted to understand and explain illness, injury and death from an observational
scientific standpoint. They advanced the study of diseases from a supernatural viewpoint to a
standpoint based on scientific foundation. Initially epidemiological knowledge advanced
slowly with large sectors in time where little or no advance in in the field occurred.
(Gerstman 2013). The key players involved in development of epidemiology are elaborated
below:
DISCUSSION OF KEY PLAYERS
1. HIPPOCRATES (460-377 B.C)
Hippocrates was the first person to have examined the relationship between the occurrence of
disease and environmental influence. He developed ideas that diseases might be associated
with physical environment. He tried to explain the disease from rational perspective rather
than supernatural basis. Hippocrates identified hot and cold diseases and consequently hot
and cold treatment (Friis and Sellers 2009). According McGavin et al (2001), Hippocrates
put up an explanation that disease was due to the improper mixture of body fluids known as
humours. This was the beginning of evidence based medicine and for that, Hippocrates is
considered as the father of Medicine. According to his theory, there were four fluids
responsible for health, these included blood from the heart, black bile from the spleen, yellow
bile from the liver and phlegm or mucus from the brain. If any of these fluids were in an
incorrect proportion, disease resulted. It also postulated that there were also 4 elements
responsible for the changes of the humours and these were water, air, earth and fire (Kumar et
al 2005). He also gave advice on people pursuing the science of medicine and provided the
vision on the effect of the season of the year and cold and hot winds on health (Friis and
Sellers 2009). He also made some noteworthy observations on the behaviour of the general
public. For travelling physicians, Hippocrates suggested they become familiar with local
diseases and with nature of those prevailing diseases. The essentials of epidemiology noted
by Hippocrates included observations on how diseases affected populations and how disease

3. FOUNDERS OF EPIDEMIOLOGY AND THIER CONTRIBUTIONS

AUTHOR: SHAREEF NGUNGUNI 3
EMAIL: [email protected]
spread. He further addresses issues of diseases in relation to time, seasons,
place, environmental conditions, and disease control, especially as it
related to water and the seasons.
The broader contribution to epidemiology made by Hippocrates was that
of epidemiologic observation. His teachings about how to observe any and
all contributing or contributory factors of a disease are still comprehensive epidemiological
concepts (Friis and Sellers 2009).
2. JAMES LIND (1716-1794)
Designed first experiments to use a concurrently treated control group. In 1700s, it was
observed that armies lost more men to disease than to sword. James Lind, a Scottish naval
surgeon, focused on illnesses in these populations. His 1754 book a Treatise on scurvy
identified the symptoms of scurvy and the fact that the disease became common in sailors
after as little as a month at sea. Lind noticed that while on long ocean voyages, sailors would
become sick from scurvy. Lind noted that even though water was good and the provisions
were not contaminated, the sailors still fell sick. Lind pointed out that the months most
common to scurvy were April, May and June. Influenced by the Hippocratic theory of
medicine, Lind kept looking to the air as source of disease. Although not correct about the
link with weather and climate at sea, Lind looked at all sides of issue and considered what
was happening to the sick. Lind looked at the diet of the mariners which was gross and hard
on digestion extremely. Lind set up some experiments with mariners on study of scurvy. He
took 12 ill patients who had clinical symptoms of scurvy (Friis and Sellers 2009). He divided
the sailors into the group of two and each group was given an additional dietary intervention
and two men who were given citrus were fit for duties in 6 days. Lind observed that oranges
and lemons were most effective for remedies of scurvy at sea. Lind epidemiological work led
to the British navy to include limes or lime juice in the diet for seamen. Lind was also
concerned with the occurrence of disease in large groups of people. Lind made clinical
observations, used experimental design, asked classical epidemiological questions, observed
population changes and their effect on disease and considered sources of disease, including
place, time and season (Friis and Sellers 2009).
3. EDWARD JENNER (1749-1843)
According to Frederick et al (1999), Jenner founded clinical trials for vaccination to control
spread of smallpox. Jenner's work influenced many others, including Louis Pasteur who
developed vaccines against rabies and other infectious diseases. Jenner observed that
dairymen’s servants and milkmaids got cowpox and did not get small pox. Jenner attempted
to give a dairymaid, exposed to mild case of cowpox in her youth, a case of smallpox by
cutting her arm and rubbing some of the infectious grease into the wound. She did not
become ill. Cowpox was found to shield against smallpox. Jenner inverted a vaccination for
smallpox with this knowledge. The vaccine was used to protect populations from this disease
(Friis and Sellers 2009).
4. IGNAS SEMMELWEIS (1840s)
Semmelweis Pioneered hand washing to help prevent the spread of septic infections in
mothers following birth (Gerstman 2013). In the 1840s, one of the greatest fears a pregnant

4. FOUNDERS OF EPIDEMIOLOGY AND THIER CONTRIBUTIONS

AUTHOR: SHAREEF NGUNGUNI 4
EMAIL: [email protected]
mother had was dying of childbed fever. Babies were born to mothers
with the usual risks that warranted obstetric assistance, and this often
resulted in an uneventful birth, however after the birth of the child, the
mother would get an infection and die of child birth fever, a streptococcal
disease. Semmelweis began an investigation after many years of observing
the course and the symptoms associated with childbed fever (Friis and
Sellers 2009). The Viennese maternity hospital where Semmelweis was clinical director was
divided into two clinics. One clinic reported more death rates than the other. Semmelweis
observed that it was not the actual labour that was the problem but that the examination of the
patients seemed to be connected to onset of disease. Through clinical observation,
retrospective study, collection and analysis of data on maternal deaths and infant deaths and
clinically controlled experimentation, he was able to ascertain that the communication of
childbed fever was through germs passed from patient to patient by physicians in the process
of pelvic examinations as the medical students would come directly from death house after
performing autopsies of infected and decaying dead bodies and then would conduct pelvic
exams on mother ready to give birth (Friis and Sellers 2009). Hand washing or any form of
infection control was not common. Semmelweis discovered that any infected or putrefied
tissue, whether from a living patient or a cadaver, could cause the spread of disease and in
order to prevent that it was necessary that every person, physician or midwife, performing
examination should wash their hands in chlorinated lime upon entry to labour ward between
each examination. Mortality rates fell at unbelievable rates in the clinic due to hand washing.
It was known that hand washing with chlorinated lime between each examination reduced the
illness and deaths from childbed fever (Friis and Sellers 2009).
5. MARY AND GEORGE SOPER
Mary Mallon, a cook responsible for most famous outbreaks of carrier-borne disease in
medical history. Recognized as carrier during 1904 New York typhoid fever epidemic. When
source of disease was traced, Mary had disappeared only to resurface in 1907 when more
cases occurred. Again Mary fled, but authorities led by George Soper, caught her and had her
quarantined on an island (Gerstman 2013). In 1910 the health department released her on
condition that she never accept employment involving the handling of food. Four years later,
Soper began looking for Mary again when two new epidemics broke out; Mary had worked
as a cook at both places. She was found and returned to North Brother Island, where she
remained the rest of her life until a paralytic stroke in 1932 led to her slow death, six years
later (Friis and Sellers 2009).
6. JOHN GRAUNT (1620-1674)
Grant contributed to epidemiology in a different manner. In 1607 in London a systematic
recording of deaths commenced and was termed bills of mortality and this was the major
contribution to record keeping on a population and was the beginning of the vital statistics.
When grant took over the work he systematically recoded ages and gender, who died, what
killed them, and where and when the deaths occurred? He also recorded how many persons
died each year and the cause of death. Graunt summarised mortality data and developed a
better understanding of diseases as well as sources and causes of death. Graunt was the first

5. FOUNDERS OF EPIDEMIOLOGY AND THIER CONTRIBUTIONS

AUTHOR: SHAREEF NGUNGUNI 5
EMAIL: [email protected]
to develop and calculate life tables and life expectancy. He divide deaths
into two types of cause, acute and chronic (Greenberg et al, 2004).
7. LEMUEL SHATTUCK (1850)
According to Shattuck (1850), Shattuck Proposed creation of a permanent
state-wide public health infrastructure. Recommended establishing state
and local health offices to gather statistical information on public health conditions. Shattuck
report stipulated the importance of establishing state and local boards of health. It
recommended that an organised effort to collect and analyse vital statistics be established. He
also recommended the exchange of health information, sanitary inspections, research on
tuberculosis, and the teaching of sanitation and prevention in medical schools. Quarantine
Commissions (1857), 1
st
Public Health Book (1879), U.S. Public Health Service founded
(1902), Pure Food and Drug Act (1906), Pasteurization of milk (1913), 1
st
School of Public
Health (1913) were done due to Shattuck’s information of gathering information (Shattuck,
1850).
8. THOMAS SYDENHAM
Thomas Sydenham is regarded as a founder of clinic medicine and epidemiology. Thomas
Sydenham’s fundamental idea was to take diseases as they presented themselves in nature
and to draw up a complete picture the objective characters of each. He wrote what he
observed about diseases without putting aside traditional theories and knowledge about
medicine influenced his work and observation (Friis and Sellers, 2009). According to
Greenberg et al (2004), Sydenham’s contributions include [1] the advocacy use of quinine-
containing cinchona bark for treatment of malaria caused by Plasmodium malariae and
treatment of smallpox by using cinchona “Sydenham’s chorea” aka. St Vitus Dance [2] wrote
explanations about dysentery, pneumonia, mental disease, tuberculosis, influenza, trigeminal
neuralgia, croup and syphilis [3] he also introduced the idea that some diseases are acute or
chronic. He classified fever in 3 different levels which was continuous fever, intermittent
fever and small pox. Acute diseases included fever, inflammation and Chronic diseases, on
the other hand, were an imbalance condition of the humours as explained by Hippocrates and
it was due to environmental errors such as errors in diet and general manner of life and
advised the use of good diets and other remedies for disease treatments (Greenberg et al,
2004).
In an overview he contributed the knowledge of the causative agents of diseases, how to treat
them, the on-set of disease and how environment influences the health.
9. JOHN SNOW
John snow is considered to be the father of epidemiology. He carefully mapped the cases of
cholera in east London during cholera epidemic of 1854. At fourteen, he was apprenticed to
Dr William Hardcastle and when he was eighteen cholera epidemic struck in London and The
first symptom of cholera was nausea/queasiness, followed by stomach-ache, vomiting, and
diarrhoea so plentiful that it caused victims to die of dehydration. Dr William Hardcastle sent
Snow to treat the many coal miners who had fallen sick at the Killingworth Colliery until the
epidemic ended. In his time days cholera was believed to be caused by "miasmas",
poisonous gases that were thought to arise from sewers, swamps, garbage pits, open graves,
and other foul-smelling sites of organic decay (Greenberg et al, 2004). But he discovered that

6. FOUNDERS OF EPIDEMIOLOGY AND THIER CONTRIBUTIONS

AUTHOR: SHAREEF NGUNGUNI 6
EMAIL: [email protected]
the miners were working underground far from the swamps, sewers etc.
and thought that cholera was caused by invisible germs found in the hands
of the miners since they had no water to wash their hands. When a new
outbreak of cholera occurred he started to track the progress of the disease
and to know how it was spread. He noticed that the same room that one
victim was dead with cholera brought with similar cases and he concluded
that cholera was a contagion disease; this pushed him to examine sick patients and all of them
reported that their first symptoms had been digestive problems. This proved that the gut must
be ingested with polluted food or water since if the victims had absorbed cholera poison from
polluted air, then their first symptoms should have appeared in their noses or lungs not in
their digestive tracts (Susser and Adelstein, 1975). According to Gerstman (2013), after
another outbreak struck, Snow identified the source of the outbreak as the public water pump
on Broad Street and carried out chemical and microscope examination of a water sample but
the finding didn’t pose any danger to water pump. Snow later used a dot map to illustrate the
cluster of cholera cases around the pump. He also used statistics to illustrate the connection
between the quality of the water source and cholera cases. He showed that the Southwark and
Vauxhall Waterworks Company was taking water from sewage-polluted sections of
the Thames and delivering the water to homes, leading to an increased incidence of cholera.
Snow's study was a major event in the history of public health and geography.
Snow is regarded as the founding event of the science of epidemiology as he involved
descriptive epidemiologic investigation of outbreak in Soho district and analytic
epidemiologic investigation of cholera epidemic in which he compared death rates from the
sufferers where they got their water, either from Lambeth Water Company or Southwark and
Vauxhall Waterworks Company (Friis and Sellers, 2009).
10. BERNARDINO RAMAZZINI (1633-1714)
Ramazzini was interested in the practical problems of medicine and not in the ancient
theories of medicine a fact not well received by his colleagues. Through his curiosity and
unwillingness to the study of ancient theories, he became recognised for his innovative
approach to medical and public health problems (Gerstman, 2013). At the age of 60 he tried
to associate the barometric readings with the cause of disease by taking daily readings during
typhus epidemic. He came on a worker in cesspool and his conversation with them he was
told that continued work in this environment caused the worker to go blind. The event with
cesspool worker turned his mind to a general interest in the relationship of work and health.
Ramazzini observed that disease among workers arose from two causes (Friis and Sellers
2009). The first he believed, was the harmful character of the materials that workers handled
because the materials often emitted noxious vapours and very fine particles that could be
inhaled. The second cause of the disease was ascribed to certain violent and irregular motions
and unnatural postures imposed while working. He described the dangers of poisoning from
lead using potters in their glaze. He also identified the danger posed by the use of mercury as
used by mirror makers, goldsmiths, and others and he also observed that few workers reached
old age. If they did not die young their health was undermined that they prayed for death.
Ramazzini further examined the harmful effects of the physical and mechanical aspects of
work such as varicose veins from standing sciatica caused by turning the porter’s wheel, and
ophthalmia found in glassworkers and blacksmiths. He was also concerned for prevention of

7. FOUNDERS OF EPIDEMIOLOGY AND THIER CONTRIBUTIONS

AUTHOR: SHAREEF NGUNGUNI 7
EMAIL: [email protected]
the diseases (Friis and Sellers 2009). He suggested that the cesspool
workers fasten transplant bladders over their eyes to protect them and take
long rest periods. If their eyes were weak, they should get into different
line of work. Ramazzini described outbreak of lathyrism in Modena in
1690. He also described the malaria epidemics of the region and the
paduan cattle plague in 1712 (Friis and Sellers 2009).
11. EDGAR SYDENSTRICKER (EARLY 1900s)
Sydenstricker Pioneered public health statistician. He advanced the study of disease statistics
(morbidity). Three notable studies: Tuskegee syphilis study (1932-1970), Framingham heart
study (1948-present) and Epidemiology of cigarette smoking (1950’s - present) (Kasius,
1974). Sydenstricker saw that public health was related in important ways to the economic
health, size, and composition of populations (Gerstman 2013). He practiced public health at
the height of the infectious disease era: from his appointment as the first public health
statistician in the U.S. Public Health Service in 1915 until his death in 1936. Together with
Joseph Goldberger, in the 1920s he carried out a series of classic studies in the mill towns of
South Carolina, eventually demonstrating that dietary deficiency rather than infection was the
cause of pellagra, and furthermore, documenting how the social conditions of these towns lay
behind the dietary deficiencies of their inhabitants (Friis and Sellers 2009). Particularly
germane to the present discussion, at the Milbank Fund in the 1930s, Sydenstricker was an
advocate of population studies, and played an important role in funding the work on
contraception and fertility that led to Pearl’s 1939 The Natural History of Populations
(Kasius, 1974).
12. WILLIAM FARR
Farr is one of “founding fathers” of epidemiology. According to Susser and Adelstein (1975),
he took responsibility for designing and analysing the census over a period of more than 30
years, and played a key role in creating the British system of vital statistics, and demonstrated
its uses as epidemiology and demography now. From observations made by John Snow,
William Farr analysed several variables and their association with death from cholera and he
held the belief that elevation was the major contributor to the occurrence of the disease
(Greenberg et al, 2004). His statistics encompassed questions about the population and its
health and questions about economic growth on the other hand .He also presented how
topographical features are able to prevent certain diseases similarly to immunization since
John Snow discovered that people supplied with water from two companies in particular: the
Southwark and Vauxhall and the Lambeth water companies – which drew their water directly
from the Thames were particularly likely to suffer (Friss and sellers, 2009). Farr's research
was detailed and showed that mortality and elevation are inversely correlated. He showed
that improving health and reducing mortality could be compatible with stabilizing “the
condition of England (Friss and Sellers, 2009)
13. FROLENCE NIGHTINGALE
Nightingale is the founder of modern nursing. She tried to give nursing a highly favourable
status. According to Greenberg et al, (2004) Florence Nightingale trained nurses during the
Crimean war to treat the wounded soldiers. Since the soldiers were given poor care,
Medicines were in short supply, hygiene was being neglected, and mass infections were

8. FOUNDERS OF EPIDEMIOLOGY AND THIER CONTRIBUTIONS

AUTHOR: SHAREEF NGUNGUNI 8
EMAIL: [email protected]
common, many of them fatal. There was no equipment to process food for
the patients. The death rates were high but after her intervention the death
rates were decreased through improvement in hygiene. She believed that
the death rates were due to poor nutrition, lack of supplies, stale air and
overworking of the soldiers. She developed Model Hospital Statistical
Form on which she collected data and made statistics (Friss and Sellers,
2004). She found out that improving sanitary conditions reduces death rates. The data
collected and statistical method contributed to an organized way of learning, improving
medical and surgical practices; and also trained nurses to have an innate understanding for
their patients (Friss and Sellers, 2004).
CONCLUSION
Epidemiology is multidisciplinary in its nature and studies how physical and social
experiences across the life course impact lifelong health and wellbeing and it has been
contributed by different key actors to shape it as it is presented today.
REFERENCES
1. Frederick A. Murphy, E. Paul J. G, Marian C. Horzinek and Michael J. Studdert.
(1999).Veterinary virology, 3
rd
edition, academic press, London, U.K.
2. Friis, R.S., and Sellers, A.T. (2009).Epidemiology for Public Health Practice. 4
th

Edition. Ones and Bartlett publishers, LLC. USA
3. Gerstman, B.B. (2013), Epidemiology Kept Simply: Introduction to Traditional and
Modern Epidemiology 3
rd
Edition. John Wiley and Sons, Oxford, UK.
4. Greenberg,R.S.,Daniels,R.S.,Flanders,D.W.,Eley,W.J.,and Boring,R.J.(2004).Medical
epidemiology.4
th
Edition. McGraw-Hill medical New York, USA
5. Kasius, R.V. 1974. The Challenge of Facts: Selected Public Health Papers of Edgar
Sydenstricker. Prodist. New York, USA
6. Kumar, V., Abbas, K., Fausto, N. (2005).Robbins and Cotran Pathologic Basis of
Diseases. 7
th
Edition. Elsevier, Inc. Philadelphia, USA.
7. McGavin, M.D., Carlton, W.W., Zachary, J.F., (2001). Thomson’s Special Veterinary
Pathology. 3rd Edition, Mosby, Inc., USA.
8. Shattuck, L. (1850). Report of the Sanitary Commission of Massachusetts.
Cambridge: Harvard University Press, UK.
9. Susser, M. and Adelstein, A. (1975). Vital Statistics: A Memorial Volume of Sections
from the Reports and Writings of William Farr. The Scarecrow Press, Inc. Metuchen,
USA