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Epidemiology:
doi: 10.1097/01.ede.0000255222.91693.62
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Austin Flint, Clinician Turned Epidemiologist

Winkelstein, Warren Jr

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Readers with a medical background will immediately recognize “Austin Flint” as the name for the rumbling murmur of aortic regurgitation. Flint was a physician who described this murmur in 1866, and his interpretation has stood the test of time. Austin Flint achieved distinction in other respects as well: he helped to establish 2 major medical schools, served on the faculties of 6 medical schools, wrote a major medical text, and was the first American to address the British Medical Society.

So why should epidemiologists take notice of Austin Flint?

In October 1841, an epidemic of typhoid fever broke out in the tiny village of North Boston, 8 miles south of Buffalo, New York. Among its 43 inhabitants, 23 were infected, and 10 died. Thirty-one-year-old physician Austin Flint was sent by the county superintendent of the poor to investigate.

Flint found that a traveler from an area with typhoid was overcome by illness and stopped at the local inn. He died 4 weeks later. The first North Boston case occurred 21 days after his arrival. Many local residents, including the innkeeper and his family, had visited the sick traveler. Flint inferred that the illness had been transmitted by those contacts, rather than through miasmas, as was the prevailing theory.1

There was another theory among the villagers. The innkeeper was feuding with a man named Stearns, and had denied Stearns access to the inn’s well. As it happened, Stearns and his family were among those unaffected by the outbreak. This led some in the village to believe that Stearns had poisoned the well. Flint called in a medical examiner, who confirmed that typhoid—and not poisoning—was the cause of the deaths. Flint’s 1845 paper attributed the typhoid transmission to contagion, and became important in opposing the prevalent miasmatic theory of contagion.

Twenty-eight years later, Flint returned to the possibility that the well had in fact been the source of the outbreak – perhaps after reading William Budd’s observations of typhoid fever transmission through drinking water. Flint concluded that, indeed, the inn’s well must have been contaminated by the sick traveler’s excrement. Flint wrote, “It can hardly be doubted that the exemption of the family of Stearns was due to the animosity of the innkeeper, which led the latter to prohibit the use of his well, and compelled Stearns to dig a well of his own.” (italics in the original). Flint humbly reported his revised conclusions at the very first meeting of the American Public Health Association in 1872.2

Figure. Austin Flint...
Figure. Austin Flint...
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REFERENCES

1. Winkelstein W Jr. Observations on the history of epidemiology in western New York, 1843–1960. Am J Epidemiol. 1997;146:896–906.

2. Flint A. Relations of water to the propagation of fever. Reports and papers presented at the meeting of the American Public Health Association. New York, NY: Hurd and Houghton; 1873;164–172.

© 2007 Lippincott Williams & Wilkins, Inc.

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