David Lilienfeld1 has given us an interesting and instructive insight into the landmark contributions of 2 of the great men in epidemiology and biostatistics. I had the good fortune to have worked for and with both Abe Lilienfeld and Jacob (Yak) Yerushalmy.
Abe and I were both junior officers in the United States Public Health Service (USPHS) at the end of World War II. At the war's end, each of us was assigned to projects to evaluate the mass chest photofluorographic surveys that were so prominent a part of tuberculosis control at that time. Yak and Carroll Palmer (Director of the Research Section of the newly created Division of Tuberculosis Control in the USPHS) had designed 2 research projects to assess the importance of the asymptomatic cases of tuberculosis detected in mass surveys.
One research center was in Philadelphia. Cases there were invited to come to a central clinic for careful examinations that included collection of gastric fluid for tubercle bacilli. This was not a pleasant procedure. Participants soon learned that a request to report for examination “without breakfast” meant that a gastric examination was scheduled. Attendance after such a request was understandably low. Abe quickly saw that the Philadelphia study was doomed to failure. He resigned from USPHS and joined the research unit at the New York State Health Department. There he started a career that would lead to his recognition as one of the world's greatest epidemiologists.
I do not know the circumstances that led Abe to be assigned to the Research Section in Philadelphia. Certainly, Yak knew that Abe had a remarkably fertile mind and could make important contributions to any study to which he was assigned. Perhaps it was an unfounded fear that anti-Semitism would be a handicap in the other proposed research site in Georgia.
I went to Georgia, where the evaluation project was based on long-term follow-up of the surveys rather than on exams. Yak and Palmer had recognized that follow-up was another way to evaluate the value of these photofluorographic chest surveys. The first of these surveys was conducted in Chatham County (Savannah) Georgia in 1945. Because presurvey planning was needed to establish a facility for conducting the follow-up, the second mass survey was selected for this purpose. This second survey was scheduled for early summer of 1946 in Muscogee County (Columbus), Georgia. An added attraction was that the Muscogee County Health Officer, James A. Thrash, was anxious to have the follow-up facility in his Health Department. During the following years, he built a remarkably complete and competent health department through the integration of various special projects.
Following World War II, there was considerable political pressure for the United States to add Bacille Calmette Guerin (BCG) vaccination against tuberculosis to the other routine childhood vaccinations. This was spearheaded by the prominent philanthropist, Mary Lasker, and the Health Officer from Chicago where Rosenthal's strain of BCG vaccine was already in use. Partly to appease the proponents of BCG vaccination, and partly to answer the very real doubts about the place of this vaccination in tuberculosis control in the United States, the USPHS initiated 4 controlled trials of BCG vaccination. Two trials, among western Indian reservations, were soon discontinued because of difficulties in maintaining adequate follow-up. The other 2—one in Puerto Rico and the other in Muscogee County, Georgia—were completed, with follow-up for nearly 20 years.
Faced with the possibility that the use of BCG vaccine would become more widespread, Yak devised a scheme that would allow some evaluation of its usefulness. He proposed that children born in even years be vaccinated and children born in odd years be left unvaccinated as controls. This system was used in Muscogee County. Had BCG vaccination become more common, Yak's suggestion might well have salvaged useful information about its value.
It is clear from the preceding discussion that Yak had a major role in the Muscogee County Study. Abe had no direct connection with that study, but in his later role as Chairman of the Johns Hopkins Department of Epidemiology, his support was crucial in enabling me to continue long-term studies of the participants.
1. Lilienfeld DE. Abe and Yak: the interactions of Abraham M. Lilienfeld and Jacob Yerushalmy in the development of modern epidemiology (1945–1973). Epidemiology