TEXTE PARTIEL :
In 2001, on the 50th anniversary of the founding of the Epidemic Intelligence Service (EIS), four young cpidcmiologists and an HIS alumna gather around a table at the John Snow Pub in London. Each of the epidemiologists shares his or her life story: a South African epidemiologist testing the efficacy of a new human immunodeflciency virus vaccine; a young Hungarian engineer challenged with controlling the lethal effects of environmental pollution; a Thai epidemiologist who has the responsibility of setting her country's national prevention goals for the year 2020; and a Brazilian defining the epidemiology of health and disease in urban slums. As the conversation works Its way around the table, the EIS alumna is questioned as to who Alexander D. Langmuir was. Answering that question is the challenge of this article on Langmuir' contribution to the development of epidemitologic capacity around the world.
Four images emerge: 1) Langmuir the teacher, bringing Far, Snow, Goldberg, and Frost to life in the classroom; 2) Langmuir the visionary, who believed that anyone bright enough to be accepted into the EIS could, with a month's training in epidemiology and biostatistics, effectively respond at a moment's notice ("before the sun goes down or you are not going") to an epidemiologic emergency anywhere in the world; 3) Langmuir the mentor, who loved his offIcers, congratulating them when successes rolled in, providing them with new idea when investigations hit a blank wall, sending them back again and again until the job was done right, and showing concern for the officers and their families in their triumphs and tragedies; and 4) Langmuir the editor, returning draft number 10 with more red marks on it than draft number 1.
The global impact of this great man is best encapsulated by images of Langmuir's lighting the epidemioologic torch from the lamp of Farr; passing on this light of knowledge to the 672 EIS offIcers trained during his years (1949 -1970) as Chief Epidemiologist of the Communicable Disease Center (now the Centers for Disease Control and Prevention (CDC)); the continued spreading of this light to an additional 1,300 officers under the tutelage of Philip Brachman, Carl Tyler, and Stephen Thacker; and, in 1980, the development of Field Epidemiology Training Programs in other nations. "A thousand points of epidemiologic light" have been kindled and are providing direction for improving methods of disease control and prevention around the world.
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The hemorrhagic fevers
In 1968, CDC assistance was requested in the investigation of a cluster of deaths in Germany which was eventually linked to green monkeys imported from Africa. This was the CDC's first encounter with a new group of viral agents, subsequently classified as Filoviruses. Subsequent studies of this group of agents included investigations of the Marburg virus in South Africa, the Ebola virus in Zaire and Sudan, an Ebola-like agent that had been imported into the United States, and the 1995 Ebola epidemic in Kikwit, Zaire. Describing the 1992 US cases, C. J. Peters said, "The quarantine procedures that had been put in place as a consequence of the 1967 Marburg episode served to limit infected monkeys to the involved facility". This statement illustrates the important linkages between interational health and the legislative mandate of the CDC to protect the health of the American people.
Investigation of a new viral agent, the Lassa virus, in Nigeria and Sierra Leone led to the establishment of a high-security retrovirus laboratory at the CDC and a CDC field laboratory in Kenema, Sierra Leone. Studies conducted under Joseph McCormick at Kenema documented Lassa fever as the predominant cause of adult hospital admissions. Over the years, a multifaceted research agenda documented the basic epidemiology of Lassa fever; identified the role of a rat, Mastomys natalensis, in its transmission; documented that rodent control could decrease transmission; developed and tested methods for rapid clinical diagnosis; and developed an effective treatment regimen using antiviral drugs. McCormick now heads the Aga Khan University Department of Community Medicine in Karachi, Pakistan.
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As one looks at Langmuir's contributions to international public health, the most apparent (though not readily identifiable) "contributions" are the people who are alive today because of the use of basic epidemiologic principles to make disease prevention, control, and eradication a reality, and the future generations that will benefit. Also frequently unrecognized are the enormous economic savings that have accrued. In changing the face of international public health, Alexander Langmuir has truly passed the epidemiologic torch to the entire world.