Notes from Korstad, Robert Rodgers Dreaming Of A Time; The School of Public Health, The University of North Carolina at Chapel Hill, 1939-1989, UNC School of Public Health, 1990,

(Location on Vic's drive: K:\VicsStableFiles\HistoryOfUNCandSPHandRelated  -

See page 116 for photos of young Epidemiology faculty - John Cassel, John Fulton,  Al Tyroler, Cecil Slome, David Jenkins, Ralph Patrick, Bert Kaplan
page 163 for photos of Barbara Hulka, Gerardo and Al, Carl Shy, David Kleinbaum, Caroline Becker, Vic with Joyce Allen, Sherman James

"In 1932 the university also established a School of Public Administration to provide more formal training for public officials. An important feature of the new curriculum was a program in public health administration designed for physicians who were already engaged in public [21] health work or wished to enter the field. The faculty would be drawn from various schools on the Chapel Hill campus and from the State Board of Health in Raleigh. Unfortunately, when the school offered a 'Short Course in Public Health Administration' in the fall of 1933, only three students registered, and the course had to be canceled. The shortage of state funds prevented some interested persons from applying, but the program also needed to build a constituency among health workers if it was to succeed.
      Meanwhile, efforts to devise some workable scheme for public health work continued. M. V. Ziegler of the Public Health Service prodded the Medical School, the School of Engineering, and the State Board of Health to cooperate in offering two twelve-week short courses during the 1934-35 academic year. The eleven students divided their time between classroom instruction in sanitary engineering, vital statistics, and epidemiology and "practical work" at State Board of Health facilities in Raleigh and at county health departments. The program failed to attract enough qualified in-state students to justify continuing the courses the next summer, but Medical School Dean Charles Mangum appealed to the Public Health Service to provide funding that would allow the university to accept students from other states. The Public Health Service responded favorably, and Mangum prepared a plan for the State Board of Health to submit to Washington.
      This time the plan took, thanks in large measure to heightened interest in public health at the federal level." (Korstad, 1990, chapter 1, pp 21-22)  

"Four health officer trainees registered for courses during the winter quarter, but they were only the beginning. Students supported by funds from the Social Security Act began arriving in the spring. By March 28 [1936], fifty-one health officers, sanitary engineers, sanitarians, and sanitary officers had registered. All the members of Interstate Sanitary District Number 2, with the exception of Maryland, sent representatives. Rosenau taught epidemiology and the medical faculty helped out, but the staff of the State Board of Health handled much of the instruction and classroom work. Without their efforts, the school could not have opened." (Korstad, chapter 2, p26)

"When classes began in the fall of 1936, forty-six students enrolled in the Division of Public Health. Among them was A. Worth Petty, a recent graduate in sanitary engineering at North Carolina State College employed by the State Board of Health. The program "looked like a bonanza," he remembered, "because they were going to pay my salary and pick up all my travel, and a public health scholarship paid for the fees, tuition, and books. They broke us up into groups. If you didn't have a degree you were a sanitary officer. If you had a degree other than medicine or engineering you were a sanitarian. If you had a degree in engineering, of course, you were an engineer and a degree in medicine [made you] a health officer."
      Students took courses in public health administration, epidemiology, vital statistics, principles of sanitation, and child hygiene. 'The big course was epidemiology with Dr. Rosenau,' Petty recalled. 'This big book he had written, thicker than the Sears & Roebuck catalog, was the whole story on everything to do with communicable diseases.' Rosenau did not limit his instructional materials to the lectern, black- [p29] board, and textbook. The students staged a mock courtroom trial to demonstrate their knowledge of the social dimensions of disease control. Dr. Rosenau presided, dressed up in his black robe and wig. 'It was a remarkable course,' Petty recalled. 'We thoroughly enjoyed it.'" (Korstad, chapter 2, p31)

"The school's involvement in the campaign began a few years later when the State Board of Health allocated $17,500 for a professor of syphilogy and a staff to conduct research on venereal diseases. The school conducted a national search and selected Dr. William A. Fleming for the professorship. With a B.A. and M.D. from Vanderbilt University, where his father was a well-known southern historian, Fleming had gone on to The Johns Hopkins to study and conduct research on syphilis.
Shortly after Fleming came on board, the Rockefeller Foundation contributed additional funds for a major epidemiological study of VD. The school selected Dr. John Wright, an M.D. from Vanderbilt Uni- [p38] versity and a recent M.P.H. from The Johns Hopkins, to head the project. Initially the study targeted the Orange-Person-Chatham County Health District, but Wright soon realized the need to include a more urban area and added the Durham City-County Health Department. The project's goals included establishing the prevalence of syphilis in the area, gathering data to determine incident rates and trends, identifying the contacts of infected people, and developing programs to treat the afflicted. Wright and his staff used a number of innovative techniques. They collected data from a variety of sources and entered it on McBee keysort cards for analysis, the first application of computer technology at the school. Film strips provided an alternative method of instruction for patients, and recordings of nurse-patient interviews helped train public health nurses." (Korstad, p39)

"As the school began tackling some of the many health problems that faced the South in the postwar period, it lost its founding director. On April 9, 1946, at the age of seventy-six, Dr. Rosenau suffered a heart attack and died. In some respects Rosenau died at the height of his career. Only the year before, he had been elected president of the American Public Health Association, the final (and long overdue) tribute to one of the great leaders of the public health movement. Dr. Rosemary Kent, a student in Rosenau's last class and later a professor at the school, recalled the dean's last day in the classroom.

"Probably, short of construction blasts, nothing has ever rocked the building across the street [MacNider Building] as did the unaccustomed applause from the auditorium the day Rosenau closed the course in epidemiology in December 1945. On, on and on it thundered and rolled. Overcome at last. Dr. Rosenau turned to the stairs at the front of the room and slowly, quietly started down the long two flights to his office. And still the applause followed him every step of the way and could be heard by the staff on the ground floor Only then, with damp eyes, did the class depart. . . . He knew, as did somehow the students upstairs, that he had just delivered his valedictory.'"
(Korstad, chapter 3, p53)


"Dr. Cecil G. Sheps joined the faculty as associate professor of public health administration in the fall of 1947. A native of Winnipeg, Canada, Sheps received his M.D. from the University of Manitoba and his M.P.H. from Yale University. His parents were Jewish socialists from the Ukraine, who immigrated to Canada after the 1905 revolution. Sheps initially considered law and politics as the proper sphere in which to fight for his notions of social justice, but a lecture on the triumphs of public health convinced him otherwise. 'I was inspired by that lecture,' he remembered, 'and decided that I would go into medicine, that I could achieve my social objectives through medicine.' After a few years of general practice, a stint in the Canadian Army, and a job in public health in Saskatchewan, Sheps accepted a fellowship to study medical care administration at Yale. From there he ventured to Chapel Hill to teach a summer session in epidemiology and biostatistics. Sheps's army experience in venereal disease control attracted the attention of John Wright, and Wright offered Sheps a job. Wright and Sheps began sifting through the data collected by the venereal disease project and published their findings in a number of papers." (Korstad, p66)

"With the addition of new departments and faculty in the 1940s, McGavran pushed for a core curriculum. All M.P.H. and M.S.P.H. students were required to take Epidemiology, Public Health Administration, Public Health Statistics, Parasitism and Human Diseases, Principles of Sanitation, and Public Health Nursing." (Korstad, p87)

"Epidemiology had been one of the original departments in the school, headed first by Rosenau and then by McGavran. But administrative responsibilities left little time for teaching or research by either of the deans. "The result," McGavran wrote in the 1953-54 annual report, "is that this department, which should be the strongest in the School of Public Health, is actually the weakest." That situation began to turn around in 1954 when McGavran obtained funds from the Public Health Service to start a Chronic Disease Section, for which he hired Dr. John Cassel." (Korstad, p90) (intervening paragraphs about John Cassel)

"Epidemiology grew dramatically in 1958 with the addition of three new faculty members paid by training grants from the Public Health Service and NIH. McGavran wanted an experienced, well-known person for the job of chairman and, through John Cassel, contacted Dr. Sidney Kark. Kark was professor of social, preventive, and family medicine at the University of Natal in South Africa, but prior to his academic appointment had had extensive experience as a public health officer and as a research epidemiologist. Kark was at the time pursuing a job with the World Health Organization (WHO), but McGavran offered him a one-year contract to help direct the growth and reorganization of the department.
Kark left after a year to be WHO professor of public health and social medicine at the Hebrew University in Jerusalem. McGavran recommended John Cassel as Kark's replacement. A few years later McGavran wrote to Kark, 'I am sure you would be proud to see how well John Cassel has continued and developed your good work here in establishing a dynamic Department of Epidemiology. John is a jewel and is gaining more and more national recognition. His department is stimulating to students and faculty alike and intensely loyal to John. I think we have a new and fresh approach to the teaching of epidemiology which is going to make its mark.'
That fresh approach involved a focus on the social causes of disease. Michel Ibrahim, another future dean, came to study at the school in 1960. He spent one year in biostatistics, but a desire to use his medical [p91] background led him to transfer to epidemiology. Ibrahim described the insights that propelled Cassel's research and teaching: 'Most of medicine was very biologically oriented. We thought in terms of germs and degenerative diseases. He advanced the theory — he did not invent it, but he pushed it very hard — that social and psychological factors affect people's health. [He was concerned with] cultural values, societal values and stress and how they related to illness.'
While biostatistics and epidemiology flourished in the 1950s, the Department of Mental Health hung on for dear life." (Korstad, p92)  

"The other bright star in Dean Mayes's "constellation" was the Department of Epidemiology. The department undertook numerous studies in the 1960s, but the Evans County Cardiovascular and Cerebrovascular Epidemiologic Study drew the most attention. Evans was a small Georgia county about sixty miles inland from Savannah. Dr. Curtis Hames, a local physician in Claxton, noticed in the 1950s that the black patients he treated seemed to have a lower incidence of coronary heart disease than whites. He contacted the Public Health Service about the possibility of doing a study in Evans County to see if his clinical observations were correct, and if so what the explanation might be. The Public Health Service suggested that Hames contact the Department of Biostatistics at Chapel Hill for help in designing the program. Bernie Greenberg remembered the occasion:

The Public Health Service asked me to evaluate a research project proposed by a solo medical practitioner in private practice in Claxton, Georgia. I visited there for a few days with this physician but returned with serious doubts about the project's feasibility.
Nevertheless, I persuaded John Cassel to go back to Georgia with me a few weeks later to meet Dr. Curtis Hames in order to take a closer look at this project. I was still skeptical when we got on the plane to go there, but by the time we came home, John and I were thoroughly convinced that this project represented a unique epidemiological potential.
Between 1960 and 1962, 92% of Evans County's population over the age of forty underwent medical examinations and laboratory tests. The results confirmed Hames's observation. Black males suffered heart disease at half the rate of white men. More surprising, however, was the fact that white men in lower socioeconomic groups had rates comparable to blacks. When the investigators studied the population again between 1967 and 1969, there was less difference among white men. 'The only circumstances in which white men had as low rates as blacks,' John Cassel reported, 'was when they were both sharecroppers. The only relevant difference between white sharecroppers and all other white men that could be invoked to explain this finding was the high level of physical activity in sharecropping.' Hames and the school's epidemiologists concluded that psychosocial experiences and genetics might be contributing factors, but that levels of physical activity were primarily responsible: [p117]
That study grew exactly as John [Cassel] had predicted. Today it is the most famous nongovernmentally-administered cardiovascular study in the world. Dr. Curtis Hames turned out to have the medical and managerial capability that John had seen in him, and the Evans County project became a uniquely comprehensive field of study of heart disease in a natural, rural setting.
The project had given rise to hundreds of manuscripts, dozens of doctoral dissertations, and best of all, to some of the most important discoveries ever made about the precursors of coronary thrombosis, hypertension, and myocardial infarction. (13)

"The rapid expansion of the Departments of Environmental Sciences and Engineering, Biostatistics, and Epidemiology caused concern among some members of the faculty. The increasing emphasis on research was one issue, but, in addition, not everyone supported the strategy of building the school on soft money supplied by the federal government." (Korstad, 117-118)

[Korstad, pages 118-120 has an interesting description of issues about growing with federal research dollars]

"A more ambitious training and service project was "The Malawi Public Health Program," a Peace Corps project supervised by the Department of Epidemiology. The program took Peace Corps volunteers with no professional health training, brought them to Chapel Hill for four months of instruction and then sent them to Malawi in south central Africa to work on the prevention and cure of tuberculosis. The program's objectives were twofold: implementation of an integrated health program using nonprofessionally trained personnel and the training of national counterparts so that health activities could continue following the Peace [p130] Corps's withdrawal. John Cassel beamed with pride as he inspected the troops. 'I have just completed a tour of Malawi with Bill Peck looking at our Peace Corps project. I must say that even though I realize that it's still in its early stages, I was absolutely delighted with the way it had progressed. ... I am really proud of the training they got in Chapel Hill ... as they are probably the best-prepared bunch that have ever been sent out to Malawi.'" (Korstad, pp130-131)

"Although the practice-oriented departments improved during the 1970s, the research-oriented departments — epidemiology, environmental sciences and engineering, biostatistics, and parasitology and laboratory practice— remained the key to the school's national standing. A centerpiece of the Department of Biostatistics's research program in the 1970s was the Lipid Research Clinics Program." (Korstad, p159)  

"One of the more intriguing aspects of the [LRC] program was the participation of two clinics in the Soviet Union. In 1973 James Grizzle of the Biostatistics Department and Herman Tyroler of the Epidemiology Department visited the Soviet Union to work out plans for a cooperative United States-Soviet Union lipids research project. A few years later, Soviet specialists began visiting Chapel Hill. 'Flowering in the climate of detente,' an observer noted, 'the historic collaboration has seen visiting teams of scientists and physicians traveling back and forth . . . between the two countries working toward the mutual goals of cutting the high number of deaths from heart disease in both countries.'" (Korstad, p160)  

"To comply with these new [federal environmental] requirements and improve public relations, corporations began efforts to address some of their problems. This corporate campaign had two effects on the school. First, departments such as epidemiology, environmental sciences and engineering, and biostatistics contracted with firms to conduct health studies and run training programs. Second, a larger proportion of the school's graduates found employment in industry and nonprofit organizations.
One of the more interesting consulting projects involved the school in a cooperative venture with the United Rubber Workers Union and major tire companies. In 1970 the discovery of a respiratory illness associated with a chemical process in tire manufacturing spurred the creation of the Joint Occupational Health Program involving both the union and the tire manufacturers. The program contracted with the school to study health problems among rubber workers. Led by Dr. David Fraser, the Occupational Health Studies Group first conducted mortality studies and then began investigating environmental problems in the workplace. The long-term goal was to establish a system to monitor employees' health and to evaluate the health risks of new manufacturing processes.
The Department of Epidemiology also addressed itself to more local concerns. In cooperation with the North Carolina Affiliate American Heart Association and the Tarboro Clinic, Dr. Michel Ibrahim and Dr. Lawrence Cutchin directed a hypertension control program in Edgecombe County. High blood pressure was a major health problem in North Carolina, particularly among blacks and other rural people. The program sought to identify patients suffering from hypertension who could then be treated with different methods to determine levels of effectiveness. The program also taught physicians new ways of encouraging patients to maintain their treatment regimen." (Korstad, p164)

"The relatively small percentage of women on the faculty stemmed from structural factors, as well as from decisions by the school. In 1960, twenty years after the school began granting graduate degrees, women occupied roughly one-third of the faculty positions. By 1980 the proportion had slipped to less than 20 percent. The Departments of Public Health Nursing and Public Health Education accounted for the majority of the 1960 positions. The presence of these programs was notable because few schools of public health had either one. The federal gov- [p168] ernment's romance with health issues in the 1960s, however, benefited medical and scientific endeavors — disciplines that were dominated by men — rather than the helping professions, which were dominated by women. Nursing, education, nutrition, and maternal and child health lost ground to hard sciences such as epidemiology and biostatistics. The result was an erosion of the number of women at the school." (Korstad, pp168-169)

"University officials chose Dr. Michel A. Ibrahim, professor and chair of the Department of Epidemiology, to succeed Greenberg. Ibrahim had been a member of the school's community since 1960, when he began study for an M.P.H. in biostatistics. He switched fields and took a Ph.D. in epidemiology in 1964 before leaving for Buffalo, New York, to serve on the faculty of the State University of New York at Buffalo Medical School. In conjunction with his faculty position, he later became first deputy commissioner in the Erie County Health Department. Ibrahim returned to Chapel Hill in 1971 as a professor in the Department of Epidemiology and succeeded John Cassel as chair of that department in 1976. This combination of academic excellence, administrative ability, and familiarity with the school made Dr. Ibrahim an outstanding choice for the deanship." (Korstad, p172) [continues with Michel's description of the school's needs and the importance of the new building]