AMERICAN JOURNAL OF EPIDEMIOLOGY
Copyright © 1976 by The Johns Hopkins University School of Hygiene and Public Health
Vol. 104, No. 4 Printed in U.S.A.
WADE HAMPTON FROST: AN APPRECIATION ERNEST L. STEBBINS1 Editors' note: The following paper was presented by Dr. Stebbins in Charlottesuille, Virginia on April 18, 1975 in celebration of the establishment of an endowed Professorship of Epidemiology by the University of Virginia Medical School in honor of Wade Hampton Frost, an alumnus. Dr. Stebbins had been a student of Dr. Frost's, and his presentation adds considerable biographical and personal information. It is, therefore, published in this issue along with the proceedings of the Reed-Frost Symposium.
ogy of yellow fever in the control of one of the most feared diseases of mankind. Not long after this experience, he was assigned to the newly formed Hygienic Laboratory of the Public Health Service, the predecessor of the National Institutes of Health. Here Frost not only had the opportunity to develop competency in the laboratory methods of the study of disease, but came under the influence of men such as Rosenau, Goldberger, and others who were exploring the frontiers of epidemiologic science. Frost was given the opportunity to apply his knowledge of laboratory techniques and natural skills in observation in the field through the investigation of epidemics. He was assigned to the study of epidemics of typhoid fever, poliomyelitis, and septic sore throat among others. At that time, much of the investigative work in epidemiology was largely descriptive in nature, but this was not satisfying to a man of Frost's inquiring mind. As an astute observer, he was meticulous in gathering data and organizing it in such a way as to make possible a detailed analysis from which inferences could be drawn. It was undoubtedly during this phase of his career that he became aware of the need for a more sophisticated approach to the analysis of the statistical data and set about improving the analytical approach to epidemiology which he was to continue throughout the remainder of his professional life.
I am pleased and honored to comment on the appropriateness in selecting a name for the Professorship in Epidemiology at the University of Virginia in honor of Wade Hampton Frost. It is quite appropriate that the professorship be named for Dr. Frost because it is he who is generally recognized as the most important contributor to the development of modern epidemiologic science. It is also fitting that this professorship be established at the University of Virginia since Dr. Frost was born not far from this campus and obtained both his undergraduate and professional education at the University of Virginia. Frost was a remarkable man in many respects, and would have adorned any branch of medical science to which he chose to devote his professional life. Undoubtedly, circumstances influenced his selection of epidemiology as the chosen field of endeavor. Upon graduation from medical school, Frost devoted two years to further his clinical knowledge of medicine and then, as was true of many graduates of the University of Virginia, joined the United States Public Health and Marine Hospital Service. Within months after joining the Service, he was assigned with other Public Health Service officers to investigate an epidemic of yellow fever in New Orleans. He found this a stimulating and rewarding experience and observed at first hand the successful application of the relatively new knowledge of the epidemiol1
Department of Public Health Administration, School of Hygiene and Public Health, The Johns Hopkins University, Baltimore, MD 21205.
At that time, typhoid fever was a major health problem, particularly in cities which drew their public water supplies
392
Downloaded from https://academic.oup.com/aje/article-abstract/104/4/392/48791 by University of Durham user on 30 January 2018
WADE HAMPTON FROST: AN APPRECIATION
from polluted streams. As the population increased, the extent of pollution increased and typhoid fever became both endemic and epidemic along the large river systems. A major study of this problem was directed by the Congress when the Public Health Service and the Hygienic Laboratory were given the responsibility for carrying out a program of study of water pollution and water purification. The laboratory was situated in Cincinnati and a group of physicians, sanitary engineers, and microbiologists were brought together to carry out the studies under Frost's direction. As director of the program, Frost's responsibility was to organize and correlate all of these studies and with his associates, masses of information were brought together and subjected to complex quantitative analysis in order to bring out the important underlying relationships between stream pollution and typhoid fever epidemics. The clarity and skill with which Frost presented these findings had a major influence upon the control of typhoid fever resulting from contaminated public water supplies. By this time, Frost was recognized as an outstanding epidemiologist and was called upon when major epidemiologic investigations were required. Among these was the devastating epidemic of poliomyelitis in New York City in 1916. Frost, with many of his associates from the Cincinnati group, undertook a detailed study of this epidemic; the subsequent report of this investigation constituted one of the first thorough investigations of a major epidemic of this disease. By a strange coincidence, early in 1918 Frost was assigned to do a statistical and epidemiologic study of influenza in the United States which was well under way when the pandemic of influenza of 1918 swept the world and Frost was swept into a global study of the disease, which he undertook in collaboration with Edgar
Downloaded from https://academic.oup.com/aje/article-abstract/104/4/392/48791 by University of Durham user on 30 January 2018
393
Sydenstricker with whom he continued to collaborate for many years. FROST, THE TEACHER
William H. Welch had long had a dream of the creation of an Institute of Hygiene and a School of Public Health and in 1916, the Rockefeller Foundation offered the Johns Hopkins University support for the development of such an Institute and School. Welch resigned his position in the Medical School to become the director of the new School of Hygiene and Public Health. The actual recruitment of faculty had been delayed by World War I, but upon the conclusion of the war, Welch actively began recruiting a faculty. One of the major research and teaching areas of the new Institute and School was to be in the field of epidemiology and Frost was clearly recognized as the outstanding epidemiologist of the country. Welch was able to persuade the Surgeon General of the United States' Public Health Service, Hugh Cumming, to assign Frost, first as a lecturer in epidemiology and then as professor and chairman of the Department of Epidemiology in the new school. Frost was admirably equipped to develop and direct the research activities in the field, but there was no precedent for the development of a major course for the training of physicians in epidemiology. However, Frost, a natural born teacher, from the beginning captured the interest and enthusiasm of his students. His lectures were prepared with great care, carefully organized and presented with clarity and precision. As examples of the epidemiologic method, Frost used classical studies by such men as Snow in cholera, Budd in typhoid fever, and Panum in measles. He also drew largely from his own experience which was presented with great modesty but with sound reasoning and stimulated the enthusiasm for the subject in his students. He developed to a high degree the "laboratory" method of teaching epidemi-
394
ERNEST L. STEBBINS
ology and presented the students with Professor of Biostatistics, and Huntington original data from illustrative investiga- Williams, Commissioner of the Baltimore tions and suggestions for the method of City Health Department, to develop within analysis of the material. Frost and his a section of the city surrounding the School assistants worked closely with small groups of Public Health, the Eastern Health Disof students in the laboratory and the infor- trict, which provided the opportunity for mal discussions of problems and issues the collection of pertinent data concerning were an important part of the educational the population and to observe the populaprocess. The problems presented for study tion over a long period of time. This in the laboratory were increasingly drawn laboratory for many years served as a from the current research activities of Frost major field of study for graduate students and others in the department. The major in epidemiology. emphasis in the course was to introduce the At the same time that Frost was interstudent who for the most part had been ested in the long-term observation of the solely concerned with the development of chronic diseases, he was also involved in disease in an individual to the considera- studies of the occurrence of minor respiration of disease occurring in the populations tory diseases such as the common cold. In and this to many of his students was a this area, another of his innovations was unique approach. the observation of the occurrence of minor respiratory disturbances, the common FROST, THE INNOVATOR cold, through voluntary collaboration with Throughout his career, Frost was looking student groups in 10 universities over a for new and innovative approaches to the period of time and in the families of faculty study of epidemiology and through his and professional groups also reporting to a innovations, the study of disease was central analysis unit. Through this mechagreatly modified. Rather than the study of nism he was able to sample broadly the epidemics, Frost conceived of epidemiology whole of the United States in terms of the as something much broader. He was con- occurrence of minor respiratory disease and cerned with the natural history of disease, developed a technique for involving widely both epidemic and endemic, acute and separated groups of individuals with a chronic. In order to accomplish this type of coordinating unit. This technique has been investigation, he early recognized the need used by many of his students and others in for continuous observation of population a wide variety of investigations, both clinigroups. The epidemiologic study of the cal and epidemiologic. occurrence of disease in the population FROST, THE PUBLIC HEALTH STATESMAN over a period of time captured his interest and for this purpose tuberculosis was Frost was primarily known for his selected as an area of intensive study. research and teaching activities, but his Working closely with students engaged in interests were always broader than the the tuberculosis control activities, data field of epidemiology. Throughout his cawere gathered on the occurrence of tuber- reer he recognized the practical applicaculosis in defined populations and sub- tions of the work that he was doing, and jected to detailed analysis which revealed became increasingly involved in the applipreviously unrecognized characteristics of cation of new knowledge in his field to the the spread of the disease. improvement of public health practice. Feeling the necessity to establish such a Frost continued as a consultant to the population laboratory near at hand, he was Surgeon General of the Public Health able in collaboration with Lowell J. Reed, Service and participated actively in the
Downloaded from https://academic.oup.com/aje/article-abstract/104/4/392/48791 by University of Durham user on 30 January 2018
WADE HAMPTON FROST: AN APPRECIATION
improvement of health services to the nation. As a member of the board of scientific directors of the International Health Division of the Rockefeller Foundation for many years, his influence on the development of epidemiologic research and public health practice on an international scale was significant. As a member of the advisory council and technical board of the Milbank Memorial Fund his influence was felt in many of their activities in both the United States and abroad. Frost took an active part in the American Public Health Association's activities through its section on epidemiology and on the executive board of the Association. After Frost's death the Association honored him though the establishment of the Wade Hampton Frost Lectureship in Epidemiology. FROST, THE MAN
Dr. Frost was a gentleman in the finest sense of the word. His personality was courteous, warm and friendly and he gave of himself unstintingly. His former students relied on him for friendly counsel and advice, and many of the publications of his
Downloaded from https://academic.oup.com/aje/article-abstract/104/4/392/48791 by University of Durham user on 30 January 2018
395
former students and colleagues bore the clear imprint of his thoughtful and friendly criticism and suggestions. All who knew him professionally and socially were enriched by this contact. An editorial appearing in the Baltimore Sun at the time of his death on May 1, 1938 expresses more eloquently than I can the feeling of all who knew him. One of the fine and rare spirits passed from this earth on Sunday morning in the death of Dr. Wade Hampton Frost. He was a distinguished figure in medical science. To his work his associates will give tribute in due course. But, with all gratitude for his notable professional services, it is of the man himself that those who knew him well will think in the hour of his departure. What they will think will be this: Wherever he stood, there knighthood remained in flower. His personality had many facets. He had deep wisdom for the affairs of life, and he had subtle and penetrating wit. He had an austere sense of duty and a fine instinct for leisure. He could be the Spartan and he could be the bon vivant. No matter which facet he turned to life, it shone as in the sun. No one can recall the mean or malicious as his contribution in any relationship. All who knew him recall at this time the thoughts and the acts that were generous and just, high of mind and mood. He made living a noble adventure. Those who were privileged to have his friendship find their sorrow embedded in deep thankfulness for his life.
Copyright © 1976 by The Johns Hopkins University School of Hygiene and Public Health
Vol. 104, No. 4 Printed in U.S.A.
WADE HAMPTON FROST: AN APPRECIATION ERNEST L. STEBBINS1 Editors' note: The following paper was presented by Dr. Stebbins in Charlottesuille, Virginia on April 18, 1975 in celebration of the establishment of an endowed Professorship of Epidemiology by the University of Virginia Medical School in honor of Wade Hampton Frost, an alumnus. Dr. Stebbins had been a student of Dr. Frost's, and his presentation adds considerable biographical and personal information. It is, therefore, published in this issue along with the proceedings of the Reed-Frost Symposium.
ogy of yellow fever in the control of one of the most feared diseases of mankind. Not long after this experience, he was assigned to the newly formed Hygienic Laboratory of the Public Health Service, the predecessor of the National Institutes of Health. Here Frost not only had the opportunity to develop competency in the laboratory methods of the study of disease, but came under the influence of men such as Rosenau, Goldberger, and others who were exploring the frontiers of epidemiologic science. Frost was given the opportunity to apply his knowledge of laboratory techniques and natural skills in observation in the field through the investigation of epidemics. He was assigned to the study of epidemics of typhoid fever, poliomyelitis, and septic sore throat among others. At that time, much of the investigative work in epidemiology was largely descriptive in nature, but this was not satisfying to a man of Frost's inquiring mind. As an astute observer, he was meticulous in gathering data and organizing it in such a way as to make possible a detailed analysis from which inferences could be drawn. It was undoubtedly during this phase of his career that he became aware of the need for a more sophisticated approach to the analysis of the statistical data and set about improving the analytical approach to epidemiology which he was to continue throughout the remainder of his professional life.
I am pleased and honored to comment on the appropriateness in selecting a name for the Professorship in Epidemiology at the University of Virginia in honor of Wade Hampton Frost. It is quite appropriate that the professorship be named for Dr. Frost because it is he who is generally recognized as the most important contributor to the development of modern epidemiologic science. It is also fitting that this professorship be established at the University of Virginia since Dr. Frost was born not far from this campus and obtained both his undergraduate and professional education at the University of Virginia. Frost was a remarkable man in many respects, and would have adorned any branch of medical science to which he chose to devote his professional life. Undoubtedly, circumstances influenced his selection of epidemiology as the chosen field of endeavor. Upon graduation from medical school, Frost devoted two years to further his clinical knowledge of medicine and then, as was true of many graduates of the University of Virginia, joined the United States Public Health and Marine Hospital Service. Within months after joining the Service, he was assigned with other Public Health Service officers to investigate an epidemic of yellow fever in New Orleans. He found this a stimulating and rewarding experience and observed at first hand the successful application of the relatively new knowledge of the epidemiol1
Department of Public Health Administration, School of Hygiene and Public Health, The Johns Hopkins University, Baltimore, MD 21205.
At that time, typhoid fever was a major health problem, particularly in cities which drew their public water supplies
392
Downloaded from https://academic.oup.com/aje/article-abstract/104/4/392/48791 by University of Durham user on 30 January 2018
WADE HAMPTON FROST: AN APPRECIATION
from polluted streams. As the population increased, the extent of pollution increased and typhoid fever became both endemic and epidemic along the large river systems. A major study of this problem was directed by the Congress when the Public Health Service and the Hygienic Laboratory were given the responsibility for carrying out a program of study of water pollution and water purification. The laboratory was situated in Cincinnati and a group of physicians, sanitary engineers, and microbiologists were brought together to carry out the studies under Frost's direction. As director of the program, Frost's responsibility was to organize and correlate all of these studies and with his associates, masses of information were brought together and subjected to complex quantitative analysis in order to bring out the important underlying relationships between stream pollution and typhoid fever epidemics. The clarity and skill with which Frost presented these findings had a major influence upon the control of typhoid fever resulting from contaminated public water supplies. By this time, Frost was recognized as an outstanding epidemiologist and was called upon when major epidemiologic investigations were required. Among these was the devastating epidemic of poliomyelitis in New York City in 1916. Frost, with many of his associates from the Cincinnati group, undertook a detailed study of this epidemic; the subsequent report of this investigation constituted one of the first thorough investigations of a major epidemic of this disease. By a strange coincidence, early in 1918 Frost was assigned to do a statistical and epidemiologic study of influenza in the United States which was well under way when the pandemic of influenza of 1918 swept the world and Frost was swept into a global study of the disease, which he undertook in collaboration with Edgar
Downloaded from https://academic.oup.com/aje/article-abstract/104/4/392/48791 by University of Durham user on 30 January 2018
393
Sydenstricker with whom he continued to collaborate for many years. FROST, THE TEACHER
William H. Welch had long had a dream of the creation of an Institute of Hygiene and a School of Public Health and in 1916, the Rockefeller Foundation offered the Johns Hopkins University support for the development of such an Institute and School. Welch resigned his position in the Medical School to become the director of the new School of Hygiene and Public Health. The actual recruitment of faculty had been delayed by World War I, but upon the conclusion of the war, Welch actively began recruiting a faculty. One of the major research and teaching areas of the new Institute and School was to be in the field of epidemiology and Frost was clearly recognized as the outstanding epidemiologist of the country. Welch was able to persuade the Surgeon General of the United States' Public Health Service, Hugh Cumming, to assign Frost, first as a lecturer in epidemiology and then as professor and chairman of the Department of Epidemiology in the new school. Frost was admirably equipped to develop and direct the research activities in the field, but there was no precedent for the development of a major course for the training of physicians in epidemiology. However, Frost, a natural born teacher, from the beginning captured the interest and enthusiasm of his students. His lectures were prepared with great care, carefully organized and presented with clarity and precision. As examples of the epidemiologic method, Frost used classical studies by such men as Snow in cholera, Budd in typhoid fever, and Panum in measles. He also drew largely from his own experience which was presented with great modesty but with sound reasoning and stimulated the enthusiasm for the subject in his students. He developed to a high degree the "laboratory" method of teaching epidemi-
394
ERNEST L. STEBBINS
ology and presented the students with Professor of Biostatistics, and Huntington original data from illustrative investiga- Williams, Commissioner of the Baltimore tions and suggestions for the method of City Health Department, to develop within analysis of the material. Frost and his a section of the city surrounding the School assistants worked closely with small groups of Public Health, the Eastern Health Disof students in the laboratory and the infor- trict, which provided the opportunity for mal discussions of problems and issues the collection of pertinent data concerning were an important part of the educational the population and to observe the populaprocess. The problems presented for study tion over a long period of time. This in the laboratory were increasingly drawn laboratory for many years served as a from the current research activities of Frost major field of study for graduate students and others in the department. The major in epidemiology. emphasis in the course was to introduce the At the same time that Frost was interstudent who for the most part had been ested in the long-term observation of the solely concerned with the development of chronic diseases, he was also involved in disease in an individual to the considera- studies of the occurrence of minor respiration of disease occurring in the populations tory diseases such as the common cold. In and this to many of his students was a this area, another of his innovations was unique approach. the observation of the occurrence of minor respiratory disturbances, the common FROST, THE INNOVATOR cold, through voluntary collaboration with Throughout his career, Frost was looking student groups in 10 universities over a for new and innovative approaches to the period of time and in the families of faculty study of epidemiology and through his and professional groups also reporting to a innovations, the study of disease was central analysis unit. Through this mechagreatly modified. Rather than the study of nism he was able to sample broadly the epidemics, Frost conceived of epidemiology whole of the United States in terms of the as something much broader. He was con- occurrence of minor respiratory disease and cerned with the natural history of disease, developed a technique for involving widely both epidemic and endemic, acute and separated groups of individuals with a chronic. In order to accomplish this type of coordinating unit. This technique has been investigation, he early recognized the need used by many of his students and others in for continuous observation of population a wide variety of investigations, both clinigroups. The epidemiologic study of the cal and epidemiologic. occurrence of disease in the population FROST, THE PUBLIC HEALTH STATESMAN over a period of time captured his interest and for this purpose tuberculosis was Frost was primarily known for his selected as an area of intensive study. research and teaching activities, but his Working closely with students engaged in interests were always broader than the the tuberculosis control activities, data field of epidemiology. Throughout his cawere gathered on the occurrence of tuber- reer he recognized the practical applicaculosis in defined populations and sub- tions of the work that he was doing, and jected to detailed analysis which revealed became increasingly involved in the applipreviously unrecognized characteristics of cation of new knowledge in his field to the the spread of the disease. improvement of public health practice. Feeling the necessity to establish such a Frost continued as a consultant to the population laboratory near at hand, he was Surgeon General of the Public Health able in collaboration with Lowell J. Reed, Service and participated actively in the
Downloaded from https://academic.oup.com/aje/article-abstract/104/4/392/48791 by University of Durham user on 30 January 2018
WADE HAMPTON FROST: AN APPRECIATION
improvement of health services to the nation. As a member of the board of scientific directors of the International Health Division of the Rockefeller Foundation for many years, his influence on the development of epidemiologic research and public health practice on an international scale was significant. As a member of the advisory council and technical board of the Milbank Memorial Fund his influence was felt in many of their activities in both the United States and abroad. Frost took an active part in the American Public Health Association's activities through its section on epidemiology and on the executive board of the Association. After Frost's death the Association honored him though the establishment of the Wade Hampton Frost Lectureship in Epidemiology. FROST, THE MAN
Dr. Frost was a gentleman in the finest sense of the word. His personality was courteous, warm and friendly and he gave of himself unstintingly. His former students relied on him for friendly counsel and advice, and many of the publications of his
Downloaded from https://academic.oup.com/aje/article-abstract/104/4/392/48791 by University of Durham user on 30 January 2018
395
former students and colleagues bore the clear imprint of his thoughtful and friendly criticism and suggestions. All who knew him professionally and socially were enriched by this contact. An editorial appearing in the Baltimore Sun at the time of his death on May 1, 1938 expresses more eloquently than I can the feeling of all who knew him. One of the fine and rare spirits passed from this earth on Sunday morning in the death of Dr. Wade Hampton Frost. He was a distinguished figure in medical science. To his work his associates will give tribute in due course. But, with all gratitude for his notable professional services, it is of the man himself that those who knew him well will think in the hour of his departure. What they will think will be this: Wherever he stood, there knighthood remained in flower. His personality had many facets. He had deep wisdom for the affairs of life, and he had subtle and penetrating wit. He had an austere sense of duty and a fine instinct for leisure. He could be the Spartan and he could be the bon vivant. No matter which facet he turned to life, it shone as in the sun. No one can recall the mean or malicious as his contribution in any relationship. All who knew him recall at this time the thoughts and the acts that were generous and just, high of mind and mood. He made living a noble adventure. Those who were privileged to have his friendship find their sorrow embedded in deep thankfulness for his life.
