Centers for Disease Control and Prevention (CDC) and Joseph Mountin
The Communicable Disease Center, the first variant of the CDC, arose from the World War II Malaria Control in War Areas Agency and for a time was headed by USPHS officer, Joseph Mountin, known to this history as the founder of the Framingham Study. The new agency was the result of his vision that the nation’s public health needs could best be met by centers of excellence for environmental issues, for emerging problems in health, and for communicable diseases. He also observed that the urgencies of the Korean War and the Cold War required epidemiological intelligence, the seed concept for the later, much-admired CDC Epidemic Intelligence Service (Etheridge, 1992).
According to his memoirist, Hugh Leavell, “Mountin was recognized for his vision and his passion for facts. Never satisfied with the status quo, he sought the reason for things, and he kept asking what the people wanted done about their health. . . Because Mountin’s views of health were so dynamic, he not infrequently trod on the toes of those content to look backward rather than forward” (Leavell, 1953, 19).
According to Etheridge, “The CDC was the capstone of Joseph Mountin’s effort to supply state and local health units with the support they needed. It was focused on the traditional concern of public health–communicable diseases–but its approach would be different, its mission broader than anything attempted before” (ibid. 18).
Already in 1934, Mountin foresaw what came to be called the epidemiologic transition: “The outstanding factors which will determine the direction of public health activities in the next decades are the general aging of the population, and the increase in chronic diseases” (Etheridge 1992, 20).
Milton Terris, Public Health scholar who worked with Mountin in the American Public Health Association in the late 1940s, characterized thusly his contributions and personality: “Joseph W. Mountin was the foremost public health worker in the United States in the second quarter of this century. A public servant actively engaged in the administration of health services, who used theory and practice to create new programs and new horizons of public health. He was public health personified, concerned with improving the health of the public and finding new and better ways to do so. He was the public health worker for a very simple reason, perhaps too simple for these cynical times –namely, to serve humanity” (Terris 1983, 8)
Terris provides the most colorful anecdote on Mountin: “The story goes that at a conference of the public health establishment, the talk went on and on about coordination, integration,” and other impressive phrases like the ones we use today: ‘evaluation, comprehensive care,’ and the rest. Finally, Mountin couldn’t stand it any longer. He stood up, banged his fists on the table, and said: ‘You folks can do all the coordinating, integrating, and fornicating you want to do. Give me the money, I’ll do the job!’” (Ibid. 9).
On the still-contemporary topic of comprehensive versus categorical public health approaches to disease prevention, Terris explained how, with old-fashioned, Midwestern American realism, he proposed that the two of them should work together for an overall chronic disease program instead of continuing the popular categorical disease approach. Mountin quickly protested, pointing out that, “Members of Congress weren’t suffering and dying from ‘chronic disease,’ but from heart disease, cancer, and stroke” (ibid.).
According to Terris, Mountin was thoroughly modern in his early conviction that the basic approach to chronic disease must be prevention, that otherwise chronic disease problems would simply grow larger with time and an aging populace, and that the remarkable declines in morbidity and mortality to mid-century had resulted primarily from social changes, environmental control, immunization, and other public health prevention activities, while treatment services played a secondary role (ibid.).
In July 1946, when Mountin was head of the USPHS Bureau of State Services, the Communicable Disease Center was established in Atlanta as the Bureau’s field station. It was through Mountin’s connections, while in the Malaria Control Agency, with Emory University and with the head of the Coca Cola Company, that CDC was established in Atlanta, obtained a near-campus site, and eventually took an active academic role.
Mountin would argue before Congress that if NIH were to be concerned with basic research, CDC would be concerned with service to the states. In fact, CDC left NIH freer to pursue its basic research in chronic diseases. Its formulation would presumably get Mountin “off the back” of NIH by assuming responsibility for applying new knowledge directly to disease control.
In 1948, Mountin became frustrated at the inactivity of the Epidemiology Division at the new CDC, and, after a thorough search, engaged Alexander Langmuir from Johns Hopkins to head Epidemiology, thus assuring the intense and thoughtful pursuit of infectious disease control. As infectious diseases diminished in national urgency by the 1950s, two dramatic events established the further essentiality of CDC. First, was the Cutter Laboratory incident in 1955, when live virus got into the Salk polio vaccine, and the second, in 1957, the epidemic of Asian influenza, after which the CDC’s central position and its permanence were assured.
During the ‘60s, under the Great Society, CDC expanded rapidly and became involved in the world campaign to eradicate smallpox and in such side issues as NASA flights, assuring that no exchange of organisms occurred between Earth and Moon. In 1967, it became the National Communicable Disease Center and a bureau in the Public Health Service. In 1970, it became the Center for Disease Control, and in 1973 an agency of the Public Health Service.
In 1976, CDC got into political trouble with its massive swine flu vaccination for an epidemic that never materialized.
In 1980, the new name became: Centers for Disease Control. Barely had the new name taken hold when AIDS appeared.
In 1990 Congress extended the reach of CDC to promote healthy lifestyles. It seemed to historian Etheridge that “such an extended reach might have surprised even the visionary Joseph Mountin” (Etheridge 1992, xviii).
Eventually, each major unit of CDC became a Center sub-divided into divisions that further sub-divided into branches, so that today, cardiovascular diseases, for example, enjoy the position as a Division for Heart Disease and Stroke Prevention in a National Center for Chronic Disease Prevention and Health Promotion, among the presently named overall, Centers for Disease Control and Prevention; still CDC! (Henry Blackburn)
Etheridge, Elizabeth W. 1992. Sentinel for Health. A history of the Centers for Disease Control. University of California Press, Berkeley, Los Angeles: Oxford.
Leavell, Hugh R. 1953. The Role of the Local Health Department. Mountin Memorial Session. American Journal of Public Health 43: 19-24.
Terris, M. 1983. The Complex Tasks of the Second Epidemiologic Revolution: The Joseph W. Mountin Lecture. Journal of Public Health Policy, 4: 8-24.