University of Minnesota

Early Academic Program at the London School of Hygiene and Tropical Medicine

From the late 1950’s on, according to Alessandro Menotti of Rome, the London School of Hygiene and Tropical Medicine (LSHTM) was universally considered in Europe “the School” for aspiring epidemiologists. This was true also for non-communicable diseases, from the foundation laid by A. Bradford Hill and the reputations of Professor Donald Reid and his teaching associates, Geoffrey Rose and Walter Holland. The European Office of WHO began to sponsor fellows in the early 1960s and scores of future epidemiologists eventually attended one or more of the post-graduate courses offered, two of which were more popular:

The two-week short course in Cardiorespiratory Survey Techniques was entirely devoted to topics in field operations: survey organization, questionnaire formulation and administration, blood pressure measurement, anthropometric measurements, respiratory symptoms and pulmonary function, ECG coding, and reporting of results. Grounding was in measurement error and variability and procedures to reduce intra- and inter-observer variation.

A solid four-month course in Medical Statistics and Epidemiology was presented with two days a week devoted to medical statistics, two days to epidemiology and (for those sponsored by WHO) one day to site visit research institutions in and around London. Both medical statistics and epidemiology included theoretical and practical classes on basic statistics, means, proportions, distributions, indicators of variability, t-test and chi square tests, correlation, and multiple regression and correlation, analysis of variance, sequential analysis and planning and design of experiments. A section was devoted to health statistics with elementary demography, mortality, life tables, and the use of computers. “Practical classes included solutions of problems with the terrible experience of using manually operated mechanical calculators.”

Topics covered general principles of epidemiology, host-environment interaction, measurements of disease and mortality, causes and risk factors and their measurement, the relation between risk factors and disease, and types of population studies and their design and organization.
Toward the end of the course a simulated survey was planned with fellows who were at the same time subjects, observers, and then analysts and interpreters of results.

Extensive site visits specially arranged by the European Office of WHO included visits with Michael Oliver in Edinburgh, WHO Headquarters in Geneva and Copenhagen, and the London School of Economics. Menotti describes the impressive latter visit, where “an investigator presented a study on all babies born in London during the first year after the end of World War II, with evolution of socio-economic conditions of the new generations as related to the…occurrence of tuberculosis. The report in 1967 covered the first 20 years of follow-up. My immediate reaction was that only some crazy guys could spend and wait so long…to build up a study” [he noted this after having recently collected 45-year mortality data for the Italian rural areas of the Seven Countries Study!]

Menotti comments further on the quality of instruction in 1967:

Principal teachers were Professors Donald Reid, Peter Armitage, and Richard Remington (Visiting Professor) while, among assistant professors was Ronald Prineas, future faculty member in Minnesota and Wake Forrest. Prof. Armitage, beyond the elegance of his presentations, was a little difficult to follow without a deeper mathematical background; Prof Remington was simpler and clear, despite [covering] the most complex multivariate approaches (and omitting the math.); Prof. Reid has been the teacher most clear…in my postgraduate training of any sort.

The atmosphere was definitely English-British, complemented by the international composition of the student group.

Marcel Kornitzer colorfully recounts his specially arranged three-day crash course in cardiovascular epidemiology at the LSHTM in December 1964, shortly after his chief, Jean Lequime , drafted him to lead epidemiological undertakings in Belgium.

Lequime obtained for me a WHO grant to tour European centers where research was ongoing before starting my own. Being afraid of flying at that time I criss-crossed Europe by train, ending my tour at the LSHTM, where I was introduced to the formidable Prof. Donald Reid by his secretary. He was forthcoming but astonished that I would only stay three days. He informed me that a certain G. Rose would work with me those days and also that his secretary would make a reservation for me to a theater performance called “The Mousetrap” that was running already for years in London. It was ritual that LSHTM visitors see it.

I then met Professor Rose who had already prepared for me an intensive short course. He first introduced the concept of standardization in epidemiological methodology, and then gave me the Minnesota Code for ECG classification and a special magnifying loupe. The first day was spent coding ECGs and in the late afternoon Prof. Rose reviewed my results. Many of my codes were, of course, wrong but he was soft-spoken and made the corrections in a kind and gentlemanly manner.

The second day he introduced me to the random zero sphygmomanometer he had designed to prevent digit preference bias in blood pressure recording. I worked the whole day on taped Korotkoff sounds using stopwatches to time the appearance, muffling, and disappearance of the sounds.
Finally, the third and last day Prof. Rose introduced me to the Rose standardized questionnaires on angina and claudication that I was to use in my first prospective study, the Belgian Bank Study. The kind reception I received at the LSHTM would become some years later a most fruitful and amicable scientific collaboration. (A. Menotti, M. Kornitzer, and H. Blackburn)