Exhibition on the Evolution of Concepts and Methods of Epidemiology and a Panel Discussion on the People’s Epidemiology Library at the Royal College of Physicians of Edinburgh
Royal College of Physicians of Edinburgh, 9 Queen Street, Edinburgh, EH2 1JQ
Exhibition, Monday August 8 to Friday August 12, 9 am to 5 pm
Is health improving? Is health better elsewhere? How do we know what's effective in keeping us healthy? How do we know if a treatment works? These questions are answered in this Exhibition at the Sibbald Library of the Royal College of Physicians of Edinburgh, organised for participants of the World Congress of Epidemiology. The Exhibition, which is open daily during the week of the Congress, covers four key aspects of the discipline, namely measuring survival, classifying diseases, searching for causes, and assessing the effects of interventions. Participants are invited to visit the Exhibition during the week and/or sign up for a guided tour of the Exhibition, led by Iain Milne, Librarian of the College, on Thursday August 11, from 2 to 3 pm, (Places are limited for the guided tour, for further details and information on signing up please see below).
A fifth display in the Exhibition shows how epidemiological knowledge is disseminated. The term 'epidemiology' gained currency in 1802, when Don Joaquin Villalba published a chronicle of epidemics in Spain. Two centuries lapsed before the history of the ideas and concepts underlying the discipline appeared. Alfredo Morabia's A History of Epidemiologic Methods and Concepts documents this history. The James Lind Library (jameslindlibrary.org), which explains and illustrates the evolution of tests of treatments, inspired the idea of a People's Epidemiology Library. Professors Alfredo Morabia and Jan Vandenbroucke will lead a Panel Discussion with Audience Participation on the People's Epidemiology Library, entitled “Challenges and Opportunities in Communicating With Users of Epidemiology”. This will take place in the Queen Mother Conference Centre at the College on Tuesday August 9, from 7:30 pm to 9:30 pm. (Places are limited for the Panel discussion for further details and information on signing up please see below).
Guided visit of the Exhibition: Thursday August 11, from 2 pm to 3 pm
Iain Milne will comment on historic items that are sourced from the Rare Books Collection of the Royal College of Physicians of Edinburgh Library and the Ross Collection of the Royal College of Physicians and Surgeons of Glasgow. Participants will be able to handle and browse items on display, which illustrate the following themes:
Measurement of survival
The science of epidemics began with the analysis of population mortality, which led to the construction of life tables. Such survival tables generate 'expectation of life' values. The first item in the Exhibition is the 1662 publication by John Graunt (1620 - 1674) of Natural and Political Observations Made Upon The Bills of Mortality.
The earliest classifications were based on manifestations of disease. Illustrations of this second theme include Synopsis nosologiae methodicae, published by William Cullen of Edinburgh (1710 - 1790) and works by William Farr (1807 - 1883). The nosology in current use, the International Classification of Diseases (ICD10), is employed to generate mortality and morbidity statistics that are comparable within and among countries.
The search for causes
Simple hygiene prevents disease. This fact emerged from the 19th century observation in Vienna that medical students, who transited from the autopsy room to the hospital, were more dangerous than midwives to puerperal women (on exhibit is the rare and valuable copy of Ignaz Semmelweis's Etiology, Concept and Prophylaxis of Childbed Fever, as well as a 1795 copy of Alexander Gordon's A Treatise on the Epidemic Puerperal Fever in Aberdeen). Safe water is essential for good health. We know this from John Snow's 19th century publication On the mode of communication of cholera, in which he compares death rates in populations supplied by two London water companies. A healthy diet includes vitamins. In the early 20th century, individuals consuming corn-based diets were shown by Joseph Goldberger to be greatly at risk of contracting pellagra, a disease later shown to be a B vitamin deficiency that was endemic in the southern United States. Breast is best. A study of two groups of Berlin babies, by Janet Lane-Claypon, showed the special importance of breast-feeding during the early weeks of life. Smoking kills. We are sure of this from long-term monitoring, by Richard Doll and Austin Bradford Hill, of the mortality of a cohort of British male doctors from whom information on smoking habits was collected in 1951.
Methods for assessing the effects of interventions
- On scurvy, blood-letting, diphtheria and pertussis
The move to testing treatments, objectively, began over two centuries ago. In 1747, six treatment regimens were tried out prospectively by James Lind on six pairs of sailors suffering from scurvy aboard a British ship. Dramatic benefits were seen in the pair who received two oranges and a lemon each day for six days.
In 19th century France, the importance of ensuring comparability between study groups was demonstrated in evaluating regimens of blood-letting. The strong tradition of blind assessment in German pharmacology began with an assessment of two treatments of diphtheria. Physicians were asked to guess which patients had received which treatment (no difference was detected between the two). Random allocation was employed in a comparative study in the United States in the 1930s to assess whether the pertussis vaccine confers protection against whooping cough.
- On tuberculosis
A trial of a new antimicrobial, streptomycin, which was in short supply at the time, was reported in 1948. Conducted under the aegis of the British Medical Research Council, the trial greatly contributed to popularizing randomised controlled trials in medicine. It set out to demonstrate the efficacy of streptomycin against pulmonary tuberculosis. The design ensured comparability, since an eligible patient was assigned either to a group who received the current treatment (bed rest alone) or the trial treatment (bed rest plus streptomycin) by means of an allocation contained in a sealed envelope, which had been generated via a table of random numbers. Concealing the allocation sequence in this way assured unbiased allocation to the treatment and comparison groups. Comparison of outcome between the groups showed that streptomycin was effective.
Places are limited for the Guided Visit of the Exhibition, to attend delegates should sign up through the main congress registration process.
Free Wine and Cheese Reception & Panel Discussion with Audience Participation
“Challenges and Opportunities in Communicating With Users of Epidemiology”
Panel Members will include -
Iain Milne, Chair
George Davey Smith
Jan P. Vandenbroucke
Junior epidemiologist (TBA)
Date and Time: Tuesday August 9, from 7:30 pm to 9:30 pm
Place: Royal College of Physicians of Edinburgh, 9 Queen Street, Edinburgh, EH2 1JQ and the Foyer of the Queen Mother Conference Centre at the College (wine and cheese reception)
Special Feature: During the evening event, The People’s Epidemiology Library (PEL), a new online tool for communicating with users and the general public, will be launched officially. The PEL is a repository of documents and commentaries about milestone publications in the history of epidemiological methods and concepts. The PEL will be described and input sought on how the new tool fits in with current needs of users of epidemiology and their views on how to improve the tool’s format. Additionally, the results of an essay contest on how to present material to the lay public in the People's Epidemiology Library will be announced (see http://www.epimonitor.net, March 2011)
Places are limited for the Reception and Panel Discussion, to attend delegates should sign up through the main congress registration process.