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This volume is dedicated to John E. Gordon, an extraordinary scientist and naturalist through his careers in bacteriology, medicine, and epidemiology. As a young bacteriologist and physician directing the huge fever hospital in Detroit in the 1930s he was appalled by the high prevalence of infectious diseases, particularly among young children. In those early days of nutrition studies he considered possible relations between infections and the nutritional status of the sick. Longing to document and understand a scarlet fever epidemic from its first to its last case he found the Rockefeller Foundation ready to support his goal. In his chosen site in Rumania he drew on the experience of the Rockefeller Foundation scientists in China, who had pioneered a community-based approach to primary health care, notably John B. Grant, father of the recently deceased head of UNICEF, James Grant. Meanwhile the Harvard University School of Public Health pursued Gordon to head its Department of Epidemiology, even before the now meticulously documented scarlet fever epidemic in Rumania had ended.
But only two years later World War II claimed John Gordon for six years. For two years he was responsible to the British government to identify all unrecognized epidemics in Britain. From 1943 to 1945, he was Chief of Preventive Medicine for all U. S. forces, first in Europe and then in Asia. In this capacity he learned how to use military units as the denominador base for studying the frequencies of every conceivable kind of disease and injury affecting the military. He quickly applied findings to the design, management, and evaluation of preventive and curative programs.
Returning to Harvard in 1946, John Gordon broadened his epidemiologic career into noninfectious disease and non-disease epidemiology. One example of the former was his work with Scrimshaw and Taylor on interactions between infection and malnutrition which led to the standard statement on the subject by the World Health Organization (Scrimshaw, Taylor, and Gordon, 1968). At the level of concepts, Gordon returned the word "epidemiology" from its earlier restriction to infectious diseases only to its broad meaning in Greek of "the study of things that happen to people."
In 1951 he took the first steps towards a longitudinal field study of rapid population growth, and of its component rates of birth, death, and migration. Gordon, as consultant, and I worked together on that study for seven years of field work in defined sets of Indian villages, and ten years, in Boston analyzing the data and reporting the findings. This included studies of non-diseases, such as conception, pregnancy, lactation, and migration. During the later years of our field work John Gordon also spent three months each year in Guatemala with Nevin Scrimshaw.
John Gordon had a direct hand in the development of the studies described in the first four chapters of this book. Through my role as a teacher of the Berggrens' he had an indirect hand in the design of the field projects described in the fifth and last chapter.
The earliest of these five field studies started in 1959, the latest in 1969. All are based on the long term study of the whole or known parts of defined rural populations. They reflect the recently acquired knowledge of that era of the high death rates in poor third world populations from common infections in the first two or three years of life; and the high rates of severe malnutrition as indicated by stunting and wasting at the same ages. The power of these studies to yield remarkable results depends on their meticulous design based on hypotheses of the active processes of infection and malnutrition in the context of rapidly growing and developing young bodies, and also on the persistent collection of data accurately projected to detect significant changes in rates of bodily and mental growth and development over periods of up to 24 years. The Haiti project was based on much the same background knowledge of infection and malnutrition as the other four cases. It engendered highly ingenious ways to keep costs within range of what Haiti might afford long term and country-wide. It was also the source of new insights into relations between fractured families and high child morbidity and mortality.
This set of cases illustrates persuasively the value of applying the concepts of long term field work within defined populations as the wave of the future in the permanently necessary primary health care services of all poor human societies.
Scrimshaw NS, Taylor CE, Gordon JE. (1968) Interactions of Nutrition and infection. Geneva: World Health Organization.
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