Reflections on the New York City Health Czar Proposal of 1977 and Its Origins.

New York City's fiscal crisis of 1975 was the result of many years of deficit spending to support a variety of expanded services and generous union contracts. These deficits were covered for years by the issuance of city short-term notes and long-term bonds. Eventually, the city's mounting debt of $14 billion led to its inability to sell its notes and bonds. In order to deal with the possibility of the city's financial collapse, the governor of New York State and the state legislature created the Emergency Financial Control Board (EFCB), whose purpose was to manage the city's budget and cost reduction plans. They also created the Municipal Assistance Corporation (MAC) responsible for fiscal oversight and the sale of specially issued bonds. Both agencies eventually played major roles in preventing the city's financial collapse. In an effort to address the costly 5,000 excess acute care hospital beds in the city, the governor and his advisors proposed the creation of a Health Czar (HC). The purpose of this position was to shift responsibility for hospital closures and downsizing from the state government to a para-governmental individual. While there was early support for this proposal by some print media, opposition soon arose because of the flawed structure of the proposal. Also, many initially opposed it because it included the city's public health agency, the New York City Department of Health (NYCDOH), which did not have any responsibility for hospitals. The HC proposal eventually lost broad support because it bypassed legally established processes for the oversight of hospitals. It also almost uniquely focused on the public hospital system, and in so doing gave a pass to the voluntary hospitals and their excess bed capacities. The proposal eventually lost the support of the then mayor when the governor publicly supported a rival candidate in an upcoming election. The election success of yet a third candidate opposed to the proposal resulted in its eventual abandonment by the governor.

The Depiction of Smallpox and Other Dermatologic Lesions on the Surfaces of Ancient Terracotta Statues from Mali, West Africa.

Between 1100 A.D. and 1700 A.D., terracotta statues were created in the Interior Delta of the Niger River in what is now the Republic of Mali. They are known as Djenné-Jeno terracottas because of their geographic proximity to an ancient town of that name. Some of these statues possess surface excrescences that have long perplexed archaeologists, art historians, curators, and others. This study of these surface excrescences employed clinical, diagnostic, and epidemiological methodologies to elucidate their possible meanings. It has not been possible to ascribe these excrescences to a single cause. However, examination of all the evidence permitted consideration of several possibilities. These include diseases such as smallpox, onchocerciasis, and the secondary stage of venereal syphilis. On certain statues, the anatomic placement of excrescences possibly symbolizes intentional cicatrization that resulted in keloid formation which may have been a form of beautification.

John P. Craig, MD, MPH. Physician-Scientist, Educator, and Mentor. 1923-2016.

John P. Craig (1923-2016) was an eminent physician-scientist, gifted educator, and greatly valued mentor. Born in West Liberty, Ohio on 29 November 1923, he attended Oberlin College, and received his medical degree from Case Western Reserve University, School of Medicine. This was followed by an internship at Yale University Medical Center, and then service in the U.S. Army during the Korean War. He was a battalion surgeon, preventive medicine officer, and epidemiologist. While in Korea, he conducted important investigations of hemorrhagic fever among American troops. His observations led to the recognition of hemorrhagic fever with renal syndrome, now called Korean hemorrhagic fever. He also identified a new Hanta virus. Craig received his Master of Public Health degree magna cum laude from the Harvard School of Public Health. He then worked with Nobel Laureate, Max Theiler, at the Rockefeller Foundation. Soon afterwards, he joined the faculty of the Department of Microbiology and Immunology at the State University of New York, Downstate Medical Center, where he established a new research laboratory. Over the years, his research focused on diphtheria infections and cholera. He became internationally respected for his work on cholera, and specifically on cholera toxin and its relationship to vascular permeability. He served for over 6 years as the Chair of the Cholera Panel of the U.S.-Japan Cooperative Program, and in this position set the direction for future research. The author of over 100 articles published in the peer-reviewed scientific literature, he also gave numerous presentations at national and international scientific meetings on a wide range of microbial diseases. Craig was highly regarded by colleagues and students as a superb teacher. He was a leader in initiating patient-oriented problem-solving (POPS) exercises for medical students. He also led curricular reform in the medical school in the 1990s whose purpose was to reduce lecture hours and expand time for small-group interactive sessions. Craig was designated Distinguished Teaching Professor by the State University of New York, and inducted as an Honorary Alumnus of the College of Medicine. The John P. Craig Award for Excellence in Microbiology and Immunology was established in 1993, and is annually presented to a graduating medical student. Following retirement to Tucson, Arizona, Craig devoted time to planning and teaching a tropical medicine course in Costa Rica that was co-sponsored by the University of Costa Rica Medical School and Louisiana State University. He was a member of the Board of Managers of the Wright Nature Center in Trinidad, and an active volunteer in the Herpetology Department of the Arizona-Sonora Desert Museum in Tucson, Arizona. He also had a great interest in ornithology. John P. Craig passed away in Tucson, Arizona on 27 September 2016 in his ninety-third year. He was an eminent success as a research scientist as well as an outstanding educator and mentor. As a result, he had a lasting influence on the lives and careers of both students and colleagues.

Charles William Lacaillade. Biologist, Parasitologist, Educator, and Mentor.

Charles William Lacaillade (1904-1978) was an eminent biologist in the middle decades of the twentieth century. He was born in Lawrence, Massachusetts of parents whose ancestors were French Canadians. His father, also named Charles William Lacaillade, was a dentist who graduated from Tufts University School of Dentistry in 1898. His mother, Elodia Eno, came from a family of very successful businessmen. Lacaillade was the third of six children. His two older brothers, Harold Carleton and Hector Eno, both graduated from the University of Louisville, School of Dentistry, while his younger brother, Lawrence, became a businessman. His sister, Luemma, married Dr. Henry Steadman, a veterinarian, while his youngest sister, Gloria, married a U.S. Army officer, Lieutenant Colonel Victor Anido. Lacaillade received his MS and PhD degrees in biology and zoology from Harvard University. He then became a fellow at The Rockefeller Institute for Medical Research. At both institutions, he studied under some of the most eminent biological scientists of the time. These included Rudolf W. Glaser, George Howard Parker, Theobald Smith, Carl TenBroeck, and William Morton Wheeler. At the Rockefeller Institute, he co-discovered the vector and mode of transmission of Eastern Equine Encephalomyelitis. This discovery, and the research he conducted with Rudolf W. Glaser, quickly established him as an outstanding biological researcher. However, a change in leadership at the Rockefeller Institute resulted in research priorities being given to the disciplines of general physiology, physical chemistry, and nutrition. This shift in the research agenda away from the biological sciences precluded career advancement at the Rockefeller Institute for post-doctoral fellows like Lacaillade. It was the height of the Great Depression, and even biologists with terminal doctoral degrees found it difficult to find positions. In 1935, Lacaillade accepted a position as an assistant in biology at St. John's College in Brooklyn, New York. Although a small single-gender college for men, the Department of Biology there under Dr. Andrew I. Dawson had an impressive record of research achievements. Lacaillade remained at this institution for the remainder of his career until his retirement in 1970. He eventually became Distinguished Professor of Biology, Chair of the Department of Biology, and the recipient of numerous awards and recognitions. Lacaillade quickly developed a reputation as an outstanding teacher, mentor, and scientist. He taught introductory courses in biology as well as advanced ones in parasitology and entomology. He preceptored graduate students and guided their dissertation research. Above all else, he was a superb mentor who provided sage advice to pre-professional students planning careers in medicine and dentistry. Lacaillade effortlessly adapted to the transformation of St. John's College, with an annual enrollment of some 600, to St. John's University, with an average annual student census of 20,000. He also oversaw the geographic relocation of his department from Brooklyn to the then new campus in Jamaica, New York in 1955. He proved to be a stabilizing presence during the faculty strike of 1966 and its aftermath which included a reorganization of the university. Throughout his life, Lacaillade was admired as a man of letters. His interests spanned art, literature, opera, and the theater. He had a passionate interest in English literature, about which he wrote, and was proud of his collection of first editions of English writers. Charles William Lacaillade was an eminent success as a research biologist early in his career. However, his greater successes came later as an outstanding educator and mentor. As such, he had a positive and lasting influence on the lives and careers of many students and colleagues. He passed away on 17 September 1978 in Danvers, Massachusetts.

Public Health Concerns Associated with the New York City Blackout of 1977.

The 1977 New York City blackout began at 9:36 p.m. on 13 July and lasted some 25 h until 10:39 p.m. on 14 July. The New York City Department of Health rapidly set up a Blackout Contingency Plan, established priorities, and mobilized its staff to address remedial interventions. Top priorities included water supplies, sewage disposal, perishable food supplies, hospital and emergency room services, solid waste disposal, beach contamination with untreated sewage , and assisting those on electrically powered home life support systems. The 1977 blackout occurred during an extended heat wave. An analysis of total deaths and deaths due to pulmonary and cardiovascular/renal diseases by day correlated with temperatures. However, there was no direct correlation with the blackout itself, in part perhaps because of the confounding influence of high temperatures. The increase of deaths on very hot days outside of the blackout period lends strong support to the relationship between increased deaths and high ambient temperatures. The 1977 New York City blackout was distinguished from those of 1965 and 2003 by violence, arson, and looting that occurred in several areas. These acts resulted in 204 civilian injuries, 436 police injuries, 80 firefighter injuries, and 1037 fires. The violence, arson, and looting caused extensive long-term physical and functional damage to certain areas of two boroughs of the city, Brooklyn and the Bronx. Although the New York City Department of Health had not previously established a disaster preparedness plan, its professionals quickly rose to the occasion because they were able to draw upon vast public health practice experience and ingenuity.

The Convergence of a Virus, Mosquitoes, and Human Travel in Globalizing the Zika Epidemic.

The Zika virus was first identified in 1947 in the Zika Forest of Uganda. It was discovered in a rhesus monkey that had been placed in a cage on a sentinel platform in the forest by the Virus Research Institute. When this writer visited the institute and the Zika Forest in 1961, work was underway to identify mosquito species at various levels of the tree canopy. This was done through the placement of traps at various levels of a 120-foot-high steel tower which this writer climbed. At that time, researchers isolated 12 strains of Zika virus from traps on the tower. Over the next six decades, the virus spread slowly to other parts of Africa, and eventually appeared in Southeast Asia, transmitted by Aedes aegypti and other Aedes mosquito species. By 1981, only 14 cases of illness had been reported as due to the Zika virus. Since most infections with this virus are either mild or asymptomatic, its true geographic spread was not fully appreciated. The current globalization of the Zika epidemic began on the Pacific island of Yap in the Federated States of Polynesia in 2007. This was the first known presence of the Zika virus outside of Africa and Southeast Asia. It was estimated that 73 % of the island's population had been infected. In 2013, the virus spread to French Polynesia where an estimated 28,000 cases occurred in a population of 270,000. During that year and afterwards, microcephaly and other congenital abnormalities were observed in the infants of women who were pregnant when they contracted the virus. It is currently not known if cases of microcephaly have resulted from infection of pregnant women or from infection plus some other co-factor. The epidemic rapidly spread to the Cook Islands and Easter Island. In 2015, Zika virus infection was diagnosed in Brazil where it was associated with microcephaly in the infants of some women who were pregnant when they contracted the disease. Cases of the Guillain-Barré syndrome were also found to be associated with Zika virus infection. How the disease entered Brazil is a matter of conjecture. However, the strain responsible for the epidemic in Brazil and elsewhere in South and Central America is phylogenetically identical to that which caused the epidemic in French Polynesia. The wide distribution of Aedes aegypti, a principal vector of the virus, and other Aedes species has greatly facilitated the spread of the disease. Aedes aegypti is an invasive species of mosquito in the Western Hemisphere that has adapted well to densely-populated urban environments. In addition, male-to-female human sexual transmission has increasingly been demonstrated in the US and elsewhere. In February 2016, the World Health Organization (WHO) declared the current Zika outbreak a Public Health Emergency of international concern. On the recommendation of its Emergency Committee on Zika Virus and Observed Increase in Neurological Disorders and Neonatal Malformations, WHO issued a group of recommendations to contain the epidemic. The globalization of the Zika virus was made possible by the widespread presence in various parts of the world of Aedes vectors and increased human travel that facilitated geographic spread. This globalization of Zika follows upon that of West Nile, Ebola, Dengue, and Chikungunya. Its ultimate spread is difficult to predict, but will hopefully be restricted through vigorous preventive measures.

Ensuring the Health, Safety and Preparedness of U.S. Medical Students Participating in Global Health Electives Overseas.

Global health electives based in resource-poor countries have become extremely popular with medical students from resource rich ones. As the number of such programs and participants increase, so too do the absolute health and safety risks. It is clear from a number of published reports that many institutions provide little or no meaningful preparedness for students and do little to ensure their health and safety. These deficiencies together can affect students, their foreign hosts, and sponsoring institutions. The School of Public Health at the State University of New York, Downstate Medical Center, and its predecessor, the Department of Preventive Medicine and Community Health, have sponsored a 6-8 week global health elective for fourth year medical students since 1980. The purposes of this elective are to provide students with an opportunity to observe the health care and public health systems in resource-poor countries, provide medical service, and have a cross-cultural experience. Over the course of the past 35 years, 386 students have participated in this global health elective in more than 41 resource-poor countries. Recent annual applications for this elective have been as high as 44 out of a class of 200 students. Over the past 10 years, annual acceptance rates have varied, ranging from a low of 32 % in 2007-2008 to a high of 74 % in 2010-2011 and 2013-2014. Careful screening, including a written application, review of academic records and personal interviews, has resulted in the selection of highly mature, adaptable, and dedicated students who have performed well at overseas sites. Appropriately preparing students for an overseas global health experience in resource-poor countries requires the investment of much professional and staff time and effort. At the SUNY Downstate School of Public Health, these resources have underpinned our Global Health in Developing Countries elective for many years. As a result, the elective is characterized by meticulous organization, extensive preparedness measures for students, and continuous monitoring of site and country safety. The health of students is ensured by one-on-one assessment of immunization needs, anti-malarials, and the provision of a five-day supply of post-exposure HIV prophylaxis. Students sign agreements regarding the legal issues, immunizations, and anti-malarials recommended as well as HIV post-exposure prophylaxis. They are also required to obtain medical evacuation insurance provided by the university, and medical care insurance valid overseas. Student travel plans are also approved as is in-country lodging. The focus of our 6-8 week global health elective is not clinical medicine. Rather, it is to enable students to learn about the health care and public health systems in a resource-poor country. Through that focus, they also come to understand the causes of health and health care disparities that exist in the country to which they are assigned. Our students are greatly advantaged with regard to cross-cultural understanding since our school is located in New York City's Borough of Brooklyn, where 40 % of the population was born outside of the U.S. Our comprehensive effort at risk management for this global health elective includes a thorough debriefing for each student upon his/her return. Special attention is given to ascertaining illness or injury while overseas, and, when necessary, immediate referral is made to an appropriate university clinical department where a student can be appropriately case managed. Meticulous oversight, careful selection of safe overseas sites, and attention to preparing students have resulted in significant risk reduction and successful experiences for the majority of our 386 students. This article describes the model we have developed for ensuring the health, safety, and preparedness of students participating in our global health elective.

The Second World Cholera Pandemic (1826-1849) in the Kingdom of the Two Sicilies with Special Reference to the Towns of San Prisco and Forio d'Ischia.

The second world cholera pandemic in Europe (1829-1849) was significant because of its geographic extent and the enormous numbers of people who fell ill or died. It was also singularly important because it demonstrated the profound levels of ignorance in both Europe and North America concerning the cause, modes of transmission, and treatment of cholera. This paper discusses the pandemic in the Kingdom of the Two Sicilies in great detail. Even though medical and public health authorities in this kingdom had several years to prepare for cholera's eventual arrival in 1836-1837, their elaborate preventive and therapeutic measures proved no more successful than elsewhere. Despite their efforts, it was estimated that there were 32,145 cases of cholera in the city of Naples by July 1837. Some 19,470 people were estimated to have died among the city's then 357,283 population. This amounted to a cholera-specific mortality rate of 54.5/1000 population. Sicily was also severely affected by the epidemic. It was estimated that 69,000 people died of cholera in Sicily, 24,000 of them in the city of Palermo. Two rural towns in the kingdom, San Prisco and Forio d'Ischia, were selected for in-depth epidemiologic study. The former had a population of 3700 in 1836-1837, while the latter had a population of 5500. The economic basis of both towns was agriculture. However, because Forio is located on an island, fishing and sea transport were then also important industries. Cholera appeared in San Prisco in July 1837 and quickly swept through the population. By August, the epidemic was essentially over. It is estimated that some 109 people died from cholera in San Prisco for a disease-specific mortality rate of 29.5/1000 population. The age range of those who died from cholera was 1 to 90 years. The majority of deaths (60.6 %) were among women. The first cases of cholera appeared in Forio d'Ischia in June 1837. The epidemic then peaked in July. It is estimated that approximately 316 people died from cholera in Forio out of a population of 5500. This resulted in a cholera-specific mortality rate of 57.5/1000 population. Among the first 42 fatal cases in whom the disease was documented on their death certificates, ages ranged from 15 to 88 years. The mean age was 52.4 years. The majority of deaths (57.1 %) were among women. We reached beyond the statistics of this epidemic by presenting an in-depth study of the first person to die from cholera in Forio d'Ischia, Nicola Antonio Insante. By focusing on him, we were able to develop a broad account of the social and economic consequences of his death on his family. At the same time, our research demonstrated the resiliency of his immediate and distant descendants. Similarly, we discuss the D'Ambra and Scola families of Forio d'Ischia, and the Caruso and Valenziano families of San Prisco, among whom a number died from cholera in 1837.

The Forced Surrender of Infants Born to Unwed Mothers in Southern Italy. A Case Study of Late Nineteenth Century Practices in the Town of Forio d'Ischia.

For many centuries, unwed mothers in southern Italy were forced to surrender their infants because of a number of social, religious, economic, and political pressures. This study focuses on the policies and practices that were in place in southern Italy regarding illegitimate infants in the late nineteenth century. A detailed analysis of the policies and practices present in the town of Forio d'Ischia during the 20-year period 1880-1899 is also presented. During these two decades, there were 37 illegitimate live births representing 0.70% of the 5249 live births recorded in this town. Although small in number, these illegitimate births, referred to as spuri in Italian, from the Latin spurius, meaning bastard, were managed by standard predetermined procedures. These included anonymity for the parents, the transfer of such infants to an official town receiver of foundlings, and their transport to Naples' orphanage, the Real Casa Santa dell'Annunziata. This orphanage maintained fairly detailed records about the children who were delivered to it. After a few days at the orphanage, infants were often entrusted to the care of external wet nurses, preferably outside of Naples. This was done in the belief that infant survival was better assured in more rural environments. The case of an illegitimate infant, Antonino Spinalbese, is presented in detail. Born on 14 February 1882 in the town of Forio d'Ischia, he was brought to the orphanage 4 days later. Following a two-day stay at the orphanage, he was entrusted to an external wet nurse, Michele Mondella, and her husband, Ciro Fiscale di Felice, a mariner in the town of Torre del Greco. The available evidence indicates that Antonino Spinalbese became a mariner like his stepfather. As a crew member of the passenger ship, Vulcano, he made three trips from Naples to New York City in 1922 and 1923.

Reflections on New York City's 1947 Smallpox Vaccination Program and Its 1976 Swine Influenza Immunization Program.

In 1947, a smallpox outbreak occurred in New York City with a total of twelve cases and two deaths. In order to contain this outbreak, the New York City Department of Health launched a mass immunization campaign that over a period of some 60 days vaccinated 6.35 million people. This article examines in detail the epidemiology of this outbreak and the measures employed to contain it. In 1976, a swine influenza strain was isolated among a few recruits at a US Army training camp at Fort Dix, New Jersey. It was concluded at the time that this virus possibly represented a re-appearance of the 1918 influenza pandemic influenza strain. As a result, a mass national immunization program was launched by the federal government. From its inception, the program encountered a myriad of challenges ranging from doubts that it was even necessary to the development of Guillain-Barré paralysis among some vaccine recipients. This paper examines the planning for and implementation of the swine flu immunization program in New York City. It also compares it to the smallpox vaccination program of 1947. Despite equivalent financial and personnel resources, leadership and organizational skills, the 1976 program only immunized approximately a tenth of the number of New York City residents vaccinated in 1947. The reasons for these marked differences in outcomes are discussed in detail.

A global health elective for US medical students: the 35 year experience of the State University of New York, Downstate Medical Center, School of Public Health.

The School of Public Health at the State University of New York, Downstate Medical Center has sponsored a 6-8 week global health elective for fourth year medical students since 1980. The purpose of this elective is to provide students with an opportunity to observe the health care and public health delivery systems in low-income countries, provide medical service and have a cross-cultural experience. Over the course of the past 35 years, 388 students have participated in this global health elective in more than 41 low-income countries. The most popular sites include the Dominican Republic, Guatemala, India, Kenya and Thailand. Overall, interest in this elective has persisted throughout the course of time, sometimes temporarily increasing or decreasing with outside factors, such as the events of 11 September 2001 and the outbreak of Severe Acute Respiratory Syndrome in Asia. Recent annual applications for this elective have been as high as 44 out of a class of 200 students. Over the past 10 years, annual acceptance rates have varied, ranging from a low of 32 % in 2007-2008 to a high of 74 % in 2010-2011 and 2013-2014. Careful screening, including a written application, review of academic records and personal interviews has resulted in the selection of highly mature, adaptable and dedicated students who have performed well at overseas sites. Student rated satisfaction levels with this elective are almost universally high, with most rating it the best experience of their medical school years. Students undergo extensive preparation prior to their travel overseas, including a review of individual health and safety issues, travel and lodging, and the nature of the host country culture, health care system and assignment site. Downstate medical students are especially experienced in cross-cultural understanding because of the unusual diversity of the patient population in Brooklyn, and the diversity of local hospital staff and the medical school class. The Alumni Fund of the College of Medicine has steadfastly supported this elective with both a philosophical commitment and financial grants to help defray costs since the very early years. The Dr. Michael and Lona B. Kennéy Endowment, the Joshua H. Weiner endowment, and the LSK Foundation have also provided financial support for this elective. Throughout the course of this elective, overseas preceptors have willingly given of their time and institutional resources to make these experiences available and meaningful for our students.

Clinical manifestations of Waardenburg syndrome in a male adolescent in Mali, West Africa.

Waardenburg syndrome (WS) is a genetic disorder of which there are four distinct types. These four types are differentiated by the physical defects which they produce. Presented here is the case of a 13-year-old boy with WS Type I who was observed and physically assessed in Mali, West Africa in 1969. His physical findings included a bright blue coloring to the irises of the eyes, profound sensorineural deafness, mutism, dystopia canthorum (lateral displacement of the inner canthi of the eyes), broad nasal root, bushy eyebrows, and scaphoid deformities of the supraorbital portions of the frontal bone. Because family members were not available for interviews or physical examinations, it was not possible to determine if this patient was suffering from a congenital form of the disorder or from a spontaneous mutation. Given the patient's then location in a remote rural area of Mali where electricity was absent, it was not possible to perform additional diagnostic tests. The patient described here is the first with WS in Mali, West Africa to have been medically observed and evaluated and later documented in the medical literature. A second case of the syndrome in Mali was described in the medical literature in 2011 in an 18-month-old infant who did not have sensorineural hearing loss, but who did have a bilateral cleft lip. An historical overview of WS is presented along with details concerning the characteristics of the four types of the disorder.

Smallpox inoculation (variolation) in East Africa with special reference to the practice among the Boran and Gabra of Northern Kenya.

Smallpox inoculation (variolation) was widely reported in sub-Sahara Africa before, during, and after the colonial era. The infective smallpox materials and techniques used, as well as the anatomical sites for inoculation, varied widely among different ethnic groups. The practice among the Boran and Gabra pastoralists of northern Kenya resembled that which was prevalent in a number of areas of Ethiopia. This is not surprising as the Boran also live in southern Ethiopia, and Gabra herdsmen frequently cross the border into this region. The Boran and Gabra technique for smallpox inoculation consisted of taking infective material from the vesicles or pustules of those with active smallpox, and scraping it into the skin on the dorsum of the lower forearm. Although the intent was to cause a local reaction and at most a mild form of smallpox, severe cases of the disease not infrequently resulted. Also, variolated individuals were capable of infecting others with smallpox, thereby augmenting outbreaks and sustaining them. The limited known reports of smallpox inoculation among the Boran and Gabra are presented in this communication. The expansion of vaccination with effective heat stable vaccines, the development of medical and public health infrastructures, and educational programs all contributed to the eventual disappearance of the practice among the Boran and Gabra.

New York City's innovative epidemiologist: the life and career of Morris Greenberg.

Dr Morris Greenberg was an eminent American epidemiologist who served with the New York City Department of Health for a 40 year period, from 1920 until his passing in 1960. In 1946, he became Director of the department's Bureau of Preventable Diseases. In this role, he set very high standards for outbreak and epidemic investigations joined with a commitment to scholarly research and collaboration with the city's medical centers. He received his medical degree from Columbia University College of Physicians and Surgeons and then interned at Bellevue Hospital in New York City. He later trained in pediatrics in Vienna, Austria and received a Master of Science in Public Health degree from Columbia University School of Public Health. In 1942, he became a member of the teaching staff at the School of Public Health. During his years with the New York City Department of Health he led efforts to control outbreaks of smallpox and rickettsialpox, and initiated important studies of poliomyelitis, hepatitis, trichinosis, congenital cardiac anomalies in children, and the embryopathic effects of rubella in pregnancy. Dr. Greenberg's outbreak and epidemic investigations were popularized by The New Yorker writer, Berton Roueché, whose most widely read book remains, Eleven Blue Men and other Narratives of Medical Detection. The book's title is based on Greenberg's investigation of accidental sodium nitrite poisoning among eleven elderly men in Manhattan who as a result, became cyanotic. A pioneer in epidemiology and the prevention and control of communicable disease, Greenberg established very high performance standards for the discipline before there was a Center for Disease Control and Prevention and an Epidemic Intelligence Service in the United States.

The correlation between global health experiences in low-income countries on choice of primary care residencies for graduates of an urban US medical school.

This study sought to determine whether medical students who participate in a global health elective in a low-income country select residencies in primary care at higher rates compared with their classmates and US medical graduates in general. Given the projected increase in demand for primary care physicians, particularly in underserved areas, understanding possible factors that encourage training in primary care or enhance interest in the care of underserved populations may identify opportunities in medical school training. The authors used data from the Office of Student Affairs, SUNY Downstate College of Medicine and the National Residency Matching Program to compare rates of primary care residency selection from 2004 to 2012. Residency selections for students who participated in the SUNY Downstate School of Public Health Global Health Elective were compared with those of their classmates and with residency match data for US seniors. In 7 of the 8 years reviewed, students who participated in the SUNY Downstate School of Public Health Global Health Elective selected primary care residencies at rates higher than their classmates. Across years, 57% of the students who completed the elective matched to primary care residences, which was significantly higher than the 44% for the remainder of Downstate's medical student class (p = 0.0023). In 6 of the 8 years, Downstate students who participated in the Global Health Elective selected primary care residencies at rates higher than US medical school seniors in general; rates were the same for both Downstate Global Health Elective students and US medical school seniors in 2009. Students who participated in a global health experience in a low-income country selected primary care residencies at higher rates than their classmates and US medical school graduates in general. Understanding how these experiences correlate with residency selection requires further investigation; areas of future study are discussed.

Mortality disparities among groups participating in an East Africa surveying expedition: the Herbert Henry Austin expedition of 1900-1901.

In the late nineteenth and early twentieth centuries, a number of European expeditions traveled to the region of Lake Rudolf, now largely in northern Kenya. Although diverse in intent, many of these were undertaken in the interests of furthering colonial territorial claims. In 1900-1901, Major Herbert Henry Austin led a British expedition down to the lake from Khartoum in the north. Of the 62 African, Arab, and European members of this expedition, only 18 (29 %) arrived at its final destination at Lake Baringo in Kenya. Because of a confluence of adverse climatic, social, and political conditions, the expedition ran short of food supplies when it arrived at the northern end of the lake in April 1901. For the next 4 months, the members of the expedition struggled down the west side of the lake and beyond. The greatest mortality (91 %) occurred among the 32 African transport drivers who were the most marginally nourished at the outset of the trip. The lowest mortality among the Africans on the expedition (15 %) occurred among the members of the Tenth Sudanese Rifles Battalion, who had an excellent nutritional status at the start of the expedition. Major Austin himself suffered from severe scurvy with retinal hemorrhages which left him partially blind in his right eye. An analysis of the mortality rates among the groups that participated in this expedition was undertaken. This revealed that poor nutritional status at the start of the trip was predictive of death from starvation.

The management of subacute bacterial endocarditis superimposed on rheumatic heart disease in the immediate pre-penicillin era: the case of Pasquale Imperato.

Subacute bacterial endocarditis (SBE) was invariably a fatal disease in the pre-penicillin era. The availability of sulfonamide antibiotics beginning in the mid-1930s raised hopes that they would be effective in SBE. Unfortunately, except in rare instances, they were not. This paper reviews the clinical experience with sulfonamides in the pre-penicillin period in treating patients with SBE. It presents in detail the case of Pasquale Imperato, who died from the disease at the age of 72 years on 30 November 1942. In so doing, it focuses on the medical management measures then available to treat patients with SBE and on the inevitable course of the illness once it began. Also discussed is the relationship of acute rheumatic fever and its sequela, rheumatic heart disease, to predisposing people to SBE and possible genetic factors. The well-known case of Alfred S. Reinhart, a Harvard Medical School student who died from SBE in 1931 and who kept a detailed chronicle of his disease, is also discussed and contrasted with Pasquale Imperato's case.