A matter of opportunity

Abstract

It has been our belief for some time in the National Institute of Allergy and Infectious Diseases that occupational immunologic lung disease is a matter of medical importance. Because there are so many of you here, from nearly every state of the Union, apparently this is not just a case of we bureaucrats “ginning up” some extra busy work. As an aside, I can recall as a second-year medical student hearing for the first time about bagassosis. I can tell you that as students, none of us believed a disease could have, let alone deserve, a name like that. But, of course, bagassosis has a serious aspect and is a respiratory disease associated with the workplace. I shall not, in these few remarks, spell out the objectives of this conference. That is best left to those who organized this meeting and to all of you who are participating in it. But what you do here and the conclusions you come to will be of importance to all of us. In these few minutes, let me step back in time and take a brief look at the historical origins of epidemiology and preventive medicine-subspecialties that are concerned with the occurrence of diseases in the community, with occupational diseases, with diseases associated with the workplace-diseases associated with the way we live as the result of the social changes that have occurred through modern practices in agriculture, industry, and housing. The philosophical basis for the practice of medicine for centuries has been the care of the individual patient, and rightly so. And yet how fortunate we are that there emerged in the last century a few perceptive and powerful individuals who realized that disease might be related to a person’s environment, not a new idea to be sure. It was advanced by Hippocrates more than 2400 years ago. But that notion languished until the Victorian Age, when modern epidemiology was born. Much of what you discuss here will be based on epidemiology and preventive medicine. The modern origins of such medicine began with the English physician, William Farr. In 1839 he was given responsibility for medical statistics. He established a tradition for the careful application of vital data to the problems