Commentary: George W. Comstock's Contributions to Respiratory Disease Epidemiology

Abstract

George W. Comstock’s career spanned a remarkable era in the epidemiology of respiratory diseases. At its beginning, tuberculosis was a leading cause of death, and the emerging epidemics of lung cancer and chronic obstructive pulmonary disease (COPD) were being recognized. Occupational lung diseases were common among workers in dusty trades, industry, and mining. At its end, tuberculosis had been largely controlled in many of the more developed countries, including the United States, as had many of the major occupational lung diseases. Unfortunately, the dual epidemics of smokingcaused lung disease—lung cancer and COPD—were still causing increasing numbers of deaths even though the causes of most cases of disease had been identified. Not surprisingly, given Comstock’s broad reach and curiosity, his studies on respiratory health extended beyond tuberculosis to cigarette smoking, indoor and outdoor air pollution, and COPD. The decades of his career also saw the development of carefully standardized methods for the study of respiratory diseases. These methods were first developed in the United Kingdom by Cochrane, Fletcher, and others for investigating the causes and natural history of chronic lung diseases. Benjamin Ferris (1), a physiologist at the Harvard School of Public Health, brought these methods to the United States for his pioneering air pollution studies. Comstock contributed to one of the major efforts to adapt these methods for use in the United States. He was a key participant in the American Thoracic Society’s Epidemiology Standardiza