C.-E. A. Winslow, who launched public health at Yale a century ago, still influential today
The Yale School of Public Health (YSPH) is celebrating its 100th anniversary this year. Here's a look at the man who founded the School of Medicine department that eventually became YSPH.
In 1915 when Yale added the Department of Public Health to its medical school, such programs were rare. The University of Pennsylvania had one. Harvard and MIT had a joint School for Health Officers. Johns Hopkins was a year away from starting its School of Hygiene and Public Health. As suggested by these names, the field was still finding its identity. Yale considered naming its department “Public Health and Public Service” or “Hygiene and Philanthropy.”
The new professorship at Yale was endowed by the family of Anna M.R. Lauder. The money came with conditions. The appointee had to be a physician with experience in public health and sanitary science and also had to be willing to enter the political fray and bring about change in the state’s public health regulations. The university was wise enough to ignore the stipulation requiring a physician, instead hiring a 38-year-old bacteriologist named Charles-Edward Amory (C.-E. A.) Winslow. He turned out to be an inspired choice beyond anyone’s expectations, except perhaps his own.
Winslow ran the department for the next 30 years, until his retirement in 1945. His initial budget covered salaries for him, one instructor, a secretary and a janitor. Using ingenuity and energy, he built a Department of Public Health unlike any in the country, with a dual focus on the lab and the community. For Winslow, the boundaries of that community began in one’s neighborhood but encompassed the wider world. He embedded his ideals so deeply that they still guide what is now known as the Yale School of Public Health.
A prolific life
His influence on the field and on health care policies—local, national and international — was way out of proportion to one person’s professional career. That’s because Winslow seemed to juggle several careers and be everywhere at once. His bibliography bulges with nearly 600 articles and books. The quantity is impressive, but what’s mind-boggling is the breadth of topics.
A few examples: typhoid and public water supplies; garbage disposal in big cities; seasonal variations in the chemical and bacterial composition of the sewage discharged into Boston Harbor; workplace threats to health; the training of nurses; infant paralysis and insect-borne disease; the air quality in New York City public schools; food poisoning; poverty as a factor in disease; sex hygiene for teachers and parents; poison hazards in industry; the influence of odor on appetite; housing as a public health issue. His eminently readable short history, “The Evolution and Significance of the Modern Public Health Campaign” (1923), traces developments in public health from the ancient Greeks to modern times and laces its medical scholarship with allusions to, among others, Erasmus, Thucydides, Lucretius, Boccaccio’s “Decameron,” Samuel Johnson and the poetry of Alexander Pope. He wrote books about children’s health, rural health, sewage disposal and insects as vectors of disease. Among his books is a translation of a popular drama, “Magda,”by the German playwright Hermann Sudermann. He once wrote an essay about 10th-century medicine in Japan.
This abundant written output would seem to leave little time for anything beyond his desk, but Winslow spent the greater part of his life in the public arena, in his own neighborhood and worldwide. He served as a health delegate to the League of Nations and later consulted for the World Health Organization. He traveled to assess public health needs from the U.S. Midwest to Russia.
Winslow's definition of public health, written in 1920, helped to shape the discipline and is still, 95 years later, cited as the standard.
Winslow was president or chair of many organizations, including the American Public Health Association and the American Association for the Advancement of Science (Section K) and surprises such as the American Society of Heating and Ventilating Engineers. His many professional memberships suggest his wide interests, ranging from the New England Water Works Association and the Society for Experimental Biology and Medicine to the American Society of Naturalists and the Connecticut Academy of Arts and Sciences.
He affected the conversation about public health not only as a writer, academic and professional activist but also as an editor of influential publications. He was the first editor of the Journal of Bacteriology and held the position from 1916 to 1944. That same year, he started his 10-year stint as editor of the American Journal of Public Health. Because of his extensive experience and eloquence, he was also in great demand as a speaker all over the country. His definition of public health, written in 1920, helped to shape the discipline and is still, 95 years later, cited as the standard:
“Public Health is the science and the art of preventing disease, prolonging life, and promoting physical health and efficiency through organized community efforts for the sanitation of the environment, the control of community infections, the education of the individual in principles of personal hygiene, the organization of medical and nursing service for the early diagnosis and preventive treatment of disease, and the development of the social machinery which will ensure to every individual in the community a standard of living adequate for the maintenance of health; organizing these benefits in such fashion as to enable every citizen to realize his birthright of health and longevity.
Closer to home, Winslow pushed for legislation to improve Connecticut’s health laws and also led the campaign for the bill that created the State Department of Public Health. He served on Connecticut’s Public Health Council. He participated in the development of the Connecticut Mental Health Association, one of the first associations of its kind, later serving as its president, and also helped convince the state to start a Department of Mental Health.
Even closer to home, Winslow and his students went into New Haven neighborhoods to conduct health surveys that led to better public health care. In keeping with his strong belief that inadequate housing was hazardous to both physical and mental health, he served for two decades as chair of the New Haven Housing Authority and was largely responsible for getting 2,500 apartments built for low-income residents. (From 1942 to 1943 he was president of the National Association of Housing Officials.) He also served as president of the Community Chest in New Haven, which raised money for community projects.
Throughout his time at Yale, Winslow championed the importance of nurses. For instance, in 1919 he founded the New Haven Demonstration Health Center, and he served as chair for three years. The center confirmed his conviction that nurses were vital to public health. As chair of the Rockefeller Foundation’s Committee for the Study of Nursing Education, he oversaw the milestone Goldmark Report in 1923. That same year, he was instrumental in the founding of the Yale School of Nursing, the nation’s first such university-based school.
Within his own department he was a busy, popular teacher, and he held weekly salons for faculty and graduate students at his home on Prospect Street in New Haven. He was also the first director (1932-1957) of Yale’s John B. Pierce Laboratory.
There’s more. With Winslow there’s always more. How did this dynamo get to New Haven?
He was born in 1877 into blueblood Boston wealth. Both his parents were passionate about causes and ideas. His father, Erving Winslow, was a Harvard graduate, merchant, editorialist, poet and fervent critic of imperialism. His mother, Catherine Mary Reignolds, was an English actress known for playing Shakespearean heroines and for promoting Ibsen’s socially controversial plays in America. Winslow was their only child. He went to Boston’s English High School and belonged to an informal scientific group called the Boston Bug Club, whose topics of discussion, according to a former member, “included shoes and ships and sealing wax and, on occasion, whether bacteria had wings.”
Winslow entered MIT planning to major in biology and become a physician. His course was altered by William H. Sedgwick, a professor of biology and a pioneer in bacteriology and sanitary science. Considered the first scientific epidemiologist, Sedgwick did research in the emerging field of public health science and also worked with government organizations to implement his findings. He studied the links between dirty water, sewage and disease, and worked to eliminate these threats to public health by preventing water pollution and by using modern methods of sanitation. He investigated the poisonous fumes released by coal and gas, which led to improvements in systems of heating and ventilation. He studied typhoid epidemics and their causes in factory towns in Massachusetts. Winslow saw that Sedgwick’s work benefitted not just individual patients but entire populations. His work inspired Winslow to switch from medicine to the broader field of public health, especially the prevention of disease.
After graduating, Winslow stayed at MIT to earn a master’s, his highest degree earned. During this time he worked at MIT’s sewage experiment station and conducted research investigations, while also teaching sanitary biology. He immediately began publishing, including the first American textbook on water bacteriology in 1904 (with co-author Samuel C. Prescott), followed the next year by a book titled “Elements of Applied Microscopy.”
During these years he met a co-worker in Sedgwick’s lab, Anne Rogers, who became his wife and lifelong scientific partner. After a brief stop at the University of Chicago, he joined the biology department at the College of the City of New York in 1910. Since no single job could contain his energies, he also lectured on public health and nursing at Columbia University Teachers College and worked as the director of public health education for the New York State Department of Health.
In addition, Winslow became curator of public health at the Museum of Natural History. There, as always, he found ways to expand the reach of public health through the lab and through public education. In 1910 he established a Bacteriological Museum and Bureau of Exchange of Bacterial Cultures at the museum. Labs throughout the country began sending cultures. By the end of 1912 the collection held 578 strains, and 1,700 cultures had been provided to investigators at 122 labs and colleges.
He once wrote that teaching people simple ways to prevent disease had almost as profound an effect on public health as the discovery of germ theory.
The museum gave Winslow a highly visible platform where he could exercise his passion for public education. He once wrote that teaching people simple ways to prevent disease had almost as profound an effect on public health as the discovery of germ theory. This was the era when New York’s ghettos were crammed with immigrants. Epidemics were common, caused by overcrowding, raw sewage, tainted water, and disease-carrying rodents and insects. At the museum, to educate the public and also to drum up support for programs to control diseases, Winslow mounted educational exhibits.
“He believed in public education,” says Elaine Anderson ’76 M.P.H., a lecturer and retired director of special studies at YSPH, “and he used everything in his bag of tricks to get things done. For instance, he developed the first exhibit ever in America on the process of how diseases are spread by insects. He had huge models built of flies and mosquitoes. It was a phenomenal success. People hadn’t ever seen anything like that, and it translated to them what was going on and what was needed. You can still see the mosquito model on the museum’s bottom floor.”
As Winslow noted in “The Evolution and Significance of the Modern Public Health Campaign,” advances in science such as vaccines, ventilation control, and sanitary engineering had steadily given humanity more control over the death rate and, more broadly, had improved countless lives. But there was still so much to do. Poverty was an incubator for disease, both physical and mental. Basics of public health — clean water, uncontaminated food, safe disposal of garbage, good personal hygiene, decent housing, safe workplaces, prenatal care, children’s health and nutrition — were not universally understood, much less regulated. People continued to get sick and catch diseases that science knew how to avert.
This unnecessary suffering drove Winslow. He never tired of pointing out that treatment of disease was certainly important, but preventing it was preferable in every way — prevention was less expensive, reduced needless suffering and produced long-lasting benefits. Prevention was the key to public health. In 1923 Winslow predicted that the preventative method of the future would be annual physical examinations.
When Winslow arrived at Yale, he set about building a program in public health within the medical school. This also entailed introducing the faculty and students to his emerging field. He arranged for the courses he taught — on public health principles, public health administration and vital statistics — to be cross-listed as electives in the offerings of Yale’s other schools and departments, a way of infiltrating public health into those subjects. He believed in an interdisciplinary approach but didn’t have a budget for faculty. Improvising again, he poached professors from other Yale departments and schools. This allowed him to offer courses in areas where research could benefit public health: pathology, immunology, sanitary bacteriology and sanitary engineering, physiological chemistry, zoology, pediatrics.
Winslow’s department was one of eight in the medical school, and to the chagrin of some faculty members, he rejected the common assumption that public health was secondary to medicine. In Winslow’s view, the two were equal complementary partners, the yin of prevention joined indivisibly to the yang of cure. He tried to instill this view in medical students as well as in those destined for careers in public health. In his course for fourth-year medical students, he stressed the crucial link between physicians and community health organizations and the role of physicians in the broader public health movement, including the need for a national program of affordable health care for all, funded through insurance and taxes. “Before medicine becomes truly preventive,” he wrote, “there must be a radical alteration in the basis of payment for medical service.”
This idea caused some friction within the medical school and outright hostility from the wider medical establishment. Nevertheless, Winslow advocated it throughout his career, dismayed that money could open a gap between health care services and those who needed them. On the first page of “The Evolution and Significance of the Modern Public Health Campaign,” Winslow described the discipline of public health as “a field of social activity.” He added that the discipline should build upon basic sciences to create “a comprehensive program of community service.”
“He looked at public health as social action,” says Lowell S. Levin ’60 M.P.H., D.Ed., professor emeritus of and lecturer in public health. “Winslow was instrumental in establishing that principle at Yale and in the field at large. Other schools of public health later struggled to adopt the social model, but we already had it because of Winslow. He wasn’t all that tolerant — this is hearsay — of people who didn’t understand that public health was public service, not a way to make a lot of money.”
Winslow infused these ideals in his students. By all accounts he was a stimulating, congenial teacher and colleague. Even when colleagues vehemently disagreed with him, they found him difficult to dislike. One such colleague at Yale, Haven Emerson, recalled Winslow’s “engaging and quizzical smile,” and described him as “critical and challenging but ever so friendly and cooperative.” Winslow launched countless students into careers in public health. In the summer of 1918, for instance, he was one of the teachers at the first Training Camp for Nurses, held at Vassar College. The purpose was to convince the 350 college women, who came from all over the country, to go into nursing. Winslow must have been persuasive. Afterward the students wrote a group letter thanking him for his inspiration.
One of those women, Mary Elizabeth Tennant, later said, “His final lecture was a charge to his students. He made us feel that we were capable of great achievement in nursing. It was the most inspiring appeal that I have ever heard from a teacher. In retrospect, my decision to become a public health nurse was owing directly to Professor Winslow’s inspiration, an inspiration that I and others who knew him have treasured these many years.” Tennant spent 27 years at the Rockefeller Foundation as a nurse specializing in nursing and public health.
There was nothing of the mandarin academic about him. He was empathetic and accessible. A. Pharo Gagge, who later joined the John B. Pierce Laboratory and taught epidemiology at Yale, remembered being invited as a new grad student to Winslow’s house for Sunday dinner. Gagge, wearing a sport coat and slacks, was stunned when Winslow opened the front door dressed in a black dinner jacket, as were all the other male guests. Winslow excused himself. By the time Mrs. Winslow had finished introducing the deeply embarrassed student to everyone, Winslow was back downstairs in a sport coat and slacks.
Winslow achieved so much partly because he understood both science and people. He was adept at politics and public relations, whether among national policymakers or residents of a neighborhood. He could have been describing himself when he wrote a tribute to London’s first Medical Officer of Health named John Simon, who worked for decades to improve public health in mid-19th-century Britain. Simon, wrote Winslow, possessed “the ideal qualities of a preacher of the gospel of health”: a skilled administrator, a teacher who made general concepts of health understandable to the public, a skillful molder of public opinion, and a dogged advocate who got legislation passed.
Anderson and Levin believe that the Yale School of Public Health is still guided and animated by Winslow’s founding principles: rigorous research combined with social action and community outreach.
Winslow was a historian who applauded the achievements of the past but was also an activist who always saw much left to do. In 1948, in an essay titled “Poverty and Disease,” he wrote, “Since the days of John Simon, the public health movement has had a history of approximately one century. I have fought in the ranks of the health army for nearly half of those hundred years. You and I have determined that men should not sicken and die from polluted water, from malaria-breeding swamps, from epidemics of diphtheria, from tuberculosis. Those battles have been, in large measure, won. We must now determine that men shall not be physically and emotionally crippled by malnutrition, by slum dwellings, by lack of medical care, by social insecurity. If there are better ways than public housing, and sickness insurance, and social security, let us find them. If not, let us move forward. … I urge those who do not agree with me to mend their ways; and those who do agree with me to go forward with hope and courage.”
This story originally appeared in the Fall 2014-Spring 2015 centennial issue of Yale Public Health magazine.