Public Health and Services

1812 Vet Med Today: Public Veterinary Medicine JAVMA, Vol 217, No. 12, December 15, 2000

Public Veterinary Medicine:Public Health

Historically, veterinary medicine has made its great-est contributions in the public sector and in set-

tings other than direct care of the individual patient.1

So why are so many of us unaware of our profession’sachievements in this arena?

My introduction to veterinary preventive medicineand public health was through military service. Myobligation to serve a two-year doctor draft in theUnited States Air Force became an adventure for myfamily and me, rather than an unwelcome intrusion onmy ultimate desire to return to private clinical practice.The operative words are private and clinical. Why wasI unaware of the opportunities available to those of useducated in this discipline sometimes referred to ascomparative medicine?

C. W. Schwabe, in the second edition of VeterinaryMedicine and Human Health,2 quotes Rudolf Virchow:“Between animal and human medicine there is nodividing line—nor should there be. The object is dif-ferent but the experience obtained constitutes the basisof all medicine.”

On July 23, 2000, a symposium titled “Publichealth in the new millennium” was held during the137th AVMA Annual Convention in Salt Lake City tocelebrate the first 50 years of the American College ofVeterinary Preventive Medicine. Prominent, well-known individuals in the field of preventive medicineshared their perspectives on the past, current, andanticipated contributions of veterinarians to thisimportant medical field.

During the symposium, we learned from the past.Jim Steele, former Assistant Surgeon General forVeterinary Affairs, offered his folksy reminiscence ofthe origins of veterinary public health in the UnitedStates Public Health Service, which served to remindus that individuals can make a difference. RetiredBrigadier General Tom Murnane’s articulate recollec-tion of the initial organizing efforts for the AmericanBoard of Veterinary Public Heath and the AmericanCollege of Veterinary Preventive Medicine reminded usthat groups of people sustain individual efforts.

We also learned from today. Current leaders in fed-eral agency efforts reminded us that opportunitiesabound. It is the year 2000, and emerging infectiousdiseases of animal origin are major agricultural, animalindustry, and public health challenges.

We reaffirmed that we must learn for the future.During the symposium, we were reminded that,although lists of preventive medicine and public healthachievements can be enumerated, the past is the pro-logue to the future.

Drs. Steele and Murnane and several other speakersat the symposium offered to share their perspectives withthe entire veterinary community through the Journal ofthe American Veterinary Medical Association. I hope thefollowing articles convince you, members of the veteri-nary profession, that there is only one medicine.

References1. Smithcors JF. The American veterinary profession, its back-

ground and development. Ames, Iowa: Iowa State University Press,1963.

2. Schwabe CW. Veterinary medicine and human health. 2nd ed.Baltimore: The Williams & Wilkins Co, 1969;ii.

From the School of Public Health, University of Texas, San Antonio,TX 78229-3900. Dr. Herbold is a retired Colonel in the UnitedStates Air Force.

Symposium: Public health in the new millennium

Introduction

John R. Herbold, DVM, MPH, PhD, DACVPM

Table of ContentsIntroduction—John R. Herbold . . . . . . . . . . . . . . . . . . 1812The history of public health and veterinary public service—James Harlan Steele . . . . . . . . . . . . . 1813Historic and future perspectives of the American College of Veterinary Preventive Medicine—Thomas G. Murnane . . . . . . . 1821Blue ribbon task force report on the future of Food Safety and Inspection Service veterinarians: public health professionals for the 21st century—Bonnie J. Buntain . . . . . . . . . . 1828The National Antimicrobial Resistance MonitoringSystem (NARMS) for enteric bacteria, 1996-1999:surveillance for action—Nina N. Marano et al. . . . . . 1829Public health education of veterinarians and veterinary students for the futureMichael G. Groves . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1831Ten great veterinary public health/preventive medicine achievements in the United States,1901 to 2000—Donald L. Noah et al . . . . . . . . . . . . . . 1834

1812_1836.qxp 9/23/2005 2:44 PM Page 1812

Animal diseases are believed to be the origin ofmany human diseases. Jared Diamond states,

“Infectious diseases like small pox, measles, and fluarose as specialized germs of humans, derived by muta-tions of very similar ancestral germs that infected ani-mals.” These emerging diseases appeared about 10,000years ago after the humans changed from beinghunters to farmers with animals in their midst.1 Hecontends that the people who domesticated the ani-mals were the first to be victims. Those humans thendeveloped resistance to the zoonotic diseases whereagriculture developed.

The relation of animal disease to human diseasewas observed in the ancient civilizations of Babylon,the Nile Valley, and China. Later, they were describedby Leviticus in the Old Testament, by Hippocrates inGreece, and by Virgil and Galen in Rome. In the MiddleAges, rats carried the plague that killed millions of peo-ple across Europe. The invasion of Europe by rinder-pest in the 18th century disrupted commerce and gov-ernment. The Papal authority created a medical com-mission to advise the Vatican on what measures shouldbe taken to control animal plague and rinderpest.2

The movement of animal diseases into theAmericas is believed to have first occurred when live-stock were used to help create the settlements foundedin Santo Domingo, Dominican Republic, byChristopher Columbus in 1493. In the next century,Hernando de Soto, the Spanish explorer of Florida andthe southeast, brought cattle, horses, swine, and dogs.Further north, the Virginia colonists brought animalsto Roanoke Island, but neither humans nor animalssurvived. Later, the Jamestown colonists importeddomestic animals that survived and became valuablefoundation stock. Rabies was the first zoonotic diseaserecorded in Virginia in 1753, and later as an epizooticin the colonies and the Federation of States in the late18th century.3

In 1798, editors of the newly founded MedicalRepository were the first to inquire about emerging dis-eases in the United States and territories. They askedfor information on human diseases, diseases amongdomestic animals, accounts of insects, the condition ofthe vegetation, and even the state of the atmosphere.They hoped to put the facts together as an annualreport on the status of health in the United States. Inhis address at the AVMA centennial, Surgeon GeneralLuther Terry of the United States Public HealthService (USPHS) called that report the first referenceof veterinary medical support of the public health.4 Afew years after the report was written, Benjamin Rushcalled for the establishment of veterinary medical edu-cation at the University of Pennsylvania.

The United States Sanitary Commission, which

was organized during the Civil War by public-spiritedwomen, was largely concerned with sanitary condi-tions and food hygiene. The commission was the firstto call attention to putrid meat, and later embalmedbeef sent to the Army. In the years following the CivilWar, the commission was to be a forerunner of publichealth service.5

In the 1870s, there was interest in developing anational health service. Yellow fever epidemics werefrightening as they spread up the Mississippi Riverfrom New Orleans. The possibility that yellow feverinvolved animals brought Professor John Gamgee, afamous veterinarian from Germany, to investigate theepidemic. He recognized a seasonal occurrence (coldweather stopped the epidemic) and suggested traffic belimited to the colder months. He failed to associate theeffect of cold weather on mosquitoes, the vector ofvirus that causes yellow fever.

The United States Board of Health came into beinglargely because of the morbidity and mortality causedby the yellow fever epidemic. At the same time, malar-ia was widespread in the south, tuberculosis was a rec-ognized disease, and typhoid fever and enteric diseaseswere common. Animal diseases were of concern, espe-cially the spread of glanders and anthrax that followedthe Civil War.

In 1879, the president of the United States Boardof Health, Dr. J.L. Cabell, asked James Law, a professorof veterinary medicine at Cornell University, to advisethe board on how they should supervise diseases andmovements of domestic animals. Law’s report was thefirst comprehensive recognition of the importance ofzoonotic diseases to the public health published in theUnited States.6 The two-part report describes the ani-mal diseases that are directly communicable to humansand plagues that affect only animals.7

Further discussion of the organization of publichealth service in the post–Civil War period wasreviewed by W.D. Miles, the former historian of theNational Institutes of Health.8 Miles discussed thestruggle between interests in public health and agricul-ture in the decade leading up to the inauguration of theBureau of Animal Industry in 1884. The bureau’s initialinterest was to protect animal health, but later provid-ed a meat inspection service for public health, interna-tional trade, and interstate commerce.

The Relation of Animal Diseases to the Public Healthand their Prevention, by Frank S. Billings, was the firstbook to review this subject as well as the state of bac-teriology and parasitology in the 1880s. It is limited asto the diseases he writes of: trichinosis, hog cholera,tuberculosis, anthrax, Texas fever, rabies, and glanders.His knowledge of these diseases was remarkable for thetime. He observed veterinary activities while he trav-eled in Europe. While obtaining an education inBerlin,a he learned about the history of animal diseases

The history of public health and veterinary public service

James Harlan Steele, DVM, MPH

From the School of Public Health, University of Texas, Houston, TX77225

JAVMA, Vol 217, No. 12, December 15, 2000 Vet Med Today: Public Veterinary Medicine 1813

1812_1836.qxp 9/23/2005 2:44 PM Page 1813


in the Greco-Roman period. He states that the Latinorigin of the word “veterinarian” first appeared in thefourth century writings of Vegetii.

Billings made a strong plea for the development ofveterinary public health to control the animal diseasesthat affected humans. He believed it was essential tohave scientifically educated veterinarians. He was oneof the veterinarians active in the early years of theAmerican Public Health Association. During meet-ings, there were discussions about trichinosis andother animal diseases. Billings also pointed out thatmilk from diseased cows was dangerous.9 He appealedto the government to set up laboratories to use thenew science of bacteriology to find the cause of illnessof milk origin. Billings was a visionary of veterinarypublic health.

Pasteur changed science and veterinary medicine.He created a new concept of the origin of disease. Nolonger would myth and spontaneous origin of diseaseguide society, even though there were as many objec-tions to scientific advances then as now. The 1984 cen-tennial celebration of Pasteur’s rabies vaccine was atribute to the man of many accomplishments. He was achemist who discovered the cause of fermentation andapplied it to the beer and wine industries, which led tomilk pasteurization. He was known to theImpressionists of the 19th century because he helpedprepare better paint colors. Pasteur was a genius whogave public health the science and vaccines to combat19th century diseases and prepare his followers for the20th century’s emerging problems.10

The frightful toll of milk-borne disease is reviewedby F. Stenn.11 He cites the shocking figure of 400 deathsper 1,000 births in New York City in 1880. Spoiledmilk accounted for the deaths of thousands of childrenin the early 1900s. In 1905, a milk-borne typhoid epi-demic in Washington, DC, caused President TheodoreRoosevelt to order the USPHS to investigate the localsupply. Surgeon general Walter Wyman ordered hisstaff to examine not only the Washington milk prob-lem but also the national milk problem. The 1908records cited by Stenn list many outbreaks of typhoidfever and diphtheria associated with consumption ofmilk. He stated that 16% of the milk cans from farmssampled contained tubercle bacilli, and in cities, half ofthe milk had tubercle bacilli. The 1908 report Milk andIts Relation to Public Health, issued by the USPHS,12

brought reform to the dairy industry and support forthe Bureau of Animal Industry program to controlbovine tuberculosis.13

The eradication of bovine tuberculosis and brucel-losis has ensured a safe milk supply and protected thehealth of farmers, dairymen, veterinarians, and thehandlers of milk and milk products. The case for pas-teurized milk and milk products is conclusive.14 In thelate 20th century, however, a new array of milk-bornezoonoses became a concern.

Salmonella organisms were identified in 1885 byone of the most distinguished public servants of the vet-erinary profession, Dr. Daniel Salmon. He was the firstchief of the Bureau of Animal Industry (1884 through1905). He assembled and trained a great staff includingTheobald Smith, V.A. Moore, and E.C. Schroeder.

Dr. Salmon was the leading proponent of veteri-nary public health in the 1890s. He asked Congress forauthority for a Federal Meat Inspection Service in 1890but was circumvented by the local interests citingstate’s rights. The Meat Inspection Act of 1890 wasineffective. Salmon sought support from the AmericanPublic Health Association and the American MedicalAssociation for these early veterinary efforts to protectpublic health.15 The Federal Meat Inspection ServiceAct of 1906 came about only after Upton Sinclairexposed the filthy conditions of the Chicago stock-yards.16 Although he had no authority, Salmon wasblamed for his lack of control over the local hygienefailure and was removed from office. Salmon is remem-bered today for the bacterial organism named after himas well as by the Salmon Award for Leadership.

In 1906, the Bureau of Animal Industry initiatedtuberculin testing of dairy cattle in the District ofColumbia, which resulted in detection an infectionrate of almost 19%. This was the beginning of success-ful tuberculosis control campaign that led to eradica-tion with the guidance of John R. Mohler, who wasdirector of the Bureau of Animal Industry from 1917 to1943. Control of bovine tuberculosis was one of thegreat accomplishments of veterinary public service.The late Jay Arthur Myers memorialized the near erad-ication of bovine tuberculosis in his 1940 book, Man’sGreatest Victory Over Tuberculosis.17

At the start of the 20th century, there was greatinterest in comparative medicine by pathologists,which was led by Karl F. Meyer, a Swiss veterinarianwho was to become one of the outstanding leaders andscientists of the 20th century. He was among the earlypublic health scientists to delve into virology when hewas a professor of pathology at the University ofPennsylvania Veterinary Faculty. In 1913, he may havebeen among the first to recover a virus causing equineencephalitis. As director of the Pennsylvania LivestockSanitary Board Laboratory, he published informationon glanders, anthrax, anaplasmosis, sporotrichosis,paratuberculosis, and septicemia among many otherdiseases of animals. In 1914, he left the University ofPennsylvania to accept a position at the University ofCalifornia newly established medical center. The fol-lowing year, he accepted an appointment at the GeorgeWilliams Hooper Foundation for Medical Research atthe University of California Medical Center where hewould remain the rest of his life. He became a legendthere. His lectures introduced medical students tozoonoses, plant life, the atmosphere, and all that iscalled the environment today.

At Hooper, Meyer performed research on the ani-mal diseases of public health importance. He contin-ued his virus research and was active in the investiga-tion of human influenza from 1918 to 1920. He wentinto the field to define the epidemiologic characteris-tics of malaria, dysentery, and even dental diseases. Hisstudy of the bacterial causes of abortion in animalsresulted in grouping Brucella abortus, Brucella meliten-sis, and Brucella suis in a new genus honoring DavidBruce. Another important event was his report onBacillus botulinus in nature. Botulism became a nation-al concern in the 1920s when California canned fruit

1812_1836.qxp 9/23/2005 2:44 PM Page 1814


and vegetables were found to contain botulinus toxin.The industry asked him to resolve the problems and heunderwrote a laboratory to maintain surveillance.Meyer was active in food safety for the remainder of hislife.

In 1933, Meyer and his long-time lab associate,Bernice Eddie, began their series of reports on psitta-cosis in birds, which eventually led to control of thedisease 30 years later by feeding seeds impregnatedwith tetracycline. The same antibiotic is used to pre-vent ornithosis in domestic fowl.18

One of Meyer’s memorable lectures was in 1931when he called attention to the importance of the ani-mal kingdom as a reservoir of diseases that endangerthe health and welfare of people throughout theworld.19 In 1954, he had the opportunity to review ani-mal reservoirs of diseases, by then referred to aszoonotic diseases, before the World Health Generalassembly. He repeated the same theme before theWorld Health Organization (WHO) ExpertCommittees for Zoonoses, Plague, and Food Hygieneand for the Pan American Health Organization(PAHO) until his 90th year.

Meyer’s work on plague was reported in the specialsupplement of the Journal of Infectious Diseases to com-memorate his 90th birthday, which he failed to reachby one month. This was underwritten by Max Stern,president of Hartz Mountain. Hartz Mountain played amajor philanthropic role in supporting investigationsof psittacosis control at the Hooper Foundation.20

Larry Altman, the medical editor of the New YorkTimes, wrote a lengthy obituary from which the fol-lowing excerpt is taken:21

Dr. Karl Friedrich Meyer was regarded as the mostversatile microbe hunter since Louis Pasteur and a giantin public health.

As a youth in Basel, Switzerland, pictures of theBlack Death, or plague, so fascinated him that he becamean outdoor scientist instead of following in the aristocrat-ic business world in which he grew up. He told friendsthat in choosing to become a veterinarian he could ‘be auniversal man and study all diseases in all species.’

Public health leaders yesterday called his contribu-tions to medicine ‘monumental.’ His scientific work hadsuch broad implications that it touched on virtually allfields of medicine.

The obituary was placed in the CongressionalRecord in May, 1974. Albert Sabin wrote a biographicmemoir for the National Academy of Science in 1980.22

The 1930s were memorable for scientific advancesin public health. The viral cause of influenza wasuncovered by Richard Shope and Thomas Francis atthe Rockefeller Institute. The use of egg embryos was anew method of growing viruses that would lead to thechick-embryo rabies vaccine and other viral vaccines.The development of strain 19 Brucella vaccine and theStern anthrax vaccine in South Africa were importantto the control of brucellosis and anthrax worldwide.The investigation of toxoids by Gaston Ramon, aFrench military veterinarian, led to the discovery oftetanus toxoid for horses and humans.

In 1938, the brucellosis epidemic among veteri-nary students and others in the bacteriology building

at Michigan State College raised epidemiologic ques-tions about how Brucella organisms were spread.23 Upto then the disease was believed to be caused by directexposure or ingestion of milk containing Brucella bac-teria. Airborne organisms had not been thought of,although Professor I.F. Huddleson, whose research lab-oratory was the focus of this investigation, disagreedwith this opinion. The Michigan state investigatorswere public health scientists and engineers whofocused on the water-borne theory of contaminatedglassware not being autoclaved properly, which per-mitted contamination of the water system.24 While Iwas a student in the brucellosis testing laboratory, Iheard the discussion about the means of spread beingby water and back siphonage.

Dr. Stafseth encouraged many students to consid-er public health as a career. Dean Ward Giltner learnedof my interest, which had been heightened by my expe-riences with the brucellosis epidemic, and arranged forme to become eligible for an USPHS fellowship. Thatwas done by assigning me to an internship at theMichigan Health Department. There, health depart-ment veterinarians, pathologists, and bacteriologiststaught me how to remove and examine an animal’sbrain for rabies and inoculate mice with the matter tofurther the diagnosis. I also learned to grow vacciniaon the belly of a calf that had been shaved, scrubbed,and disinfected. Harvested scabs were be tested forcontaminants, which was a lengthy procedure. Highstandards were maintained for development of pertus-sis/whooping cough vaccine, equine antiserum fortetanus, and rabbit pneumococcal antiserum.

Dean Giltner and C.C. Young, the director of theMichigan Public Health laboratories, put together myfellowship application to the USPHS and the HarvardSchool of Public Health. Approval came the weekbefore graduation.

The summer of 1941 was spent as an intern at thePetoskey Animal Hospital. There I learned about swim-mer’s itch, a common affliction of humans and petscaused by an avian schistome. At Harvard it becamemy thesis subject. In addition, it was the first subject Ireported on at the 1942 AVMA convention in Chicago,with Dean Giltner in the audience.

Harvard was exciting. There was talk of war, andPresident Conant addressed the incoming class withthe admonition there would be important changes inthe world during their student years. The School ofPublic Health faculty and students were stimulating. Iwas the only veterinarian, which attracted some atten-tion.

The first position offered to me was from K. F.Meyer, but it wasn’t funded. After discussing optionswith the USPHS Chicago Regional Offices, I accepted aposition as a civilian sanitarian in the OhioDepartment of Health.

In September 1943, the United States Army offeredme a commission as a veterinary officer. I received acommission as a sanitarian. After I was commissioned,I spent a short tour of duty in the region with SeniorSanitarian William H. Haskell, an authority on pas-teurization methods and practice. He was one of thecivil service veterinarians who were USPHS milk spe-

1812_1836.qxp 9/23/2005 2:44 PM Page 1815


cialists brought in as early as 1924. In 1943, othernewly recruited veterinarians, Raymond Helvig andTed Price, were also commissioned as sanitarians.

My assignment was in Puerto Rico and the VirginIslands, where I was to be responsible for coordinatingmilk and food sanitation and evaluating any zoonoticdiseases in areas that had been isolated by the war.Brucellosis and bovine tuberculosis were widespread.Diagnosis of Venezuelan equine encephalitis and batrabies in Trinidad caused some concern in the Islands,but did not spread beyond Trinidad. Rabies was indige-nous in the Dominican Republic and Cuba in the1940s.

Origins of Organized Veterinary PublicHealth in the USPHS

In March 1945, the Pan American Sanitary Bureauasked the USPHS San Juan, Puerto Rico, office to do anassessment of the post-war veterinary public healthproblems in the Dominican Republic and Haiti, neitherof which had a functional veterinary service. I wasdirected to make a report on their problems. Therewere no reported diseases, but bovine tuberculosis,brucellosis, and mastitis were known. Veterinary labo-ratory support was nonexistent, and the abattoirs keptno records. There were reports of rabies in dogs, andpossibly in horses. Some years later there was an epi-zootic of equine encephalitis.

The end of the war in Europe and shortly there-after changed the reassignments. I met with AssistantSurgeon General Joe Mountin who asked me, “Whatare you veterinarians going to do for the public healthnow that the war is over ?” The follow-up to that inter-view is in the JAVMA article titled “The 50th

Anniversary of the Veterinary Medical Corps Officersof the US Public Health Service.”25

After the approval of a veterinary public healthsection in the States Relation Division, some monthswere spent at the National Institutes of Health estab-lishing a liaison with federal agencies, congressionalinterests, state relations, and professional associationssuch as the American Veterinary Medical Associationand the American Public Health Association.

Inauguration of veterinary public health in 1945 asa national program in the USPHS stimulated interestworldwide, especially in the newly created internation-al agencies. The United Nations Health Office organiz-ing committee, chaired by Surgeon General TomParran, met in New York in June 1946. The PublicHealth Service officers and personnel were asked bythe surgeon general’s chief of staff, G.L. Dunnahoo, tosuggest topics. Veterinary public health was new, but afew weeks before the organizing group was to meet, Iwas directed to make a presentation about veterinarypublic health and answer questions at the surgeon gen-eral’s staff meeting. After the meeting, I asked Dr.Dunnahoo if he would be interested in recommendinga veterinary public health program for the WorldHealth Organizing Committee. He urged me to givehim a memo recommending a veterinary public healthactivity wherein I indicated that the Veterinary PublicHealth (VPH) program would be concerned with ani-mal diseases transmissible to humans, would carry on

liaisons with veterinary activities in the agricultureagencies, and collect information on animal health.

Some months later I asked how the VPH recom-mendation was received. Dr. Dunnahoo said there wereno objections or discussion. The VPH item was accept-ed and placed in the records.

In September 1947, after Surgeon General Parran’sapproval of the veterinary medical officer cadre, Dr.Mountin felt my activities were successful. He told meI was to be assigned to the newly created Centers forDisease Control (CDC), formerly the Malaria Controlin War Areas. There the veterinary public health pro-gram was established as a division. The new director ofthe CDC was Dr. R.A. Vonderlehr, who previously wasChief of the Puerto Rico Regional Office, which is whoI served under. He gave excellent support, as did hisdeputy, Dr. Justin Andrews, who succeeded Dr.Vonderlehr a year later.

As the war wound down, I was in Washington forfurther assignment. While in Washington, I visited thePan American Sanitary Bureau to discuss my reportwith Surgeon General Hugh S. Cummings, who servedthe Pan American Sanitary Bureau for a decade afterretiring from the USPHS. At our meeting, I emphasizedthe need for a veterinary public health program to helpupdate animal health, prevent zoonotic diseases, andensure food safety. Dr. Cummings listened and told meto discuss the need for a veterinary public health pro-gram with his medical staff, where the proposal wasenthusiastically accepted. The veterinary public healthprogram was initiated with Dr. Aurelio Malaga Alba, aPeruvian military veterinarian, as a consultant in 1948.Dr. Fred Soper, the post-war director of the reorganizedPAHO, later appointed Dr. Ben Blood to organize a vet-erinary public health program in June 1949. He serveduntil the 1960s.

RabiesRabies was a national problem after the war. There

was a great movement of people as war industries andencampments closed. Pets were lost or abandoned. Theincidence of rabies in humans was the highest everrecorded. Human vaccines were not always effective.Canine rabies vaccine protection was short and thevaccines were given every six months. Rabies becamethe lead program of the Veterinary Public HealthDivision. To head the activity, Dr. Ernest Tierkel, aUniversity of Pennsylvania graduate who had complet-ed his Masters of Public Health, was recruited.

He, Bob Kissling, and Martha Eidson, along with astaff of animal handlers, became the nucleus of thenational rabies program.26-27 They successfully demon-strated the effectiveness of a new chicken embryorabies vaccine in the laboratory28 and later in epidemicsituations.29 Some others who followed from CDC andwho contributed to the control and prevention ofrabies are George Baer, Keith Sikes, Jerry Winkler, andCharles Rupprecht.

BrucellosisDr. Mountin had said that the public health

authorities of Indiana, Michigan, and other statesbelieved that brucellosis in humans was of concern.

1812_1836.qxp 9/23/2005 2:44 PM Page 1816


They went so far as to say that, as the sanitariums losttuberculosis patients, brucellosis patients would taketheir place. The Indiana Health Department was to beour brucellosis project site under Sam Damen, PhD,the director of laboratories. The goal was to determinewhat action the health agencies should take.

The federal Bovine Brucellosis Control programwas active in all states. It became apparent that if thehealth authorities got active, the animals could beeliminated as a source of human disease. We broughtthe problem to the attention of Dr. Herman Bunderson,Chicago’s health officer who remembered the struggleto eradicate bovine tuberculosis in the Chicago milkshed which included dairy herds in six midwesternstates. In 1928, he had required all milk coming intoChicago to be from tuberculosis-free herds regardlessof whether the milk was to be pasteurized. He recog-nized the brucella problem and shortly thereafter insti-tuted the same standards for the elimination of bovinebrucellosis.

The brucella eradication program was supportedby the USPHS milk code, which required that allGrade-A milk be from disease-free herds.30 TheChicago control program was soon adopted by big cityhealth authorities, which gave impetus to the state fed-eral testing programs. Human brucellosis declinedrapidly in the Midwest from thousands to hundreds,and to less in a decade. Most of the human cases wereof occupational origin and among people using rawmilk in rural areas.

There was a scare of brucellosis in Dugway prov-ing ground in western Utah in the early 1950s. H.G.Stoenner, who investigated the alleged contaminatedarea, found the problem to be a rodent disease causedby Brucella neotoma, which does not cause disease inhumans or domestic animals, but will cause antibodyformation in cattle.31

TrichinosisThe late Professor S.E. Gould initiated studies at

the Wayne State Medical School on the use of irradia-tion to destroy Trichinella.32 After the war, there wasgreat interest in the application of atomic energy forcivilian use. He persuaded the American MedicalAssociation to host a Symposium on Trichinosis in1953 in which the CDC participated. The evidence wasconclusive that gamma radiation was effective at lowdoses.33 It was not until 1985 that irradiation for com-mercial use was approved by federal agencies. TheZimmerman Human Tissue survey from 1966 to 1970revealed the lowest rate ever.34 Modern methods in rais-ing pigs, the prohibition of feeding garbage to swine,and consumer education are all contributing factors inthe decline of disease in pigs and humans.35 Trichinosisgradually declined in the United States.

Other Parasitic DiseasesOther veterinary public health studies of parasitic

diseases involved cutaneous larva migrans caused bythe common dog hookworm larva Ancylostoma can-inum entering the skin and causing an intense itching.This was common in the southeast states among per-sons exposed to damp, sandy soil; children playing in

sandboxes; bathers at the beach, and utility men.36

Toxocariasis or larva migrans is another parasitic dis-ease attributed to parasite larvae of dogs migrating inthe body of a foreign host, such as human beings.37

Toxoplasmosis has been recognized as a commonhuman infection. The domestic cat is recognized as acommon source of human infection. Infection may becaused by consuming meat. Irradiation is effective indestroying the oocyst in pork.32

Equine Encephalitis, Plague, and AnthraxIn the early 1950s, there was a large equine

encephalitis epizootic in central California thatrequired the assignment of all CDC Veterinary Officers.Another equine encephalitis epizootic was in NewJersey in 1959. Since then there have been a few epi-zootics of the equine encephalides. The principal reser-voir is birds. In addition, the virus survives in mosqui-to eggs over winter. The CDC–Fort Collins laboratoryhas been at the forefront of investigations of arbovirus-es and their role in human health.

Plague is sporadic in the United States. It is pri-marily a disease of rodents. The appearance of plaguein domestic and feral cats has brought the ancientscourge to households in the western states.38

An unusual epidemic of anthrax, introduced bycontaminated bone meal in the 1950s, caused alarm inpublic health circles. The problem of whether milkcould be a vehicle was of concern. A search of literaturefound that milk was never a cause of human or animalanthrax disease.39

SalmonellosisSalmonellosis was a recognized public health

problem among the civilian populations during andafter World War II.40 After the war, investigators deter-mined that it was widely disseminated. Phil Edwardsled the way at the University of Kentucky and later atCDC. Mildred Galton, Chief of the Veterinary PublicHealth Laboratory, contributed in many ways. She hadan unusual ability to find evidence that others hadoverlooked. She demonstrated Salmonella in animals.Her studies on transported pigs revealed how stresscaused latent infection and induced shedding. Thesame reaction was found in other species. Her work onraw egg meats led to their pasteurization even thoughthe egg slurry was to be in baked or cooked products.She was among the first to find Salmonella in raw milk40 years ago. Her work on the frequent presence ofSalmonella led to the federal poultry inspection pro-gram in the late 1950s.41

LeptospirosisLeptospirosis was identified in animals as a sepa-

rate clinical entity in 1850, about 30 years prior to thetime Weil described the disease in humans. In 1898, anepidemic in dogs was recorded in Stuttgart, Germany,but it wasn’t until the etiologic agents were discovered30 years later that it was realized the disease in dogsand humans was caused by microorganisms of identi-cal morphology. Three years after the discovery of lep-tospires, it had already been shown that injection of themicroorganisms into puppies would lead to a severe

1812_1836.qxp 9/23/2005 2:44 PM Page 1817


icterohemorrhagic disease. During the first half of the20th century, analysis of evidence accumulatedthroughout the world revealed that morphologicallyand serologically identical leptospires could affect vir-tually all known mammals and some lower vertebrates.By the late 1940s and early 1950s, leptospirosis indomestic animals was already established as a diseaseof major concern in veterinary medicine and veterinarypublic health.

During the years of the late 19th century and early20th century, especially during the period precedingthe discovery of the causative agents by Insada, onlysevere cases of leptospirosis could be diagnosed clini-cally. This fact led to the still prevailing notion that lep-tospirosis has to be associated with jaundice andnephritis. With improvement of diagnostic proceduresand their availability to more laboratories, it was soonrealized that most affected animals have no signs ofdisease or may have various clinical signs. Anotherpoint that contributed to the confusion in clinical diag-nosis was the fact that isolated serovars were givennames denoting the clinical signs observed in thepatients. Thus, it was expected that infection by theserovar icterohemorrhagia would lead to hemorrhagicjaundice whereas infection with serovar grippotyphosashould resemble the signs of catarrhal fever. In fact,both serotypes can cause both signs.42

From 1950 to 1970 in the United States, numerousoutbreaks were recognized among animal handlers,veterinarians, and swimmers, as well as people whoseoccupation exposed them to contaminated wastewater.Galton edited the Leptospiral Serotype DistributionLists through 196643 and Sulzer carried it up to 1973.44

They were truly dedicated in keeping records of lep-tospiral serotypes.

Stoenner and associates investigated a large epi-zootic involving L pomona in cattle in Washington,which involved many herds but fortunately few humanbeings.45 The effectiveness of vaccines was observed. Inrecent years there have been few epizootics reported,and epidemics are most commonly reported amongswimmers. There is wide agreement that vaccination ofcattle and dogs has reduced environmental contamina-tion.

ListeriosisListeriosis was first recorded in 1926 and the first

reported human case was in Denmark in 1929.Prevention of listeriosis is not possible with the knowl-edge available. There are no immunizing agents ofproven worth. Killed bacterins have been disappoint-ing and living attenuated vaccines have not been eval-uated properly nor have they shown promise in limit-ed experiments.

High-risk groups are pregnant women, neonates,diabetics, alcohol dependents, persons with neoplasticdisease, or those being treated with corticosteroids orantimetabolites. Among animals, ewes are at the high-est risk late in the first pregnancy. Sheep in late preg-nancy should not be fed ensilage of doubtful qualitynor be exposed to severe cold, inclement weather, orcrowding. Chinchilla also have high susceptibility.

Lack of accurate epidemiologic information on lis-

teriosis hampers prevention and control. Only by com-pulsory reporting of human and animal infections canthe prevalence of this uncommon disease be estimated.Medical and veterinary health agencies shouldexchange information and coordinate their controlmeasures. Farmers and veterinarians should adoptsound sanitary practices in handling sick or abortingdomestic animals and livestock. Prevention and con-trol of listeriosis in humans will depend on an increas-ing index of suspicion and increasing awareness of itsdiverse clinical manifestations. Because L monocyto-genes is susceptible to most antibiotics, early adminis-tration after the diagnosis substantially decreases mor-tality. Cortisone and its derivatives may, however, causesubclinical infections to become overt.46

After the end of the war in Europe, the breakdownof veterinary food hygiene allowed salvaged food tospread zoonotic diseases. Although there likely weresporadic cases, food-borne listeria went largely unno-ticed until the period between 1949 and 1957, when asharp increase in the number of stillborn infants wasobserved in an obstetrical clinic in Halle, in the formerEast Germany. Seeliger47 confirmed that L monocyto-genes had caused the stillbirths, and he suspected thatraw milk, sour cream, sour milk, and cottage cheesewere the vehicles that transmitted the pathogen. LaterPotel48 isolated identical serotypes of L monocytogenesfrom a mastitic cow and from stillborn twins deliveredby a woman who had consumed raw milk produced bythe mastitic cow. Additional outbreaks of listeriosiswere recorded in Halle between 1960 and 197149,50 andin Bremen, in the former West Germany, in 1960 and1961.49 Unfortunately, the vehicle that transmitted Lmonocytogenes in these outbreaks was never identified.At the same time there were numerous cases of abor-tions, stillbirths, and reproductive tract diseases report-ed in France. The disease remains prevalent in westernEurope to the extent that all midwives and obstetri-cians alert their patients.

Listeriosis of food-borne origin was virtually for-gotten until 1981, when an outbreak occurred in theMaritime Provinces of Canada and was associated withconsumption of contaminated coleslaw.51 Two yearslater, a major outbreak in Massachusetts was epidemi-ologically linked to consumption of a particular brandof pasteurized whole and 2% (milk fat) milk.52

Although questions have been raised about the ade-quacy of the epidemiologic study,53 no other food hasemerged as the vehicle that transmitted L monocyto-genes in this outbreak. In 1985, Mexican-style cheesemade in a factory near Los Angeles was definitivelylinked to a large outbreak of listeriosis.54 This was fol-lowed in 1987 by the linking of consumption ofVacherin Mont d’Or, a variety of cheese, to an outbreakof listeriosis in the Canton of Vaud in Switzerland.55

In recent years, food-borne outbreaks continued tobe reported in North America and Europe. During the1990s, many more human cases and deaths werereported in the United States. The vehicle being report-ed as contaminated are cold cuts, canned meats, andfrankfurter sausages. Worldwide, listeriosis is a prob-lem in the temperate zones.Emerging zoonotic food-borne diseases

1812_1836.qxp 9/23/2005 2:44 PM Page 1818


Escherichia coli O157:H7, the enterohemorrhagicstrains, and other E coli characterized by cytotoxins aremajor causes of enteric disease in humans, but so lessfor food-producing animals that may be infected with-out clinical signs. Pasteurization of milk is effective inthe control of E coli spread. Now irradiation of otherfoods of animal origin is also effective for the protec-tion of public health.

Other emerging food-borne zoonotic diseaseagents, such as Cryptosporidia parvum, a coccidian pro-tozoa, have been found worldwide. Cyclospora cayeta-nensis is a coccidian protozoa, which is primarily waterborne, but also found as a contaminant of fruit andvegetables. A similar coccidia has been associated withbirds. Giardia spp are found in numerous animals.During the late 20th century, the flagellate protozoanwas identified worldwide as the cause of disease inhumans and animals.

An old problem, but new in the United States, isthe emergence of Taenia saginata and T solium, whichare largely found in migrating persons. The cystsinduced by the Taenia spp are found in beef and porkand are easily destroyed by irradiation, a technologythat is being accepted in the southern countries wherediseases caused by Taenia are economic as well as pub-lic health problems.

TuberculosisAmerican veterinarian Martin M. Kaplan, VMD,

MPH, was recruited by an English physician withwhom Kaplan worked with in United NationsRehabilitation and Recovery Agency in Greece. In1948, Kaplan came to the newly established WorldHealth Organization in Geneva, Switzerland. He sin-gle-handedly developed a VPH program in the com-municable disease division that is a model for a publichealth program. During the next 20 years, he organizedthe expert committee meetings and technical reports.The first was in 1950,56 which reviewed tuberculosis.

At the end of World War II, tuberculosis was a majordisease problem in humans and animals. Americantuberculosis authorities had reported that 30% of thehuman cases in the American-occupied Germany werecaused by Mycobacteria tuberculosis bovis. The problemwas referred to the WHO Expert Zoonoses Committee bythe WHO Expert Tuberculosis Committee. There was noconsensus on what recommendation to make. TheDanish veterinarians spoke for the classical tuberculintest and identification. The French urged use of BCG vac-cinations. The success of eradication of bovine tubercu-losis in the United States was held up as the idealmethod. Eventually the committee recommended testand removal, with the caveat for developing countries totry other methods, including BCG vaccination.

World Health OrganizationThe first WHO Expert Committee on the

Zoonoses was held in late 1950. This was followed in1958 by zoonoses study groups that were chaired byK.F. Meyer in Stockholm.57 In 1965, at the next meet-ing of the WHO Zoonoses Expert Committee inGeneva, I was the chairman.58 The next meeting in1974 was chaired by Calvin Schwabe,59 professor of

epidemiology at the University of California School ofVeterinary Medicine and the School of HumanMedicine. Schwabe summarized the WHO VeterinaryPublic Health in his third edition of Veterinary Medicineand Human Health: “The final objective of veterinarymedicine does not lie in the animal species that the vet-erinarian commonly treats. It lies very definitely inman, and above all in humanity.”60

Pan American Health OrganizationThe PAHO Veterinary Public Health program was

inaugurated in June 1949 with the recruitment of BenBlood, a retired United States Army veterinary officer.25

Blood established the Pan American Zoonoses Centerin Azul, Argentina, in the 1950s, and the Pan AmericanFoot and Mouth Center in Rio de Janeiro, Brazil, aboutthe same time. Later, the Zoonoses Center was movedto Buenos Aires where Joe Held was director.

Pedro Acha succeeded Ben Blood in the 1960s andgave impetus to VPH in the Americas with support ofthe World Bank. He was able to recruit public healthveterinarians and staff to the regional offices of PAHOand assist national health administrations with trainedofficers. Dr. Acha was followed by Dr. Mario Fernandez,an experienced virologist who had been director of thePAHO Foot and Mouth Disease Center. Dr. Joe Held, aformer assistant surgeon general, USPHS, was the nextdirector. Currently, Primo Arambulo is the coordinatorof the VPH program. All have made substantial contri-butions. The control of urban rabies is important topopulation centers. The eradication of foot and mouthdisease in southern South America, with the leadershipof Vincent Estudillo, for the past decade has given stim-ulus to the goal of the Americas being free of foot andmouth disease. The progress in bovine tuberculosiscontrol is credited to Isabel Kantor, who taught scien-tists how to make tuberculin, evaluate tuberculin testresults, and gather epidemiologic data, which are criti-cal to good surveillance. Jaime Estupinan, as director ofthe PAHO Zoonoses Center, guides the transition toencompass food-borne diseases.

We in veterinary public health recognize the con-tributions of Pedro Acha and Boris Szyfres for theirinvaluable book, Zoonoses and Communicable DiseasesCommon to Man and Animals, in Spanish and English.62

It has been the foundation of veterinary public healthepidemiology and surveillance in the Spanish-speakingcountries of the Americas.

George Beran is to be recognized as one of the con-sultants to PAHO and WHO, and for his work in thePhilippines. He has performed in admirable style formore than 50 years in teaching, research, health pro-motion, consulting, writing, and editing. He has updat-ed the CRC Zoonoses Handbook Series63 and the PAHOZoonoses reports, and hopefully will continue to do so.

We pay tribute to all the American veterinarianswho demonstrated and promoted veterinary publichealth in the United States. Most of these early pio-neers were recruited by the CDC and assigned to statesthat had zoonotic disease problems. Their service tothe public health in the 20th century is better health inall humans and animals.aRoyal Veterinary Institute, Berlin, Germany.

1812_1836.qxp 9/23/2005 2:44 PM Page 1819


References1. Diamond J. Farmer power. In: Guns, germs and steel. New

York: WW Norton, 1997;85–92. 2. Steele JH. The socioeconomic responsibilities of veterinary

medicine. Pub Health Rep 1964;79:613–618.3. Smithcors JF. The veterinarian in America 1625–1975. Santa

Barbara, Calif: American Veterinary Publications, 1975.4. Terry L. A century’s progress in public health. J Am Vet Med

Assoc 1963;142:1287–1291.5. Furman B. A profile of the US public health service

1798–1948. Department of Health, Education and Welfare.Publication No. NIH–73–369, Washington, DC: US GovernmentPrinting Office, 1973.

6. Law J. Report on diseases of domestic animals. Am Vet Rev1880;4:215–238.

7. Steele JH. Zoonoses 1879–1883: an update of James Law’sreport on diseases of animals. Vet Heritage 2000;23:14–20.

8. Miles WD. History of the bureau of animal industry. In:Myer JA and Steele JH, eds. Bovine tuberculosis control in man and ani-mals. St Louis: Warren H Green Publishers, 1969.

9. Billings FS. The relation of animal diseases to the public healthand their prevention. New York: D Appleton and Co, 1884;1–446.

10. Koprowski H,Plotkin SA, eds. World’s debt to Pasteur. WistorSymposium Series. New York: Alan R. Liss, 1985;3:1–303.

11. Stenn F. Nurture turned to poison. Prospect Biol Med1980;69–80.

12. Rosenau M. Milk and its relation to public health.Washington, DC: USPHS Hygiene Laboratory, 1908.

13. Myers JA, Steele JH. Attempts to control tuberculosisamong cattle. In: Bovine tuberculosis control in man and animals. StLouis: Warren H Green Publishers, Inc, 1969;74–76.

14. Fontenot B. Much ado about milk. 2nd ed. New York:American Council on Science and Health, 1999;1–38.

15. Schwabe CW. Food safety. In: Veterinary medicine and humanhealth. 3rd ed. Baltimore: The Williams & Wilkins Co,1984;539–560.

16. Sinclair U. The jungle. New York: Doubleday, Page & Co,1906.

17. Myers JA. Man’s greatest victory over tuberculosis.Springfield, Ill: CC Thomas, 1940.

18. Meyer KF. History of medical research and public health: anoral interview. Berkeley, Calif: University of California Press, 1976.

19. Meyer KF. The animal kingdom—a reservoir of disease, inProceedings. Intl Med 1930;8:234–261.

20. Steele JH. Biographical notes on the occasion of Karl F.Meyer’s 90th birthday, May 19, 1974. J Infect Dis 1974;129(suppl):3–10.

21. Altman L, Meyer KF. Viral scientist dies—public healthgiant. New York Times 1974 April 29.

22. Sabin A. Karl Friedrich Meyer 1884–1974. A biographicalmemoir. Vol 52. Washington, DC: National Academic Press, 1980.

23. Holland CF. Undulant fever outbreak at Michigan StateCollege. Mich State Med Soc 1940;39:666–670.

24. Newitt AW, Koppa TM, Gudakunst DW. Water borne out-break of Brucella melitensis infection. Am J Public Health1939;29:739–743.

25. Steele JH, Blackwell MJ, Andres CR. The 50th anniversaryof the veterinary medical corps officers of the US public health ser-vice. J Am Vet Med Assoc 1998;212:952–954.

26. Steele JH, Tierkel ES. The US public health service nationalprogram for the control of rabies, in Proceedings. US Livestock SanAssoc 1948;201–210.

27. Steele JH, Tierkel ES. Rabies. Problems and control. Anationwide program. Pub Health Rep 1949;64:785–796.

28. Tierkel ES, Kissling RE, Eidson M, et al. A brief survey andprogress report of controlled comparative experiments in caninerabies immunization, in Proceedings. Am Vet Med Assoc, 1953;443.

29. Tierkel ES, Graves LM, Tuggle HG, et al. Effective control ofan outbreak of rabies in Memphis and Shelby County, Texas. Am JPub Health 1948; 40:1084–1090.

30. US Public Health Service. Milk ordinance and code. PublicHealth Bulletin No. 220, Washington, DC: Department of theTreasury, 1943.

31. Stoenner HG, Lackman DB. A new species of Brucella iso-lated from the desert wood rat Neotoma lepida (Thomas). Am J Vet Res1957;18:947–951.

32. Gould SE, Gomberg HJ, Bethell FH. Prevention of trichi-nosis by gamma irradiation of pork as a public health measure. Am JPublic Health 1953;43:1550–1555.

33. Gould SE, Gomberg HJ, Bethell FH. Control of trichinosisby gamma irradiation of pork. JAMA 1954;154:653–658.

34. Zimmerman WJ, Steele JH, Kagan IG. Trichinosis in humansin the United States 1966–1970. Health Serv Rep 1973;7:606–610.

35. Steele JH. Trichinosis. In: Schultz MC, Steele JH, eds.Handbook series in zoonoses, section c, parasitic zoonoses. Vol 2. BocaRaton, Fla: CRC Press, 1982;293–330.

36. Cypess RH. Cutaneous larva migrans. In: Schultz MC,Steele JH, eds. Handbook series in zoonoses, section c, parasiticzoonoses. Vol 2. Boca Raton, Fla: CRC Press, 1982;213–219.

37. Cypess RH. Visceral larva migrans. In: Schultz MC, SteeleJH, eds. Handbook series in zoonoses, section c, parasitic zoonoses. Vol2. Boca Raton, Fla: CRC Press, 1982;205–212.

38. Poland JD, Barnes AM. Plague. In: Steele JH, ed. Handbookseries in zoonoses. Vol 1. Boca Raton, Fla: CRC Press, 1979;515–559.

39. Steele JH, Helvig RJ. Present status of anthrax. Public HealthRep 1953;68:616–623.

40. Galton MM, Steele JH, Newell KW. The world problem of sal-monellosis. The Hague, The Netherlands: Dr. W Junk Publisher, 1964.

41. Steele JH, Galton MM. Epidemiology of food borne salmo-nellosis. Health Lab Sci 1967;4:10–14.

42. Torten M. Leptospirosis. In: Steele JH, ed. Handbook seriesin zoonoses, section a. Vol 1. Boca Raton, Fla: CRC Press, 1979;363–421.

43. Galton MM. Leptospiral serotype distribution lists (through1966). Veterinary Public Health Laboratory. Atlanta: US Dept ofHealth, Education, and Welfare Public Health Service, Centers forDisease Control, 1966.

44. Sulzer CR. Leptospiral serotype distribution lists (1966 to1973). Bureau of Laboratories. Atlanta: US Dept of Health,Education, and Welfare, Public Health Service, Centers for DiseaseControl, 1975.

45. Stoenner HG et al. The epizootiology of bovine leptospiro-sis in Washington. J Am Vet Med Assoc 1956;129:251–259.

46. Bomer EJ, Conklin RH, Steele JH. Listeriosis. In: Steele JH,ed. Handbook series in zoonoses, section a. Vol 1. Boca Raton, Fla:CRC Press, 1979;423–445.

47. Seeliger HPR. Listeriosis. New York: Hafner Publishing,1961.

48. Potel J. Aetiologie der Granulomatosis. Wiss Z MartinLuther Univ 1953/1954;3:341–354.

49. Fischer M. Listeriose-Häufung in Raume Bremen in denJahren 1960 and 1961. Dtsh Med Wochenschr 1962;87:2682–2684.

50. Ortel S. Bakteriologische, serologische und epidemiologis-che Untersuchungen während einer Listeriae-Epidemie. DtschGesundheitswes 1968;23:753–759.

51. Schleck WF, Lavigne PM, Bortolussi RA, et al. Epidemic lis-teriosis: evidence for transmission by food. N Engl J Med1983;308:203–206.

52. Fleming DW, Cochi SL, MacDonald KL, et al. Pasteurizedmilk as a vehicle of infection in an outbreak of listeriosis. N Eng JMed 1985;312:404–407.

53. Ryser ET, Marth EH. Listeria, listeriosis, and food safety.New York: Marcel Dekker, 1991.

54. Linnan MJ, Mascola L, Lou XD, et al. Epidemic listeriosisassociated with Mexican-style cheese. N Engl J Med 1988;319:823–828.

55. Bille J, Rocourt J, Mean F, et al. Epidemic food-borne listeriosisin western Switzerland. II. Epidemiology. Presented at the InterscienceConference of Antimicrobial Agents and Chemotherapy, 1988.

56. World Health Organization. Joint WHO/FAO Expert Groupon Zoonoses: Bovine tuberculosis, Q fever, anthrax, psittacosis,hydatidosis—Report on the first session. WHO Technical ReportSeries No. 40. Geneva: WHO, May 1951.

57. World Health Organization. Joint WHO/FAO ExpertCommittee on Zoonoses, 2nd report. WHO Technical Report SeriesNo. 169. Geneva: WHO, 1959.

1812_1836.qxp 9/23/2005 2:44 PM Page 1820


58. World Health Organization. Joint WHO/FAO ExpertCommittee on Zoonoses, 3rd report. WHO Technical Report SeriesNo. 378. Geneva: WHO, 1967.

59. World Health Organization. Parasitic zoonoses: report of aWHO expert committee with the participation of FAO. WHOTechnical Report Series No. 637. Geneva: WHO, 1979.

60. Schwabe CW. Veterinary medicine and human health. 3rd ed.Baltimore: The Williams and Wilkins Co, 1984;192–242,309.

61. Acha PN, Szyfres B. Zoonoses and communicable diseasescommon to man and animals. Washington, DC: Pan American HealthOrganization, 1980.

62. Beran GW. Handbook of zoonoses—section a: bacterial, rick-ettsial, chlamydial and mycotic. Section b: viral. 2nd ed. Boca Raton,Fla: CRC Press, 1994.

This year, the American College of VeterinaryPreventive Medicine, originally incorporated as the

American Board of Veterinary Public Health(ABVPH), in Washington, DC in 1950, is celebratingthe 50th anniversary of its founding. The AVBPH andthe American College of Veterinary Pathologists(ACVP) were the first specialties in veterinary medi-cine to be recognized by the American VeterinaryMedical Association (AVMA). This distinction wasconferred unanimously by the AVMA House ofRepresentatives during its 88th annual meeting inMilwaukee, Wis.1 Such was the birth of specializationin veterinary medicine in the United States or else-where in the world.

Actions taken by the House of Representativeswere important for the future of specialty practice inveterinary medicine in the United States. First, theAVMA Council on Education was authorized “toexpress its approval of such examining boards in vet-erinary medical specialties as conform to standards ofadministration formulated by the Council.” Second,the Essentials of Approved Specialty Boards or Colleges inVeterinary Medicine, formulated by the Council onEducation, was approved. Finally, as noted, the appli-cations from the ACVP (Feb 10, 1950) and the ABVPH(Jul 31, 1950) for specialty recognition were approvedunanimously by the House.

Unrelated, but equally indicative of the progressiveoutlook of the AVMA in 1951, was the action by theHouse to approve an AVMA Executive Board recom-mendation for “the establishment of some type ofAVMA representation in Washington, at a beginningmaximum expenditure of $2,500 a year.” Thus was thebeginning of the AVMA Washington Representative.

Specialty Evolution in Human MedicineThe growth of specialization in human medicine is

linked to advancements of medical science and result-ing improvements in medical care and diagnosticssince the turn of the 20th century. The American Boardfor Ophthalmic Examinations, the first recognizedmedical specialty, was incorporated in 1917. It was thefirst time guidelines were established for training andevaluating candidates desiring to practice ophthalmol-ogy. The second specialty board, the American Board ofOtolaryngology, founded and incorporated in 1924,developed along the same lines as its predecessor.Others followed in the 1930s, and by 1948 there were18 recognized medical specialties. Among the latermedical specialties was the American Board ofPreventive Medicine and Public Health. It was incor-porated in 1948 and recognized in 1949, only twoyears before the ABVPH. In 1952, the name waschanged to the American Board of PreventiveMedicine. Diplomates of this board are certified in thespecialty area of aerospace medicine, occupationalmedicine or public health, and general preventive med-icine. Undoubtedly, the establishment and recognitionof the American Board of Preventive Medicine andPublic Health spurred the interest of veterinarians topromote a specialty in veterinary public health.

Today, there are 24 member medical boards recog-nized by the American Board of Medical Specialties and20 member boards or colleges recognized by theAmerican Board of Veterinary Specialties. Unlike theearly medical specialties, which were clinically orient-ed, five of the first seven veterinary medical specialtiesrecognized in the period of 1951 to 1970 were in thepublic or institutional practice sector.

Evolution of Veterinary Public Health andPreventive Medicine as a Specialty

The history of the American College of VeterinaryPreventive Medicine (ACVPM) can be traced to 1949,when a group of 12 veterinarians formed an organizingcouncil for the purpose of establishing what they then

Historic and future perspectives of the American College of Veterinary Preventive Medicine

Thomas G. Murnane, DVM, DACVP

Dr. Murnane is a retired Brigadier General in the United States Army This historical and future perspective account of the American

College of Veterinary Preventive Medicine is based on documentsand correspondence in the archives of the college; personal com-munications; information kindly provided by the AmericanVeterinary Medical Association, the American Board of MedicalSpecialties, and the American Board of Preventive Medicine; andcomments and additions offered by 35 diplomates of the ACVPM.

1812_1836.qxp 9/23/2005 2:44 PM Page 1821


designated the American Academy of Veterinary PublicHealth. The first meeting of the council was held Jul11, 1949, in Detroit, Mich, during the annual meetingof the AVMA.2 The successor to the academy, theABVPH/ACVPM has held its annual executive andmembership meetings concurrently with the annualconvention of the AVMA, an annual alliance of 50years!

The organizing council members were distin-guished public health practitioners and academicians:three were active duty United States Army VeterinaryCorps officers (Lieutenant Colonels Frank A. Todd,Phillip R. Carter, Mervyn B. Starnes); one was a com-missioned Public Health Service officer (Dr. James H.Steele); one was an international veterinary publichealth consultant (Dr. Benjamin D. Blood); three werecity or state health department veterinarians (Drs. L.W.Rowles, Martin D. Baum, Alexander Zeissig); threewere academicians (Drs. Ival A. Merchant, Henrik J.Stafseth, Franklin A. Clark), and one, Dr. John G.Hardenbergh, after a distinguished practice, military,and academic career was serving as the executive sec-retary of the AVMA. Colonels Todd and Carter hadserved together for several years in the EuropeanTheater of Operations during and following World WarII, where they were assigned to civil affairs/militarygovernment operations. Colonel Carter, one of twosurviving members of the council said, “We had manytalks about the idea of a veterinary public health spe-cialty,” and “we kept up such interest after our returnto the United States.”

Dr. James H. Steele, the other surviving member ofthe 12-member council, who is known and familiar tomany as a leading icon in veterinary public health,served as the first secretary to the organizing council.His report of the first meeting of the council stated thatFrank Todd was elected temporary chairman and hewas selected temporary secretary. Chairman Toddappointed two committees: one to establish a defini-tion of veterinary public health; the other to developbylaws to include criteria for eligibility. The next meet-ing of the council was scheduled for Sunday, Oct 23,1949. This coincided with the annual meeting of theAmerican Public Health Association, with which somecouncil members were affiliated.

Secretary Steele included this cautionary note inhis first report:

It should be explained to all members of the OrganizingCouncil and interested parties that physical presence atthese organization meetings does not make one a charteror founding member. Membership cannot be determineduntil the bylaws eligibility report of Doctor Rowles’ com-mittee can be accepted by the Organizing Council.

At some time during or immediately following theNew York meeting in October 1949, the academyredesignated itself as the American Board of VeterinaryPublic Health. A copy of the constitution and bylaws,dated Nov 30, 1949, stated that the name of the orga-nization would be the American Board of VeterinaryPublic Health. Perhaps this designation was promptedby the fact that the term “board” is more accurate forthe purpose of the organization, which is the examina-

tion and certification of veterinarians in the specialty ofveterinary public health. Likewise, the name of the cor-responding specialty in human medicine, theAmerican Board of Preventive Medicine and PublicHealth, which was officially recognized earlier in 1949,and may have inspired the change from academy toboard. Whatever the circumstances, the designationwas professionally and technically appropriate. TheABVPH was officially incorporated as a non-profitorganization under the jurisdiction of the District ofColumbia on Feb 3, 1950.

Early Organization of the ABVPHThe first constitution and bylaws of the ABVPH

provided for an executive council of a president, vicepresident, secretary, treasurer, and six councilors. Thepositions were filled by 10 of the 12 organizing fellows.Dr. Frank Todd, then Lieutenant Colonel Frank Toddof the US Army Veterinary Corps, the first president,was elected by the other organizing fellows. Terms ofoffice were three years for all positions. Initially, a pairof councilors served one or two years in order to estab-lish a turnover of two councilors each year.

Four classes of membership or fellowship wereestablished. They were organizing committee fellow,charter fellow, fellow, and honorary fellow. The term“fellow” persisted until the constitution was amendedon Aug 14, 1960. The term “diplomate” supplanted theterm “fellow.”

The original prerequisites described for applicantswishing to take the board examination were that they:

' Be a graduate from a veterinary school recognizedby the AVMA

' Have an Masters of Public Health (MPH) orequivalent degree from a school of public healthrecognized by the American Public HealthAssociation (APHA) and at least six years of expe-rience in a recognized civilian or military publichealth agency, and have made a distinct contribu-tion to the advancement of veterinary publichealth; four years of additional experience alongwith recognized accomplishments in veterinarypublic health may be substituted for an advanceddegree

' Possess a license to practice veterinary medicineissued by a recognized national or state licensingagency.

Administration of the board and all other dutiesand powers ordinarily delegated to the governing bodyof a corporation were vested in the board’s council ofofficers. The council also judged compliance of candi-dates with prerequisite requirements for examination,appointed the examining board, and certified all suc-cessful candidates as specialists in veterinary publichealth. The early constitutions did not provide for anystanding committees. In essence, the council, com-posed of the four elected officers and six councilors,was responsible for the entire operation of the ABVPH.

The first meeting of the newly constituted ABVPHwas held in Miami Beach, Fla, in August 1950 duringthe annual meeting of the AVMA.3 The constitutiondecreed that all regular meetings of the board and

1812_1836.qxp 9/23/2005 2:44 PM Page 1822


council be held annually at the time and the place ofthe annual meeting of the AVMA. The board and itssuccessor, the ACVPM, have adhered to this practicefaithfully for the past 50 years.

In 1950, the board was occupied largely with theprocessing and approval of applicants for charter fel-lowship. An initial group of 55 candidates was com-piled from veterinarians recommended by the 12 fel-lows of the organizing committee. The group wasscreened by the council and those selected were invit-ed to apply for charter fellowship. Twenty-one appli-cants were approved as charter fellows bringing thetotal number of fellows in the ABVPH to 33 in early1951.

The second annual meeting of the ABVPH washeld in 1951 in Milwaukee, Wis. Thirteen of the 33 fel-lows attended this meeting. The occasion was of par-ticular importance as the AVMA House ofRepresentatives approved the applications of theABVPH and the ACVP as the first recognized special-ties in veterinary medicine.

President Todd also announced with pleasure thatthe definition of veterinary public health, as preparedby the board and adopted in 1950 at its first meeting,had since been adopted by the World HealthOrganization and the Food and AgricultureOrganization of the United Nations. The definition,developed in response to President Todd’s 1949 requestreads, “Veterinary public health is all communityefforts influenced by the veterinary medical arts andsciences applied to the prevention of disease, protec-tion of life and promotion of the well-being and effi-ciency of man.”

Prerequisites and Examination ProcessThe method, time, and place for holding the first

examination of candidates was discussed intensely atthe second annual meeting of the ABVPH. PresidentTodd appointed the first examining committee, whichconsisted of four fellows: Drs. Alexander Zeissig,Stanley L. Hendricks, James E. Scatterday, and MervynB. Starnes. For the balance of the year and throughmuch of 1952, the committee reviewed the possiblemethods of conducting the examinations. A set ofquestions based on the APHA merit system examina-tions and New York State Health Department examina-tions were used in developing a multiple choice writ-ten examination. No further details are available on thenature of the written examination. The first examina-tion was planned to be given in connection with theAPHA meeting in Cleveland, Ohio in October 1952.

Seven veterinarians were approved to take the firstformal examination. All were in the military services:six Air Force and one Army veterinarian. They passedand were certified as veterinary public health special-ists on May 29, 1953. Brigadier General Wayne Kester,first Chief of the Air Force Veterinary Corps, was insis-tent that his officers receive postgraduate public healtheducation and take the board examination in the pub-lic health specialty. His interest carried substantialinfluence with his officers, as they comprised 82% ofthe 1953 and 1954 successful candidates examined bythe ABVPH. The predominance of military veterinari-

ans among veterinary public health and preventivemedicine specialists no doubt reflects the focus of thisprofessional group of veterinarians, the strong careerdevelopment policies of their agencies, and the encour-agement of senior officers like General Kester of theAir Force, Brigadier General Charles “Chuck” Elia ofthe Army, and their successors.

The qualification or prerequisite requirements forexamination, and the examination format, consistingof a written and oral examination, continued essential-ly the same over the next few years. In 1956, the pre-requisites for board examination were strengthened byrequiring sponsorship of applicants by a fellow of theboard. The sponsors were assigned the responsibility toprovide a written statement addressing the applicant’sabilities, training, and experience.

From 1953 through 1960, 60 veterinarians wereexamined and certified as fellows of the ABVPH. Atotal of 93 veterinarians, including the 33 charter andorganizing committee fellows, were certified as veteri-nary public health specialists during the first decade ofoperations of the board. From 1953 to 1960, a formatof written and oral examinations was followed.However, there is no record of the exact composition ofthe written examination or specific subject matteraddressed in the oral examination. Applicants werereviewed and evaluated by the nine-member council ofthe ABVPH and examined by a committee appointedby the council.

The first ad hoc evaluation committee appointedby the board reported its concern for the examinationprocess on Aug 15, 1959, stating, “Our administrativecontrol, examination and review procedures as nowestablished in the Constitution and Bylaws leave muchto be desired.”a The resulting constitution and bylawsrevision of Aug 14, 1960, instituted several changes inthe examination process, the most important of whichwas creation of an examination committee and specif-ic guidelines for its composition and responsibilities.The council of the ABVPH retained sole authority forreview and approval of applicants for examination andthe review and approval of all actions of the examina-tion committee.

This revision also designated members of theABVPH as diplomates, eliminating the designation offellow. The board reasoned that the term diplomate isused almost exclusively by medical specialty boards.Fellow is more commonly used in referring to individ-uals in a preferred status in a professional associationor educational institution.

Between 1978 and 1983, the organization and con-tent of the written examination were again revised sub-stantially. Examination questions were evaluated forambiguity, currency, applicability, and correctness. Thiswas a major effort and the first time that the examina-tion questions had been totally consolidated, edited,and then assembled into a computerized databanksince the inception of the college.b The college con-tracted with Texas Tech University School of Medicinefor data processing services and assistance in the main-tenance and evaluation of examination questions.Questions failing scrutiny were eliminated. Members,particularly new diplomates, were requested to con-

1812_1836.qxp 9/23/2005 2:44 PM Page 1823


tribute new questions. These were major steps in orga-nizing and advancing the quality and security of theexamination process.

The examination was organized into five areas rel-evant to veterinary preventive medicine and appropri-ately balanced. The categories of questions encom-passed in the examination process were infectious dis-eases, particularly zoonotic diseases, immunology, andpharmaceuticals (35%), environmental health (20%),food hygiene or safety (20%), epidemiology (20%),and public administration and health education (5%).The same subject matter was carried over into the oralexamination, not in a format of specific questions, butas a guide for the areas of questioning.

The examination process was again revised in1992.4 The oral examination was eliminated and theentire examination formatted into three sections.Section one consists of 300 multiple-choice questionscovering infectious diseases (25%), environmentalhealth (25%), food hygiene (20%), epidemiology(20%), and health education and administration(10%). Section two consists of five problem-solvingscenarios for which logical and reasonable solutionsmust be composed. Section three consists of one essayquestion to measure the ability of a candidate to com-municate effectively. The database for the examinationquestions was transferred from Texas Tech Universityto the college’s computer, which was maintained by theexecutive vice president. These arrangements continuetoday.

Transition of the Board to the AmericanCollege of Veterinary Preventive Medicine

The most important development in the history ofthe specialty of veterinary public health and preventivemedicine was the transition of the ABVPH to theACVPM.5 The resulting college was formally recog-nized by the AVMA on Jul 16, 1978, and incorporatedin the District of Columbia on Jan 23, 1979. This seam-less transition preserved the continuity of the organi-zation, its legacy, and the historical founding in 1950,expanded the opportunity for all practitioners of vet-erinary preventive medicine to achieve specialty recog-nition.

The transition was much more than a constitu-tional revision and organizational restructuring. Itenabled the bonding of two sometimes-quarrelsomefactions, veterinary public health and veterinary regu-latory medicine practitioners, into one specialty orga-nization: veterinary preventive medicine. It occurredduring a 12-year period, from 1966 to 1978,c,d resultingin evolution and maturity of the membership of theABVPH, as well as the organizing members of a seriesof proposed specialty groups variously identified as theAmerican College of Veterinary Public ServicePractitioners (1966), the American College ofRegulatory Veterinary Medicine (1971),6 and as theAmerican College of Veterinary Preventive Medicine(1973),e which was granted probational status by theAdvisory Board on Veterinary Specialties (ABVS) in1975. The last is not to be confused with the ACVPM(1978) successor to the ABVPH. There were a numberof meetings, telephone conversations, and exchanges

of correspondence between representatives of theABVPH and the probational college representatives,particularly between 1971 and 1978.7,f Although theprolonged process detracted energy and money fromthe operations of the ABVPH, the beneficial outcomeatones for the labor and costs. Ultimately, it was thedecisive action of the administration of the ABVPH toscrub previous approaches to unifying the specialtyinterests of public health and regulatory veterinariansand simply revise the constitution of the functioningABVPH.8

Past accounts of this transition have described thisoutcome as a merger of the ABVPH and probationalACVPM (1975). In fact, there was no merger of theseorganizations, but rather an induction of members ofthe probational college into a fully recognized andfunctioning certifying organization. The constitutionand bylaws of the ABVPH were revised and unani-mously approved by its membership to rename theboard the ACVPM, and adjust the categories of mem-bers and representation on the council and examina-tion committee. Twenty-six veterinarians, members ofthe probational college, were invited to become charterdiplomates of the ACVPM. Twenty-three accepted,three of whom were appointed to the board of coun-cilors and two to the examinations committee. Theexpertise of members of the probational college wasmerged with the ACVPM. Certification and examina-tion procedures remained essentially the same. Anamendment to the responsibilities of the council to“recognize specific subspecialties and approve proce-dures for certification in such subspecialties,” whichwould separate diplomates into public health, publicadministration, or regulatory medicine subspecialties,was never approved.

The first meeting of the fully approved ACVPMwas held Jul 17, 1978, with Dr. John H. Helwig presid-ing. It was appropriate that Dr. Helwig preside at thefirst meeting of the ACVPM, as he had been involvedin this issue since 1966. At that time, he was theABVPH representative to the ABVS. At the time, therewas interest for specialty recognition among some reg-ulatory veterinarians who were members of the com-mittee on Meat and Milk Hygiene of the United StatesLivestock Sanitary Association.9 Addressing the group’sinterest, Dr. Helwig reasoned that food inspection is apart of public health and stated, “I see no reason forhaving a separate specialty board for this area” but sug-gested that “we (ABVPH) give some attention to thepossibility of incorporating new needs in our ABVPH”and “perhaps a name such as the American Board ofVeterinary Preventive Medicine would take care oftheir needs.” Much later, in a Nov 30, 1977, corre-spondence to Dr. John O’Harra of the probationalACVPM, Dr. Helwig stated, “There is no questionabout wanting to merge and we hope to do so withconsideration and dignity for everyone.”

Dr. Helwig was succeeded by Dr. William E.Jennings (1979 to 1982). Dr. Jennings was the last ofthe three-year-term presidents. Succeeding presidentsserved one-year terms; however, beginning in 2000,the presidents of the ACVPM will serve two-yearterms.

1812_1836.qxp 9/23/2005 2:44 PM Page 1824


Like many of their predecessors, Drs. Helwig andJennings gave much of their time and abilities tostrengthening the organization and improving thequality of service of the college. For their exceptionalcontributions, these two men were recognized with theestablishment of the Helwig–Jennings Award in 1980.The award recognizes diplomates who have renderedoutstanding and prolonged service to the college.

Other Historical Aspects and Progress of the ACVPM' In March 1983, the ACVPM submitted a proposal to

the ABVS for the establishment of a specialty in epi-demiology. The ACVPM Epidemiology Specialtywas granted full approval by the AVMA in 1984.10

Twenty-six charter members were initially recog-nized by the specialty. Examinations for the special-ty commenced in 1987. The specialty now has 59active diplomates. The preferred name, “ACVPM,Epidemiology Specialty,” was approved by the ABVSand ACVPM Board of Councilors in 1992.

' Epidemiology is the only specialty that has soughtcollege recognition. Interest in other specialtyareas waxes periodically. Currently there is grow-ing interest in a food safety specialty.

' Perhaps one of the distinctive developments inrecent history of the college was the formulation ofa definition for veterinary preventive medicine.This was initially detailed in Article II of the July1989 revision of the college’s constitution. Inessence, veterinary preventive medicine isdescribed as an integral component of veterinarymedicine concerned with improving animal andhuman health through the prevention and controlof animal diseases, infectious waste contamina-tion, and related human illnesses. Veterinary pre-ventive medicine is a more encompassing practicethan veterinary public health practice. Diplomatesof the ACVPM are engaged in public, private,industrial, military, or institutional practice andare involved in regulatory medicine, diagnosticmedicine, extension service, public health, epi-demiology, food safety, research, teaching, herdhealth management, population medicine, con-sulting, and other similar activities.

' The need for executive assistance became apparentwith increased activities and growth of membershipin the 1980s. In 1989, a salaried position for anexecutive vice president was established and filled.The incumbent serves as the chief administrativeofficer of the college and is responsible to the exec-utive board. The employment of an executive offi-cer has been of critical importance in enhancing thequantity, quality, and timeliness of services offeredto the membership, profession, and the public.

' The organization, management, and composition ofthe college were intensely reviewed in 1990.11

Changes were effected in the constitution inSeptember 1992 to create a smaller, more efficientexecutive group, improve financial management, fur-ther define the position of the executive vice presi-dent, and elevate the status of emeritus membership.

' An ad hoc credentialing committee was formed by

the president’s direction in 1995 to study and makerecommendations concerning the prerequisite qual-ifications for examination; the avenues for attainingthe prescribed education, training, and experience;and the need to establish a credentials committee,separating the function from the examination com-mittee.12 These issues were reviewed and appropri-ate amendments to the constitution and bylawswere prepared and approved in November 1996.These amendments enabled the formation of a per-manent standing credentials committee, awardedgreater time credit for formal postgraduate educa-tion and training, and established an applicationprocess to include documentary evidence of veteri-nary preventive medicine experience. Subsequently,the college’s constitution and bylaws were amendedin April 2000 to award additional time credit for for-mal education and training to remove any percep-tion of a waiting period before a candidate mightqualify for examination.

' In recent years, many United States veterinary med-ical schools have de-emphasized or eliminateddepartments, faculty, and curriculums of veterinarypublic health and preventive medicine. To counter-act this unseemly movement, the ACVPM hasdeveloped a model curriculum for teaching veteri-nary preventive medicine programs. Unfortunately,it has received limited use. Colleges of veterinarymedicine, however, seem to be showing an increas-ing interest in food safety.

' An early attempt was made in 1967 to promote aresidency program in veterinary public health, butunfortunately was discontinued for lack of finan-cial support.13 There are a few opportunities opento veterinarians for residency training in publichealth with the Centers for Disease Control andPrevention, the California State HealthDepartment, and a new program in applied epi-demiology and preventive medicine at theUniversity of Virginia-Maryland Regional Collegeof Veterinary Medicine. These, particularly the lat-ter, offer encouragement that other residency pro-grams will become available to veterinarians.

' The college has endeavored to encourage studentsand enhance the professional abilities of certifiedveterinary preventive medicine specialists throughsponsorship of awards and educational programs.The ACVPM routinely sponsors or cosponsors sci-entific programs at the AVMA and other profession-al associations’ regional meetings. The collegecosponsored and participated in the seminar“Public Health in the New Millennium” at theAVMA Annual Convention in July 2000. In 1997,the epidemiology specialty, ACVPM, cosponsored asession at the AVMA Annual Convention titled“Medical Geography and Geographic InformationSystems.” The college has repeatedly served as anaffiliate sponsor of the meetings of the InternationalSociety for Veterinary Epidemiology andEconomics, which are held every three years. TheACVPM’s Paul S. Schnwrenberger Award is present-ed annually to a veterinary student for excellence inpublic health research or studies. The college

1812_1836.qxp 9/23/2005 2:44 PM Page 1825


awards an honorarium and plaque at the annualmeeting of the Conference of Research Workers inAnimal Diseases (CRWAD). As a result of the col-lege’s participation in the CRWAD, a scientific sec-tion, “Epidemiology and Animal Health,” wasestablished in 1992. In 1988, the ACVPM, theUniversity of Iowa, and the National Coalition forAgricultural Safety and Health cosponsored aninternational Conference on Agriculture andEnvironmental Health. The conference has led to anational policy to protect the health of the nation’sfarm communities. During the past 10 years, theACVPM has co-sponsored and participated in theUSDA/APHIS symposia emphasizing the veterinari-an’s role in public health.

' Strategic approaches to meet the needs of a grow-ing list of users of veterinary preventive medicinehave been undertaken. For example, an ad hoccommittee on production medicine is studying theintegration of teaching and research of preventivemedicine into clinical veterinary education, theinclusion of preventive medicine topics at live-stock specialty meetings, and encouragement ofveterinary students and clinical practitioners tobecome board certified in the ACVPM.

' The college has entered into a partnership with theAmerican Association of Public HealthVeterinarians (AAPHV), formerly the Conferenceof Public Health Veterinarians, to combine theirrespective ACVPM News and Views and theAAPHV Newsletter into a single publication. Thisenables distribution of news and information to alarger professional community having commoninterests and increases awareness of both organiza-tions. The arrangement benefits the organizations,and the combined force of the two groups assiststhe coalition of veterinary organizations involvedin public health and preventive medicine inaddressing issues of mutual concern.

Future PerspectivesThe number of diplomates in the ACVPM has

grown steadily from the initial membership of 286 in1978 to 666 members entering the year 2000. Of these,455 (68%) are active, 107 (16%) have emeritus status,15 (2%) are honorary, and 89(14%) are inactive,according to the ACVPM Directory 2000.

Analysts expected substantial growth (61%) of vet-erinarians in the nonprivate practice sector between1980 and 2000.14 Although this has not been quanti-fied, the impression is that the predictions were cor-rect. With such growth in the nonprivate practice sec-tor, which is the principal employment area of veteri-nary preventive medicine specialists, one might expecta similar surge in certification of these specialists.Indeed there has been a modest increase in the numberof certified veterinary preventive medicine specialists.

In a 20-year period, 1980 to 1999 inclusive, 367new diplomates have been certified with the ACVPM.This is almost half (49%) of the total 751 veterinarianswho have been certified as veterinary publichealth/preventive medicine specialists since 1950. Thenumber of veterinarians certified in each five-year peri-

od was 35 from 1980 through 1984, 128 from 1985through 1989, 117 from 1990 through 1994, and 87from 1995 through 1999. This represents an overallfavorable growth for the 20-year period; however, thecollective downward trend in the most recent 5 years isdisquieting. There were also successive years in whichfew veterinarians were certified (eg, five, six, and eightin years 1982, 1983, 1984, respectively, and 13 and 12in years 1995 and 1996, respectively). Given increasedpromotion and recruitment, the 128 veterinarians cer-tified from 1985 through 1989 suggests an attainablegoal for the number of veterinarians to be certified inthe next five years and thereafter.

From 1950 through 1999, 751 veterinarians havebeen certified as veterinary public health/preventivemedicine specialists. Today, the ACVPM is the sixthlargest of the 20 veterinary specialty organizations rec-ognized by the AVMA. The 455 diplomates of theACVPM comprised about 7% of the 6,518 veterinaryspecialists active in the United States in 1999.

Approximately 12% of the 55,380 United Statesveterinarians of known employment in 1999 were cer-tified veterinary specialists. Although veterinary prac-titioners are trending toward specialization, the pro-portion of veterinary specialists among all practitionersis not substantially high. The expectation of reaching25% of all employed practitioners is perhaps a distantreality.

On the other hand, the 455 active veterinary pre-ventive medicine specialists comprised only about4.5% of the 10,180 veterinarians engaged in public andcorporate practice in 1999. It is reasonable to expectthe proportion of veterinary preventive medicine spe-cialists to increase in the public and corporate sectoreven though federal, state, and local governmentemployers, with the exception of the UniformedServices, have not emphasized nor compensated pre-ventive medicine specialization in their employmentsystems.

Recent legislative action awarding veterinarians inthe Uniformed Services annual bonus payments forspecialty certification will sustain, if not increase, thenumber of veterinarians seeking specialty status, par-ticularly in the Public Health Service. Retirees from theUniformed Services often pursue a second career inother federal, state, or local public or animal healthagencies. There will be an increasing transfusion ofspecialists and accompanying interest for promotingveterinary medical specialties. Perhaps, too, other fed-eral or state agencies will follow the lead of theUniformed Services and award monetary bonuses forthe veterinary specialty certification.

Compensation is but one motivational factor forboard certification. Underlying remuneration for certi-fication are other less tangible but far more profession-ally motivational forces. Attaining specialty certifica-tion is a distinguishing professional career accomplish-ment. Peer recognition for one’s qualifications andcompetence in the exclusive practice of a specialty is arewarding experience of itself. Members of the collegeshare a commonality in professional objectives thatfocuses their efforts and improves the quality of pro-fessional services.

1812_1836.qxp 9/23/2005 2:44 PM Page 1826


Veterinary preventive medicine is the most pub-licly involved of all veterinary specialties. Yet, despite50 years of activity, the veterinarian’s role in publichealth is not appreciated or is ignored by some physi-cians, other health professionals, and agriculture offi-cials. Most often, this attitude is for lack of associationor familiarization with veterinarians and their special-ty education and training. This lack of recognition is animpediment to expanding use of the veterinary pre-ventive medicine specialist. A sustained and focusedeffort in public relations and physician education mustbe mounted by veterinarians, individually and collec-tively, if the profession, and particularly the specialty,are to ensure its rightful place in the maintenance ofhuman and animal wellness.

A Noble and Serving SpecialtyThe veterinary profession exists primarily to pro-

vide preventive health care services and expertise toanimals and humans. Of all the recognized specialtiesin veterinary medicine, veterinary preventive medicineis the single specialty that most nearly fulfills all theproclaimed objectives of the profession as described inthe Veterinarian’s Oath. Contrary to popular terminol-ogy, the practice of veterinary public health/preventivemedicine is not nontraditional practice. Practitionersof the specialty prefer the collective designation ofpublic/institutional or corporate practice and, individ-ually, veterinary preventive medicine or public healthpractitioners.

The college has been an instrument not only forcertification of veterinary specialists and the advance-ment of veterinary public health and preventive medi-cine, but also the basis for the formation of lastingfriendships and many pleasurable experiences. Itserves as a network for like-minded practitioners andenhances professional relationships. The college has adistinguished heritage, counting among its diplomatessome of the most outstanding veterinary personalitiesin public health and preventive medicine on thenational and international scene. Many are the recipi-ents of prestigious AVMA awards. Slightly over half ofall the recipients of the AVMA Public Service Award,established in 1968, are diplomates of the ACVPM.

The areas of societal needs serviced by preventivemedicine specialists include research and disease pre-vention, and control programs for zoonoses, foodborneillnesses, antimicrobial resistant microorganisms,chemical and microbiologic safety of the national foodchain, animal herd health and protection of the live-stock industry from foreign animal diseases, disasterpreparedness, and environmental and occupationalhealth.

Veterinary preventive medicine is a public and ani-mal health service-oriented specialty. Specialists areprepared to complement traditional practices with newstrategies for disease prevention and control, as hasbeen achieved in Texas with the containment andreduction of rabies in coyotes and foxes using oralrabies vaccine.

Often animal diseases are amenable to biologicaland chemical prophylaxis, quarantine, and slaughter, ifnecessary, given responsible and cooperative owners. In

the case of owner irresponsibility or opposition, waysmust be found to effect human behavioral changes.Fines and other penalties promote some compliance,but there remains a segment of resistant humans whomust be treated with effective persuasion. Health edu-cation is an aspect of the specialty to be emphasized forenhancement of animal disease control measures.

In this increasingly complex world in which thereis resurgence of old and new diseases, veterinary pre-ventive medicine specialists practicing communityhealth and animal population medicine will contributesubstantially to the improvement of human and animalwellness and welfare.

The LegacyThe legacy of the founders of the specialty of vet-

erinary public health/preventive medicine is convic-tion and the will to carry on. They were convincedthere was a professional role for the veterinarian as aspecialist in public health. Despite the novelty of theidea, they had the will to carry on and secured recog-nition for a unique professional organization. Laterthere were leaders who took control of a fractious situ-ation and provided an expeditious and effective resolu-tion binding all parties in a common organization ben-efiting public and animal health.

The college has had a long series of able and dili-gent elected officers and committee members.Constraints of this report do not permit recognition ofthe many individuals who have made substantial con-tributions. However, special mention should be made ofsecretaries and secretary-treasurers who worked, oftensacrificing personal time and resources, to maintain theday-to-day activities, respond to urgent inquiries, andensure the fiscal security of the organization. They arethe unsung heroes and heroines of the college.

The ACVPM is endowed with a remarkably richheritage and foundation for further growth and theexpansion of specialty involvement. The collegerespects this inheritance and will continue to move for-ward for the next 50 years in advancing the cause ofveterinary preventive medicine.

aBaum MD. Letter to Stanley L. Hendricks, President, AmericanBoard of Veterinary Public Health. Sep 25, 1959.

bRosser WW. Letter to Thomas G. Murnane. Nov 17, 1999 and Jun12, 2000.

cHummer RL. Letter to Stanley L. Hendricks, President, AmericanBoard of Veterinary Public Health. Mar 17, 1971.

dAtkinson JW. Letter to members, American Board of VeterinaryPublic Health. Nov 29, 1974.

eO’Harra JL. Letter to Advisory Board of Veterinary Specialties of theAmerican Veterinary Medical Association. Mar 11, 1971.

fGrogan EA. Letter to Council Members, American Board ofVeterinary Public Health. Feb 14, 1978.

References1. Specialty Examining Boards. Business sessions, in

Proceedings. Am Vet Med Assoc: 1951:335–336.2. Steele JH. Secretary’s report of the first meeting of the council

to organize an American Academy of Veterinary Public Health; 1949.3. Blood BD, Secretary, American Board of Veterinary Public

Health. Secretary’s Annual Report, 1950-51; 1951.4. Donham KJ. Five year in-depth report of the American College

of Veterinary Public Health, 1988–1992. San Antonio, Tex: AmericanCollege of Veterinary Preventive Medicine, 1993.

1812_1836.qxp 9/23/2005 2:44 PM Page 1827


5. Clayton FW. Five year in-depth report of the AmericanCollege of Veterinary Preventive Medicine, 1978–1983. SanAntonio, Tex: American College of Veterinary PreventiveMedicine, 1983.

6. Schroeder RJ. A specialty board for regulatory veterinarymedicine? J Am Vet Med Assoc 1969;155:2182–2187.

7. Whitehair LA. Memorandum for record. American Board ofVeterinary Public Health, 1975.

8. Helwig JH. Status report to all diplomats. American Board ofVeterinary Public Health, 1978.

9. Jennings WE. Report of committee on meat and milk hygiene.US Livestock Sanitary Association, 1966.

10. Murnane TG. Five year in-depth report of the American

College of Veterinary Pubic Health, 1983–1988. San Antonio, Tex:American College of Veterinary Preventive Medicine, 1988.

11. Nossov G, Groves M, Gunnels R. Report of ad hoc committeeon organizational structure. American College of VeterinaryPreventive Medicine, 1991.

12. Russell LH. Five year in-depth report of the American Collegeof Veterinary Public Heath, 1992–1997. San Antonio, Texas: AmericanCollege of Veterinary Preventive Medicine, 1997.

13. Blenden DC, Parrish HM, Price ER. Experimental residencyprogram in veterinary public health. Public Health Rep 1967;82:545–548.

14. Wise JK, Kushman JE. Synopsis of US veterinary medicalmanpower study: demand and supply from 1980 to 2000. J Am VetMed Assoc 1985;187:358–361.

In 1999, the USDA Food Safety and InspectionService (FSIS) established a Blue Ribbon Task Force

of experts (internal and external to the agency) to eval-uate the role of veterinarians in public and animalhealth and food safety. The veterinarian’s role isdescribed as the purveyor of knowledge and expertisebridging animal and human health. The intent of thisreport is to fuel a renaissance in thinking about howveterinary medical expertise is considered, cultivated,nurtured, and used in the FSIS.

The task force developed recommendationsaround five major issues: defining the role of the FSISveterinarian; education, training, recognition, andrecruitment; partnerships; coordinated informationmanagement; and veterinary contributions to interna-tional credibility of FSIS.

In 1996, the FSIS issued the Pathogen ReductionHazard Analysis and Critical Control Point(HACCP) Systems final rule to control and reducefoodborne pathogens on meat and poultry products.Federal and state meat and poultry plants must adoptHACCP, a system based on hazard prevention withperformance standards set by FSIS. The rule gives allFSIS employees a much greater role in food safetyand public health. Overseeing HACCP systemsrequires FSIS employees to make increasingly morescience-based judgments. Veterinarians in the FSISnow have unique opportunities to enhance food safe-ty by interacting more with other animal and humanhealth professionals, promoting implementation offarm-to-table food safety and quality systems,improving the sharing of information, conductingscientific analysis of complex food safety systems,and enhancing public health through better use ofresources.

Roles and Responsibilities of the FSISVeterinarian Outside the Slaughter PlantEnvironment

By virtue of their broad education and experience,veterinarians are qualified to deal with a wide range ofareas important to food safety, including but not limit-ed to: ' Disease recognition, especially zoonotic diseases' Emerging pathogens' Threats of bioterrorism' Threats of foreign animal disease' Public health' Epidemiology (including outbreak investigations)' Science-based certification and auditing processes' Animal science and population medicine' Pathology' Parasitology' Microbiology, virology, and bacteriology' Comparative medicine and multi-species chem-

istry/toxicology and pharmacology' Drug resistance mechanisms

The FSIS will depend more and more on the vet-erinarians’ analytical and problem solving skills fordevelopment and evaluation of broad public healthpolicy, risk assessment, data management and evalua-tion, leadership, and administrative activities that havenational and international impact.

An increasingly important role will be that of eval-uators of risk-based data systems. Veterinarians inFSIS currently serve by sharing epidemiologic datafrom live animals and in-plant and post-processingpathogens and residues. Data collection and evalua-tion are essential components of risk analysis (assess-ment, management, and communication).Veterinarians need to lead effective food safety moni-toring and surveillance programs to identify risks,evaluate interventions, and improve the allocation ofrisk-based resource management. The data results will

Blue ribbon task force report on the future of Food Safety and Inspection Service veterinarians:

public health professionals for the 21st century

Bonnie J. Buntain, DVM, MS

From the Office of Public Health and Science, Food Safety andInspection Service, United States Department of Agriculture,Washington, DC 20024.

1812_1836.qxp 9/23/2005 2:44 PM Page 1828

guide veterinary epidemiologists in their risk analysisduties from farm-to-table.

The expanded duties of FSIS veterinarians willalso include more opportunities as educators, man-agers of teams, and creators of partnerships withresearchers, industry, and consumer groups. In thefuture, partnering will require FSIS veterinarians tobuild consensus among diverse groups that are exter-nal to the agency. Commodity groups, governmentagencies, academe, and the food industry are key part-ners in producing safe food from farm-to-table. TheFSIS veterinarians will play important roles in provid-ing information on food safety and public health toassist our partners in developing verifiable HACCP-compatible systems all along the food chain.

To meet the expanding roles for agency veterinari-ans, FSIS envisions a Career Planning Guide forVeterinarians with the following potential career tracks:

' Public health policy and assessment—This track

will hone veterinary analytic and problem-solvingskills for risk assessment, data management, epi-demiology, research, and policy development andevaluation.

' Inspection application—In addition to traditionalroles in antemortem and postmortem inspection,FSIS veterinarians will verify and monitor animalhealth and product safety systems from farm-to-table.

' Administration/management—Veterinarians willbe trained and mentored to be the future execu-tives and program leaders.

' International—The FSIS veterinarians will learnthe skills necessary for international negotiations,foreign languages, policies, and consensus-build-ing around issues involving foods of animal origin.An FSIS Chief Veterinarian Public Health Officercould be appointed to coordinate FSIS activities indomestic and international technical issues relatedto meat, poultry, and egg products.

The National Antimicrobial Resistance MonitoringSystem (NARMS) for enteric bacteria was initiated

in l996 as a collaboration between the National Centerfor Infectious Diseases at the Centers for DiseaseControl (CDC), United States Food and DrugAdministration Center for Veterinary Medicine (FDA-CVM), the Agricultural Research Service, Food Safetyand Inspection Service, and the Animal Plant HealthInspection Service of the United States Department ofAgriculture (USDA).1,2 Bacterial isolates from humansare currently provided by 17 state and local publichealth laboratories. The purpose of NARMS is toprospectively monitor antimicrobial resistance in iso-lates of selected enteric bacteria collected from humans,animals, and animal products. The goals of NARMS areto provide descriptive data on the extent and temporaltrends of antimicrobial resistance in enteric organismsfrom the human and animal populations; provide time-

ly information to veterinarians and physicians; prolongthe life span of approved drugs by promoting the pru-dent use of antimicrobial agents; identify areas for moredetailed investigation; and guide research on antimicro-bial resistance. This paper addresses NARMS surveil-lance conducted at CDC from 1996 through 1999.

Materials and MethodsThe total population in 17 NARMS sites (California,

Connecticut, Colorado, Florida, Georgia, Kansas,Massachusetts, Maryland, Minnesota, New Jersey, New York,Oregon, Tennessee, Washington, West Virginia, Los AngelesCounty, and New York City) in 1998 was 103 million people,or 38% of the United States population. Since 1996, NARMShas conducted surveillance for antimicrobial resistance amongisolates of nontyphoidal Salmonella. In 1997, surveillance wasexpanded to include human isolates of Campylobacter.

Clinical laboratories isolate Salmonella or Campylobacterfrom patient specimens. Salmonella are isolated from blood,feces, urine, or other specimens; Campylobacter isolates areobtained from fecal specimens only. Most clinical laborato-ries in participating sites submit almost all Salmonella, butfew submit Campylobacter isolates to state or local publichealth laboratories. Serotyping of Salmonella isolates is doneat the submitting state public health laboratory. Participatingstate and local public health laboratories submit every 10thnontyphoidal Salmonella isolate and one Campylobacter iso-late per week to CDC for susceptibility testing.

The National Antimicrobial Resistance Monitoring System(NARMS) for enteric bacteria, 1996–1999:

surveillance for action

Nina N. Marano, DVM, MPH; Shannon Rossiter, MPH; Karen Stamey, BS; Kevin Joyce, BS; Timothy J. Barrett, MS, PhD; Linda K. Tollefson, DVM, MPH; Fredrick J. Angulo, DVM, PhD, MPVM, DACVPM

From the Foodborne and Diarrheal Diseases Branch, Centers forDisease Control and Prevention, 1600 Clifton Rd, MS C-09,Atlanta, GA 30333 (Marano, Rossiter, Stamey, Joyce, Barrett,Angulo); and the Office of Surveillance and Compliance, Centerfor Veterinary Medicine, Food and Drug Administration, 7500Standish Pl, HFV-12, Rockville, MD 20855 (Tollefson).

Dr. Marano’s present address is the Meningitis and Special PathogensBranch, MS C-O9, Centers for Disease Control and Prevention,1600 Clifton Road, Atlanta, GA 30333.


1812_1836.qxp 9/23/2005 2:44 PM Page 1829


At CDC, isolates are tested for susceptibility using min-imum inhibitory concentrations (MIC). Salmonella isolatesare tested with a semi-automated systema for susceptibility to17 antimicrobial agents. Campylobacter isolates are testedusing the E-test systemb for susceptibility to 8 antimicrobialagents. Data are analyzed by a SAS system.c

ResultsFrom 1996 through 1999, 5,592 NARMS

Salmonella isolates were serotyped and tested for sus-ceptibility. In 1999, the most frequently isolatedserotypes included S Typhimurium (24%) and S enter-itidis (18%). Other common serotypes included SNewport (6.5%), S Heidelberg (6%), S Montevideo(3.5%), S Muenchen (3.4%), and S Javiana (2.8%).Other serotypes accounted for 36% of isolates andincluded 120 other serotypes. Antimicrobial resistanceis more common in some serotypes than others. In1999, all S Hadar isolates and 51% of S Typhimuriumisolates were resistant to ≥ 1 agent, whereas only 2.4%of S Javiana isolates were resistant to ≥ 1 agent. In1999, 26% of Salmonella isolates were resistant to ≥ 1antimicrobial agent. Although most Salmonella isolatesremain susceptible to the 17 antimicrobial agents test-ed, several concerning trends in antimicrobial resis-tance among Salmonella are evident. These includemulti-drug resistance, highly resistant isolates, and theemergence of resistance to ceftriaxone and fluoro-quinolones, which are antimicrobial agents commonlyused to treat people with Salmonella infections.

Increasing multiresistance is most evident withincertain serotypes, particularly S Typhimurium. In1999, 28% of S Typhimurium isolates were resistant toampicillin, chloramphenicol, streptomcyin, sul-famethoxazole, and tetracycline (R-type ACSSuT), thecharacteristic pattern of Definitive Phage Type 104.Some S Typhimurium R-type ACSSuT isolates werealso additionally resistant to kanamycin (11.8%),cephalothin (8.8%), amoxicillin/clavulanic acid(6.9%), trimethoprim-sulfamethoxazole (6.9%), ceftio-fur (2.9%), and ceftriaxone (1%). Another penta-resis-tant pattern is prevalent among S Typhimurium iso-lates; resistance is to ampicillin, kanamycin, strepto-mycin, sulfamethoxazole, and tetracycline (R-typeAKSSuT). The percentage of S Typhimurium isolateswith this pattern increased from 4.5% in 1996 to 11%in 1999, making it the second most common multi-drug resistant pattern.

From 1996 through 1999, 59 (1.1%) of 5592Salmonella isolates were highly resistant, that is, resis-tant to ≥ 8 of 17 antimicrobial agents. Among highlyresistant Salmonella, 42% were S Typhimurium and39% were S Newport. Other serotypes included S Berta,S Stanley, and S Paratyphi-A. The most resistant isolatein the NARMS collection was an S Typhiumurium vari-ant Copenhagen isolate; it was susceptible only toapramycin, amikacin, and ciprofloxacin.

Since 1996, 22 Salmonella isolates were identifiedwith resistance to ceftriaxone, an extended-spectrumcephalosporin. Most of these isolates were STyphimurium. The percentage of Salmonella isolateswith decreased susceptibility to ciprofloxacin (MIC ≥0.25µg/ml) has increased since 1996. The percentageof isolates with decreased susceptibility to

ciprofloxacin was 0.4% in 1996, 0.6% in l997, 0.7% in1998, and 1.0% in 1999. These data included twociprofloxacin-resistant isolates from 1998 to 1999.

From 1997 through 1999, 881 Campylobacter iso-lates were tested; 60% of Campylobacter isolates wereresistant to ≥ 1 agent; 25% were resistant to ≥ 2 agents.Of concern, the percent of Campylobacter isolates resis-tant to ciprofloxacin increased from 13% in 1997 to18% in 1999.

Discussion Since 1996, NARMS has accumulated information

on antimicrobial resistance among Salmonella andCampylobacter isolates collected from humans. AmongSalmonella isolates, several multi-drug resistant strainsare prevalent, particularly S Typhimurium R-typeACSSuT and AKSSuT. There is also emergence of resis-tance to antimicrobial agents that are commonly usedto treat people with Salmonella infections (ceftriaxoneand ciprofloxacin).

Increasing resistance to ciprofloxacin is also evi-dent among Campylobacter isolates.

The public health utility of NARMS data is wide-ranging; the data have supported field investigations ofoutbreaks of illness marked by a pathogen that dis-played an unusual antimicrobial resistance pattern,provided data for a risk assessment of the humanhealth impact of fluoroquinolone use in poultry, stim-ulated research in molecular characteristics of resis-tance emergence and transfer, improved knowledge ofrisk factors associated with the development of anantimicrobial-resistant infection, and triggered broaderresearch projects of prudent antimicrobial use in ani-mals and the role of the environment in the emergenceand spread of antimicrobial resistance.

For example, the FDA recently proposed to with-draw approval of the use of fluoroquinolones in poul-try based on their risk assessment.3 The risk assess-ment concluded that the use of fluoroquinolones inpoultry causes the development of fluoroquinolone-resistant Campylobacter in poultry, which is transferredto humans, compromising the use of fluoroquinolonesfor the treatment of human Campylobacter infections.The FDA’s action is based on data from NARMS andother sources. This example, and others, demonstratethat the NARMS multi-agency collaboration hasbrought the problem of antimicrobial resistance to theforefront; it is indeed “surveillance for action.”

aSensititre, Trek Diagnostics, Westlake, Ohio.bE-test system, AB Biodisk, Solna, Sweden.cSAS, version 6.12, SAS Institute, Cary, NC.

References1. Tollefson L, Angulo FJ, Fedorka-Cray PJ. National surveil-

lance for antibiotic resistance in zoonotic enteric pathogens. Vet ClinNorth Am Food Anim Pract 1998;14:141–150.

2. National Center for Infectious Diseases, Centers for DiseaseControl and Prevention. National Antimicrobial ResistanceMonitoring System (NARMS) for Enteric Bacteria Website. Availableat: http://www.cdc.gov/ncidod/dbmd/narms.

3. Center for Veterinary Medicine, Food and DrugAdministration. Enrofloxacin for Poultry; Opportunity for Hearing.Federal Register 27832:64954-64965, October 31, 2000. Available at:http://www.fda.gov/OHRMS/DOCKETS/98fr/1031001.htm.

1812_1836.qxp 9/23/2005 2:44 PM Page 1830


It is important to define what is encompassed by theterm veterinary public health. Public health includes

all those topics that are traditionally associated with thesubject, such as zoonoses, food safety, and environmen-tal studies, as well as the discipline of epidemiology. Inmodern day public health, it is impossible to separatethe study of human diseases related to animals from thescience that studies the distribution and determinantsof disease in human and animal populations.

I approach this topic from the perspective of a per-son who has spent considerable time in what somemight call public practice, that being 26 years in theUnited States Army conducting research on infectiousdiseases and research administration. This was fol-lowed by nine years as head of the Department ofEpidemiology and Community Health at the LouisianaState University (LSU) School of Veterinary Medicine,where I taught graduate veterinarians and veterinarystudents public health and epidemiology. TheDepartment of Epidemiology and Community Healthis one of the few stand-alone veterinary epidemiologyand public health departments remaining in a UnitedStates school of veterinary medicine. Finally, for a littlemore than a year, I have viewed the training of veteri-narians and future veterinarians in public health fromthe standpoint of the chief administrator of the LSUSchool of Veterinary Medicine.

All that said and done, I find myself in a predica-ment. I cannot say with any certainty what the relativeimportance veterinary public health, in the profession-al program and at the graduate level, will assume in thecrowded curriculums of the new millennium. I canpredict that there will be ups and downs. Like so manythings in life, components of curriculums can beviewed as a giant sine wave with peaks and valleys thathave a periodicity of five to more than 30 years.Educators are not very original, and we tend to recyclethings as a new generation of teachers mature. Onecommon phrase heard at faculty meetings is, “Oh, wetried that 20 years ago.” Depending on where we are onthe sine wave of veterinary public health (ie, in atrough or on a peak), we may think that outlook iseither gloomy or rosy.

Still, I think there are some things we can look atthat will help us make some predictions on what wemight see in the short term. They are:' What will be the relative importance of public

health and epidemiology in medicine and health inthe near future?

' How much of public health will be related to veteri-nary medicine and what role will veterinarians play?

' What are the external and internal factors andpressures on schools of veterinary medicine thatwill influence the teaching of public health?

First, what will be the relative importance of pub-lic health and epidemiology in medicine and health inthe near future? I think the outlook for public health isvery bright. I believe it will be the most critical andimportant thrust in medicine for the foreseeable future.The world’s major health problems and emerging dis-eases are almost all related to public health. Many ofthe factors responsible for making public health a highpriority for funding and research include humandemographics, international travel and commerce,technology and industry, microbial adaptation andchange, human encroachment into wilderness areas,global climate changes, and bioterrorism.

Human demographics account for societal eventsthat encompass such things as population growth,which is in part responsible for deforestation, war, andmalnutrition. Also included are those preventablehuman diseases classified as behavioral risks. Theseinclude everything from not wearing a seatbelt andsmoking to the human conduct that has contributed tothe current modern pandemic of AIDS. Internationaltravel and commerce needs no explanation. Whether itis diarrhea caused by cyclospora infection from SouthAmerican raspberries, brucellosis from Mexicancheeses, cases of malaria and leishmaniasis, or newstrains of influenza, all are related to the break down oftrade barriers and the rapidity and ease with whichpeople can move around the globe.

Technology and industry include such things asthe integration and concentration of food animal pro-duction facilities. In the United States, trends in allfood animal production are following the poultryindustry. For example, there are less than 350 produc-ers of swine in the United States today, and conserva-tive estimates place the number at less than 100 by theyear 2003. The dairy and beef industries are followingsuit. All of this translates into increased stress on ani-mals caused by intensive husbandry practices thatpush rapid gains and greater distances that animalsmust be shipped for processing. The increase inEscherichia coli O157:H7 infections in the UnitedStates, as well as the recent epidemic of infections anddeaths in humans and swine in Malaysia caused by thepreviously unknown Nipah virus, are believed to berelated to intensive animal husbandry.

Another example of technology’s effect on publichealth is the widespread long-term use of corticos-teroid and immunosuppressant drugs in humans withcancer and various other medical conditions and thosereceiving organ or tissue transplants. Because of this

Public health education of veterinarians and veterinary students for the future

Michael G. Groves, DVM, MPH, PhD, DACVPM

From the Dean’s Office, School of Veterinary Medicine, LouisianaState University, Baton Rouge, LA 70803.

1812_1836.qxp 9/23/2005 2:44 PM Page 1831


trend, new diseases and life-threatening illnessesresulting from infectious agents considered to be oflow pathogenicity have emerged.

Recent examples of microbial adaptation andchange are the genetic reassortment of influenzastrains that threaten to cause an influenza pandemicand the current controversy over the use of low-levelantibiotics in animal feeds. For years, those of us in theveterinary profession have questioned whether med-icated feeds contribute measurably to increased resis-tance in human pathogens. The answer now appears tobe yes. A Minnesota study revealed an increase inquinolone-resistant Campylobacter jejuni infectionsthat were acquired from poultry.

Human encroachment into wilderness areasresults in closer contact with wild animals and vectorsof disease. Fairly recent examples include the outbreakof monkey pox in humans in Africa, and borreliosis,babesiosis, and ehrlichiosis, all tick-transmitted dis-eases that have arisen in the United States because ofincreased intrusion into underdeveloped and undo-mesticated areas.

Global climate changes brought about by El Niñoand La Niña account for epidemics of Rift Valley feverin Africa and new world hantavirus infections anddeaths in the southwestern United States. During thepast two years, we have seen deaths of large bulls inLouisiana caused by persistent hyperthermia, whichhas been attributed to drought and higher than normalambient temperatures.

Finally, during the past two years there has beenan increased fear that the United States is vulnerable tobioterrorism aimed at human, livestock, or crop tar-gets. Governmental public health, agricultural, lawenforcement, and national defense organizations haveall greatly increased their financing in these areas toeducate first responders, upgrade diagnostic laborato-ries, establish communication networks, and developrapid diagnostic methods.

If we are convinced that public health will be anexpanding field over the next decade and beyond, thequestion then becomes a matter of how much of thepublic-health pie will be related to veterinary medicineand what role veterinarians will play. Even narrowlydefined, I believe veterinarians will be involved in lead-ing large portions of public health activities focusingon disease control and research. Veterinarians are cur-rently doing this in such traditional areas as food safe-ty, zoonosis control, and regulatory medicine. Somepublic health veterinarians function seamlessly acrossveterinary and strictly human-disease-related spheres.This will no doubt expand in the future as the need forpublic health professionals increases.

I conclude that the future is bright for publichealth careers in general and in veterinary publichealth specifically. The question now becomes a matterof what internal and external factors will influence therelative importance of veterinary public health educa-tion in the curricula of United States veterinaryschools. One is that students are not drawn to veteri-nary medicine because they are seeking a career inpublic service. Overwhelmingly, veterinary studentsenter professional school with the goal of practicing

clinical medicine. A few students will begin to think ofalternatives to practice in the second and third years,and, depending on their clinical experience, some mayeven make a career change in their final year. Theseconversions from the “dark side” usually result fromeither disappointments in the clinical training or posi-tive experiences in public health course work or sum-mer jobs.

Schools are moving away from the passive modelof letting students choose their careers by default to amore active, anticipatory approach. First-year studentsare frequently required to take courses that providecareer options in addition to such topics as history, vet-erinary administrative structures and professionalorganizations. Later in the curriculum, students maytake specialized electives that may include working inareas of public health and epidemiology.

One trend in graduate public health education isthe dissatisfied practitioner who is looking for a careerchange. These individuals have spent a varied amountof time in clinical practice and found it wanting. Oneextreme example of this at LSU was a particularly out-standing student in his early 40s. He had owned andoperated a solo dairy practice in Oregon for 17 years.Two things influenced this individual to pursue acareer in public health. One was a strong social com-mitment, and the second was the fact that he wasexposed to an excellent public health program at theUniversity of Minnesota during his veterinary training.

The important message here is that faculty andschool administrators must continuously deliver themessage about the rewards and challenges of a publiccareer, and they must never underestimate theirresponsibility as a role model. It is a basic precept ofacademia that students are relentlessly judging facultyand their education. These have long-range conse-quences from alumni donations to career choice. Also,it is important that at least some schools of veterinarymedicine maintain a nucleus of public health facultycapable of providing graduate education. If veterinaryschools do not do this, then all public health training,including veterinary public health, will be done atschools of public health, medical schools, or someother academic setting.

A factor that negatively impacts veterinary publichealth education during professional education is thecrowded curricula. In the early days of veterinary edu-cation, physiology, histology, and gross anatomy con-sumed large portions of the curriculum simply becausethat was where the science existed and there wereexcellent textbooks on these subjects. Relatively littlewas known about other disciplines. Later, pathology,pharmacology, microbiology, and parasitology assumedimportance as these disciplines matured. This was thesituation until the 1970s when there was an upsurge ofspecialization and knowledge in the clinical sciencesand some of the basic sciences. This is still true andwill no doubt continue well into the millennium.

Great advances have been made in basic scienceareas such as immunology, pharmacology, and micro-biology because of the advent of recombinant DNAtechniques and other advanced technologies. The basicscience teaching, if we can call veterinary public health

1812_1836.qxp 9/23/2005 2:44 PM Page 1832


a basic science, began to shrink to make way for hith-er to unheard of courses like problem solving, ethics,practice management, animal behavior, and informat-ics, and the more specialized clinical courses such asproduction management, oncology, cardiology, anes-thesiology, and exotic and laboratory animal medicine.This downsizing of some traditional areas was not allbad, because many of them were overtaught.

Despite this reluctance to change, curriculumreview is an ongoing, albeit contentious, process. Thecurriculum is under the control of and jealouslyguarded by the faculty at all the schools of veterinarymedicine with which I am familiar. Because of ourlarge teaching hospitals, clinicians make up approxi-mately half of most faculties, so there is some dangerthat curricula in veterinary schools can becomeskewed toward the clinical sciences. Clinical facultyare not, however, unreasonable, and most are aware ofthe increasing importance of public health and epi-demiology in our modern society. We in public healthoccupy a unique position in veterinary schools in thatwe sit with one foot in the basic sciences and one footin the clinical sciences. Therefore, it is up to us to con-tinuously demonstrate our importance and relevanceto all members of the academic community to ensuresupport for our programs. Also, we in public healthmust likewise be sensitive to the need to create a bal-anced curriculum that does not overload veterinarymedicine at the expense of biomedical and basic sci-ences.

The size and content of public health and epi-demiology courses in a curriculum implies that theirpresence is not debatable. One particular threat to pub-lic health as a separate academic subject is the notionthat public health is taught across the entire curricu-lum in all disciplines and courses. For example, thedermatologists will teach the public health aspects ofringworm, parasitologists will teach the prevention ofvisceral larval migrans, and microbiologists will speakto the epidemiology of Borrelia burgdorferi infections.This is just not true, and meticulous reviews of curric-ula will substantiate this. Let us take, for instance, animportant zoonotic disease such as rabies. Rarely will amicrobiology instructor (which in many schools is nota veterinarian) or a clinician discuss the epidemiologyof rabies, wildlife vaccination, pre- and post-exposureprophylaxis, or the various quarantine periods. Inaddition, there are a whole host of important zoonoticdiseases such as cat scratch disease, borreliosis, plague,Rocky Mountain spotted fever, and tularemia thatcause little or no disease in domestic animals. Also, keysubjects such as pet animal bites, animal-bite infec-tions (probably the most important modern dayzoonotic disease), environmental toxicology, and foodsafety do not lend themselves to inclusion in the teach-ing of other disciplines. A stand-alone public healthcourse and faculty is a must!

Finally, there are budgetary constraints that canthreaten the future position of public health in veteri-

nary curricula. State funding for higher education hassuffered over the past few years. The public’s demandfor lower taxes combined with their desire forimproved health care, highways, and crime preventionhas meant that funding for most state universities hasnot kept pace with inflation. To save money, schoolshave tended to consolidate departments so that manybasic science disciplines are lumped together in a sin-gle megadepartment. This leads to a loss of identityand, more importantly, can lead to an imbalance in dis-ciplines if a strong department head selectively hiresnew faculty in a single research area. Also, more andmore, schools of veterinary medicine are turning toalternative funding sources, such as private develop-ment dollars and research grants and contracts. AtLSU, only slightly more than half of our budget is madeup of state appropriated monies.

To maximize their portion of the research fundsavailable from federal agencies, schools have movedaway from their strong agriculture connection andbegun to paint themselves as the biomedical researchfacility of the campus. This has increasingly meantthat, more and more, basic science faculty are hired fortheir research competence and, more specifically, theirability to bring in the large, federally funded grantsrelated to human health or the environment.Consequently, many new faculty in the basic sciencesare not veterinarians, but rather PhDs with existinggrants and postdoctoral experience. If I may use myown school again to illustrate, the Department ofMicrobiology and Parasitology at LSU, a truly out-standing research department, has 11 faculty, onlythree of whom are veterinarians. Classic veterinarypublic health and epidemiology does not lend itself tosecuring large research grants, but there are areas close-ly allied with human health and environmental toxi-cology that can be exploited. Also, the renewed inter-est in food safety by the public and increased fundingin this area is encouraging.

Given that public health has a place in the veteri-nary school curriculum, what should be taught in themodern curriculum? I believe the core teaching shouldbe unchanged from what it has been over the past fewdecades. Epidemiology, zoonoses, food safety, and theenvironmental aspects of public health are all stillimportant. Beyond that, electives that offer advancedconcepts or hands-on training should be offered. Someschools will allow tracking so students can emphasizea particular area, such as equine, small animal, foodanimal, or public practice.

In conclusion, I believe that, for the foreseeablefuture, public health will occupy a small but importantniche in schools of veterinary medicine. To ensure this,we must continue to have advocates for veterinarypublic health at university and national levels. Wemust also communicate to our best and brightest stu-dents the advantages and rewards of a career in publicpractice. And finally, we must seek to retain and growgood graduate and resident training programs.

Symposium continued on next page.

1812_1836.qxp 9/23/2005 2:44 PM Page 1833


Since the beginning of the 20th century, veterinarianshave contributed to the health and welfare of ani-

mals, humans, and the environment. In fact, that centu-ry marked nearly the entirety of American veterinarymedicine to date, as the American Veterinary MedicalAssociation was christened in 1898 (subsequent to itsorigin in 1863 as the United States Veterinary MedicalAssociation), and there were few graduates of Americanveterinary colleges until the early 1900s.1 At the dawn ofthe century, nearly all veterinarians were engaged in pri-vate general practice, with horses being the focus ofthose practices.2 Today, more than 70,000 veterinariansin the United States are engaged in a wide variety of pri-vate, public, corporate, and government endeavors andmay pursue one of 20 board specialties. Among the firstof these board specialties was the American College ofVeterinary Preventive Medicine (ACVPM), officiallyrecognized by the AVMA in 1951.3 The Apr 2, 1999,issue of the Centers for Disease Control and Prevention’sMorbidity and Mortality Weekly Report celebrated the20th century’s greatest public health achievements in theUnited States.4 The ACVPM’s 50th anniversary of itsfounding provides a similarly fitting occasion to identifyand celebrate a few of the many veterinary publichealth/preventive medicine accomplishments during thepast century. Although it would be impossible and per-haps inappropriate to exhaustively list or prioritize thosecontributions within this text, we offer this categoricalsummary of some of the more important.

Animal Disease EradicationLargely attributable to the efforts of local, state,

and federal veterinarians, the following diseases wereeliminated (year of elimination is in parentheses) fromanimal populations within the United States1:

' Contagious pleuropneumonia (1892)' Fowl plague (1929)' Foot and mouth disease (1929)' Glanders (1934)' Dourine (1942)' Cattle tick fever (1943)' Vesicular exanthema of swine (1959)' Screwworm myiasis (1959)' Sheep scabies (1973)' Exotic Newcastle disease (1974)' Classic swine fever (hog cholera, 1978)

Laboratory Animal ScienceThe first professor of laboratory animal science in

the United States was Dr. Carl Schlotthauer, appointedin 1945 at the University of Minnesota. Dr. CharlesGriffin oversaw the development of pathogen-free ani-mal colonies at the New York State Board of HealthLaboratories from 1919 to 1954. Other veterinary pio-neers in laboratory animal medicine included Dr.William Thorp at the National Institutes of Health, Dr.James Steele at the Centers for Disease Control andPrevention, and Dr. Karl Meyer at the University ofCalifornia at San Francisco.1

Infectious Disease ControlIn 1900, tuberculosis was the single leading cause

of death in humans in the United States1 and common-ly resulted in malformations in the bones of children.Of this disease burden, 40 to 50% was reported to bebovine in origin. Constant veterinary disease controlmeasures have reduced this prevalence to near zeroamong Americans and marked the passing of thehunchback.5 The early 1900s also saw the discovery ofthe etiologic agents for many prevalent animal diseases.Among these were African horse sickness (1900),rinderpest (1902), sheep pox (1902), rabies (1903),hog cholera (1903),1 and the first discovery of a viralcause of a cancer, fowl leucosis (1908).a On a broaderscale, the first cancer-preventing vaccines, which are forprotection against Marek’s disease and feline leukemiavirus, were developed by veterinarians and are con-tributing to the development of human applications.1

Livestock Herd Health and ProductionOptimization

In 1937 and 1938, Dr. C.L. Cole, who was at theNorth Central Experiment Station at Grand Rapids,Minn, was the first to demonstrate that large numbersof cows could be bred successfully by artificial insemi-nation.1 The first calf sired by artificial insemination offrozen semen was born in 1953.1 A 10-year dairy pro-duction study published in the late 1940s noted thatamong the many benefits of annual physical examina-tions for dairy cattle was an average increase in milkproduction by 40 percent.6

Food Safety (Human)Although the 1904 publication of Upton Sinclair’s

provocative book The Jungle led to the dismissal of Dr.Daniel E. Salmon from the fledging Bureau of AnimalIndustry, the resultant public furor successfully rein-vigorated his mission and facilitated the promulgationof the Meat Inspection Act of 1906.a,1 Dr. Salmon’s totalcontribution to foodborne disease control was consid-ered so valuable that the Salmonella spp were namedfor him. Montclair, NJ, was the first community to

Ten great veterinary public health/preventive medicineachievements in the United States, 1901 to 2000

Donald L. Noah, DVM, MPH, DACVPM; J. Kevin Grayson, DVM, PhD, DACVPM; Lester C. Caudle III, MD

From the Office of the Surgeon General, United States Air Force, 110Luke Avenue, Bolling AFB, DC 20332-7050 (Noah); TricareGolden Gate Region, 510 Mulheron Street, Travis AFB, CA 94535(Grayson); and the Office of the Surgeon General, Medical Corps,United States Army, Pentagon, VA 20310 (LTC Caudle). Dr. Noah’spresent address is 902 Seminole Road, Frederick, MD 21701.

The views expressed in this article are those of the authors andshould not be construed as an official Department of Defense orUnited States Government position, policy, or decision.

1812_1836.qxp 9/23/2005 2:44 PM Page 1834


institute routine microbiologic examination of milk in1900; in 1908, Chicago was the first to require pas-teurization of dairy products,1 and in 1948, Michiganbecame the first state to implement a state-wide milkpasteurization law.7 In the 1920s, veterinarians alsoaccomplished the basic work in developing the UnitedStates Public Health Service Milk Ordinance andCode.a Although slow to achieve industry acceptance,irradiation of food has been shown to have substantialbeneficial effects on the safety and quality of manyfoodstuffs. Previously approved for items such asspices, fruits, vegetables, and poultry, ionizing radia-tion was approved for use in 1999 to reduce bacterialloads on frozen raw meat and meat by-products.8

Recognition and Enhancement of theHuman-Animal Bond

Throughout recorded history, mankind hasbefriended and benefited from its association with ani-mals. Indeed, the histories of all animals, includinghumans, cannot be dissociated. That symbiotic part-nership, perhaps the cornerstone of veterinary medi-cine, became the life work of Dr. Leo Bustad, who oncestated, “One cannot have a healthy community with-out a strong human-animal bond.”9 From an enhancedunderstanding of that inextricable bond have evolvedsuch relationships as guide dogs for the sight and hear-ing impaired and military working dogs. Further, thepositive physical and psychologic benefits of thesehuman-animal relationships, such as the lowering ofblood pressure10,11 and as companions for elderly and illpeople,12 have been described.

Border Inspection/SurveillanceThe USDA has the responsibility for preventing

the introduction or reintroduction of foreign animaldiseases into the United States. The Herculean propor-tions of this task are exemplified by the fact that priorto free trade, the United States imported 1.9 millioncattle, 700,000 swine, and about 28 million birdsannually.13 Inspecting representative samples of theseanimals and their by-products is the task of the veteri-narians, directly or indirectly, of the USDA. This efforthas been greatly aided since 1954 by the USDA ForeignAnimal Disease Diagnostic Laboratory on Plum Island,NY, which provides valuable research toward the pre-vention and control of these biologically and econom-ically devastating diseases.1

Surgery and MedicineIn the field of fracture repair, Dr. Otto Stader

developed the first steel pin method for external frac-ture fixation.a,14 This was followed in the 1950s by Dr.H. A. Gorman’s development of the first surgicallyimplanted prosthetic hip joint and Dr. F. L. Earl’s dis-covery of the tranquilizing effects of reserpine.a

Regional anesthesia via the spinal route was first intro-duced into the United States in 1926 at a meeting ofthe American Veterinary Medical Association.15

Uniformed Services Veterinary MedicineIn 1916, with the establishment of the United

States Army Veterinary Corps, the United States was

the last of the industrialized countries to commission acorps of military veterinarians.a During World War II,Army veterinarians were credited with providing high-er quality rations for troops as well as more space forarmaments on cargo ships by thoroughly trimmingmeat products and freezing them in compact contain-ers.16 Dr. Robert A. Whitney, Jr. reached the pinnacle ofUnited States health care as Deputy Surgeon General,and later as the Acting Surgeon General in 1993. Today,veterinarians in the United States Army, Air Force, andPublic Health Service contribute substantially to mili-tary and civilian public health missions, such ashuman and animal disease control, occupationalhealth, food safety, medical research, deploymenthealth surveillance, and biological warfare/terrorismdefense.

Integration With Public HealthPractitioners

Under the leadership of Dr. Karl Meyer, an earlyarchitect of veterinary public health, the HooperFoundation of Medical Research became a world’s lead-ing institute for the study of comparative medicine andzoonotic diseases. Additionally, he developed the orig-inal curriculum for the University of California Schoolof Public Health.1 One of the many important achieve-ments by Dr. James H. Steele was the status elevationof veterinarians in the United States Public HealthService from sanitarians to veterinary medical offi-cers.1,17 Finally, one of the most concrete examples ofthis integration is provided by the 1964 publication ofDr. Calvin Schwabe’s seminal work, Veterinary Medicineand Human Health.1

Historically, the term public health has referred tothe process of the betterment of groups of humansthrough medical assessment, surveillance, research,and intervention (primarily by physicians) and thatveterinary public health applied exclusively to groupsof animals.a Evidence of the integration of these activi-ties is provided by the ACVPM’s 1989 definition of vet-erinary preventive medicine. In essence, veterinarypreventive medicine is an integral component of theprocess of improving animal and human healththrough the prevention and control of animal diseases,infectious waste contamination, and related humandiseases.18 The future of this integration was eloquent-ly stated by Dr. Calvin Schwabe:

The real challenge of one medicine derives, therefore,from the fact that veterinary medicine, like human medi-cine, is a human activity which was created by man most-ly for its positive effects upon man’s physical and mentalwell-being, that is his own health. This is not to say vet-erinary medicine’s creation did not also reflect concern forother animals’ well-being, because it did so in those cir-cumstances where man closely identified himself withother animal species, as he did, for example, in creatingmany of his religions. Realization that veterinary medi-cine is a human health profession, however, whateverthese additional qualities, extends the social conse-quences of one medicine far beyond most current percep-tions of each of its branches functioning separately.19

aDr. Edward L Menning, National Association of Federal Veterinarians,Washington, DC: Personal communication, Sep 29, 1993.

1812_1836.qxp 9/23/2005 2:44 PM Page 1835


References1. Dunlop RH, Williams DJ. Veterinary medicine: an illustrated

history. St Louis: Mosby-Year Book Inc, 1996;421, 424, 559, 560,564, 565, 574, 579, 580, 639, 653, 656, 664.

2. Armistead WW. From my armchair: Y2K. J Am Vet MedAssoc 2000;216:1081.

3. American Veterinary Medical Association. 2000 MembershipDirectory & Resource Manual. Schaumburg, Ill: AVMA, 2000.

4. Centers for Disease Control and Prevention. Ten great pub-lic health achievements—United States, 1900–1999. MMWR MorbMortal Wkly Rep 1999;48:241–243.

5. The passing of the hunchback [advertorial]. J Am Vet MedAssoc 1940;96:iii.

6. 40% more milk [advertorial]. J Am Vet Med Assoc 1946;109:xxxv.

7. Steele, JH. History, trends, and extent of pasteurization. JAm Vet Med Assoc 2000;217:175–178.

8. Meat irradiation gets green light, approval process stream-lined. J Am Vet Med Assoc 2000;216:472.

9. Olson PN. The human-animal bond: a multidisciplinaryapproach for the 21st century using guide dog schools as a model.2000 Convention Notes. Schaumburg, Ill: American VeterinaryMedical Association, 2000;320–321.

10. Anderson WP, Reid CM, Jennings GL. Pet ownership andrisk factors for cardiovascular disease. Med J Aust 1992;157:298–301.

11. Nagengast SL, Baun MM, Megel, et al. The effects of thepresence of a companion animal on physiological arousal and behav-ioral distress in children during a physical examination. J PediatrNurs 1997;12:323–330.

12. Beck AM, Meyers NM. Health enhancement and com-panion animal ownership. Annu Rev Public Health 1996;17:247–257.

13. Animal and Plant Health Inspection Service, United StatesDepartment of Agriculture. Report to the import-export committee ofthe US animal health association. Washington, DC: USDA–APHIS,1993.

14. That bones may mend [advertorial]. J Am Vet Med Assoc1944;104:iii.

15. Easier childbirth [advertorial]. J Am Vet Med Assoc1945;106:iii.

16. More space for armaments [advertorial]. J Am Vet Med Assoc1942;101:iii.

17. Steele JH, Blackwell MJ, Andres CR. The 50th anniversaryof the veterinary medical corps officers of the US Public HealthService. J Am Vet Med Assoc 1998;212:952–954.

18. Murnane TG. ACVPM: historical and future perspectives.2000 Convention Notes. Schaumburg, Ill: American VeterinaryMedical Association, 2000;802.

19. Schwabe C. Veterinary medicine and human health. 3rd ed.Baltimore: Waverly Press, Inc, 1974.

1812_1836.qxp 9/23/2005 2:44 PM Page 1836

Date post:	21-Jul-2016
Category:	Documents
Upload:	munsif-ali
View:	32 times
Download:	7 times

Public Health and Services

Documents