In 1955 in Iowa, there were 195,000 farms incorporating 35 million acres, and an estimated 600,000 farmers, their families and workers (22% of the population of Iowa at the time). Iowa was a leading agricultural state in the U.S. Iowa was at the top compared to other states in the production of corn, cattle, and hogs (USDA). The occupational trauma experiences of this population totaled 670,000 disabling injuries per year. Fatalities in the agricultural population accounted for nearly 50% of all occupational fatalities in Iowa. The agriculture industry was third highest in occupational fatalities behind mining and construction (Knapp, 1966, Knapp 1974). These facts generally flew under the radar of the medical and public health professions, as well as the general population. Mentioned previously, agricultural injury prevention programs prior to 1955 were the purview of the Extension Services of the land grant colleges. Extension programs historically focused on prevention of traumatic injuries, primarily through passive dissemination of safety information. They had no mandate for research. Meanwhile, medical and public health institutions were not paying attention to the health, medical or safety issues of the farm population. However, that all changed when two friends from the medical community got together and discussed these issues.
The Birth of an Idea – The Kellogg Connection
In 1866, the Seventh Day Advent Church founded a health and wellness spa in Battle Creek Michigan. Under the leadership of Dr. John Harvey Kellogg (1865 – 1943), the spa and related business grew to include up to 1300 guests/patients, a medical school, a nursing school, a publishing house, and several processed cereal food companies (Wilson 2014). Kellogg’s Seventh Day Adventists faith focused on a holistic and dietary approach to wellness; for example, they practice vegetarianism. Kellogg developed processed cereals for a component of a healthful diet. His brother William Kellogg took that concept and along with John Harvey developed the Kellogg Cereal Company in 1900 (Kellogg history) (https://www.kelloggs.com/en_US/who-we-are/our-history.html). This history explains how processed cereals have become a common breakfast food in most of the western world. As this company grew, they were able to establish a charitable foundation, which became the primary benefactor of the IAM and thus a fundamental factor in establishing medicine and public health into the field of agricultural medicine nationally, and internationally. The following pages detail how this connection occurred.
Skip forward to 1953. Two friends during that time had a fundamental effect on the future of Agricultural Medicine. They were Norman Nelson MD, DrPH, Dean College of Medicine (1953 – 1962) at the University of Iowa and Mathew Kinde MD, Director of the Division of Medicine and Public Health, at Kellogg’s Corporate headquarters in Battle Creek, Michigan. Kellogg’s corporate interest in public health came from the founders, John Harvey Kellogg MD and WK Kellogg. The company had a corporate initiative to promote public and community health during those times. Dr. Kinde had an important hand in that effort.
Dr. Kinde and Dr. Nelson were colleagues from medical school at the University of Michigan. Dr. Nelson held a doctorate in public health in addition to his MD degree. Kinde shared with Nelson public health and community health interests as a well as professional practice in public health. They both attended the American Public Health Association (APHA) meeting in 1954. They met at a side meeting to the APHA Conference and discussed the issue of occupational health and safety in agriculture. They outlined some ideas of how to attack this issue (perhaps sketched out on a napkin). Dr. Kinde said to Nelson “drop me a note.” Sometime later, Dr. Nelson sent a one and one-half page letter to Dr. Kinde with the idea of initiating a special institution within the Iowa College of Medicine to address the health of farmers. Nelson called the concept Occupational Health and Industrial Hygiene for the Farm. The very basic plan included the suggestion that the staffing should be multidisciplinary in nature, which would allow the best approach to research and solve the complicated issues of agricultural health and prevention in agriculture. There was no detailed written plan found for the proposed new Institute. In 1955, the Kellogg Foundation awarded the U.I. College of Medicine, $108,000 ($1,018,161 in 2019 dollars) per year for three years to form a special unit to research and prevent injuries and illnesses in the farming population (Berry 2003). There was an agreement that the State of Iowa legislature would assume this cost at the end of the three years of the Kellogg’s Grant (Clear Lake Mirror Aug. 18, 1955, Appendix B, Newspaper clipping notebook 1955-1985, Department of Occupational and Environmental Health). (Note: According to Long and Berry, such funds were appropriated but never reached the IAM (Berry 2001).
Dean Nelson had to decide where this unit would be located administratively and who would lead it. Dr. Franklin Top (Head, DPMEH 1952 – 1970) after only one year at Iowa was handed the charge to develop this unit, within the DPMEH. Dr. Top said regarding Kellogg’s contributions “— In terms of better health and safety for rural families in Iowa, the nation and in other nations, the impact of the Kellogg Foundation support has indeed been great. While support to increase agricultural productivity comes from many sources, only a handful of the most enlightened private benefactors such as the Kellogg Foundation have addressed themselves to the important human element in agriculture” (Knapp 1974, Knapp 2000).
Dr. Top was a pediatric infectious diseases physician and a scholar. He was an author and the principal editor of the primary text on infectious diseases during his time; Communicable and Infectious Diseases: Diagnosis, Treatment and Prevention (Top 1964). One of the memorable quotes I remember from him during his time of writing the text “Oh that my enemy should write a text book.” Dr. Top was a humble, kind person. His employment prior to coming to Iowa was staff physician at Henry Ford Children’s Hospital of Michigan in Detroit. Dr. Top was not an agriculturalist. He was new to Iowa, new to academia, and new to his position. It was clear he needed help to flesh out the concept that was so briefly described by Kellogg in the one and one-half page letter previously mentioned. He recognized he needed to hire someone to plan, deploy, lead, hire faculty and staff, and manage this new (novel in the world) center.
Top consulted various persons to help develop a faculty and staff team. One person he consulted with was Ralph Herron MD, a faculty member in the College of Medicine. He was the former graduate advisee of Clyde Berry during his PhD graduate studies in Industrial Hygiene at the University of Iowa. Clyde was a farm boy from Posey, Illinois, a small-town East of St. Louis in Southern Illinois (Berry 1999). Clyde had undergraduate degrees in Chemistry and Chemical Engineering from Iowa. He wanted a degree in Industrial Hygiene (IH), but Iowa did not have an IH program. Therefore, Clyde self-designed and completed a PhD degree in Industrial Hygiene. Later during his tenure on the faculty at Iowa, Dr. Berry used this impetus and experience to initiate de novo the IH graduate training program at Iowa (Berry 2003). Following graduation, Dr. Berry served as an IH in the U.S. Public Health Service during WWII, and then served as corporate IH for Esso Oil Company. Dr. Herron recommended Berry to Dr. Top as a good fit to set up the IAM unit. Top hired him. Dr. Berry was given the title “Associate Director.” Dr. Berry said that “— my agricultural background was essential in developing the IAM. Otherwise, I would have had no idea of the problems, the connections to rural doctors, specific injuries (e.g., p.t.o.), the subculture of agriculturalists, and common injuries etc.” (Berry 2003). Dr. Top apparently gave a free hand to Berry, as he was the principal person to craft the mission, vision, and operational plan. Dr. Berry also hired the foundational faculty. His primary vision and mission were as he stated: “… a mission/vision based on an economic model. Economic stress can be caused by sickness, injury, and death. Failures to prevent sickness injury and death results in millions of dollars (lost) when spread out over 180,000 farms. Therefore, prevention is key. We must find and provide the agricultural prevention necessary to fill the gap between acute care and rehabilitation” (Berry 2001, Berry 2003).
Dr. Berry was one of my primary mentors when I was a graduate student and young professor. He was the quintessential mentor – not only to me, but also to all students who would have contact with him. He would spend hours upon hours offering advice and expounding on how to progress in professional life.
What is in a name?
There was a name to be coined for this new unit, and an organizational structure designed to fit within the DPMEH and the Medical College. The name was coined THE INSTITUTE OF AGRICULTURAL MEDICINE (IAM). Why institute? This came after consideration of European Models, which were research organizations with a focus on topical areas that were generally outside of and separate from universities (e.g. the Max Planck Institute in Germany). The term agricultural medicine was first coined worldwide in the founding of IAM. That term has been confusing to some. The definition has evolved out of the preventive philosophy and multidisciplinary approach of the IAM. Elliott (1979) first published a suggestion for a definition of Agricultural Medicine. Donham (2005) expanded on that definition and offered the current standing definition as “… an academic discipline, a specialty area of (agricultural) occupational and environmental health and safety and public health.” Besides the IAM, the only other organization in the world (until 1981) with a focus on the occupational health of rural populations was the Institute for Rural Occupational Health, initiated in 1951 in Poland. This institute focused generally on the health care delivery to rural populations rather than prevention of occupational illnesses of agricultural populations. However, much later (1984) the Polish Institute was renamed the Institute of Agricultural Medicine (Donham 2006). In 1981, the second health organization in the U.S. to focus on the health of agricultural populations was National Farm Medicine Center (NFMC 1981). Dean Emanuel MD, a Wisconsin farm boy who became a cardiologist at the Marshfield Medical Clinic in Wisconsin, noted that he frequently saw patients with a lung disease that he connected to their farm work. This led him on a quest to research the condition called Farmers Lung, which in turn led to the development of the Farm Medicine Center in Marshfield, Wisconsin. A more detailed history of the development of Agricultural Medicine and the terms used in this field is described by Donham and Thelin (2016).
Other terms in the field include Agromedicine, a term defined by a program originating in 1985 in South Carolina as a collaboration between Family Medicine at the Medical University of South Carolina and Cooperative Extension at Clemson, the land grant university in South Carolina. Dr. Stan Schuman MD at the University of South Carolina was a principal proponent of the Agromedicine Program. At one time, there were several Agromedicine Programs in the U.S., which formed the North American Agromedicine Consortium. There is only one remaining organization of the former consortium that retains the Agromedicine term in its name: the North Carolina Agromedicine Institute on the East Carolina University Campus in Greenville, NC, directed by Dr. Robin Tutor as of this writing. The Journal of Agromedicine, which is one of the primary journals in this field, arose from the early publications of this consortium. This journal today is managed and edited by Marshfield Farm Medicine Center. Today, the terms agricultural medicine, agromedicine, and agricultural health and safety can be used interchangeable. Note I will use both terms (Agricultural Medicine and Agricultural Health and Safety) in this manuscript.
Foundational Faculty and Staff of the Institute of Agricultural Medicine
The IAM was founded with a focus on research (not teaching and or service/outreach; the usual triad of functions of an academic unit). However, the core faculty members were given tenure track appointments. Dr. Berry and Dr. Top set out to fill a slate of faculty and staff to carry out the mission of IAM. In the brief document from Kellogg that came with the award was the suggestion that a multidisciplinary faculty and staff may be suited to help identify and research critical health and safety hazards in Iowa’s farming population. The following professional specialty positions were targeted for recruitment. The lead founding faculty hired are listed below:
- Dr. Franklin Top MD; a pediatric infectious diseases physician/IAM Director and Head DPMEH;
- Dr. Clyde Berry PhD; An industrial hygienist/associate director;
- Richard Tjalma DVM; Infectious diseases (zoonoses) specialist (former CDC Epidemiologic Intelligence Service trainee); followed shortly by William McCulloch DVM MPH (public health veterinarian);
- Dr. Ralph Herron MD; Faculty member, College of Medicine
- Lafayette W “Pete”. Knapp MS; An agricultural engineer/ safety engineer;
- Dr. Keith Long PhD; A microbiologist/toxicologist;
- Dr.Tom McCorkle; An anthropologist;
- Darrel Heggen; A statistician.
The hiring philosophy in the founding years was unique when compared to the climate of today’s research university academic hiring. The latter requires a high level of academic credentials, including post-doctoral experience, a record of authoring peer-reviewed publications, and most important, having potential for garnering funding for research. The IAM philosophy was to hire young, beginning professionals with “grit,” an agricultural background, and a desire to take on a mission with a promise of opportunity and hard work, and above all supportive of the mission of the IAM to improve the health of farmers. It worked! The founding faculty were productive and established important funded research programs.
The hiring philosophy was also based on a medical and public health approach and was an early example of the “one health approach”— a collaborative, multi-professional and trans-disciplinary approach to research and problem solving (One Health Basics). Much was gained from professionals of different backgrounds and training—working in collaboration to solve complex problems.
Subsequent to the hiring of Dr. Clyde Berry in 1956, the second hire was Tom McCorkle, an anthropologist. McCorkle was hired to study social and cultural behaviors of farmers. He was already present in DPMEH and was assigned to the IAM. Richard Tjalma DVM, a public health veterinarian was hired along with, Keith Long a microbiologist (later turned toxicologist) in 1957. Dr. Long was born and raised in rural Kansas and obtained an MS in microbiology from the University of Kansas. The State Hygienic Laboratory (SHL) hired him first as a clinical microbiologist. However, Dr. Berry then recruited him from SHL to work at the IAM. Long took time off to complete his PhD in Microbiology at Iowa before returning to the IAM. In 1959, Lafayette “Pete” Knapp, an agricultural engineer was hired to study agricultural injury prevention. Pete came from the Extension Service of Cornell University in New York. He was a farm boy from the Ithaca, New York; born and raised in the shadows of Cornell University. Darrell Heggen, statistician, a critical staff person who was hired to round out the initial core-founding faculty and staff of the IAM. Other staff included John Braun who worked alongside Dr. Tjalma. Kelton Ferguson was a PhD student working in the DPMEH. Ferguson who went on to serve in the National Aeronautics and Space Administration, responsible for preventing any potential “Andromeda strain” agent on space craft and samples brought back from the moon explorations ongoing at the time.
Early changes in the founding faculty and staff included the following. Dr. Tjalma (circa 1957 – 1960) left for a career in the National Cancer Institute, where he became the Assistant Director. In 1960, Dr. William McCulloch DVM, MPH (1960 – 1968) came in to advance the field of zoonoses research. He brought in Dr. Richard Crawford DVM, MPH, who worked in the field of brucellosis and leptospirosis, which led him to complete his PhD requirement from the University of Minnesota. Crawford left the IAM circa 1970 for Texas A&M University where he spent a productive career in veterinary microbiology. Dr. McCulloch also brought in Dr. Stanley Diesch DVM MPH (1963 – 1966) to work on the leptospirosis research project. Diesch left for the University of Minnesota where he spent a productive career in Veterinary Public Health. Dr. McCulloch hired me (in 1964) as a research assistant and later as graduate research assistant. BG Foster also a graduate student was hired to work on toxoplasmosis research with Dr. McCulloch. A critical staff person that was hired to work on the zoonoses project was Gerald Walkup (a wildlife trapper). Walkup worked mainly in the field, trapping various species of wildlife that were then tested for zoonotic infections (mainly leptospirosis and toxoplasmosis) which aided in defining the ecology of these infectious organisms. Dr. Victor Beat DVM worked with Dr. Long in pesticide research as a field epidemiologist. Ed Slach served as gas chromatography technician. Darrel Heggen, statistician in the early years, was replaced by Paul Leaverton PhD who helped to develop what eventually transitioned to the biostatistics section of the DPMEH. (Later, Dr. Leaverton moved to the University of South Florida where he became the head of the Epidemiology and Statistics Department of their College of Public Health). Anthropologist, Dr. Tom McCorkle left in 1960. The IAM did not have another anthropologist until Kendall Thu PhD joined in 1985. Thu received his PhD during his tenure at Iowa. Dr. Thu left Iowa in 1996, for a faculty position at the University of Northern Illinois, where he currently is Department Head of Anthropology. Sixteen years following Dr. Thu’s departure, anthropology came back to IAM with the hiring of Brandy Janssen PhD in 2014. In 2015, Dr. Janssen took on the duties of the Director of Iowa’s Center for Agricultural Safety and Health.
The Administrative Arrangement and Space Accommodations
Administratively, the IAM was a division of DPMEH, which reported through the Department Head to the Dean of the College of Medicine to the University President. With its special mission, there was a separate funding line to assure the focus remained on the health and safety of the farm population. Internal (College of Medicine) and external (relevant state professionals) advisory boards were set up under Dr. Berry’s leadership. Among many prominent Iowa members of the Board, one outside member was Dr. Jim Steele DVM MPH. Dr. Steele was Assistant Surgeon General for the U.S. He is considered the “father of veterinary public health.” In Dr. Carter’s biography of Steele he noted that Steele thought that veterinary students should be taught about the health and safety concerns of famers, as they can advise them on health matters as they treat their farm animals (Carter, 2015).
As research focus areas developed, the administrative divisions within the IAM fell out in three sections: 1) Toxicology Section, 2) Infectious Disease Section (zoonotic infectious agents), and 3) Accident Prevention Section. A primary faculty leader in each of these areas was given the title of “Section Chief”. Dr. Long was Chief of Toxicology, Pete Knapp was Chief of Accident Prevention, and Dr. McCulloch Chief of Infectious diseases. In 1962, Dr. McCulloch changed the name of the Infectious Disease Section to the Comparative Medicine Section. This change accommodated greater breadth for research and funding as nationally the scientific community felt that infectious diseases were becoming a lower priority hazard relative to the greater and emerging concern for chronic disease hazards. (Note the reemergence of infectious diseases threats returned in the 1980’s with the AIDS epidemic, Ebola, antibiotic resistant infections, West Nile virus, zoonotic influenza, corona viruses among many others emerging infectious zoonotic diseases). The IAM Zoonotic Diseases Section activities were renewed with the current Center for Emerging Infectious Diseases (CEID) in the Department of Epidemiology. Dr. Greg Gray founded this center in 2003. Dr. Gray moved from Iowa first to the University of Florida and then to Duke University where he directs the Global Health Institute and studies emerging zoonotic diseases. In 2019, Dr. Gray and I were recognized at the same awards ceremony for the Veterinary Epidemiologic Society, for work in the field of One Health). In 2013, Christine Petersen DVM PhD took over as Director of CEID, which is a collaborative center together with the College of Medicine, Iowa State College of Veterinary Medicine, and the Iowa Department of Public Health.
In the founding years of the IAM, the research and office space scattered across the main medical campus and the Oakdale research campus (six miles from the main campus). Space for various components of the IAM was found in the University of Iowa Water Purification plant, the Medical Laboratory Building, and later the old Oakdale Sanitarium Hospital on the Oakdale Campus.
This scattered physical space separated the faculty and worked against the original concept of the IAM which was a collaborative one health concept – where faculty of different training and experience could work together gaining synergy from the collaboration to solve complex problems. Pete Knapp recognized the challenges of working in scattered spaces. He approached Kellogg foundation with this problem, and prepared a proposal to construct a building that would house all IAM faculty and staff under one roof.
The first problem was to find a location on U.I. property for the proposed IAM building. Space was available on the Oakdale Campus, six miles north and west of the main campus. Oakdale was the former State Tuberculosis Hospital and Farm. It had been a 640-acre farm, a self-contained community with its own food supply from the farm and its own post office. It was customary in the 19th and 20th centuries for state chronic care facilities to have associated farms where patients/inmates could work to assist their physical, mental, and social maintenance or rehabilitation; the produce from those farms was consumed by the residents and the surplus sold to help provide income to the State to operate those facilities. However, the state farms concept, lacking cost-effective outcomes, was losing popularity among lawmakers in the mid-20th century. Further, the Tuberculosis Sanitarium concept was breaking down, as this disease was less common, and communicability and treatment could be managed with new antibiotics and better socio-economic conditions. Treatment required less hospitalization; most treatment could occur as outpatient service. The state was in the process of moving TB patients to the general hospital on the main campus, and the Oakdale facility and grounds were donated from the State to the University of Iowa. Therefore, the 640-acre working farm and hospital at Oakdale became a target for repurposing. Dr. Clyde Berry was a member of a University Committee to determine the repurposing of the Oakdale campus. He was able to negotiate with the committee to reserve a space of eight acres on the West end of the campus (site of the current IREH building, then west to Highway 965) to construct the new IAM facility. A plan for the future included not only an IAM facility, but a future building site for the University of Iowa Hygienic Laboratory (the State Public Health Laboratory) and a space for a possible combined site for the Johnson County Public Health Department (Berry 2001). The IAM building was built on this space in two stages, 1968 and 1971. Dr. Berry had a “tractor test track” built just west of the building site. The test track was a series of berms that tractors could be driven on to test their stability. It was also useful, as intended, in saving that space for future construction compatible with the IAM mission and vision. It was not until 2007 that a new building for the Hygienic Laboratory was built and opened on this space that Dr. Berry had “reserved” with the test track in the early 1960’s (Berry 2001, 2003). The Johnson County Public Health Department did not find their place on this spot, and they built elsewhere in Iowa City. However, had the original vision had been carried out, there would have been a critical mass of health scientists and activities that could have been a boon to public service and research.
Knapp’s proposal to Kellogg was awarded in 1965, for the sum of $250,000 ($2.2 million in 2018 dollars). The building was dedicated in 1968. The 7000 square feet in this building provided office space for faculty and staff, but with little room for laboratory and classroom space. Therefore, Pete Knapp prepared a second building proposal to Kellogg for an addition to the first building to provide for the extra needed space. In 1970, Kellogg awarded $890,000 ($7.2 million in 2018 dollars) to add 27,000 square feet of space that included classrooms and research space that completed a connected four-wing building with a center courtyard. A feature of the research space included a complete machine shop to fabricate experimental safety equipment, and 14-foot-high, bay doors that allowed entry of large farm machines such as tractors and combines.
Research During the Foundational Years
In the foundational years, the results of IAM research were primarily published as bulletins and disseminated through the State Extension Services, the Public Health System, Medical and Veterinary associations, and primary care health practitioners. Thirteen bulletins were produced during the foundational years that reflect the early years of research efforts. These bulletins written from 1955 – 1970 are the following:
- 1.Culture and Medical Behavior in a Bohemian Speech Community in Iowa. Edward Kibbe and Thomas McCorkle
- Culture and Medical Behavior in the Old Order Amish on Johnson County, Iowa. Jochem van Heeringen and Thomas McCorkle
- Q Fever in Animals and Man in Iowa. R. A. Tjalma
- Preliminary Studies in Economic Poisons. Keith R. Long
- The Farmer Lends a Hand: Field Trails in Corn Harvest Safety and a Note on Stalk Ejectors. Thomas McCorkle
- Eye Injuries, Safety Gear, and Values in Iowa Farm Life. Thomas McCorkle
- Epidemiological Studies of Farm Tractor-Motor Vehicle Accidents. L.W. Knapp and Larry Hindaman
- An Epidemiological Study of Tetanus in Iowa. Franklin H. Top, Darrel W. Heggen, and William F. McCulloch
- Epidemiology of Rotary Power Lawn Mower Injuries. William H. McConnell and L. W. Knapp
- An Epidemiological Study of Power Take-Off Accidents. L. W. Knapp and Larry R. Piercy
- The Farm Tractor: Overturn and Power Take-Off Accident Problem. L. W. Knapp, Jr
- Accidental Poisonings in the Cedar Rapids-Linn County, Iowa Area. By Frank S. Lisella and Keith R. Long
- Epidemiological Aspects of Self-Induced Poisonings in the Cedar Rapids-Linn County. Frank S. Lisella and Keith R. Long
These bulletins were written in a practical style so that their essence could be applied directly to prevention. Also, these documents have been used by many other researchers as bases upon which to build new research. The documents are still relevant and may be obtained from the University of Iowa Library, Special Collections, and Archives.
Although most of these technical bulletins were written before 1970, a later bulletin, published in 1974, was titled The University of Iowa Institute of Agricultural Medicine (Knapp 1974). Previously mentioned, that nine-page bulletin was an overview of the early activities and developments during the IAM foundational years. That nine-page paper was an important resource for this current history of the foundational years. In 1974, the bulletin format ended. All IAM publications from there forward were written for peer-reviewed journals.
In 1960, Dr. McCulloch took over the infectious diseases section from RA Tjalma and led a research team in which I was included. Previously noted, Dr. McCulloch changed the name of the section to Comparative Medicine. We studied the following diseases: Leptospirosis, toxoplasmosis, zoonotic animal ringworm, histoplasmosis, tetanus, toxoplasmosis, Q fever, and brucellosis (McCulloch 1969 A, and McCulloch 1969 B). In addition to the farm population, we studied workers in meat packing plants for evidence of infection with leptospirosis and brucellosis. Dr. McCulloch conducted serologic studies of wildlife and conservation workers and veterinarians for evidence of infection with zoonotic diseases (McCulloch 1969 B, Diesch. Crawford, McCulloch, Top 1967. Diesch, McCulloch 1966. Crawford, McCulloch, Top, and Diesch 1969). Dr. McCulloch was an international expert in zoonotic diseases in his time. His authorship and editorial work in producing and publishing the textbook Diseases of Transmitted from Animals to Man (the most complete work on zoonotic diseases in its time) justifies his recognition as a national expert in the field (Hubbert, McCulloch, and Schnurrenberger 1975)
Teaching and Research During the Foundational Years
The IAM did not have a formal educational program in the foundational years. However, there were courses and graduate students in PMEH, some of whom conducted research under the supervision and mentoring of IAM faculty on agricultural health problems (including this author [KJD from 1964 – 1971]). Some of those graduate students are listed as authors or co-authors (Donham 1973, Foster and McCulloch 1968. Smith, McCulloch, and Davis 1970, and Top, Heggen, McCulloch 1965) on peer reviewed publications. Other co-authors listed were staff persons who worked on early research programs of the IAM, including BG Foster, Darrel Heggen, William McConnell, and Larry Piercy (the latter two who worked in the Accident Prevention Section under Knapp).
Dr. McCulloch initiated an educational effort consisting of guest lectures for pharmacy students, medical students and others in the health sciences. He thought it important to inform pharmacists and other providers of the risk of farmers self-medicating. Then and still today, many veterinary pharmaceuticals and biologicals are available over the counter to farmers as well as the general public. Veterinary pharmaceuticals are sold at feed and farm stores, animals supply houses, on line, and in veterinary practices. Dr. McCulloch was concerned that if these pharmaceuticals were being used off label and for self-medication that a public health problem could result. Starting in 1963, in cooperation with the Iowa Pharmacy Association and Iowa Veterinary Medical Association, McCulloch initiated 12 animal and public health lectures to senior Pharmacy students at U.I. and at Drake University (the first time such lectures were presented in a Pharmacy College in the US). With publicity following this effort, McCulloch gave an invited paper (Socioeconomic Aspects of Pharmacy-Veterinary Medical Relations) at the 1966 AVMA meeting in Kentucky.
In addition to teaching pharmacy students, Dr. McCulloch taught zoonoses and epidemiology to medical, dental, and graduate students. In 1973, I expanded this education endeavor teaching courses for pharmacy students (along with other public health and health sciences students) in a new three-hour graduate course called Agricultural Medicine that included information on veterinary pharmaceutical products and safe use of them. Details of the advanced educational program in agricultural medicine that developed from these foundational years is discussed later in this manuscript.
During the foundational years, collaborating with the Iowa Department of Public Health, the Institute hosted the Midwest Conference on Zoonotic Disease beginning in the mid-1960s that continuing into the 1990s. One of the conferences featured collaboration with the Iowa Pediatrics Association on the topic of zoonotic diseases risks of children. As Chief of the Comparative Medicine Section, I ran this conference for several years, until it was discontinued.
Continuing this thread of work in the field of zoonoses in modern times, mentioned earlier, the Center for Emerging Infectious Diseases, founded in 2003 by Dr. Greg Gray re-instituted the infectious diseases conference as the Great Plains Emerging Infectious Diseases Conference. Dr. Gray deployed a “one health” approach to his center’s research, meaning he involved veterinarians among other scientists to solve problems. Dr. Mike Male DVM, MPH, a swine medicine veterinary practitioner in Eastern Illinois and MPH graduate student, worked with Dr. Gray, Dr. Tara Smith PhD (microbiologist) and myself on methicillin resistant staphylococcus aureus (MRSA). Dr. Smith was the first in the U.S. to discover swine-associated MRSA. We studied the Swine MRSA reservoir as a possible occupational and public health issue. Community-acquired MRSA (distinct from livestock-associated MRSA) is a major health hazard as a hospital, and community acquired infection. In a 2019 report (Kourtis et.al.,2019), MRSA accounted annually 120,000 blood-born infections and 20,000 fatalities. MRSA infections may occur outside and independent of hospitals, caused by community associated MRSA (CA-MRSA). In Germany, researchers found that at least 10% of sporadic MRSA infections were due to livestock-associated MRSA (LA-MRSA) (Cuna, Weiler and Witte 2015). We were not able to determine the occupational or public health significance of livestock-associated MRSA in the U.S. Dr. Smith moved to Kent State University where she continues work in zoonotic infectious diseases. However, research on livestock associated MRSA is still in progress at other venues globally.
Dr. McCulloch created a Comparative Medicine Externship for second-year veterinary students during his tenure at IAM. Over a four-year period, eight veterinary students participated. All of them eventually went into human health-related governmental or academic positions. I continued this training for veterinary students beginning in 1974. This experience facilitated my long-sought goal of a more defined veterinary public health program. This goal led to a combined DVM-MPH program in conjunction with Iowa State University College of Veterinary Medicine. Dr. James Merchant and I worked together with Dr. James Roth at Iowa State and founded the program in 2003.
Outreach and Consultation During the Foundational Years
Outreach in the foundational years consisted of consultation to health care professionals in the University of Iowa Hospital and private health care practitioners in the state. Additional outreach was provided to national health and safety governmental and non-governmental organizations and internationally to a variety of rural and agricultural health organizations. University of Iowa physicians and private practitioners commonly called upon IAM faculty to consult on cases where a rural or farm environment may have been a factor in a patient’s condition. We were often called on to take an occupational history or go to the farm site to investigate and determine causation and preventive methods. This collaborative consultation not only helped the physician and patient but also led to funded research to find preventive measures to protect exposed persons. Several examples follow of field case studies that lead to funded research.
Leptospirosis Consultations and Investigations
Two examples of consultations that led to funded research were investigations cases led by Dr. McCulloch. I was involved in these investigations as a graduate student and research assistant. In 1964, we began a case investigation based on phone calls from a physician in Linn County, Iowa. He had seen a patient with influenza-like and meningitis-like symptoms. A field epidemiologic investigation resulted in identifying that more than one person had those symptoms and history. In fact, 15 persons were identified with common environmental history; they all had been swimming in a local stream (Big Creek) to which cattle had direct access. Armed with this history and appropriate diagnostics, we conducted a field investigation which resulted in the diagnosis of leptospirosis for all 15 persons (Diesch, McCulloch 1966). This case was not the first of this type of exposure and we learned that in 1959, two persons contracted leptospirosis swimming in the same creek. L. interrogans, serovar pomona (the primary serovar infecting swine and cattle) had been isolated from five cattle who had access to Big Creek. In this same year, there were an additional 38 cases of leptospirosis diagnoses in humans in Iowa. The field studies during these investigations resulted in isolating serovar pomona from a variety of wildlife mammals in the area, as well as a frog (Rana pipiens), and from water where these animals had access (Diesch, McCulloch, Braun, and Ellinghausen 1966). These studies are notable as they were the first-time isolation of pathogenic leptospires from water in Iowa (Diesch and McCulloch, 1966).
Pathogenic leptospires establish chronic kidney infections. Large numbers of leptospires are passed in the urine from infected animals. Many of the infected animals become carriers without clinical signs of disease. The hypothesis was confirmed that urine from infected domestic livestock and wildlife can contaminate ponds and streams. Those swimming in water contaminated with urine from infected animals are at risk from becoming infected by water contacting open sores, or mucous membranes of the swimmers. Of the 38 cases diagnosed that year, water contact was found to account for 50% of the cases. The remainder include those having direct contact with infected animals, including livestock producers, hunters, and workers in swine or cattle processing plants. For example, McCulloch and Diesch reported in the New England Journal of Medicine on four cases of human leptospirosis acquired from hunting and cleaning squirrels —the first such report (Diesch, McCulloch, Crawford and Top, 1977). One of the four was a farmer. This new finding defined a host-agent relationship by the isolation of serovar grippotyphosa from a fox squirrel (Siuris niger) and isolation and or serological evidence of the same serovar infection in the human contacts. This was the first report of human cases for hunting and cleaning squirrels (Diesch, SL, Crawford, RP, McCulloch, et. al. 1967).
These studies of the ecology and pathogenesis of leptospirosis in people and animals was led by Dr. McCulloch. The research team at Iowa included Drs. John Braun, Dr. Stan Diesch DVM, Dr. Richard Crawford DVM, Dr. Herman Ellinghausen (Dr. Ellinghausen was a colleague from the National Animal Disease Laboratory in Ames, Iowa), and Dr. Stanley Hendricks DVM (Iowa Department of Public Health). Crawford, McCulloch, Top and Diesch (1969) provided a summary of sporadic cases of human leptospirosis. As a graduate student, I was fortunate to have participated in this research. This research led to a better understanding of the ecology and prevention of this disease in people and animals.
The Leptospira research at IAM fostered many productive collaborations, such as the Iowa Department of Public Health (Dr. Hendricks), and the USDA, National Animal Disease Laboratory (NADL). Collaboration with Dr. Ellinghasen at NADL was very fruitful. He was able to develop a culture medium for the fastidious leptospires enhancing the prospects of isolation of these organisms. McCulloch, working with Diesch and using Ellinghausen’s medium enabled them to isolate serovar hardjo from cattle identifying this organism as the primary serotype infecting cattle. They also isolated serovar grippotyphosa from cattle. This work made a scientific breakthrough identifying cattle as an important host for this zoonotic agent.
Even with the improved Elinghausen medium, isolation of leptospira from animal and human tissues and fluids was difficult and time consuming, taking as long as two weeks to get an early and specific diagnosis in either humans or animals. To answer that problem, I worked with Drs. Crawford and McCulloch on a research project to develop a more rapid diagnostic test. We developed a rapid fluorescent antibody stain to enable microscopic identification of leptospira organisms in urine, cerebral spinal fluids, and other body tissues. That research (the subject of my M.S. thesis at the IAM) added a new tool for a more rapid diagnosis of this disease (Donham and Crawford 1973).
Toxoplasmosis Consultations and Investigations
Another consultation with physicians at the University of Iowa Hospital led to long term research on the ecology and pathogenesis of toxoplasmosis in people and animals. The key case was a patient who presented to UI physicians with a presumptive diagnosis of lymphosarcoma. However, the consultation by Dr. McCulloch with the physicians resulted in a biopsy of the patient’s affected lymph nodes. The histopathology report resulted in a presumptive diagnosis of toxoplasmosis. Dr. McCulloch isolated Toxoplasma gondii from the biopsied lymph node of the farmer (Smith, McCulloch, and Davis 1970). Similar to the leptospirosis story, this case consultation led to several years of funded field and laboratory studies resulting in a better understanding of the ecology of this disease in people and animals. Important insights were gained to improve prevention of the disease in agricultural workers and the general public (McCulloch 1969A, McCulloch 1969B, Foster and McCulloch 1968). This research was at the cutting edge of discovery of the occupational and public health significance of toxoplasmosis. An important collaborator was Jack Remington MD, then at the Infectious Diseases Division at the Harvard University School of Medicine and Boston City Hospital. McCulloch and Remington co-authored a chapter on toxoplasmosis in the then leading textbook on zoonoses (McCulloch and Remington 1975). Again, I was fortunate to work with Dr. McCulloch, and be a part of this research team as a graduate student.
Acute Injuries Consultations and Research
Consultations by Pete Knapp led to the discovery of a certain model and make of corn picker that was commonly associated with the many entanglements of farmer’s hands and arms in the snapping rolls of the machine. These incidents resulted in numerous disabling injuries including amputation of fingers, hands and arms as well as loss of life. Studying the epidemiology of these injuries and conducting a forensic mechanical investigation of these incidents, Knapp found a defect in the original design of the machine (McCorkle 1965). Working with the manufacturer, the machine was redesigned (both new machines and well as retrofitting machines in service) with a new safety feature that eliminated the entanglement hazard. This helped to control that problem, saving many severe injuries and preventing loss of productivity for many farmers.
National Outreach During the Founding Years
Dr. Berry was prominent during this period in national service consultation. He served as president of the American Industrial Hygiene Association (AIHA), and the Iowa-Illinois Section of AIHA. He served on the boards of the Industrial Hygienist Certification process, the Safety Professional Certification, and the Society for Occupational and Environmental Health. Dr. Berry also served on the national committee of the Department of Labor that resulted in Public Law 91-596, which created the Occupational Safety and Health Act of 1970, the Occupational Safety and Health Administration (OSHA) and the National Institute for Occupational Safety and Health (NIOSH) (Berry 2001, and Berry 2003).
International Organization Outreach Activity During the Foundational Years
Knapp was the most active IAM faculty person in the international arena. He was essential in the International Labor Organization Committee of WHO, which developed the code of practice for the health and safety of rural and agricultural populations in developing countries. A quotation from Pete follows: “… We must not cease to encourage the expanding use of machinery, chemicals, improved seeds, and other advances in the world, but such use must also preserve and increase the wellbeing of the individual. We feel that the things the Institute has accomplished and hopes to accomplish in the future may have a great and beneficial effect in enhancing the welfare of the rural workers in developing nations, who really will be the most important factors in the success or failure of the green revolution” (Knapp, 1974) .
Knapp was also active in the International Association of Agricultural Medicine and Rural Health. As this organization was just beginning, Knapp and Dr. Top were influential in launching this organization, grounded in the concepts of C.K. Elliott, a rural physician in England (Elliott 1979). It would progress to involve health and safety practitioners from Europe, Asia, and North America. Knapp was also active in the International Social Security Association which involved European nations who addressed the health of rural and agricultural people.
Summary of Critical Advances During the Foundational Period (1955 – 1973)
- The Institute of Agricultural Medicine (IAM) was founded in 1955 at the University of Iowa with a grant from the Kellogg Foundation. It was the first such Institute in the World from a medical and public health approach to focus on the occupational health of the farming population and the first to use the term “Agricultural Medicine.”
- Dr. Norman Nelson MD, Dean of the College of Medicine, University of Iowa at the time, collaborated with Dr. Mathew Kinde MD (Director of Medical and Public Health, Kellogg Corporation) to develop the concept of an organization to address the health and safety hazards of Iowa’s farming population. This collaboration resulted in a gift from the Kellogg Foundation to initiate such a program.
- The development of the program was assigned to the Department of Preventive Medicine and Environmental Health. Dr. Franklin Top was the Department Head. He hired Dr. Clyde Berry as Associate Director to develop the concept, create a mission and vison, hire, and manage a faculty and staff.
- The operational philosophy aimed for hiring a multidisciplinary faculty and staff. With our varied backgrounds and training we were expected to work together— gaining synergy from joining our varied skills and knowledge to solve the complex problems of health and safety of farmers, their families, and workers. This approach is what we call today a “one health” approach.
- The initial hires (beside Dr. Berry, Industrial Hygienist and manager), included an anthropologist (Tom McCorkle), a veterinarian (Dr. Richard Tjalma), a virologist/toxicologist (Dr. Keith Long), and an agricultural / safety engineer (Lafayette “Pete” Knapp), and a statistician (Daryl Heggen).
- Early research focused on four different areas, which eventually became organized as sections with (Section Chiefs) within the IAM. The sections included 1) Comparative Medicine (William McCulloch DVM) that studied infectious diseases common to animals and man, i.e., zoonoses, 2) pesticide toxicology (Keith Long PhD), and 3) The Accident Prevention Injury Laboratory (L.W. Knapp) studying traumatic injury prevention associated with farm machinery.
- Although teaching was a minor aspect of the IAM faculty at the time, outreach and service were extensive. Strong collaborative relationships and respect developed between IAM faculty and the medical faculty of the College of Medicine and private physicians across the state. Consultations with these health care professionals on specific cases not only provided a great service, but in several instances led to funded research programs resulting in further discovery of causes and prevention of farm health and safety hazards.
- Following the initial Kellogg grant to found the IAM, later additional Kellogg Foundation gifts were won to build a new building on the Oakdale Research Campus. The 34,000 square feet building was built in two phases. The first phase building was dedicated in 1968 and second phase in 1972. This building resulted in space to house research, teaching and office space for all faculty and staff members of IAM.
- Several of the founding faculty had long tenures at the IAM, including Dr. Top, Dr. Berry, Dr. Long, and Pete Knapp. Others had great opportunities elsewhere and moved on. Dr. Richard Tjalma DVM (served 1957 – 1959) became the Assistant Director of the National Cancer Institute. Dr. William McCulloch DVM (Tenure from 1960 – 1968) had successive stints in veterinary public health at the Universities of Missouri, Texas A&M, and finished up an exceptional career as Dean of the Veterinary College at Oregon State University. Dr. Richard Crawford DVM (tenure from 1962 – 1969) went on to a long career at Texas A&M, and Dr. Stanly Diesch DVM (1963 – 1966) had a long and productive career at the University of Minnesota.
Having joined the IAM as a research assistant in 1964, I consider myself a staff person of the founding generation. My faculty appointment in 1973 was on the cusp of the transition of the IAM to what I called the Middle Ages of the IAM. I continued through the academic ranks to full professor in 1984, and then moved to Professor emeritus in 2013. The experience has given me the institutional memory and perspective to write this history and reflect on the foundational years on into developments and changes in the IAM through more recent times.
The following chapter (The Middle Ages) describes the transition of the IAM from a relatively independent research institute to the Occupational and Environmental Health Section of the Department of Preventive Medicine and Environmental Health.