This is the story of an Iowa idea that with support from Kellogg Corporation Foundation led to the first in the world academic institution dedicated to the occupational health of farmers, their families, and workers. The Institute of Agricultural Medicine (IAM) was foundational to the development of the professional field of agricultural occupational health, the growth and advancement of the Department of Preventive Medicine and Environmental Health (DPMEH) in the College of Medicine, and the evolution of the DPMEH to the College of Public Health in 1999.
The IAM was founded in 1955 in the DPMEH. The IAM can be likened to a vintage vineyard whose roots gave life to fruit during its lifetime and to its progeny, long after it was planted. This manuscript is a story tracing the branches and fruits that arose from the “roots” of the IAM. The IAM was an important force in establishing the International Association of Agricultural Medicine and Rural Health, and the Rural Health section of the International Commission on Occupational Health. Further, the IAM was foundational to the development of the NIOSH Agricultural Health and Safety Program, and the now (2021) 13 specialized centers in the U.S. focused on the health of farmers, farm families, and farm workers. Further, the IAM was the foundation and a model for eight non-profit organizations focused on the health of farmers. The IAM was influential as a model and in assisting the development of “sister” organizations at Colorado State University, North Carolina Agromedicine Institute, Canadian Centre for Health and Safety in Agriculture and the Australian National Centre for Farmer Health. Further, roots of research areas founded in the IAM from 1955 to1986 can be found in the current (2021) research, teaching, and outreach activities. Examples of those areas include injury surveillance, injury epidemiology, zoonotic infectious diseases, health effects of pesticides and chlorinated and brominated chlorophenols, agricultural respiratory diseases, health hazards of intensive livestock housing, graduate education in agricultural medicine and continuing education in agriculture medicine.
Prior to the IAM, the DPMEH had only a few faculty members and few resources. The IAM more than doubled the faculty size, adding resources, status, and other elements required for a public health enterprise.
In this manuscript, in collaboration with Dr. William McCulloch (one of the key foundational faculty of IAM), I will track the progress from the early beginning that led to the founding of the Institute of Agricultural Medicine (IAM) at the University of Iowa. Also, we will trace the impact of the IAM on expansion and development of national and international activities in the field of Agricultural Occupational Health and Safety up to more recent times. We will trace how the IAM has been a leader in developing the core knowledge and education programs in Agricultural Medicine and a leader in developing the field as a specialized professional area of agricultural occupational safety and health. I will trace Iowa’s IAM idea that arose out of the observed need to help protect the health of our farmers their families and workers and has served as a model and facilitator for the dissemination of this idea within Iowa, nationally, and internationally.
Let me say upfront, what this history is not. It is not a history of the Department of Preventive Medicine at the University of Iowa. It is not a history of the College of Public Health. It is not a history of the field of Agricultural Safety and Health. This is the story of the IAM—how it developed and how the threads of it have lived on in the former Department of Preventive Medicine and Environmental Health in the College of Medicine. This history then follows how the IAM influenced the mission and the evolving portfolio of agricultural health and safety research, education, and outreach which remains as an important part of the College of Public Health (CPH) today (2021).
Who Are We to Write this History?
Kelley Donham will serve as the narrator and chronicler for this story. For me, this writing will be part memoir and part documentary. To date (2021) I have had 56 years of continuous association with the IAM, the DPMEH and later the CPH. Also, note that as the story unfolds, there will be shifts from first person to third person, dictated by the timing and sequence of events. Co-author Dr. William McCulloch (one of the foundational faculty) and Dr. Keith Long serve as additional sources of institutional memory and trusted reviewers. Long began service to the IAM in the late 1950’s, and McCulloch began service in the IAM faculty in 1960.
For me, it all started having grown up on a farm near Iowa City, Iowa. Members of my family, farm neighbors and I experienced numerous illnesses and injuries from the work of producing food. At age 8, I was with my grandfather and our neighbor Herby Cole when we were loading ear corn into a crib. I witnessed Mr. Cole lose the fingers on his right hand to the chain and sprocket gears of a corn elevator. In an extension of that same incident, I witnessed my grandfather suffer a serious disabling injury. He jumped on the WD 45 Allis Chalmers Tractor with no roll over protection and roared out of the driveway to get help. The tractor overturned in the ditch, throwing him off. Luckily, the tractor did not completely overturn, allowing him to survive with only a broken arm. This eight-year-old was left to deal with this situation. At age 12, I witnessed a boar attack my grandfather. He escaped that attack with a severe injury, which sent him to the hospital for several days to repair the severe lacerations and contusions from bite wounds. At age 13, I was thrown off my horse (Toby) while driving cattle from the lower pasture up to the farmstead. I suffered a clavicular-scapular dislocation of my shoulder that left me taped up with limited work capacity for three months. At 14, I unintentionally ran over my father with a manure spreader causing a severely contaminated compound fracture of both the tibia and fibula bones in his leg. The leg bones became infected (osteomyelitis and gas gangrene) and this almost cost him the loss of his leg and potentially his life. The inappropriate treatment of my father by his medical attendants made it obvious to me that they had little special medical or social understanding of how to best treat a farmer and his/her occupational injuries. Regarding chronic farm exposures over years, I personally acquired noise-induced hearing loss, an obstructive lung condition, and bilateral osteoarthritis of my hip joints, requiring total hip joint replacements.
Incidents to other farm family members included fatal farm-related injuries to two of my close relatives, an aunt and a cousin. In addition to my grandfather and my father, a total five first-degree relatives suffered non-fatal permanent disabilities resulting from farm hazard exposures. All of these injuries occurred in Johnson County Iowa, within 15 miles from our family farm.
I came away from these experiences with not only the knowledge and respect for agents of injury and disease on farms, but also a deep and abiding love for agriculture and its people. They do the work and experience the injury and illness risks to produce food, fiber and fuel for the rest of us, enabling the rest of us to pursue other careers such as doctors, artists, professors, plumbers etc.
One of my best friends from junior high school through undergraduate college (Kent Berry) was the son of Dr. Clyde Berry. In my sophomore year (1964) in undergraduate study at the University of Iowa, Dr. Berry invited me to dinner at their home. He asked me what I was studying in college and what I intended to do with it. I told him I was majoring in biological sciences, and was interested in the health sciences. Clyde said “—– Come up to my office tomorrow. Let’s talk”. The next day I found Dr. Berry in his office in the Medical Laboratories Building on the University of Iowa health sciences campus. He told me he was the Associate Director of the Institute of Agricultural Medicine (IAM), which was in the Department of Preventive Medicine and Environmental Health (DPMEH) in the University of Iowa College of Medicine. He told me the aim of the IAM was to research methods to preserve health and to prevent injuries in the farm population. I expressed my interest in that goal as a lifelong Iowa City area farm boy. I left his office with the offer of a position as research assistant in the IAM. He lined me up with some of the IAM faculty persons to gain further information. I talked mainly with two of the four veterinarians on the faculty/staff (Dr. William McCulloch DVM MPH and Dr. Richard Crawford DVM MPH). I was intrigued by what they were studying, which was infectious diseases common to animals and man (zoonoses) in the farming environment. I accepted that research assistantship with great joy and anticipation. I held that position from 1964 to1966. I received my BS in premedical sciences in 1966. Berry and McCulloch encouraged me to apply for graduate school. In the fall of 1966, I was accepted into the graduate program in the DPMEH and became a graduate research assistant. Dr. McCulloch was my primary graduate advisor. As time went on, I wanted further education and considered studying either human medicine or veterinary medicine. Dr. McCulloch and Crawford suggested that Veterinary Medicine might prepare me better for a career in Agricultural Medicine because of the broader education compared to human medicine and its closer connection to agriculture. Therefore, I applied and was accepted into the College of Veterinary Medicine, Iowa State University (ISU) in 1967. I remained connected to the IAM as a graduate student (while studying Veterinary Medicine at ISU). I worked on my graduate research during vacations and summers. I finished my course work and thesis in DPMEH at U.I. and completed my studies in Veterinary Medicine and graduated with both an MS in DPMEH the College of Medicine and a Doctor of Veterinary Medicine from Iowa State University in May 1971. (Note: Later in my tenure on the faculty of the College of Public Health (2003), Dr. Merchant and I we were able to build on this model of combined training in Public Health and Veterinary Medicine founding the DVM – MPH program in collaboration with Iowa State University College of Veterinary Medicine).
I will digress here to emphasize the connection of the Veterinary Medicine College at Iowa State University to the IAM. In my freshman year in Veterinary Medicine, we had a guest lecturer in our Public Health class from the former Dean of the Veterinary College. His was a distinguished person. He was living in Hemet, California in his retirement as Professor Emeritus. His name was I.A. Merchant DVM MPH. He was a co-author of the textbook Veterinary Bacteriology and Virology, which we used, as did most first year students around North America. I.A. Merchant had a distinguished career, leading the Division of Veterinary Medicine to the new College of Veterinary Medicine where he became the founding dean in 1959. I.A. Merchant was a member of the IAM founding advisory committee. I.A Merchant’s son James A Merchant, had entered medical school at the University of Iowa. James Merchant, as a first-year medical student, was invited to sit in on an advisory committee meeting in 1962, and met several of the IAM founding faculty at that time.
James Merchant then returned to the University of Iowa in 1983 and is an important part of the direction during the middle years of the IAM described later in this history. This story of the Merchant”connections to the college of veterinary medicine links back to the effort described above in establishing the Veterinary Public Health MPH program. As a professor at IAM, I implemented a program of having veterinary students as interns working on research projects and gaining an exposure to Public Health and Agricultural Medicine. We were able to build on that connection as James Merchant and I worked with Professor Jim Roth DVM, PhD at the Veterinary College to establish the joint University of Iowa – Iowa State University Veterinary DVM-MPH program beginning in 2001.
Now I return to my personal journey in the IAM. Following graduation in 1971 with a Doctorate in Veterinary Medicine (DVM) I went on for a brief career in veterinary practice, and then served as voluntary veterinarian and public health officer for the non-profit organization “Health and Economic Development in Appalachia.” My wife and I moved to the heart of economically depressed Appalachia—Breathitt County, Kentucky. There I was the veterinarian for a startup cooperative pig production organization. Also, as there were few public services in the county, I became the principal public health professional for the county. This allowed me to experience first-hand agricultural and rural medicine. As I had been an ROTC cadet in undergraduate, I had a military obligation that required me to leave Kentucky. I entered active duty in the Army as a Captain, assigned to the the Veterinary Core—Military District of Washington DC, stationed at Walter Reed Army Medical Center.There I was responsible for environmental health of the armed forces within the Military District of WDC, in charge of zoonoses control, and clinical veterinarian in a military practice that included care for military working dogs trained for duty in the U.S. Army.
Dr. Berry and Pete Knapp called me just as I was leaving the Army and encouraged me to come back to Iowa and join the faculty at the IAM. Although I was considering two opportunities, a faculty position at MIT and a veterinary practice in Cascade, Iowa. I readily turned those down and seized the opportunity to return to my roots, my passion and my farming background. I believed that at the IAM, I would have the opportunity to make a difference in the health of my people. Therefore, I came back to the IAM in the fall of 1973. Dr. Berry offered me “opportunity and hard work.” I was given the “opportunity” to build an agricultural medicine education and training program, to direct the Comparative Medicine section and create a laboratory and research program. I was hired first an instructor. The salary offered was $17,000, left over from the IAM Kellogg facilities grant. (The details of that grant are discussed later in this manuscript). That $17,000 was to cover my salary, and startup expenses. That was a onetime offer for one year. I would have to “make” my way after that. Soon, I was promoted to assistant professor in the tenure track. With the help and guidance of senior faculty (especially Drs. Berry, Long, McCulloch, and Knapp) along with opportunities, good luck, and hard work, I was able to parlay that $17,000 to a sustained position. I progressed through the academic ranks, achieving full professor in 1984.
In October of 2013, I progressed to Professor Emeritus. I have retained an office at the CPHB to work on publishing the second edition of my textbook, publishing several research articles and book chapters with students and faculty and lecturing around the country. This lengthy tenure in the field has given me the experience, institutional memory and privilege to discuss the early foundational years of the IAM. Further this long professional history has enabled me to observe the growth and expansion of agricultural medicine, modeled and sparked by the IAM and its people to now a nationally and internationally recognized field of research and service, and an ever evolving professional specialty area of occupational safety and health.
Mentioned previously, my collaborator on this manuscript is Dr. William (Bill) McCulloch DVM MPH DACVPH. He was my primary mentor as his graduate student and research assistant. His mentoring continued when I was a young assistant professor trying to learn the ropes of academia, even though he had moved on to other opportunities. We kept in touch over the years.
Dr. McCulloch’s roots were similar to mine in that he grew up on farms. He lived his first 12 years (1932 – 1944) on farms in Southern Minnesota. Those farms had a variety of domestic farm animals including dairy cattle, draft horses, pigs, sheep, chickens, and geese. His farm experiences gave him firsthand view of farm health and safety hazards, as well as the understanding of the sociological and cultural aspects of farming people.
McCulloch told me of his early farm experience with zoonotic diseases. Their Guernsey dairy herd suffered a series of abortions due to Brucellosis. Two of their four draft horses died of Western Equine Encephalitis during the major U.S. epidemics of 1937 – 1939. Both of these infectious agents were zoonotic (capable of infecting both man and animals) and carried serious occupational hazards for farmers and the general public. Regarding his farm injury experiences, Dr. McCulloch was thrown from a riding horse, sustaining significant injuries. He also fell through an opening in the barn haymow floor with hay and pitch fork in hand landing on top of two dairy cattle below. The cows cushioned his fall (no broken bones). He experienced a near fatal injury when he was driving a tractor at 10 years of age (a common age when kids begin driving tractors on farms). The tractor almost tipped over when pulling a hay wagon and hay loader. Like me, Dr. McCulloch knew first-hand about health and safety challenges of farming.
All the foundational faculty and staff of the IAM had farming in their background. Having the farming background not only gave the faculty an understanding of the critical issues of farm health and safety, but also it gave them the passion, focus, and dedication to pursue this area of research. One of Dr. Clyde Berry’s sayings relative to this issue —- “Having the farm background gave me the necessary experience to understand the risks and the people of farming that enabled me to develop the Institute of Agricultural Medicine as a relevant endeavor” (Berry 1999, Berry 2000, Berry 2001).
Goals of this Manuscript
In my early years as a new assistant professor (1973 – 1974) in the IAM, I would often come up with what I thought were novel ideas of how to prevent injuries and illnesses all too common in our farm population. I would present the ideas to the faculty and my mentors. The common refrain in response to what I thought was a great idea came from one of my mentors (Pete Knapp) was “— that is a good idea, we tried that 10 years ago, and it did not work because —.” The importance of knowing history is to prevent “reinventing the wheel,” to learn from former mistakes, and to retain what works. The history of an institution can be likened to a relay race where a runner passes the baton to the next runner who takes the work and energy of a previous runner and adds to it. Alternatively, an institution’s history in many cases acts as a shuttle race, where a runner passes the baton to the next runner, but that person runs in a different direction. As a result, the baton moves inefficiently resulting in slow or limited progress. Sir Thomas Moore (Renaissance humanist, philosopher, 1478 – 1535) said “— an absolutely new idea is one of the rarest things known to man” (Moore, T. Quotes). A major goal of this document is to review the history and to trace how the baton (progress in agricultural medicine) has been passed. We aim to accomplish this by tracing the history and contributions of the IAM to the Department of Preventive Medicine and Environmental Health (DPMEH) in the College of Medicine (1955 – 1998), and following in the Department of Occupational and Environmental Health (DOEH) in the College of Public Health (1999 – 2016). (Please note that there were many other activities in addition to Agricultural Medicine within these Departments, mainly beginning in 1975 as the department broadened in resources and activities). Dr. Robert Wallace, Professor Emeritus of Epidemiology and former Head of DPMEH, penned a brief history of DPMEH from 1930 – 2000 (Wallace 2002 and Appendix A). A primary goal of this manuscript is to review the history of the IAM component, of the former DPMEH and how the agricultural medicine activities were integrated into the into the College of Public Health beginning in 1999. A second goal is to expand on two bulletins about the IAM written in 1974 (Knapp 1974) and a later article written in 2000 (Knapp 2000). This work expands significantly on the breadth, depth, and time covered by Knapp’s papers.
Finally, a goal of this manuscript is to highlight the culture and academic background of the foundational faculty of the IAM. Their rural and farm backgrounds gave them emotional and cultural connections to farm people.Their academic qualifications gave them the skills as researchers to solve their occupational risks. These characteristics kept the focus of the IAM on the real problems of the farm population, even when program funding for other areas of research may have been easier to acquire. These characteristics also kept a grounded approach – not seeking high fame and visibility to more popular issues of the day, but to that, which more efficiently and expediently would lead to actual prevention of injuries and illness in the target population. Dr. Clyde Berry (Founding Associate Director of the IAM) revealed his focus and philosophy that permeated and helped guide the IAM —“You don’t have to study a problem to death to prevent it” (Berry 2001).
Resources for this Manuscript
The invited foundational faculty (Long, Knapp, McCulloch) strongly supported the idea of writing a history of the IAM. The effort on my part smoldered until 2017 when more time became available in retirement. Previously mentioned, Pete Knapp wrote two short papers on the history of the IAM (Knapp 1974 and Knapp 2000) which serve as important resources for this project. Further, I wrote a piece for Iowa’s Center for Agricultural Safety and Health (ICASH) Newsletter to commemorate the 10-year anniversary of the organization. That paper documents that history of ICASH – an extension of the IAM from 1990 – 2000 (Donham 2000, Appendix F).
I visited Dr. Berry and interviewed him at his retirement home in Ashehville, North Carolina. Dr. Berry was the first person hired by Dr. Franklin Top (DEO of DPMEH) to form the IAM. He was hired as the Associate Director.” However, he was in reality the Director who put details into the initial concept of the IAM and put that plan into action. Age 87 at the time of my interview, Dr. Berry remained very willing and lucid in sharing his oral history of his time from 1956 – 1992. I spent two days with him, taking copious notes, which I returned to Dr. Berry for editing, corrections, deletions, and elaborations (Berry2001). These notes supplemented Dr. Berry’s own memoir writings, which were provided to me following his passing by his son David K. Berry (Berry 1999, and Berry 2003).
I interviewed other foundational faculty, including Drs. Keith Long, Dr. William McCulloch, and Pete Knapp. Dr. Long was an important component of the founding faculty of IAM. Later in his tenure, he served as Director of the IAM from 1975 – 1985 and served a period as Department Head of DPMEH from 1970 – 1973 (Long, personal communication). Dr. Long retired in 1986, and I lost touch with him over the years. However, in March of 2019, I re-established contact with him. I visited with him and conducted an in-depth interview at this residence in Lone Tree, Iowa, a small town near Iowa City. Even at his age of 97, he was lucid recalling many aspects of the IAM foundational years. Dr. Long read an early draft of this manuscript. His comments and suggestions are incorporated in this manuscript. Dr. McCulloch provided important oral history as well as many of the photographs include in this manuscript. He also read several drafts of this manuscript adding to its accuracy and comprehensiveness. His extensive input into this project (going back to the meeting in 1999) warrants his co-author status.
In addition to the above resources, I reviewed faculty meeting minutes, past Institute Bulletins, and published papers of IAM faculty. Further, I relied on the research that I conducted for three of the textbooks that I wrote in the field of Agricultural Medicine, including Medical Practice in Rural Communities (Mutel and Donham, 1983), Agricultural Medicine: Occupational and Environmental Health for the Health Professions (Donham and Thelin, 2006) and Agricultural Medicine: Rural Occupational Health, Safety, and Prevention (Donham and Thelin, 2016).
Note that my lengthy professional involvement and institutional memory (beginning in 1964) with the IAM, provides personal experiences which flavor this report. No doubt, projects and experiences in which I was personally involved are given more ink compared to other projects and initiatives. If another person were to write this history, it might read differently. However, I have taken great aim to make sure the information provided here is correct.
This History will be written highlighting the accomplishments and major activities in six time periods, (1) Before the IAM (1985 – 1954) , (2) The Foundational Years (1955 – 1973), (3) The Middle Ages (1974 – 1985), (4) New Directions (1986 – 2007), (5) Modern Times (2008 – 2013), and (6) Current and Future Times 2014 —.