Sophia Smith Collection - Population and Reproductive Health Oral History Project

Sharpless	Today is July 18, 2002, my name is Rebecca Sharpless and this is the first oral history interview with Dr. Reimert Ravenholt. The interview is taking place at Dr. Ravenholt’s home on the shores of Lake Washington—
Ravenholt	—in Seattle.
Sharpless	—in Seattle. We’re sitting on the third floor looking out over the lake on a beautiful day. This interview is part of the Hewlett Foundation work on population pioneers. Dr. Ravenholt, thank you so much for allowing me to come spend time with you today.
Ravenholt	Well, it’s a pleasure.
Sharpless	I had thought, as we’ve talked this morning, we discussed some of your growing up years on the farm in Wisconsin, and let’s start at the beginning. When and where were you born, sir?
Ravenholt	Yes, I will just rough in quickly as I can—my childhood. I was born on March 9, 1925, on a dairy farm halfway between Luck and Milltown, Wisconsin. I was actually the sixth of the ten children that my mother had, but her firstborn died at six weeks, and so there were the nine of us and I am the middle child of the nine. And that has continued until the present, because we’re all still living in our seventies and eighties. When I was born, on this little farm my mother had five children under the age of six. My oldest brother, Albert, then five and a half, Halvor, then twins Eiler and Johanne, and then me. So, how she did it, I don’t know, because we didn’t have electricity, running water, indoor toilet. It was almost as though we were born in the nineteenth or even eighteenth century. It was fairly similar, because quite a lot of the time we didn’t have an automobile that worked, either. But, our mother, Kristine, was an extraordinarily able and well-directed person. Our father was a brilliant person—both of them were well educated. My father had had a couple of years at the University of Wisconsin, and in Danish schools. Our social home, there in Wisconsin was actually West Denmark, Wisconsin, which was a small Danish colony. And, even though my parents had both been born there, they still held very much to the Danish. They were completely bilingual. We spoke Danish at home and went to Danish church at West Denmark, and summer school to learn to read and write some Danish. So, I could almost as well have been born in Jutland, as in Wisconsin.
Sharpless	When you say your “social home,” what do you mean?
Ravenholt	It was where we went to church, where we went for any holiday, and where we congregated with many relatives.
Sharpless	All of them Danish?
Ravenholt	Yeah, just about all of them Danish, because my four grandparents had emigrated from Denmark to there. Yes, so it was very Danish. And we didn’t really learn English until we started first grade. Then, of course, we learned it quickly and had no problems that I recollect. We grew up on a farm, and my first memories are really during the Depression of the 1930s. I can remember when the dairy farmers, trying to improve the prices they received, went on strike. (laughs) Well, they ought to have had better sense. When you’ve got a herd of dairy cattle, and you strike, that means you don’t deliver it anywhere, so milk accumulates and you must do something with it. I can remember all this milk collecting and trying to make cheese out of it, and butter and so forth. Interesting. Actually, before that, beginning in the 1880s, my father’s parents, Anders and Hanne Ravenholt, participated in the creation of the first cooperative creamery in the state of Wisconsin and it may have been the first one in the U.S., I’m not sure. But my grandmother, Hanne, became the butter maker. She’d been trained in butter making in Denmark. So, our lives were interwoven with dairying and creameries throughout our youth.
Sharpless	You told me a story before we started about your starting to milk when you were about six.
Ravenholt	Yes, on the dairy farm, I can remember, as soon as I was old enough to do it, when I was about six,. I can remember a Sunday, I wanted to show how capable I was, or something. So, I went down to the barn about four o’clock and started milking the cows and by the time my father and brothers came down there, I had milked four or five cows. Not so well, I’m sure, but I guess they liked my spirit, even if my milking was not perfect. In my youth I did a lot of milking, and when I was twelve, living on another farm, a neighbor hired me to go with his hired hand to milk every morning. His hired hand would pick me up about 5:30 A.M. We would travel a mile or two, and I’d get the cows and then he and I would milk the cows and get home in time for breakfast and regular work, and then again, in the evening. I did that daily during that summer. I can remember, I was at West Denmark on the Fourth of July, and at about four-thirty I had to leave my friends and go with Verner Petersen, a cousin, to get the cows and milk the cows. And for this I got three dollars a month.
Sharpless	Wow.
Ravenholt	That was five cents in the morning and five cents in the evening. And then when I got the money, being as poor as we were, I remember my mother helped me pick out in the Sears-Roebuck catalog a jacket for the winter. So, I applied the monies to get a winter jacket.
Sharpless	That was a big help.
Ravenholt	Yeah. (laughs) So, these were formative experiences of my youth. Another formative experience was an attack of the flu at age twelve.
Sharpless	Yes, but let’s put that on the tape. That’s a wonderful story.
Ravenholt	Well, in 1937, it must have been February, there was a flu epidemic in Wisconsin, and many other places in the U.S., I’m sure. And I got the flu and I was home in bed with fever for three-four days. And, as usual, I loved to read, so I read, even though ill. I read as much as I could, in bed. And when the fever receded, something had happened to my eyes. It—when I tried to read, it just made me dizzy. There was something I couldn’t explain, that had happened to change my reading ability. (motorboat passes) It was so severe in those early weeks, and for months, actually, that I couldn’t even read the funny papers. My sister read the funny papers to me. Then I went back to school at Milltown Elementary School, in the sixth grade. I tried to read, do my schoolwork, but it produced a splitting headache. And so the teacher let me go home. We lived a couple miles from school, and I walked home. I remember it was winter with snow on the ground, because there was a bright sun and I couldn’t stand to have my eyes open looking at the sun on the snow, so I’d take a peek down the road, then walk with my eyes closed for awhile, then just take a peek every now and then to make sure I was staying at the right place on the road until I got home. Well, my visual difficulty gradually got better, but I couldn’t watch a movie. They had some free shows on Saturdays in Milltown, but I couldn’t stand to watch a movie, then. And for some years, I was limited in how much reading I could do. I think this changed my I/D ratio.
Sharpless	Your I/D ratio being—
Ravenholt	Intake to Digestion of information. So, instead of reading more, I think I thought more, because I had to do something. So, I would think very deeply about things rather than intaking more information. And I think that really did tilt my tendencies throughout my life. So, I’ve always enjoyed thinking most deeply about various phenomena and actions that I have been working with.
Sharpless	And what have been the ramifications of that?
Ravenholt	Well, I think I’m more independent in my thinking and in my decisions than most of my peers. And that is sometimes a problem when one sees a different solution to something and wants to publish it. Then you may have difficulty publishing it. And it may make you unpopular, too, when you see a different solution than the way your peers are viewing it. Many things along the way, but I mentioned to you that my view of statistics—I’ve done a lot of research analysis and publication during my professional life and when I took my master’s degree at the University of California at Berkeley in epidemiology and public health, I was taught the usual statistics, including Chi-square tests, and “p” values and such. And I knew there was something basically not right about them, but in studies for a degree you pretty much have to do whatever the professor says, so I learned Chi-square tests. But, the view that there was something unsound in the use of esoteric statistical tests of significance always stayed with me and I’ve published repeatedly, in various ways to that effect. But only half a dozen years ago did it fully come to mind why these esoteric tests of statistical significance are not valid. And that is, that it violates the scientific principle that one must use Consistent Precision when assembling and analyzing scientific data. I did manage to publish this in 1997 and ’98 at CDC in the Epidemic Intelligence Service Bulletin. (Epidemiology: The Ultimate Health Science; and Esoteric Statistics: the Quackgrass of Epidemiology, at www.ravenholt.com. ) An enormous amount of money is wasted in many ivory towers by statisticians and others devoting undue time and effort toward trying to analyze the statistical significance of numbers that one finds in studies, instead of simply accepting those operative numbers. The fallacy is that they are only applying this kind of precision to the actual numbers resulting from a study, not to the other main determinants of the worth of that study—such as the intelligence, the specific knowledge, the honesty, and the care with which the investigators have done the study, the study plan—whether it’s appropriate or not, how appropriate is it, and so forth. You simply must not expend all this time and effort to do esoteric tests of the statistical significance of the numbers resulting from studies, when you don’t have that kind of precision over the other determinants of the worth of the study. So again, I think sometimes this derives from thinking very independently and deeply about whatever I’m doing. Likewise, thinking deeply about whatever I was reading led to my diagnosis of the underlying cause of death of Meriwether Lewis, just three years after returning from the Pacific – that it was caused by progressive neurosyphilis. No one else had ever published to that effect in 180-some years. But again, once I saw the pattern—once I understood it—because I’d had wide experience with many infectious diseases, I had no hesitation publishing to that effect.
Sharpless	Hm-hm. Hm-hm. So—
Ravenholt	I mentioned other things, such as some farm experiences that have fashioned my life—my way of attacking things. One memorable experience was going to Dakota in the harvest fields when I was seventeen and eighteen and working, for example shocking grain all by myself in endless fields, twelve-hour days, day after day. You’d go crazy unless you did a lot of thinking about all kinds of other things while busy gathering the bundles and putting them in shocks. We were very poor during the Depression years, because we lost our farm to foreclosure in 1935 when I was ten. Our father worked for the WPA (Works Progress Administration) during the next five years and we gradually acquired more cattle; so we had a small dairy farm that we boys took care of, so we always had plenty of work with that and cutting wood and all the other things. When I was eighteen my Dakota experience was really the final farming experience because after that I went to Minneapolis and worked at a variety of hard-labor jobs. After a half a year, I realized that I didn’t want to do that forever. So then I decided to go to the University of Minnesota and get an education.
Sharpless	What types of things were you interested in when you were a child? Were you interested in medicine?
Ravenholt	Oh, some, but not so particularly. Our father was brilliant, but he was a hypochondriac, so we heard a lot about doctors and nerve medicines and so forth. But I didn’t have a clear knowledge of what I wanted to do.
Sharpless	You just knew you didn’t want to do physical labor.
Ravenholt	Well, I knew I needed to get out of the rut I was in, somehow. When I applied at the University of Minnesota, they sent me forms that I should fill out. And on the form—this is now the spring of ’44—they asked me to put down my major. And I wrote down “engineering or pre-med.” By then my sister, Johanne, was in nurse’s training at Fairview Hospital, in Minneapolis. And so, I was learning more about medicine from what she was telling me. Earlier, I had thought of going into engineering, but then I got a job working for the engineering department of the Milwaukee Railroad as a surveyor’s helper, and listening to graduate engineers bitching about their pay, and their hours, and so forth, sort of lessened my enthusiasm for engineering. And what I learned from my sister indicated that if you became a physician you had many advantages. But anyway, I got a letter back from the University of Minnesota saying I would have to make a decision on what major I’d go into. I can remember lying awake one night, wrestling, engineering or pre-med, pre-med or engineering. It took me most of the night before I decided on pre-med.
Sharpless	Let me ask you, Why were you not drafted into World War II?
Ravenholt	Oh well, you’ll find that in this account of “Dakota Harvest Adventures.” (www.ravenholt.com).
Sharpless	Right.
Ravenholt	Actually, when I was a senior in high school in 1943, a new program was instituted called the “V-12 Program.” Again, it was a product of President Roosevelt and Harry Hopkins, and the navy. It was a program by which the navy could select promising youth and put them in a sort of a holding pattern until they were needed. So, we senior boys took examinations, and then shortly thereafter I was invited to go to Milwaukee for physical examination and processing for the V-12. I hitchhiked down there. It was April, and I was standing along highways, freezing badly. I got down there and the next morning I went for examination and they discovered “protein in my urine”. I think it was because I was freezing so badly that previous day. But they rejected me from the V-12 program. Which would have been ideal because they sent you off to a university until you were needed, and then after the war I would have had the GI Bill and everything; but that knocked me out of that. So I knew I’d be coming up for the draft the summer when I was eighteen. And I did get a draft call while I was in Dakota. So, I returned from Dakota to Wisconsin and on the first of September, 1943, went with a busload of other draftees, again to Milwaukee. This time, everything went along ok until a doctor put a stethoscope on my chest and then said, he wasn’t sure, but he thought he might be hearing a heart murmur. So, he called an adjacent doctor to listen, who said he didn’t hear one. So, they called over a third doctor who listened, who thought he heard one. They called over a fourth doctor; who did not hear one. Then they called over a fifth, and last, doctor who listened and said he thought he heard one, too. So they voted three-to-two that I had a heart murmur, and rejected me. When I got back to Luck, Wisconsin, my folks seemed kind of happy that I’d been rejected so I wouldn’t become canon fodder. I went back out to finish the harvest in Dakota. I’d never really thought about my heart before that much, at all. Because I was active in football and basketball and so on, but after I got back out to Dakota and was pitching bundles, it must have got on my mind, because I developed a severe pain in my chest, in the vicinity of my heart. Until it seemed I could hardly lift a bundle for awhile. But after a bit it ceased. I had heard that there was a relationship between bad tonsils and heart murmurs. So, when we finished the threshing and I was staying with the Berners a few weeks to help with some plowing after the threshing. I decided to get my tonsils out. With my boss lending me the car, I drove to Hankinson, North Dakota, to the GP there and told him I’d like to have my tonsils out. He looked at my throat, and said they were somewhat enlarged and if I’d come back the next Monday, he’d take them out. So, I returned the following Monday, and he set me up in the surgical chair. I suppose he must have tried to inject some anesthetic, but I’m sure it never took, because that was the most agonizing experience I have ever had. (laughs) But, he did finally succeed in removing my tonsils. Whereupon I stood up and I asked him, “How much?” To which he replied, “Thirty dollars.” I paid him, and was just leaving, when he said, “You better rest awhile.” So, I rested on his couch for a while and his nurse brought me some ice cream, but I couldn’t eat it. It hurt too much. Then I drove home the twelve miles, and the next day was out shocking corn, but I was in misery because of pain and bleeding and difficulty swallowing during most of a week. Such was life in those years. I plowed until the end of September, then went back to Wisconsin and helped with dairying and cutting wood for a couple of weeks, before going down to Minneapolis and working at various labor jobs. Then, in February, I still wanted to get into the army, so I wrote to my draft board at Balsam Lake, telling them I really wanted to get into the army. They said, Okay, they’d send my record to Fort Snelling, in Minneapolis. After awhile, I got a letter from the Draft Board, requesting I report to Fort Snelling, on the outskirts of Minneapolis for induction into the army. It was in February and very cold. This time, I went through the regular examination without difficulty. But at the end, there was a doctor checking records, and he said, “Oh, I see you were rejected down at Milwaukee last summer.” So, he listened a little bit to my chest, and then he rejected me, basically because I’d been rejected at Milwaukee. It was after that I gave serious thought, how I could get out of the rut I was in. And that’s when I decided I better get myself over to the university.
Sharpless	Okay, let me turn the tape over.
	*Side 1, tape 1 ends; side 2 begins.*
Sharpless	So, you lay awake, and then, based on what your sister had said, and other things, you decided to go pre-med?
Ravenholt	Yes, I was aware that pre-med offered greater flexibility in what I would take than did the engineering curriculum. Anyway, I kept working for the Milwaukee Railroad, engineering department; and that summer I had my own train. They made me director of the weed-spraying train. I guess I knew Agent Orange long before they did in Vietnam, because these were herbicides. On these rural railway lines, ordinarily, if nothing was done the weeds grow up and get on the rails and then the train—the drive wheels slip on the rails. So, they make it a practice of spraying herbicide on the right-of-way, each summer. And for this I had my own train. We had a steam locomotive, with an engineer, and a caboose with a conductor. Then three tank cars for herbicide, and a spray car out front was a modified railcar with a canopy over it. Anyway, we moved along about twenty miles an hour, spraying the right-of-way with herbicide. And, indeed, I was the director of this train, so I’d tell the engineer where we would be going and stopping, and all that. It was quite a nice little change from farm work. At the end of September, I started at the University of Minnesota.. By the time I started at the University, I’d only saved $150.00. And I can remember the entering tuition to the University of Minnesota in the fall of 1944 was $37.50, for the fall quarter. With the help of my sister, I bought a good suit for $54.00. Then paid for a month’s board and room and some books. And then got started immediately looking for part-time jobs. I remember the first one I got, making sweeping compound in an old warehouse in northern Minneapolis—a miserable job. First we unloaded railroad carloads of sand, and then of sawdust, after which we mixed it in an oily, dirty combination, then sacked it and loaded the sweeping compound back into railway cars. I wore a certain set of clothes for this work, which I did nights and Saturdays. After a month or six weeks, I quit that job and got others. But I remember, some months later, having stored those work clothes atop my closet, I disturbed them and the smell of sweeping compound just about made me sick. (laughs) I got lots of part-time jobs. When starting at U of M, I’d moved into the Students’ Cooperative at 1721 University Avenue, SE in Minneapolis—right on the campus—which had been an old fraternity. And so, it was really good because we were living at minimal cost and had all the advantages of fellowship, right by the university. In my second year, I was invited to become the business manager of the Students’ Cooperative by a shirttail relative, Hermod Strandskov, a very able CPA, who, in a couple evenings, taught me enough about bookkeeping and accounting that I could keep proper log records of all income and expenses, sufficient to make monthly and annual profit and loss statements each month and keep the record, and so forth. And so I took over. And the reason I had to take over as business manager, was that the previous business manager—a student—had failed to do his work; had not made monthly profit/loss statements during six months. And this happened to be the fall of 1945, just after the war, when the OPA—Office of Price Administration—went off and ceased to function in September. So, prices went up sharply. And when I began, the first thing I had to do was a profit and loss statement for the last six months. Which I did. And when this was done, I discovered that for every dollar we were collecting—we had forty-some young men living at the students’ co-op plus a large number of other students just eating there—we were actually providing them a dollar and eight cents worth of food. And we were paying for all the overhead—the cook, et cetera. So, the bigger the volume, the bigger the losses. Of course, we rapidly had to make some adjustments. We had been paying $6.50 a week for the three meals a day, except only two on Saturday.
Sharpless	We being the boarders or we being the co-op?
Ravenholt	Well, both—both the forty resident fellows, and up to about a hundred boarders in addition. We raised the price from $6.50 to $8.50 a week. For $8.50 (laughs) we got breakfast, lunch and dinner five days a week plus breakfast and lunch on Saturdays. So, prices were very low. Actually, even at $8.50 we managed to make a little money so we could begin to make improvements in bathrooms, et cetera. Initially, we got our milk delivered in ten-gallon cans, and we would just simply fill pitchers and put them on the tables. Then the health department decided to implement a program against that. We had to buy a cooler—a cooler that would dispense the milk to individual users from a refrigerated ten gallon can. That, of course increased the cost. We were really very concerned about the increased cost of this. Because nobody—as far as we knew, was getting sick from the old way of dispensing milk. Last fall, when I was in Minneapolis for a bit–—
Sharpless	–—hit the pause.
Ravenholt	I’ll show you something.
Sharpless	Okay, hang on. Okay, so you went back to the co-op last fall?
Ravenholt	Yes, I gave a seminar on cardiovascular disease at the University of Minnesota in Epidemiology. And I went over to the Students’ Co-op, and there was a helpful person there who found the old logbook that we used back in ’44, ’45, ’46, ’47, ’48, to keep the records of every expense.
Sharpless	I’m looking at the ledger sheets, so that’s great.
Ravenholt	Recording all expenses in this log book was a wonderful discipline for me.
Sharpless	Yes.
Ravenholt	I’ve thought since then that I learned more from getting my board and room for three years doing this—collecting all the money and paying all the bills—than I would have learned from many classes. On Monday evenings, I sat right at the head of the stairs that went to the basement, which was where the kitchen and dining room were, and I would collect, $8.50 from each boarder. It was then I developed my signature RTR because I didn’t have time to write my long name.
Sharpless	Kind of like a cipher, yeah. (laughs)
Ravenholt	Yeah, I’ve done that ever since.
Sharpless	So, you do three lines then the loop on the R and then the loop over the T and the second R at the same time.
Ravenholt	Yes, this worked very well, collecting the $8.50 or the monthly fee for the ones living there. I collected the money. I banked the money, and I employed the cook and a few others on occasion, and paid all the bills, and did monthly profit and loss statements and annual profit and loss statements.
Sharpless	That’s fabulous training for an undergraduate.
Ravenholt	(talking at the same time) I wonder how many quarters of accounting I would have had to take at a university to become as really knowledgeable about this as I became simply from doing it.
Sharpless	And what a huge responsibility for an undergraduate.
Ravenholt	Yes, I was not in accounting, but in pre-med. While working for the engineering department at Milwaukee Railroad, I had improved my printing. There was an engineer there who, between trips, asked me do some printing, so I learned how to print more neatly then than I otherwise would have. My records at the Students’ Co-op were done in ink, so I had to be quite careful not to make many mistakes. (moves papers) And, I’ve often thought how valuable it would have been for my children to have had the same experience. But of course, by then I wanted them to have a better time in college than I had had because I naturally didn’t have as much free time as I might have wanted to have in college.
Sharpless	Right. How did your formal curriculum go?
Ravenholt	Okay. I was in an accelerated pre-med curriculum which had been put into effect during the war, and so they condensed into three years the premedical studies that would ordinarily take four.
Sharpless	(speaking at same time) That sounds challenging.
Ravenholt	I was ordinarily carrying seventeen or eighteen credits per quarter. And so it baffled me a bit when my—three of my children subsequently went to the University of Washington and they were taking thirteen or fourteen credits per quarter, you know. At Minnesota they had designed some special courses for the accelerated curriculum—intensively taught you, you know, algebra, geometry, trigonometry and—just touching a little bit on calculus. Chemistry was where I really learned to study. I’d never really learned to study in high school—small high school—only thirty-six in my graduating class. We lived on the farm, we didn’t have any electricity. We had morning and evening chores. So, I never did any studying at home. And the only studying I did, really, was noon hour at school. When taking math or chemistry I tried to do whatever I could at noon hour. But, I was mainly interested in football and basketball (laughs) and reading. Always interested in reading. But now, starting at the University of Minnesota, mathematics and chemistry and physics and zoology were the main courses in these first several pre-med years. And I can remember very vividly being at the Students’ Co-op in my room at a little desk with my face against the wall and having to learn chemistry. It was agonizing, and I had to force myself to stay at that desk and study rather than doing all the other things that I preferred doing. But, there was no escape from it. In chemistry, no matter how capable you may be, you actually do have to study. The first quarter was very difficult—not having studied much in high school, I got three C’s and a D; the only D I ever got in my seven years of academic studies was in English that first quarter. That quarter mainly taught me what I didn’t know. But, I somehow began to really study in chemistry. Then, in the second quarter, I can just remember, at Minnesota, if you wished, when you took your final examination, you could put in a penny postcard, and the professor would send you—during Christmas vacation—your grade in the mail. I was then working each evening in an engineering department near Honeywell in south Minneapolis. I was working from four to eight—I really had a pretty good regimen going, because I’d take my courses mainly in the forenoon and early afternoon, then take a streetcar down to the Ohio-Heidbrink Engineering Co.; worked in the engineering department from four until eight p.m., then I’d take a streetcar home again. So it would be like 9:30 by the time I got back to Students’ Co-op, where the cook would have left supper in the oven for me. After eating, I cleaned the kitchen and dining room floors, for which I got certain credits. So, by the time I got to my studies it’d be after ten o’clock and I’d be kinda tired. Almost too tired to study. So, it went on like that. But that’s how I made my money. Oh, yes. In March 1946 I phoned home to Luck and I spoke with my brother, Otto, two years younger. He said something about an A in chemistry. “Oh, good for you,” I said, “I’m hoping to get a B this quarter.” He said, No, you got the A. (laughs)
Sharpless	Oh, he got the card. Okay.
Ravenholt	He got the card at Luck stating I’d gotten the A. in chemistry. So, that was really a great spur for me to get on with studying. It showed that I could get some results if I really applied myself, which I did, increasingly.
Sharpless	Was there a clinical component to it? (motorboat passes closer)
Ravenholt	No, there was laboratory—chemistry laboratory in qualitative analysis, and quantitative analysis, and Organic Chemistry. Oh, I had lots of chemistry—Physical Chemistry. And it really was a wonderful discipline for learning how to study. Chemistry was really for me the most important of my pre-med studies. Of course, the thing that I was aiming for was to get into medical school. In 1946 the competition became additionally intense because the veterans enrolled in large numbers.
Sharpless	Right.
Ravenholt	Many of these were more experienced, more mature and so forth. And I think, actually, studies that would perhaps get one a B in ’45, before the veterans came back, would only get a C after they came back. It became more difficult to get the grades that one needed—the A’s and B’s. But, somehow I managed to get enough that in the spring of ’47 I was accepted for the next medical school class beginning in the fall of ’47. That summer I had my first real release from the study grind. My brother Otto and I went with several colleagues—students from the Students’ Co-op. We went west. One of them drove. He was going to visit an uncle in Seattle, and Norwegian student [Arne] and Otto and I rode with him to Ellensburg, from where Tom went on to Seattle, while we went southwest to Portland.
Sharpless	Portland, Oregon?
Ravenholt	We stopped at Sunnyside, Washington. My older brother, Albert, had married a girl from Sunnyside, so we visited there a couple of days and then went on to Portland. We were looking for any kind of work, but we could not find work in Portland because rain had ruined the cherry crop and the lumber mills were on strike. We couldn’t even get a dishwashing job. So, realizing that, I decided to hitchhike down to Los Angeles, where my father and my brother Halvor were, and try to find work down there, which I then did. And I worked the rest of the summer—several jobs—punch press operating at first. Then, mainly I worked as a soda jerk for Simmons Drive-In. I could say many other things about it, but suffice it to say that in the latter part of September, I hitchhiked back to Minneapolis and started medical school.
Sharpless	Well, do you want to stop here for a little while?
Ravenholt	Maybe we should check with my wife Betty.
	*Tape 1 ends; tape 2, side 1, begins.*
Sharpless	Okay, this is the second tape with Dr. Reimert Ravenholt on July the eighteenth. Okay, Dr. Ravenholt, we—tell me about medical school.
Ravenholt	Well, medical school was a substantial challenge, but in some ways not quite as critical as pre-med, because necessarily during pre-med I’d learned to study. (laughs)
Sharpless	Hm-hm.
Ravenholt	And learned many things that I absolutely needed to learn.
	(pause in recording)
Sharpless	Medical school—you’d learned things in under—in pre-med.
Ravenholt	Yeah, it was a good adventure, actually. It starts with a bang—coming to medical school. The first day we started in the anatomy lab. Many of the medical students came from medical families—fathers who were doctors, grandfathers who were doctors, friends, and other relatives, so on, whereas I had had very little exposure to doctors. I was living at the Students’ Cooperative. Unfortunately, I had not learned the importance of selecting a skinny cadaver, so I ended up, along with a partner, with a big, fat, Mexican cadaver. Which meant spending the next six months carving through fat to find vital structures. (laughs) Anyway—in some ways that was just as well, because it was more difficult, we may have learned better. We did not use gloves. We just started working dissecting certain parts of the body. We had to handle all this grease and formaldehyde during several hours lab in the afternoon. Immediately after which I’d go back to the Students’ Co-op and eat dinner. Well, you can’t wash the smell off your hands, you know, the formaldehyde smell stays through multiple washings. And so, I developed a little habit then, of taking a piece of bread by a corner, eating around it and discarding the corner I had taken with my hands because I could smell the formaldehyde. (laughs) And that little habit stayed with me, I think for most of ten years until I forgot about it. But, that whole anatomy lab thing is quite a compelling shock—you either get immersed in it or you are repelled. I remember, there was one sort of shortish girl who I understood had had straight A in pre-med, but who was so repelled by the anatomy lab that after three days she quit medical school. Just couldn’t stand it.
Sharpless	It’s not her thing.
Ravenholt	Yeah. It really does make a profound change in your perspective. There were many other tough courses in physiology, bacteriology, and the preclinical courses in the first year and most of the second year.
Sharpless	How soon did you have to declare a specialty?
Ravenholt	Oh, you don’t do that in medical school. No, that’s something that happens after medical school. At that time, it was something that happened after internship. Well, let me just finish the medical school. What else?
Sharpless	What about your clinical experiences?
Ravenholt	Well, this mainly began in the third year, when we began to learn elementary things—diagnosis and care. I lived at the Students’ Cooperative during my first year in medical school and then in the spring of that year I married. Thereafter we lived in apartments; and I joined the Phi Chi medical fraternity. But, in the last couple of years of medical school—junior and senior—I worked as an extern in Mounds Park Hospital in St. Paul. Every fourth night and every fourth weekend, sharing the duty with some of my classmates. In this suburban hospital, one would be the foremost medical person in the hospital during nights and weekends. So, you had to try to handle anything that needed handling. This may sometimes have been a bit tough on patients, but was a great learning experience for medical students. Indeed, I found that a very helpful experience. In medical school one is often overwhelmed by the information flood, with thirty-some hours of class a week. So, you’re really sponging up as much as you can of new stuff. Somewhere along there in the spring of my junior year [1950], an epiphany came to me. One day, while sitting in Eustice Amphitheatre attending a tumor clinic—during which a professor demonstrated a succession of cancer patients while discussing their cases, there came to me, out of the blue, the sudden realization that cancer was surely an evolutionary phenomenon; that the development of a cancer in a tissue was analogous to the development of a new species of plant or animal on earth—both being the product of evolutionary change due to relentless reproduction and turnover and the natural selection of the more proliferative cell clones. The body has these zillions of cells grouped in various tissues, but to maintain function they have to reproduce and turn over—I mean the cells have to reproduce, so there’s cellular turnover. Wherever there is unit reproduction and turnover, there is evolution occurring. And suddenly, it came clear as a bell that the best way to understand cancer is to apply evolutionary principles. One must apply evolutionary principles to understanding the development of each type of cancer. And as soon as it hit me, I was quite confident that this was true, even though nobody had told me that.
Sharpless	And this is while you were a medical student?
Ravenholt	Yes, a junior medical student in March of 1950. I tried to explain it to my classmates and it didn’t seem to mean as much to them as it did to me. But it stayed with me, so that whenever I read about a cancerous entity, I’d try to understand in evolutionary terms. How does this fit under the evolutionary thing? And of course, when considering the effects ofsmoking, one can easily understand that, when one knows that tobacco contains mutational agents and also causes increased cellular turnover, so of course it will accelerate the evolutionary divergence until a cancerous strain develops. I went on to other things, but that concept always stayed with me, and I came back to it subsequently. Anyway, what else in medical school? Externship. Well, one summer—the summer of ’49, after my sophomore year, I went down to Fort Sam Houston, Texas, in a medical ROTC program. It was hot (laughs), but it was a good experience, basically.
Sharpless	Where did you do your internship?
Ravenholt	I was coming to that, because it comes at the end of medical school. We had to take an internship, and I was fortunate because, somehow, I had learned there was such a thing as a U.S. Public Health Service Hospital Internship. A half-dozen U.S. Public Health Service Hospitals offered rotating internships. I was immediately interested, because my first child—a daughter, was born at the beginning of my senior year in medical school. Since then we were barely making ends meet. Before that, my wife had worked as a secretary to the Department of Obstetrics and Gynecology at the University of Minnesota.
Sharpless	And what’s her name?
Ravenholt	Millie was her name. Mildred Froysland. Our financial situation diminished rather rapidly that senior year. Though, it is of interest that in those seven years of pre-med and medicine at Minnesota—starting with only $150, and working my way, plus my wife’s income during several years, we ended medical school having only borrowed $500. We were fortunate I was able to get an internship in the U.S. Public Health Service hospital in San Francisco, as a Commissioned Officer in the USPHS. And I was eager to go to San Francisco.
Sharpless	Did you? Why?
Ravenholt	Well, I loved the West. I always loved the West. And, I’d seen San Francisco.
Sharpless	So, you packed up and moved?
Ravenholt	We packed up. Then I did borrow from my brother Albert, a thousand dollars to buy a car and get started in California. We never had a car during medical school. So now we bought a car and moved to San Francisco. If I’d interned at Minneapolis General, they only paid about ten dollars a month. Many other internships only paid a tiny amount, whereas the U.S. Public Health Service offered many advantages. First, I was into the federal service; second, I was paid about $350.00 a month.
Sharpless	Goodness.
Ravenholt	Yeah. So, I went for that internship, rotating to the various services—medicine, surgery, obstetrics, tuberculosis, neurology, and so forth. I got quite a lot of surgical experience as first assistant with the chief of surgery on pneumonectomies, gastrectomies and such, and I got to do by myself, appendectomies and hernia repairs, and such. So, I really liked surgery, and if I could have gone immediately into a surgical residency, I would have done so. But, that was not possible. I needed to put in two additional years in the Public Health Service to complete my obligatory military service, which I’d not gotten before. Interesting, when I went to Public Health, I never told them I’d been rejected before, and nobody ever suggested that there was anything wrong with my heart after that. Actually, the cardiologist at the University of Minnesota Health Service, to whom I was referred when I entered, because of my history, worked me over carefully, and said there wasn’t anything wrong with my heart. And all these years later, seems to confirm my cardiovascular health. I needed to stay in the Public Health Service two more years. I could not get a surgical residency, because that was prized and those ahead of me in the seniority line would get those. But in the latter months of my internship I wrote to the Division of Personnel in the Public Health Service in Washington, exploring whether they had any openings in the Division of Foreign Quarantine, because they had officers assigned in various places in Europe. And I’d always dreamed of going to Europe. I got a letter back from them saying, No, they were cutting back their forces in Europe. They’d had more of people over there for awhile, because of all the visa handling (airplane passes) after World War II, but in 1952 they were cutting back. They wrote me they had sent my file to Dr. Langmuir in CDC who was recruiting for an Epidemic Intelligence Service. Soon I got a letter from Dr. Langmuir inviting me to a conference at CDC in May of 1952, with them paying the travel expenses. I was delighted to accept that and turned over my internship duties to a dozen or so fellow interns while I flew off to Atlanta, for a week’s conference. Which indeed, was determinative, because Langmuir was a very able and persuasive fellow, and after that week, I decided that the EIS of CDC made better sense than going into an OPD. And that was a momentous thing, because that got me into the whole field of epidemiology in the very best fashion.
Sharpless	Do you want to stop here for today, or do you want to go on?
Ravenholt	Yeah, we could stop here.
Sharpless	Okay, well, why don’t we start and pick it up with EIS tomorrow.
Ravenholt	Yeah, that probably—did you look in my website?
Sharpless	Yes.
	*end Interview 1*

Sharpless	Today is the nineteenth of July. My name is Rebecca Sharpless and this is the second oral history interview with Dr. Reimert Ravenholt. The interview is taking place at his home, in Seattle, and it’s part of the Population Pioneers Project. Okay, Dr. Ravenholt, when we stopped yesterday, we were—you were just getting to the Epidemic Intelligence Service under the tutelage of Alexander Langmuir. And I guess I’d like to back up just a little bit. Now, you told me that you took the internship at the public hospital in Seattle—I’m sorry, San Francisco, for very practical reasons. What philosophical reasons did you have for going into a public health hospital, there?
Ravenholt	Well mainly, I was coming to the end of my medical school education. Of course, there was a need to select an internship. At that time, ordinarily, it was a one year, rotating internship—rotating on the various services—medicine, surgery, obstetrics, urology, and so forth. And interns were paid very little. In many places, favored internships, they were paid like ten dollars a month for a hundred-plus hours per week. (laughing) I was then married, with one child and had very little resources. So, I was of course trying to find an internship that paid at least a moderate amount. And the Public Health Service at that time paid something like $350.00 a month—a living wage. So, that was very important. Then the Public Health Service had perhaps nine Marine Hospitals, U.S. Public Health Service hospitals sited, especially in port cities—San Francisco, Seattle, Boston, Savannah, New Orleans and Staten Island, and so forth. And of all those, San Francisco appealed most to me, at that time. So, I had a double reason for selecting the U.S. Public Health Service Hospital in San Francisco. And as mentioned, finishing medical school, I borrowed $1,000 from my brother to purchase an automobile and relocate to San Francisco. We drove out and immediately found the Public Health Service hospital was on the Presidio, right above Seacliff. So, it was a very lovely setting, with the Presidio grounds around it. A good thing was that the Public Health Service, being a federal agency does things in a thorough and deliberate fashion, with employment and so forth. It’s all done quite thoroughly. As I began the internship we found an apartment in the Richmond district, not far from the hospital, and moved there for several weeks. But the landlady had glaucoma and our daughter, Janna, tumbling various things on the floor bothered her so much that we thought it best to locate another abode. We weren’t really happy with that, but managed to find a good house we could rent in the Sunset district, just a dozen blocks from the Pacific—south of the Presidio. We moved there and it proved ideal.
Sharpless	Now, was there any kind of shift in your thinking between private practice and public health?
Ravenholt	No, not at that point. I was overwhelmingly concerned with clinical matters.
Sharpless	Okay.
Ravenholt	Doing histories and physicals and diagnosis, treatment, ward rounds, and outpatient service, and so forth. No, I was, as I’d had been in medical school, overwhelmingly concerned with clinical matters.
Sharpless	Okay, now you told me yesterday about wanting to go abroad, and then Dr. Langmuir picking you up for the EIS.
Ravenholt	Let me just say a word or two more about the internship. I did quite a lot of surgery as first assistant on major operations and doing various surgeries myself. So much so, that I wanted to go into surgery, but—I guess I—we talked about that yesterday.
Sharpless	Yes, sir.
Ravenholt	Anyway, I was invited by Dr. Langmuir to come there in May, to the first Epidemic Intelligence Service conference, and was sufficiently impressed with Dr. Langmuir and the activity there that I decided in favor of going with the Centers for Disease Control—the Epidemic Intelligence Service. Even though, up until that time, I had not really focused on epidemiology nor on public health. I think by nature I was public health oriented.
Sharpless	Why do you say that?
Ravenholt	Well, it’s sort of a Danish kind of philosophy. And my parents were very much public service oriented. And so, it was something that came naturally as far as wishing to work in the public service rather than simply going out and making as much money as I might be able to. Leaving San Francisco at the end of June, we drove to Minneapolis, where I left my wife, Millie, and children, Janna and Mark, who was born in San Francisco. They stayed with her folks in Minneapolis while I proceeded to Atlanta for six weeks introductory training at the CDC. I remember it was very hot. (laughs) There was no air conditioning in the home where I stayed with a couple of other E/S officers near CDC.
Sharpless	Was CDC on Clifton Road, then?
Ravenholt	No, it was on Peachtree Street.
Sharpless	Oh, okay.
Ravenholt	Yeah.
Sharpless	That was before Clifton Road was built, then.
Ravenholt	Yes, that was a decade or so later that they moved out to Decatur-Emory area. CDC was in the embryonic stage, but Dr. Langmuir was always a very communicative, capable, challenging kind of personality. Great—very expert as chairman of a session, or conference or anything. And we began to learn some of the fundamentals—some statistics of quite a utilitarian nature. Learning about CDC and its activities. We visited several laboratories outside of Atlanta at Montgomery, Alabama and one at Oat Island near Savannah, Georgia. But mainly, we worked at the Peachtree Street headquarters. We had a chance to read and study the classics in epidemiology, and various epidemic outbreaks and investigations. Then came the matter of where we might be assigned
Sharpless	Um-hm. Let me ask you one quick question. What were your classmates like?
Ravenholt	Well, there were just a dozen of us. And they came from varied backgrounds. The ones that I came to know best were Drs Harald Fredericksen and Charles Leftwich, with whom I roomed. Fredericksen was a Dane, though born in the Panama Canal zone; educated in Denmark and in Vienna; and he had an MPH from Harvard. He spoke fluent Danish, as I did, so we had quite a lot of fellowship. Also, somehow he had acquired a large white Jaguar sedan. (laughs) And we enjoyed driving around Atlanta in this quite noticeable automobile there in the summer of ’52. We enjoyed getting acquainted with Atlanta—Grant Park with its Cyclorama, which I enjoyed, and Aunt Fanny’s Cabin at Smyrna—very good place. We sometimes played golf on the Fulton County golf course outside of Buckhead. I had more freedom then than I’d ever had in my life. (laughs) That was nice. Toward the end of the summer, the matter of assignments became the key issue. I had no preconceived knowledge of where I would end up after orientation training, but for a confluence of reasons I was assigned to go with the Ohio Department of Health in Columbus, Ohio, which proved to be a very good assignment. The Director of Health for the State of Ohio at that time was Dr. John Porterfield, a really able and pleasing person. And my immediate chief was Dr. Fred Wentworth, who had been in the previous—first EIS class. He had likewise been assigned to Ohio, and then moved up to be chief of the Communicable Disease Division, so I was assigned with him. This was really ideal because I had these expert people to relate to, with freedom to go and investigate disease outbreaks. I still vividly remember arriving in Ohio, in Columbus. The Ohio Department of Health was in a high-rise office building by the Scioto River in downtown Columbus. I immediately felt a great loss—no white coats, and I was shorn of my stethoscope and other diagnostic paraphernalia. Given a desk in the corridor outside of Fred’s office and some communicable disease reports, I began reading and learning public health activities. I really felt a great sense of loss from being divested of my clinical experience. This lasted just a few weeks; and then I became involved in a classic disease investigation. What happened was that a five-year-old girl living in Vinton County, in southeastern Ohio, developed diphtheria, was referred to the Ohio State University Hospital in Columbus, and died soon after admission. The death from diphtheria was reported to the state Health Department, and Fred Wentworth gave the report to me and requested I go ahead and investigate it. (airplane passes) This immediately got me out of my torpor because I had to immediately read about diphtheria, do practical things such as, checking my immunity and my wife’s immunity with Shick tests. The children had been recently immunized. And I had to obtain laboratory support throat culture materials and so forth, plus phoning the Vinton County health authorities—the local Health Department to arrange an invitation to go and investigate in that locality. After several preparatory days, I drove down to Vinton County and went to the home of the five-year-old girl who had died, met with the family and got history from them. I learned that several days before the five-year-old developed her sore throat illness, the seven-year-old sister had had a fairly severe sore throat illness. The seven-year-old sister attended the second grade in the Allensville Consolidated School in that region. Then, of course, I went to the school and met with the principal and with the teacher in the classroom the seven-year-old had attended, and took a history of what had been observed that fall. They’d had a variety of sore throat illnesses, but no really serious illness in that room. I took throat cultures from the teacher and the twenty-six children and then took the cultures back to Columbus to the Ohio State lab. A couple days later they reported that eleven of the twenty-six children had virulent diphtheria organisms in their throat. So, that immediately of course confronted us with the need to investigate the entire school. Then, I got the help of Berttina Wentworth, a very good lab specialist. We proceeded to get the materials together and then went down to Allensville and throat cultured all the children in the school. I forget just how many other cases we found—a fair number, but not nearly as many—as dense as in that one classroom. Also, of course, we organized an immunization program and immunized the school—two rounds of immunization. And because we found a number of other diphtheria carriers we, of course, had to do secondary and tertiary cultures. So, much of the next several months I was busy doing follow-through in that school.
Sharpless	Were you actually doing the immunizations?
Ravenholt	Yes.
Sharpless	Okay, so you were back in your clinical mode, to—
Ravenholt	Oh yes, so I enjoyed that, it was very good that way. So, we handled that. And there were other diphtheria incidents, too, elsewhere in Ohio that I was involved with, but this was the main one. Dr. Wentworth had been involved in one over at Zanesville area, Muskingum County, the previous year. So, there was fair amount of diphtheria still in Appalachian Ohio. Anyway, I’d gotten busy, also with other things, in Ohio, there in the spring. But I made a final—what I thought was a final trip to Allensville Consolidated School just as a wrap-up to report and sort of put an end to that. And then, when talking with the principal, with whom I’d become somewhat familiar—he said, Oh, he wanted to bring to my attention the fact that they’d had a number of students coughing up blood. (laughs) I thought I was done with my work at Allensville, but I could hardly ignore that. My foremost thought was that perhaps there was tuberculosis, because this was a poor area. So, we organized—again with the help of Berttina Wentworth—a study of the entire school, with tuberculin testing and also skin testing for histoplasmosis, also chest x-ray. Just proceeding as though we expected to find appreciable tuberculosis. But, from initial results, it was clear it was not tuberculosis, and it was not histoplasmosis; but thirty-seven students had pneumonia—x-ray evidence of pneumonia in their lungs. So, then we got blood specimens from these cases. Now, school was just ending in the spring. From the blood specimens we got a tip-off of causation because we found that many of these had excessive eosinophilia—a kind of white blood cell in greater proportion than it ordinarily would be, indicative of parasitic disease. By now school had let out and yet we needed to follow-up on these thirty-seven cases. For this work I got the help of a young man, who had until then been a VD investigator—Charles Adams. We proceeded to Vinton County and visited homes to get blood specimens and stool specimens. That got us immediately aware of the living conditions there. It truly was a primitive Appalachia culture, places like Corn Pone Hollow and Pumpkin Ridge, old Cumberland Mountain type topography and people. Anyway, I remember vividly one family that Charles and I visited, where an eighth-grader had, indeed, developed pneumonia and been picked up on x-ray. We went there to interview and to get stool specimens from the family. It was a very poor household. The mother was nursing her ninth infant while giving me the history, shifting the infant from one breast to the other occasionally; and the unemployed father was lying on a couch. When I mentioned the matter of worms, they became a bit agitated as the mother said, a cousin of Will, our eighth grader, had died the previous year. They didn’t know what killed him, but had been told that they’d taken more than a pint of worms from his intestine. And so, it seemed that he probably had the same thing. The father spoke up, “Oh, worms,” he said. A year or more before, he’d been doing as he was doing then, lying on the couch watching television, when he felt something gagging him. He then coughed or vomited up a large worm, about a foot long. It is of interest that they had a large television set, though not much else, as was the case in many hillbilly homes. At that time I could not afford a TV set. I had not had much exposure to roundworm [Ascaris] disease before that. Anyway, I was interested in the household ecology—why they had so much trouble. It soon became evident: their water supply was an indolent spring with a concrete catch-basin located behind the house, halfway to the outhouse. And it was fairly obvious that when they sent a child for water—that child would often visit the outhouse before sloshing up a pail of water, and thus the water would become heavily contaminated with Ascaris eggs, leading to super-infestation.
Sharpless	It’s a wonder they didn’t have typhoid or cholera.
Ravenholt	The whole family was loaded with roundworm disease. We’d been getting this information and were leaving specimen containers to get stool specimens from them. And as we finished that, the woman invited us to stay for lunch. (laughing) I didn’t have appetite for that, so said we must hurry back to the lab.
Sharpless	How readily would this family then accept treatment?
Ravenholt	Oh, they accepted that. The treatment was done by the local doctor in McArthur, who handled this—a general practitioner. So, I did not have to become involved with that much. Later, I happened to meet that doctor, and he told me he frequently de-wormed such patients. The thing I learned from the diphtheria and the roundworm investigations, and soon from some typhoid outbreaks that I investigated was the challenge of preventative medicine. These experiences really shifted my gears from reparative medicine to preventive medicine. I became immediately fascinated and challenged by how we could interrupt the development of these diseases, especially when one can apply some inexpensive, mass approaches like immunization and improved potability of water and so forth. Because, with the individual coming to the hospital or coming to the clinic, they present with this or that, but often it is pretty much guesswork what they have or why they got it and so forth. You do your best to alleviate it, but frequently it’s not possible to really understand it very fully. And individuals are very variable in the way they react to anything; whereas the population is very predictable how they will react to this or that pathogenic agent. One learns the pathologic spectrum of each disease: how many will develop it and how many will die and so forth, so one can really practice scientifically when dealing with populations. My Ohio experience certainly got me very interested in epidemiology and public health.
Sharpless	Let me turn the tape.
	*Side 1, tape 1 ends; side 2 begins.*
Ravenholt	What else happened in Ohio in 1953? It happened at the beginning of ’53—probably January—that the Saturday Evening Post decided to do an article on the Epidemic Intelligence Service of CDC—“Disease Detectives.” And they sent two very good writers, Edward and Ruth Brecher, both very capable writers—to several locations to gather information for that article. They came to Columbus, and Fred and I then filled them in on what we’d been doing in Ohio. And about a month after they departed, the Post sent out a photographer from Philadelphia to get pictures to go with this article. When he arrived in Ohio, Fred Wentworth should have helped him get the desired pictures. But he said he was tied up in meetings, and so I should handle it. I was in bed with mumps, six days after onset, but got up and accompanied the photographer to Muskingum County, where Fred had investigated diphtheria the prior year. So, I did that, got out of bed and went with the photographer over to Muskingum. But when we got there the photographer clearly did not know what pictures he should get. Hence I put my imagination to work, and devised several tableaus which might be useful for that article. With the help of the local health officer, Dr. Maggie O’Neal, and the principal—we set up a classroom of children and arranged that each child held a culture tube. Dr. O’Neal and I got busy taking throat cultures, while the photographer snapped pictures. He got good pictures of this. I also organized other pictures, still just trying to jazz it up for all that it was worth. Right there in the school, I gathered half a dozen boys together in a tableaux as though they were—as if they’d had infectious hepatitis. Dr. Wentworth had been involved in an infectious hepatitis outbreak, where gamma globulin or immune globulin was used, so I just simulated that I was giving a gamma globulin shot to one of these boys—pubescent-age boys. We went back to Columbus, and I pretty much forgot about it all until May when I was in Atlanta for the Second Annual Epidemic Intelligence Service conference. In the course of which, Dr. Langmuir, and the director of CDC at that time, Dr Ted Bauer, came in with copies of The Saturday Evening Post that had just appeared on the newsstands. They were happy to bring this to the attention of all the EIS. And I was a bit overwhelmed when I saw it. I had been given a prominent role and they’d used two of the pictures that I had arranged. They had rewritten the story around the pictures, somewhat, so that somehow some of the work which should have been attributed to Dr. Wentworth was attributed to me. Anyway, I felt rather embarrassed about it. But still, Dr. Langmuir, even though he didn’t get his picture in the story, was generous in his comments. The next week, I was back up in Wisconsin for my sister’s wedding, and of course, The Saturday Evening Post was on the newsstands, and I was a considerable point of discussion. And one good thing that happened from it was that my brother, Otto, who had been in the Army in Japan. He was back at the University of Minnesota, and he’d gone into economics for a while, and journalism for a while. He was a little uncertain about his major. Somehow, when he saw the fun that I was having in the epidemiology and public health, he raised the question to me. Whether it would make any sense for him to go into medicine. I had not urged him before that, because he had a wife and two children—but he had been getting very good marks in whatever he was taking. I said, “Yes, you stupid idiot, of course that’s what you should do.” I gave him the hard sell, then. And he shifted majors, and went on to finish pre-med and get his medical degree. Indeed, he was twice president of his class in medical school, and he went on into a career in public health, too, and served as health officer Las Vegas, Clark County for thirty-five years, and also coroner for twenty-five years. So, where are we now? In the summer of ’53, Dr. Langmuir and CDC authorities had decided that we should participate, actively, in the “National Program for the Evaluation of Gamma Globulin for the Prevention of Poliomyelitis.” There was then no active immunizing agent for polio, but as a stopgap they were trying to use immune globulin as, perhaps, a preventive for polio. The regimen in 1953 was that when someone developed polio, they gave immune globulin to household and neighbor contacts.
Sharpless	How well was it working?
Ravenholt	Well, that was what this program was to—supposed to discover.
Sharpless	So, it was an evaluation.
Ravenholt	Yes. We gathered at Pittsburgh—the EIS—and we were given intensive muscle-testing training there, that spring. My main duty in the summer of ’53 was, whenever a multiple case polio household occurred in the state of Ohio, I went immediately and get the history and some specimens and did a thorough muscle-testing of the afflicted cases. And sixty days later I went back, repeated the muscle-testing so we could get an accurate measure of the severity of the paralysis. Sometime in the latter part of the summer I got a letter from a Dr. Sanford Lehman, director of Public Health for Seattle and King County, Washington, inquiring whether I might be willing come there. He had also written to Dr. Langmuir, seeking to recruit me I think it likely that he had read the Saturday Evening Post article. (laughing) (airplane in background) I was immediately interested, because I’d looked forward to getting back west, and my oldest brother, Albert, maintained a home in the Seattle area, even though he was overseas quite a lot of the time. Because of its mountains and waters I had a natural inclination for the northwest. I was enjoying my work in Ohio, but I knew I didn’t want to remain in Ohio, because of the lack of mountains and lakes. So, I talked to my chiefs there, and to Langmuir, and Langmuir and Porterfield agreed that if they could assign another EIS officer to succeed me in Ohio, then they would approve my move to Seattle. They found an EIS officer, Martin Keller, who was susceptible to assignment there. It was arranged for him to begin in October and for me to leave in November. Growing up in New York City, Martin had never learned to drive an automobile.
Sharpless	This is Dr. Keller?
Ravenholt	Yes, he had an M.D. and a Ph.D., but he’d not learned to drive an automobile. And it was essential that EIS officers be able to drive automobiles. Dr. Keller had taken not just one, but two driving courses while in Atlanta, those six weeks. But, he still had no license. So, they said that I should help him with his driving. I took him and his wife, Judy, along on a trip to Cleveland on polio follow-up. And on the way back I let him drive a while. But after nearly having a head-on collision I took back the steering wheel. (laughing) I really wasn’t able to do much more with him before I left. And it was just as well, because not long after I got to Seattle I heard he’d had quite a serious collision. (laughing) But, he did learn to drive, the hard way, somehow, and went on to have a good career in epidemiology and public health in Ohio. In November ’53, we drove southwest to Los Angeles, where my father was and then up the west coast to Seattle. Upon arrival in Seattle, we checked in at a motel on Aurora Avenue, and went to visit some colleagues we knew at the Public Health Service Hospital on Beacon Hill, here. And at midnight, in the rain, driving back to the motel, we paused before making a left turn and, Whammo. Someone plowed into the rear of my car, at pretty good speed, so that—fortunately our one child was lying down in front and one in back. But, it was sudden, traumatic sort of thing. My wife and I both thrown against the bench front seat—it tore the seat loose.
Sharpless	My goodness.
Ravenholt	And I didn’t think so much about it then. Everything was turmoil, getting the police and so on. We got all that done, and it was an eighteen-year-old girl who had hit us, with several companions. It was raining, and the old cars didn’t have such huge rear tail lights, so it can happen pretty easily. And I—pausing as I did before we—I can just remember that I could’ve made the left turn and gotten over, but as—to be extra careful because it was raining, I decided to wait until that other car passed. And it was while I was sitting there waiting that I got it from behind. The thing was, the next morning, when I woke up, my neck was frozen. I couldn’t turn it, so I really had taken a severe whiplash. I still have evidence of it here, you can feel the lump on my neck.
Sharpless	Oh, yeah. Yeah.
Ravenholt	I immediately started work at the Seattle-King County Health Department, but indeed, my neck did bother me, severely for a week or two, and a fair amount for some months, then gradually receded. I could have pursued getting some kind of compensation for it. But shortly before leaving Columbus, during a sleet storm, in my state car, a V-8, on Broad Street, and going down hill a little bit, it was just glare ice, I tried to stop about a hundred feet from the car in front, but it just glided ahead, and I plowed it into the bumper of the car ahead of me. So, I felt a little somewhat sympathetic to that, so I did not sue, but just got $400.00 to repair the damage to the back of my car.
Sharpless	But you’re starting your new job with a painful neck.
Ravenholt	My office was on the fifteenth floor of the Public Safety Building. I was fortunate there. Dr. Sandy Lehman was an extraordinarily affable, well directed, active public health officer of the old school.
Sharpless	When you say “of the old school,” what—
Ravenholt	Well, he was one of those who—during the thirties, under the Roosevelt administration, he had a master’s degree and gotten his initial public health training, I think, through some federal program, at that time. And there was a noticeable number of really dedicated public health leaders. And he was certainly this. His father had been a medical missionary in Africa and he was born in the Cameroon, and so he had a missionary public health fervor. But he was especially genial, and he was politically very competent. He, himself did not particularly enjoy public speaking and public writing. He mainly maintained good relations with all the city councilmen and the mayor. And he did all the things that needed to be done. But, as I began to investigate and became epidemiologist for the Seattle-King County Health Department, I would investigate disease outbreaks and then increasingly I’d report it to the papers, and after a while, on television, and radio. I became so active that way, in investigations and reporting that quite a few in the community thought I was the health officer, whereas I was director of the division of epidemiology and communicable disease control. But that didn’t bother Sandy Lehman. He rather liked that, because he preferred behind the scenes work. So, he always was urging me and allowing me to do anything that really excited me. So, that was a marvelous seven years that I spent there with him.
Sharpless	What were some of the major issues in King County, at that point?
Ravenholt	At first, I just had an immunization clinic immediately adjacent to my office, and shared a secretary with the director of maternal/child health. I also had the assistance of a nurse who was mainly clinically occupied. So, that’s how I started. And again, it takes a while before things catch fire. But I began investigating interesting disease problems. The first thing that really came to my attention (motorboat passes) was an outbreak of psittacosis—parrot fever, especially among employees of the five-and-dimes where they were selling psittacine birds—parakeets. I’d had one experience in Ohio with a case of psittacosis in Cleveland, a railway messenger—a person who tended livestock on trains from St. Louis to Cleveland to New York, and had developed psittacosis. So, I was somewhat aware of the relationship of psittacosis with the movement of psittacine birds. I had very limited resources, just had the half a secretary and the nurse fully occupied with the clinic. Now, we knew that there was psittacosis in some of these five-and-dime stores, or pet shops. But if I immediately strictly enforced the laws, and quarantined the stores, they would soon be out of business. So I hesitated to do that, but yet, had to do something. And what I devised, just to handle that situation, was I created a retail sales slip with information on psittacosis on the back, and our telephone number and advising the buyers of psittacine birds, if they had any illness to phone us. Thus I got their cooperation and they used the specially designed sales slip. We printed up the special sales slip books, so customers got special information, and we got their telephone numbers. Then several weeks after the sale, my secretary or myself telephoned the buyer to see if there had been any illness. Indeed, we found cases of psittacosis that had occurred. Not a huge number, but appreciable numbers. And it was educative, as I became additionally aware of psittacosis ecology. The sales were mainly at Christmas and at Easter, and sometime before that, the shops would contact someone connected with Southern California, and order certain numbers of parakeets. And many of these were “wetback parakeets,” raised in Mexico and brought over the border. The entrepreneur in Southern California would ship perhaps fifty birds in one container, by air, to Seattle and they would be distributed to the various retail outlets. And of course, if there was one infected bird among those fifty, the rest of them would get infected on route. But because of a prolonged incubation period, the infected bird would often become ill after sold to individuals, and be most infectious to associated humans. Whereas, locally produced birds would be less exposed to infection. It was the mass importation that enabled this epidemic propagation of the psittacosis virus. And so, Dr. Wally Giedt, epidemiologist for the state health department, and I, proceeded, with the help of the state board of health to change the regulations so that there could not be mass importation of birds into Washington State—that any entrepreneur would be limited to bringing twelve birds per year. And indeed, that seemed to dampen the whole occurrence of psittacosis during the rest of my seven years as epidemiologist in Seattle. Again I encountered diphtheria here. It was different in its distribution than Ohio. Here, diphtheria at that time was a sporadic occurrence in the Skid Road area of Seattle. After several years I realized the ultimate source of the diphtheria that we were having in Seattle were the regional Indian reservations—because of low levels of immunization on the Indian reservation. Indians came to Seattle and engaged in drinking, and quite a lot of prostitution, too. And they infected others on Skid Road who frequented the bars downtown. I recall occasionally finding chronic alcoholics with severe diphtheria and immediately driving them to King County Hospital.
Sharpless	Okay, I’m going to change the tape while you do that.
Ravenholt	Okay, and you’ll be interested to see this one page from my website, www.ravenholt.com.
	*Tape 1 ends; tape 2, side 1, begins.*
Sharpless	This is the second tape with Dr. Reimert Ravenholt, on July 19^th. Okay.
Ravenholt	Yeah, Becca, you see, here is an example—
Sharpless	Okay we’re looking at the Historical Disease Occurrence in Seattle, and this is on your website.
Ravenholt	Eighteen ninety to 1960. As I started working with this, I was really frustrated by the lack of any record or memory of what had gone before. And I’m sure this is true for just about all the health departments and other agencies, too, of government—that people come in and they work awhile and go on, but most don’t make a systematic record of what’s been going on.
Sharpless	You can see when the epidemics are. There are huge spikes in those.
Ravenholt	I was struggling with that. And the tools for epidemiology here, at mid-century, in ’54, were really very primitive. We had a health educator in the health department who would occasionally made some charts for Dr. Lehman to show this or that. But it was laboriously done in those days. Initially, I looked intuitively to her, for help, but soon discovered I couldn’t really get the help I needed. Finally, in desperation, I went to an engineering store to get the papers and the pens needed, so that I could begin to draw charts myself. This had not been really handled at CDC and they’d not taught us how to do charting—
Sharpless	How to graph things? Huh-uh.
Ravenholt	Yeah, so I really had to pick it up as best I could. I did get, with Rapidograph pens and proper papers and tapes, and so forth.
Sharpless	It’s not just plain graph paper?
Ravenholt	Well, it’s the overlay papers, anyway.
Sharpless	Not onion skin?
Ravenholt	I had a growing need for this as I gathered more historical data. For television and newspapers and for formal publication I needed to be able to chart my data. And here you see charts that I made along the way, for smallpox, the cases and the deaths from smallpox from 1890 to 1960, and likewise typhoid fever and diphtheria and poliomyelitis, and you can see how they contrast.
Sharpless	You can really see those spikes.
Ravenholt

Population and Reproductive Health

Oral History Project

Reimert Thorolf Ravenholt