Dr. Reimert Ravenholt



TORGHELE: It is Tuesday, November 8, 2016, which also happens to be Election Day. We are at the home of Dr. Rei and Betty Ravenholt in Seattle to record an interview with Dr. Ravenholt for the CDC [Centers for Disease Control and Prevention] Global Health Chronicles Polio Oral History Project. I am Karen Torghele, and I will be interviewing Dr. Ravenholt today. Thank you so much for agreeing to be interviewed, Dr. Ravenholt, and I'm glad we're finally able to get together.

RAVENHOLT: Oh, my pleasure. Glad to finally see you in Seattle.

TORGHELE: It's been a long time coming, hasn't it?

RAVENHOLT: When did you first start working at CDC?

TORGHELE: Well, on this project it was 2012, so it's been a number of years that we've been trying to get together. But you were in the second Epidemic 00:01:00Intelligence Service class, the class of 1953, so you were right in the thick of things when CDC was just beginning and getting going. I would love to get started by hearing what your background was and how you got interested in public health and connect it to CDC.

RAVENHOLT: Okay. As documented in that book beside you, I grew up on a dairy farm in Wisconsin in the middle of a large family.

TORGHELE: That's a big family.

RAVENHOLT: My mother had ten children, but the first one died at just six weeks. 00:02:00But nine of us all have lived at least into our eighties, some of us into the nineties. We were born in that dairy farm in Wisconsin, and it was a fairly primitive one, because we didn't have electricity and we didn't have running water. The main product was dairy--milk cows and that was mainly it. We lost our farm to foreclosure in 1935, when I was in fourth grade. Then we barely survived for a time for this 1935-'36. We were removed from the farm at foreclosure in May. We belonged to a Danish community. We spoke Danish at home. My four grandparents all emigrated from Denmark, and they clustered in this area of Wisconsin. It was named West Denmark, Wisconsin. On surrounding farms there were 00:03:00many Danes, so we could just about as well have been born in Jutland then growing up in Denmark as in West Denmark, Wisconsin.

Yes indeed, my grandfather, grandparents, had pioneered in terms of turning woods into fields and so forth. Anyway, my parents were both well educated, both in Danish and in English, so they were bilingual and bicultural. We spoke Danish 00:04:00at home and then generally didn't learn English, really, until we started first grade. Of course that goes very quick and no problem. In 1935, we moved into this old schoolhouse without electricity and so forth. We lived there that winter. One thing that happened in 1935, we were fortunate that President Roosevelt started a WPA, Works Progress Administration. So my father was able to 00:05:00go to work on various projects, but the income was just $40 a month, or $50 when he managed to retain a team of horses and wagon and sleds and so forth. He usually used those in the Works Progress Administration construction jobs and so forth. The income was $50 a month for nine of us, for my parents and us nine children. That was pretty slim, but we were very fortunate. My dad was very 00:06:00intelligent and brilliant in a way, and did a lot of reading and some writing and so forth. My mother was really the pick of the litter. We could not have asked for--yeah, here you see the family with me being a ten-year-old.

TORGHELE: Your mother was beautiful too.

RAVENHOLT: Yeah, she was a tall, beautiful woman, very capable. Indeed, bore ten children, two sets of twins, in there without electricity or running water, nor 00:07:00an indoor toilet. She managed remarkably well to where she was just a very capable person.

TORGHELE: And where were you in the lineup of children?

RAVENHOLT: I'm the middle of the nine.

TORGHELE: It's a good-looking group.

RAVENHOLT: Oh yes. My eldest brother Albert was, I think, particularly handsome. Let me just see that. I don't know if it's in this one.

TORGHELE: There's one of you in a uniform, I think. I think one of you was in a uniform.

RAVENHOLT: Yeah. My eldest brother became a war correspondent. Here you can see. [pointing to book] There are the five eldest there. There are all nine of us and spouses.

TORGHELE: There's a strong family resemblance, isn't there?

RAVENHOLT: Yes, but indeed our oldest brother had breakaway abilities. In high 00:09:00school he was taking agricultural studies, quite a few of those. In Wisconsin they had it so that in the fall many seniors were in agricultural studies, and they congregated in Madison, at the University of Wisconsin. And they had then, at least that year, Wisconsin Farm Facts Contest where they wrote--examination a couple days, and he and several thousand students there with their agricultural teachers. Anyway, he was number one in Wisconsin Farm Facts Contest. Oh, at that 00:10:00time, he was earning his room and board working for a family we were somewhat related to. After we had lost the farm in foreclosure he worked there three years, through high school. Also that same year--this was his senior high school year--he had a very good English teacher, and she acquainted him with the fact that there was a national competitive essay competition. And he wrote that and 00:11:00he placed first in the United States in that. Actually, he had a full scholarship to a half a dozen Big Ten universities. This essay had to do with the formation of the United States.

This is a rental, an old rental farm, we lived on, after we lost the farm that we had owned. A good thing was this was the home. It wasn't a very fancy one--no electricity and no indoor toilet and so forth. We were fortunate that it was 00:13:00across the road from a golf course, one that had been created there. The work projects under that WPA created the course beside the lake there, and our rental farm bordered upon it. So there you can see that jacket there I'm wearing--it's a little bit small, but what happened was two years before this, when I was twelve, this neighbor hired me to help the hired hand with milking during a 00:14:00summer when the cattle were placed away from the home farm, and we had to go there and milk them. He had a hired hand, and he'd pick me up in the morning at 5:30, and we'd go and I'd get the cows in from the pasture there. We'd milk about a dozen cows and then I'd go home and have breakfast and so forth. For that work, I was paid $3 a month. That turned out to be $.10 a day. A nickel in 00:15:00the morning and a nickel in the evening.

Anyway, I remember I got paid $3 at the end of August, and I had them in my breast pocket and then somehow I had lost them. I found them by the pump, by the water. These three dollars. Of course what my mother did was she automatically quickly had me--she sat down, and Sears Roebuck had a coat for the winter, a 00:16:00jacket. We got one for $3, and this one picture--well, here, you can see it. That jacket's a little tight. That was the second winter I was wearing that and I had just about grown out of it.

TORGHELE: It doesn't look very heavy for a Wisconsin winter.

RAVENHOLT: No. We had--in that previous winter, we had temperatures down to fifty-two degrees below zero. We knew something about winter. So I did a lot of 00:17:00milking in my youth until through high school. I used to milk for neighbors and others. After that, we lost our farm when I was ten. And we lived first in this old schoolhouse, and that winter I went to a one-room schoolhouse indeed where the teacher had eight grades. Then we moved to a rental farm. We had retained three cows at the time of the foreclosure, so they had young ones and gradually 00:18:00we accumulated--in several years we accumulated up to about a dozen cows. I had a brother two years older and another one two years younger, and we were always taking care of our cattle and so forth--milking through the youth there. The thing that saved us was that President Roosevelt and company had created this WPA, and so they paid about $40 or $50 a month, which was enough. My mother was very able. We retained, initially, three cows and a team of horses. All of us 00:19:00had milk. We always had adequate dairy products, a garden and several hogs and so forth. It sort of grew over the next few years.

One thing that happened was in 1940, with the war coming on, the government stopped the WPA, because now the people could find work in companies that were 00:20:00producing arms.

TORGHELE: So in 1940----

RAVENHOLT: My dad was, in a sense, very well educated in both Danish and English. And he had a couple years at the University of Wisconsin, and he'd had some years in Danish colleges. One year he was in Denmark when he was a young man. He was highly educated, book-wise, but there was something sort of lacking 00:21:00as far as his work--it, whatever--and he ended up becoming so depressed that he ended up going to the state mental institution, where he was for two years. That impacted our youth because we had to do everything. Then he got out and he ended up going to California and working out there in civil service in later years. 00:22:00Well, that's probably enough on high school. We always had chores to do. I liked football and basketball. But without electricity, we had chores morning and night, and walking a mile and more to school and back. We didn't have any electricity at home, so I rarely studied at all at home, because I was doing chores and this and that. I'm mainly interested in football and basketball.

TORGHELE: You must have had a very good memory.

RAVENHOLT: Well, I must have had something.

TORGHELE: What made you decide to go to college, and how did that all come about?

RAVENHOLT: Well, what happened is my eldest brother was really a breakaway genius type, and he had one winter of college at the Danish college in Des Moines, Iowa, but then he went after the World Fair. The summer after he 00:24:00graduated from high school, he went down to Minneapolis, and he went to a foremost hotel there and managed to see what he wanted to do, because pretty soon there, he had decided during high school he wanted to be a foreign correspondent. Then he reasoned that to do this it would be helpful if he had learned how to cook and do that--earn his way--and that's what he did. He went to the foremost restaurant hotel in Minneapolis and got a job in the summer as a cook's helper and a very thorough sort of training there. Then he went off 00:25:00adventuring as chief cook on a Swedish steamer and ended up in the Orient. Initially, he went to Shanghai, but then they went up through the Mediterranean and then they were at Marseille, France, in June of 1940 when the Germans attacked. But they managed then to get out of Marseille and go to Spain and then around Africa and back to Shanghai. He got off there and he worked. He had some savings from having cooked his way around the world there, and he worked for a 00:26:00year in China for the International Red Cross, hauling medical supplies up into interior China. Then the Japanese took Shanghai, and he managed to get out of there and went down to India. Down there, he rather quickly became employed by the United Press as a war correspondent. He had excellent writing and such skills. He sort of led us out into the world that way.

Our mother was a very capable woman, and we all benefited from that. There's my 00:27:00brother Albert, who became a foreign correspondent and stayed in that pretty much his life. Then, he got a degree from Minnesota. He was in the Army, but when he got out, he got a degree there and became a teacher, but then after a while he got interested in politics and he went to Washington to work for Senator [Hubert H.] Humphrey. He worked for Senator Humphrey and also Senator [Daniel K.] Inouye from Hawaii. He spent most of his time as assistant to those senators at the U.S. government. Johanna was very capable and went into nursing 00:28:00and surgical nursing and so forth. Myself, I got into medicine. And then my brother saw how much fun I was having. He'd been in Japan in the Army for several years and came back. I got rejected from going into the Army.

TORGHELE: So you got rejected?

RAVENHOLT: Yes. I went just after high school when I was eighteen. I was called up for the draft, and I'd been working in the harvest fields that summer, but then by the first of September I went back to Wisconsin to Milwaukee for the 00:30:00military. But when I was going through that military examination, a doctor put a stethoscope to my chest and he listened and he said he wasn't sure, but he thought he might be hearing a heart murmur. So he called over another doctor and he listened and he didn't hear one. They called over a third doctor, he listened, he thought he heard one too. They called over a fourth doctor who listened, he didn't hear one. They called over the fifth and last doctor and he also thought he heard one, so they voted three to two that I had a heart murmur and rejected me. That was a key element because indeed, I was rejected from the Army.

That fall I went down to Minneapolis and started working in various labor jobs. I really wanted to get into the Army, and so in December I wrote my draft board and told them I really wanted to get in there, and they said, so, okay. They would send my file from Milwaukee. Now they said they'd send my file to Ft. Snelling in Minneapolis, and in February I went for examination. And this time I went through the regular examination, but at the end there was somebody checking 00:32:00records. They said, "Oh, I see you were rejected because of a heart murmur." So he just rejected me again. I was 4F and then got working with the Milwaukee Railroad that winter in Minneapolis, but then I decided I better get myself an education at the University of Minnesota.

Indeed, I started there in 1944 at the University of Minnesota. And because my sister had gone into nursing I had learned something of what medicine might 00:33:00offer, so I opted for pre-medicine. But when I started I had only saved $150, and the entering fall tuition at Minnesota was $45--not too much. I bought a suit--my sister helped me select a good suit, so I got that for $54, and then I had bought books, and I moved into a student cooperative house and paid a month rent. I was immediately down to having to earn anything and everything, and I 00:34:00got a succession of jobs. The first one was really the worst, working making a sweeping compound in an old factory. After a while, in the wintertime I got a job keeping the heat going in a factory during the weekends. So I would go there on Friday evening and quite often stay until Monday morning, just sleeping on an 00:35:00old table or something. Then the second year I got a job as manager of the students' cooperative, for which I then got my board and room, and that was a good discipline. So I learned how to keep books and everything. I was always having to do that. I didn't really manage the work. I've probably talked more than I should.

TORGHELE: I'll interrupt if I think we need to go a different direction, but I think all that background is very interesting.

RAVENHOLT: I managed to fall in love along the way there, and married after my 00:36:00junior year in medical school. I married and then proceeded. While I was in medical school, I managed to get involved with a program that paid a little bit, which would lead to going in the military after graduation. At graduation, I 00:37:00managed to select for internship the Public Health Service Hospital in San Francisco. The U.S. Public Health Service Hospital, at that time, was integrated with the military, so I didn't tell them that I had been rejected earlier. They admitted me and I became----in the Army. During my internship there I was in the Public Health Service in San Francisco, at the Public Health Service Hospital as 00:38:00an intern, a medical intern. It earned me $350 a month. I could do that, which was good because right there in my last year of medical school, our first daughter was born, so I needed that. Following the internship I needed to put two more years into the Public Health Service, and I discovered there was such a thing as Epidemic Intelligence Service and Centers for Disease Control. Now that is how I got to CDC.

TORGHELE: Do you remember how you found out about it?

RAVENHOLT: Well, what happened was--I'm thinking--my internship, of course, medical and rotating internship at Public Health Service Hospital in San Francisco. And then at the end of that I had to commit for two more years, and I had always dreamed of going to Europe. I wrote to the Public Health Service, and I knew they had core officers in Europe. I wanted to see if I might be able to do that, and they wrote back no, that they were cutting back their forces in Europe, where they'd had additional Public Health Service officers that connect with migration from Europe to the U.S. They said there was an Epidemic 00:40:00Intelligence Service that had gotten underway at CDC, so they suggested that I might want to go there. They invited me to come down for the Supreme round up--the first one, actually, in May of 1952. I went down--and Alex Langmuir and Dr. Seal and others--I was there just to see if I wanted to come there. I was there for one week--a spring gathering. I learned enough about it that I decided I did want to do that, and so that way I was recruited in to the Epidemic 00:41:00Intelligence Service. That went very well. I was assigned to the Ohio State Health Department after six weeks of training, of course, at CDC. That worked very well. I had a very good director there. Dr. [Frederick H.] Wentworth was one year ahead of me at EIS [Epidemic Intelligence Service], and so he'd gone through Ohio State one year before, and then he was chief when I came in to understudy him. So that was very good--he was very good. A very good experience 00:42:00there. Investigating, especially, diphtheria.

TORGHELE: Was this a rural community that you worked in?

RAVENHOLT: I was stationed in Columbus, Ohio, but what happened was I investigated diphtheria in several places in Ohio, mainly in the poorest parts 00:43:00of Ohio. Then it happened that the Saturday Evening Post had a couple very good writers, investigators in writing, and they decided they wanted to do an article on the Epidemic Intelligence Service for the Saturday Evening Post--Dr. Wentworth, then my chief. They had--a couple very expert writers came out from Philadelphia to Columbus and a few other places. And Dr. Wentworth should have gone with them to go over the place where he had done some work, but he said he 00:44:00had staff meetings, so they'd have to take me--I should take care of the writer from Saturday Evening Post. I went with them over to Muskingham in Ohio, and when I got there, this fellow from--this writer from Philadelphia, he clearly had little idea what he should do, so they then challenged me and I decided, well, we've got to do this. We've got to do a picture of me, taking throat cultures on a classroom of children. We set this up.

TORGHELE: That's a great picture.

RAVENHOLT: Yeah. I composed that picture. Then he took a number of others. One, 00:45:00here, was at a poor home doing a throat culture, where it was actually Wentworth who had been in that place, but I somehow got credit somehow having been involved with that. Anyway, so that was the Saturday Evening Post, and it was published on the 30th of May, 1952, and it had two pictures that I was in--that one you see there particularly--and that Saturday Evening Post article was published on the 30th of May, 1952--or '53, was it? I guess it was '53. A sister 00:46:00of mine got married just then, and I went home for the wedding just the same time that this article came out in the Saturday Evening Post. That was very fortunate because my brother Otto, two years younger than I--he had been in Japan, 00:47:00and he'd come back to the University of Minnesota and was an excellent student, but he didn't quite know what he wanted to do, this or that. When he saw what I had done and got involved with, he decided he wanted to get into it too. He quickly modified his studies to pre-medicine and medicine, and indeed, he was a very excellent student, and president of his class both as a sophomore and a senior. Later, he was in Seattle one summer, one year there during internship, 00:48:00and he was sufficiently impressed with the fun I was having in public health, epidemiology, he decided to go into it too. He ended up as health officer and also coroner and various other roles.

TORGHELE: Was it Las Vegas?

RAVENHOLT: Yeah, that's right. Las Vegas--they employed him. He spent a year or two in Minnesota and Kansas, but then he was employed by Las Vegas. He got over 00:49:00there and he had a big career there and it all went very well. He worked there thirty-five years.

TORGHELE: Now before you went to EIS, you were in medical school. Were you saying that one of your jobs was to take care of polio patients in the iron lungs?

RAVENHOLT: Yes, when I was in medical school, a sophomore in medical school, there was a big polio epidemic, 3,000 cases or so. And the most seriously ill 00:50:00were hospitalized at University of Minnesota, from across Minnesota. They required a lot of care, in turning them and so forth. They employed myself and another medical student during Christmas so the nurses could get a little time off for their family, so we did that. I had really a down-to-earth getting acquainted with polio then. Then later, when I was with CDC and Ohio--that year 00:51:00I was with Ohio, CDC took on a special responsibility for dealing with polio, trying to diminish. This was before the Salk vaccine, in which it was just being introduced. They were trying to bridge to that by using immune globulin, so CDC would get involved in sort of a large program. We got special training by 00:52:00Pittsburgh in muscle testing and so forth, and that one summer, '53, my task was to investigate every household where there was more than one polio case. I had to go there and get all the facts and do muscle testing to see how much paralysis there was. Sixty days later, go back and check on the paralysis and so forth. So that occupied me quite a lot that summer of '53.

TORGHELE: Did the therapy work at all?

RAVENHOLT: No, the immune globulin did not work. Our finding was negative then. 00:53:00I guess because, of course, the immune globulin was taken from general. So if they'd gotten all the immune globulin from previous polio cases, I suppose it might have worked, but it didn't work. It was an important part of our work at CDC there for a year or two. It kept us busy and it was useful experience indeed from an epidemiological point of view.

TORGHELE: I was going to ask you too, when you were in Minnesota in medical school, was Sister Kenny there during those years?

RAVENHOLT: Who?

TORGHELE: Sister Kenny.

RAVENHOLT: Oh yeah, she was. Many of the polio patients with substantial paralysis were treated by her. It sort of was not so much for the febrile part, but for rehabilitation particularly. It was quite an important activity at that time.

TORGHELE: Do you remember how she did her therapy, and did the medical community accept it?

RAVENHOLT: Pretty well. It was fairly well. Of course, there wasn't much of it. 00:55:00There was no important alternative, but it was rather important during some years there in Minnesota that I think--also in Rochester, quite a lot of it centered there.

TORGHELE: At the Mayo Clinic?

RAVENHOLT: Well, first at the University of Minnesota, but also at the Mayo Clinic, so it was one of the leading activity centers that way in the U.S.

TORGHELE: You mention in your book a place where you went for a site visit 00:56:00called Oatland Island.

RAVENHOLT: Yeah. That was down in the northeast edge of----

TORGHELE: Near Savannah?

RAVENHOLT: Yeah. Here, I'm afraid, in my ninety-second year, I have a little trouble with some of the names. That summer when I was at CDC, we went on a tour 00:57:00of several places. One of them was this Oatland Island over by Savannah, and that was kind of interesting, and a few other places.

TORGHELE: What did they do in those research facilities? What did they do at Oatland Island? It would have been in the '40s, I guess, when they started it. Maybe malaria control?

RAVENHOLT: Yeah, CDC was started there in--what was it?

TORGHELE: 1946.

RAVENHOLT: They got involved in various things, and some of it was what they were doing there, but it was interesting just to go there and visit a couple days or something. I can't really give you much detail of it. CDC was, of course, a fledgling kind of activity there in the '40s. Langmuir and Jim Steele and half a dozen people were stalwart early workers in epidemiology and public 00:59:00health. Certainly, Dr. Langmuir and Dr. Steele and a handful of capable people, some of whom you or your husband no doubt got acquainted with. It was a good nucleus, and then the annual epidemic intelligent service class of fifteen or thirty or even fifty students. The Centers for Disease Control rather rapidly became, really, the foremost center of expertise for communicable diseases in 01:00:00the world, actually.

TORGHELE: What factors do you think contributed to that? Because it wasn't in Washington, it was in Atlanta, which wasn't a center of other government organizations.

RAVENHOLT: Tell me your question again.

TORGHELE: What factors contributed to the CDC becoming world-renowned?

RAVENHOLT: Well, it had some excellent early leaders, which derived from right there in the 1930s--under Roosevelt later in the '30s, then the '40s. You said 01:01:001946. There was a durable growing competence that was gathered at CDC, and through the Epidemic Intelligence Service we started investigating disease outbreaks. There was enough interest in Congress and certain public health 01:02:00leaders that they began to receive income. There was sufficient expertise that clustered at CDC from 1946 on that they gained increasing revenues. And as much as you start looking, you'll find this. And you'll find that it grew insofar as official government public health interest and investigation and control and so on. Certainly, CDC was the foremost such center in the world rather quickly. 01:03:00Then the U.S. had more capabilities in epidemiology investigation and control than any other country in the world. There had been some early programs, which tended to be disease-specific, which was a response to readily recognize the important diseases like yellow fever and tuberculosis, of course, and typhoid. Gradually, there was an increasing capability developed in the U.S. government, 01:04:00public health, but CDC became the foremost center of that. We had some very good people there, like Jim Steele in particular.

TORGHELE: Dr. Langmuir was quite a presence too, wasn't he?

RAVENHOLT: Yes. They got some particular skills there. But of course [Dr. William H.] Bill Foege, he was probably just about the most competent, capable 01:05:00person in that area of all. I had helped develop him.

After a year in Ohio, they changed my delegation as Epidemic Intelligence Service from Ohio to Seattle. And this happened sort of accidentally because my oldest brother--when he was not in the Orient, he married a woman from Seattle, 01:06:00so he tended to cluster here, and so I was very happy to come out and meet up. We had many things in common.

Anyway, I was the foremost epidemiological person with the health department, and my office was downtown in Investigation Control of Infectious Diseases, the main thing. But then I started teaching at the University of Washington in epidemiology. I sort of filled in there, teaching one or more courses right along.

This one year we had an epidemic infectious disease outbreak in connection with the beach.

TORGHELE: Swimming beach?

RAVENHOLT: Yeah, Lake Sammamish [Washington]. We got an outbreak. One thing 01:08:00leads to another, because what happened there was this one summer--I'm trying to remember exactly, '57, I think, probably '57, I think--there was an epidemic of shigellosis at Lake Sammamish. I actually was back in Wisconsin on a brief vacation, but then I had a call from [Dr. Sanford] Sandy Lehman. Dr. Lehman, said that I might need to come back and take over the investigation that was 01:09:00shigellosis at Lake Sammamish and so on. I drove back rather rapidly from Wisconsin. I went through North Dakota, where I had worked. I stopped, and the family that I had worked for through the years. I had my two older children Janna and Mark. They were like six and four years old.

Anyway, I started driving west immediately after I heard from Dr. Lehman that I needed to get out here. I stopped that one night with these in North Dakota 01:10:00where I had worked before, but then from there to Seattle I drove straight through, one thousand five hundred miles. The only break I had was one place in Montana, I stopped there at Butte, Montana. The children went to a movie, and I slept a couple hours while they went to a movie, but besides that, that was the only sleep I had from the edge of Minnesota to Seattle. I would take Dexedrine. 01:11:00That is a powerful thing that kept me awake while driving. It was money-saving. I could leave Seattle and drive a thousand miles without rest, and I'd do that in the summer with the family. The children and my wife, they would be in the same car sleeping, but I'd drive through the night on Dexedrine.

TORGHELE: You had an experience with polio vaccine and your children. And I wondered first of all, before we get to that, I wondered about what it was like 01:12:00for physicians when Dr. Salk made the announcement and Tommy Francis talked about the field trials and that all happened. What it was like for you physicians when that happened?

RAVENHOLT: The Salk vaccine was really being developed in '53, and achieved development either late in '53 or early in '54, probably late '53. And then 01:13:00Salk, [Dr.] Jonas Salk, went ahead to get a vaccine for that, and that was indeed an important development in public health. That was one of those important diseases that powered deep development of CDC, because when it came on it had to be handled in '54. I moved from Ohio to Seattle in '53. I came to 01:14:00Seattle, Washington, in--I guess it was January of '53, so then I was investigating.

TORGHELE: You were getting an MPH [Master of Public Health] around the same time?

RAVENHOLT: Yeah. I came out in '53 and attached to the Seattle King County Health Department, and Dr. Lehman was the director there, that was a happy kind of a----here is Dr. Lehman.

TORGHELE: Was he one of your mentors?

RAVENHOLT: Oh yes. He was the health officer with Seattle, and he was born, actually--his father was a missionary in Africa and he was born in Africa. But he went to medical school at Cincinnati, and then he went into public health under the Public Health Service program for training certain health officers, and he got into that. He was mainly a public health officer, and a very capable worker in the local government. I was fortunate that way. He gave me a lot of 01:17:00freedom to do everything. During this time, I was working day and night.

TORGHELE: Supporting your own family.

RAVENHOLT: Four children there by 1956, and we all enjoyed Seattle a lot. Here's 01:18:00that summer we were doing investigation of the waters there--in '57, I guess it was. I'd just come back from vacation, from the Midwest, and I came out investigating. And this had to do with swimming studies, investigation of beach 01:19:00waters and health, 1959.

TORGHELE: Were people getting sick after swimming there?

RAVENHOLT: We had the epidemic there in '58, I guess. It was that Lake Sammamish--this was '58--actually it started in '57 and then I came back from the Midwest and we got started, but we didn't really get a definitive answer 01:20:00then. The following summer, I got some monies from the Seattle Council to do a thorough investigation of swimming-associated illnesses. That's what that led to. That's when I then employed a half a dozen people. And this person was the lifeguard at Lake Sammamish that summer of '57. He was immediately involved with that. Bill Foege was a roommate with him. In '58, I guess it was, I got $30,000 01:21:00from the City Council to do an adequate study of the swimming-associated illnesses, because there was an intense interest then in the problems of polluted water. I got enough money to employ a half dozen to help, along with several of these people who were regular health officers, younger health officers with Seattle King County. We did this study, and here we were 01:22:00celebrating that study at the lake and the study at Madison Park.

TORGHELE: So you knew Bill Foege way back then.

RAVENHOLT: That's how I got acquainted with Bill Foege. He was a medical student at the University of Washington, and he was rooming with this Bill Randolph, and Bill Randolph was a lifeguard at Lake Sammamish when that epidemic occurred. I got involved with employing them to help with getting the study, doing all of that. It ended up that Bill Foege, of course, a very capable person, and we hit it off well together. So the next several years, summers and so on, he worked 01:23:00with me--actually for three years, while he was a medical student at the University of Washington. He became aware that there was such a thing as epidemiology and public health and the CDC and all of that. When he graduated from medical school, he took an internship in the east, a general rotating internship, and he was just about to go on into clinical work. But I was in France then, but it happened that I came back in that summer to do a major paper 01:24:00at the American Public Health Association, and I came to New York, and I stopped there and called Bill and his wife. I took him on Broadway. I invited Bill and his wife and took them to see My Fair Lady and a special event together there, because I was just in for a day or two in New York. Staying just a couple days there and then I went back to France. He was taking his internship, his rotating internship in a Public Health Service Hospital next to New York.

TORGHELE: In Boston?

RAVENHOLT: No, in New York City, Staten Island. The U.S. Public Health Service had a hospital in Staten Island and he was taking his internship there. And I took him and Paula, his wife, to Broadway that night to see My Fair Lady. He was just about done with his internship and then he was just about in the act of going to take a medical fellowship or something, a clinical fellowship. I 01:26:00happened to be there, and I acquainted him additionally about the Epidemic Intelligence Service, and why wouldn't he just go into that, and so forth. I guess he was impressed with how much fun I was having, and so indeed, I think if I had not gotten there then, he would have gone into internal medicine in some hospital somewhere. He then, indeed, decided he wanted to go into the Epidemic Intelligence Service, and he was initially assigned in Colorado and so forth. He, of course, is an extraordinarily capable person, and he worked his way 01:27:00strongly in epidemiology and so forth. So these things hang together. If I hadn't come back from Paris to the U.S. right then--I came back to give a paper at the American Public Health Association--actually, the annual conference was in Cleveland, so that was a very fortunate thing. I did succeed in recruiting [loud noise] in CDC epidemiology.

TORGHELE: That's an amazing accomplishment.

RAVENHOLT: He has proved to be an extraordinarily capable person.

TORGHELE: Did you recognize that in him when he was just a medical student as well?

RAVENHOLT: Well, I recognized that while he was a medical student here. I like to research things, and you can see this historical epidemiology great analysis, but, see, I had him working with me part-time, and also Randolph and so on. I'd 01:29:00gotten $30,000 to investigate these waters, and I had enough that I could pay a small amount, but very important for a medical student. I could employ and just pay a thousand or two thousand a month or something for weekend help. I was interested in getting a fuller understanding of the historical aspects of everything that was going on in Seattle and the area and so forth. A make-work kind of project was to go through all of the old death records, which we then 01:30:00did. I could employ them sufficiently to help satisfy their need. We went through all of the old death records, and this is the report of that historical epidemiology. I could lay out the epidemiologic history of various diseases for Seattle. That was indeed possible because I had the residue of these $30,000, maybe $10,000 that I could employ them with, and then employed Bill.

TORGHELE: And you did this all by hand, you did those graphs and charts?

RAVENHOLT: Yeah. The second summer I had enough money that I employed Bill Foege, and I was interested in getting a full understanding of what had happened with lung cancer and so forth. So I employed him that summer to go through--together--go through all the old death records and lay out the whole history of lung cancer in the Seattle area, starting with the first death from 01:32:00lung cancer in 1900, but going through all the old death records. What I and we had thought sort of as an onerous make-work thing, evenings and Saturdays we were down in the public safety building and we started going through all the old death records. In the death records, you'd find a lot of history like the Gold Rush to Alaska from the 1890s. When people died going to Alaska or in Alaska, 01:33:00they didn't have any record-keeping up there, so many of those were registered in Seattle death records. They died from typhoid and syphilis, and indeed, syphilis was of course a component, a problem in a pioneering kind of growth of a society. On the frontier, for example, across the United States, but then particularly with respect to Alaska and the Gold Rush, then you have a lot of 01:34:00young, non-married men, and somehow they are attracted to young women, and then indeed, syphilis was a common component. It flourished for many decades with very little accurate registration of everything. In various ways, I've gone into the whole history of syphilis.

TORGHELE: So, lung cancer. So you became quite an anti-smoking advocate?

RAVENHOLT: Smoking--fortunately, neither my mother nor my father smoked. That was the very important thing. In my youth, like working in the harvest fields of 01:35:00North Dakota, of course, most of the young people out there, they were smoking. And there was a time there when I was at the University of Minnesota, I had a friend from high school, an engaging person, Eugene Johnson. He was one year ahead of me in high school. We played basketball together. Well, he went in the Army and went to Europe and got stitched across the pelvis by a machine gun, with at least two of the bullets lodged in his pelvis. He was discharged, and 01:36:00that was just when I was starting in 1944 at the University of Minnesota. After convalescing, he came with us to Fitzsimons Hospital in Denver for some months and so forth, but he ended up coming to the University of Minnesota, and I was then directing the students' cooperative. I was directing that students' cooperative, and this one year he and I roomed together. He smoked with such a 01:37:00flowing, smoking and talking and so forth. I can remember one time when I said, Goddamn it, maybe I should do like Gene and learn to smoke, because he was evidently having great success with fiddling with it.

I went and bought a carton of cigarettes and started smoking them, ten packages, you know. I started smoking a pack. I got into maybe the second pack and I just couldn't stand the damn things. I was just very fortunate that my introduction 01:38:00to cigarettes was not a taking. Of course I had seen smoking in Dakota with the young people there. Most of them were smokers. There was this one young man who was one of the bundle teams, and we had half a dozen of us young fellows hauling bundles and so forth. This person was the son of one of the owners that we worked for. We would sleep together, two to a bed or one on the floor or something, moving from farm to farm. And this--Gordon was his name--I noticed 01:39:00when I bedded with him repeatedly, in the evening he had cigarettes, and he'd smoke one or two cigarettes as he came to bed and so forth. He put the cigarettes right within reach by the bed, and sometimes he'd wake up in the night and he'd have to smoke a cigarette. And he'd always smoke cigarettes immediately in the morning, and pretty much endlessly. I knew him this way this first summer that I was in North Dakota, and so I had this experience with him 01:40:00of his tremendous addiction to cigarettes. It surely would have killed him, but that following spring he took a ride on the side of a vehicle, and unfortunately the person that drove had an accident and killed him. I knew him the first summer I was in Dakota, but he was of course gone for the second one. He no doubt eventually would have died of cigarette disease.

TORGHELE: That's lucky that you didn't get addicted to them. Now one thing you need to tell me about is the Cutter incident and your own personal situation with that.

RAVENHOLT: The Cutter incident, of course you see it there, but we can discuss it.

TORGHELE: That would have been 1955. I know it was after the field trial.

RAVENHOLT: My first acquaintance with polio was in '48. That was when I was a 01:42:00sophomore in medical school, but that was where I worked for ten days or so taking care of patients, the severely paralyzed ones at the University of Minnesota. Then I got involved with that. In '59 was when we had the major epidemic of polio. The last major epidemic of polio was in '59, which I was in charge of that in Seattle. I was director of epidemiology of communicable 01:43:00disease control then, but I went into it very thoroughly-- polio there, and then the results and deaths, and polio you can see by year and age from 1900, I guess, to 1960.

TORGHELE: In 1950, between '50 and '55, there was a big epidemic. 1952 was a bad 01:44:00year, wasn't it?

RAVENHOLT: Yes, and there were several early epidemic years. I got a lot of experience with the disability from polio, and we worked in that. Poliovirus excretion of preschool children during an epidemic. So I really went deeply into polio paralytic paralysis, and tonsillectomy we considered. Indeed, once I got interested in a certain disease, I tended to dig in more deeply so I understood it.

TORGHELE: Tell me about getting your own children vaccinated.

RAVENHOLT: Oh yes. There in '55, we got Salk vaccine for the first time, and 01:46:00indeed, I was taking on the immunization of all the young people with that. Indeed, I tell the story and you've probably read it. As we crank up this program, of course, getting a lot of physicians to help provide the shots, but I was in charge of the polio programs, of course. Just then, as the vaccines Jonas Salk had in '54 developed--the Salk vaccine--was they used it in some testing 01:47:00areas and it proved good. In '55, we wanted to get everybody immunized, and that's what this is related to. Where I met with some representatives out of several main drug companies producing Salk vaccine. As I detail in here, went to 01:48:00a couple detail men from the companies that produced Salk vaccine. They invited myself and the maternal child health director from the Seattle King County Health Department--they invited us and several other people for lunch just to talk about vaccine and this and that. In the course of that, one of them apologized--a detail man from Cutter apologized that they were short of a vaccine and that they hadn't been able to provide us health department people 01:49:00with polio vaccine for ourselves. I responded nonchalantly, well, not to worry, because a detail man from this other company had promised to get me vaccine. Then we had lunch, and I went back to my office, and about a half an hour after I got back to the office, there came a breathless messenger from this one Cutter detail man that had been at lunch with me, bringing me several Cutter vaccine ampules, bottles of vaccine.

He came rushing to get those to me, so that we'd be using Cutter vaccine instead of the other companies. I remember I had a clinic next to my office, and we had a refrigerator there and put the vaccine in the refrigerator, and then while Dr. Wilke, who was adjacent, who was the maternal child health doctor, and his office was next to mine. That evening, then, he knew I had put the vaccine in the refrigerator in there. He came to get one to take home to immunize his 01:51:00couple children, and I laughingly told him, "You go ahead, and in about three or four weeks I'll go ahead." As I reflected upon that, I realized if I didn't have enough courage to immunize my children with that vaccine, I shouldn't be directing a program to give it to thousands of other children. So I took one of the ampules home and immunized my two children, Janna and Mark, about five and three years old. It was just three days after I had done that, the word came over the wire that the Cutter vaccine was causing polio in Idaho. I quickly 01:52:00called Alex Langmuir and several others to get full information and learned what the lot was, and so as soon as I got that information, I went into my refrigerator to see what I had and indeed, it was from the bad lot.

This was three days after I had immunized the children.  That night and for several days after, they both ran fevers, but fortunately they did not develop paralysis.  That was a hairy spring with all the administrative details of 01:53:00cranking up 160 practicing private physicians to give shots and get everything -- and then the bad Cutter publicity came and the program was interrupted.  Don't give it.  Then that eased, but the program was interrupted a second time before we proceeded to immunize 24,000 first and second graders in the Seattle schools.