Neurology India Medknow Publications on behalf of the Neurological Society of India ISSN: 0028-3886 EISSN: 1998-4022 Vol. 50, Num. 3, 2002, pp. 377-378

Neurology India, Vol. 50, No. 3, Sept, 2002, pp. 377-378

Letter to the Editor

In Memory of Leonard T. Kurland, the Father of Neuroepidemiology

K. Radhakrishnan

Professor and Head, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala

Code Number: ni02109

Dr. Kurland died because of a heart attack on December 4, 2001 at his home in Rochester, Minnesota, USA. He was 79. He is survived by his wife, four sons, a daughter, and eight grand children.

Often known as the 'Father of Neuroepidemiology', Dr. Kurland believed that a rigorous evaluation of the occurrence of diseases, including where and how often they occur, among what populations and seasons, might yield more insight into the cause of the disease than examination of individual patients. He was actually the first person to be interested in the epidemiological aspects of neurological diseases. His studies on the epidemiological aspects of multiple sclerosis in the USA and Canada in the early 1950's are legendary.^1,2

Leonard Terry Kurland was born on December 24, 1921, in Baltimore, Maryland, USA. He earned his bachelor's and doctoral degrees at John Hopkins, his medical degree from the University of Maryland and a master's at Harvard. He served as the first chief of the epidemiology branch of the National Institute of Neurological Disorders and Blindness from 1955 to 1964. He remained chairman of the Department of Medical Statistics, Epidemiology, and Population Genetics at the Mayo Clinic, Rochester, Minnesota, from 1964 until his retirement in 1995. Till the last day of his life, he was active as an emeritus member of the Mayo Clinic Staff.

Dr.Kurland was the major force behind the Rochester Epidemiological Project, which in the 1960's began compiling the life long medical records of virtually every resident of the Olmsted County, Minnesota, where the Mayo Clinic is based, going back to almost 70 years.³ More than 1000 population-based research studies have come out of this elaborate medical record linkage system. Apart from allowing researchers to estimate the prevalence and incidence of diseases, record linkage system permitted them to understand the pattern, risk factors and natural history of diseases.³ In addition, it has helped them to determine whether what appears to be a cluster of an illness is cause for concern or not.⁴

Dr. Kurland was often called upon to help the medical community, government and industry to investigate contentious matters. These included the effects of Agent Orange on the veterans of theVietnamWar, and the relationship between X-rays and leukemia, swine flu vaccine and Guillain-Barré syndrome,⁵ and breast implants and connective tissue disorders.⁶ I was involved with him in the epidemiological inquiry into the role of mechanical trauma in the causation of amyotrophic lateral sclerosis⁷ and multiple sclerosis,⁸ in the first ever conducted population-based incidence study on cervical radiculopathies,⁹ and in the examination of the longitudinal trends in the incidence of primary brain tumors.¹⁰ A cautious man not given to sweeping statements, Dr. Kurland often came back and reported that, however suspicious a given situation or fearful the people affected might be, nothing unusual was occurring.

Dr.Kurland authored or co-authored 530 scientific papers and edited 4 books. Along with Dr. Donald Mulder, in 1954, he described the degenerative neurological disorder characterized by ALS, Parkinson's disease, and dementia, which at that time was widely prevalent in Guam.¹¹ He also lead the team to Japan that discovered in 1958 that methyl mercury in fish was the cause of the deadly epidemic, which came to be known as Minamata disease.¹² He received numerous awards. A close friend of the underprivileged, he worked tirelessly to uplift epidemiological research in many developing countries. Several neuroscientists in India, including me, had the privilege of receiving their first lessons in neuroepidemiology from Dr. Kurland.

Dr. Kurland was a great teacher, research worker and writer. His students around the world, including me, consider him as one of the kindest and remarkable human being one could ever come across. The neurology and neuroepidemiology communities the world over will miss this magnanimous personality dearly.

References

1. Kurland LT : Multiple sclerosis morbidity and mortality studies in the United States and Canada. Trans Am Neurol Assoc 1950; 75 : 264-267.
2. Kurland LT, Estlund KB : Epidemiologic factors in the etiology and prognosis of multiple sclerosis. Ann NY Acad Sci 1954; 58 : 682-701.
3. Kurland LT, Molgaard CA : The patient record in epidemiology. Sci Am 1981; 245 : 54-63.
4. Armon C, Daube JR, O'Brien PC et al : When is an apparent excess of neurologic cases epidemiologically significant? Neurology 1991; 41 : 1713-1718.
5. Langmuir AD, Bregman DJ, Kurland LT et al : An epidemiologic and clinical evaluation of Guillain-Barré syndrome reported in association with the administration of swine influenza vaccines. Am J Epidemiol 1984; 119 : 841- 879.
6. Gabriel SE, O'Fallon WM, Kurland LT et al : Risk of connective tissue disease and other disorders after breast implantation. N Engl J Med 1994; 330 : 1697-1702.
7. Kurland LT, Radhakrishnan K, Smith GE et al : Mechanical trauma as a risk factor in classic amotrophic lateral sclerosis: lack of epidemiologic evidence. J Neurol Sci 1992; 113 : 133-143.
8. Siva A, Radhakrishnan K, Kurland LT et al : Trauma and multiple sclerosis: a population-based cohort study from Olmsted County, Minnesota. Neurology 1993; 43 : 1878- 1882.
9. Radhakrishnan K, Litchy WJ, O'Fallon WM et al : Epidemiology of cervical radiculopathy. A population-based study from Rochester, Minnesota, 1976 through 1990. Brain 1994; 117 : 325-335.
10. Radhakrishnan K, Mokri B, Parisi J et al : The trends in incidence of primary brain tumors in the population of Rochester, Minnesota. Ann Neurol 1995; 37 : 67-73.
11. Kurland LT, Mulder DW : Epidemiologic investigations of amyotrophic lateral sclerosis: 1. Preliminary report on geographic distribution, with special reference to the Mariana Islands, including clinical and pathologic observations. Neurology 1954; 4 : 355-378, 438-448.
12. Kurland LT, Faro SN, Siedler H : Minamata disease. World Neurol 1960; 1 : 370-395.

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