Louis I. Dublin and the Development of the Observational Study: The Metropolitan Life Insurance Company Natural History (Cohort) Studies of Typhoid Fever and Scarlet Fever

During 1911–1914, using the resources of the Metropolitan Life Insurance Company, Louis I. Dublin conducted two national studies into the survival of those surviving episodes of typhoid fever or scarlet fever. He identified an elevated risk of such mortality, associated with specific causes of death, among those having had typhoid fever but not among the scarlet fever survivors. The studies were methodologically sophisticated, resembling those conducted three to four decades later. The studies appear to have been accepted by the medical and public health communities. However, the absence of modern data processing technology and the lack of financial support for such studies by other investigators precluded the further development of modern epidemiology until World War II.