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RES E A R C H A R T I C L E Open Access
On the exoneration of Dr. William H. Stewart:
debunking an urban legend
Brad Spellberg
1,2*
and Bonnie Taylor-Blake
3
Abstract
Background: It is one of the most infamous quotes in the history of biomedicine: “It is time to close the book on
infectious diseases, and declare the war against pestilence won.” Long attributed to the United States Surgeon
General, Dr. William H. Stewart (1965-1969), the statement is frequently used as a foil by scientific and lay authors to
underscore the ever-increasing problems of antibiotic-resistant and emerging infections. However, the primary
source for the quote has never been identified.
Methods: We undertook a comprehensive search of multiple databases encompassing medical literature, news
articles, and congressional records to attempt to identify sources for the quote.
Results: No source of the quote was identified. However, a trail of source documents was identified that clear ly
serves as the basis for subsequent, incorrect attribution of the quote to Dr. Stewart. In multiple source documents,
Dr. Stewart made statements to the opposite effect, clearly recognizing that infectious diseases had not been
conquered. The urban legend was created by a combination of lack of primary witnesses to the originating speech,
misunderstanding of points made by Dr. Stewart in the spee ch, and increasing societal concern about emerging
and re-emerging infectious diseases.
Conclusions: Attribution to Dr. Stewart of a belief that it was time to close the book on infectious diseases is an
urban legend; he never made any such statement. Numerous other verifiable sources, howe ver, confirm that other
people in academia adopted this belief. Dr. Stewart should no longer be cited in this regard, and should be
replaced with verifiable sources.
Keywords: William H. Stewart, Urban legend, History of antibiotics, Antibiotic development, Antibiotic crisis,
Public policy
Multilingual abstracts
Please see Additional file 1 for translations of the
abstract into the six official working languages of the
United Nations.
Background
Dr. William H. Stewart (1921-2008) was a distinguished
member of the United States (US) Public Health Services
Corps, having served in the first class of the Epidemic
Intelligence Service officer program at the Communicable
Disease Center (now the Centers for Disease Control
and Prevention [CDC]), and subsequently as US Surgeon
General from 1965-1969 [1]. Among his many important
accomplishments were his dogged spearheading of anti-
tobacco campaigns, and his aggressive attempts to end
racial discrimination in health care [2].
Despite these significant achievements, history has
remembered Dr. Stewart primarily for being the source
of a legendary statement: “It is time to close the book on
infectious diseases, and declare the war against pesti-
lence won.” This spectacularly erroneous quote has been
cited innumerable times to underscore ongoing public
health problems caused by antibiotic-resistant and emer-
ging infections. The quote was referred to in Dr. Stewart’s
obituary, published in a leading medical journal in July of
2008 [3]. The persistent relevance of this quote to modern
society is underscored by its citation in a 2009 Wall Street
* Correspondence: bspellberg@labiomed.org
1
Los Angeles Biomedical Research Institute at Harbor-University of California
at Los Angeles (UCLA) Medical Center, Torrance, CA, USA
2
The David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
Full list of author information is available at the end of the article
© 2013 Spellberg and Taylor-Blake; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of
the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use,
distribution, and reproduction in any medium, provided the original work is properly cited.
Spellberg and Taylor-Blake Infectious Diseases of poverty 2013, 2:3
http://www.idpjournal.com/content/2/1/3
Journal article about the recent H1N1 influenza outbreak
[4], and in an article regarding the deadly shiga-toxin pro-
ducing E. coli 0104:H4 outbreak in Germany and Europe
in 2011 [5].
Despite the ubiquity of its citation, there is no credible
evidence that Dr. Stewart made any such statement. Be-
fore his death, the Office of the Public Health Service
Historian asked Dr. Stewart if he made such a statement
and his response was tha t he could not recall [6]. How-
ever, by following the trail of source documents back
over the past 40 years, we can now reconstruct how the
urban legend of Dr. Stewart’s apocryphal statement came
to fruition.
Methods
We searched electronic full-text databases for contem-
poraneous (late 1960s and early 1970s) and more re-
cent attributions of these sentiments to Dr. Stewart.
These databases include ProQuest Historical Newspapers
(complete collection), ProQuest Direct (including ProQuest
Newspapers), LexisNexis Academic, LexisNexis Congres-
sional, JSTOR, Periodicals Archive Online (Periodicals
Contents Index Full Text), Factiva, Google News, Google
Books, and PubMed/Medline. Keywords for all of these
search engines included various combinations of “William
[H.] Stewart,”“surgeon general,”“won the war [on infec-
tious disease],” and “close the book [on infectious disease].”
As well, Dr. Stewart’s congressional testimony, with
reference to the phrases “infectious disease(s),”“close
the book,” and “won the war,” was reviewed through the
use of LexisNexis Congressional for the years 1966 to
1970; congressional testimony of other PHS officials
were similarly scanned for such sentiments.
Results and discussion
After many years of searching [6], only one source has
been identified which contains a primary reference to
Dr. Stewart’s quote [7]. The reference is to a speech
given by Dr. Stewart at the 65
th
Annual Meeting of the
Association of State and Territorial Health Officers in
1967 [8]. However, a review of the actual contents of the
speech revealed that it contains nothing even remotely
resembling the alleged quote.To the contrary, Dr. Stewart
actually said in that speech, “Warning flags are still flying
in the communicable disease field...While we are engaged
in taking on new duties...we cannot and must not lose
sight of our traditional program responsibilities [emphasis
added].” Hence, it is clear that as of 1967, Dr. Stewart was
in no mood to signal the end of infectious diseases as a
public health problem.
Despite an exhaustive search of multiple sources, no
other primary source for Dr. Stewart’s infamous quote
was identified. However, sources were identified that
allow us to reconstruct the origins of the urban legend
surrounding the quote.
The seeds of an urban legend
In the aftermath of the astonishing power of antibiotics,
by the 1960s the US Public Health Service was shifting
its attention away from acute infections to chronic
illnesses. For example, a government report published in
1968, which bears Dr. Stewart’s name on the title page,
contained the following passage:
“The emphasis of epidemiologic investigation has
shifted markedly in the last two decades. A decline in
the interest in the infectious diseases and increase in
concern with the noninfectious diseases has resulted
from the change in relative importance of these
categories of disease in many parts of the world,
including the United States. It is also recognized that,
although major tasks still remain in the improvement
of control over the infectious diseases [emphasis
added]...the identification of cigarette smoking as the
major cause of this century’s epidemic of lung
cancer...[and] chronic diseases.. .now constitute the
predominant health problems in this country [9].”
In July of 1971, the New York Times ran an in depth
commentary on a subsequent, related government report
by the national Health Education Committ ee [10]. The
reporter wrote:
American medical science has made spectacular
advances in the last quarter-century, but
improvements in the over-all American death rate
and the infant and maternal mortality rate have
leveled off...In general, Americans are almost
certainly healthier and far less prey to disease than
they were a few decades ago. The dread infections
that used to rage through the whole communities are
muted...Their retreat has been rapid since the advent
of antibiotics and new vaccines after World War
II...In fact, the over-all American death rate declined
steadily from 1900 to about 1950. About then the
improvement slowed to a virtual halt for reasons that
are still obscure.
“This failure to experience a decline in mortality rates
in the United States since about 1950 is little known,
unexpected and extremely important,” according to
Dr. William H. Stewart, former Surgeon General of the
Public Health Service. He blames two factors for this
new trend.
The first of these is the success of the last few decades
in treating infectious disease. The degree of success
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was so marked and so rapid, he believes that there
simply has not been room for enough further
improvement to make dramatic changes in mortality.
The se cond factor, he says, was the emergence of
chronic diseases and accidents as “the great
undertone of mortality” today. These causes of death
are certainly not new, but their impact was less when
so many died of acute infections.”
Thus, due to: 1) the inability to further reduce mortality
from infections in the aftermath of antibiotic availability;
and 2) the rise of chronic illnesses as a cause of mortality,
which was in large part caused by the fact that people were
no longer dying at a young age of infections, Dr. Stewart
and the US Public Health Service made a conscious de-
cision to focus more on chronic illnesses and less on in-
fectious diseases. Such a decision was not only rational, it
wouldhavebeenirresponsiblenottopursueachangeof
focus in the context of the above factors. Nevertheless, the
decision did not reflect a belief that infectious diseases had
been “conquered” and were now irrelevant.
Within two decades, and with no published attributions
in the interim, misperceptions of Dr. Stewart’s view of
infections had already achieved the status of urban legend.
In May of 1989, the National Institute of Allergy and
Infectious Diseases (NIAID) of the National Institutes of
Health (NIH) sponsored the Conference on Emerging
Viruses in Washington D.C. A medical correspondent for
the New York Times covered the meeting and wrote:
“The public has been generally complacent about
[infectious] diseases since the development of
antibiotics and certain vaccines after World War II. One
example of this cited at the meeting was a 1969 speech
by the Surgeon General, Dr. William H. Stewart, who
assured an audience that scientists had probed most
frontiers of knowledge about infectious diseases. Such
attitudes, the scientists said, helped reduce the number
of American researchers working on infectious diseases.
Not surprisingly, the participants at the [NIAID/NIH
conference] deplored this complacency” [11].
This reference in the New York Times is the first
published instance we were able to identify by any of the
used search engines which links Dr. Stewart to a belief
that infectious diseases were no longer a compelling
problem for society. No such references were identified
before 1989 in any format.
A second report regarding the same NIAID conference
was published in Newsd ay in the same month (May
1989). The article began with the following sentence.
“Surgeon General William H. Stewart told Congress in
1969 that it was time to "close the book on infectious
diseases," to declare the war against pestilence won and
to shift national resources to such chronic disease
problems as cancer and heart disease” [12]. The use of
quotation marks represents the first direct attribution to
Dr. Stewart of those precise words. Thus the origin of
this quote can be traced directly to the 1989 conference,
which Dr. Stewart did not attend. So, what was the
source for the quote at the 1989 conference?
Subsequently, a text book chapter, written by one of
the Conference organizers, provides the first actual cit-
ation to the alleged 1969 speech by Dr. Stewart: “The
striking successes achieved with antibiotics, togethe r
with widespread application of vaccines...made many
physicians and the public believe that infectious diseases
were retreating and would in time be fully conquered...it
had become commonplace to suggest that infectious
diseases were about to become a thing of the past and that
chronic, noninfectious diseases should be our major prior-
ities” [13]. The footnote source for the statement in the
text book is a personal communication to the chapter au-
thor regarding a speech given by the William Stewart
as Surgeon General at Johns Hopkins University in
1969, in which he “assured his audience that infectious
diseases were now of marginal interest in the United
States and that we should shift our focus of attention to
the chronic diseases” [14]. The originator of the personal
communication was not present when Dr. Stewart gave
the speech, but had heard about the contents of the
speech from unspecified people who remembered the
speech, which had apparently occurred during the dedica-
tion of a new building at Johns Hopkins University.
After discovering this footnoted personal communication,
we requested the Johns Hopkins Medical Institutions Alan
Mason Chesney Medical Archives to search for records of
speeches given by Dr. Stewart at Johns Hopkins in the
late 1960s. No such speech was identified in 1969. How-
ever, the Archives indeed identified a speech given by
Dr. Stewart as part of the dedication of the Ernest Lyman
Stebbins Building at the Johns Hopkins University School
of Hygiene and Public Health on September 18, 1968 [15].
We have reviewed the content of the 1968 speech. Dr.
Stewart made no statement even remotely implying the
end of infections as a serious threat to public health. How-
ever, he did make statements which are clearly the seeds
from which sprang the urban legend that had matured to
full form by the 1989 NIAID/NIH conference:
Powerful tools have been developed to characterize
these diseases in man and in society—the tools of
microbiology, epidemiology, and biostatistics...means
for preventing or alleviating disease in an individual or
en masse have been developed and applied...and never
before in man's history has a society reached such a
peak of health...
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This success story brings us to the here and now. And
largely as a result of this success story, times have
changed. The purpose of our efforts—the preservation
and improvement of health—can no longer be
measured on the scale of microbiology. Our
exploitation of that science has just about caught up
with the frontiers of public need. Clearly we cannot
turn our backs on microbiology—certain notable gaps
remain in our knowledge and capability, and
maintenance of a vigilant effort will always be
required [emphasis added].
But just as clearly the characterization of health in terms
of microbiology and infectious disease epidemiology
cannot serve as the base for our future endeavors. Rather,
the moving tides of society, which we have helped to
move, are compelling us to redefine our purposes in
quite different terms—the terms of man's adaptation to
his total environment.
Immediately we find ourselves on dark and shaky
ground. This new definition of purpose rests on
sciences much less comfortably exact than
microbiology. We find the familiar equations of one
cause—one disease disappearing into a complex of
multiple causation [15].
These statements indicate that Dr. Stewart was in full
grasp of the critical concepts of public health in the late
1960s. He recognized that more complex scientific tools
would be necessary to reduce mortality from multi-
factorial chronic illne sses than for infections. At the
same time, Dr. Stewart unequivocally recognized that
infections would always remain an important problem,
and that “maintenance of a vigilan t effort [against
infections] will always be required.”
The urban legend becomes ingrained
Two years after the 1989 NIAID conference, the origins
of the quote were reinforced by a different journalist in
Business Week:
“In 1969, buoyed by the defeat of smallpox, polio,
and other infectious ills over the pre vious two
decades , Surgeon General William H. Stewart
declared that science had won the war on
microbes. Medicine, he said, should turn to fighting
chronic ailments such as cancer and heart dise a se.
It did: From 1970 to 1975, as the budget for the
National Institutes of Hea lth more than doubled,
funding for infectious disease research grew by just
20%” [16].
Again, no citation is provided for the quotation, but
given the similarity to the New York Times and Newsday
articles from 2 years earlier, it is highly likely that they
served as the source for the Business Week article.
By the following year, the amalgamation of Dr. Stewart
with the end of infections as a public health threat was
completed when the following statement appeared in a
book chapter written by the same jou rnalist as the
author of the 1989 Newsday article:
“In the 1960s, the world mounted a campaign against
smallpox, eliminating the disease from the planet. With
victory in sight, Surgeon General William H. Stewart
told the U.S. Congress that it was time to "close the
book on infectious diseases," declare the war against
pestilence won, and shift national resources to such
chronic problems as cancer and heart disease” [17].
Once again, the statement has no footnoted source in
the book. An extensive review of congressional records
has failed to identify any speech that Dr. Stewart gave to
Congress during his stint as Surgeon General in which
he claimed the end of infectious diseases had been
achieved. Attribution of such a statement to him appears
to reflect an erroneous conflation of concepts that
Dr. Stewart appropriately discussed in his speech at
Johns Hopkins University in 1968.
Subsequently, the attribution of the quotation to
Dr. Stewart was burned into the consciousness of the
scientific and lay communities by the same author, who
wrote in a subsequent best-selling book published in 1994
that:
“By 1967 U.S. Surgeon General William H. Stewart
would be so utterly convinced of imminent success
that he would tell a White House gathering of state
and territorial health officers that it was time to close
the book on infectious diseases and shift all national
attention (and dollars) to what he termed "the New
Dimensions" of health: chronic diseases [9].” [7]
Note that in this follow up attribution, the same
author has chan ged the date of the quote from 1969 to
1967, has removed the quotation marks likely reflecting
an inabil ity to identify a primary source for the state-
ment, and has changed the venue from Congress to the
meeting of the Association of State and Territorial
Health Officers meeting, which is what reference #9
refers to in that book. Of course, as we have discussed
above, Dr. Stewart made no such statement during that
speech in 1967, the text of which is extant [8].
Conclusion
We can therefore conclude that Dr. Stewart never
promulgated the concept that infectious diseases wa s a
dying field of research and medicine. The urban legend
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around his apocryphal quote resulted from initial
second-hand, oral referencing of statements he made
more than two decades earlier, with no successful identifi-
cation of the transcript of the originating speech. Subse-
quent citations built upon and further inflated the initial
misunderstanding of the speech. That they did so is
understandable, since numerous verifiable sources con-
firm that the belief that infe ctious diseases had been
successfully overcome was pervasive in biomedical
circle s—including among a Nobel Laureate, medical
Dean, and other thought leaders—from as early as
1948, and extending all the way i nto the mid-1980s
[18-24]. Attribution of the infamous quote reflects
collateral damage to Dr. Stewart originating from con-
flation of the legitimate points he made, which became
subsumed within the broader incorrect belief by the med-
ical community at large that infectious diseases had been
conquered. Ultimately, a string of oral communications
without source documentation, followed by publication
with an incorrect citation, gave rise to the full blown
urban legend.
Dr. Stewart should no longer be cited as a source of the
belief that infections had been conquered by modern
medicine. Nor is there need to cite him in this context, be-
cause the point legitimately can continue to be made that
the medical community at large believed that infectious
diseases had been conquered, as evidenced by numerous
other verifiable and compelling references [18-24].
Additional file
Additional file 1: Multilingual abstracts in the six official working
languages of the United Nations.
Competing interest
The authors have no conflicts of interest.
Authors’ contributions
BS and BTB both conceived of and drafted the manuscript. BTB conducted
the primary search for the source of the quote. Both authors read and
approved the final manuscript.
Acknowledgments
The authors would like to thank Andrew Harrison, Material Culture Archivist
at the Alan Mason Chesney Medical Archives of the Johns Hopkins Medical
Institutions for identifying Dr. Stewart’s 1968 speech, and Dr. John
Parascandola, formerly Historian for the Public Health Service, for helpful
discussion.
Author details
1
Los Angeles Biomedical Research Institute at Harbor-University of California
at Los Angeles (UCLA) Medical Center, Torrance, CA, USA.
2
The David Geffen
School of Medicine at UCLA, Los Angeles, CA, USA.
3
University of North
Carolina School of Medicine Chapel Hill, Wilmington, NC, USA.
Received: 10 December 2012 Accepted: 31 January 2013
Published: 18 February 2013
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Cite this article as: Spellberg and Taylor-Blake: On the exoneration of Dr.
William H. Stewart: debunking an urban legend. Infectious Diseases of
poverty 2013 2:3.
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