Lives of the fellows

Abraham Manie Adelstein

b.28 March 1916 d.18 October 1992
MB ChB Wits(1940) DPH(1947) MD(1951)FFCM(1973) MRCP(1974) FRCP(1977)

William Farr was the first and Abe was the eighth Chief Statistical Medical Statistician for England and Wales. In his 40-year tenure beginning in 1839, Farr created the first great model for national health statistics in the world. Of those who succeeded Farr, Abraham Adelstein made perhaps the greatest contribution to the further evolution of the British system. The reprint of the 1885 memorial volume for Farr bears the marks of Abe’s veneration for his illustrious predecessor. In Abe's own 14 year tenure he forged new links between national registration systems and mortality statistics and generated new ways of using them.

Abe Adelstein was born in South Africa and known as Abie to his family, who were Jewish immigrants from the Baltic seaboard. He was reared in the Afrikaner farming country of the Eastern Transvaal where his father, Nathan Adelstein, was a miller. He was educated at the Marist Brothers College in Johannesburg and later entered the University of Witwatersrand to study medicine. After a brief internship at Johannesburg General Hospital, he volunteered for service as a medical officer in the South African Medical Corps. After demobilization, he returned to the Witwatersrand medical school for postgraduate studies in public health and statistics, obtaining his DPH. In 1960, the writer - then in Manchester - was asked by C Fraser Brockington to find a candidate for the post of lecturer in medical statistics. Richard Doll, now Sir Richard, suggested the name of Abe Adelstein, who had been a colleague at the School of Hygiene and Tropical Medicine. Abe wished to relinquish his job with the South African Railways, where he was director of research and medical statistics, as despite his major contributions to the safety of workers he was in fundamental opposition to the government he served and could no longer live with apartheid. Doll assured us that among the young acolytes of Austin Bradford Hill (q.v.) in the early 1950s - not excluding himself - Abe had been the best statistician of all. With that recommendation no South African emigré mafia was needed to secure him the job. Fraser did not hesitate. It was a happy department and it was not long before this quiet, unassuming man had established himself as the Socratic mentor to us all - from the most junior member to the professor. At that time the hazards of low dose radiation were little understood and a member of the department of haematology was highly excited by a presumed clinical discovery; he had found that polycythemia vera was cured by a new treatment with radioactive phosphorus but that survival only opened the way for leukaemia to which the polycythemia was predisposed. ‘How do you know that your treatment itself is not killing them?’ asked Abe. A year of two later, Abe’s diagnosis was confirmed by studies in the USA.

Always open to ideas, Abe readily shared his own sage insights. Nothing more resembled the Socratic dialogues than periodic visits to his office - because of what he asked rather than what he said: Should we put birth weight on the birth certificate? What are the best ways to link death certificates to data in life experience? How should we monitor birth defects? What about the rise in children’s asthma mortality? Reflective questions like these were the prelude to significant innovations in the vital statistics system. At the centre of all this were guiding convictions. Abe held a Marxian and Rousseau-like view that societies mould the health and the ills of their members. He also believed that we could change states of health by changing the social and physical environment. Although he was a sensitive and biological realist the precepts of public health were deep in his understanding and underlay all his words and acts.

Nothing better illustrates Abe’s thinking than his classic early paper ‘Accident proneness: a criticism of the concept based upon an analysis of shunters’ accidents’ [J.roy Stat.Soc.,1952;CXV:Part 3]. That 40-year old paper is still a required citation in any scholarly work on the subject. In 1963 he published a major study of coronary heart disease mortality in South African railway workers. He also collaborated with D Y Downham, Z Stein, and the writer in the first substantial population-based study on the incidence of diagnosed mental disorder. Among other things, the analysis showed clearly that involutional melancholia was largely a myth that rested on the impression gained from recurrences of depressive illness with increasing age.

The years at Manchester forged a deep and enduring friendship. Abe was a man one loved not only for his sharp, uncompromising analytical mind but also for his wisdom and humanity. He was calm, kind, generous, loyal and endlessly helpful. From 1956 onwards he endured successive and sometimes arcane chronic disorders: he survived several near fatal episodes, including cardiac arrest on the operating table. Yet what was more remarkable was his hold on life and work - if he could rise from his bed he would not fail to appear at his desk; there to display a tranquility that seemed never to desert him while at work or with friends. Manchester passed up at least two opportunities to appoint Abe to a chair, but in doing so the country gained. Late in 1966, Abe was asked to apply for the post of chief statistical medical officer at what was then the General Register Office, now the Office of Population Censuses and Surveys. It seemed then to be a perfect match- and so it turned out to be. One highly original aspect of the links he forged between national registration systems and mortality statistics was the longitudinal study of mortality in a 1% sample of the national census so that all the demographic data of the census could be brought to bear in clarifying a host of epidemiological issues in mortality, not least the role of social class, migration and employment. Abe Adelstein was a private man; he achieved through collaboration not conflict. He was able to transcend class, disciplinary and ethnic boundaries, and enable those with whom he had dealings to achieve their potential. He married Cynthia née Miller in 1942 and they had two children. Through all his health problems he was sustained by the love of many friends - but particularly by his wife.

M W Susser

[Brit.med.J., 1992,305,1358; The Independent, 3 Nov 1992;The Guardian, 27 Oct 1992; J.Epidem.& Comm.Health, 1993,47,no.1,Editorial]

(Volume IX, page 3)

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