John Paul was born in Chestnut Hill, Pennsylvania; his father, a lawyer, was Henry Neill Paul and his mother had been Margaret Crosby Butler of New York City.
Paul attended St. George’s School, Newport, Rhode Island, before entering Princeton University in 1911. He elected to go to the Johns Hopkins Medical School, and despite an 18-month absence for service with a military hospital in France he managed to complete his medical studies in the standard 4-year period of an American medical school.
During the immediate post-graduation years he studied pathology at Johns Hopkins, then spent two years as a medical house physician at the Pennsylvania Hospital in Philadelphia. He accepted the offer of Directorship of the Ayer Clinical Laboratory at the Pennsylvania Hospital, in which post he served from 1922 until 1928. During that time he also held teaching and research appointments at the University of Pennsylvania, the Post-Graduate School of Medicine, and Jefferson Medical School.
In 1928 he was offered an assistant professorship in the Department of Medicine at Yale, and began his long association with that Medical School, eventually heading his own section of Preventive Medicine, with the rank of Professor. When he reached the retirement age in 1961 he continued work in the same laboratories as Director of the World Health Organization Reference Serum Bank. After 1966 he was associated with Yale’s History of Science and Medicine Department, where he continued writing until a few weeks before his death.
Paul’s major medical thrust was in the field of clinical epidemiology, which he defined, in his 1938 Presidential Address before the American Society of Clinical Investigation, as follows:
"It is a science concerned with the ecology of human disease. But it is more than that, for any science worthy to be qualified by the name Clinical, should involve some attempt at the interpretation of the circumstances with which it deals. It must face the question ‘why’ as well as ‘how’."
Paul’s approach to the study of disease fully merited that description. He not only made careful clinical observations but went out into the community to determine the circumstances in which illness had developed. At the same time he directed an active research laboratory in which the most modern techniques of microbiology and immunology were brought to bear on the diseases under study.
Although perhaps best known for his studies of poliomyelitis he investigated several other infectious diseases. From the very beginning he studied the association between streptococcal infections and rheumatic fever. By following cases back into their homes he was able to make investigations of the patterns of streptococcal ‘epidemics’ within family groups. His monographs on the epidemiology of rheumatic fever, published in 1930 and 1943, established beyond doubt the aetiological role of the haemolytic streptococcus, and the old controversy concerning this association was settled.
In the course of his immunological investigations of patients with sore throat he chanced upon the heterophile antibody that develops in patients with infectious mononucleosis. That test is still referred to as the Paul-Bunnell test. He conducted many studies of the conditions under which infectious mononucleosis develops, making use of "serological epidemiology", i.e. tracing the occurrence of both clinical and sub-clinical infections, especially among college students. The stored sera he had collected were of the greatest value later to his younger associates when they were able to demonstrate a relationship between that disease and the EB virus.
During World War II he served with the US Armed Forces Epidemiological Board, giving special attention to neurotropic virus infections, infectious hepatitis, sandfly fever and haemorrhagic fever.
Paul’s interest in poliomyelitis was continuous and highly productive. His Yale Poliomyelitis Unit made significant contributions to the understanding of that disease over a 30-year period. This included proof of the frequency of serious illness caused by the virus, evidence for the enteric route of infection, definition of different serological types of the virus, and the demonstration of viraemia in the early phase of infection. His two principal collaborators in the poliomyelitis work were James Trask and Dorothy Horstmann. During the tumult surrounding the development and mass testing of polio vaccines he played a significant role as biologist-statesman. In his retirement he wrote a magnificent book A History of Poliomyelitis, in which he chronicled not only successes and failures but also gave interesting vignettes of the principal characters.
Paul’s field investigations were remarkably diverse. He carried out work in a score of North American states and provinces, as well as in Costa Rica, Cuba, Iceland, Germany, Egypt, Morocco, Israel, Japan and Korea.
Many honours were given him; among these were Fellowship in this College, the U.S. Government Medal of Freedom, the Ricketts Award (University of Chicago), the Phillips Award (American College of Physicians), and the Kober Medal (Association of American Physicians).
His companion throughout this life of remarkable achievement, the former Mary Leita Harlan of Baltimore, survived him.
PB Beeson
[Brit.med.J., 1971, 2, 534; Lancet, 1971, 1, 1080; J. Hist. Med., 1971, 26, 308]