Tales from the Century: Janet Lane-Claypon and epidemiology
Janet Lane-Claypon pioneered two research methods that today are central to epidemiology, but she doesn’t have the profile of other barrier-breaking female scientists from the first quarter of the 20th century. Katherine Nightingale spotted her name in the first MRC annual report and went in search of information about this trailblazing scientist, admired for her intellect and rigour.
Unsurprisingly, the first MRC annual report, published in 1915, is a rather male affair; the text is littered with Williams, Henrys and Stanleys. Aside from the mildly mysterious “Miss Ferguson” and “a woman bacteriologist” whose identity we may never know, one of the few women mentioned in the report is the physician and epidemiologist Dr Janet Elizabeth Lane-Claypon.
Janet is referenced in the report because she had been funded in that year to bring together and critique all existing research in milk and its ‘hygienic relations’ — its composition, nutritional value and hygienic production. At the time Janet was working as Assistant Medical Inspector to the Local Government Board, having already achieved much in her research career.
She was born in Wyberton, Lincolnshire, in 1877, the daughter of a wealthy banker. In 1898 she entered the London School of Medicine for Women (now part of UCL) gaining a first class Honours degree in 1902, her doctorate in 1905 and her MD in 1910. Her research career followed a winding path, from her more laboratory-inclined doctoral research on the structure and function of the ovary and the hormonal control of lactation, to her later move into public health, during which she advocated breastfeeding and campaigned for better midwifery training.
But Janet is best known for her contributions to epidemiology, the population-level study of the causes of, and patterns in, disease. Between 1907 and 1912, Janet was one of just two women working at the Lister Institute of Preventative Medicine in London (the other being Harriette Chick, another important figure in the early days of the MRC). It was the Jenner Fellowship that she received from the institute in 1908 that allowed her to produce one of her seminal works: the first cohort study. Cohort studies are now a staple of epidemiology, allowing researchers to study health and disease in a defined group of people.
Janet was interested in whether feeding a baby breast milk or cows’ milk would affect his or her growth. To do this she knew she’d need large numbers of children similar in every practical way aside from which milk they were fed. To find these children, she travelled as part of her fellowship to Berlin, and tracked the weights of two groups of children (204 who had cows’ milk and 300 who had breast milk). She found that infants fed with breast milk gained more weight than the cows’ milk group. And in keeping with the careful way she approached her work, she tested for ‘confounding’— verifying that there wasn’t another hidden factor at work that might account for the difference in weight. She compared the wages of the children’s fathers to see whether the social conditions of infants might have played a role (they didn’t).
Between 1917 and 1923, Janet was the Dean of the Household and Social Sciences Department at King’s College for Women, before moving to the Ministry of Health to study cancer epidemiology. In was in this phase of her career that she pioneered the use of the case-control study. Case-control studies look for the causes of a disease by matching a group of people with a condition to a group without it who are similar in other ways. In doing this, researchers hope to pinpoint the differences in lifestyle that might cause a disease.
Janet published a case-control study of women with breast cancer in 1926. She tracked down 500 women with breast cancer and 500 controls — women of similar age and social background but without the disease. Six London hospitals and three in Glasgow took part in the research, and used the 50-question survey Janet developed to gather information about the women’s reproductive health histories. From these Janet concluded that the more children a woman had, the earlier she married and the more she breastfed, the less likely she was to develop breast cancer.
When this research was revaluated in 2010, the authors found that her conclusions match many of the factors recognised in modern times to cause breast cancer.
When epidemiologists write about Janet now, they praise her thoroughness, her exhaustive statistical analyses, and ability and willingness to recognise the limitations and uncertainties in her work. The MRC’s second annual report — published once her monograph on milk had been released — is similarly glowing. “The Committee desire to express their gratitude to Dr Lane-Claypon for the care and skill with which she has marshalled her materials from widely scattered sources of information,” the authors wrote.
Janet married Sir Edward Rodolph Forber, Deputy Secretary at the Ministry of Health, in 1929 at the age of 52. Married women weren’t allowed to work in the civil service at the time, so she retired from professional life. Who knows what she could have achieved if she’d carried on?