Interface of epidemiology and history: a commentary on past, present, and future.

Abstract

From time immemorial, epidemics have ravaged the human species. In his book Rats, Lice, and History, Hans Zinsser reviewed the mechanisms by which infectious diseases arise and become epidemic and chronicled their impact on the populations affected (1). By implication, Zinsser also indicated the analogous impact of noninfectious diseases. His analyses revealed a broad range of outcomes, from the interruption of military conquests to the disorganization of nation-states. Furthermore, Zinsser correctly predicted the emergence of epidemic diseases with consequent impact. Thus, as we enter the new millennium, we find ourselves experiencing a great pandemic of a new disease, acquired immunodeficiency syndrome, which is decimating the populations of sub-Saharan Africa and disrupting the health and disease care resources of many other locales. Indeed, it is a truism that epidemics have been major contributors to the course of history and that in the future we will experience further visitations. The epidemiologic literature is replete with reports of particular investigations which led to the identification of etiologic mechanisms and subsequent effects on disease incidence and prevalence in the populations affected. Although there may be some disagreement as to whether epidemiology is truly a science or simply a method (2), most modern epidemiologists consider themselves biomedical scientists investigating a particular paradigm—i.e., the interaction of host, environment, and agent—to explain the occurrence of health and disease in human populations. This commentary examines the historical origins of this science and considers several examples of how it has interfaced with some historical trends.