Epidemiology, History of

Student: What is epidemiology, father?

Teacher: It is all things to all men, my son … The plethora of definitions is the very heart of the problem … a structure sturdy enough to … shelterphysicians, dentists, veterinarians, and nurses; very small (micro) biologists and fat chemists; mammalogists, bugmen, birdmen, and spacemen; traffic directors and city planners; engineers mechanical, sanitary, electrical, stationary, and human; sociologists, psychologists, and anthropologists, cultural and otherwise … everything!

—Anonymous (1963)

The preceding satirical barb from 1963, titled ‘Epidemi(olog)2y ∗,’ goes on to define epidemiology (‘or epidemiologology’) in circular fashion as ‘simply the study of epidemiology,’ and hints at why a comprehensive history of the subject has neither been written nor, apparently, even attempted. From the vantage point of 2007, looking back over the past few decades, it appears that epidemiology has further expanded in breadth from the diffusion satirized in 1963. Moreover, it has become increasingly absorbed in methods, mathematics, and models; some critics have charged that it has reached its limitations and is spending too much time nibbling at the edges of public health rather than solving the big problems. It is thus hard to escape confusion about epidemiology's identity and origins. Like the different branches of a tree bending down to examine shared roots, the question can be seen from different vantage points leading to different conclusions about what epidemiology is, what its core techniques are, what constitutes epidemiologic practice, who is and who is not a practitioner of epidemiology, and so on. Moreover, borrowing Thomas Huxley's description of science, it seems that fundamentally epidemiology is ‘nothing but trained and organized common sense’ (1854). Tracing the history of commonsensical solutions to health problems in populations is a subject so broad and so all-encompassing that it becomes almost impossible to grasp in toto.

This entry is thus focused narrowly on tracing the roots of core and traditional epidemiologic activities such as those canonized by epidemiology textbooks—notably, disease surveillance, outbreak investigation, and discovery of disease etiology and modes of transmission/acquisition. In this effort, we are led disproportionately to the infectious diseases, which have been the principal shapers of epidemiologic endeavor almost up to the present time, placing less emphasis on, for example, chronic and behavioral conditions, and their relatively newer and still-evolving methodologies.

The term epidemiology came into being, or at least came to have its modern meaning only fairly recently, at about the same time medical science began to appreciate that communicable diseases might actually be infectious and that such infections not only were not distributed randomly in populations but that their specific patterns of ‘nonrandomness’ constituted powerful etiologic clues. These important realizations seem to have been formed around the time of the second cholera pandemic in Europe (1831–1832). Conveniently for historical purposes, the term epidemiologie or e´pide´miologie begantobeusedinthe modern sense in Germany, France, the Netherlands, and probably other countries as well, at around the same time, apparently coming to the English-speaking [Page 318]world a decade later. The eventful year of 1832 also saw the first proposal to establish an academic chair in epidemiology, reflecting a greatly heightened awareness of the importance of systematic and quantitative study of epidemics. In examining the history of epidemiology in both before and after its ‘birth’ in a recognizable form, it is necessary to avoid the sin of ‘presentism’ (imputing to past observers modern concepts and terms of which they were not aware). Therefore, the terms proto-epidemiology and epidemiology have been used here to refer to epidemiologic efforts and their antecedents occurring, respectively, before and after the period in which recognizably modern epidemiologic concepts and terms came into common use.

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