© Jones & Bartlett Learning LLC, an Ascend Learning Company. NOT FOR SALE OR DISTRIBUTION. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett© Kevin Eaves/Shutterstock Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION CHAPTER 2 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC HistoricNOT FOR Developments SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC in EpidemiologyNOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION OBJECTIVES © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALEAfter OR completing DISTRIBUTION this chapter, you will be able to: NOT FOR SALE OR DISTRIBUTION ■ Describe important historic events in the field of epidemiology. ■ List and describe the contributions made by several key individuals to epidemiology. ■ Recognize the development and use of certain study designs in the advancement of epidemiology. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION he history of epidemiology has involved of the natural course of disease to a knowledge of the many key players who sought to understand probable causes, modes of transmission, and health and explain illness, injury, and death from an outcomes; and from no means for preventing and Tobservational scientific perspective. These individuals controlling disease to effective approaches for solving © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC also sought to provide information for the preven- public health problems. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION tion and control of health-related states and events. Initially, epidemiologic knowledge advanced They advanced the study of disease from a super- slowly, with large segments in time where little or natural viewpoint to a perspective based on a scien- no advancement in the field occurred. The time tific foundation; from no approach for assessment to from Hippocrates (460–377 BCE), who attempted © Jones & Bartlettsystematic Learning, methods for LLC summarizing and describing© Jones to &explain Bartlett disease Learning, occurrence LLC from a rational view- NOT FOR SALEpublic OR health DISTRIBUTION problems; from no clear understandingNOT FORpoint, SALE to John OR Graunt DISTRIBUTION (1620–1674 CE), who described © Jones & Bartlett Learning LLC, an Ascend Learning Company. NOT FOR SALE OR DISTRIBUTION. 18 Chapter 2 Historic Developments in Epidemiology © Jonesdisease & Bartlett occurrence Learning, and death LLC with the use of system- © Jonesshould be& Bartlettexamined Learning,and advised LLCthat the source of atic methods and who developed and calculated life water should be considered.1–4 He asked questions NOT FOR SALE OR DISTRIBUTION NOT FORtables SALE and ORlife expectancy,DISTRIBUTION and Thomas Sydenham such as, “Is the water from a marshy soft-ground (1624–1689), who approached the study of disease source, or is the water from the rocky heights? Is the from an observational angle rather than a theoretical water brackish and harsh?” Hippocrates also made one, was 2,000 years. Approximately 200 years later, some noteworthy observations on the behavior of the William Farr (1807–1883)© Jones advanced & Bartlett John Graunt’s Learning, populace. LLC He believed the effective© Jones physician & Bartlett should Learning, LLC work to better describe NOTepidemiologic FOR SALE problems; OR JohnDISTRIBUTION be observant of people’s behavior,NOT FOR such SALEas eating, OR DISTRIBUTION Snow laid the groundwork for descriptive and analytic drinking, and other activities. Did they eat lunch, eat epidemiology; Robert Koch and Louis Pasteur pro- too much, or drink too little? Were they industrious? vided scientific evidence for germ theory; Ignaz Sem- Hippocrates suggested that traveling physicians melweis© discoveredJones & thatBartlett handwashing Learning, standards LLC in become familiar© Jones with local& Bartlett diseases Learning, and with theLLC obstetrical clinics could reduce the incidence of puer- nature of those prevailing diseases. He believed that as NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION peral fever; and Florence Nightingale showed that time passed, the physician should be able to tell what certain environmental conditions (e.g., fresh air, light, epidemic diseases might attack and in what season, cleanliness) could improve recovery among patients and that this could be determined by the settings of in hospitals. In the early 1900s, Edgar Sydenstricker the stars. Sources of water, smells, and how water sets © Jonesclassified & Bartlett morbidity Learning, statistics LLC to improve the value of © Jonesor flows & were Bartlett always Learning,considered in LLC his study of disease NOT FORthis SALE information OR DISTRIBUTION and conducted community health NOTstates. FOR1–4 SALE OR DISTRIBUTION surveys to provide valuable public health information; Hippocrates identified hot and cold diseases and, Janet Lane-Claypon developed study designs for iden- consequently, hot and cold treatments. Hot diseases tifying risk factors for breast cancer; Alice Hamilton were treated with cold treatments, and cold diseases pioneered the field of ©toxicology; Jones & and Bartlett Wade Learning,Hamp- required LLC hot treatments. The© Jones process & of Bartlett deciding Learning, LLC ton Frost showed that epidemiology is an analytical whether a disease was hot or cold was complex. An NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION science closely integrated with biology and medicine. example is diarrhea, which was considered a hot dis- Since then, the science of epidemiology has rapidly ease and was believed to be cured with a cold treat- progressed. Although it is impossible to identify all ment, such as eating fruit.1–4 the contributors to the field of epidemiology here, sev- Hippocrates also ascribed to and incorporated eral of ©these Jones individuals & Bartlett and their Learning, contributions LLC are into his theory© Joneswhat is &now Bartlett considered Learning, the atomic LLC consideredNOT in FOR this chapter. SALE OR DISTRIBUTION theory—thatNOT is, the FOR belief SALE that everything OR DISTRIBUTION is made of tiny particles. He theorized that there were four types of atoms: earth atoms (solid and cold), air atoms (dry), ▸ Hippocrates, the First fire atoms (hot), and water atoms (wet). Additionally, Epidemiologist Hippocrates believed that the body was composed of © Jones & Bartlett Learning, LLC © Jonesfour humors: & Bartlett phlegm Learning, (earth and LLCwater atoms), yel- NOT FORHippocrates SALE OR was DISTRIBUTION a physician who is commonly NOTlow FOR bile (fireSALE and OR air DISTRIBUTIONatoms), blood (fire and water regarded as the father of medicine. He may also be atoms), and black bile (earth and air atoms). Sickness thought of as the first epidemiologist. In his three was thought to be caused by an imbalance of these books, Epidemic I, Epidemic III, and On Airs, Waters, humors, and fever was thought to be caused by too and Places, he attempted© Jonesto describe & Bartlett disease from Learning, a much LLC blood. The treatment for© fever Jones was &to Bartlettreduce the Learning, LLC rational perspective ratherNOT than FOR from SALE a supernatural OR DISTRIBUTION amount of blood in the body throughNOT FOR bloodletting SALE ORor DISTRIBUTION basis. He observed that different diseases occurred the application of bloodsuckers (leeches). Imbalances in different locations. He noted that malaria and yel- were ascribed to a change in the body’s “constitution.” low fever most commonly occurred in swampy areas. Climate, moisture, stars, meteorites, winds, vapors, It was not known, however, that the mosquito was and diet were thought to cause imbalances and con- responsible© Jones for such & Bartlettdiseases until Learning, Walter Reed, LLC MD, tribute to disease.© Jones Diet was & Bartlettboth a cause Learning, of and a cure LLC a U.S. NOTArmy FORphysician SALE working OR DISTRIBUTIONin the tropics, made for disease. CuresNOT for FOR illness SALE and protection OR DISTRIBUTION from dis- the connection in 1900. Hippocrates also introduced ease came from maintaining a balance and avoiding terms like epidemic and endemic.1–4 imbalance in the constitution. Hippocrates gave advice to people wishing to pur- The essentials of epidemiology noted by Hippo- © Jonessue & theBartlett science Learning, of medicine LLCand provided insights on © Jonescrates included & Bartlett observations Learning, on how LLC diseases affected NOT FORthe SALEeffects ORof the DISTRIBUTION seasons of the year and hot and cold NOTpopulations FOR SALE and ORhow DISTRIBUTION disease spread. He further winds on health. He believed the properties of water addressed issues of diseases in relation to time and © Jones & Bartlett Learning LLC, an Ascend Learning Company. NOT FOR SALE OR DISTRIBUTION. The Epidemiology of Scurvy 19 © Jones & Bartlettseasons, place,Learning, environmental LLC conditions, and disease© Jones Sydenham & Bartlett published Learning, his observations LLC in a book in control, especially