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We can consider the ecology of disease to be the sum total of all the influences on pathogens and their hosts and, because of the interdependence of the two for disease expression, the internal structures and systems of both that bear upon a disease question. Thus we are clearly considering a structure of relations whose complexity surpasses all comprehension. Such may also be said of a single disease. No one has yet fully defined all that constitutes the expression of even one disease, and such an explanation would be its ecology. To describe the disease ecology of Europe is a task at first so daunting as to admit no possibility. Still, there are a few aspects of the ecology of disease in Europe that can be described, if without claim to completeness or ultimate value, at least with an eye to creating a target for more detailed studies and criticism.

With such cautions in mind, I should like to offer a few general comments on human disease and its expression, and then set forth a very limited number of aspects of the totality of my subject, which I feel can be discussed. For most of the sojourn of humankind on Earth, we have only skeletal remains upon which to build any concept of disease in the past. Even after the advent of agriculture and the earliest civilizations, we have little upon which to develop a coherent view. General trends are perceptible in classical times, and very sketchy numbers can be offered for population in the late medieval period. Modern times have, of course, brought masses of statistics, but these as often confuse as enlighten. Still, it is possible, at least, to discern some of the impact of disease upon demography and to infer some aspects of the influences that played upon certain diseases. Because it is so difficult to identify diseases in the past, I confine myself largely to the specific diseases of plague, leprosy, tuberculosis, and smallpox. Otherwise, the influence of epidemic disease of unknown type will be the other main consideration, along with some presumed diseases of childhood. There is at least some reason to feel that the four specific diseases may be identified as factors in human demography in the past, as can epidemic and endemic diseases whose exact nature is unidentifiable.

All human populations share some common features, and European populations carry some particular features, which can help us at least conjecture about factors influencing the expression of disease. For example, about 105 males are born per 100 females (Russell 1977). Although malnutrition can cause disease, major population losses do not necessarily reflect malnourishment (Wilson 1957; Wrig-ley 1962; Rotberg and Rabb 1983). Certainly the diseases of postindustrial society are those of an abundance of food. Despite the fascination since ancient times with food as a cause, predisposing factor, and therapeutic agent in disease, very little is actually known about the relationship between food and health beyond the effects of some vitamin-deficient states, and full-blown protein-energy malnutrition.

The ability of human populations to replenish themselves is limited. A birthrate above 50 per 1,000 population per year is truly exceptional, and above 30 is quite uncommon (Wrigley 1962). There are well-known age and sex predilections for a variety of diseases, but they are as etiologically obscure as they are epidemiologically well documented (Wilson 1957). For example, although infants are extremely susceptible to tuberculosis, children between the ages of 5 and 15 exhibit a relative immunity to the disease. Then a sex predilection occurs, with women much more commonly the victims from about 25 years up to around age 45, at which time men are the predominant victims of the disease until late in life (Wilson 1957). These observations are based on data gathered mainly in the British Isles during the nineteenth century, but no one knows the extent to which they represent the result of metabolic versus environmental factors in pathogen and host. It is also generally

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