Introduction

Between 1860 and 1864, August Hirsch published his monumental Handbuch der historisch-geographi-schen Pathologie in two volumes. In 1881 he finished an introduction to an updated edition, which Charles Creighton translated from German into English. This opus, published by the New Sydenham Society in three volumes, appeared during the years 1883 to 1886 and was entitled Handbook of Geographical and Historical Pathology. The Handbook represented a Herculean effort to detail the distribution of diseases of historical and geographic interest in time and in place.

Our work represents a similar undertaking, but with a major difference. In the second half of the nineteenth century, the dawn of germ theory, it was still possible (as Hirsch proved) for an individual working alone to produce a compilation of this sort. Today even the contemplation of such an attempt boggles the mind. The Cambridge World History of Human Disease project was launched in 1985 as a collective effort of some 160 social and medical scientists to provide at the close of this century something of what the Hirsch volumes provided at the end of the preceding century. We hope that, like the Hirsch volumes, our own effort will aid future students of health and disease in grasping our present-day understanding of diseases in their historical, spatial, and social dimensions.

Another important purpose of the project is to make available an understandable and accessible history of disease to social scientists and humanists in their many varieties. As historians, geographers, anthropologists, and other researchers have become increasingly aware of the importance of adding a biological dimension to their work, they have found the usual medical tomes, with their unfamiliar ter minology and concepts, daunting indeed. We do not, however, ignore the needs of specialists in the many fields our work encompasses. Most of the following essays have been written by specialists, and all have been refereed by one or more of our board members, who are also specialists.

Parts I Through VIII

Part I of the work presents the major historical roots and branches of medical thought from ancient times to the twentieth century, and introduces the reader to the interplay of human migration, epidemiology, and immunology. Some may be interested to learn that despite popular notions about the antiquity of Chinese medicine, it actually trailed behind medicine in the West as a systematic discipline.

Part II deals with concepts of disease in the East and in the West, as well as with concepts of complex physical and mental ailments, the emphasis being on how those concepts have changed over time. As medicine has become more a science and less an art, it has helped to tame yesterday's plagues, which capriciously brought sudden death so frequently to so many. As a result, many now have the questionable privilege of living long enough to develop cancer or heart-related illnesses, which have supplanted infectious disease and malnutrition in the developed world as the most important causes of death. Increasing life expectancy has also contributed to the growth of that branch of medicine that deals with disorders of the mind and that, as Vern Bullough points out, has tended over time to appropriate for itself the right to decide what is deviant in sexual as well as other matters.

Some chapters in Part III deal with the inheritance of disease. Certainly one can inherit genetic diseases just as one can inherit disease immunities. Some disease immunities are acquired, but even these can be viewed as a heritage of the disease environment of one's birth. Children "inherit" what might be considered special illnesses because of their age, and the heritage of human-modified environments has frequently been famine, illnesses of malnutrition, and illnesses triggered by occupation. In addition, the "heritage" of habits can often produce illness, as is made clear in the essays on substance abuse and tobaccosis (along with those on cirrhosis and emphysema in Part VIII). The remaining chapters of Part III deal with efforts outside mainstream medicine to prevent and control disease; these include public health projects and the rise of chiropractic - a system of alternative medicine.

Part IV is essentially demographic. It focuses on measuring the health of various groups by nutritional status, by morbidity, and especially by mortality. An extremely important contribution of this section derives from the methodological questions that are raised.

The following three parts provide regional histories of disease around the globe from prehistory to the present. Part V concentrates on Europe, the Middle East, Africa, and most of the Americas, whereas Part VI is devoted to Asia. We have employed two types of historical division in these sections -Western idiosyncratic divisions in Part V and the more straightforward (and convenient) divisions of "ancient," "premodern," and "modern" for Asia in Part VI. Part VII completes the regional treatment by presenting a larger picture of changing disease ecologies. In addition to encapsulating the more detailed discussions of Europe, the Americas, Africa, and Asia that appear in Parts V and VI, this section deals with two more geographic areas —the Caribbean and Australia/Oceania. Because of their diversity and relatively small populations, they were omitted from the history sections.

Collectively, the essays in Parts V through VII reveal how much more is known about the history of disease in Europe and the Americas than in the rest of the world. There are a number of reasons for this, but three stand out. One is that anthropologists and other investigators of diseases that afflicted our distant ancestors have been considerably more active in the West than elsewhere. The second is that Western medical observers have historically been more empirically oriented than their philosophically inclined counterparts elsewhere. The third reason is that Western observers have had greater opportunities to observe a greater variety of illnesses. From the Renaissance onward, increasing urbanization created more and larger breeding grounds for disease in Europe. In addition, the expanded travel of Europeans into the larger world - travel fraught with pathogenic peril - introduced them to still more diseases. All of this seems to have stimulated a compulsiveness in the West to give names to illnesses, which was not shared by medical practitioners elsewhere.

Part VIII discusses the history and geography of the most notable diseases of humankind in alphabetical order, from AIDS through yellow fever. Most essays are divided by the subheadings definition, distribution and incidence or prevalence, epidemiology, etiology, clinical manifestations and pathology, and history and geography. However, because of the variable nature of illnesses, some essays are organized in a way that is more suitable to the topic under discussion.

In Part VIII readers will encounter some disease entities discussed under archaic names, because they occur with some frequency in historical works. In certain cases we know what disease entity or entities they were intended to describe. The term catarrh, for example, was used in the past (and occasionally is still used) to label a variety of conditions that produced an inflamation of the mucous membranes of the head and throat. In other instances, such as chlorosis, which was proabably often anemia, we kept the name because it specifically signifies a "disease" recognized in the past as one that struck mostly young women. However, in the case of other ephemeral diseases such as sweating sickness, typhomalarial fever, and the plague of Athens, we had no choice but to use the archaic terms because to this day we can only guess what they were.

Most of these ailments are found in Hirsch under their now archaic names. He did not, of course, discuss AIDS or other newly discovered, extremely deadly infections such as Ebola virus disease, Lassa fever, or Legionnaires' disease, or illnesses such as Alzheimer's disease that were not recognized as specific clinical entities when Hirsch wrote. Others, however, like poliomyelitis are treated in his work under a different name (in this case, epidemic cerebrospinal meningitis). Indeed, what is striking about a comparison of the illnesses discussed in our volume and those dealt with by Hirsch is how few diseases have disappeared and how few new ones have arisen to take their places in the century that divides the two efforts. Perhaps most striking of all, however, is the change in emphasis. When Hirsch wrote, the world was still ignorant of the causes of epidemic diseases. Today, it is the chronic diseases such as cancer, Alzheimer's disease, and heart-related ailments about which we are most ignorant.

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