Preface

Over the past few decades or so, scholars and the public alike have been made increasingly aware of the role pathogens have played in shaping the history of humankind - an awareness now underscored by Quincentenary literature and exhibitions, which depict disease as a potent ally of the Spanish explorers and conquerors of the Americas. Certainly the swath that disease cut into the ranks of the Indians, and the chain of events the thinning of those ranks set in motion, constitute a vivid example of the importance of epidemiology in the unfolding of the historical process - a process that quickly spilled over from the Western Hemisphere to influence profoundly events in Africa, Europe, and ultimately the entire globe.

Yet this example, however compelling, can be as misleading as it is instructive when it creates the impression that the forces unleashed by pathogens in the Americas were products of circumstances that render them discrete. In fact, as the pages that follow demonstrate, pathogens have wielded (and are wielding) a similar dramatic and decided power over the history of all peoples everywhere throughout the whole of humankind's stay on the planet.

To make such a demonstration in substantial detail and from many different angles is one of the major purposes of this work. Another is to provide a place to start for others who wish to elaborate a biological dimension for their own research. A final purpose is to encapsulate what this generation knows or thinks it knows about disease and history as an artifact for generations to come.

One of the most striking features of world health today that scholars of those generations (as well as our own) will doubtless struggle to explain is the widely varying differences in infant, child, and adult mortality rates from region to region (as well as within regions) and the causes that generate those rates. In those less developed areas that embrace the majority of the world's population, the diseases that winnow human ranks remain, for the most part, the very killers that brought death to distant ancestors. In the world's more developed portions, however, new maladies of old age, such as heart diseases, cancer, and Alzheimer's disease, have supplanted communicable and deficiency diseases as the greatest outlets of human life.

Such differences confront us with political, economic, social, and certainly moral questions-questions that make the study of health in the less developed world a very pressing matter indeed. For this reason we have endeavored to bring the epidemiological history of that world right up to the present. Yet because of a certain "sameness" in the history of disease of the developed countries we felt no such obligation, but rather permitted these regional treatments to "trail off" and let topical entries such as "Alzheimer's Disease," "Concepts of Cancer," "Concepts of Heart-Related Diseases," and the like continue the story into the twentieth century.

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