The Development of Modern Epidemiology: Personal Reports from Those Who Were There (review)

Epidemiology is still young as a formal scientific discipline. Its existence as an academic entity in the United States can be dated to the appointment of Wade Hampton Frost to the Johns Hopkins School of Hygiene and Public Health in 1918 and his subsequent founding of the school’s Department of Epidemiology. The methods of epidemiology were largely developed over the last century, particularly during its last half when the scope of epidemiological inquiry was broadened beyond infectious diseases to cover the rising epidemic of chronic diseases, particularly cancer, cardiovascular diseases, and chronic lung diseases. Today, epidemiology is viewed as one of the core disciplines of public health. To date, the rise of epidemiology as a scientific discipline has not been fully described. Several epidemiologists have written about epidemiology’s history—Lillienfeld in the past and Morabia more recently—and several key figures have been well chronicled, particularly John Snow. However, a comprehensive historical analysis, particularly one that addresses the interplay among science, policy, and public health, remains to be written.

This new book, developed by the editorial team of Holland, Olsen, and Florey for the International Epidemiological Association, provides a start toward that needed history by capturing accounts from epidemiologists about the origins of the field. The authors were asked to provide personal stories about their involvement in the field and to cover specific topics grouped within themes related to history, diseases, methods and applications, and regions and countries. The book’s development was timely, as it includes contributions from epidemiologists whose careers span the period from the field’s blossoming in the 1950s to now: Henry Blackburn, Lester Breslow, George Comstock, Richard Doll, John Pemberton, and Mervyn Susser, for example. The editors were also comprehensive in their selection of authors, including epidemiologists from developed and developing countries.

Not surprisingly, the chapters are mixed in their scope, approach, and quality. Some, authored by pioneering epidemiologists, superbly capture the rise of fields within epidemiology; the careers of several authors, in fact, spanned much of the history of these fields—Richard Doll and cancer epidemiology and George Comstock and tuberculosis epidemiology, for example. We are fortunate that the book captures the accounts of these recently deceased epidemiologists, both active into their 90s. Other chapters on particular areas of epidemiology are also highly informative, again reflective of the long experience of the authors: chapters on social epidemiology, cardiovascular epidemiology, respiratory disease epidemiology, and infectious diseases epidemiology.

In describing the rise of epidemiology, the editors include contributions on the methodology of the field and on its development within specific countries. This approach has fragmented the broader picture of the field’s evolution, which has been interdisciplinary and transnational. Varying and sometimes replicative accounts of the development of epidemiological methods are offered, and linkages are not made to the parallel developments in biostatistics that enabled the analysis of increasingly complex data. Some of the chapters on particular countries and regions focus largely on particular epidemiologists and their studies or on institutions without placing internal happenings within the broader context of the field’s overall development.

Historians may find many of the contributions to be lacking in depth of documentation and of contextual analysis. They need to approach the book with the recognition that it was written for epidemiologists and students in epidemiology and not for historians. However, some of the accounts are important for their documentation and for capturing the views of a leading group of epidemiologists. For epidemiologists, I recommend a selective reading of the book; find those chapters that are relevant to your interests, but do not skip the contributions by the field’s founders.

I still await the single volume on the history of epidemiology that I can give to my students and younger faculty. My generation of epidemiologists, who began their careers in the 1960s and 1970s, was fortunate to have...