A BSTRACT : In this paper we trace the history of epidemiology from 1800 to the present time. The history is highly selective because our purpose is to illuminate the evolving relationship of epidemiology with demography. We first describe the common "prehistory" of these two disciplines in the early nineteenth century, and then describe their divergence during three successive eras of epidemiology up to the end of the twentieth century. In the final section, we draw attention to exceptional individuals who bridged the two disciplines despite the historical trend in the other direction, and express our hope that recent signs of convergence in the face of globalization and the AIDS pandemic will be borne out during the coming decades.
K EYWORDS : epidemiology; history
PREHISTORY OF EPIDEMIOLOGYThe earliest attempts to quantify changes in the size and health of populations extend at least as far back as John Graunt, who used the Bills of Mortality kept in England in the seventeenth century. 1 By the eighteenth century, some Scandinavian countries were recording numbers of births and deaths, and by the turn of that century, the population registers established by Napoleon provided a base for collecting vital statistics in other European countries. It was in England during the midnineteenth century, however, that the process was first articulated, systematized, applied to a large population, and used to draw implications for health policy. [2][3][4][5][6] Thus, we must look to England during the period of the Industrial Revolution in order to understand how the foundations were laid for the modern disciplines of epidemiology and demography.We refer to the period before 1850 in England as the "prehistory" of epidemiology and demography. By 1850 in England, the census was well established, Parliament had legislated sanitary reform, and vital statistics were being used to support inferences about population growth, patterns of health and disease, and public health policy. Therefore, by mid-nineteenth century, epidemiology and demography were recognizable, although not labeled as such.