American Journal of Epidemiology
6
Copyright ª 2005 by the Johns Hopkins Bloomberg School of Public Health
All rights reserved
BOOK REVIEW
A History of Epidemiologic Methods and Concepts
Edited by Alfredo Morabia
ISBN 3-7643-6818-7, Birkhäser Verlag, Basel, Switzerland (Website: www.birkhauser.ch),
2004, 405 pp., $119.00 (softcover)
Surprisingly little has been written on the history of
epidemiology. A 1980 volume edited by Abraham Lillienfeld
presents a series of essays, Rosen’s history of public health
covers highlights, and biographies have been written on some
key figures: Snow, Chadwick, Goldberger, and Frost, for
example. Yet, there has not been a single volume that
attempted to cover the topic, nor even a comprehensive
review to recommend to students. Alfredo Morabia has taken
a step toward addressing this gap by bringing together a set of
papers that originated with a 1996 meeting on the history of
epidemiology. The volume begins with his own lengthy
synthesis of the individual contributions, which sweep
broadly across the major themes of epidemiology—study
design, bias, and causation. The essays that follow cover
these and other topics; the authors are epidemiologists,
including some of the field’s most senior leaders, and
historians.
Alfredo Morabia’s lengthy contribution anchors the
volume. He skillfully blends materials from across the
individual chapters to offer a long-needed single paper
on the evolution of epidemiologic methods. His approach
is didactic, combining historical snippets with lessons on
epidemiology. This approach will work for students of
epidemiology but may frustrate those looking for a
flowing, historical account, and of necessity, he cannot
cover any individual topic in depth. He attempts to
characterize the evolution of epidemiology, offering a
four-phase sequence from ‘‘preformal’’ to ‘‘modern’’ and
proposing that there have been qualitative leaps from
phase to phase. Although necessarily arbitrary in its
distinctions among these phases, Morabia’s sequence
indicates that epidemiology is probably at another point
of transition.
The remaining 250 pages present essays, commentaries,
and republication of an 1838 paper by William Farr. As
with most multiauthored volumes, the chapters are mixed
in style, approach, and quality. Readers will find a range
of approaches to documenting the history of epidemiol-
ogy: the detail-based styles of the historian; personal
accounts; and more conventional reviews. The variety
limits the volume, as readers cannot find equal depth of
review across topics, and coverage of some topics would
have benefited from the perspective of unrepresented
disciplines, for example, philosophy, in the example of
causality.
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Some of the chapters sparkle. Richard Doll’s paper on the
cohort study blends the evolution and application of the
design with a recounting of his own seminal contributions in
remembrances that only he could provide. George Com-
stock reviews Frost’s development of cohort analysis and
carefully documents that Andvord had published a similar
analysis of Norwegian data 6 years previously. Farr’s paper,
‘‘On Prognosis,’’ sets out an epidemiologic perspective on
disease survival and its determinants with remarkable
conceptual clarity, particularly considering its 1838 publi-
cation date. The four commentaries that follow guide the
reader in understanding Farr’s early contributions and
document his prominence in setting the foundation for
contemporary epidemiology. Many other papers are note-
worthy: the evolution of the case-control study, an account-
ing of statistical methods in epidemiology, and perspectives
on Snow. Eyler provides a fascinating comparison of the
work of Farr and Snow on cholera, as viewed in the disease
paradigms of their times. Vanderbroucke traces the evolu-
tion of ‘‘the image of John Snow,’’ proposing that this image
has been shaped over time as Snow has been transformed
into the present ‘‘hero of epidemiology.’’ Hardy and
Magnello summarize the methodological work of Pearson,
Ross, Greenwood, and Hill, whose analytical work set
a foundation for modern epidemiology. Greenwood, at the
London School of Hygiene and Tropical Medicine, appre-
ciated the nexus of biology, epidemiology, and statistics and
was Hill’s mentor.
Some contributors took on difficult topics—bias, con-
founding, and causality. These papers draw on the epide-
miologic literature to a large extent without an in-depth
historical perspective. Nonetheless, they offer useful over-
views and biographies for those seeking future insights.
These chapters may be particularly useful for students and
younger epidemiologists who have not witnessed the
evolution of these concepts in recent decades. However,
those of us who are not new to the field can also benefit: I
learned, for example, from Vanderbroucke that historical
uses of the term ‘‘confounding’’ are closely related to
current epidemiologic concepts, as well as from Vineis’s
chronicle of the concept of bias. Causality is covered from
an epidemiologic perspective, but the book would have
benefited by a contribution from a philosopher or histo-
rian of science who has focused on this difficult, but
central, topic. Stellman covers causation in occupational
Am J Epidemiol 2005;161:604–605

epidemiology, an area of inquiry where causal conclusions
have had significant regulatory and legal implications.
This book will be my recommended starting point for
reading about the history of epidemiology. Although patchy
in its coverage, it introduces readers to key figures and the
historical dimensions of central concepts. I hope that the
work of Morabia and his colleagues will be extended into
Am J Epidemiol 2005;161:604–605
Book Review 605
a long-needed, comprehensive accounting of epidemiol-
ogy’s evolution. To paraphrase, ‘‘More history is needed.’’
Jonathan M. Samet
Department of Epidemiology, Johns Hopkins Bloomberg
School of Public Health, Baltimore, MD 21205
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