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{"id":49051,"date":"2024-12-19T11:00:04","date_gmt":"2024-12-19T16:00:04","guid":{"rendered":"https:\/\/circulatingnow.nlm.nih.gov\/?p=49051"},"modified":"2024-12-19T11:04:45","modified_gmt":"2024-12-19T16:04:45","slug":"why-epidemiology-should-have-been-first-discovered-in-china-but-wasnt","status":"publish","type":"post","link":"https:\/\/circulatingnow.nlm.nih.gov\/2024\/12\/19\/why-epidemiology-should-have-been-first-discovered-in-china-but-wasnt\/","title":{"rendered":"Why Epidemiology Should Have Been First Discovered in China but Wasn\u2019t"},"content":{"rendered":"<p>Circulating Now<em> welcomes Alfredo Morabia,<\/em> <em>to share some thoughts on the history of epidemiology. Dr. Morabia, is Editor in Chief of the American Journal of Public Health. He is also a recipient of an <a href=\"https:\/\/www.nlm.nih.gov\/ep\/GrantPubs.html\">NLM Grant for Scholarly Works in Biomedicine and Health<\/a> (G13) supporting his 2023 publication<\/em> <a href=\"https:\/\/catalog.nlm.nih.gov\/permalink\/01NLM_INST\/1o1phhn\/alma9918469386906676\">The Public Health approach: Population Thinking from the Black Death to COVID 19<\/a><em>.<\/em><\/p>\n<figure id=\"attachment_51413\" aria-describedby=\"caption-attachment-51413\" style=\"width: 400px\" class=\"wp-caption alignright\"><a href=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2024\/12\/Graunt_Observations-Bills-Mortality_2356015R.jpg?ssl=1\"><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" data-attachment-id=\"51413\" data-permalink=\"https:\/\/circulatingnow.nlm.nih.gov\/2024\/12\/19\/why-epidemiology-should-have-been-first-discovered-in-china-but-wasnt\/graunt_observations-bills-mortality_2356015r\/\" data-orig-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2024\/12\/Graunt_Observations-Bills-Mortality_2356015R.jpg?fit=856%2C1200&ssl=1\" data-orig-size=\"856,1200\" data-comments-opened=\"1\" data-image-meta=\"{"aperture":"0","credit":"","camera":"","caption":"","created_timestamp":"0","copyright":"","focal_length":"0","iso":"0","shutter_speed":"0","title":"","orientation":"1"}\" data-image-title=\"Graunt_Observations-Bills-Mortality_2356015R\" data-image-description=\"\" data-image-caption=\"<p>Natural and Political Observations, Mentioned in a Following Index, and Made Upon the Bills of Mortality, John Graunt, 1662.<br \/>\nNLM #2356015R<\/p>\n\" data-medium-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2024\/12\/Graunt_Observations-Bills-Mortality_2356015R.jpg?fit=214%2C300&ssl=1\" data-large-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2024\/12\/Graunt_Observations-Bills-Mortality_2356015R.jpg?fit=730%2C1024&ssl=1\" class=\"wp-image-51413\" src=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2024\/12\/Graunt_Observations-Bills-Mortality_2356015R.jpg?resize=400%2C561&ssl=1\" alt=\"The title page to an old book called "Natural and Political Observations, Mentioned in a Following Index, and Made Upon the Bills of Mortality," by John Graunt\" width=\"400\" height=\"561\" srcset=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2024\/12\/Graunt_Observations-Bills-Mortality_2356015R.jpg?resize=730%2C1024&ssl=1 730w, https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2024\/12\/Graunt_Observations-Bills-Mortality_2356015R.jpg?resize=214%2C300&ssl=1 214w, https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2024\/12\/Graunt_Observations-Bills-Mortality_2356015R.jpg?resize=768%2C1077&ssl=1 768w, https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2024\/12\/Graunt_Observations-Bills-Mortality_2356015R.jpg?resize=840%2C1178&ssl=1 840w, https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2024\/12\/Graunt_Observations-Bills-Mortality_2356015R.jpg?w=856&ssl=1 856w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><\/a><figcaption id=\"caption-attachment-51413\" class=\"wp-caption-text\"><em>Natural and Political Observations…Upon the Bills of Mortality<\/em>, Second Edition, by John Graunt, 1662.<br \/><a href=\"http:\/\/resource.nlm.nih.gov\/2356015R\"><em>National Library of Medicine #2356015R<\/em><\/a><\/figcaption><\/figure>\n<p>It seems that before its discovery in 17th century Britain, no one had contemplated the concept of “population thinking”\u2014the idea that studying populations or groups of people can provide insights into health that individual studies cannot. By quantifying the occurrence of certain diseases, we can predict their future trends. Additionally, comparing groups with different habits or health statuses helps us identify the causes of these differences. Such insights are not possible when focusing solely on individuals. However, human psychology favors individual thinking, generalizing from singular observations. This individual-centered approach has been the basis of clinical medicine for millennia.<\/p>\n<p>Population thinking was \u201cdiscovered\u201d in 17th century Britain by <a href=\"https:\/\/circulatingnow.nlm.nih.gov\/2017\/09\/27\/revealing-data-londons-deadly-visitation\/\">John Graunt<\/a>, a merchant who analyzed mortality data from London. The reason why population thinking was discovered in Britain and not in another region of the world is a fascinating question. If a modern observer looks back in time and wonders which society as of 1600 CE would have appeared more likely to discover population thinking, China would have been a better candidate than Western Europe.<\/p>\n<h3><strong>China or Western Europe?<\/strong><\/h3>\n<p>There are several reasons to think that China had an advantage over Britain when it came to discovering population thinking: the type of society, the mode of medical thinking, and the experience of registering and centralizing population data.<\/p>\n<p><strong>Types of Society<\/strong><\/p>\n<figure id=\"attachment_49056\" aria-describedby=\"caption-attachment-49056\" style=\"width: 200px\" class=\"wp-caption alignleft\"><a href=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2024\/11\/James-I-of-England.jpg?ssl=1\"><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" data-attachment-id=\"49056\" data-permalink=\"https:\/\/circulatingnow.nlm.nih.gov\/2024\/12\/19\/why-epidemiology-should-have-been-first-discovered-in-china-but-wasnt\/james-i-of-england\/\" data-orig-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2024\/11\/James-I-of-England.jpg?fit=800%2C1349&ssl=1\" data-orig-size=\"800,1349\" data-comments-opened=\"1\" data-image-meta=\"{"aperture":"0","credit":"","camera":"","caption":"","created_timestamp":"0","copyright":"","focal_length":"0","iso":"0","shutter_speed":"0","title":"","orientation":"0"}\" data-image-title=\"James I of England\" data-image-description=\"\" data-image-caption=\"<p>King James I of England<\/p>\n\" data-medium-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2024\/11\/James-I-of-England.jpg?fit=178%2C300&ssl=1\" data-large-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2024\/11\/James-I-of-England.jpg?fit=607%2C1024&ssl=1\" class=\"wp-image-49056\" src=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2024\/11\/James-I-of-England-178x300.jpg?resize=200%2C337&ssl=1\" alt=\"A portrait of King James I of England weather 17th century European clothing\" width=\"200\" height=\"337\" srcset=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2024\/11\/James-I-of-England.jpg?resize=178%2C300&ssl=1 178w, https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2024\/11\/James-I-of-England.jpg?resize=607%2C1024&ssl=1 607w, https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2024\/11\/James-I-of-England.jpg?resize=768%2C1295&ssl=1 768w, https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2024\/11\/James-I-of-England.jpg?w=800&ssl=1 800w\" sizes=\"auto, (max-width: 200px) 100vw, 200px\" \/><\/a><figcaption id=\"caption-attachment-49056\" class=\"wp-caption-text\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/James_VI_and_I#\/media\/File:JamesIEngland.jpg\"><em>King James I of England<\/em><\/a>, John de Critz, ca. 1605<\/figcaption><\/figure>\n<p>China and Britain in 1600 were monarchies. Emperor Shenzong (1563-1620) of the Ming dynasty and James I (1566-1625) of the Stuart family were in power at about the same time and were at the top of a hierarchy of nobles. Only James I, however, ordered the weekly publication of the Bills of Mortality, which provided the data for the analysis by Graunt that revealed the scientific potential of studying populations rather than individuals.<\/p>\n<figure id=\"attachment_49055\" aria-describedby=\"caption-attachment-49055\" style=\"width: 200px\" class=\"wp-caption alignright\"><a href=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2024\/11\/Emperor-Shenzong-of-Ming.jpg?ssl=1\"><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" data-attachment-id=\"49055\" data-permalink=\"https:\/\/circulatingnow.nlm.nih.gov\/2024\/12\/19\/why-epidemiology-should-have-been-first-discovered-in-china-but-wasnt\/emperor-shenzong-of-ming\/\" data-orig-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2024\/11\/Emperor-Shenzong-of-Ming.jpg?fit=800%2C1153&ssl=1\" data-orig-size=\"800,1153\" data-comments-opened=\"1\" data-image-meta=\"{"aperture":"0","credit":"","camera":"","caption":"","created_timestamp":"0","copyright":"","focal_length":"0","iso":"0","shutter_speed":"0","title":"","orientation":"0"}\" data-image-title=\"Emperor Shenzong of Ming\" data-image-description=\"\" data-image-caption=\"<p>Seated Statue of Emperor Shenzong of Ming Dynasty, artist and date unknown<\/p>\n\" data-medium-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2024\/11\/Emperor-Shenzong-of-Ming.jpg?fit=208%2C300&ssl=1\" data-large-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2024\/11\/Emperor-Shenzong-of-Ming.jpg?fit=710%2C1024&ssl=1\" class=\"wp-image-49055\" src=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2024\/11\/Emperor-Shenzong-of-Ming.jpg?resize=200%2C288&ssl=1\" alt=\"A portrait of Emperor Shenzong of Ming wearing a flowing robe\" width=\"200\" height=\"288\" srcset=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2024\/11\/Emperor-Shenzong-of-Ming.jpg?resize=208%2C300&ssl=1 208w, https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2024\/11\/Emperor-Shenzong-of-Ming.jpg?resize=710%2C1024&ssl=1 710w, https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2024\/11\/Emperor-Shenzong-of-Ming.jpg?resize=768%2C1107&ssl=1 768w, https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2024\/11\/Emperor-Shenzong-of-Ming.jpg?w=800&ssl=1 800w\" sizes=\"auto, (max-width: 200px) 100vw, 200px\" \/><\/a><figcaption id=\"caption-attachment-49055\" class=\"wp-caption-text\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wanli_Emperor#\/media\/File:MingShenzong1.jpg\"><em>Emperor Shenzong of Ming<\/em><\/a>, Ming Dynasty (1368\u20131644)<\/figcaption><\/figure>\n<p>This difference cannot be explained by Britain having greater level of technological advancement than China. The Chinese Empire of the 16th and 17th century was of comparable if not greater modernity than Britain or France. The existence of large cities and the quality of life in these cities is a great indicator of technological sophistication. Chinese capitals, such as Kaifeng or Hangzhou, were larger than London, but seem to have been cleaner and more hygienic.<\/p>\n<p><strong>Efficiency of Medical Care<\/strong><\/p>\n<p>Medicine treats individuals and was not involved in the discovery of population thinking, but its characteristics are telling about its impact on societal health. Traditional Chinese medicine and Galenic medicine practiced in the West were based on the same holistic principle of health being the result of a harmonious equilibrium between the individual organism and its close and remote environments. The Galenic principles of the theory of the four elements are similar to those of the Chinese ying\/yang theory. Still, Chinese traditional medicine had a strong empirical, observational foundation, while Western medicine was at times highly speculative. I am not aware of any therapeutic legacy from pre-18th century Western medicine continuing up to the present, whereas Chinese traditional medicine is still thriving today.<\/p>\n<figure id=\"attachment_49064\" aria-describedby=\"caption-attachment-49064\" style=\"width: 300px\" class=\"wp-caption alignleft\"><a href=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2024\/11\/Smallpox-Insufflation-in-China.jpg?ssl=1\"><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" data-attachment-id=\"49064\" data-permalink=\"https:\/\/circulatingnow.nlm.nih.gov\/2024\/12\/19\/why-epidemiology-should-have-been-first-discovered-in-china-but-wasnt\/smallpox-insufflation-in-china\/\" data-orig-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2024\/11\/Smallpox-Insufflation-in-China.jpg?fit=2126%2C1711&ssl=1\" data-orig-size=\"2126,1711\" data-comments-opened=\"1\" data-image-meta=\"{"aperture":"0","credit":"","camera":"","caption":"","created_timestamp":"0","copyright":"","focal_length":"0","iso":"0","shutter_speed":"0","title":"","orientation":"1"}\" data-image-title=\"Smallpox Insufflation in China\" data-image-description=\"\" data-image-caption=\"<p>Hanmiaofa (dry variolation) via insufflation of crushed smallpox scabs, artist unknown, Q’ing Dynasty (1636-1912)<\/p>\n\" data-medium-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2024\/11\/Smallpox-Insufflation-in-China.jpg?fit=300%2C241&ssl=1\" data-large-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2024\/11\/Smallpox-Insufflation-in-China.jpg?fit=840%2C676&ssl=1\" class=\"wp-image-49064 size-medium\" src=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2024\/11\/Smallpox-Insufflation-in-China.jpg?resize=300%2C241&ssl=1\" alt=\"Black and white woodcut of a man holding a long pipe and blowing something into the nose of an infant in its mother's arms\" width=\"300\" height=\"241\" srcset=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2024\/11\/Smallpox-Insufflation-in-China.jpg?resize=300%2C241&ssl=1 300w, https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2024\/11\/Smallpox-Insufflation-in-China.jpg?resize=1024%2C824&ssl=1 1024w, https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2024\/11\/Smallpox-Insufflation-in-China.jpg?resize=768%2C618&ssl=1 768w, https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2024\/11\/Smallpox-Insufflation-in-China.jpg?resize=1536%2C1236&ssl=1 1536w, https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2024\/11\/Smallpox-Insufflation-in-China.jpg?resize=2048%2C1648&ssl=1 2048w, https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2024\/11\/Smallpox-Insufflation-in-China.jpg?resize=840%2C676&ssl=1 840w, https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2024\/11\/Smallpox-Insufflation-in-China.jpg?w=1680&ssl=1 1680w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><\/a><figcaption id=\"caption-attachment-49064\" class=\"wp-caption-text\"><a href=\"https:\/\/www.jtraumainj.org\/journal\/view.php?number=1218\"><em>Hanmiaofa<\/em> (dry variolation) via insufflation of smallpox scabs<\/a>, Q’ing Dynasty (1636\u20131912)<\/figcaption><\/figure>\n<p>Perhaps more relevant to the discovery of population thinking, Chinese traditional medicine has proved to be more insightful in terms of response to epidemics than Western science. Consider smallpox. It killed rich and poor in China too. However, in contrast to Britain, China understood that surviving smallpox conferred a lifelong immunity. For this reason, the Chinese adopted a form of smallpox inoculation through insufflation\u2014the act of blowing something into a bodily cavity\u2014by expelling dried scabs from sick people into the nostrils of children. The child would then develop a mild form of smallpox and become immune.<\/p>\n<p>Insufflation was probably not more lethal than inoculation of smallpox pus by skin scarification, as practiced in Turkey and later in 18th century Britain. In China, there was no controversy with the Church and the medical profession about the use of inoculation. Changxi became a Q\u2019ing emperor before his older brother because he had survived a severe case of smallpox as a child and thus did not succumb to a new infection as his father, Shunzhi, did. Changxi used smallpox inoculation widely to protect his family and his army.<\/p>\n<figure id=\"attachment_51409\" aria-describedby=\"caption-attachment-51409\" style=\"width: 840px\" class=\"wp-caption aligncenter\"><a href=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2024\/12\/Smallpox-Vaccination_101458843.jpg?ssl=1\"><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" data-attachment-id=\"51409\" data-permalink=\"https:\/\/circulatingnow.nlm.nih.gov\/2024\/12\/19\/why-epidemiology-should-have-been-first-discovered-in-china-but-wasnt\/smallpox-vaccination_101458843\/\" data-orig-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2024\/12\/Smallpox-Vaccination_101458843.jpg?fit=1600%2C1223&ssl=1\" data-orig-size=\"1600,1223\" data-comments-opened=\"1\" data-image-meta=\"{"aperture":"0","credit":"","camera":"","caption":"","created_timestamp":"0","copyright":"","focal_length":"0","iso":"0","shutter_speed":"0","title":"","orientation":"1"}\" data-image-title=\"Smallpox Vaccination\" data-image-description=\"\" data-image-caption=\"<p>“La vaccination gratuite contre la variole dans le grand hall du Petit journal” (“Free smallpox vaccination in the main hall of the Petit Journal”), 1905<br \/>\nNLM #<br \/>\n101458843<\/p>\n\" data-medium-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2024\/12\/Smallpox-Vaccination_101458843.jpg?fit=300%2C229&ssl=1\" data-large-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2024\/12\/Smallpox-Vaccination_101458843.jpg?fit=840%2C642&ssl=1\" class=\"size-large wp-image-51409\" src=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2024\/12\/Smallpox-Vaccination_101458843.jpg?resize=840%2C642&ssl=1\" alt=\"An illustration of men and women standing in a hall receiving smallpox inoculations next to a cow\" width=\"840\" height=\"642\" srcset=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2024\/12\/Smallpox-Vaccination_101458843.jpg?resize=1024%2C783&ssl=1 1024w, https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2024\/12\/Smallpox-Vaccination_101458843.jpg?resize=300%2C229&ssl=1 300w, https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2024\/12\/Smallpox-Vaccination_101458843.jpg?resize=768%2C587&ssl=1 768w, https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2024\/12\/Smallpox-Vaccination_101458843.jpg?resize=1536%2C1174&ssl=1 1536w, https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2024\/12\/Smallpox-Vaccination_101458843.jpg?resize=840%2C642&ssl=1 840w, https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2024\/12\/Smallpox-Vaccination_101458843.jpg?w=1600&ssl=1 1600w\" sizes=\"auto, (max-width: 840px) 100vw, 840px\" \/><\/a><figcaption id=\"caption-attachment-51409\" class=\"wp-caption-text\">“La vaccination gratuite contre la variole dans le grand hall du Petit journal” (“Free smallpox vaccination in the main hall of the Petit Journal”), Paris, 1905<br \/><a href=\"http:\/\/resource.nlm.nih.gov\/101458843\"><em>National Library of Medicine #101458843<\/em><\/a><\/figcaption><\/figure>\n<p>It is also of note that Chinese culture viewed cats as a protective agent against the plague, even though they did not know that rats played a key role in the transmission of the disease. Cats are not as effective against rats as they are against mice, and may, if infected by a rat, transmit plague to humans, but the massacres in London of tens of thousands of cats and dogs in an attempt to halt the plague were based on superstition.<\/p>\n<p><strong>Population Data<\/strong><\/p>\n<p>Chinese gazetteers were local diaries of events occurring in communities. Some of their information, such as the occurrence of major epidemic outbreaks, was recorded centrally in dynastic histories, and in the 18th century it was included in the great encyclopedia of the Q\u2019ing. Modern historians have been able to generate a catalogue of major epidemics reported in dynastic histories between 321 BCE and 1911 CE. These catalogues were reproduced by recent authors such as William McNeil in <em>Plagues and People<\/em> (1976).<\/p>\n<figure id=\"attachment_53374\" aria-describedby=\"caption-attachment-53374\" style=\"width: 840px\" class=\"wp-caption aligncenter\"><a href=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2024\/12\/smallpox_8105450_1676v8.jpg?ssl=1\"><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" data-attachment-id=\"53374\" data-permalink=\"https:\/\/circulatingnow.nlm.nih.gov\/2024\/12\/19\/why-epidemiology-should-have-been-first-discovered-in-china-but-wasnt\/smallpox_8105450_1676v8\/\" data-orig-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2024\/12\/smallpox_8105450_1676v8.jpg?fit=1324%2C1200&ssl=1\" data-orig-size=\"1324,1200\" data-comments-opened=\"1\" data-image-meta=\"{"aperture":"0","credit":"","camera":"","caption":"","created_timestamp":"0","copyright":"","focal_length":"0","iso":"0","shutter_speed":"0","title":"","orientation":"1"}\" data-image-title=\"smallpox_8105450_1676v8\" data-image-description=\"\" data-image-caption=\"<p>Dou Zhen JinJjing Lu Zhen Ben, 1676<br \/>\nNational Library of Medicine #8105450<\/p>\n\" data-medium-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2024\/12\/smallpox_8105450_1676v8.jpg?fit=300%2C272&ssl=1\" data-large-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2024\/12\/smallpox_8105450_1676v8.jpg?fit=840%2C761&ssl=1\" class=\"wp-image-53374 size-large\" src=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2024\/12\/smallpox_8105450_1676v8.jpg?resize=840%2C761&ssl=1\" alt=\"A printed text in Chinese with illustrations of two individuals covered in dots.\" width=\"840\" height=\"761\" srcset=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2024\/12\/smallpox_8105450_1676v8.jpg?resize=1024%2C928&ssl=1 1024w, https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2024\/12\/smallpox_8105450_1676v8.jpg?resize=300%2C272&ssl=1 300w, https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2024\/12\/smallpox_8105450_1676v8.jpg?resize=768%2C696&ssl=1 768w, https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2024\/12\/smallpox_8105450_1676v8.jpg?resize=840%2C761&ssl=1 840w, https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2024\/12\/smallpox_8105450_1676v8.jpg?w=1324&ssl=1 1324w\" sizes=\"auto, (max-width: 840px) 100vw, 840px\" \/><\/a><figcaption id=\"caption-attachment-53374\" class=\"wp-caption-text\"><em>Dou Zhen JinJjing Lu Zhen Ben<\/em> (<em>Discussion of Smallpox<\/em>), 1676<br \/><a href=\"https:\/\/catalog.nlm.nih.gov\/permalink\/01NLM_INST\/a7hdtr\/alma995401343406676\"><em>National Library of Medicine #8105450<\/em><\/a><\/figcaption><\/figure>\n<p>Moreover, the Chinese state was known for its efficiency at collecting taxes. It was able to do so thanks to population registries. Registration criteria varied across dynasties, but they have allowed scholars, in particular demographers, to describe in a unique way the demographic trends in population during the Chinese Empire. China was counting its population, recording its pandemics, and centralizing this information for centuries before Western Europe. As a result, China is the only region in the world that has a consistent series of data points over the last 2000 years attesting to the frequency or intensity of infectious diseases.<\/p>\n<p>Thus, by 1600, China was ahead of any other region in terms of population data. None of this data, however, was recorded for public health purposes and it did not inform understandings of population traits. This access to data is what allowed John Graunt to infer that population evidence could provide clues about the cause of health events that, with rare exceptions, no individual clinical observation could offer.<\/p>\n<h3><strong>Count of Deaths<\/strong><\/h3>\n<figure id=\"attachment_20321\" aria-describedby=\"caption-attachment-20321\" style=\"width: 400px\" class=\"wp-caption alignleft\"><a href=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2021\/01\/London-plague-1665_101392764.jpg?ssl=1\"><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" data-attachment-id=\"20321\" data-permalink=\"https:\/\/circulatingnow.nlm.nih.gov\/2021\/01\/07\/defoe-and-the-plague-year\/london-plague-1665_101392764\/\" data-orig-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2021\/01\/London-plague-1665_101392764.jpg?fit=794%2C1200&ssl=1\" data-orig-size=\"794,1200\" data-comments-opened=\"1\" data-image-meta=\"{"aperture":"0","credit":"","camera":"","caption":"","created_timestamp":"0","copyright":"","focal_length":"0","iso":"0","shutter_speed":"0","title":"","orientation":"0"}\" data-image-title=\"London-plague-1665_101392764\" data-image-description=\"\" data-image-caption=\"<p>The Plague Of London 1665, 1790<br \/>\nNational Library of Medicine #101392764<\/p>\n\" data-medium-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2021\/01\/London-plague-1665_101392764.jpg?fit=199%2C300&ssl=1\" data-large-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2021\/01\/London-plague-1665_101392764.jpg?fit=678%2C1024&ssl=1\" class=\"wp-image-20321\" src=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2021\/01\/London-plague-1665_101392764.jpg?resize=400%2C605&ssl=1\" alt=\"An engraved illustration of people in a town square carrying shrouded stretchers, weeping over a body and expressing distress.\" width=\"400\" height=\"605\" srcset=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2021\/01\/London-plague-1665_101392764.jpg?resize=678%2C1024&ssl=1 678w, https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2021\/01\/London-plague-1665_101392764.jpg?resize=199%2C300&ssl=1 199w, https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2021\/01\/London-plague-1665_101392764.jpg?resize=768%2C1161&ssl=1 768w, https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2021\/01\/London-plague-1665_101392764.jpg?w=794&ssl=1 794w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><\/a><figcaption id=\"caption-attachment-20321\" class=\"wp-caption-text\">“The Plague Of London, 1665,” 1790<br \/><a href=\"http:\/\/resource.nlm.nih.gov\/101392764\">National Library of Medicine #101392764<\/a><\/figcaption><\/figure>\n<p>Britain began counting deaths from plague and recording them in Arabic numbers towards the end of the 16th century. Plague heavily disrupted political life to the point that it threatened the monarchies in power with becoming victims of rebellion, plunder, and social unrest. As a rule, outbreaks occurred after years of absence of plague cases. They were closely preceded by harbinger cases in poor parishes. This was the time when the monarch, his family, the wealthy, and the powerful had to flee, but wanted to leave a protected city behind them. Hence the decision by the King and the aldermen to monitor deaths from plague and post them, on a weekly basis since 1603, on the walls of London.<\/p>\n<p>Can it be that the epidemics and pandemics never became a major threat to the Chinese emperors, and therefore there was never an incentive to collect health data to organize the protection of society? The catalogue of major epidemics indicates that 2-4 epidemics occurred per year in the vast Empire. A similar number of outbreaks occurred in London alone. These may have remained almost imperceptible centrally in China, and never have represented the threat they were for the British kingdom.<\/p>\n<h3><strong>Population Thinking<\/strong><\/h3>\n<p>So, although China had sufficient technology, information infrastructure, and an empirical view of medicine, the first time a series of death data was available for analysis was in London. This was crucial for the discovery of the existence of phenomena at the population level that could not be observed through individualized medicine.<\/p>\n<figure id=\"attachment_12824\" aria-describedby=\"caption-attachment-12824\" style=\"width: 400px\" class=\"wp-caption alignright\"><a href=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2017\/09\/2378023r_page_011.jpg?ssl=1\"><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" data-attachment-id=\"12824\" data-permalink=\"https:\/\/circulatingnow.nlm.nih.gov\/2017\/09\/27\/revealing-data-londons-deadly-visitation\/2378023r_page_011\/\" data-orig-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2017\/09\/2378023r_page_011.jpg?fit=883%2C1200&ssl=1\" data-orig-size=\"883,1200\" data-comments-opened=\"1\" data-image-meta=\"{"aperture":"0","credit":"","camera":"","caption":"","created_timestamp":"0","copyright":"","focal_length":"0","iso":"0","shutter_speed":"0","title":"","orientation":"1"}\" data-image-title=\"2378023R_Page_011\" data-image-description=\"\" data-image-caption=\"<p>London\u2019s Dreadful Visitation, 1665-1666<br \/>\nNational Library of Medicine #2378023R <\/p>\n\" data-medium-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2017\/09\/2378023r_page_011.jpg?fit=221%2C300&ssl=1\" data-large-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2017\/09\/2378023r_page_011.jpg?fit=753%2C1024&ssl=1\" class=\"wp-image-12824\" src=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2017\/09\/2378023r_page_011.jpg?resize=400%2C544&ssl=1\" alt=\"Title page of London's Dredful Visitation printed with a motief of skulls, hourglasses, and shovels surrounding the text.\" width=\"400\" height=\"544\" \/><\/a><figcaption id=\"caption-attachment-12824\" class=\"wp-caption-text\"><em>London\u2019s Dreadful Visitation: or, a Collection of the Bills of Mortality…<\/em>, 1665\u20131666<br \/><a href=\"http:\/\/resource.nlm.nih.gov\/2378023R\"><em>National Library of Medicine #2378023R<\/em><\/a><\/figcaption><\/figure>\n<p>In Britain, the church provided a convenient instrument to collect and centralize health information. Officials extended the practice of recording burials and christenings to include causes of death. They printed the information weekly and in annual summaries. Londoners could spot the occurrence of new cases of plague in the poorest parishes as a harbinger of a major outbreak and organize an ordered retreat from London. After a few decades, a significant mortality series was available for John Graunt to analyze. The constancy of the proportion of deaths due to endemic causes of death, such as tuberculosis, flicked a perspective switch from an individual to a population perspective in Graunt\u2019s mind.<\/p>\n<p>In contrast, China did not build on its demographic registration advantage to develop a modern form of public health. And without data, history tells us, it has proved to be impossible to even have a clue about the population dimension of health. It is therefore not a surprise if, though they were not the first to do it, public health and epidemiology are thriving in China today. It is the region of the world with the oldest and longest recording tradition of population data.<\/p>\n<p><em><a href=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2024\/12\/Morabia_Headshot_2024_s_nobkg.jpg?ssl=1\"><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" data-attachment-id=\"53029\" data-permalink=\"https:\/\/circulatingnow.nlm.nih.gov\/2024\/12\/19\/why-epidemiology-should-have-been-first-discovered-in-china-but-wasnt\/morabia_headshot_2024_s_nobkg\/\" data-orig-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2024\/12\/Morabia_Headshot_2024_s_nobkg.jpg?fit=1027%2C1200&ssl=1\" data-orig-size=\"1027,1200\" data-comments-opened=\"1\" data-image-meta=\"{"aperture":"0","credit":"","camera":"","caption":"","created_timestamp":"0","copyright":"","focal_length":"0","iso":"0","shutter_speed":"0","title":"","orientation":"1"}\" data-image-title=\"Alfredo Morabia\" data-image-description=\"\" data-image-caption=\"\" data-medium-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2024\/12\/Morabia_Headshot_2024_s_nobkg.jpg?fit=257%2C300&ssl=1\" data-large-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2024\/12\/Morabia_Headshot_2024_s_nobkg.jpg?fit=840%2C982&ssl=1\" class=\"alignleft wp-image-53029\" title=\"Alfredo Morabia\" src=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2024\/12\/Morabia_Headshot_2024_s_nobkg.jpg?resize=100%2C117&ssl=1\" alt=\"A portrait of a man with white hair in glasses and a tie.\" width=\"100\" height=\"117\" srcset=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2024\/12\/Morabia_Headshot_2024_s_nobkg.jpg?resize=257%2C300&ssl=1 257w, https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2024\/12\/Morabia_Headshot_2024_s_nobkg.jpg?resize=876%2C1024&ssl=1 876w, https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2024\/12\/Morabia_Headshot_2024_s_nobkg.jpg?resize=768%2C897&ssl=1 768w, https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2024\/12\/Morabia_Headshot_2024_s_nobkg.jpg?resize=840%2C981&ssl=1 840w, https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2024\/12\/Morabia_Headshot_2024_s_nobkg.jpg?w=1027&ssl=1 1027w\" sizes=\"auto, (max-width: 100px) 100vw, 100px\" \/><\/a>Alfredo Morabia, MD, PhD, MPH, has been serving as the Editor in Chief of the American Journal of Public Health since 2015. Currently, he holds positions as Professor of Epidemiology at the Barry Commoner Center for Health and the Environment at Queens College, City University of New York, as well as Professor of Clinical Epidemiology in the Department of Epidemiology at the Mailman School of Public Health, Columbia University, New York. His research for his most recent book, <a href=\"https:\/\/catalog.nlm.nih.gov\/permalink\/01NLM_INST\/1o1phhn\/alma9918469386906676\">The Public Health approach: Population Thinking from the Black Death to COVID 19<\/a>, was supported by an <a href=\"https:\/\/www.nlm.nih.gov\/ep\/GrantPubs.html\">NLM Grant<\/a>.<br \/>\n<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Circulating Now welcomes Alfredo Morabia, to share some thoughts on the history of epidemiology. Dr. Morabia, is Editor in Chief<\/p>\n","protected":false},"author":156494306,"featured_media":53378,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_coblocks_attr":"","_coblocks_dimensions":"","_coblocks_responsive_height":"","_coblocks_accordion_ie_support":"","advanced_seo_description":"","jetpack_seo_html_title":"","jetpack_seo_noindex":false,"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","enabled":false},"version":2}},"categories":[12763,51014,347145303],"tags":[678876003,1470,25639,678876004,678875987,145811,132985,73766,12467],"class_list":["post-49051","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-collections","category-guests","category-rare-books-journals","tag-britain","tag-china","tag-epidemiology","tag-john-graunt","tag-nlm-g13-grants","tag-plague","tag-population","tag-smallpox","tag-spotlight"],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2024\/12\/smallpox_8105450_1676v8_feature.jpg?fit=900%2C400&ssl=1","jetpack_likes_enabled":true,"jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/p3xcDk-cL9","jetpack-related-posts":[],"amp_enabled":true,"_links":{"self":[{"href":"https:\/\/circulatingnow.nlm.nih.gov\/wp-json\/wp\/v2\/posts\/49051","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/circulatingnow.nlm.nih.gov\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/circulatingnow.nlm.nih.gov\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/circulatingnow.nlm.nih.gov\/wp-json\/wp\/v2\/users\/156494306"}],"replies":[{"embeddable":true,"href":"https:\/\/circulatingnow.nlm.nih.gov\/wp-json\/wp\/v2\/comments?post=49051"}],"version-history":[{"count":38,"href":"https:\/\/circulatingnow.nlm.nih.gov\/wp-json\/wp\/v2\/posts\/49051\/revisions"}],"predecessor-version":[{"id":53382,"href":"https:\/\/circulatingnow.nlm.nih.gov\/wp-json\/wp\/v2\/posts\/49051\/revisions\/53382"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/circulatingnow.nlm.nih.gov\/wp-json\/wp\/v2\/media\/53378"}],"wp:attachment":[{"href":"https:\/\/circulatingnow.nlm.nih.gov\/wp-json\/wp\/v2\/media?parent=49051"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/circulatingnow.nlm.nih.gov\/wp-json\/wp\/v2\/categories?post=49051"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/circulatingnow.nlm.nih.gov\/wp-json\/wp\/v2\/tags?post=49051"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}} |