¹ For a recent discussion of these trends in the context of econometric production models, see Nelson, R. R., “Aggregate Production Functions and Medium-Range Growth Projections”, American Economic Review, LIV (1964), pp. 575–606Google Scholar.

² One may compare these differences in approach to the two basic orientations which have always defined man's approach to disease. One sees disease as an invading entity, attacking the body from without, while the other views disease as a resultant of the sum of the individual's responses to certain patterns of stimuli. Cf. Temkin, Owsei, “The Scientific Approach to Disease: Specific Entity and Individual Sickness”, in Crombie, A. C., ed., Scientific Change, Historical Studies in the Intellectual, Social and Technical Conditions for Scientific Discovery and Technical Invention from Antiquity to the Present (London, Heinemann, 1963), pp. 629–647Google Scholar.

³ For a brief historical statement of the position of “social medicine”, see Rosen, George, “Approaches to Social Medicine. A Historical Survey”, Milbank Memorial Fund, Backgrounds to Social Medicine (New York, Milbank Memorial Fund, 1949), pp. 9–23Google Scholar. For a discussion of Virchow's classic statement of this standpoint, see Ackerknecht, Erwin H., Rudolf Virchow (Madison, Wis., Univ. of Wisconsin Press, 1953), pp. 124–130Google Scholar and the same author's Beitrage zur Geschichte der Medizinalreform von 1848 (Leipzig, J. A. Barth, 1932)Google Scholar.

⁴ Ackerknecht, Erwin H. has provided an excellent exposition of this interpretation of malaria: Malaria in the Upper Mississippi Valley 1760–1900 (Supplements to the Bulletin of the History of Medicine, No. 4) (Baltimore, The Johns Hopkins Univ. Press, 1945)Google Scholar.

⁵ Lanoix, J. N., “Relation between Irrigation Engineering and Bilharziasis”, Bulletin of the World Health Organization, XVIII (1958), pp. 1011–1035Google ScholarPubMed; Russell, Paul F., “Public Health Factors. Malaria and Bilharziasis”, in Stamp, L. Dudley, ed., A History of Land Use in Arid Regions (Paris, UNESCO, 1961), pp. 363–372Google Scholar.

⁶ A recent and inclusive outline of cholera's history may be found in Pollitzer, R., Cholera (Geneva, World Health Organization, 1959), pp. 11–50Google ScholarPubMed. Still important are Hirsch, August, Handbuch der historischgeographischen Pathologie, Bd. I: Die allgemeinen acuten lnfektionskrankheiten (Stuttgart, 1881), pp. 278–348Google Scholar and Sticker, Georg, Abhandlung aus der Seuchengeschichte und Seuchenlehre, Bd. II: Die Cholera (Giessen, 1912)Google Scholar. For an account of cholera in the United States, see Rosenberg, Charles E., The Cholera Years. The United States in 1832, 1849, and 1866 (Chicago, Univ. of Chicago Press, 1962)Google Scholar. Charles Creighton's is still the best general history of cholera in England, though it has been superseded in its treatment of certain incidents. Creighton, , A History of Epidemics in Britain. Vol. II (Cambridge, at the University Press, 1894), pp. 796–862Google Scholar. McGrew's, Roderick E.Russia and the Cholera, 1823–1832 (Madison, Univ. of Wisconsin Press, 1965)Google Scholar, which came to my attention after the paper was written contains a number of interesting parallels and incidents.

⁷ Morbidity statistics in the 1830's, even in the larger cities, were reported and recorded in a somewhat tenuous fashion, partially as a reflection of the formlessness of most physician's diagnoses. For an example of the difficulty of determining even so relatively uncomplicated a fact as comparative class and occupational death rates from cholera, see Chevalier, Louis, Le Choléra. La Première Epidemie du XIXe Siécle (Biblio théque de la Révolution de 1848, Tome XX) (La Roche, Imprimerie Centrale de L'Ouest, 1958), pp. 1–45Google Scholar. Chevalier–s demographic study of Paris during the 1832 cholera epidemic - a study, it should be noted, based on atypically full records - represents what is probably the most complete study of any community during this epidemic.

⁸ Rosenberg, Cholera Years, pp. 40–54, 121–132, and passim. Though the preceding reference is based on American sources, subsequent research has indicated that these conclusions hold true, on the whole, for England and the Continent.

⁹ There is no detailed modern study of this incident. For useful summaries, however, see Pollitzer, Cholera, pp. 611–615; Garrod, A. B., On the Pathological Condition of the Blood in Cholera (London, Richards, 1849), pp. 2–11Google Scholar, 29. Garrod's summary is particularly useful as it embodies the author's already more critical view of the rough-andready methods and conclusions of the medical chemists of the 1830's. The English discussion of saline injection and its rationale may be followed in the London Lancet and London Medical Gazette for 1832; for parallel work done in Russia, see Hermann, R., Analyses chimiques: contenant l'exposé des altérations qui subissent le sang et les sécrétions du corps humain pendant le choléra (Moscou, 1832)Google Scholar.

¹⁰ For an enlightening contrast between the appeal which novelty, if clothed in the prestige and style of science makes to the Western mind, and the place of supernatural values in the mind of a Chinese village during a cholera epidemic, see Hsu, Francis L. K., Religion, Science and Human Crises (London, Routledge … Kegan Paul, 1952)Google Scholar. Equally relevant to the same consideration is the somewhat undignified struggle for priority in the discovery and popularization of this new mode of therapy. (See, for example, Thomas Craigie's, Statement of Facts with Observations, Edinburgh, 1832.) It is important to remember that many physicians were already quite conscious of their place in an international structure of knowledge and status.

¹¹ William Farr, another pioneer English epidemiologist, came to very similar conclusions at almost the same time. For the sake of convenience, however, I shall refer in succeeding passages to these new ideas as “Snow's”, though he was not alone in holding them. Snow's major publications have been reprinted by the Commonwealth Fund, with an introduction by Wade Hampton Frost (Snow on Cholera, New York, The Commonwealth Fund, 1936). The best brief discussion of Snow's work, though perhaps overly anti-heroic, is Brown's, P. E., “John Snow - The Autumn Loiterer”, Bulletin of the History of Medicine, XXV (1961), pp. 519–528Google Scholar.

¹² Snow on Cholera, pp. 156–157.

¹³ These investigators were, not surprisingly, wrong in their identification of particular fungi. But their interest is symbolic of a steadily increasing interest in the study of microscopic phenomena. A recent reviewer, for example, accepts the claims of at least four different investigators as having actually seen the cholera vibrio by 1867 - that is sixteen years before Koch's discovery. De, S.N., Cholera. Its Pathology and Pathogenesis (Edinburgh, Oliver … Boyd, 1961), pp. 14–15Google Scholar.

¹⁴ Snow found that - despite the help of the Registrar-General's Office - it was in many cases difficult to discover which of the two companies had serviced particular houses. Significantly, Snow also tested the actual water with a silver nitrate solution, finding that the sewage polluted water of the Southwark … Vauxhall Company had a much higher sodium chloride content than that of the Lambeth Company's water. Snow on Cholera, pp. 77–78.

¹⁵ Gilbert, E. W. (“Pioneer Maps of Health and Disease in England”, Geographical Journal, CXXIV (1958), 172–183)CrossRefGoogle Scholar has emphasized the role of cholera in first stimulating the application of cartography to problems of epidemiology. For examples of such mapping by contemporaries, see Acland, Henry, Memoir on the Cholera at Oxford in the Year 1854, with considerations suggested by the epidemic (London, 1856)Google Scholar and Shapter, Thomas, The History of the Cholera in Exeter (London and Exeter, 1849)Google Scholar. It should be noted, however, that mapping cases did not guarantee one's accepting some theory of infection or contagion. The often erratic pattern of distribution of cholera cases frequently seemed to preclude contagion. Lloyd G. Stevenson in a recent article has argued that the first use of spot maps came in the discussion of yellow fever in the 1790's and in the first decades of the nineteenth century (“Putting Disease on the Map: The Early Use of Spot Maps in the Study of Yellow Fever”, Journal of the History of Medicine, XX (1965), pp. 226–261)Google Scholar. It seems clear, however, that the first general use of such maps came in the study of cholera; certainly their general use by mid-nineteenth century would indicate an increasingly pervasive empiricism in temper.

¹⁶ Snow on Cholera, p. 159. Compare Snow's equally casual dismissal of the problem of vitalism, Ibid., p. 146.

¹⁷ For a discussion of the reaction to Snow's ideas, see Rosenberg, Cholera Years, pp. 196–200. Particularly striking was the example of John Simon, the great organizer of English public health; despite what would seem to be his detailed and overwhelmingly elaborate proof of Snow's contention that cholera was essentially a water-borne disease, Simon himself could, in the 1850's, consider contaminated water to be only one among several possible causes of the disease. Lambert, Royston, Sir John Simon 1816–1904 and English Social Administration (London, Macgibbon … Kee, 1963), pp. 247–249Google Scholar.

¹⁸ Particularly illuminating is the United States Government's report on The Cholera Epidemic of 1873 in the United States; this report shows in exhaustive detail the general acceptance of these new ideas even in small, semi-rural communities (Executive Doc. No. 95, 43rd Cong., 2nd sess., Washington, Government Printing Office 1875)Google Scholar.

¹⁹ The most detailed account of the Metropolitan Board of Health's fight against cholera in 1866 is to be found in its first annual report (New York State, Annual Report of the Metropolitan Board of Health, 1866, New York, 1867)Google Scholar.