W. F. Bynum in Science and the Practice of Medicine in the Nineteenth Century traces early ideas about the social ecology of diseases to this important piece within the Hippocratic corpus. Of its importance to the history of community health, he says: “…the Hippocratic authors of this work (there were undoubtedly at least two) yoked together medicine, physical geography, and ethnology so persuasively that subsequent medical speculations on why epidemics occurred, and why certain diseases were prevalent in particular regions, made frequent reference to features such as wind, climate, temperature, soil, and humidity.” (59) Reading it today in preparation for Aparna’s History of Public Health class, I’m inclined to agree with this assessment.
I can see a basic proto-epidemiological approach; the authors are trying to understand the prevalence of certain kinds of diseases among particular populations in distinct locations. They take into account many potential “determinants”: climate, winds, water source and quality, habits, and base constitutions. Sudden changes in anything — temperature, humidity, air flow, etc. — are understood as unhealthful. Climates that vary tend to breed ecologies that are also varied, which in turn breeds unbalanced flora, fauna, and humans. In this sense, the theories in Airs, Waters, Places are incredibly ecologically deterministic.
The authors also discuss “distribution.” An example will clarify this assertion. Part 22 deals with Scythians and attempts to explain the high number of eunuchs in their ranks. They are a nomadic tribe in which horse-riding is the primary method of movement, and wealthier citizens are more likely to be able to afford a horse. A higher proportion of eunuchs are wealthy. From this information, the authors deduce that it is the frequent horse-riding that is the root determinant; it causes inflammation of the joints, which is treated via bloodletting behind the ears, which, according the authors, causes impotence. Realizing that they can no longer perform sexually, these men don the clothes and social roles of women, becoming eunuchs. After establishing an abnormal incidence rate in a population and subsequently combining culture-specific behaviors with the physiological effects they have, the authors come up with an environmental explanation for a disease.
This does feel a bit whiggish — looking to the past and cherry-picking methods that look familiar to modern-day epidemiology — but if we are looking for the history of basic public health strategies, I can see why historians have understood this work to be of importance. I’m hoping we discuss how its ideas were or were not used contemporaneously and whether or not it was read and followed by later individuals concerned with community health.
Another interesting bit — the authors’ thoughts on the supernatural character of diseases are of note. Though not ready to throw the possibility of divine will completely out, they were certainly sure that the cause of illness was natural and knowable;
"...no one disease is either more divine or more human than another, but that all are alike divine, for that each has its own nature, and that no one arises without a natural cause." (Part 22)