Microbial Disease Devastates Human Populations
Historians traditionally emphasize the role of war-fare in shaping human destiny; and the brilliance of leaders or the advantage of new technology, in determining which civilizations rise or fall. Yet the fate of human societies has often been determined by microbes. For example, much of the native population of North America was exterminated by smallpox introduced by European invaders. Throughout history, more soldiers have died of microbial infections than of wounds in battle. The significance of disease in warfare was first recognized by the British nurse and statistician Florence Nightingale (1820-1910) (Fig.1.11A). Better known as the founder of professional nursing, Nightingale also founded the science of medical statistics. She used methods invented by French statisticians to demonstrate the high mortality rate due to disease among British soldiers during the Crimean War. To show the deaths of soldiers due to various causes, she devised the "polar area chart" (Fig. 1.11B). Blue wedges represent deaths due to infectious disease, red wedges represent deaths due to wounds, and black wedges represent all other causes of death. Infectious disease accounts for more than half of all mortality. Before Nightingale's study, no one understood the impact of disease on armies, or on other crowded populations, such as cities. Nightingale's statistics convinced the British government to improve army living conditions and to upgrade the standards of army hospitals. In modern epidemiology, statistical analysis continues to serve as a crucial tool in determining the causes of disease.