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Causation and Disease: A Chronological Journey

Myron E. Wegman, MD, MPH
JAMA. 1994;271(8):632-633. doi:10.1001/jama.1994.03510320074036.
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Establishing causation of disease has been one of Alfred Evans' major concerns throughout his distinguished career. In this personalized and interesting monograph he brings historical perspective to his thoughts on determining whether a particular agent or factor causes a particular disease or condition. A distinctive part of the presentation is attention to the personalities of the players, a technique that makes the story more lively. Many illustrations, both drawings and photographs, help bring a human touch. "the justification for seeking control of cigarette smoke in attacking lung cancer without necessarily knowing the precise etiologic chain"

Evans starts with the Bible and leprosy, moves quickly to Fracastoro and syphilis, and then describes four pre-bacteriology "epidemics," scurvy and lead colic in the 18th century and cholera and puerperal sepsis in the 19th, as examples of how astute observers deduced causation. Evans uses the reasoning process of the four heroes—James Lind, George Baker,


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