Going (Way) Back to the Basics

The turn of a year or a century or an epoch begs a good list of accomplishments and generally begets a good debate. The turn of the 21st century was no exception, generating a few great lists of the greatest contributions to the improved health of humankind. A few scholars in Britain took umbrage with the long list of 20th century accomplishments, noting with some cheek that we really owed all recent progress to actions that took place in the 19th century.

Miasmas, malodors, the “Great Stink” of undiluted sewage floating on the Thames, the impenetrable dark soot-filled noons in Liverpool, spoiled milk and meats in the markets, mad hatters, and colicky plumbers were all keenly described by the first heroes of public health before 1900. Without the benefit of soon-to-be-discovered—and disputed—science, these heroes would propose and take steps to protect water, food, air, the home, and the workplace. Deaths and illness decreased from diseases whose pathophysiology they could not accurately describe. The top 10 list of the 20th century was populated by creative and against-the-grain inquiry and the stuff of gumshoe detective novels. Don't be blinded, the 21st century British scholars chided, by the bells and whistles of technology and double helix of the genome. Our problems and their solutions are all too close. Our health, they argued, was and is predicated on how we protect the air we breathe, the water we drink, the soil we stand and grow our food upon—in so many words, our environment and ecology.

This issue of the journal reminds us that water, food, air, soil, the home, and the workplace remain areas where illness and disease can be found by keen observers of our health. This issue also reminds us that while our science is vastly improved, we are still left with unanswered questions about the connections between exposures and illness. Much like those pioneering professionals of the 19th century, we find ourselves framing questions for which there is no previous context. Is there no safe exposure for some naturally occurring elements? How do we predict and protect when the environmental baseline itself is unstable and shifting?

The ancient Greeks thought all matter, and perhaps all that mattered, could be explained by the 4 elements of earth, water, air, and fire. Aristotle, in his wisdom, added a 5th: the ether. The more we learn, the more we return to learn anew.

• ©2018 by the North Carolina Institute of Medicine and The Duke Endowment. All rights reserved.