The word "civilization" usually brings forth images of moral, spiritual, artistic, and intellectual achievement and progress. If we stop to consider the penalties, if any, of becoming civilized, the list might include stress, loss of individuality, and the possibility of tyrannical leaders. Not entirely positive aspects of civilization should also include its effects on patterns of health and disease, or epidemiology. Indeed, the disease environment of civilizations is a predictable and recurrent concomitant of civilized society and very much of our own creation. It is as artificial and as essential as the civilized thought, art, technology, and architecture in which we take pride. And like the other issues described in this volume, it is a negative consequence of activities widely thought constructive and positive.