Engendered/endangered: women,tuberculosis, and the project of citizenship

The anti-tuberculosis campaign of the late nineteenth and early twentieth centuries was an unprecedented display of medical authority and public health purview. With accumulating evidence that the disease disproportionately struck the poor, tuberculosis by the early decades of the century was perceived epidemiologically as embedded in individual practices including hygiene and domestic order. Tuberculosis was in a sense a trope for national degeneration, and as such it became the vehicle for a self-conscious thrust towards national renewal and moral regeneration. This paper uses a feminist Foucauldian framework in its analysis of the anti-tuberculosis campaign. In the case of San Francisco, efforts to combat tuberculosis centred in part on women in their roles as wives and mothers. Women were the gatekeepers of health because they were responsible for keeping the home clean and bacillus free. Not only did this focus become a medical legitimization of women's domestic duties, but it also became a discourse of citizenship. Whether explicitly or implicitly, physicians concentrated their attention on white middle class women in their messages of health maintenance. Within sanatoria, a primary agenda of tuberculosis treatment was the inculcation of middle class behaviour into the working class patients. The anti-tuberculosis campaign was thus a part of the early-twentieth-century project of nationhood where citizenship was largely calculated through the lens of class and race.     

State,peasant, mosquito: The biopolitics of public health education and malaria in early republican Turkey

State officials in early republican Turkey framed malaria as both a medical and a political issue. In doing so, they engaged in public health education campaigns not only to resolve medical concerns but also to better govern the country's population and promote a broader modernist agenda. This article employs primary sources from Turkish archives and other collections in order to examine the governmental and the biopolitical implications of this experience. We thus scrutinize the civilizational discourse employed by politicians and physicians as they dealt with this “village disease,” the peoples who they encountered—and taught, and the obstacles that they perceived to exist within the traditional curative beliefs and practices found throughout rural Anatolia. Emphasizing modernist ideals in their medicine as much as in their politics, we conclude that health officials' lessons for waging an effective “war” on malaria targeted not just the disease but also its perceived societal sources of origin and—hence—the very populace it presumably sought to protect.     

Tuberculosis: an airborne disease

This article focused on the complications for medical management of airborne diseases, such as tuberculosis. The bacilli that cause tuberculosis were first isolated in 1882, by Robert Koch. It took until 1944 for breakthrough treatment of tuberculosis. In 1998, the World Health Organization (WHO) is waging a new war against the spread of tuberculosis, which has made a comeback after years of quiescence. WHO predicts that 30 million people will die of tuberculosis and 300 million will be infected by 2008. Tuberculosis is transmitted by air in coughing, sneezing, talking, or spitting. A tuberculosis infected person can easily infect an additional 10-20 people in the same year with the same strain. The re-emergence of tuberculosis infections is due to increased migration, international travel and tourism, AIDS, multi-drug resistance, and the weakening of public health care systems in both developed and developing countries. Multi-drug resistance occurs due to people's failure to take prescribed medications for the allotted time period. Treatment takes 6-8 months, but symptoms disappear after 2-3 months. People forget to take their drug regimens over such a long period. Some find costs too high for drugs or doctor visits. Tuberculosis bacilli can mutate and become resistant to new drugs if strains are not eradicated. WHO new management strategies offer a short course of treatment that must be followed up with support from medical staff. The Directly Observed Treatment Strategy (DOTS) eliminates the bacteria from the body and reduces the potential for contagion. DOTS has demonstrated high cure rates and low cost ($11-40/person).     

Technologies of compliance: Surveillance of self‐administration of tuberculosis treatment, 1956–1966

The development of antibiotics for tuberculosis in the 1950s liberated patients from prolonged hospitalization and enabled physicians to bring treatment to underserved populations. However, outpatient treatment programs could only be as effective as the reliability with which patients self‐administered medications. This anxiety with non‐compliance quickly became ubiquitous in medicine. Several physicians, treating tuberculosis among the Navajo, attempted to use technologies of surveillance to overcome this limitation. They used fluorescent tracers, urine testing, and radioactive pill dispensers to expose non‐compliance. Although successful, these techniques threatened patient‐doctor relationships with secrecy and distrust. Physicians turned instead to personal surveillance through directly observed therapy.     

CHANGING PUBLIC ATTITUDES ABOUT PUBLIC WELFARE CLIENTS AND SERVICES THROUGH RESEARCH

Research findings aye useful in interpreting the widely misunderstood services of public welfare departments to the public. This article describes three research projects that were conducted and publicized by a state welfare department primarily to clarify public understanding of welfare programs. The three projects examined the characteristics of a special allowance given families to purchase school clothing for their children, the rate of turnover of Aid to Families with Dependent Children cases, and the numbers of and reasons for public employees receiving assistance from a state welfare department. Strategies for dealing with the media in interpreting public welfare programs are also suggested.     

Governing population, public health, and malaria in the early Turkish republic

In the early Turkish republic of the 1920s, population was a central question of concern for the leadership of the Kemalist state. This article focuses on how a demographic discourse concerning population – in terms both numerical and medical – provided a basis for emerging programs in public health, confronting the very real threats posed by disease. Employing the example of the nascent republic’s anti-malarial campaigns, this study thus examines the discursive, cartographic, and legislative measures employed in combating this widespread disease in the wider contexts of nation-building. In doing so, it traces one vital trajectory of the development of modern governmentality (i.e., that of public health) in the case of Turkey during the 1920s and 1930s, prior to the wartime slowing of state investments (due to national defense priorities), the post-World War II infusions of foreign aid and the incorporation of DDT in confronting malaria.     

"Yea, I have a goodly heritage": health versus heredity in the Fitter Family contests, 1920-1928

By the 1920s, the future of the middle-class family had become a topic of great concern for mainstream Americans. This widespread concern led to a new acceptance of the discussion of sexual and marital issues in print and in public. Within this public discussion, eugenicists, physicians, clerics, sociologists, and various others offered solutions to the questions and concerns of their rapidly changing society. The Fitter Family contests, sponsored by eugenicists and held at state fairs in the 1920s, reflected these public and professional anxieties. Though infused with eugenic ideas about race betterment through better breeding, the contests were equally concerned with improving the health of individuals and strengthening American families.     

The dearth of the clinic: lead,air, and agency in twentieth-century America

By surveying myriad ways that twentieth-century American experts and nonexperts grappled with the health implications of aerial exposures to lead or substances that may have contained lead, this paper urges medical historians' attention toward environments-workplaces, homes and the outdoors-and their extrabodily ontology. Health histories framed around dust, toxins, fumes, and pollution rather than around particular diseases challenge long-accepted narratives, such as Hibbert Hill's old generalization about a "New Public Health" shift from "the environment to the individual." Greater environmental focus can also advance "bottom-up" health history. Pushing the gaze of twentieth-century medical and public health historians beyond hospitals, "public health" departments, clinically confirmable disease, and "patient" roles, it draws historians' attention to health-related realms in which laypeople often claimed greater knowledge and competence.     

Reproductive rights,family planning: a cornerstone of control

The main objective of the action plan for the International Conference on Population and Development is to assure access to high quality information and reproductive health care services in a manner that is affordable, acceptable, and convenient. Informed choice should be voluntary for childbearing and fertility control decisions. Services must be sensitive to the cultural, economic, and demographic diversity of local communities. The target date for countries to implement family planning (FP) and reproductive health programs that are available to all is 2015. Programs must involve women in all phases of planning, management, and delivery of services; outreach programs must be developed to involve men. Public and private FP programs should be directed to removing all obstacles to method use by the year 2005 by redesigning and expanding information and services. IEC (information, education, and communication) should also focus on sexually transmitted diseases, including AIDS. Programs should provide high quality condoms from stock on hand. About 55% of couples in developing countries use some form of contraception. The increase in contraceptive use has contributed to the decline in total fertility from 6.1 children per woman in the 1950s to 3.7 in the 1990s. At least 350 million couples still lack access to modern FP methods. The draft plan emphasizes that couples must be given the freedom and responsibility to decide on the number and spacing of their children.     

Understanding children’s neighbourhood destinations: presenting the Kids-PoND framework

ABSTRACT

Children interact with and are greatly affected by their neighbourhoods. This research aims to understand the places children go in their neighbourhood and their perceptions of them. A child-centred approach was used to map destinations and ask open-ended survey questions, using Maptionnaire (a public participation geographic information system (PPGIS) mapping software). Overall, 1102 children aged 7–13 years, from 19 schools in Auckland, New Zealand participated. PPGIS destinations were mapped with parks, unhealthy food outlets and advertising to contextualise children’s neighbourhood destinations. We developed and present here the Kids-PoND (Kids- Perceptions of Neighbourhood Destinations) framework for understanding children’s perceptions and use of neighbourhood destinations. We found parks with a variety of options for active play and socialisation are important to children as are shops where children consumed unhealthy food and drink. Our findings have implications for public health, town planning, children and their parents and schools.     

Disaffection and Everyday Life in Interregnum England

Abstract

This article analyses factional and institutional tensions on late-nineteenth-century Tyneside, using disputes over maritime public health and the prevention of seaborne epidemics as its central case study. The Tyne had a complex institutional landscape in this era, much of it created in the middle decades of the century to meet the challenges of increasing trade, mobility and industrial growth. Institutions such as the Tyne Improvement Commission and the Tyne Port Sanitary Authority struggled to balance their specialist missions against the demands of the town councils and sectional economic interests that were represented on their boards. They also faced difficulties in managing the new professional officers who worked for them, most notably, for the purposes of this article, the physicians responsible for port health. Although highly successful in protecting its communities from epidemics, the Tyne PSA casts revealing light on the tensions of late Victorian public service, and the pronounced localism that permeated Tyneside throughout and beyond this era.     

The business of ethics: gender, medicine, and the professional codification of the American Physiotherapy Association, 1918-1935

The history of codes of ethics in health care has almost exclusively been told as a story of how medical doctors developed their own professional principles of conduct. Yet telling the history of medical ethics solely from the physicians' perspective neglects not only the numerous allied health care workers who developed their own codes of ethics in tandem with the medical profession, but also the role that gender played in the writing of such professional creeds. By focusing on the predominantly female organization of the American Physiotherapy Association (APA) and its 1935 "Code of Ethics and Discipline," I demonstrate how these women used their creed to at once curry favor from and challenge the authority of the medical profession. Through their Code, APA therapists engaged in a dynamic dialogue with the male physicians of the American Medical Association (AMA) in the name of professional survival. I conclude that, contrary to historians and philosophers who contend that professional women have historically operated under a gender-specific ethic of care, the physiotherapists avoided rhetoric construed as feminine and instead created a "business-like" creed in which they spoke solely about their relationship with physicians and remained silent on the matter of patient care.     

‘Brothel of the Pacific’: Syphilis and the Urban Regulation of Laikini Wahine in Honolulu, 1855–75

ABSTRACT

By 1860, Hawai‘i’s Indigenous population had declined by 75 per cent when compared to its estimated pre-contact level. Legislators and physicians attributed this crisis to the seasonal migration of Hawaiian prostitutes. After contracting syphilis from sailors in Honolulu, these women returned to their Native villages where they unwittingly spread the disease. Drawing on legislation, health reports, and newspapers, this article underscores the urban-rural nature of Hawai‘i’s syphilis epidemic by analyzing the 1860 Act to Mitigate the Evils and Diseases Arising from Prostitution (ATM). The law compelled prostitutes to enlist on a government registry, undergo medical inspections, and submit to treatment if infected. Arresting depopulation, adherents argued, hinged on the government’s ability to police Indigenous women within a conspicuous urban environment. In designing and enacting the ATM, legislators and physicians characterized Honolulu as a syphilitic breeding ground that catalyzed Indigenous depopulation by sheltering transient carriers of this highly gendered disease.     

茶馆、戏园与通俗教育——晚清民国时期成都的娱乐与休闲政治

晚清民国时期的茶馆戏园,作为公共空间为大众提供娱乐,从中除了可以了解人们在茶馆戏园的日常生活外,还可以看到改良精英和地方政府竭力改革戏曲作为控制大众娱乐的一部分,把他们的政治灌输在表演的节目之中,把他们所认为的"新的"、"进步的"情节加入到传统戏曲中,以"教育"民众.精英和国家对茶馆戏园的改良和控制揭示了大众文化与精英文化之间、地方文化的独特性与国家文化的同一模式之间的斗争.在国家权力及其文化霸权之下,大众娱乐不可避免地被改变了.但国家要达到控制的目的远非轻而易举,从晚清改革到国民政府的崩溃,成都地方文化和习惯堡垒顽固地坚守着它们的防线,充分显示了近代中国文化变化与持续性同时并存这样一个重要的历史现象.     

Understanding the Field of Public Affairs through the Lens of Ranked Ph.D. Programs in the United States

The goal of this article is to understand the multidisciplinary field of public affairs. Based on data and text mining on the profiles and publications of all faculty members from a list of research‐oriented U.S. public affairs programs, we describe the landscape of public affairs schools and scholars, identify 15 topics in public affairs research and discuss their trends of change between 1986 and 2015, and show the clustering and hiring networks of public affairs schools. Our results suggest a broader approach to understanding the field of public affairs than the public administration focus in the literature. Although public administration is highly visible in the field, which is evidenced by the journals most favored by public affair scholars, various specific policy areas (such as health, social, urban, environmental, global, and education policies) show strong representations based on our topical analysis of public affairs research.     

Scientific research and corporate influence: smoking, mental illness, and the tobacco industry

Mentally ill individuals have always smoked at high rates and continue to do so, despite public health efforts to encourage smoking cessation. In the last half century, the tobacco industry became interested in this connection, and conducted and supported psychiatric and basic science research on the mental health implications of smoking, long before most mental health professionals outside the industry investigated this issue. Initially, representatives of tobacco industry research organizations supported genetics and psychosomatic research to try to disprove findings that smoking causes lung cancer. Tobacco industry research leaders engaged with investigators because of shared priorities and interests in the brain effects of nicotine. By the 1980s, collaborative funding programs and individual company research and development teams engaged in intramural and extramural basic science studies on the neuropharmacology of nicotine. When mental health researchers outside the industry became interested in the issue of the mentally ill and smoking in the mid-1990s, they increasingly explained it in terms of a disease of nicotine addiction. Both the idea that smoking/nicotine does something positive for the mentally ill and the conclusion that it is the result of nicotine dependence have the potential to support corporate agendas (tobacco or pharmaceutical).     

Treatment or Placebo: Are State Programs Decreasing the Proportion of Uninsured?

Currently there are over 45 million Americans without health insurance. Recent growth in Medicaid and State Children's Health Insurance Program (SCHIP) enrollment of children has filled in the sizable gap created by decreased employer‐sponsored insurance since 2000. While the share of children who are uninsured actually decreased between 2000 and 2003, little progress was made in expanding public insurance to adults. As a result, advocates and policymakers at the federal and state level are searching for approaches to deal with the growing number of the uninsured. Conservatives advocate encouraging individuals to buy private insurance while liberals advocate the provision of health coverage through publicly financed health care. Using a 50‐state multilevel individual growth model, this study estimates the net effect of two state approaches in terms of reducing the uninsured: tax incentives (the conservative approach) and direct‐coverage programs (the liberal approach). The results suggest that these approaches have not achieved the results that many advocates had suggested. In the case of tax incentives, the results suggest that states with tax incentives experience increases in the rate of the uninsured. In the case of direct‐coverage programs, results suggest that states receive no relief in the number of uninsured individuals. Finally, the analysis suggests that the efforts originating at the federal level are most successful. These programs are a continuation of the incremental approach policymakers in America have taken to address the problem of the uninsured, rather than taking steps toward a truly comprehensive solution.     

At the border: contagion, immigration, nation

In recent publications and as an ongoing project I have been pursuing the idea that public health and infectious disease control have been part of the legal and technical constitution of 'undesirable' and prohibited entrants: an under-recognised means by which individuals and certain populations have been specifically classified and excluded from the territory and body politic of Australia. This article surveys and summarises these ideas and points to some of the recent redirections. These include a growing interest in the legacy of twentieth-century medico-legal border control on current (highly discriminating) regulations governing entry; a concern to make admissions under immigration and health law and regulation conceptually central; and the more familiar focus on race-based exclusions. Overall, my aim is to integrate the history of health and infectious disease control into the already extensive study of immigration and citizenship. Part of the effect of joint infectious disease and immigration regulation over the twentieth century has been the imagining, as well as the technical implementation of the island-nation as ostensibly secure, racially and territorially.     

Epilepsia Verminosa

Epilepsy is a major public health threat in the developing world, with much higher prevalence and incidence rates than those observed in developed countries. At present, one of the most common causes for epilepsy worldwide is the parasitic worm, Taenia solium, and the associated neurocysticercosis (NCC) that may often result from this infestation. Worm infestation was already recognized as a cause of epilepsy by the middle of the 18th century. Helminths and their effects on health were a daily medical concern in the 18th and 19th centuries--with prevailing views ranging from the beneficial effects of the presence of adult worms in the gut, to considering them as culprits for a wide variety of diseases. A number of cases followed longitudinally by various nineteenth-century French physicians showed that there was good reason to believe that the verminous influence on seizures was real, as the expulsion of the T. solium often coincided with a notable amelioration of symptoms. Several theories were proposed to account for how the worms could lead to Epilepsia nervosa, including notions of competition for nutritional resources between the host and the parasite, and irritation of the medulla and of peripheral nerve endings predisposing to epileptiform episodes. Recently, after almost a century of quiet, interest in the neurological effects of helminths has been rekindled, due in part to the growing number of cases in the United States with NCC-related neurological disorders. In this article, we review the history of our understanding of the relationship between seizure disorders and parasitic worms, and we relate this history to contemporary epidemiologic and public health issues in developing countries.     

Epilepsia Verminosa*

Epilepsy is a major public health threat in the developing world, with much higher prevalence and incidence rates than those observed in developed countries. At present, one of the most common causes for epilepsy worldwide is the parasitic worm, Taenia solium, and the associated neurocysticercosis (NCC) that may often result from this infestation. Worm infestation was already recognized as a cause of epilepsy by the middle of the 18th century. Helminths and their effects on health were a daily medical concern in the 18th and 19th centuries with prevailing views ranging from the beneficial effects of the presence of adult worms in the gut, to considering them as culprits for a wide variety of diseases. A number of cases followed longitudinally by various nineteenth-century French physicians showed that there was good reason to believe that the verminous influence on seizures was real, as the expulsion of the T. solium often coincided with a notable amelioration of symptoms. Several theories were proposed to account for how the worms could lead to Epilepsia nervosa, including notions of competition for nutritional resources between the host and the parasite, and irritation of the medulla and of peripheral nerve endings predisposing to epileptiform episodes. Recently, after almost a century of quiet, interest in the neurological effects of helminths has been rekindled, due in part to the growing number of cases in the United States with NCC-related neurological disorders. In this article, we review the history of our understanding of the relationship between seizure disorders and parasitic worms, and we relate this history to contemporary epidemiologic and public health issues in developing countries.