The Poliomyelitis Epidemic in Johannesburg in 1918: Medical and Public Responses

ABSTRACT

This article traces the appearance of poliomyelitis in Johannesburg during the first recognised epidemic in South Africa in the early months of 1918. The course of the epidemic is examined by reviewing available statistics and investigating the problems that the epidemic imposed on medical and health authorities, both locally and within higher echelons of power. The response of the Johannesburg community to the disease is explored, as are the treatments available to polio patients at a time when the disease was regarded as ‘a mystery’. The place of the 1918 epidemic in the wider history of polio in South Africa is also explored.     

Stigmatized ethnicity, public health, and globalization

The prejudicial linking of infection with ethnic minority status has a long-established history, but in some ways this association may have intensified under the contemporary circumstances of the "new public health" and globalization. This study analyzes this conflation of ethnicity and disease victimization by considering the stigmatization process that occurred during the 2003 outbreak of Severe Acute Respiratory Syndrome (SARS) in Toronto. The attribution of stigma during the SARS outbreak occurred in multiple and overlapping ways informed by: (i) the depiction of images of individuals donning respiratory masks; (ii) employment status in the health sector; and (iii) Asian-Canadian and Chinese-Canadian ethnicity. In turn, stigmatization during the SARS crisis facilitated a moral panic of sorts in which racism at a cultural level was expressed and rationalized on the basis of a rhetoric of the new public health and anti-globalization sentiments. With the former, an emphasis on individualized self-protection, in the health sense, justified the generalized avoidance of those stigmatized. In relation to the latter, in the post-9/11 era, avoidance of the stigmatized other was legitimized on the basis of perceiving the SARS threat as a consequence of the mixing of different people predicated by economic and cultural globalization.     

检方施治:防疫方书与清代的疫情防控

抄录、编撰、刊印、传播、参阅防疫方书,是清代疫情期间常见的医疗实践活动。防疫方书的大量涌现是一次次疫病流行激发的结果,是疫情防控实践本身的重要组成部分。它们在染疫病人救治、防疫力量动员、防疫知识整合和普及等方面发挥着独特的媒介作用,是相关人、事、物实现链接和互动的一种重要途径,是人们积极主动地应对疫病、控制疫情、维护生命健康的一种"原动力"。相较于其他常见防疫举措,防疫方书深度参与到多种疫情防控实践中,实际构成了一种自发性、分散性、非制度性的疫病应对机制,具有成本低廉、传导性强、覆盖面广、溢出效应大等特征。     

分析SARS:在我国的地理扩散和地理障碍

SARS疫情在我国的迅速传播已经对我国的社会和经济生活造成了重大的影响,也为我们观察和分析地理扩散提供了难得的机会。SARS的扩散显然是一种地理过程,这个过程的第一个特征是以等级扩散为发展方式的,第二个特征是必然在扩散中遇到障碍。第一个特征的存在使疫情在一段时间里在我国得以迅速的蔓延,但是当采取各种医疗、隔离和防护措施后,SARS的扩散在出现障碍的条件下受到抑制。文章描述了疫情扩散的方式,在我国形成的地理格局(以广东和北京为源地),认为这个地理格局的形成与我国流动人口的分布、人口流动的条件有关。同时指出,在疫情扩散的地理格局中,在中心城市形成的高度集中是一种令人担忧的现象。因为这样的集中已经对这些中心城市的包括"医疗中心"在内的行政、经济、交通等核心地的功能产生严重影响。为此,文章注意到我国一些没有发现疫情的地区的地理条件,认为存在着如地理距离(距离衰减)、地理环境、产业特征等地理障碍。通过对这些障碍的分析,文章最后提出了防治疫情及其继续扩散的措施。     

The Ryan White Act in Dallas

Virtually every locality affected by the AIDS epidemic has had to confront changes in the demographics of the disease, shifts in federal priorities, and medical advances in AIDS treatment. Creating a consistent federal policy has proven difficult because the epidemic manifests itself differently in virtually every locality it invades. As a result, some local caseloads increasingly are dominated by intravenous drug users and others by gay men. In recognition of this reality, the primary federal program to fund AIDS services relies on local decisionmakers to make allocation decisions for serving the needs of their caseload. Under the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act of 1990, local Health Services Planning Councils were assigned the task of creating an effective continuum of care for persons with HIV I AIDS and were empowered with the task of allocating federal funds to accomplish that objective. In some cases creating and fostering an effective continuum of care proved to be an essentially noncontroversial managerial task, while in other localities political turmoil and rampant self-interest served as barriers to program effectiveness. This article explores the relationship between local political culture and the development of AIDS programs in Dallas County, Texas. Specifically, we compare the provision of AIDS services in Dallas before passage of the Ryan White Act in 1990, how these services were affected by the Ryan White program, and the experiences since the reauthorization of the Ryan White Act in 1996.     

1918年流感的中国疫情初探--以直隶获鹿县为中心

文章以民国报纸和档案为主要资料,分析了直隶获鹿县的1918年流感疫情,给出了具体的感染率、死亡率以及在不同年龄、性别和区域之间的差异。指出此次流感虽然未在中国形成大面积流行,但由于对发病原因认识不足,医疗手段落后,北洋政府未能采取统一的防疫措施,导致个别地区流感死亡率偏高。作者认为国家的积极作用是控制疾病大流行的关键。     

Models of masculinity: sex education,the United States Public Health Service,and the YMCA, 1919-1924

In 1918, the U.S. Public Health Service (PHS) told American parents that "it is no longer possible for you to choose whether your child will learn about sex or not." According to the PHS, most American boys learned about sex from "improper sources" by the age of nine. The "unfortunate effect of these early impressions" had, PHS warned, not only resulted in a gross misunderstanding of sex, but also been a major factor in the spread of venereal disease (The Parents' Part [the U.S. Public Health Service, 1918], p. 5). To counter and correct this miseducation, PHS joined with the Young Men's Christian Association (YMCA) to create a sex education program aimed at adolescent boys. Officially launched in the spring of 1919, the "Keeping Fit" campaign provides a unique insight into the federal government's attempt to medicalize and regulate American sexuality through the forum of public health.     

针对突发灾害:大城市的人居安全及其政策

非典事件折射出了大城市在应对突发灾害时抗灾能力低下的脆弱性以及严重的人居安全问题。大城市的人居安全问题与其规模、密度和形态的不协调有关。基于人居安全的城市政策应该是规模、密度、形态三位一体的城市政策。规模过大会引起安全问题,技术进步使人们解决城市问题的能力不断增强,因而城市规模的极限也不断被突破。但是,连续的、密集分布的城区终究不应该是无限放大的,从这点上看,城市形态的不佳将加重规模和密度过大所导致的问题。现阶段我国的城市政策几乎是不存在的,城市安全意识尚未发展成为全局性的"城市安全观",目前大城市的规模、形态、密度的失控是缺乏有效制约的市场力量作用的结果,规划失效的原因之一是没有清晰的城市政策,因而市政当局过分迁就开发商。新的城市政策对于大城市尤其要严格控制其密度,对城市提出明确的形态要求,制止城市蔓延,推进有组织的"都市区化"。     

Legislating fear and the public health in gilded age Massachusetts

Between 1876 and 1881 Massachusetts experienced an outbreak of human rabies (hydrophobia). The entire state--the Governor, the legislature, the State Board of Health, newspapers, and the citizenry and elected officials of every town and city--reacted to the disease. Central to the response was the Commonwealth's legislature--called the General Court. Through public hearings, their own debates, and the passage of legislation, it resolved widespread fear and anger, mediated conflicting concepts of disease, and promoted social solidarity in the face of an epidemic. This article first narrates the General Court's legislative actions; it then examines the conflicting understandings of disease causality; finally, it explores the social and political rituals the legislature drew upon to deal with this public health crisis. Arguing that public health legislation is simultaneously instrumental and symbolic, this article demonstrates that attention to both enriches the study of epidemics, historical and yet to come.     

Governing the Sick City: Urban Governance in the Age of Emerging Infectious Disease

Abstract: Based on a case study of the 2003 severe acute respiratory syndrome (SARS) outbreak in Toronto, Canada, this article suggests that we may have to rethink our common perception of what urban governance entails. Rather than operating solely in the conceptual proximity of social cohesion and economic competitiveness, urban governance may soon prove to be more centrally concerned with questions of widespread disease, life and death and the construction of new internal boundaries and regulations just at the time that globalization seems to suggest the breakdown of some traditional scalar incisions such as national boundaries in a post‐Westphalian environment. We argue that urban governance must face the new (or reemerging) challenge of dealing with infectious disease in the context of the “new normal” and that global health governance may be better off by taking the possibilities that rest in metropolitan governance more seriously.     

明清以来的疫病应对与历史省思

明清时期,国家对疫病救疗虽有行动,但缺乏制度上的规定,日渐兴起的民间社会力量发挥了重要的作用。近代以降,国家逐渐建立了现代卫生防疫机制,应对疫病的观念也日渐积极。这些启示我们:第一,国家对救疫在制度上的缺失,既反映了传统国家在统治理念上缺乏对民众生命的真正关怀,同时也是承认自身能力不足的务实之举;第二,利用日渐兴起的民间社会力量,不仅有助于实际的疫病救疗,而且也实现了官民之间的良性互补;第三,现代卫生防疫机制的引建,实际也是国家权力的扩展与深化,虽然意义重大,但需充分重视其限度;第四,应历史和人文地认识传统时期多元的疫病和防疫观念;第五,畅达而有效的信息传递对于瘟疫的防治至关重要。     

‘Too little,too late’? Science,policy and Dutch Elm Disease in the UK

The Dutch Elm Disease outbreak of the late 1960s and early 1970s was arguably one of the most dramatic environmental events to affect the British countryside in the last fifty years. The demise of over 28 million elms destroyed the much celebrated, and publicly valued, ‘elmscapes’ of lowland England and brought about extensive habitat loss. During the middle and later phases of the epidemic, the policy response from the UK Forestry Commission, Ministry of Agriculture and local government came to be seen as ‘too little, too late’. Yet forty years after the outbreak it is still unclear whether the epidemic could have been better managed and how far any lessons can be drawn for the way present day disease risks to trees should be tackled. Drawing on the extensively documented (but hitherto unexplored) public record of the outbreak held at Forest Research and the National Archives, together with materials from retrospective interviews conducted by the authors with scientists and policymakers closely involved in the epidemic at the time, this paper presents a fresh analysis of Dutch Elm Disease in the UK. The paper seeks to explain the catastrophic outcome of the outbreak, not only in terms of the underlying (and highly malign) pathology of the disease itself, but also because of an initially inaccurate scientific assessment of the nature of the threat constructed within a small but influential community of forest pathologists and policy officials.     

The “Weakened Spring of Government” and the Executive Branch: The Department of Justice in the Late 19th Century

Recent research on American government and public life in the late 19th century suggests that the extensive growth of the American state during this time did not necessarily involve a corresponding expansion of national authority or effective executive bureaucratic administration. Rather, the American polity was characterized by what Wallace Farnham termed the “weakened spring of government,rdquo; a government that “failed to use the powers it had.” This study examines how the late 19th century Department of Justice exemplified this problem. Despite increased personnel, resources, and responsibilities, effective law enforcement by the department was often frustrated by corruption, partisan political activity by department personnel, and by traditional reliance on local, decentralized responsibility for law enforcement. Examples of this were the attempts by the Justice Department to protect federal timber lands and enforce the federal election statutes in the south. Moreover reforms within the department were little more than “patchwork” efforts to achieve effective enforcement capacities.     

How the ideology of low fat conquered america

This article examines how faith in science led physicians and patients to embrace the low-fat diet for heart disease prevention and weight loss. Scientific studies dating from the late 1940s showed a correlation between high-fat diets and high-cholesterol levels, suggesting that a low-fat diet might prevent heart disease in high-risk patients. By the 1960s, the low-fat diet began to be touted not just for high-risk heart patients, but as good for the whole nation. After 1980, the low-fat approach became an overarching ideology, promoted by physicians, the federal government, the food industry, and the popular health media. Many Americans subscribed to the ideology of low fat, even though there was no clear evidence that it prevented heart disease or promoted weight loss. Ironically, in the same decades that the low-fat approach assumed ideological status, Americans in the aggregate were getting fatter, leading to what many called an obesity epidemic. Nevertheless, the low-fat ideology had such a hold on Americans that skeptics were dismissed. Only recently has evidence of a paradigm shift begun to surface, first with the challenge of the low-carbohydrate diet and then, with a more moderate approach, reflecting recent scientific knowledge about fats.     

Military and Maritime Evidence of Pandemic Influenza in Canada during the Summer of 1918

Analysis of archival correspondence, the daily logs of troopships transporting soldiers to Europe and the Commonwealth War Graves Commission database for soldier deaths from pneumonia and influenza across Canada indicate that influenza was more common during the summer of 1918 than previously thought. Evidence of pandemic influenza so close to the outbreak of the fall wave calls into question the storyline of a mutated virus causing the emergence of the fall wave of the 1918 influenza pandemic. This highlights the significance of other host, social and environmental circumstances, many related to the First world war, that may have contributed to the severity and timing of pandemic waves in Canada.     

先秦两汉时期疫灾地理研究

疫灾是由传染病大规模流行导致人类健康与生命损失的灾害。先秦两汉时期(公元前771～220年)见于记载的疫灾年份57个,疫灾频度5.74%。其中,春秋战国为1.64%;西汉为7.33%;东汉为15.90%;公元前二世纪为4%,公元前一世纪为9%,公元一世纪为12%,公元二世纪为15%。不排除疫灾记载有近详远略的可能,但从全国范围看,先秦两汉时期疫灾越来越频繁的趋势是客观存在的。疫灾发生的季节除秋季较少外,春、夏、冬季的概率差不多。在周期性规律上,该时期经历了2个大的疫灾稀少期和3个大的疫灾频繁期,第一个波动周期(公元前200～公元前120年)约80年时间,波峰不很明显;第二个波动周期(公元前120～80年)长达2个世纪,其中公元前50～50年的疫灾频度高达17%,为两汉之际的疫灾高峰;第三个波动周期始于80年,东汉灭亡尚未结束,而是下接三国时期的疫灾高峰。在空间分布上,疫灾分布与人口分布有高度相关性,先秦时期仅黄河、长江流域有疫灾发生,西汉时期由于匈奴的介入,蒙新高原开始有疫灾记载,东汉时期南方人口大量增加,东南沿海开始有疫灾记载。总体来说,先秦两汉时期的疫灾是北方甚于南方,但随着时间推移,南方疫灾比重不断提高,反映了南方人口与经济的发展。     

Explanations for the Outbreak of Cattle Plague in Cheshire in 1865–1866: 'Fear the Wrath of the Lord'

Abstract

'Explanations for the Outbreak of Cattle Plague in Cheshire in 1865–66: "Fear the Wrath of the Lord"'. This article examines the explanations advanced for the outbreak of rinderpest in 1865–66, which bore disproportionately upon Cheshire. Although there was some criticism of unsatisfactory farming practices and their role in spreading disease, most people were prepared to accept that the epidemic was God's punishment for sin — either sin by the population or by the government on their behalf. This explanation was made all the more acceptable by the failure of veterinary surgeons and other parties to produce an effective cure. The views expressed were those of an age where atonement for sin was a dominant element in religious thought.     

Strengthening the Role of Public Health in Environmental Policy

Over the past 25 years there has been a steady decline in the role of public health agencies in environmental protection. This paper examines the major factors that have contributed to that decline, including the impact of federal environmental laws, the disparity in funding between regulatory and public health activities in environmental protection, and the emergence of risk assessment as a basis for environmental decisions. The methods of risk assessment and traditional public health approaches are contrasted, and the advantages of the involvement of public health agencies are discussed. Recommendations are presented for strengthening the role of public health in environmental decisionmaking to address more effectively public concerns about environmental risks.     

Epidemic temporalities: A concise literature review

How do individuals and institutions make sense of epidemics in time, before, during and after outbreaks? This concise review follows a linear chronology of outbreak ‘events’ to explore debates in medical anthropology on epidemic temporalities. It excavates key notions relating to the technologies, imaginary and governance of epidemic anticipation, epidemic emergency and epidemic aftermaths. Building upon ethnographic works which depict how epidemic temporalities are constructed, and how they travel and affect social life, it argues that they are an integral component of the evental construction of epidemics.     

Die Grippe‐Pandemie 1918–20 in der medizinischen Debatte

The Influenza Pandemic of 1918–20 in medical debate. The history of the so called Spanish Influenza 1918–1920 is summarized especially in regard to the developments in medical debate. In Germany, Richard Pfeiffer, who had discovered Haemophilus influenzae after the previous pandemic 1890 / 91, managed it to defend his thesis that his “bacillus” was the causative agent of the flu, by modifying his theory moderately. The Early Virology of influenza in postwar times was still fixed to bacteriology and did not yet have the force of school‐building. Aggressive therapy, e.g. with derivatives of chinine, were used in a concept of polypragmasy. The connection between influenza in animals and influenza in mankind was unknown or of no major interest till the rise of virology as an academic discipline in the 1950s. Since the outbreak of avian influenza in Asia 1997 virological archaeology is challenged to fill the historical part in the attempt to fight the threat of the highly pathogenic bird flu. In the beginning of the “short 20. century” politicians and doctors had no interest to build a “monument” of influenza. Today, virological reductionism does not have the power to (re‐)construct such a monument.