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The image of dazed, plague-infected rats coming out of their nests and performing a pirouette in front of the surprised eyes of humans before dying is one well-known to us through Albert Camus's The Plague (1947). This article examines the historical roots of this image and its emergence in French missionary narratives about plague outbreaks in the Chinese province of Yunnan in the 1870s on the eve of the Third Plague Pandemic. Showing that accounts of the "staggering rat" were not meant as naturalist observations of a zoonotic disease, as is generally assumed by historians, but as a cosmological, end-of-the-world narrative with a colonial agenda, the article argues for an approach to historical accounts of epidemics that does not succumb to the current trend of "virus hunting" in the archive, but rather takes colonial outbreak narratives ethnographically seriously., (© The Author(s) 2024. Published by Oxford University Press.)

During the sixteenth century, Italian scholars revised their conception of the field of history so that its purposes went beyond providing political and morally edifying narratives. These scholars contended that history must also account for culture and nature in an encyclopedic fashion. In the same years, numerous newly available texts from antiquity, the Byzantine empire, and the Middle Ages provided insight into the character of earlier outbreaks of plague. Italian physicians, embracing new visions of the field of history, the culture of humanism, and an inductivist epistemology, used these texts to argue that there were continuities among ancient, medieval, and Renaissance epidemics. They catalogued plague and formed historical categories based on severity and perceived origins, leading to the rejection of the conclusions of fourteenth-century western Europeans who viewed the plague of 1347-1353 as unprecedented. These erudite physicians saw medieval plague to be one example of the extreme epidemics that have regularly occurred throughout history., (© The Author(s) 2023. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

The scientific understanding of disease causation was crucial to the ways in which the Spanish colonial state addressed epidemic diseases which periodically struck nineteenth-century Philippines. Scholars have often described Spanish colonial responses in terms of ineptitude and failure, and have often glossed over the multiple and competing scientific theories that preoccupied Spanish and Filipino physicians. This article examines the work and ideas of nineteenth-century Spanish colonial and patriotic Filipino physicians regarding disease causation in the tropical environment of the Philippines. It will focus on two key developments-Spanish environmentalist thinking and the emerging fields of microscopy and bacteriology. Much like the British and French colonialists, Spaniards viewed tropical climates as insalubrious and conducive to disease, perceiving themselves as constitutionally at risk in hot places, ill-suited, exposed, and vulnerable to so-called native diseases. By the 1880s, however, young Filipino researchers, some of whom had trained in Spain and France, were undertaking new research on polluted water, malaria, and cells. Influenced by the revolutionary new discoveries being made in bacteriology, these researchers questioned prevailing environmentalist explanations and focused, for the first time, on the nature of pathogens and microbial pathogenesis in disease development and transmission. But germ theory remained an idea among many. This article argues that although late nineteenth-century studies in microscopy by Filipinos slowly began to challenge Spanish colonial ideas, different streams of thinking overlapped and no single scientific explanation came to predominate., (© The Author 2013. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Koro is a syndrome in which the penis (or sometimes the nipples or vulva) is retracting, with deleterious effects for the sufferer. In modern psychiatry, it is considered a culture-bound syndrome (CBS). This paper considers the formation and development of psychiatric conceptions of koro and related genital retraction syndromes from the 1890s to the present. It does so by examining the different explanations of koro based on shifting conceptions of mental illness, and considers the increased recognition of the role culture has to play in psychiatric concepts. Conceptions of culture (deriving from colonial psychiatry as well as from anthropology) actively shaped the ways in which psychiatrists conceptualized koro. Cases under consideration, additional to the first Dutch descriptions of koro, include the ways in which koro was identified in white western cases, and the 1967 Singaporean koro epidemic. Following a number of psychiatrists and psychologists who have addressed the same material, attention is also paid to the recent genital-theft panics in sub-Saharan Africa, considering the implications of the differences between koro and other genital-theft panics. Finally, the paper addresses the role played by koro in the development of the concept of CBSs, which was first presented in the DSM IV in 1994. This is explored against the backdrop of emerging ideas about culture and psychiatry from the late colonial period, especially in Africa, which are central to modern ideas about transcultural psychiatry.

Smallpox ravaged the people of Europe and the Americas in the early modern era. Why it was a catastrophic cause of death for American Indians that helped lead to severe depopulation, but a manageable cause among Europeans that allowed continued population growth, has puzzled scholars. Research on variola continued after smallpox eradication in 1977, prompted in part by the fear that aerosolized smallpox might be used in bioterrorism. That research updates factors that may have aggravated smallpox lethality in American Indians, giving new information about infectivity, the proportion of people who may have contracted smallpox, the burden on infants of mothers who had not had smallpox, and the toll for pregnant women. This essay reviews old and new hypotheses about why so many in the New World died from smallpox using recent smallpox research and older sources.

Bacterial vaccines of various sorts were widely used for both preventive and therapeutic purposes during the great influenza pandemic of 1918-19. Some were derived exclusively from the Pfeiffer's bacillus, the presumed cause of influenza, while others contained one or more other organisms found in the lungs of victims. Although initially most reports of the use of these vaccines claimed that they prevented influenza or pneumonia, the results were inconsistent and sometimes contradictory. During the course of the debates over the efficacy of these vaccines, it became clear that the medical profession had no consensus on what constituted a proper vaccine trial. Even among those who asserted that clinical impression was not enough, there was no agreement on how a trial ought to be conducted. The American Public Health Association, through its Working Program on Influenza, sought to establish standards for the profession. The standards the APHA set in December 1918 guided American vaccine trials for a quarter century.

While many works have examined urban mortality rates in nineteenth-century Europe, much less attention has been placed on disease patterns in the peripheral areas surrounding these population centers. This study demonstrates that during the Swedish diphtheria epidemic of the early 1880s, mortality rates among children living in the industrial parishes on the outskirts of the town of Sundsvall exceeded those found in the town itself. The epidemic was fueled by the mass in-migration of laborers and their families from distant provinces who sought work in the region's sawmills. Thus, in contrast to the common pattern of disease entering through a port city and spreading into the interior, in this case diphtheria followed the paths of migrants through the rural parishes of the Sundsvall region to the sawmills and then finally into the town itself. This spatial pattern was reversed in the late fall when migrants returned home. Conflicts within the medical profession regarding how best to prevent or contain diphtheria, popular suspicion and distrust of local physicians, and the introduction of the disease into a population with no prior contact with it, all helped increase the number of young corpses.

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.

This article compares the Toronto Health Department's role in controlling the 1918 influenza epidemic with its activities during the SARS outbreak in 2003 and concludes that local health departments are the foundation for successful disease containment, provided that there is effective coordination, communication, and capacity. In 1918, Toronto's MOH Charles Hastings was the acknowledged leader of efforts to contain the disease, care for the sick, and develop an effective vaccine, because neither a federal health department nor an international body like WHO existed. During the SARS outbreak, Hastings's successor, Sheela Basrur, discovered that nearly a decade of underfunding and new policy foci such as health promotion had left the department vulnerable when faced with a potential epidemic. Lack of cooperation by provincial and federal authorities added further difficulties to the challenge of organizing contact tracing, quarantine, and isolation for suspected and probable cases and providing information and reassurance to the multi-ethnic population. With growing concern about a flu pandemic, the lessons of the past provide a foundation for future communicable disease control activities.

Asiatic cholera reached Britain for the first time in late 1831, with the main epidemic occurring during 1832. The disease caused profuse diarrhea, severe dehydration, collapse, and often death. There was widespread public fear, and the political and medical response to this new disease was variable and inadequate. In the summer of 1832, a series of "cholera riots" occurred in various towns and cities throughout Britain, frequently directed against the authorities, doctors, or both. The city of Liverpool, in the northwest of England, experienced more riots than elsewhere. Between 29 May and 10 June 1832, eight major street riots occurred, with several other minor disturbances. The object of the crowd's anger was the local medical fraternity. The public perception was that cholera victims were being removed to the hospital to be killed by doctors in order to use them for anatomical dissection. "Bring out the Burkers" was one cry of the Liverpool mobs, referring to the Burke and Hare scandal four years earlier, when two men had murdered people in Edinburgh in order to sell their bodies for dissection to the local anatomy school. This issue was of special concern to the Liverpool citizenry because in 1826, thirty-three bodies had been discovered on the Liverpool docks, about to be shipped to Scotland for dissection. Two years later a local surgeon, William Gill, was tried and found guilty of running an extensive local grave-robbing system to supply corpses for his dissection rooms. The widespread cholera rioting in Liverpool was thus as much related to local anatomical issues as it was to the national epidemic. The riots ended relatively abruptly, largely in response to an appeal by the Roman Catholic clergy read from church pulpits, and also published in the local press. In addition, a respected local doctor, James Collins, published a passionate appeal for calm. The Liverpool Cholera Riots of 1832 demonstrate the complex social responses to epidemic disease, as well as the fragile interface between the public and the medical profession.

San Francisco played a crucial in the formulation of American immigration policy vis-à-vis Asia in the late nineteenth and early twentieth centuries. During this period, it was often difficult to differentiate political struggles over the exclusion of Asians from other conflicts. This article examines one such arena: an acrimonious, well-documented argument in 1899 between Federal and various State and local authorities over the arrival of a Japanese passenger liner that may--or may not--have been carrying bubonic plague. Six months later, the plague unquestionably arrived, resulting in the well-known San Francisco plague epidemic of 1900 in which more that 110 people died. Reviewing the 1899 prelude, the public attitudes of the various health authorities, and the way the press reported health issues, collectively give some sense of that historical space where the regulation of public health, politics, and the immigration industry intersected and were fiercely contested.