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In the first half of the nineteenth century, New Yorkers fought passionately over the presence of hogs on their streets and in their city. New York’s filthy streets had cultivated an informal economy and a fertile environment for roaming creatures. The battles—both physical and legal—reveal a city rife with class tensions. After decades of arguments, riots, and petitions, cholera and the fear of other public health crises ultimately spelled the end for New York’s hogs. New York struggled during this period to improve municipal services while adapting to a changing economy and rapid population growth. The fights between those for and against hogs shaped New York City’s landscape and resulted in new rules for using public space a new place for nature in the city.

Surveillance of the serotypes causing invasive pneumococcal diseases in the UK has indicated increasing incidence of serotype 1- and serotype 3-related disease in recent years. The introduction of a pneumococcal conjugate vaccine to the paediatric vaccination schedule in 2006, which did not cover these serotypes, has been regarded as a contributing factor. Serotypes 1 and 3 were perhaps the most extensively studied pneumococcal serotypes in the early twentieth century when pneumococcal serotyping began. Such historical observations are pertinent to our understanding of contemporary disease manifestations for these serotypes as many parallels can be seen between their behaviour in the early twentieth century and the early twenty-first century. There are many relevant lessons to be learned from these pre-antibiotic era descriptions and the observations of our predecessors.

The role of the American Red Cross in the U.S. response to the 1918-1919 influenza pandemic holds important lessons for current-day pandemic response. This article, which examines local ARC responses in Boston, Pittsburgh, St. Louis, and Richmond, Virginia, demonstrates how the ARC coordinated nursing for military and civilian cases; produced and procured medical supplies and food; transported patients, health workers, and bodies; and aided influenza victims' families. But the organization's effectiveness varied widely among localities. These findings illustrate the persistently local character of pandemic response, and demonstrate the importance of close, timely, and sustained coordination among local and state public health authorities and voluntary organizations before and during public health emergencies. They further illustrate the persistently local character of these emergencies, while underscoring the centrality and limits of voluntarism in American public health.

Without the modern tools of surveillance, or the ability to develop a national vaccination campaign, local health departments were often on their own in preparing and combating the spread of the disease during the influenza epidemic of 1918. This article reviews the state of public health before the epidemic, seeking to place the reaction to the disease in the context of the evolution of public health. The epidemic struck at a critical time in the history of the nation and of public health, and we must explore not only the tools and technologies that were available to practitioners at the time, but also the authority provided by local and state public health practitioners to apply these tools. Much of public health was rooted in the experiences and practices developed over the previous century in responding to often dramatic outbreaks of cholera, yellow fever, typhoid, and a host of other infectious diseases.

When the 1918 influenza epidemic began, African American communities were already beset by many public health, medical, and social problems, including racist theories of black biological inferiority, racial barriers in medicine and public health, and poor health status. To address these problems, African Americans mounted efforts such as establishing separate hospitals and professional organizations and repudiating racist scientific theories. Contradicting prevailing theories about African Americans' increased susceptibility to disease, it appears that during the 1918 epidemic the incidence of influenza was lower in African Americans. Although the epidemic had a less devastating impact on African American communities, it still overwhelmed their medical and public health resources. Observations about the lower rates of influenza in African Americans did not derail racist theories about the biological inferiority of black people or overturn conceptualizations of black people as disease threats to white people. When the epidemic ended, the major problems that African Americans faced still remained.

New York City approached the 1918 influenza epidemic by making use of its existing robust public health infrastructure. Health officials worked to prevent the spread of contagion by distancing healthy New Yorkers from those infected, increasing disease surveillance capacities, and mounting a large-scale health education campaign while regulating public spaces such as schools and theaters. Control measures, such as those used for spitting, were implemented through a spectrum of mandatory and voluntary measures. Most of New York City's public health responses to influenza were adapted from its previous campaigns against tuberculosis, suggesting that a city's existing public health infrastructure plays an important role in shaping its practices and policies during an epidemic.

In 1918, excellent nursing care was the primary treatment for influenza. The disease was not well understood, and there were no antiviral medications to inhibit its progression or antibiotics to treat the complicating pneumonia that often followed. The social, cultural, and scientific context of the times shaped the profession's response. The Great War created a severe civilian nursing shortage: 9,000 trained white nurses were sent overseas and thousands more were assigned to U.S. military camps. The shortage was intensified because the nursing profession failed to fully utilize African American nurses in the war effort, and refused to use nurses' aides in the European theater. Counterbalancing these problems, excellent nurse leaders, advanced preparations for a domestic emergency, infrastructure provided by the National Organization for Public Health Nurses and the Red Cross Town and Country Nurses, and a nationwide spirit of volunteerism enhanced the profession's ability to respond effectively to the emergency on the home front.

Influenza A viruses infect large numbers of warm-blooded animals, including wild birds, domestic birds, pigs, horses, and humans. Influenza viruses can switch hosts to form new lineages in novel hosts. The most significant of these events is the emergence of antigenically novel influenza A viruses in humans, leading to pandemics. Influenza pandemics have been reported for at least 500 years, with inter-pandemic intervals averaging approximately 40 years.

The influenza pandemic of 1918-1919 coincided with a major wave of immigration to the United States. More than 23.5 million newcomers arrived between 1880 and the 1920s, mostly from Southern and Eastern Europe, Asia, Canada, and Mexico. During earlier epidemics, the foreign-born were often stigmatized as disease carriers whose very presence endangered their hosts. Because this influenza struck individuals of all groups and classes throughout the country, no single immigrant group was blamed, although there were many local cases of medicalized prejudice. The foreign-born needed information and assistance in coping with influenza. Among the two largest immigrant groups, Southern Italians and Eastern European Jews, immigrant physicians, community spokespeople, newspapers, and religious and fraternal groups shouldered the burden. They disseminated public health information to their respective communities in culturally sensitive manners and in the languages the newcomers understood, offering crucial services to immigrants and American public health officials.

The American military experience in World War I and the influenza pandemic were closely intertwined. The war fostered influenza in the crowded conditions of military camps in the United States and in the trenches of the Western Front in Europe. The virus traveled with military personnel from camp to camp and across the Atlantic, and at the height of the American military involvement in the war, September through November 1918, influenza and pneumonia sickened 20% to 40% of U.S. Army and Navy personnel. These high morbidity rates interfered with induction and training schedules in the United States and rendered hundreds of thousands of military personnel non-effective. During the American Expeditionary Forces' campaign at Meuse-Argonne, the epidemic diverted urgently needed resources from combat support to transporting and caring for the sick and the dead. Influenza and pneumonia killed more American soldiers and sailors during the war than did enemy weapons.

During the 1918-1919 influenza pandemic in the United States, most cities responded by implementing community mitigation strategies, such as school closure. However, three cities--New York City, Chicago, and New Haven, Connecticut--diverged from the dominant pattern by keeping their public schools open while the pandemic raged. This article situates the experiences of these three cities in the broader context of the Progressive era, when officials and experts put great faith in expanding public programs in health and education. It adds an important dimension to the historical understanding of the 1918-1919 influenza pandemic and offers lessons for public health practitioners and policymakers today who might face difficult decisions about how to respond to the 2009 H1N1 influenza pandemic.

Americans were stunned when pandemic influenza hit the United States in 1918. Recent advances in bacteriology and public health allowed Americans to imagine a future free of infectious disease, even as their familiarity with influenza tempered their fears of it. They soon realized this influenza was something unprecedented, as it shocked them with its pace, virulence, mortality patterns, and symptoms. Patients endured and frequently succumbed to a miserable illness, their suffering often made worse by the chaotic circumstances the epidemic produced in families and communities and shaped in significant and sometimes discriminatory ways by their gender, class, and race. While the nation's public culture soon forgot the epidemic, it lived on in lives changed irrevocably by its consequences. As they face present and future influenza pandemics, Americans can learn from this earlier experience, guarding against identity-based discrimination and acknowledging and remembering the grief and loss fellow citizens suffered.

The influenza pandemic of 1918-1919 dramatically altered biomedical knowledge of the disease. At its onset, the foundation of scientific knowledge was information collected during the previous major pandemic of 1889-1890. The work of Otto Leichtenstern, first published in 1896, described the major epidemiological and pathological features of pandemic influenza and was cited extensively over the next two decades. Richard Pfeiffer announced in 1892 and 1893 that he had discovered influenza's cause. Pfeiffer's bacillus (Bacillus influenzae) was a major focus of attention and some controversy between 1892 and 1920. The role this organism or these organisms played in influenza dominated medical discussion during the great pandemic. Many vaccines were developed and used during the 1918-1919 pandemic. The medical literature was full of contradictory claims of their success; there was apparently no consensus on how to judge the reported results of these vaccine trials. The result of the vaccine controversy was both a further waning of confidence in Pfeiffer's bacillus as the agent of influenza and the emergence of an early set of criteria for valid vaccine trials.

The Spanish influenza arrived in the United States at a time when new forms of mass transportation, mass media, mass consumption, and mass warfare had vastly expanded the public places in which communicable diseases could spread. Faced with a deadly "crowd" disease, public health authorities tried to implement social-distancing measures at an unprecedented level of intensity. Recent historical work suggests that the early and sustained imposition of gathering bans, school closures, and other social-distancing measures significantly reduced mortality rates during the 1918-1919 epidemics. This finding makes it all the more important to understand the sources of resistance to such measures, especially since social-distancing measures remain a vital tool in managing the current H1N1 influenza pandemic. To that end, this historical analysis revisits the public health lessons learned during the 1918-1919 pandemic and reflects on their relevance for the present.

This article discusses responses to disease in Aberdeen during a formative period in the provision of healthcare within the city. The foundation of King's College was followed, in 1497, by the establishment of the first royally endowed university Chair of Medicine in the British Isles, and its first incumbent, James Cumming, was employed by the local government as the first city doctor in 1503. His appointment had been preceded in 1497 by another legislative innovation in Aberdeen, when its council became the first civic body in the British Isles to implement regulations against the threat of the Great Pox (usually considered to be syphilis). It had subsequently to pass measures to prevent the spread of plague to the city, and these were typical of those already imposed elsewhere in Scotland and on the continent. Their apparent success in staving off plague lasted until 1514, when the city was struck by a severe outbreak which lasted two years.

An acute infectious epidemic almost eliminated the St Kilda community in 1727. An epic tale of survival in adversity followed. Contemporary records reveal atypical features, suggesting a speculative alternative.

In the nineteenth century it was not uncommon for doctors to die from infectious diseases, but the death of five young physicians in Greenock--one third of the medical profession in a medium-sized Scottish town--from epidemic typhus, during four consecutive months in 1864-65, was an unusual event. This paper describes the lives and backgrounds of these five doctors, whose deaths in the line of duty earned them the description 'medical martyrs'.

Arsenic has been used for millenia. Although it has been known for many years that arsenic is soon fatal when ingested at high doses, the effects of low dosages became apparent in the 1980s. The full societal implications are only now becoming clear. It is now known to pose the highest calculated risk of any substance regulated by the US Environmental Protection Agency (EPA); high concentrations have been found in drinking water in many countries. In Bangladesh, in particular, the number of people suffering from over exposure vastly exceeds the number affected by the catastrophic accident at Chernobyl. This article shows the development of the human understanding about chronic arsenic poisoning with Bangladesh as a particular example.

The 1918-1919 influenza pandemic resulted in more deaths than any other medical event in human history; the most recent scholarship puts the death toll worldwide at 100 million. Scotland suffered a proportionate loss of life but it was little reported at the time and has been little studied by social historians since. The Great War had been such a traumatic experience that the authorities, and the general public, could take no more tragic news and the result was an uncanny silence. There is little information on the way in which people were affected by the pandemic. Such information could now be valuable as we plan a response to a pandemic of avian flu. This article aims to initiate study of an important episode in healthcare in Scotland.

The 2005 completion of the entire genome sequence of the 1918 H1N1 pandemic influenza virus represents both a beginning and an end. Investigators have already begun to study the virus in vitro and in vivo to better understand its properties, pathogenicity, transmissibility and elicitation of host responses. Although this is an exciting new beginning, characterization of the 1918 virus also represents the culmination of over a century of scientific research aiming to understand the causes of pandemic influenza. In this brief review we attempt to place in historical context the identification and sequencing of the 1918 virus, including the alleged discovery of a bacterial cause of influenza during the 1889-1893 pandemic, the controversial detection of 'filter-passing agents' during the 1918-1919 pandemic, and subsequent breakthroughs in the 1930s that led to isolation of human and swine influenza viruses, greatly influencing the development of modern virology.

The paper assesses the contribution of Dr Thomas Latta of Leith to the treatment of cholera in Leith and Edinburgh during the cholera epidemic of 1832. The historiography of cholera treatment in the nineteenth century is discussed and contemporary analyses of the use of intravenous saline infusion are reviewed. In conclusion, the reasons why Latta's contribution and reputation did not long survive his death are examined.

Municipal solid waste management (MSWM) in the United States is a system comprised of regulatory, administrative, market, technology, and social subcomponents, and can only be understood in the context of its historical evolution. American cities lacked organized public works for street cleaning, refuse collection, water treatment, and human waste removal until the early 1800s. Recurrent epidemics forced efforts to improve public health and the environment. The belief in anticontagionism led to the construction of water treatment and sewerage works during the nineteenth century, by sanitary engineers working for regional public health authorities. This infrastructure was capital intensive and required regional institutions to finance and administer it. By the time attention turned to solid waste management in the 1880s, funding was not available for a regional infrastructure. Thus, solid waste management was established as a local responsibility, centred on nearby municipal dumps. George Waring of New York City organized solid waste management around engineering unit operations; including street sweeping, refuse collection, transportation, resource recovery and disposal. This approach was adopted nationwide, and was managed by City Departments of Sanitation. Innovations such as the introduction of trucks, motorized street sweepers, incineration, and sanitary landfill were developed in the following decades. The Resource Conservation and Recovery Act of 1976 (RCRA), is the defining legislation for MSWM practice in America today. It forced the closure of open dumps nationwide, and required regional planning for MSWM. The closure of municipal dumps caused a 'garbage crisis' in the late 1980s and early 1990s. Private companies assumed an expanded role in MSWM through regional facilities that required the transportation of MSW across state lines. These transboundary movements of MSW created the issue of flow control, in which the US Supreme Court affirmed the protection of garbage under the Commerce Clause of the Constitution. Thus MSWM in America today is largely managed by municipalities, and operated by a relatively small number of private companies. It consists of a mixture of landfill, incineration, recycling, and composting, and is regulated under RCRA, the Clean Air Act and other related federal and state laws.

Two examples-the "swine flu affair" in 1976 and the emergence of HIV in the blood supply in the early 1980s-illustrate the difficulties of decision-making in public health. Both cases illustrate trade-offs between product risks and public health benefits, especially with regard to uncertainty in estimates of product risks, public health risks, and the benefits of prevention. The cases also illustrate the tendency of public health policy makers to go all the way or do nothing at all, rather than consider intermediate options that can be adapted as new information emerges. This review suggests three lessons for public health policy makers: (1) be open and honest about scientific uncertainty; (2) communicate with the public, even when the facts are not clear; and (3) consider intermediate, adaptable policy options, such as obtaining more information, thus reducing uncertainty, and building in decision points to reconsider initial policies. Underlying all of these lessons is the need to commission studies to resolve important uncertainties and increase the information base for public communication, and to review regulations and other policy options in the light of the new data that emerge.

Background: Our knowledge of skin disease is often based on fortuitous situations that have provided opportunities for observation and study of the disease. One of these diseases is sporotrichosis., Objective: This article examines a symposium published in 1947 by the Transvaal Chamber of Mines in South Africa. It reviews the approach taken in the investigation of a large outbreak of sporotrichosis in the mine workers., Conclusion: The investigation of this outbreak has contributed significantly to our present day knowledge of sporotrichosis, the causative organism, its mode of spread, and its clinical features. It is also a striking example of meticulous scientific research and observation.

Anderson Gray McKendrick's 1926 paper, 'Applications of mathematics to medical problems', was the earliest reference cited in Dempster et al.'s 1977 paper that defined and popularized the EM algorithm. McKendrick's paper was prominently featured by Joseph Oscar Irwin in his 1962 inaugural address as the President of the Royal Statistical Society (in the UK), entitled 'The place of mathematics in medical and biological statistics'. The link of McKendrick's work to the EM algorithm is due to an improvement made by Irwin on a novel method McKendrick used for estimating an infection rate when the observed data do not distinguish between those individuals who are not susceptible to the infection and those who are susceptible, but do not develop symptoms. This article examines this link, along the way illustrating the central ideas underlying the EM algorithm as well as its properties; the examination also suggests a profiling strategy for speeding up EM, which may be worthy of general investigation. McKendrick's data on an epidemic of cholera are used for illustration and to compare EM with Irwin's method as well as the Newton-Raphson algorithm. Issues beyond computation are also discussed whenever appropriate.

IN ORDER TO demonstrate the dire effects that contagious epidemic diseases were having on the population of Washington DC, Public Health Officers of the District of Columbia used epidemiological maps in their annual reports to city commissioners from 1878 until 1909. These maps charted information graphically that was included as statistical tables elsewhere in the reports. Their evolution occurred during a period when the Health Officers themselves were coming to grips with the causes of diseases that included diphtheria, scarlet fever, typhoid and malarial fevers, smallpox, consumption (tuberculosis), and diarrheal diseases. The maps may have encouraged laws that were passed during this period which required Washington DC physicians to report cases and deaths from these diseases.

The history of epidemics reveals the imposition of controls over time and space on the sick and powerless other in the interests of the well and powerful same. In contrast, effective prevention requires the sharing of values, space, and time: coevality in the broadest sense. Adolescents are seen as merely transitional: they were children in the recent past, they will be adults in the recent future. Thus as an other who must become the same, they are seen as out of time and threatening. Conventional adults fear uncontrolled sexuality, especially if it is perceived as taking place out of time and is therefore anachronistic or in the wrong places, out of bed and through the wrong orifices (anatopistic). These unshared cultural perceptions are a barrier against both education for life and effective prevention of HIV infection.

The motto of the Public Health Service (PHS) is "Service with Distinction." An example of how that motto was earned can be seen in the work of the professionals of the Marine Hospital Service (as PHS was then known) in a smallpox epidemic on the Texas border in 1895. Barely 2 years after Congress had given the U.S. Surgeon General the authority to intervene and prevent the spread of contagious diseases from one State to another, Surgeon General Walter Wyman, MD, stepped in. In response to a request from the Texas State Health Officer, Wyman sent a team of officers to assist the State and prevent the spread of smallpox. At that time the Surgeon General was head of the Marine Hospital Service, which became the Public Health Service in 1912. In a period of slightly more than 2 months, the epidemic was contained in the population of 411 refugees. Sixty people had died at the camp, 51 from smallpox. Although that fatality rate would be incredibly high by current standards, it was low under the circumstances. Milton Rosenau, MD, was a key to the containment of the disease and the humanitarian treatment of the survivors, a group of black Americans who had fled from Mexico after having been lured there with the promise of land that would be their own. Rosenau would later become the head of the Hygienic Laboratory, precursor of the National Institutes of Health.