Revisiting Traditional Chinese Medicine in Hong Kong during the Influenza Epidemics in the 1950s and 1960s

This paper examines the supply and utilization of traditional Chinese medicine (TCM) in Hong Kong during the influenza epidemics of the 1950s and 1960s. Existing narratives of TCM in Hong Kong have predominantly framed with within the dichotomy of Western medicine "Xiyi" and Chinese medicine "Zhongyi," portraying TCM as marginalized and nearly wiped out by colonial power. Departing from this binary opposition, this study views TCM as an autonomous space that had never been subjugated by the colonial power which opted for minimal interventionist approach toward TCM. By adopting diachronic and synchronic perspectives on Hong Kong's unique environment shaped by its colonial history and the geopolitics of the Cold War in East Asia, particularly its relationships with "China," this research seeks to reassess the role and status of TCM in post-World War II Hong Kong. In Hong Kong, along with other countries in East Asia, traditional medicine has ceded its position as mainstream medicine to Western medicine. Faced with the crisis of "extinction," Chinese medical professionals, including medical practitioners and merchant groups, persistently sought solidarity and "self-renewal." In the 1950s and 1960s, the colonial authorities heavily relied on private entities, including charity hospitals and clinics; furthermore, there was a lack of provision of public healthcare and official prevention measures against the epidemic influenza. As such, it is not surprising that the Chinese utilized TCM, along with Western medicine, to contain the epidemics which brought about an explosive surge in the number of patients from novel influenza viruses. TCM was significantly consumed during these explosive outbreaks of influenza in 1957 and 1968. In making this argument, this paper firstly provides an overview of the associations of Chinese medical practitioners and merchants who were crucial to the development of TCM in Hong Kong. Secondly, it analyzes one level of active provision and consumption of Chinese medicine during the two flu epidemics, focusing on the medical practices of TCM practitioners in the 1957 epidemic. While recognizing the etiologic agent or agents of the disease as influenza viruses, the group of Chinese medical practitioners of the Chinese Medical Society in Hong Kong adopted the basic principles of traditional medicine regarding influenza, such as Shanghanlun and Wenbingxue, to distinguish the disease status among patients and prescribe medicine according to correct diagnoses, which were effective. Thirdly, this paper examines the level of folk culture among the people, who utilized famous prescriptions of Chinese herbal medicine and alimentotherapy, in addition to Chinese patent medicines imported from mainland China. In the context of regional commercial network, this section also demonstrates how Hong Kong served as a sole exporting port of medicinal materials (e.g., Chinese herbs) and Chinese patent medicines from the People's Republic of China to capitalist markets, including Hong Kong, under the socialist planned or controlled economy in the 1950s and 1960s. It was not only the efficacy of TCM in restoring immunity and alleviating symptoms of the human body, but also the voluntary efforts of these Chinese medical practitioners who sought to defend national medicine "Guoyi," positioning it as complementary and alternative medicine to scientific medicine. Additionally, merchants who imported and distributed Chinese medicinal materials and national "Guochan" Chinese patent medicine played a crucial role, as did the people who utilized Chinese medicine, all of which contributed to making TCM thrive in colonial Hong Kong.

The Autumn Ghost-The Danish Polio Epidemic of 1952 and the Birth of Intensive Care Medicine

This Arts and Medicine feature reviews The Autumn Ghost, an historical retelling of the 1952 polio epidemic in Copenhagen, Denmark, which catalyzed developments in anesthesia and respiratory support procedures that are still in use today.

[The Japanese emperors' view of epidemic and medical relief in the 8th-10th centuries]

At the end of the 7th century, Chinese medicine was widely spread in the upper class of Japanese society, and Japanese emperors developed a medical based view on epidemics. At the beginning of the 8th century, emperors determined to reform by imitated the Tang to build a state ruled by law.They determine the way of TCM to relieve the epidemic in the form of legislation, and used medical measures in outbreaks on many occasions.However, with the spread of smallpox and other epidemics during the Tenpei year, Japan's backward medical level and poor medical resources were unable to cope with the epidemic, and the emperors turned to the epidemic as calamity. From the late 8th century to the end of 10th century, Japanese emperors responded with Buddhist, Shinto, and Confucian measures. Medical relief gradually became obsolete at the national level. But at the individual level of the emperors, they attached great importance to the use of Chinese medicine for epidemic prevention and treatment, in the mid to late 9th century, medical prevention measures were established in the court through legal means.

Histories of Medieval Plague in Renaissance Italy

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.

Ancient DNA reveals Black Death source

Graves in Kyrgyzstan hold early victims of plague that swept medieval Europe.

Changes in characteristics and case-severity in patients hospitalised with influenza A (H1N1) pdm09 infection between two epidemic waves-England, 2009-2010

BACKGROUND

During 2009-2010, pandemic influenza A (H1N1) pdm09 virus (pH1N1) infections in England occurred in two epidemic waves. Reasons for a reported increase in case-severity during the second wave are unclear.

METHODS

We analysed hospital-based surveillance for patients with pH1N1 infections in England during 2009-2010 and linked national data sets to estimate ethnicity, socio-economic status and death within 28 days of admission. We used multivariable logistic regression to assess whether changes in demographic, clinical and management characteristics of patients could explain an increase in ICU admission or death, and accounted for missing values using multiple imputation.

RESULTS

During the first wave, 54/960 (6%) hospitalised patients required intensive care and 21/960 (2%) died; during the second wave 143/1420 (10%) required intensive care and 55/1420 (4%) died. In a multivariable model, during the second wave patients were less likely to be from an ethnic minority (OR 0.33, 95% CI 0.26-0.42), have an elevated deprivation score (OR 0.75, 95% CI 0.68-0.83), have known comorbidity (OR 0.78, 95% CI 0.63-0.97) or receive antiviral therapy ≤2 days before onset (OR 0.72, 95% CI 0.56-0.92). Increased case-severity during the second wave was not explained by changes in demographic, clinical or management characteristics.

CONCLUSIONS

Monitoring changes in patient characteristics could help target interventions during multiple waves of COVID-19 or a future influenza pandemic. To understand and respond to changes in case-severity, surveillance is needed that includes additional factors such as admission thresholds and seasonal coinfections.

Anti-Epidemic Emergency Regimes under Polish Law in Comparative, Historical and Jurisprudential Perspective

The SARS-CoV-2 crisis of 2020 triggered a number of unprecedented reactions of European states, in particular in the form of either constitutional emergency measures or statutory anti-epidemic emergency measures. Poland chose to deal with the crisis by delegating powers to the executive by ordinary legislative means and declared a nationwide state of epidemic emergency on 13 March 2020 and a week later a state of epidemic on the basis of the Act of 5 December 2008 on preventing and combating infections and infectious diseases. For a century, Poland has been dealing with epidemics by delegating powers to the executive by ordinary legislative means. Anti-epidemic emergency measures were developed under the relevant acts of 1919, 1935, 1963, 2001, 2008 and now form an autonomous normative model authorised directly by Article 68 (4) of the Constitution of the Republic of Poland of 2 April 1997. The Constitution of 2 April 1997 authorises also extraordinary measures in situations of particular danger, "if ordinary constitutional measures are inadequate". This article analyses anti-epidemic emergency regimes under Polish law in a comparative, historical and jurisprudential perspective.

Sinophobic Epidemics in America: Historical Discontinuity in Disease-related Yellow Peril Imaginaries of the Past and Present

Modern scholarship has drawn hasty and numerous parallels between the Yellow Peril discourses of the 19th- and 20th-century plagues and the recent racialization of infectious disease in the 21st-century. While highlighting these similarities is politically useful against Sinophobic epidemic narratives, Michel Foucault argues that truly understanding the past's continuity in the present requires a more rigorous genealogical approach. Employing this premise in a comparative analysis, this work demonstrates a critical discontinuity in the epidemic imaginary that framed the Chinese as pathogenic. Consequently, those seeking to prevent future disease racialization must understand modern Sinophobia as fundamentally distinct from that of the past.

The nurse COVID and historical epidemics literature repository: Development, description, and summary

Background

During COVID-19, a Kaggle challenge was issued to data scientists to leverage text mining to provide high-level summaries of full-text articles in the COVID-19 Open Research Dataset (CORD-19) data set, a data set containing articles around COVID-19 and other epidemics. A question was asked: “What if nursing had something similar?”

Purpose

Describe the development and function of the Nursing COVID and Historical Epidemic Literature and describe high-level summaries of abstracts within the repository.

Method

Nurse-specific literature was abstracted from two data sets: CORD-19 and LitCOVID. LitCOVID is a data set containing the most up-to-date literature around COVID-19. Multiple text mining algorithms were utilized to provide summaries of the articles.

Discussion

As of July 2020, the repository contains 760 articles. Summaries indicate the importance of psychological support for nurses and of high-impact rapid education.

Conclusion

To our knowledge, this repository is the only repository specific for nursing that utilizes text mining to provide summaries.

Plagues, pandemics and epidemics in Irish history prior to COVID-19 (coronavirus): what can we learn?

OBJECTIVES

This paper seeks to provide a brief overview of epidemics and pandemics in Irish history and to identify any lessons that might be useful in relation to psychiatry in the context of COVID-19.

METHODS

A review of selected key reports, papers and publications related to epidemics and pandemics in Irish history was conducted.

RESULTS

Viruses, epidemics and pandemics are recurring features of human history. Early Irish sources record a broad array of plagues, pandemics and epidemics including bubonic plague, typhus, cholera, dysentery and smallpox, as well as an alleged epidemic of insanity in the 19th century (that never truly occurred). Like the Spanish flu pandemic (1918-20), COVID-19 (a new coronavirus) presents both the challenge of the illness itself and the problems caused by the anxiety that the virus triggers. Managing this anxiety has always been a challenge, especially with the Spanish flu. People with mental illness had particularly poor outcomes with the Spanish flu, often related to the large, unhygienic mental hospitals in which so many were housed.

CONCLUSIONS

Even today, a full century after the Spanish flu pandemic, people with mental illness remain at increased risk of poor physical health, so it is imperative that multi-disciplinary care continues during the current outbreak of COVID-19, despite the manifest difficulties involved. The histories of previous epidemics and pandemics clearly demonstrate that good communication and solidarity matter, now more than ever, especially for people with mental illness.

Past Epidemics, Natural Disasters, COVID19, and Mental Health: Learning from History as we Deal with the Present and Prepare for the Future

As cases of the coronavirus disease (COVID-19) continue to rise, psychological endurance is a challenge many people will face. For mental health, heightened stress responses to the pandemic, is likely to manifest in three ways: 1) development of a new episode of a disorder in those with a predisposition to a major psychiatric disorder or an acute exacerbation in those who already have such a disorder, 2) development of a trauma or stressor related disorder, such as acute stress disorder, Post Traumatic Stress Disorder (PTSD), or adjustment disorders, and 3) development of a symptomatic stress response that does not meet the diagnostic criteria of a psychiatric disorder. The authors reviewed existing literature on past epidemics, natural disasters, and COVID-19 with a focus on psychiatry and mental health. Psychological effects of past epidemics (Severe Acute Respiratory Syndrome CoV-1, Ebola, Middle East Respiratory Syndrome, the Anthrax threat), past natural disasters, and current COVID-19 data suggest numerous psychological effects following the pandemic. Alcohol use, PTSD, anxiety, anger, fear of contagion, perceived risk, uncertainty, and distrust are a few of the immediate and long-term effects that are likely to result from the COVID-19 pandemic. Identifying people in need of mental health care and determining the appropriate psychiatric services and therapy needed will be important. Increasing the use and availability of telehealth, group meetings, and online resources are some ways that health care workers can prepare for the increasing demand of psychiatric services during and following the pandemic.

[The epidemic, prophylaxis and treatment of cholera in Su-Wan Liberated Area in 1946]

Rugao and Haian belonging to First Branch of Su-Wan Liberated Area found fulminant cholera in 1946. The fulminant cholera spread throughout the Su-Wan Liberated Area in a short period of time. Thus, local mass and military led by CPC actively launched the Movement of Epidemic Prevention. They took some actions to clear up the circumstance, eliminate the pathogen, prevent the food contamination and cut off the route of transmission. Vaccination was carried out on a large scale. As a result of these measure, the fulminant cholera was efficiently controlled.

Demographic perspectives on the mortality of COVID-19 and other epidemics

To put estimates of COVID-19 mortality into perspective, we estimate age-specific mortality for an epidemic claiming for illustrative purposes 1 million US lives, with results approximately scalable over a broad range of deaths. We calculate the impact on period life expectancy (down 2.94 y) and remaining life years (11.7 y per death). Avoiding 1.75 million deaths or 20.5 trillion person years of life lost would be valued at $10.2 to $17.5 trillion. The age patterns of COVID-19 mortality in other countries are quite similar and increase at rates close to each country's rate for all-cause mortality. The scenario of 1 million COVID-19 deaths is similar in scale to that of the decades-long HIV/AIDS and opioid-overdose epidemics but considerably smaller than that of the Spanish flu of 1918. Unlike HIV/AIDS and opioid epidemics, the COVID-19 deaths are concentrated in a period of months rather than spread out over decades.

Learning from history: do not flatten the curve of antiviral research!

Here, we explore the dynamics of the response of the scientific community to several epidemics, including Coronavirus Disease 2019 (COVID-19), as assessed by the numbers of clinical trials, publications, and level of research funding over time. All six prior epidemics studied [bird flu, severe acute respiratory syndrome (SARS), swine flu, Middle East Respiratory Syndrome (MERS), Ebola, and Zika] were characterized by an initial spike of research response that flattened shortly thereafter. Unfortunately, no antiviral medications have been discovered to date as treatments for any of these diseases. By contrast, the HIV/AIDS pandemic has garnered consistent research investment since it began and resulted in drugs being developed within 7 years of its start date, with many more to follow. We argue that, to develop effective treatments for COVID-19 and be prepared for future epidemics, long-term, consistent investment in antiviral research is needed.

Lessons from past epidemics and pandemics and a way forward for pregnant women, midwives and nurses during COVID-19 and beyond: A meta-synthesis

OBJECTIVE

To consolidate qualitative research studies that examined the experiences and needs of pregnant women, midwives, and nurses of maternity units to provide a way forward for future research and practices during the current pandemic and future epidemics and pandemics.

DESIGN

Qualitative systematic review and meta-synthesis.

DATA SOURCE

Four electronic databases-PubMed, Scopus, PsycINFO, and Cumulative Index to Nursing and Allied Health (CINAHL).

REVIEW METHODS

Qualitative studies with samples of pregnant women, midwives, and/or nurses of maternity units who experienced epidemics and/or pandemics were searched from 1 January 2000 to 4 April 2020. The included studies were critically appraised using the ten-item Critical Appraisal Skills Programme (CASP) tool.

FINDINGS

Eight studies were included in this review. Four themes emerged from the synthesis: (1) psychological responses, (2) challenges faced, (3) coping strategies, and (4) sources of support and support needs.

KEY CONCLUSIONS

Pregnant women, midwives, and nurses experienced negative psychological responses during epidemics and pandemics. Challenges, such as limited available information and public stigma, were faced. Various coping strategies, such as actively looking for more information and seeking solace in religions, were practiced by pregnant women, midwives, and nurses. Families were both sources of support and stress and they expressed needs for more informational, emotional, and financial support during pandemics.

IMPLICATIONS FOR PRACTICE

More culturally diverse research in the future that includes the development of technology-based programs, trained community volunteer-led programs, psychosocial interventions, and anti-stigma and awareness initiatives are needed to combat the current pandemic and future public health crises.

[History of epidemics in urology in German-speaking countries]

Pandemics are relevant for many fields of medicine from microbiology to economics and epidemiology. Many medical specialties which developed during the 19th century, e. g., urology, have had much impact on diagnostics and therapy, such as during the treatment of tuberculosis and sexually transmitted diseases. For some of them, including urology, treatment of, for example, sexually transmitted diseases, was constitutional and differed between countries.

The 1918/19 Spanish Flu in Pisa (Tuscany, Italy): Clinical, Epidemiological and Autoptic Considerations

The Spanish flu pandemic spread in 1918-19 and infected about 500 million people, killing 50 to 100 million of them. People were suffering from severe poverty and malnutrition, especially in Europe, due to the First World War, and this contributed to the diffusion of the disease. In Italy, Spanish flu appeared in April 1918 with several cases of pulmonary congestion and bronchopneumonia; at the end of the epidemic, about 450.000 people died, causing one of the highest mortality rates in Europe. From the archive documents and the autoptic registers of the Hospital of Pisa, we can express some considerations on the impact of the pandemic on the population of the city and obtain some information about the deceased. In the original necroscopic registers, 43 autopsies were reported with the diagnosis of grippe (i.e. Spanish flu), of which the most occurred from September to December 1918. Most of the dead were young individuals, more than half were soldiers, and all of them showed confluent hemor agic lung bronchopneumonia, which was the typical feature of the pandemic flu. We believe that the study of the autopsy registers represents an incomparable instrument for the History of Medicine and a useful resource to understand the origin and the evolution of the diseases.

The plague in Bologna in the year 1527

In the year 1527, following the invasion of Italy by Landsknechts, who were headed by Georg von Frundsberg, the bubonic plague appeared in the country. These soldiers were part of an army that Charles V sent to invade Italy in order to subjugate the Italian states which had adhered to the League of Cognac. In Bologna during the year 1527 believers held a procession from the Sanctuary of the Madonna del Soccorso, through the city, as far as the Church of San Rocco. The reason for this practice was linked with the plague epidemic. After some cases of plague observed in the Borgo di San Pietro district the miracle of the interruption of the epidemics, thanks to the intervention of Our Lady, was narrated by the faithfuls. Later, after several decades, it was reported by several authors from Bologna, who were not witnesses to the facts, that the epidemic had involved 12,000 out of a total population of around 60,000 inhabitants at that time. We re-evaluated this situation starting from the demographic data concerning the citizens in Bologna during the 15th, 16th and 17th centuries. Furthermore, we performed a search in the State Archives in the city of Bologna in order to find any public notices from the city authorities in the year 1527 aiming to counteract a plague epidemic. Our investigation found no elements to support the outbreak of this disease. Throughout the 16th century, until 1590, the population grew significantly, and no public notices were issued or specific laws enacted to deal with the plague until the year 1557. However, it remains possible that in the area in question, some episodes of plague occurred, but it was fortunately a micro-epidemic, which involved a very poor area of the city. Then this disease was self-limited. However, in our opinion, this episode proved very important, since in this district of Bologna, and around a wooden image of the Madonna del Soccorso, a confraternity took place, and its activities continued until the year 1798. This group of citizens also played a major role in many charitable activities to aid the inhabitants of Bologna, during a difficult historical period, namely the Protestant Reformation, and contributed to strengthen the faith of Catholic believers.

[Infectious Socialization-The History of Contagious Bodies]

This paper is part of Forum COVID-19: Perspectives in the Humanities and Social Sciences. Being a "trauma of mankind" epidemics have been a major subject of historical research for a long time and regarding every historical period. Recurring to the concept of Rudolf Schlögl ("Vergesellschaftung unter Anwesenden") my proposal is to research epidemics as a history of the communicating body and thus including the contagium as part of this communication.

[The "Plague Doctor's Mask" in the German Museum for the History of Medicine, Ingolstadt]

This paper is part of Forum COVID-19: Perspectives in the Humanities and Social Sciences. The figure of the plague doctor with the beak mask has become the symbol of the plague par excellence. It's little wonder that the plague mask in the collection of the German Museum of the History of Medicine in Ingolstadt (Bavaria) is one of the museum's most popular objects and motifs. This forum paper investigates the figure of the plague doctor on several levels: first, it analyses contemporary textual and image sources in regard to protective clothing used in times of plague and the respective role of the beak-like part of the mask. Then it takes a close look at the Ingolstadt specimen. By examining the mask's materiality and fabrication, questions of its authenticity and practicability are raised. Finally, the Ingolstadt mask is compared with the specimen at the German Historical Museum in Berlin.The conclusion: the beak mask is not mentioned before the mid-seventeenth century, and then only in Italy and Southern France. There is no proof at all of its use during plague outbreaks in Middle Europe. And the specimens in Ingolstadt and Berlin? Both masks present details which suggest that they were not used as protective clothing at all. We do not know, however, if they were produced as replicas for historic reasons or as fakes for the modern art market.

Entomological surveillance with viral tracking demonstrates a migrated viral strain caused dengue epidemic in July, 2017 in Sri Lanka

Dengue is the most important mosquito-borne viral infection disease in Sri Lanka triggering extensive economic and social burden in the country. Even after numerous source reduction programmes, more than 30,000 incidences are reporting in the country every year. The last and greatest dengue epidemic in the country was reported in July, 2017 with more than 300 dengue related deaths and the highest number of dengue incidences were reported from the District of Gampaha. There is no Dengue Virus (DENV) detection system in field specimens in the district yet and therefore the aim of the study is development of entomological surveillance approach through vector survey programmes together with molecular and phylogenetic methods to identify detection of DENV serotypes circulation in order to minimize adverse effects of imminent dengue outbreaks. Entomological surveys were conducted in five study areas in the district for 36 months and altogether, 10,616 potential breeding places were investigated and 423 were positive for immature stages of dengue vector mosquitoes. During adult collections, 2,718 dengue vector mosquitoes were collected and 4.6% (n = 124) were Aedes aegypti. While entomological indices demonstrate various correlations with meteorological variables and reported dengue incidences, the mosquito pools collected during the epidemic in 2017 were positive for DENV. The results of the phylogenetic analysis illustrated that Envelope (E) gene sequences derived from the isolated DENV belongs to the Clade Ib of Cosmopolitan genotype of the DENV serotype 2 which has been the dominant stain in South-East Asian evidencing that a recent migration of DENV strain to Sri Lanka.

Epidemic of Chronic Kidney Disease of Nontraditional Etiology in El Salvador: Integrated Health Sector Action and South-South Cooperation

In El Salvador, chronic kidney disease had reached epidemic propor-tions towards the end of this century's first decade. In 2011-2012, the Ministry of Health reported it was the leading cause of hospital deaths in men, the fifth in women, and the third overall in adult hospital fa-talities. Farming was the most common occupation among men in dialysis (50.7%). By 2017, chronic kidney disease admissions had overwhelmed hospital capacity.In 2009, El Salvador's Ministry of Health, Cuba's Ministry of Public Health and PAHO launched a cooperative effort to comprehensively tackle the epidemic. The joint investigations revealed a total prevalence of chronic kidney disease in the adult population of farming communities higher than that reported internationally (18% vs.11%-14.8%), higher in men than in women (23.9% vs 13.9%) and higher in men who were farmers/farmworkers than in men who were not (31.3% vs. 14.8%). The disease was also detected in children. An association was found between chronic kidney disease and exposure to agrochemicals (OR 1.4-2.5). In 51.9% of all chronic kidney disease cases, traditional causes (diabetes, hyperten-sion, glomerulopathies, obstructive nephropathies and cystic diseases) were ruled out and the existence of a particular form of chronic kidney disease of nontraditional etiology was confirmed (whose initial cases were reported as early as 2002). In the patients studied, functional altera-tions and histopathologic diagnosis confirmed a chronic tubulointerstitial nephritis; most presented with neurosensory hearing loss, altered tendon refiexes and tibial artery damage. The main results of this cooperation were the epidemiologic, physio-pathologic, clinical and histopathologic characterization of chronic kid-ney disease of nontraditional etiology. This characterization facilitated case definition for the epidemic and led to the hypothesis of systemic toxicity from agrochemicals (e.g., paraquat, glyphosate), which par-ticularly affect the kidneys and to which farmers/farmworkers (who may also become dehydrated in the fields) are most exposed. The research thus also laid the foundations for design of comprehensive intersectoral government actions to reduce cases and put an end to the epidemic. KEYWORDS Chronic kidney disease; chronic renal failure; tubuloint-erstitial nephritis; epidemiology; histopathology; international coopera-tion; agrochemicals; environmental pollutants, noxae, and pesticides; occupational health; PAHO; El Salvador; Cuba.

Cholera epidemic and quarantine of open ports in Joseon in 1886

In 1886, cholera was prevalent nationwide in Joseon. This year was not yet the time when the Joseon government officially overhauled quarantine rules to go into effect. Thus, quarantine efforts to prevent cholera varied depending on each of the three opening ports in the Joseon Dynasty. In Wonsan, officials of the three countries(Joseon, Japan and Qing) discussed ways to deal with cholera, and quarantine activities were carried out smoothly. On the other hand, Busan underwent friction and conflict between the parties over the implementation of quarantine rules within the region. When the Japanese consulate said that it would establish quarantine rules first and implement them, officials from various countries, including the Joseon Dynasty, strongly protested against the movement, saying that they did not reach prior consent. On top of that, economic interests were also affecting circumstances of port trade. In Incheon, there were differences between the home country and the local consulate over the urgent issue to be dealt with locally and the legal principles of applying the treaty. Since consular officials were not authorized to establish quarantine rules, the situation was settled into cancellation of the rules already issued there. The Japanese consul working at each port in the Joseon Dynasty suggested specific rules to develop quarantine activities. At this point, we can read Japan's intention to preempt the standard of future quarantine inspections. The enforcement of quarantine rules, however, was a matter that required consent from the Joseon official Gamri, the Acting Commissioner of the Joseon Maritime Customs and diplomats from each country. Furthermore, they had to go through the process of obtaining review and approval from their home countries if there were any problems in the operation of the treaty. The establishment and implementation of quarantine rules were complicated by interests of various players in each country concerning protection of their own citizens. Even though it was timely and the purpose of implementation was good, it could not follow through the quarantine rules as proposed by the Japanese consul at the opening port. The accumulation of quarantine experience and information at each port of Joseon in 1886 provided the foundation for the Joseon government to move toward to establish quarantine rules and implement them with the consent of each country in the following year.

Can Chinese Medicine Be Used for Prevention of Corona Virus Disease 2019 (COVID-19)? A Review of Historical Classics, Research Evidence and Current Prevention Programs

OBJECTIVE

Since December 2019, an outbreak of corona virus disease 2019 (COVID-19) occurred in Wuhan, and rapidly spread to almost all parts of China. This was followed by prevention programs recommending Chinese medicine (CM) for the prevention. In order to provide evidence for CM recommendations, we reviewed ancient classics and human studies.

METHODS

Historical records on prevention and treatment of infections in CM classics, clinical evidence of CM on the prevention of severe acute respiratory syndrome (SARS) and H1N1 influenza, and CM prevention programs issued by health authorities in China since the COVID-19 outbreak were retrieved from different databases and websites till 12 February, 2020. Research evidence included data from clinical trials, cohort or other population studies using CM for preventing contagious respiratory virus diseases.

RESULTS

The use of CM to prevent epidemics of infectious diseases was traced back to ancient Chinese practice cited in Huangdi's Internal Classic (Huang Di Nei Jing) where preventive effects were recorded. There were 3 studies using CM for prevention of SARS and 4 studies for H1N1 influenza. None of the participants who took CM contracted SARS in the 3 studies. The infection rate of H1N1 influenza in the CM group was significantly lower than the non-CM group (relative risk 0.36, 95% confidence interval 0.24-0.52; n=4). For prevention of COVID-19, 23 provinces in China issued CM programs. The main principles of CM use were to tonify qi to protect from external pathogens, disperse wind and discharge heat, and resolve dampness. The most frequently used herbs included Radix astragali (Huangqi), Radix glycyrrhizae (Gancao), Radix saposhnikoviae (Fangfeng), Rhizoma Atractylodis Macrocephalae (Baizhu), Lonicerae Japonicae Flos (Jinyinhua), and Fructus forsythia (Lianqiao).

CONCLUSIONS

Based on historical records and human evidence of SARS and H1N1 influenza prevention, Chinese herbal formula could be an alternative approach for prevention of COVID-19 in high-risk population. Prospective, rigorous population studies are warranted to confirm the potential preventive effect of CM.

An Analysis of the United States and United Kingdom Smallpox Epidemics (1901-5) - The Special Relationship that Tested Public Health Strategies for Disease Control

At the end of the nineteenth century, the northern port of Liverpool had become the second largest in the United Kingdom. Fast transatlantic steamers to Boston and other American ports exploited this route, increasing the risk of maritime disease epidemics. The 1901-3 epidemic in Liverpool was the last serious smallpox outbreak in Liverpool and was probably seeded from these maritime contacts, which introduced a milder form of the disease that was more difficult to trace because of its long incubation period and occurrence of undiagnosed cases. The characteristics of these epidemics in Boston and Liverpool are described and compared with outbreaks in New York, Glasgow and London between 1900 and 1903. Public health control strategies, notably medical inspection, quarantine and vaccination, differed between the two countries and in both settings were inconsistently applied, often for commercial reasons or due to public unpopularity. As a result, smaller smallpox epidemics spread out from Liverpool until 1905. This paper analyses factors that contributed to this last serious epidemic using the historical epidemiological data available at that time. Though imperfect, these early public health strategies paved the way for better prevention of imported maritime diseases.

Looking Sideways: Locating Epidemics and Erasures in South Asia

While focused on the United States, Rosenberg's work on epidemics offers a nuanced framing that defines the stages and unfolding trajectories of epidemics. His writing is a good starting point to analyze the scope and challenges of epidemic historiography in South Asia. To redress its gaps, I have suggested an approach focused on writing histories of epidemics "sideways" and examined plague and influenza epidemics to situate the fluid politics of lived risks and marginality, moving away from dominant interpretations that have tried to characterize epidemics as finite and episodic.

Reconsidering the Dramaturgy

This essay reconsiders epidemic narratives through the lens of polio to examine temporal shifts and overlapping and conflicting temporalities and assess some of the stakes in how we conceptualize the epidemic dramaturgy. I argue that while the dramaturgy of epidemics serves as a thread around which people, state actors, and institutions organize experiences, responses, and expectations, consideration of the multiplicity of epidemic temporalities is crucial in understanding how medical practice and knowledge are shaped and transferred, particularly with attention to actors that might be rendered invisible by the conventional narrative arc.

The Dramaturgy of Epidemics

My essay focuses on Charles Rosenberg's provocative and enduring ideal type of epidemic drama in three acts, which he assembled from a vast knowledge of disease history that stretched from the end of the seventeenth century to his then-present pandemic, HIV/AIDS of the 1980s. Reaching back to the Plague of Athens, my essay elaborates on Rosenberg's dramaturgy by questioning whether blame, division, and collective violence were so universal or even the dominant "acts" of epidemics not only before the nineteenth century but to the present. Instead, with certain pandemics such as yellow fever in the Deep South or the Great Influenza of 1918-20, unity, mass volunteerism, and self-abnegation played leading roles. Finally, not all epidemics ended "with a whimper" as attested by the long early modern history of plague. These often concluded literally with a bang: lavish planning of festivals of thanksgiving, choreographed with processions, innumerable banners, commissions of paintings, ex-voto churches, trumpets, tambourines, artillery fire, and fireworks.

Epidemics Have Lost the Plot

This article draws on Charles Rosenberg's classic essay "What Is an Epidemic?" (1989) to reflect on the complex narrative structures and temporalities of epidemics as they are experienced and storied. We begin with an analysis of Rosenberg's use of Albert Camus's The Plague and a discussion of how epidemics have been modeled in literature and in epidemiology concomitantly. Then, we argue that Charles Rosenberg's characterization of epidemics as events bounded in time that display narrative and epidemiological purity fails to account for the reinvention of life within health crises. Adopting the ecological, archaeological, and anthropological perspectives developed within African studies enriches the range of available plots, roles, and temporal sequences and ultimately transforms our way of depicting epidemics. Instead of events oriented toward their own closure, epidemics might be approached as unsettling, seemingly endless periods during which life has to be recomposed.

An analysis of deaths in Tuliszków parish caused by a cholera epidemic in 1831

BACKGROUND

Information is presented about cholera as an infectious disease and an epidemic in Polish lands and in Europe in 1831 based on old and modern sources.

OBJECTIVE

To analyze the difference in the percentages of deaths from cholera depending on age, in the Tuliszków parish during the cholera epidemic in 1831.

MATERIAL AND METHODS

A query was carried out in the archives. Information on deaths between 1829 and 1839 was obtained from the parish registry files. The following factors were taken into account: the cause of death, the age of the deceased and the place of residence. For individual age groups, the numbers of people who died of cholera in 1831 and those who died from other causes in the control year 1835 were compared by the Fisher test. The GBL and PubMed database was searched using the keywords: cholera, cholera epidemic, deaths, Tuliszków, the year 1831, Holy Spirit Hospital, Konin.

RESULTS

An outbreak of cholera in Tuliszków parish in 1831 began around the 8th of August and lasted until about the 10th of October. 81 people died of cholera: 74 people in Tuliszków and 7 people in Sarbicko. The number of deaths in infants and children up to 5 years of age was in fact significantly lower than in other age groups (p = 0.0052). The percentage of deaths from cholera compared to deaths from other causes among infants and children under 5 years of age decreased from 52.46% to 28.4%. In the age group of 20 to 40 years old it increased from 13.11% to 23.46% and in the age group over 55 years from 9.84% to 19.75%.

CONCLUSIONS

In Tuliszków parish in 1831, the number of deaths of infants and children under 5 years of age caused by cholera was indeed significantly lower than in other age groups (p = 0.0052).

Epidemics from the Perspective of Professional Nursing: Beyond Germs, Public Health, and Pot Banging

In his classic article, Charles Rosenberg brilliantly sets up epidemics as social phenomena of three interrelated stages-progressive revelation, develop ment of an explanatory framework to manage randomness, and negotiation of public response. This framework, although written almost thirty years ago, still resonates. Even as we have experienced different kinds of infectious epidemics over the last century (Ebola, AIDS), his stages still help us understand how society constructs the meaning of epidemics and manages policies, structures, and postepidemic explanations. Whether Rosenberg's three stages actually help frame the meaning of an epidemic for individual patients and professional care providers, for whom the epidemic is local and personal, is the subject of this essay, with an emphasis on the following question: What is the meaning of an epidemic from a nursing perspective?

Epidemics And Disability

This essay argues that considering disability and disability history needs to be part of any history of epidemics. Recent scholarship has shown the many intersections of disability history and history of medicine. This essay argues that disability plays many roles in an epidemic from establishing pre-existing conditions, to affecting the acute phase of the disease, to creating lingering disabilities in the long aftermath. Histories of epidemics that ignore the many ways in which disability affects the experience of an epidemic are incomplete.

Introduction: Reimagining Epidemics

Over the past year, historians of medicine have found our discipline invested with a new sense of relevance. In trying to make sense of epidemics past and present, many of us have been substantially influenced by Charles Rosenberg's 1989 Daedalus essay, "What Is an Epidemic? AIDS in Historical Perspective." Writing in the middle of another unfolding global pandemic, Rosenberg suggested that all epidemics possessed similar forms of social choreography, and that applying a narrative framework could help to understand their sequence, structure, and social impact. This issue of the Bulletin offers contributions from thirteen scholars working in various geographic, chronological, and thematic areas that engage with Rosenberg's fundamental historical question about what defines an epidemic, although the question takes on different forms, and different forms of urgency, in each of their works.

Spectacles of Difference: The Racial Scripting of Epidemic Disparities

This essay explores how epidemics in the past and present give rise to distinctive, recurring racial scripts about bodies and identities, with sweeping racial effects beyond the Black experience. Using examples from cholera, influenza, tuberculosis, AIDS, and COVID-19, the essay provides a dramaturgical analysis of race and epidemics in four acts, moving from Act I, racial revelation; to Act II, the staging of bodies and places; to Act III, where race and disease is made into spectacle; and finally, Act IV, in which racial boundaries are fixed, repaired, or made anew in the response to the racial dynamics revealed by epidemics. Focusing primarily on North America but touching on global racial narratives, the essay concludes with reflections on the writers and producers of these racialized dramas, and a discussion of why these racialized repertoires have endured.

Revisiting "What Is an Epidemic?" in the Time of COVID-19: Lessons from the History of Latin American Public Health

This essay considers what thirty years of scholarship on the history of epidemics in Latin America and the larger hemisphere can bring to a current reading of Charles Rosenberg's influential 1989 essay, "What Is an Epidemic? AIDS in Historical Perspective." It advocates that taking a broader geographical view is valuable to understanding better the arc of an epidemic in society. In addition, it proposes that, to see the ways in which the United States is experiencing the COVID-19 pandemic, we need to place the United States alongside the experiences of other countries of the Americas rather than making comparisons to Europe.