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Chapter twenty-four follows Hodge into a feverish period of publishing as he completes some twenty articles for the Repertory along with three variations of his Romans commentary. During this period, he struggles with whether he is making the best use of his abilities as life’s brief and precarious nature are brought home to him as his mother dies, the Asiatic Cholera breaks out in New England, and he is confined to his study by lameness in his right leg.

Cuba has had a large medical presence in Haiti since 1998, when Hurricane Georges devastated the country. Cuba responded by sending hundreds of medical staff to help with emergency medical support. It has also trained over a thousand Haitians to become doctors. Some 300 Cuban doctors remained there, and were present when the earthquake struck in 2010. This chapter analyses their role during that tragic period. A year later a cholera outbreak resulted, and again Cuban medical personnel played a major role in bringing it under control. An overview of the Cuban role is provided, and an assessment of 15 years of medical support is provided.

This chapter examines the process by which the boundary between Spain and the British colony of Gibraltar formed during the second half of the nineteenth century. Although the Spanish conceded Britain’s right to maintain a naval garrison there in 1713, they never recognized Gibraltar as a British sovereign space. As a result, no boundary was ever drawn, leaving a vaguely defined neutral zone that worked to the benefit of Spanish political dissidents and smuggling networks. In the nineteenth century, a number of new pressures, including the British ideology of free trade, the politics of revolutionary Spanish liberalism, and the global rise of cholera, created the need for a more precisely defined and regulated border. The result was a somewhat expanded British colony, which bred consternation among later Spanish nationalists but at the time was viewed locally as a practical solution to a range of problems.

Crises provide opportunities as well as risks, and there is an argument for suggesting that the COVID-19 crisis, and the continuing impact of climate change, provide us with a chance to think longer-term beyond the present, and re-imagine the way in which cities should be like further into the future to 2030, 2050 and beyond. In the rest of this chapter, therefore, the focus is on three main themes which have emerged from the book: (i) city foresight, transitions theory and city visions; (ii) urban planning and governance; and (iii) the future for cities. In doing this, the chapter focuses on the practical and pragmatic steps city leaders and other groups need to take to develop city visions and new forms of flexible governance as part of ‘urban futures’ thinking.

A warmer climate will exert multiple and diverse effects on ecological systems. Climate change will affect disease vectors, especially mosquitoes, and disease-causing organisms, such as the protozoa that cause malaria, bacteria, and viruses. Malaria will spread to higher latitudes and altitudes. Without mitigation and adaptation to climate change half of the world’s population is likely to be at risk for contracting dengue before 2100. Lyme disease is already spreading. Hantavirus infections, which may have a 40% mortality, are likely to hospitalize as many as 200,000 individuals annually according the most recent IPCC report. Water-borne illnesses, particularly cholera, are likely to follow in the wake of tropical storms, as was the case in post-earthquake Haiti where a severe outbreak followed flooding due to Hurricane Tomas. Understanding disease ecology will become increasingly important.

Large urban centers on the northern Atlantic coast replicated the problems of urban centers of the Old World. Pressed into crowded corners, most people were confined to substandard housing and living conditions. Hygiene was a problem in the early cities no matter what class marked your social and economic status. In the cities, multiple ethnic groups struggled to earn a living away from the lands of their origin. This chapter presents discussions on the role that increased immigration, mercantile transportation, aggregated housing, commercial enterprises, and issues with sanitary waste created new disease environments for such diseases as typhoid, cholera, measles, and several winter fevers (e.g., influenza, diphtheria, scarlet fever). Historic documents, architectural information, and human skeletal analyses provide the data used in this chapter, concentrating on the southern port of Charleston and the northern ports of New York and Philadelphia.

Chapter Five looks at the special problems that accompanied poverty, problems made worse by the near total lack of buffers when special difficulties arose. It begins with those who hit rock bottom, particularly the homeless and juvenile beggars (kojiki kozō). Next, it takes up illnesses that attacked the poor with special frequency and force, including STDs, tuberculosis and cholera. There also is a discussion of the isolation hospitals (actually, dying dumps) to which poor people with contagious diseases often were sent. Then come disasters such as floods and fires, which ravaged hinmin areas more often than other parts of the cities. A section on crime examines police data to show that while petty crimes like pickpocketing were high, other types of crime were no higher in hinmin areas than elsewhere. The chapter concludes with the psychic issues that accompanied poverty, including the tendency toward self-blame and the frequency of suicide.

This chapter discusses the activities of the anarchist movement in Egypt at the end of the nineteenth century. First formed in Alexandria and Cairo in the 1860s, principally within Italian circles, the movement expanded its membership and range of activities from the early 1890s on to become an active participant in public debates on education, the labour movement and public health and a subject of concern for state security organs. Internationalist in imagination but local in its programme of action, the chapter explores the movement’s response to the cholera epidemic in Alexandria in 1902 when it used the occasion to criticise the municipal government and promote its anti-state programme as well as demonstrate its commitment to direct action and self-organisation in dealing with the health crisis.

Chapter three demonstrates that changing medical responses to alcohol abuse developed in a social context of capitalist transformation and economic instability. Developing class distinctions, along with new conceptions of gender and race, shaped both perceptions of heavy drinking and the experiences of those who suffered the consequences. The chapter constructs a social portrait of inebriates through a study of over 1,500 individuals recorded as having died of alcohol abuse in Philadelphia between 1825 and 1850. Delving into hospital records, burial registers, almshouse dockets, and other sources, the chapter links medical concerns with pathological drinking to the growth of a socially distinctive middle class, the rapid growth of urban poverty, and fears about urban decay and epidemic disease, especially cholera. The chapter argues that as temperance became the sine qua non of social respectability, the persistence of heavy drinking among the status conscious middle-class drove new medical responses to and definitions of pathological drinking.

Pope’s first year presented a mixture of challenges that required much of her. Her dual allegiance—to her native Hawaiian pupils and her missionary benefactors—was a tension that would persist throughout her career. In January 1895, Lili‘uokalani was charged with treason and imprisoned in ‘Iolani Palace. With their queen in custody, Pope had to keep a more watchful eye on the psychological states of all of her pupils, ever loyal to the monarchy. The entire community was quarantined due to the cholera outbreak affecting school operations. Her first graduates hit the job market and Pope asserts herself with Charles Bishop and the school trustees.

People have always been fascinated by cooperation and altruism in animals, in part to shed light on our own propensity or reluctance to help others. Darwin’s theory added a certain urgency to the subject because the principle of “nature red in tooth and claw” superficially seems to deny the possibility of altruism and cooperation altogether. Some evolutionary biologists have accepted and even reveled in this vision of nature, giving rise to statements such as “the economy of nature is competitive from beginning to end … scratch an ‘altruist’ and watch a hypocrite bleed”. Others have gone so far in the opposite direction as to proclaim the entire earth a unit that cooperatively regulates its own atmosphere (Lovelock 1979). The truth is somewhere between these two extremes; cooperation and altruism can evolve but only if special conditions are met. As might be expected from the polarized views outlined above, achieving this middle ground has been a difficult process. Science is often portrayed as a heroic march to the truth, but in this case, it is more like the Three Stooges trying to move a piano. I don’t mean to underestimate the progress that been made—the piano has been moved—but we need to appreciate the twists, turns, and reversals in addition to the final location. To see why cooperation and altruism pose a problem for evolutionary theory, consider the evolution of a nonsocial adaptation, such as cryptic coloration. Imagine a population of moths that vary in the degree to which they match their background. Every generation, the most conspicuous moths are detected and eaten by predators while the most cryptic moths survive and reproduce. If offspring resemble their parents, then the average moth will become more cryptic with every generation. Anyone who has beheld a moth that looks exactly like a leaf, right down to the veins and simulated herbivore damage, cannot fail to be impressed by the power of natural selection to evolve breathtaking adaptations at the individual level. Now consider the same process for a social adaptation, such as members of a group warning each other about approaching predators.

This chapter analyses the empirical examples of those events for which EC meetings were called but a PHEIC was not declared, or those for which EC meetings were never convened, but the outbreaks warranted further consideration. This starts with MERS-CoV, Yellow Fever, Cholera in Zimbabwe and Haiti, chemical weapons in Syria and the Fukushima disaster. In each of these we consider the further inconsistencies apparent in the decision making by the EC or WHO.

The village of Millersburg was established by Pennsylvania native John Miller on the bank of Hinkston Creek to take advantage of a mill site along the Maysville Road. A mill dam still spans the creek. Some early log and stone buildings still stand along the Maysville Road. North of Millersburg the old road parallels the current route creating the effect of braided roads.

On an ordinary spring morning in 1852, Ben Major and his wife Lucy are eating breakfast when they are interrupted by a frantic messenger. Ben’s only sister, Eliza Ann Davenport, is gravely ill with cholera. Ben rushes to her home, where he tries all his various botanical treatments for cholera, but to no avail. Eliza Ann dies, and within a short time it is clear that two of her sons and Ben are sick, too. All three of them die within a few days. With the deaths of Tolbert and Ben—six months apart—the remarkable correspondence between Bassa Cove and Walnut Grove ends, but the final letter from Liberia is not the last interaction between the Liberian colonists and the American Majors. Years later, Wesley Harlan travels from Liberia to pay his respects at Ben Major’s grave in Illinois.

The inadequacy of the government’s disaster relief directly contributed to the terrible cholera epidemic that followed the storm. A lack of food, clean water, and shelter had left the people of the cyclone-affected districts highly susceptible to disease. Officials blamed the people themselves for the situation, and to some extent religious and caste prejudices about the disposal of bodies had made conditions worse. The medical response to the epidemic was late and poorly organized. Although there was no effective treatment for cholera, a better-resourced response might at least have slowed the spread of disease.

In 1810, more than four in five Americans lived in one of the original thirteen seaboard states. Half a century later, though those states had grown considerably, they held less than half of the nation's population. The reason lay in the post-1815 rush of settlers beyond the Appalachians into the continental interior, “one of the great immigrations in the history of the western world.” Chaotic though this movement was in many ways, it showed at least one orderly pattern. Individually these settlers followed many paths, but the typical ones moved due west, erring to the north or south only when their path was blocked by mountains or water or political boundaries or when they were pulled aside by the easier travel routes along navigable rivers. Most of the inhabitants of every inland state in i860 came from the states to the east within its own latitudes. It was mostly New Englanders and upstate New Yorkers—themselves mostly of New England origin—who occupied the territories and states bordering on British North America. They left the central and southern parts of Ohio and Indiana and Illinois mainly to settlers from the middle states and the Chesapeake. The frontier of the Deep South was colonized from the far southern coastal states much more than from Virginia or North Carolina, states that furnished Kentucky and Tennessee and Missouri with the bulk of their inhabitants. “Ohio Fever” swept the rural Northeast after 1815, followed by “Michigan Fever” in the 1830s, but it was “Alabama Fever” and “Texas Fever” that gripped the southern states. Modern research has documented what many Americans at the time spotted for themselves, what some who could agree on little else agreed was a constant truth of human behavior growing out of a basic law of climate-society relations. “The great law that governs emigration,” announced a Massachusetts congressman during an argument against the spread of slavery, “is this: that emigration follows the parallels of latitude.” It was “a great law of emigration,” “fixed and certain,” echoed a Louisiana editor in a defense of the South and its institutions, “that people follow the parallels of latitude.” People were presumed to do so in order to avoid the change of climate that traveling north or south would have entailed.