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May 6, 2013
John Snow and cholera: how myth helped secure his place in history
The high-profile marking of John Snow’s bicentenary on the fifteenth of March would have surprised the great man. The London School of Hygiene and Tropical Medicine, the WellcomeTrust, and The Lancet were among the august UK organisations to honour him with events including an exhibition, three days of seminars, and a gala dinner. The physician was also celebrated in the United States where he has a large fan base.
By the time of his death, on 16 June 1858 at the age of 45, Snow was convinced beyond doubt that his theory on the mode of transmission of epidemic cholera was correct but had little expectation that any credit would accrue to him. His friend, the Soho curate Henry Whitehead, said Snow predicted that he might not live to see the day when great cholera outbreaks were in the past — which was true — and also that his name would be forgotten when that day came, which was not. On the contrary, he is now widely regarded as the father of the science of epidemiology, with his life and work the subject of countless books, articles and web pages, while 200 years after his birth his legacy remains the focus of lively academic debate.
But it’s an unfair world. Achievement alone isn’t always enough to ensure that an individual, however deserving, secures a place in history and in Snow’s case, myth had a role to play. Not that Snow appeared at all interested in fame, posthumous or contemporary. Another friend, Josuah Parsons from his student days, remarked: “The naked truth for its own sake was what he sought and loved. No consideration of honour or profit seemed to have the power to buy his opinions on any subject.” That was just as well, for both honour and profit were in short supply, at least where his groundbreaking work on epidemic disease was concerned.
By the mid-1850s when Snow published his seminal work on cholera he was enjoying some success in the fast-developing specialism of anaesthesia, even attending Queen Victoria at the birth of two of her children. His thinking on disease was largely ignored, however, mainly because he rejected the then widely accepted belief that foul air, or miasma, was to blame. He reasoned, correctly, that cholera was spread when some of the matter thrown off by a victim — the vomit or the massive cloudy discharges from the bowels — found its way into a healthy person’s mouth. He also explained the disease’s frightening habit of striking hundreds of people simultaneously without warning: the cause was infected sewage leaking into the water supply, a common occurrence in the first half of the 19th century. He was not believed.
In the summer of 1854 in order to test his theory Snow carried out what become known as the Grand Experiment, tramping the streets of South London while the country was in the grip of its third cholera epidemic, knocking on doors and asking which of two water companies the householder used. He discovered that customers of the company that took its supplies untreated from the Thames, right next to where the sewers of London were discharged, were between eight and nine times more likely to die of cholera than those whose supplier had recently moved its source upriver, out of reach of the filth.
It was as Snow was putting the finishing touches to this work that he became involved in the Broad Street episode. His serious academic reputation is largely based on the South London research, but it is Broad Street that has contributed most to his enduring reputation, linking as it does a compelling story with two icons — a “death map” and the image of a street pump — with the addition of a little fiction along the way.
Overnight on Thursday, 31 August 1854, 200 people in a tiny part of Soho around Broad Street and Golden Square were struck down by a massive explosion of cholera, the fastest and most deadly ever seen in Britain. Whole families were carried off together. The epidemic continued for 10 days, still confined to a few streets, before petering out. The eventual death toll was over 600.
When Snow heard what was happening, he first looked at the addresses where the fatal cases had occurred and then went on to pioneer what is now a vital tool in epidemiology, disease-mapping, marking the deaths, house by house, on a street plan. The map showed just how local the outbreak was; all the deaths clustered in and around Broad Street. What interested Snow, however, was that those deaths either plummeted or stopped altogether at every point where it was easier to go to another pump than the one in Broad Street.
On the night of 7 September then, a week into the epidemic, Snow gate-crashed a parish meeting at St. James’s church, Piccadilly, where the Board of Guardians responsibly locally for public health were discussing the outbreak. Polluted water from the Broad Street well was to blame, he told the Guardians. They must put the pump out of action.
So far, all true. At this point in some accounts though a little creative licence creeps in. After a bitter row with the recalcitrant authorities, we are told, Dr Snow then storms off, either to chain up the pump handle himself or wrench it off with his own hands. In fact while the authorities were far from convinced, they did take Snow’s advice and the pump was disabled.
The next piece of fiction is that the deaths then stopped in their tracks and, hey presto, overnight John Snow was vindicated. Truth was, the epidemic had already peaked of its own accord; putting the pump out of action proved nothing. The longer, more complex story of how John Snow was proved right is actually more interesting but it’s easy to see why such a satisfying ending to the tale has evolved. And if myth has proved helpful in ensuring that a brilliant man who was dismissed and reviled during his lifetime is now so rightly celebrated, it’s no bad thing.
Sandra Hempel is a writer and editor who specialises in health and social issues. Her book The Medical Detective – John Snow, Cholera and the Mystery of the Broad Street Pump won the British Medical Association book award for the public understanding of science and the Medical Journalists’ Association book award. Her next book The Inheritor’s Powder, which looks at arsenic poisoning and forensic toxicology, is published by Weidenfeld and Nicolson on 13 June 2013. She recently gave a talk at the London School of Hygiene and Tropical Medicine about John Snow.
Throughout the year, the International Journal of Epidemiology will be publishing special reprints marking John Snow’s bicentenary, including The Siege of Krishnapur by J. G. Farrell and Cholera, with reference to the geological theory: A proximate cause – a law by which it is governed – a prophylactic by John Lea. The IJE is an essential requirement for anyone who needs to keep up to date with epidemiological advances and new developments throughout the world. It encourages communication among those engaged in the research, teaching, and application of epidemiology of both communicable and non-communicable disease, including research into health services and medical care. OUP publishes the journal on behalf of the International Epidemiological Association.
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Image credits: (i) John Snow, seated, resting right arm on table, anon. (ii) ‘A cholera patient’, caricature of a cholera patient experimenting with remedies (Robert Cruikshank’s random shots No. 2) (iii) Street Map of Soho, around Golden Square, illustrating incidences of cholera deaths during the period of the Cholera Epidemic, 1853. All three images are used with permission from the Wellcome Trust. Do not reproduce without express permission.
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May 5, 2013
Cinco de Mayo and the insurgent taco
On the fifth of May, many in the US and Mexico will celebrate Cinco de Mayo, the commemoration of Mexico’s victory over the French at the Battle of the Puebla in 1862. In this excerpt from Planet Taco: A Global History of Mexican Food, Jeffrey Pilcher looks at Cinco de Mayo and the first written instance of the word “taco.”
Although Manuel Payno introduced the taco to many readers in the 1890s, there was at least one prior literary reference to the snack, which likewise revealed ambiguities and social divisions within the national cuisine. This earlier mention, by another liberal author, Guillermo Prieto, came at a critical moment in Mexican history—the Cinco de Mayo victory at the Battle of Puebla by largely indigenous troops over the French invaders. But rather than exalting a national dish, Prieto used the taco to spoof the Europeans and bring them down to the level of Indians. Throughout the nineteenth century, elites perceived indigenous food as a shameful category within the national cuisine; such food was undoubtedly Mexican but associated with Aztec barbarism and backwardness. It was not a treasure to celebrate but rather a condition to overcome on the path to modernity. [...]
Tortillas and Tacos by Peggy Greb, U.S. Department of Agriculture. Public domain via Wikimedia Commons.
Liberal intellectuals and gourmets such as Manuel Payno, Guillermo Prieto, and Antonio García Cubas were regular visitors in the pulquerías of the early republic, and in their memoirs and fiction, they ranked the finest street food vendors and tavern enchilada makers. But despite their praise for a few cooks, they looked with dismay on the diet of the lower classes. A satiric poem by Prieto, written around 1862 as propaganda during the war against France, illustrates this haughty attitude. Mexican troops had repulsed Napoleon’s first invasion in May at the Battle of Puebla, but reinforcements arrived in September under the command of Élie Forey. While awaiting the coronation of Maximilian, the general appointed a regency council including Juan Nepomuceno Almonte, who had led the diplomatic mission to Napoleon and unilaterally declared himself ruler of Mexico—from behind French lines. In a parody entitled “Glorias de Juan Pamuceno,” Prieto described the traitorous Almonte serving indigenous food and drink to the French general:Good Forey!
You drank wine of the maguey
until you lost your head:
ate pipián and tamalli,
tlemolito with xumiles,
and tired yourself of mextlapiles
in your tacos of tlaxcalli.
In these brief verses, Prieto first spoofed the Frenchman for going native, getting drunk on pulque while eating tamales, pumpkin seed sauce (pipián), and, most degrading of all, stinkbugs (xumiles) in chile broth (tlemolito). Unspoken in the text, but obvious to contemporaries, was an equally cruel jibe at Almonte, the illegitimate son of a Native American woman, Brígida Almonte, and the priest and independence war hero Father José María Morelos. Although the conservative diplomat moved comfortably in European royal courts, speaking fluent English and French, Prieto dismissed him with racist stereotypes of the ancient Aztecs. As a final insult, the taco served to emasculate General Forey. The mextlapil on which he tired himself was a stone rolling pin, used to grind corn by hand for making tortillas (tlaxcalli), the most stereotypically feminine task in Mexican society and one that no self-respecting man would ever be seen undertaking. What may be the first recorded taco thus served as propaganda in the campaign to expel French invaders and restore the Mexican Republic. Yet Prieto was not celebrating the indigenous troops who had helped to defeat the French.
Jeffrey M. Pilcher is Professor of History at the University of Minnesota. He is the author of several books including Planet Taco: A Global History of Mexican Food. He also edited the Oxford Handbook of Food History.
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May 4, 2013
A day for birds, birds for a lifetime
Bird Day began in 1894 as part of the wildlife conservation movement that sprang up in response to the slaughter of the bison and the Passenger Pigeon. Birds always had a large role, for they were threatened but also familiar and fascinating. More than any other form of life they drew and held people, becoming for many a lifelong interest, passion, and even obsession. This generation made identifying birds by sight or (less frequently) song a popular hobby, and with it a new kind of book: the field guide. Birding now draws more people than any other outdoor recreation, from every part of the country and ranging from those who want to see every bird on earth to the much greater number who keep a field guide on the windowsill and a casual eye on the bird feeder in the backyard. They buy guides of every kind and check websites with up-to-date information on migration, rarities, and oddities. Some birds become celebrities. “Pale Male,” one of a pair of red-tailed hawks nesting in New York City, attracted a local, then a national following, and their courtship and nesting led to a book, Red-tails in Love.
Birders always went with bird conservation for Audubon’s founders saw the hobby as a way to get women outdoors and interested in nature so they would support bird conservation. Their political work began with campaigns against market hunting and for the protection of songbirds, went on through work for nature reserves, then the banning of pesticides like DDT, and saving the ecosystems on which birds—and all of us–depend. Birders’ cooperation with science goes back as far and has a rich a history. In 1900 amateurs sent their observations to ornithological journals; in the 1920s they joined the national bird-banding program organized by the Bureau of Biological Survey; in the 1980s signed up for the US Fish and Wildlife Service’s Breeding Bird Survey; and now they contribute to citizen science programs gathering data to analyze changes in bird populations across the continent. In a world of climate change and growing human populations, birds provide one of our best windows on we affect nature, and birders serve as the eyes and ears and the interested hearts of that effort.
Reed’s sparrows Reed’s shirt pocket-sized books were easy to carry. From Chester A. Reed, Bird Guide: Part Two, Land Birds East of the Rockies from Parrots to Bluebirds (1906; reprint, New York: Doubleday, Page, 1912).
Because the world keeps changing research never stops, but what keeps the scientist active also makes birding a continuing adventure, as much an exploration of nature as a matter of checking off species. Even on their home grounds birders see annual variation as birds expand their ranges or move out of their area, and occasionally the spectacular irruptions of new species or the occasional collapse of established ones. In the 1950s the self-introduced cattle egret spread through the country, and now the introduced Eurasian collared dove is doing the same. Cave swallows began nesting in the square drainage pipes under large highways, and ornithologists and birders remade their range maps. Recently West Nile virus devastated birds in many parts of the United States. As residues of the banned pesticide DDT leached out of the environment, bald eagles and peregrine falcons returned to parts of their old ranges, and now we can hope to see a eagle soaring over Minneapolis or an urban falcon taking a pigeon over Fifth Avenue.
Birders support conservation and work for it, but they go to the field because birds fascinate them, and here we come back to Bird Day’s original purpose — celebrating birds and inviting us to learn more. Those who want to learn about birds have many more resources than their ancestors. The few field guides available in 1894 treated a small selection of birds, had poor illustrations, and gave only hints about how to tell one bird from another—not surprising when even experts could not reliably distinguish all species in the field. Now every bookstore has shelves of guides with the latest tips on field identification, illustrated with digital photographs or expert paintings even more expertly reproduced, arranged to guide the reader to the right name, and catering to every interest and level of expertise. Roger Tory Peterson’s books, written for people with some experience but not a great deal, sit on bookstore shelves next to David Sibley’s guide, the National Geographic guide, and a dozen more for those who have outgrown “Peterson.” Further along we find volumes on identifying hawks at a distance or sorting out immature gulls, and a new form that offers on one page a dozen or more views of the species sitting, standing, and soaring — a miniature library of images. Audio guides make learning bird songs as easy as sorting out their distinctive plumages, and software puts field guides on our phones. Those tired of identification or just interested in birds in other ways can consult handbooks about birds’ lives, their evolution, and their development.
Seton’s raptors, Auk 14 (Oct. 1897): 395-396
Birders can pursue their passion as far and in as many directions as they wish, for the hobby, though identified with listing, gives us a way to pay attention to the natural world. We can wander, study, and marvel in whatever ways attract us. It has never been a better or more important time to be involved with birds and never a better time to celebrate Bird Day.
Thomas R. Dunlap is Professor of History at Texas A&M University, He is the author of In the Field, Among the Feathered: A History of Birders and Their Guides and Faith in Nature: Environmentalism As Religious Quest.
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Image credit: Both images in the public domain and courtesy of the author.
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Seven things you never knew about heart failure
Heart failure affects 750,000 people in the UK alone and is fast becoming a greater threat to public health than cancer. But how much do you know about this condition? The European Heart Failure Awareness Day is designed to raise awareness of heart failure, including possible symptoms, the importance of an early and accurate diagnosis, and the need for optimal treatment. In that spirit, we’ve prepared this brief quiz on heart failure for you to test your knowledge.
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Find out more about how to prevent heart failure and keep your heart healthy.
Oxford University Press in conjunction with the European Society of Cardiology and the Heart Failure Association is offering 20% off all our books in cardiology for the month of May, including the authoritative Oxford Textbook of Heart Failure, the practical and concise Oxford Specialist Handbooks on the topic of Heart Failure, and three titles in cardiology published in conjunction with the European Society of Cardiology. In addition we will be offering one month’s free access to the Oxford Textbook of Heart Failure on Oxford Medicine Online, as well as free articles from the European Journal of Heart Failure. We are also publishing a series of special, related articles on the OUPblog.
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May 3, 2013
Is diplomatic history dying?
Despite lying at the intersection of both history and international relations — two of the most popular disciplines in the contemporary arts academy — diplomatic history is seen as old-fashioned. New, trendier, and leftier approaches have risen. Consider that of the 45 historians at the University of Wisconsin in 2009, 13 (or 29%) specialized in gender, race, and ethnicity; only 1 (or 2%) studied diplomatic history or US foreign policy. Between 1972-2009, the Journal of American History published 36 articles that expressed some sympathy for American communism and not a single one which was critical.
The bestselling history textbook remains Howard Zinn’s A People’s History of the United States (1980). Zinn was unabashedly liberal-leftist in his approach. His book is currently the 860th bestselling book in America. Paul Johnson’s A History of the American People, a conservative interpretation, is 19,331st. This is not to argue over the academic merits of both books but to observe that Zinn’s leftism has necessarily affected how many students and their teachers understand US history. Despite over 40% of Americans describing themselves as conservative, less than 16% of academics identify that way. The American academy, no less American historiography, is a liberal hegemony.
Why this imbalance? After all, diplomatic history has hardly been the preserve of conservative scholars. Perhaps the most important 20th century work of diplomatic history was William Appleman Williams’ Tragedy of American Diplomacy (1959) — the inspiration for a wave of left-leaning revisionist histories of US foreign policy. Christopher McKnight Nichols and David Milne, my two associate editors for the Oxford Encyclopedia, would comfortably locate themselves on the progressive wing of modern politics. Liberal historiography is a very broad church.
One possible answers lies in the necessary focus on the ‘great man’ thesis of history — either implicitly or explicitly — in the work of many diplomatic historians. Men, and it largely is men, have been the key foreign policy makers until comparatively recently. They have lead nations, fought wars, and dictated the terms of peace. All the great commanders-in-chief in US history have been men because all 42 presidents have been men.
As a way around this, university students are increasingly presented with impersonal forces and told these are responsible for injustice or are, conversely, the locomotives of progress. Racism, economic deprivation, and gender inequality color the research agendas of a substantial number of historians. Ameliorate these forces and we can enter the sunny uplands of progress and equality. It is not individuals that move history but forces, pressures, classes, sexes, races, even climate. Nations, led by individual leaders, are made to matter less than the United Nations, led by supposedly progressive impulses.
The diplomatic historian, of course, may be in sympathy with some of this. But he or she must also acknowledge the elite nature of much of what he or she studies: the president and his foreign policy principals, ambassadors and military commanders. And that elite, until the era of Condoleezza Rice, Hillary Clinton, and Barack Obama, was overwhelmingly white and male.
This modern bias against elitism and ‘great men’ and in favor of the explanatory power of impersonal forces is inherent in much contemporary historiography. Diplomatic historians find themselves having to bridge the divide. If only there were more of them — liberal and conservative — doing it.
Timothy J. Lynch is an Associate Professor, Director of the Graduate School of Humanities and Social Sciences, and Associate Dean for Research at the University of Melbourne. He is the editor-in-chief of the Oxford Encyclopedia of American Military and Diplomatic History. View the Melbourne launch of the Encyclopedia, or attend the American Military and Diplomatic History conference at Oregon State University on 7 May 2013.
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Image credit: A row of international flags. Photo by canbalci, iStockphoto.
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An Oxford Companion to NBC’s Hannibal
The new television show Hannibal resurrects Thomas Harris’s famous serial killer and offers a few new surprises bound to shock both newcomers and longtime fans of Dr. Lecter. So while you’re catching up on the latest incarnation of the series, why not brush up on criminology facts or learn something new about cannibalism?
CRIMINAL PROFILING
How does Will Graham get inside the minds of serial killers?
Criminal Law: The Essentials
By Sue Titus Reid
This brief text will introduce you to the main issues and developments within the field.
Crime Profiles: The Anatomy of Dangerous Persons, Places, and Situations
By Terance D. Miethe, Richard C. McCorkle and Shelley J. Listwan
Learn more about the motivation and design of criminal acts.
Forensic Psychology: A Very Short Introduction
By David Canter
A thorough overview of the field of forensic psychology including a chapter dedicated to how to track down a criminal.
CRIMINAL LAW AND JUSTICE
Jack Crawford’s FBI team doesn’t have the best record for bringing in criminals alive, but what can they expect when brought to justice?
Criminal Law: The Essentials
By Sue Titus Reid
This brief text will introduce you to the main issues and developments within the field.
Minds on Trial: Great Cases in Law and Psychology
By Charles Patrick Ewing and Joseph T. McCann
A behind-the-scenes look into high profile cases with an emphasis on the testimonies of mental health professionals.
Criminal Law
By Sue Titus Reid
A broader overview of criminal law and justice through a modified case by case approach.
The Oxford Handbook of Crime and Criminal Justice
Edited by Michael Tonry
A guide to the American criminal justice system and essential to learn what happens next to the killers caught on the show.
Criminal Law
By Nicola Padfield
Review this concise volume on criminal law before the next big case.
PSYCHIATRY
Do you need to stay ahead of Dr. Lecter’s mind games with the latest developments in psychiatry?
Psychiatry: A Very Short Introduction
By Tom Burns
Test your knowledge on this field and see if you can keep up with Dr. Lecter.
Psychiatry’s contract with society: Concepts, controversies, and consequences
Edited by Dinesh Bhugra, Amit Malik and George Ikkos
Read this to get a better handle on the complicated relationship between doctor and patient (luckily not as complicated as Graham and Lecter’s will be).
SERIAL KILLERS
Where did Thomas Harris get his inspiration from?
Gangsters, Swindlers, Killers, and Thieves: The Lives and Crimes of Fifty American Villains
Edited by Lawrence Block
Learn about the real villains that could have been the inspiration behind some of the characters on the show.
The Oxford Companion to Crime and Mystery Writing
Edited by Rosemary Herbert
Review the entry on serial killers and mass murderers by Marion Swan to see how real life killers inspire our writers.
ANTHROPOPHAGY
How does human flesh taste?
The Man-Eating Myth: Anthropology and Anthropophagy
By William Arens
No book list on Hannibal Lecter would be complete without a few reference books on cannibalism.
The Oxford Companion to the Body
Edited by Colin Blakemore and Sheila Jennett
The entry on cannibalism by W. Arens provides a historical perspective on the anthropophagic nature of ‘others’.
Now that you’re prepared, use your newfound knowledge to solve the next case before Will does!
Kimberly Hernandez is a social media intern at Oxford University Press.
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Image credit: All images from the Hannibal television series copyright NBC. Used for purposes of illustration.
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State and private in China’s economy
The central story of China’s economic reforms and the resulting economic miracle has been the move from a centrally planned to a largely market economy, and the emergence of a market-based and mainly private sector alongside the old state-owned sector. Most quantitative trends are still in that direction, and legal and institutional reforms, notably stronger property rights within a situation of limited rule of law, have provided some support. Nevertheless, China has maintained its distinctiveness from other varieties of capitalism, both in rhetoric (“socialist market economy”) and in reality. The Communist Party state retains a more powerful role in the economy than is the case with most capitalist countries, and the trend has by no means been unidirectional from state to private or from planning to market.
Indeed, over the past several years there has been a lot of discussion in China over a counter trend, that is “the advance of the state and the retreat of the private” (guo jin min tui). On the one hand this reflects the on-going perception in the Chinese leadership that only the “national champions”—the massive state-owned companies—are likely to be able to compete on the international stage. Moreover, the nature of the 2008 stimulus package—heavily weighted to large-scale infrastructure—meant that many of the resources went to state-owned companies. At the same time, the trend also involves struggles for power and wealth between different groups in society. Thus as the Economist reported, state interests were successful in the mid-2000s in seizing some 4,000 privately run oil wells in north-west China.
Chinese President Hu Jintao (L) talks with Vice President Xi Jinping as they leave after the closing session of the National People’s Congress on March 13, 2009 in Beijing, China. (Photo by Guang Niu)
One of the main arenas of contention between state and private interests has been the coal industry. Of course this is an arena where genuine claims of public interest can be made. China is critically dependent on coal as a source for its energy (coal provides around 70% of China’s total energy needs), a dependence that causes major environmental problems, and in that situation the state could be expected to pay close attention to the industry in any society. Moreover safety, or rather the lack of it, has provided a major reason and pretext for state intervention. Up to the early 2000s China’s coal safety record was an international embarrassment, with far higher levels of fatalities and fatality rates per million tons of coal produced even than other developing countries. This became a matter of concern both for the leadership and for the educated public in general. Wen Jiabao’s history as a geologist contributed to making this issue a major focus of the more “populist” agenda of the Hu Jintao-Wen Jiabao leadership. The worst safety record was found among the smaller rural and private mines, and therefore provided the pretext for a series of attempts to curtail or control such mines. It also allowed the state and the press to paint the small mine owners as “black-hearted coal owners,” and they received public sympathy.
The two trends—a general extension of state power in the economy and concern for coal safety—came together in the attempt to consolidate and rationalize the coal industry in the late 2000s. This happened most famously in Shanxi province, until 2008 China’s largest coal producer, and similar policies were then extended to other provinces, though with some variations. In Shanxi, the policy took the form of empowering State-owned mining enterprises to take over the resources of small mines within an area allocated to each of the large mines, thus ruling out any competition over resources. This was widely perceived, though not official described, as the (re-)nationalization of coal resources.
Private enterprises and owners not surprisingly felt bitter at the implementation of this policy, and argued strongly that any compensation that was paid was entirely inadequate. Owners among the local rural population were angry at being forced to sell below value, with dark rumours about bribes paid to local officials. But many of the targets of the policy were extra-provincial investors, and thus people for whom the provincial government would feel no particular responsibility. The largest group was from Wenzhouin Zhejiang, whose investors had sunk tens of billions of yuan into the Shanxi coal industry in the 1990s and 2000s. The overall trend towards the strengthening of property rights was shown by the fact that the Wenzhou owners felt able to fight the takeover, using media campaigns to denounce the nationalization and the state’s encroachment on private rights. They also attempted to call on the rule of law, hiring lawyers, who held workshops and conferences in Hangzhou to protest the policy, arguing that it contradicted the principles of the socialist market economy. Nevertheless the trends towards stronger property rights and the rule of law were only incipient, and it would appear that the mine owners’ protests had limited effect, and the nationalization went ahead.
Private owners were not the only interests adversely affected. By concentrating ownership in the hands of state owned enterprises at the provincial level, the policy also deprived local governments of the major part of their revenue streams and local populations (and migrant workers) of many employment opportunities. Thus there was much less enthusiasm for the policy at the county level and below than at the level of the province, though outright opposition was limited by the heavy weight the central state was giving to the improvement of work safety in assessing officials for transfer and promotion: the policy does appear to have very substantially reduced the accident rate, and resistance could be made to seem irresponsible. In addition to generating tax revenues, local governments had previously been able to pressure private mine owners into contributing to a wide range of social expenditures. As one local official complained, although they could get the private owners to build roads or schools almost at will, they couldn’t even get the new province-level owners to construct a public toilet.
One must be careful in extrapolating the experience of the Shanxi coal industry to the national economy, but at the minimum this episode shows that the state retains levers and the willingness to use them to impose its will on the enterprise sector to a far greater extent than in most other capitalist countries. While private owners appear to have a greater ability now to articulate their interests in public, they are still not able to roll back the advance of the state at the expense of the private where the state—or key elements of the state—sees its core interests involved.
Tim Wright, Editor-in-Chief of Oxford Bibliographies in Chinese Studies, is Emeritus Professor of Chinese Studies at the University of Sheffield, UK. His research focuses on modern Chinese economic history, in particular natural and economic shocks to the economy, and on the political economy of contemporary China. His publications include Coal Mining in China’s Economy and Society, 1895–1937, The Chinese Economy in the Early Twentieth Century: Recent Chinese Studies, and The Political Economy of the Chinese Coal Industry: Black Gold and Blood-stained Coal.
Developed cooperatively with scholars and librarians worldwide, Oxford Bibliographies offers exclusive, authoritative research guides. Combining the best features of an annotated bibliography and a high-level encyclopedia, this cutting-edge resource guides researchers to the best available scholarship across a wide variety of subjects.
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Celebrating 100 years of Indian Cinema: a quiz
On 3 May 1913, Raja Harishchandra, the first Indian feature-length film, premiered. Since then, India’s film industry, mostly known as Bollywood but operating outside of Bollywood’s Mumbai base as well, has become the world’s most prolific film industry: 1,325 films were produced in 2008. Salman Rushdie recently said on The Daily Show with John Stewart, “I always thought it was unfair on the Bombay film industry to call it Bollywood. Because it’s actually much bigger than Hollywood. Hollywood should be called ‘Hombay’.”
For many, Indian cinema will call to mind elaborate melodramatic musicals and Shah Rukh Khan, but it is, like India, far more diverse. To celebrate the 100th birthday of India’s remarkable cinematic world, take this quiz and test your knowledge!
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All answers can be found in Oxford Reference, the home of Oxford’s reference publishing.
Alana Podolsky is a publicity assistant at Oxford University Press. She graduated from the University of Chicago with a degree in South Asian Languages and Civilizations in 2011.
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DSM-5 and psychiatric progress
By Tom Burns
National Mental Health week in May this year will see the launch of the eagerly anticipated DSM-5. This is the fifth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual which defines all psychiatric diagnoses and is often referred to as ‘the psychiatrists’ bible’. How can something so dry and dull sounding as a classificatory manual generate such fevered excitement? Indeed how did the DSM compete for space in a short book such as the VSI to Psychiatry? Why does it take its place alongside acknowledged classics like Sigmund Freud’s Interpretation of Dreams, or RD Laing’s The Divided Self? The answer is that psychiatry is a practice that is highly sensitive to cultural and social pressures and the origins of the DSM-III, published in 1980, reflected a crisis in psychiatry’s self confidence and is a classic case of unintended consequences.
American psychiatry (which had been dominated by psychoanalysts from about 1940 to 1970) had its prestige seriously dented in the early 1970s. Two major international studies had indicated that they tended to dramatically over-diagnose schizophrenia compared to other developed nations. To make matters worse Rosenham’s famous study ‘being sane in insane places’ was published in 1973. Rosenham got eight volunteers to go to different emergency rooms and say that they were hearing voices that said ‘empty’, ‘hollow’, or ‘thud’ but otherwise to behave absolutely normally. All were admitted to hospital and kept there for several weeks, all were diagnosed with schizophrenia and none had their diagnosis questioned. Clearly this was dire, something had to be done.
DSM-III was the response, a totally new approach to diagnosis. Instead of making a diagnosis by recognising an overall pattern of the illness DSM-III introduced ‘criterion based diagnosis’. So to be diagnosed with a disorder, say depression, the psychiatrist had to identify a core symptom (criterion) of lowered mood for at least two weeks and then four more symptoms (e.g. disturbed sleep, reduced appetite, poor concentration or feelings of worthlessness) out of a list of eight. If you ‘score’ on enough symptoms you have the disorder, if not you don’t. This approach emphasises reliability; the symptoms are simply defined and explained so most doctors will agree on them. It leaves little scope for an overall judgment or deciding on the ‘feel’ of the patient’s presentation. Improving reliability and reducing the variation between different psychiatrists with sharper definitions was meant to reduce the loose over-diagnosis that had plagued US psychiatry up till then. It also should improve the reliability of the drug trials that were coming into prominence.
One should be careful what one hopes for. While the DSM criterion based system has undoubtedly made diagnosis more consistent, it has certainly not made it tighter. As we approach DSM-5 the expansion in this classification is simply staggering. DSM-I in 1952 had 130 pages and 106 diagnoses and has ballooned to DSM-IV in 1994 with 886 pages and 297 diagnoses. The number of individuals who are diagnosed with psychiatric disorders is at an all time high. There is a growing recognition that the DSM system has lead to a medicalisation of everyday life; far too many people with transitory sadness find themselves classified as depressed and prescribed antidepressants. Anxiety disorders such as PTSD and Social Phobia are all too easy to define and hence diagnose, but can they really be as widespread as current practice suggests? Most patients now end up with more than one diagnosis. Even the psychopharmacologists who agitated for DSM-III are now concerned that diagnoses are cast so widely that they undermine, rather than guarantee their trials.
The fact that one can define something and agree on the definition does not make it either real or important. For example, there was good agreement four centuries ago on how to recognise a witch, but that does not mean that these poor women were witches. Similarly having a definition for ‘Oppositional Defiant Disorder’ in adolescents who ‘often argue with adults’ does not make it a psychiatric disorder (any more than nicotine or caffeine dependency which are, believe it or not, listed in there).
Of course we should not be too dismissive about the progress that has been made in reliability and consistency. Psychiatric practice is vastly safer, more predictable and evidence based than ever before. We can hope that DSM-5 will transcend its committee structure and weed out earlier mistakes and sharpen up and refine the range of diagnoses, perhaps deleting those that are hardly ever used. It will certainly not be dull. Since its origins two hundred years ago psychiatry has never been without its controversies and disputes and all the signs are that this is likely to continue.
Tom Burns is Professor of Social Psychiatry at Oxford University and author of Psychiatry: A Very Short Introduction. He has worked as a psychiatrist in Scotland, Sweden, and London before moving to Oxford. He trained as a group analyst and worked as a full time NHS consultant for 10 years before becoming an academic. His research is focused on interpersonal relationships in psychiatry – increasingly relationships with health care staff and the best forms of care for patients with severe illnesses such as psychoses. He has authored over 200 scientific papers and chapters and is the author or co-author of five books. He was awarded a CBE for his services to mental health in 2006.
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May 2, 2013
Sir Robert G Edwards (1925 – 2013)
With the announcement of the death of Bob Edwards at the age of 87, on 10 April 2013, a field of medicine and science has lost its grandfather. What is more, for more than five million children worldwide the man whose life’s work made their conception possible is no more. In every generation there are scientists whose discoveries and innovations make a difference but only a small number become household names. As one half of ‘Steptoe and Edwards’ Bob Edwards achieved that elevation in the popular imagination. As a result large numbers of people know his name and that he was one of the team who made IVF possible, but it is likely that few have any idea of the scale of his contribution. His whole postgraduate career, from the early 1950s, was spent in the progressive study of the biology of fertilization leading step by step to the in vitro fertilization of a human egg in 1968 and to the possibility that human pregnancy might eventually be achievable. Although through the 1970s Patrick Steptoe’s skill in laparoscopy provided the vital practical contribution that made the eventual establishment of the first IVF pregnancy possible, it was Bob Edwards’ long-term vision that had been the driving force.
The scale of opposition to their work is difficult now to imagine. In the years leading up to the landmark event in 1978 both the Vatican and many opinion leaders raised huge concerns. Even the Medical Research Council failed to provide support. In the years after 1978 the diverse opposition continued and ultimately in the UK the sensitivity perceived to surround human in vitro fertilization lead to the Warnock Commission, then the Human Fertilization and Embryology Act 1990. With the establishment of the HFEA in 1991 this area of medical practice has been regulated more heavily than any other. The scale of the opposition over decades would have crushed lesser men and their work.
Having demonstrated that human IVF could indeed lead to the birth of healthy babies might have been sufficient for some, but Steptoe and Edwards together took clinical IVF forward by establishing the first ever IVF clinic at Bourne Hall. Through the 1980s this and a growing number of IVF clinics around the world developed the processes involved so that by the end of that decade IVF had become an effective infertility treatment option. It is important that Bob Edward’s role in the progression of IVF through the 1980s and 90s is recognized. His status as the father of IVF was unquestioned and this gave him access as a significant presence at all the major international scientific conferences on human reproduction. In this role he was continually challenging the growing clinical and scientific community to address fundamental questions of reproduction as well seeking to improve clinical progress in clinical IVF. His presence at scientific meetings was often inspirational for the following generation of IVF scientists.
An important contribution was his leading role in founding ESHRE, the European Society of Human Reproduction and Embryology in 1984. Two years later he founded the scientific journal Human Reproduction, becoming its first Editor-in-Chief and serving from 1986 up to 2000. ESHRE has become one of the world’s most influential bodies in the development of all aspects of the field and Human Reproduction and its sister journals, again created by Bob (Human Reproduction Update and Molecular Human Reproduction), became world leaders. In 2000 although now in his mid-seventies Bob Edwards founded the online scientific journal Biomedicine Online, which also carries forward his vision. Both ESHRE and the journals he created continue to carry forward his vision.
I succeeded Bob as Editor-in-Chief of Human Reproduction in 2000 and my own strongest memories of him are of conversations about how journals might meet the challenges of encouraging young scientists and of advancing knowledge in the field. Well into retirement he always demonstrated an acute grasp of key unanswered questions and communicated through his deep fascination with how reproduction works.
Bob Edwards received awards from bodies around the world and this high esteem was well deserved. He received the ultimate recognition as a British scientist in being elected to the Fellowship of the Royal Society in 1984 but it is bitter-sweet that the world’s most prestigious award, the Nobel Prize for Physiology or Medicine, which many of us felt was long-overdue, came late in his life in 2010 when his health was poor. In the circumstances his Nobel Prize was received by his wife, Ruth, and his Nobel Symposium lecture was given by his eminent student, Professor Martin Johnson, and this provides a superbly detailed and affectionate portrait of a great scientist. This and Bob’s own memoir in Nature Medicine serve as excellent guides to the long and successful path to his landmark achievements.
He was awarded a knighthood in 2011.
David H Barlow is Emeritus Professor, previously Executive Dean of Medicine at the University of Glasgow. He was 20 years at the University of Oxford where he was Nuffield Professor of Obstetrics and Gynaecology and a Fellow of Oriel College. He has contributed, through various national roles, to the strategic development of IVF in the UK and is Emeritus Editor-in-Chief of Human Reproduction having succeeded Bob Edwards in 2000. He is currently Director of Women’s Health Services at the Hamad Medical Corporation, Qatar.
Human Reproduction features full-length, peer-reviewed papers reporting original research, clinical case histories, as well as opinions and debates on topical issues. Papers published cover the clinical science and medical aspects of reproductive physiology and pathology, endocrinology, andrology, gonad function, gametogenesis, fertilization, embryo development, implantation, pregnancy, genetics, genetic diagnosis, oncology, infectious disease, surgery, contraception, infertility treatment, psychology, ethics and social issues.
Image credit: Artificial insemination. Image by alex-mit, iStcokphoto.
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