The 1991 Cholera Epidemic in Peru: Not a Case of Precaution Gone Awry

The precautionary principle calls on decisionmakers to take preventive action in light of evidence indicating that there is a potential for harm to public health and the environment, even though the nature and magnitude of harm are not fully understood scientifically. Critics of the precautionary principle frequently argue that unbridled application of the principle leads to unintended damage to health and ecosystems (risk tradeoffs) and that precautious decision making leaves us vulnerable to "false-positive" risks that divert resources away from "real risks." The 1991 cholera epidemic in Peru is often cited as an example of these pitfalls of the precautionary principle. It has been mistakenly argued that application of the precautionary principle caused decisionmakers to stop chlorinating the water supply due to the risks of disinfection byproducts (DBPs), resulting in the epidemic. Through analyses of investigations conducted in the cities of Iquitos and Trujillo, Peru, literature review, and interviews with leading Peruvian infectious disease researchers, we determined that the epidemic was caused by a much more complex set of circumstances, including poor sanitation conditions, poor separation of water and waste streams, and inadequate water treatment and distribution systems. The evidence indicates that no decision was made to stop chlorinating on the basis of DBP concerns and that concerns raised about DBPs masked more important factors limiting expansion of chlorination. In fact, outside of Peru's capital Lima, chlorination of drinking water supplies at the time of the epidemic was limited at best. We conclude that the Peruvian cholera epidemic was not caused by a failure of precaution but rather by an inadequate public health infrastructure unable to control a known risk: that of microbial contamination of water supplies.     

清末以来江南城市的生活用水与霍乱

1820年霍乱传入江南之后,城市污染的市河遂成为一严重的疾病问题.清末民国年间,在大城市,大量土井和外来人口的存在,使得饮用和使用不洁水源的现象,仍然存在,故霍乱感染人数,仍然相当多.在中小城市,由于生活用水主要依赖江河和井水,也有比较高的感染率.但在某些水流速度较快、水质清洁的小市镇,其感染率则较低.     

Hygiene, Medicine, and Modernity in Korea, 1876–1910

Modernity in relation to medicine and the body is central to discussions on modernity in Korea. I have chosen to write this paper I have already penned several writings that are related to the topic: modern hygiene, cleanliness, medical service, and medicine. First topic is about the contrast between premodernity and modernity by comparing the prevalence of cholera in the early nineteenth and the early twentieth century. I discussed the new Western hygiene to control cholera decisively contributing to the destruction of the Confucian worldview and the generation of a new colonial modern order as well as preventing an epidemic, cholera. Second topic is about the dichotomy between cleanliness—cultured and uncleanliness—barbarity. Because it was related to the five senses, the discourse of uncleanliness and cleanliness could bring about an immediate effect, which made it the most elementary and primary discourse of modernity in Korea. Third topic is about premodern bodies in topknots and modern bodies in short hair. From among the incidents and topics that I studied then, the most impressive and extreme case regarding the relationship between the body and hygiene was that of the Cut Topknot Act (斷髮令). According to this decree, there were two main reasons for cutting off topknots: hygiene and convenience. Underlying them is the idea that long hair harms political reform and national enrichment. Indeed, this legislation had served as the battleground for a fierce war between modern standards and premodern traditions. Fourth topic is about the modernizing phase of health care system in Korea between 1876 and 1910. The health care system in Korea underwent tremendous changes from 1876 to 1910. In this process, the recently imported Western practices gradually came to occupy the center and existing practices were delegated to the periphery. Final topic is about the sanitation movement that believers of Ch’ ǒntokyo initiated around the twentieth century. This voluntary movement was greatly different from the two external and forced modernizations by Japanese imperialism and Western missionaries.

西方小说中的瘟疫题材

瘟疫与人类关系密切,不仅影响社会进程还影响人们的文化和精神状态。瘟疫是文学中的重要题材,不少世界名著都以瘟疫为背景,或者直接表现瘟疫。中世纪的瘟疫促进了文艺复兴和宗教改革的出现,意大利作家薄伽丘的《十日谈》就是以瘟疫为背景的名著,突出了文艺复兴时期的价值倾向和宗教改革的必然。18世纪启蒙主义文学以客观理性的态度表现世界,英国作家狄福的《大疫年纪事》则突出表达了这一倾向。法国作家吉奥诺的《屋顶上的骑兵》和哥伦比亚作家马尔克斯的《霍乱时期的爱情》则将瘟疫与爱情同置,爱情故事在瘟疫的映衬下显得光彩夺目。法国存在主义作家加缪的《鼠疫》中,瘟疫具有更广泛的象征意义,面对瘟疫的不同选择突出表达了存在主义的哲学观。     

Cholera revolts: a class struggle we may not like

Few have studied cholera revolts comparatively, and certainly not over the vast terrain from Asiatic Russia to Quebec or across time from the first European cholera wave of the 1830s to the twentieth century. Scholars have instead concentrated on the first European cholera wave in the 1830s and have tended to explain cholera’s social violence within the political contexts of individual nations, despite these riots raging across vast differences in political landscapes from Czarist Russia to New York City but with similar fears and conspiracy theories of elites inventing cholera to cull populations of the poor. Moreover, the history of cholera’s social toxins runs against present generalizations on why epidemics spawn blame and violence against others. Cholera riots continued, and in Italy and Russia became geographically more widespread, vicious, and destructive long after the disease had lost its mystery. The article then poses the question of why historians on the left have not studied the class struggles provoked by cholera, with riots of 10,000, murdering state officials and doctors, destroying hospitals, town halls, and in the case of Donetsk, an entire city. Finally, the article draws parallels between Europe’s cholera experiences and those in West Africa with Ebola in 2014.     

因信成疫:19世纪的印度朝圣与霍乱流行

19世纪的印度霍乱流行是理解人类文明与生态环境互动关系的良好切入点。作为印度文化传统中的重要组成,朝圣活动在很大程度上导致了霍乱疫情的暴发和扩散。印度地区的霍乱所呈现出的地方性、季节性和周期性等流行病学特征,在空间和时间上与印度朝圣息息相关。印度朝圣的自然环境、社会环境以及制度环境形塑了霍乱的流行模式,影响着霍乱流行的广度和强度。