Alexandra Minna Stern

STERILIZED in the name of public health : Race, immigration, and reproductive control in Modern California

In exploring the history of involuntary sterilization in California, I connect the approximately 20,000 operations performed on patients in state institutions between 1909 and 1979 to the federally funded procedures carried out at a Los Angeles County hospital in the early 1970s. Highlighting the confluence of factors that facilitated widespread sterilization abuse in the early 1970s, I trace prosterilization arguments predicated on the protection of public health. This historical overview raises important questions about the legacy of eugenics in contemporary California and relates the past to recent developments in health care delivery and genetic screening.

The Foreignness of Germs: The Persistent Association of Immigrants and Disease in American Society

During the 20th century the United States witnessed social, political, and economic transformations as well as advancements in medical diagnosis and care. Despite changes in demography, the meaning of citizenship, and the ability to treat and cure acute and chronic diseases, foreigners were consistently associated with germs and contagion. This article explores why, at critical junctures in American history, immigrants have been stigmatized as the etiology of a variety of physical and societal ills. The article analyzes three periods from 1880 to the present and suggests that now, as germs progressively and, often, indiscriminately cross national, social, and economic boundaries through multiple vectors, the mistakes of the past must not be repeated. Protecting the public health in the current era of globalization requires an ecumenical, pragmatic, and historically informed approach to understanding the links between immigration and disease.

Research findings from nonpharmaceutical intervention studies for pandemic influenza and current gaps in the research.

In June 2006, the Centers for Disease Control and Prevention released a request for applications to identify, improve, and evaluate the effectiveness of nonpharmaceutical interventions (NPIs)-strategies other than vaccines and antiviral medications-to mitigate the spread of pandemic influenza within communities and across international borders (RFA-CI06-010). These studies have provided major contributions to seasonal and pandemic influenza knowledge. Nonetheless, key concerns were identified related to the acceptability and protective efficacy of NPIs. Large-scale intervention studies conducted over multiple influenza epidemics, as well as smaller studies in controlled laboratory settings, are needed to address the gaps in the research on transmission and mitigation of influenza in the community setting. The current novel influenza A (H1N1) pandemic underscores the importance of influenza research.

Nonpharmaceutical Influenza Mitigation Strategies, US Communities, 1918-1920 Pandemic

We studied nonpharmaceutical interventions used to mitigate the second, and most deadly, wave of the 1918–1920 influenza pandemic in the United States. We conclude that several small communities implemented potentially successful attempts at preventing the introduction of influenza.

Responsible mothers and normal children: Eugenics, nationalism, and welfare in post-revolutionary Mexico, 1920-1940

This article examines the emergence of the eugenics movement in Mexico during the 1920s and 1930s and explores the ways in which eugenicists and physicians participated in the creation of a new paternal order focused on motherhood, sexuality, and child welfare. I analyze this transformation as part of a broader process of medicalization and state expansion that recast understandings of reproduction, heredity, childhood, and the female body during the post-revolutionary period. I argue that eugenics, and the related puericulture movement, played a critical role in the emergence of novel forms of governmentality, the nationalization of women, and the neutralization of anterior forms of patriarchy in modern Mexico. The article contributes to a growing body of scholarship on the meaning of motherhood, the standardization of elementary school education, and the formation of welfare states in Latin America.

Paying the price of freedom : family and labor among Lima's slaves, 1800-1854

This study documents in detail the striving and ingenuity, the hard-won triumphs and bitter defeats of slaves who sought liberation in nineteenth-century urban Peru. Drawing on judicial, ecclesiastical, and notarial records - including the testimony of the slaves themselves - it uncovers the various strategies slaves invented to gain their freedom. The author pays particular attention to marriage relations and family life. Slaves used their family solidarity as a strategy, while slave owners used the conflicts within families to prevent manumission. The text focuses on gender relations between slaveowners and slaves, as well as between slaves.

A Quiet Revolution: The Birth of the Genetic Counselor at Sarah Lawrence College, 1969

In 1969 Melissa Richter founded the first master’s degree genetic counseling program in the country at Sarah Lawrence College in Bronxville, New York. This article examines the myriad factors that contributed to the birth of the genetic counselor and situates this historical watershed in its social, cultural, academic, and medical context. This article highlights Richter’s prescience and path-breaking vision, evaluates the Sarah Lawrence program during the years of her directorship (1969–1972), and explores how this early foundation subsequently shaped the field of genetic counseling. Close attention is paid to the ethical issues that concerned Richter and their ongoing relevance to genetic health professionals today. This article is based on historical research in archives, consultation of primary sources, and oral history interviews with genetic counselors, geneticists, and allied professionals.

What Mexico Taught the World About Pandemic Influenza Preparedness and Community Mitigation Strategies

ON APRIL 24, 2009, FOR THE FIRST TIME IN MEXIcan history, President Felipe Calderon invoked the emergency health powers outlined in Mexico’s Constitution and General Health Law. The catalyst for this dramatic action was the appearance of a novel strain of influenza A(H1N1) of unclear severity. Harkening back to measures that originated in the late 14th century, when bubonic plague stalked much of Europe and Asia prompting ports and nation-states to order mass quarantines, Mexico instituted a broad-based and exacting menu of community mitigation strategies, or nonpharmaceutical interventions (NPIs), including school closure, public gathering bans, isolation, quarantine, and social distancing. Beginning on the morning of April 24, all schools were closed in Mexico City, the world’s third largest metropolis (population 20 million), which encompasses the federal district and state of Mexico. By April 27, authorities cast the net wider and all Mexicans awoke to shuttered schools, emptied restaurants, a steady stream of personal hygiene messages, and sporting events closed to spectators but broadcast on national television. For the next 2 weeks, Mexico came to a virtual standstill. The foundation of Mexico’s response is an increasing body of historical, epidemiological, and modeling data demonstrating statistically significant associations between the early, layered, and sustained implementation of NPIs and a reduction in peak mortality rate, the time to reach peak mortality, and the cumulative mortality burden from influenza. As Ignacio Villasenor Ruiz, MD of Mexico City’s health department told us in a recent interview, “[We] had to recognize that influenza transmission could not be stopped, but we could do two things” using community mitigation strategies, “first, slow the transmission rate and second, lower mortality.” The prevailing perception among international health experts is that Mexico responded swiftly, transparently, and efficaciously to mitigate the spread of influenza. However, these actions carried high social, political, and economic costs. The critical question to ask, as nations and communities consider applying such disruptive measures this coming fall, is what successes, problems, and lessons for the future can be gleaned from what many Mexicans consider a watershed in public health. To capture a historical snapshot of these events, we traveled to Mexico in early July 2009 and interviewed dozens of Mexican citizens and public officials. The following is a precis of our impressions.

Closing The Schools: Lessons From The 1918–19 U.S. Influenza Pandemic

When the novel strain of A/H1N1 influenza first appeared in spring 2009, closing schools was initially a common and often challenging strategy implemented in many communities. Arguments for and against closing schools are likely to arise anew if influenza spikes in the fall of 2009. Policymakers and community officials considering this and other nonpharmaceutical responses can learn from the experiences of ninety-one years ago, during the 1918-19 influenza pandemic that killed thousands of Americans. Analysis of the school closure policies of forty-three U.S. cities during that pandemic shows that smooth implementation was associated with clear lines of authority among agencies and with transparent communication between health officials and the public.

Better off in school: School medical inspection as a public health strategy during the 1918-1919 influenza pandemic in the United States.

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