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Introduction to

Public Fifth
Edition

Health Mary-Jane Schneider, PhD

Clinical Associate Professor
Department of Health Policy, Management, and Behavior
School of Public Health
University at Albany, State University of New York
Rensselaer, New York

with
Henry S. Schneider, PhD
Assistant Professor of Economics
Johnson Graduate School of Management
Cornell University
Ithaca, New York

Drawings by Henry S. Schneider

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Library of Congress Cataloging-in-Publication Data

Names: Schneider, Mary-Jane, 1939- , author. | Schneider, Henry S.
Title: Introduction to public health / Mary-Jane Schneider, with Henry S.
Schneider ; drawings by Henry S. Schneider.
Description: Fifth edition. | Burlington : Jones & Bartlett Learning, MA,
[2017]
Identifiers: LCCN 2016001765 | ISBN 9781284089233
Subjects: | MESH: Public Health | Public Health Practice
Classification: LCC RA425 | NLM WA 100 | DDC 362.1--dc23 LC record available at http://lccn.loc.gov/2016001765

6048

Printed in the United States of America

20 19 18 17 16  10 9 8 7 6 5 4 3 2 1
 Dedication

To Augustus Anthony Edison Schneider

May he live a long and healthy life
Contents
Preface xiii
Prologue: Public Health in the News xv

Part I: What Is Public Health? 1

1 Public Health: Science, Politics, and Prevention 3

What Is Public Health? 4
Public Health Versus Medical Care 5
The Sciences of Public Health 7
Prevention and Intervention 10
Public Health and Terrorism 11
Conclusion 13
References 13
2 Why Is Public Health Controversial? 15
Economic Impact 16
Individual Liberty 18
Moral and Religious Opposition 20
Political Interference with Science 22
Conclusion 23
References 23
3 Powers and Responsibilities of Government 25
Federal Versus State Authority 26
How the Law Works 28
How Public Health Is Organized and Paid for in the United States 29
Nongovernmental Role in Public Health 36
Conclusion 37
References 38

Part II: Analytical Methods of Public Health 39

4 Epidemiology: The Basic Science of Public Health 41

How Epidemiology Works 42
A Typical Epidemiologic Investigation—Outbreak of Hepatitis 43
Legionnaires’ Disease 44
Eosinophilia-Myalgia Syndrome 47
Epidemiology and the Causes of Chronic Disease 49
vi Contents

Heart Disease 49
Lung Cancer 51
Conclusion 53
References 54
5 Epidemiologic Principles and Methods 57
Kinds of Epidemiologic Studies 62
Conclusion 67
References 68
6 Problems and Limits of Epidemiology 69
Problems with Studying Humans 69
Sources of Error 71
Proving Cause and Effect 73
Epidemiologic Studies of Hormone Replacement
Therapy—Confusing Results 74
Ethics in Epidemiology 75
Conflicts of Interest in Drug Trials 78
Conclusion 80
References 81
7 Statistics: Making Sense of Uncertainty 83
The Uncertainty of Science 84
Probability 86
The Statistics of Screening Tests 88
Rates and Other Calculated Statistics 90
Risk Assessment and Risk Perception 94
Cost–Benefit Analysis and Other Evaluation Methods 98
Conclusion 99
References 100
8 The Role of Data in Public Health 103
Vital Statistics 104
The Census 104
NCHS Surveys and Other Sources of Health Data 107
Is So Much Data Really Necessary? 108
Accuracy and Availability of Data 109
Confidentiality of Data 111
Conclusion 111
References 112

Part III: Biomedical Basis of Public Health 115

9 The “Conquest” of Infectious Diseases 117

Infectious Agents 118
Means of Transmission 120
 Contents vii

Chain of Infection 121

Rabies 125
Smallpox, Measles, and Polio 126
Fear of Vaccines 129
Conclusion 131
References 132
10 The Resurgence of Infectious Diseases 135
The Biomedical Basis of AIDS 135
Ebola 140
Other Emerging Viruses 144
Influenza 146
New Bacterial Threats 148
Multidrug-Resistant Tuberculosis (MDR TB) 150
Prions 154
Public Health Response to Emerging Infections 155
Public Health and the Threat of Bioterrorism 156
Conclusion 157
References 157
11 The Biomedical Basis of Chronic Diseases 163
Cardiovascular Disease 165
Cancer 169
Diabetes 171
Other Chronic Diseases 172
Conclusion 172
References 173
12 Genetic Diseases and Other Inborn Errors 175
Environmental Teratogens 176
Genetic Diseases 177
Genetic and Newborn Screening Programs 180
Genomic Medicine 184
Ethical Issues and Genetic Diseases 185
Conclusion 187
References 188

Part IV: Social and Behavioral Factors in Health 191

13 Do People Choose Their Own Health? 193

Education 197
Regulation 200
Does Prohibition Work? 201
Conclusion 203
References 203
viii Contents

14 How Psychosocial Factors Affect Health Behavior 205

Health of Minority Populations 207
Stress and Social Support 208
Psychological Models of Health Behavior 209
Ecological Model of Health Behavior 211
Health Promotion Programs 213
Changing the Environment 215
Conclusion 216
References 217
15 Public Health Enemy Number One: Tobacco 219
Biomedical Basis of Smoking’s Harmful Effects 221
Historical Trends in Smoking and Health 221
Regulatory Restrictions on Smoking—New Focus
on Environmental Tobacco Smoke 225
Advertising—Emphasis on Youth 226
Taxes as a Public Health Measure 227
California’s Tobacco Control Program 228
The Master Settlement Agreement (MSA) 230
FDA Regulation 232
Electronic Cigarettes 233
Conclusion 233
References 234
16 Public Health Enemy Number Two and Growing:
Poor Diet and Physical Inactivity 237
Epidemiology of Obesity 238
Diet and Nutrition 242
Promoting Healthy Eating 243
Physical Activity and Health 247
How Much Exercise Is Enough, and How Much Do People Get? 249
Promoting Physical Activity 250
Confronting the Obesity Epidemic 252
Conclusion 254
References 254
17 Injuries Are Not Accidents 259
Epidemiology of Injuries 260
Analyzing Injuries 263
Motor Vehicle Injuries 264
Pedestrians, Motorcyclists, and Bicyclists 267
Poisoning 268
Firearms Injuries 269
Occupational Injuries 271
Injury from Domestic Violence 272
 Contents ix

Nonfatal Traumatic Brain Injuries 272

Tertiary Prevention 274
Conclusion 275
References 276
18 Maternal and Child Health as a Social Problem 281
Maternal and Infant Mortality 282
Infant Mortality—Health Problem or Social Problem? 283
Preventing Infant Mortality 285
Family Planning and Prevention of Adolescent Pregnancy 290
Nutrition of Women and Children 292
Children’s Health and Safety 293
Conclusion 296
References 297
19 Mental Health: Public Health Includes
Healthy Minds 301
Major Categories of Mental Disorders 301
Anxiety 302
Psychosis 302
Disturbances of Mood 302
Disturbances of Cognition 302
Epidemiology 302
Causes and Prevention 303
Children 306
Eating Disorders 307
Mental Health in Adulthood 308
Mental Health in Older Adults 310
Treatment 310
Conclusion 311
References 311

Part V: Environmental Issues in Public Health 313

20 A Clean Environment: The Basis of Public Health 315

Role of Government in Environmental Health 316
Identification of Hazards 317
Pesticides and Industrial Chemicals 321
Occupational Exposures—Workers as
Guinea Pigs 324
New Source of Pollution—Factory Farms 325
Setting Standards—How Safe Is Safe? 326
Risk–Benefit Analysis 327
Conclusion 327
References 328
x Contents

21 Clean Air: Is It Safe to Breathe? 333

Criteria Air Pollutants 334
Strategies for Meeting Standards 336
Indoor Air Quality 341
Global Effects of Air Pollution 342
Conclusion 344
References 345
22 Clean Water: A Limited Resource 349
Clean Water Act 350
Safe Drinking Water 352
Dilemmas in Compliance 364
Is the Water Supply Running Out? 366
Conclusion 366
References 367
23 Solid and Hazardous Wastes:
What to Do with the Garbage? 369
Sanitary Landfills 370
Alternatives to Landfills 372
Hazardous Wastes 373
Coal Ash 377
Conclusion 377
References 378
24 Safe Food and Drugs: An Ongoing
Regulatory Battle 381
Causes of Foodborne Illness 382
Government Action to Prevent Foodborne Disease 383
Additives and Contaminants 388
Drugs and Cosmetics 389
Food and Drug Labeling and Advertising 390
Politics of the FDA 392
Conclusion 394
References 395
25 Population: The Ultimate Environmental
Health Issue 399
Public Health and Population Growth 401
Global Impact of Population Growth—Depletion of Resources 403
Global Impact of Population Growth—Climate Change 406
Dire Predictions and Fragile Hope 409
Conclusion 411
References 412
 Contents xi

Part VI: Medical Care and Public Health 415

26 Is the Medical Care System a Public Health Issue? 417

When Medical Care Is a Public Health Responsibility 418
The Conflict Between Public Health and the
Medical Profession 419
Licensing and Regulation 422
Ethical and Legal Issues in Medical Care 423
Ethical Issues in Medical Resource Allocation 426
Conclusion 427
References 428
27 Why the U.S. Medical System Needs Reform 431
Problems with Access 432
Why Do Costs Keep Rising? 435
Approaches to Controlling Medical Costs 436
Managed Care and Beyond 437
The Patient Protection and Affordable Care Act 439
Rationing 440
Conclusion 442
References 443
28 Health Services Research: Finding What Works 447
Reasons for Practice Variations 448
The Field of Dreams Effect 450
Outcomes Research 451
Quality 454
Medical Care Report Cards 456
Inequities in Medical Care 458
The Relative Importance of Medical Care for
Public Health 461
Conclusion 463
References 464
29 Public Health and the Aging Population 469
The Aging of the Population—Trends 470
Health Status of the Older Population 472
General Approaches to Maximizing Health
in Old Age 473
Preventing Disease and Disability in Old Age 476
Medical Costs of the Elderly 482
Proposals for Rationing 485
Conclusion 487
References 487
xii Contents

Part VII: The Future of Public Health 491

30 Emergency Preparedness, Post-9/11 493

Types of Disasters and Public Health Responses 494
New York’s Response to the World Trade Center Attacks 495
Response to Hurricane Katrina 496
Principles of Emergency Planning and Preparedness 500
Bioterrorism Preparedness 502
Pandemic Flu 506
Conclusion 507
References 509
31 Public Health in the Twenty-First Century:
Achievements and Challenges 513
Challenges for the 21st Century 515
Strategic Planning for Public Health 516
Dashed Hopes for the Integration of Public Health
and Medical Practice 520
Information Technology 521
The Challenge of Biotechnology 523
The Ultimate Challenge to Public Health in the Twenty-First Century 523
Conclusion 524
References 525

Glossary 529
Index 547
Preface
In the Preface to the First Edition, I wrote about the public’s general ignorance of the field
of public health and my own uncertainty about what public health was when, in 1986, I first
went to work for the newly established School of Public Health, a collaboration between
the University at Albany and the New York State Department of Health. After working
with public health professionals from the Department of Health to design curricula for
the programs at the school, and after teaching an introductory course in public health for
more than ten years in collaboration with many of the same health department faculty,
I feel much more confident about what the term means. After the bioterrorism scare of
2001 and the public health disasters of Hurricane Katrina in 2005 and Hurricane Sandy
in 2012. I believe that the public has a better sense of the field as well.
This book was written as a text for an introductory course that could be included in
the general education curriculum for college undergraduates. As I wrote in the Preface to
the First Edition, I believe that every citizen of the United States should know something
about public health, just as they should know something about democracy, law, and other
functions of government. Public health issues are inherently interesting and important
to almost everyone. They are featured almost every day on the front pages of newspapers
and in the headlines of television news programs, although often they are not labeled as
public health issues. One of my goals is to help people put these news stories into context
when they occur.
The Fifth Edition of this textbook follows the plan of the first four editions, bringing
it up to date and including new developments in infectious disease, injury control, envi-
ronmental health controversies, the reform of the American healthcare system, and many
other issues. I have illustrated public health principles by presenting stories that have been
in the news; some of these stories have been ongoing sagas that have been supplemented
with each edition. The Second and Third Editions focused on political interference with
science, but as discussed in the Fourth Edition, the Obama administration vowed to restore
honest science as a basis of policy decisions. Issues new to the Fifth Edition include the
arrival of Ebola in the United States, involving the death of an African visitor and the
involuntary quarantine of an uninfected healthcare worker returning from work in an
affected country; the introduction of electronic cigarettes and questions of how they
should be regulated; the importance of eating disorders as a major mental health issue;
and the lawsuit by retired professional athletes against the National Football League for
not disclosing risks of traumatic brain injury. Other issues discussed more extensively
here are population growth and climate change as contributors to wars and migrations
in the Middle East and the implementation of President Obama’s healthcare reform law,
the Patient Protection and Affordable Care Act.
xiv Preface

I have tried to make this book easily comprehensible to the general reader. One of the
things that makes public health fascinating to me is the fact that it is often controversial,
depending on political decisions as well as scientific evidence. The politics are frustrating
to many practitioners, but it is often the politics that put public health in the headlines.
I hope that by describing both the science and the politics, I will contribute to making
public health as fascinating to the readers as it is to me.

Mary-Jane Schneider
 Chapter
Prologue
1
Public Health in the News

What is public health? It is an abstract concept, hard to pin down. Reports about public
health appear in the news every day, but they are not labeled as public health stories, and
most people do not recognize them as such. Here in the prologue are four major public
health stories of the modern era that bring the abstraction to life. The ongoing AIDS epi-
demic, arguably the greatest challenge that the public health community has faced in the
past 50 years, illustrates the multidisciplinary nature of the field and the complex ethical
and political issues that are often an inherent component of public health. The outbreak
of waterborne disease that sickened more than 400,000 people in Milwaukee, Wisconsin
in 1993 was the consequence of a breakdown in a routine public health measure that
has protected the populations of developed countries for most of the past century. Lest
Americans forget that maintaining the health of the population requires constant vigilance,
the dramatic decline in all measures of health in Russia presents a cautionary lesson of
what can happen to a society that is unable to protect its people in one regard or another.
Finally, the terrorist attacks in the fall of 2001 made it clear that the national security of
the United States depends not only on the U.S. Department of Defense, but also on the
American public health system.

AIDS Epidemic
On July 3, 1981, The New York Times ran a story with the headline: “Rare Cancer Seen in
41 Homosexuals.”1 The cancer was Kaposi’s sarcoma, a form of skin cancer, rare in the
United States but more common in equatorial Africa. The victims were young gay men
living in New York City or San Francisco, and 8 of the 41 had died within 24 months of
being diagnosed. The report noted that several of the victims had been found to have
severe defects in their immune systems, but it was not known whether the immune
defects were the underlying problem or had developed later. Most of the victims had
had multiple and frequent sexual encounters with different partners, the article said,
xvi Public Health in the News

but there was no evidence that the disease was contagious, since none of the patients
knew each other.
On August 29, there was another story: “2 Fatal Diseases Focus of Inquiry.”2 A rare
kind of pneumonia called pneumocystis had been striking gay men with a 60 percent
fatality rate. According to The New York Times, 53 cases of pneumocystis had been diag-
nosed. Also, the number of cases of Kaposi’s sarcoma had grown to 47, and 7 patients
had both diseases. No one knew why gay men were affected, but there was speculation
that there might be a link to their sexual lifestyle, drug use, or some other environmental
cause. The article noted without comment that one woman had also been reported to
have pneumocystis pneumonia. A scientific task force had been formed at the Centers
for Disease Control and Prevention (CDC) to investigate what was going on. There was
no further news in The New York Times about what would become known as AIDS until
May 1982.3 In that article, the underlying commonality of the immune defect was recog-
nized, and the condition was called gay-related immune deficiency syndrome (GRID).
While immune deficiencies had been known and studied previously, most were genetic
conditions that afflicted children from birth or were caused by immunosuppressive drugs
used to prevent rejection of transplanted organs. The total suppression of the immune
system by whatever means leads to many infections, one of which eventually kills the
victim. Speculation as to the cause of GRID generally focused on a sexually transmitted
infectious agent, although there was a suspicion that multiple factors might be involved,
perhaps including drugs or an immune response to the introduction of sperm into the
blood through sexual contact.
As the number of reported cases grew, CDC scientists interviewed people with GRID,
questioning them about their sexual behavior and partners. The sexual activities of gay
men became the focus of scientists and the news media alike—reports of promiscuous and
anonymous sex in public baths and use of drugs to enhance sexual pleasure emerged—
which tended to worsen many people’s already negative view of gay men. Linkages were
found that began to confirm that a sexually transmitted infectious agent was responsible.
But the investigations were hampered by lack of funding. President Ronald Reagan had
been inaugurated in January 1981 on a conservative platform. His administration was
not interested in a disease that affected people who behaved in ways so unappealing to
the general population. Nor was there much concern on the part of the general public.
Most people felt no threat to themselves, although people who lived in New York, San
Francisco, Los Angeles, and Miami, where most of the cases had been reported, might
have felt more cause for concern.
Since early in the epidemic, however, there had been occasional reports of the immune
deficiency in women and heterosexual men, many of them intravenous drug users. By
the summer of 1982, cases of the syndrome had also been reported in people with hemo-
philia who were exposed to blood products used to make a clotting factor and in patients
who had received blood transfusions. A study of female sexual partners of men with the
syndrome suggested that the disease may also be transmitted by heterosexual relations. A
number of babies turned up with a syndrome that resembled GRID, possibly transmitted
from their mothers before or at birth. It was clear that the condition was not limited to
xxviii Public Health in the News

5. U.S. Centers for Disease Control and Prevention, “HIV in the United States: At a Glance.”
http://www.cdc.gov/hiv/statistics/basics/ataglance.html, accessed September 4, 2015.
6. R. Bayer, Private Acts, Social Consequences: AIDS and the Politics of Public Health (New
York, NY: Free Press, 1989), p.218.
7. A. A. Newman, “With Condoms in Particular, Local Stations Can Say No,” The New York
Times, July 16, 2007.
8. J. L. Juusola et al., “Cost-Effectiveness of Symptom-Based Testing and Routine Screening
for Acute HIV Infection in Men Who Have Sex with Men in the USA, ” AIDS 25 (2011):
1779–1787.
9. Kaiser Family Foundation, “HIV/AIDS Policy Fact Sheet: U.S. Federal Funding for HIV/
AIDS: The President’s FY 2015 Budget Request,” June 25, 2014. http://www.kff.org/global
-health-policy/fact-sheet/u-s-federal-funding-for-hivaids-the-presidents-fy-2015
-budget-request/, accessed January 12, 2015.
10. W. R. MacKenzie et al.,“A Massive Outbreak in Milwaukee of Cryptosporidium Infection
Transmitted Through the Public Water Supply, ” New England Journal of Medicine 331
(1994): 161–167.
11. N. J. Hoxie et al., “Cryptosporidiosis-Associated Mortality Following a Massive Water-
borne Outbreak in Milwaukee, Wisconsin, ” American Journal of Public Health 87 (1997):
2032–2035.
12. U.S. Environmental Protection Agency,“Cryptosporidium: Drinking Water Health Advi-
sory,” EPA-822-R-01-009, March 2001. http://water.epa.gov/action/advisories/drinking
/upload/2009_02_03_criteria_humanhealth_microbial_cryptoha.pdf, accessed January
13, 2015.
13. L. Reiter et al., eds., From Source Water to Drinking Water: Workshop Summary (­ Washington,
DC: National Academies Press, 2004).
14. U.S. Centers for Disease Control and Prevention, “Notice to Readers: National Drink-
ing Water Week—May 4–10, 2008,” Morbidity and Mortality Weekly Report 57 (2008):
465–466.
15. P. S. Corso et al., “Cost of Illness in the 1993 Waterborne Cryptosporidium Outbreak,
Milwaukee, Wisconsin, ” Emerging Infectious Diseases 9 (2003): 426–431.
16. M. Feshbach and A. Friendly, Jr., Ecocide in the USSR: Health and Nature Under Siege
(New York, NY: Basic Books, 1992).
17. Central Intelligence Agency,“The World Factbook,” July 2014. https://www.cia.gov/library
/publications/the-world-factbook/index.html, accessed January 13, 2015.
18. W. M. Johnston,“Abortion Statistics and Other Data, ” Johnston’s Archive. January 4, 2015.
http://www.johnstonsarchive.net, accessed January 14, 2015.
19. M. Denisenko,“Russia’s Population until 2025,” in M. Lipmann and N. Petrov, Russia 2025:
Scenarios for the Russian Future (New York, NY: Palgrave Macmillan, 2013).
20. M. A. Parsona, Dying Unneeded: The Cultural Context of the Russian Mortality Crisis.
(Nashville, TN: Vanderbilt University Press, 2014).
21. World Health Organization, Report on the Global Tobacco Epidemic, 2013. http://www
.who.int.tobacco/global_report/2013, accessed January 17, 2015.
22. U.S. Centers for Disease Control and Prevention, “Health Information for Travelers to
Russia.” http://wwwnc.cdc.gov/travel/, accessed March 22, 2012, and January 17, 2015.
Another random document with
no related content on Scribd:
128
It was by some of these German miners whom the merchant
venturers of Cornwall engaged in exploiting the Cornish mines,
under a charter granted by Queen Elizabeth, that the “dowsing
rod” (Schlagruthe, or striking-rod) was introduced into England
for the purpose of discovering mineral veins. Professor W. F.
Barrett, “Water-Finding,” in the Times, January 21, 1905.
129
Essay, Of Usurie.
130
Merchant of Venice, Act i. Sc. 3.
131
I. Abrahams, Jewish Life in the Middle Ages, p. 251.
132
S. R. Gardiner, History of the Commonwealth and
Protectorate, vol. ii. p. 30, n. 3.
133
See above, p. 148.
134
Spectator, No. 213, Nov. 3 1711.
135
Ib. No. 495, Sept. 27, 1712.
136
Quoted in H. Graetz’s History of the Jews, vol. v. p. 359.
137
T. Carlyle, History of Frederick the Great, bk. xvi. ch. vii.
138
This arrangement was abolished by the Separation Law
promulgated on December 9, 1905, when the Republic
resolved neither “to recognise, pay salaries to, nor subsidise
any form of worship.” The Jews have shared the effects of this
Act with the Protestants and Roman Catholics of France, and
like the former of these Christian denominations, and unlike
the latter, readily accepted the change.
139
Over the Teacups, pp. 193 fol.
140
J. G. Lockhart, Life of Sir W. Scott, Ch. xlvi.
141
The original of Scott’s Rebecca is said to have been a real
person—Rebecca Gratz of Philadelphia. Washington Irving,
 who knew Miss Gratz, introduced her to Scott’s notice. She
was born in 1781, and died in 1869. Her claim to have been
“the original of Rebecca in Ivanhoe” is sustained in a paper
with that title in the Century Magazine, 1882, pp. 679 fol.
142
Don Juan, Canto ii. lxv. It is only fair to add that Scott also, at
the time of his financial distress, embittered by the harsh
treatment which he experienced at the hands of his Jewish
creditors, Abud and Son, expressed himself in very strong
terms concerning “the vagabond stock-jobbing Jews” in
general, and the Abuds in particular. See Scott’s Diary under
dates Nov. 25, 1825, and Oct. 9, 1826, in J. G. Lockhart, Life
of Sir W. Scott, Ch. lxv. and lxxi.
143
Table-Talk.
144
Luther’s Table-Talk, Ch. 852.
145
Coleridge’s Table-Talk, April 14, 1830.
146
Cp. above, p. 225.
147
Editor’s note on May 30, 1830.
148
Aug. 14, 1833.
149
Editor’s note on April 14, 1830.
150
Charles Lamb, Essay on Imperfect Sympathies.
151
J. Morley, Life of W. E. Gladstone, Vol. i. pp. 106, 375.
152
See below, pp. 378 fol.
153
See The Jewish Encyclopaedia, passim.
154
This phase of the internal history of Russia since 1881 is well
summarised in an article on “The Constitutional Agitation in
Russia,” by Prince Kropotkin, The Nineteenth Century,
January, 1905.
155
See Memorandum of the Armenian Patriarchate, protesting
against the edict of spoliation, issued on June 12–25, 1903, in
Armenia, October and November, 1906.
156
See A. Vambéry, “The Awakening of the Tartars,” The
Nineteenth Century, February, 1905.
157
The Times, October 8, 1904.
158
According to the census returns of 1897, the number of
illiterate inhabitants in the country varies from 44.9 to 89.2 per
cent.
159
E. F. G. Law, “The Present Condition of Russia,” The
Fortnightly Review, April, 1882.
160
Vice-Consul Wagstaff’s report, in Goldwin Smith’s “The Jews,”
The Nineteenth Century, Nov. 1882.
161
See above, p. 148. Cp. p. 167.
162
Olga Novikoff, “The Temperance Movement in Russia,” The
Nineteenth Century, Sept. 1882. Cp. M. O. Menchikoff, “The
Jewish Peril in Russia,” The Monthly Review, Feb. 1904.
163
See above, p. 329.
164
Goldwin Smith, ubi supra.
165
Ibid.
166
Goldwin Smith, ubi supra.
167
See above, p. 154.
168
For a full account of this and other aspects of Russian
domestic policy, the reader is referred to Herr Wolf von
Schierbrand’s Russia: Her Strength and her Weakness, 1904.
169
E. F. G. Law, ubi supra.
170
Olga Novikoff, ubi supra.
171
Goldwin Smith, “The Jews,” The Nineteenth Century, Nov.
1882. Cp. Pierre Botkine, Secretary of the Russian Legation in
Washington, “A Voice for Russia,” The Century Magazine, Feb.
1893.
172
Laurence Oliphant, “The Jew and the Eastern Question,” The
Nineteenth Century, Aug. 1882.
173
Pierre Botkine, Secretary of the Russian Legation in
Washington, “A Voice for Russia,” in The Century Magazine,
Feb. 1893. Cp. “A reply” to it by Joseph Jacobs, Secretary of
the Russo-Jewish Committee, London, in the same periodical,
July, 1893.
174
In 1902–3 the Russian Empire, according to the Statistical
Table in the Jewish Year Book, contained 5,189,401 Jews,
representing 04.13 of the total population (125,668,000). There
are serious reasons, however, to believe that their real number
is considerably in excess of this figure.
175
The Times, June 14, 1905.
176
Towards the end of 1904 a Bill was introduced in the Council of
the Empire, preventing the promotion even of baptized Jews.
But, owing to reasons which will be explained in the sequel, it
was withdrawn.—The newspaper Voshod, reported by Reuter
in a despatch dated St. Petersburg, Dec. 23.
177
H. H. Munro in the Morning Post, June 3, 1904.
178
Statement by M. De Plehve, The Standard, April 8, 1904.
179
Reuter telegram, dated Melbourne, June 4, 1903.
180
The Daily Chronicle, June 22, 1903.
181
Reuter telegram, dated Berlin, May 30, 1903.
182
Andrew D. White, “A Diplomat’s Recollections of Russia,” The
Century Magazine, Nov. 1904.
183
Prince Kropotkin, “The Constitutional Agitation in Russia,” The
Nineteenth Century, Jan. 1905.
184
Those were the words of the Crown Prosecutor at the Kishineff
Trial, The Times, Dec. 25, 1903.
185
The Times, Dec. 19, 1903.
186
Ibid.
187
Reuter telegram, dated Kishineff, Dec. 21, 1903.
188
Reuter telegram, dated St. Petersburg, Dec. 17, 1903.
189
M. O. Menchikoff, one of the editors of the Novoe Vremya,
“The Jewish Peril in Russia,” The Monthly Review, Feb. 1904.
190
Reuter telegram, dated St. Petersburg, June 4, 1903.
191
The Standard correspondent at Kieff, under date Dec. 18,
1903.
192
A meagre account of the occurrence appeared in The
Standard, Sept. 25, 1903.
193
The Times, Dec. 21, 1903.
194
Tugan-Baranowsky, “Anti-Semitism in Contemporary Russia,”
The Monthly Review, Jan. 1904.
195
Some very illuminating revelations concerning the organisation
of these authorised riots were made during a recent trial at St.
Petersburg. See Reuter telegram from that town, Oct. 26,
1906, and an account by the Tribune correspondent under
same date.
196
See Reuter telegram, dated St. Petersburg, June 13, and Mr.
Lucien Wolf’s letter in The Times of June 14, 1904.
197
Andrew D. White, “A Diplomat’s Recollections of Russia,” The
Century Magazine, Nov. 1904.
198
The Standard, Aug. 1, 1904.
199
Lucien Wolf, “M. De Plehve and the Jewish Question,” in The
Times, Feb. 6, 1904.
200
Reuter telegram, Aug. 17, 1904.
201
Reuter telegram, dated St. Petersburg, Sept. 12, 1904.
202
Reuter telegram, dated Kattowitz (Silesia), Sept. 12, 1904.
203
The Special Commissioner of the Daily Telegraph, Dec. 10,
1904.
204
Reuter telegram, dated St. Petersburg, Sept. 3, 1904.
205
Reuter telegram, dated New York, January 10, 1905.
206
According to the returns of the last census (1899), 78 per cent.
of the population over 7 years of age can neither read nor
write.
207
See above, p. 243.
208
See a most interesting sketch of the movement in S.
Schechter’s Studies in Judaism, pp. 1 fol., the same author’s
article on the subject in Nord und Süd, January, 1905, and
S. M. Dubnow’s article in the Jewish Encyclopedia, Vol. vi. pp.
251 fol.
209
H. Sutherland Edwards, Sir William White: His Life and
Correspondence, p. 84.
210
Ibid. See also a summary of this period under title “The Jews in
Roumania” in The Standard, Sept. 30, 1902.
211
J. Morley, Life of W. E. Gladstone, Vol. iii. p. 475 (1891).
212
The story is related at length by Gibbon, Decline and Fall of
the Roman Empire, Ch. xxvi.
213
One example will suffice. The peasant word for a convivial
gathering is written sedatore, and pronounced shezetoare.
214
Alexander A. Landesco, in The Century Magazine, May, 1906,
p. 160.
215
The Vienna correspondent of The Times, June 10, 1902.
216
Carmen Sylva, “The Jews in Roumania,” The Century
Magazine, March, 1906.
217
See statistics of population in the Jewish Year Book for 1902–
03. Cp. the Statesman’s Year Book for 1906.
218
Report from Bucharest, published in the Pester Lloyd, see The
Standard, Sept. 27, 1902. Cp. the article “Oath More Judaico”
in the Jewish Encyclopedia, ix. p. 367.
219
The Vienna correspondent of The Standard, Sept. 19, 1902.
220
Reuter telegram, dated Bucharest, April 12, 1902.
221
The Times, June 10, 1902.
222
Reuter telegram, dated Washington, Sept. 17, 1902.
223
The Standard, Sept. 23, 1902.
224
The attitude of the various Powers is described at length by the
correspondents of the London Press in their respective
capitals. See Standard, Sept. 20, 25, 26; Morning Post, Sept.
20; Daily Chronicle, Sept. 22, etc.
225
The Daily Chronicle, September 29, 1902.
226
Carmen Sylva, “The Jews in Roumania,” The Century
Magazine, March, 1906.
227
Alexander A. Landesco, The Century Magazine, May, 1906, p.
160.
228
The Vienna correspondent of the Standard, Sept. 26, 1902.
229
Isocrates, Panegyr. 50.
230
In Germany, out of a total population of 56,500,000, there are
587,000 Jews, of whom 376,000 reside in Prussia. In Austria
there are 1,150,000 out of a total population of 26,000,000,
and in Hungary 850,000 out of a total population of
19,000,000. The percentage of Jews, therefore, is in Germany
01.04, in Austria 04.80, in Hungary 04.43.—Jewish Year-Book,
1902–03.
231
“The Jews in Germany,” by the author of “German Home Life,”
The Contemporary Review, January, 1881.
232
Ernest Schuster, “The Anti-Jewish Agitation in Germany,” The
Fortnightly Review, March 1, 1881.
233
Statutes quoted by Lucien Wolf in “The Anti-Jewish Agitation,”
The Nineteenth Century, February, 1881.
234
Ernest Schuster, ubi supra.
235
See above, p. 307.
236
“The Jews in Germany,” by the author of “German Home Life,”
The Contemporary Review, January, 1881. For these and
similar demands see also Ernest Schuster, ubi supra.
237
Karl Blind, “The Conflict in Germany,” The Nineteenth Century,
February, 1882.
238
The Vienna Correspondent of the Times in a letter dated Nov.
11, 1904.
239
The Times, October 22, 1904.
240
Reuter telegram, dated Vienna, June 11, 1906. Cp. “Hidden
Forces in Austrian Politics,” a letter by “Scotus Viaticus” in the
Spectator, July 7, 1906.
241
The Vienna correspondent of The Times, January 7, 1907.
242
Lucien Wolf, “The Anti-Jewish Agitation,” The Nineteenth
Century, Feb., 1881.
243
Étude sur l’Ecclésiaste, pp. 91 fol.
244
See Qu’est-ce qu’une Nation? a paper read at the Sorbonne
on March 11, 1882, in Discours et Conférences, pp. 277 fol.
245
See lectures and speeches delivered in 1883 in Discours et
Conférences, pp. 336, 374, etc.
246
See Ed. Drumont’s La France Juive, a work which, published
in 1886, raised its author at once to the rank of commander-in-
chief of the anti-Semitic forces in France.
247
86,885 in a total population of 38,595,000, i.e. a percentage of
00.22, Jewish Year Book, 1902–03.
248
The Standard, Dec. 7, 1903.
249
A statistic supplied to the Commission for Tlemcen shows that
out of 6000 Jews there are only 10 possessing more than
£2000, and another, supplied for Constantine, shows that out
of 1024 Jewish electors there are only 10 possessed of real
estate and 146 merchants. The rest lead a miserable hand-to-
mouth existence.—Le Temps, Sept. 25, 1901.
250
J. Morley, Life of W. E. Gladstone, vol. iv. pp. 552, 558.
251
E.g. Sir J. G. T. Sinclair, A Defence of Russia (1877); T. P.
O’Connor, Lord Beaconsfield: a Biography (1878); etc.
252
In justice to the writer it must be added that this ungenerous
and untrue caricature was the common estimate of Disraeli
 entertained by all his political opponents. Except Lord Acton,
they all agreed with the Duke of Argyll in holding that Disraeli
was a “fantastic adventurer”—a man who, having no opinions
of his own and no traditions with which to break, “was free to
play with prejudices in which he did not share, and to express
passions which were not his own, except in so far as they were
tinged with personal resentment.” See Duke of Argyll:
Autobiography and Memoirs, Vol. i. p. 280.
253
Malcolm MacColl, “Lord Beaconsfield,” The Contemporary
Review, June, 1881.
254
Goldwin Smith, “The Jews,” The Nineteenth Century, Nov.,
1882. The writer repeats all these views, in almost identical
terms, in The Independent, June 21, 1906.
255
Israel Abrahams, Jewish Life in the Middle Ages, Introd.
256
Rise and Influence of the Spirit of Rationalism in Europe, vol. ii.
p. 281.
257
Goldwin Smith, ubi supra.
258
S. Singer, “The Russo-Jewish Immigrant,” in The English
Illustrated Magazine, Sept. 1891.
259
David Baron, The Ancient Scriptures and the Modern Jew, p.
179, 1900.
260
Arnold White, The Modern Jew, 1899.
261
Jewish Year Book, 1902.
262
Report in The Standard, Dec. 14, 1903.
263
Arnold White, For Efficiency, 1902, price 3d.
264
“The Alien Inquiry: an omitted point,” The Standard, Sept. 5,
1903.
265
The Pioneer, Nov. 14, 1904. Commercial jealousy, embittered
by racial prejudice, is also at the root of the anti-Japanese
agitation now raging in California.
266
Charles Grant, The Contemporary Review, March, 1881.
267
See an article under the title “The East-End Hevra” in The
Standard of April 27, and a reply to it in the issue of May 1,
1903.
268
J. H. Schooling, “Foreigners in England,” The Fortnightly
Review, November, 1904. Mr. Chamberlain also, in the debate
on the Aliens Bill (May 2, 1905), frankly avowed that he
supported that measure because it harmonised with his policy
of protection, and he very logically dwelt on the identity of the
principle underlying both programmes.
269
Report of the Commission, pp. 19, 20.
270
The Daily Chronicle, January 9, 1903.
271
The Daily Chronicle, Feb. 17, 1904.
272
For the text of the Bill, see The Times, April 1, 1904.
273
The Standard, leading article, April 26, 1904.
274
Mr. Winston Churchill’s letter to a member of the Jewish
community in Manchester, May 30, 1904.
275
The Daily Chronicle, May 18, 1903.
276
The Daily Chronicle, May 4, 1904.
277
Letter by Mr. Balfour, dated May 9, 1904.
278
The Daily Chronicle, May 13, 1904.
279
Ibid. May 14, 1904.
280
A Modern Exodus. By Violet Guttenberg.
281
Report in The Standard, April 2, 1904.
282
Report in The Times, April 17, 1905.
283
Mr. Wyndham’s statement in the House of Commons, April 25,
1904.
284
“Milesian,” letter in The Times, April 4, 1904.
285
E. B. Levin, letter in The Times, April 12, 1904.
286
“Milesian,” ubi supra.
287
“Milesian,” ubi supra.
288
See The Times, April 8 and 12, 1904.
289
The Standard, August 8, 1904.
290
J. H. Schooling, “Foreigners in England,” The Fortnightly
Review, November, 1904.
291
W. Evans Gordon, “The Economic Side of Alien Immigration,”
The Nineteenth Century, February, 1905.
292
W. Evans Gordon, letter in The Times, March 22, 1904.
293
Letter in The Standard, August 8, 1904.
294
Ibid. July 7, 1904.
295
J. Morley, Life of W. E. Gladstone, vol. iii. p. 475.
296
For a list of such works see the article “Inquisition” in the
Encyclopaedia Britannica.
297
Jeremiah xxxii. 37. Cp. Isaiah xi. 12 etc.
298
S. Schechter, Studies in Judaism, pp. 131–2.
299
For an exhaustive account of the historic development of
Zionism see Lucien Wolf, “Zionism,” in the Encyclopaedia
 Britannica.
300
For a full enumeration of the arguments and sentiments which
impelled the mass of Russian and Roumanian Jews in the
early ’Eighties to prefer an Eastern to a Western exodus, see
Laurence Oliphant, “The Jew and the Eastern Question,” The
Nineteenth Century, August, 1882.
301
Laurence Oliphant, ubi supra. On the other hand, it must not
be forgotten that the members of the Chovevi Zion Societies
represented but a very small proportion of the total Jews of the
world.
302
The Jewish World, Aug. 15, 1902.
303
The St. Petersburg correspondent of The Times, Oct. 14,
1902.
304
See the late Minister’s of the Interior utterances on the subject:
Lucien Wolf, “M. De Plehve and the Jewish Question,” in The
Times, Feb. 6, 1904.
305
The Jewish Question, Gay and Bird, 1894, p. 27.
306
Pp. 31–32.
307
P. 38.
308
Table-Talk, April 13, 1830.
309
Lucien Wolf, “Zionism,” Encyclopaedia Britannica.
310
Aspects of the Jewish Question. By “A Quarterly Reviewer,”
1902, p. 76.
311
P. 16.
312
M. J. Landa, “The Doom of Zionism,” in The Manchester
Guardian, Jan. 10, 1905.
313
“Palestine Revisited,” The Statesman, Oct. 23, 1904.
314
Lucien Wolf, article on “Zionism” in the Encyclopaedia
Britannica.
315
Report in The Daily Chronicle, May 18, 1903.
316
Reuter telegram, dated Basel, Aug. 24, 1903.
317
Reuter telegram, dated St. Petersburg, Oct. 12, 1903.
318
“Palestine Revisited,” The Statesman, October 23, 1904.
319
On this aspect of the Jewish question see an article by M.
Anatole Leroy-Beaulieu in the Revue des deux Mondes, March
1, 1903; and another on La Langue Française en Orient in Le
Monde Illustré, April 11, 1903.
320
The Daily Chronicle, May 18, 1903.
321
L. J. Greenberg, report of a meeting of “Friends of Jewish
Freedom,” in The Times, Dec. 7, 1904.
322
Communication dated Foreign Office, Aug. 14, 1903.
323
Report in The Standard, May 4, 1904.
324
Reuter telegram, dated Paris, Dec. 21, 1903; Paris
correspondent of The Times, under same date.
325
The Daily Chronicle, Dec. 22, 1903. Cp. Mr. L. J. Greenberg’s
statement, The Times, Dec. 7, 1904.
326
“The East Africa Protectorate,” The Nineteenth Century,
September, 1904; cp. his book under the same title (1905), pp.
177–8; 315.
327
See The Times, Dec. 7, 1904.
328
Reuter telegram, dated Dec. 24, 1904.
329
Report in The Times, Dec. 20, 1904.
330
The American Hebrew, quoted in The Literary Digest, May 20,
1905.
 INDEX

Abdul Hamid, 491, 492, 501.

Abdul-Rahman III., 71.
Abraham, 39, 312, 502, 518.
Abramovitch, 355.
Abu-Yussuf Chasdai, 71.
Acosta, Uriel, 249–50, 298.
Act of 1858, allowing Jews to omit certain words from oath, 324.
Addison, 282–4.
Aelia Capitolina, see Jerusalem.
Africa, flight of Jews to, 150.
Age of Bronze, The (Byron), 316.
Agricultural settlements, 363, 507;
college, 509;
colonies, foundation of, 507, 509.
Agriculture, attitude of Jews towards, 509, 510, 514.
Agrippa, King, 23.
Akers-Douglas, 462–4, 469.
Albigensian sect, in France, 91–5, 144, 217.
Albigenses, 83.
Alexander the Great, 1, 20, 301, 302, 408.
Alexander Severus, Emperor, 39.
Alexander II., Czar, 332–3;
assassination of, 334, 335, 368.
Alexander II., Pope, 142.
Alexander III., restrictive policy, 335.
Alexandria, Jews in, 2, 20, 22, 47, 73, 195;
anti-Jewish movement in, 23;
Graeco-Jewish feud, 25–6.
Alexis Petrovitch, 330.
Alfonso VI. of Castile, 142–3.
Alfonso X. (the Wise), 144–5, 150.
Alfonso XI., 146, 148.
Algeria, Jewish Question in, 436.
Alien Peril, Royal Commission appointed to enquire into, 460, 465,
466.
Alien question, 460, 478.
Aliens Act, 475–6.
Aliens Bill, 462–7, 469, 472–5.
Alliance Israélite Universelle, 482, 483, 507, 510.
Almohades, the, 74.
Alroy, David, 90.
Alypius, of Antioch, 45.
Alsace, Jews in, 294–5, 296.
Ambrosius, Bishop of Milan, 52.
America, 277, 357, 397, 398, 403, 417, 460.
American Note (Mr. Hay’s), 398–403.
Amsterdam, 247, 277, 329;
synagogue inaugurated and press established, 248.
Andalusia, Semitic renaissance in, 70.
Anglo-Jewish Association, 483.
Anglo-Jewish prayer to the King, 324.
Anne, Queen, statute of, concerning Jews, 282;
repeal of, 323.
Anti-Semitic League, The, 421–2.
Anti-Semitism, origin of, 407, 411, 434;
literature, 418–9, 433;
its effect on modern Jews, 479–80.
Antioch, Jews of, 47, 49–50.
Antiochus Epiphanes, 3, 32.
Antoninus Pius, 38.
Apis, Temple of, 21.
Aquinas, Thomas, 99, 110, 185.
Aramaic Papyri (discovered by R. Mond), 2.
Archangel, British traders at, 329–30.
Argentine Republic, 361.
Argyll, Duke of, 438.
Arian kings, Israel under, 57.
Armenians, 402.
Arnold, Matthew, 457.
Asher, 200–1.
Ashkenazim, the, 508.
Asia Minor, Jews in, 90.
Assideans, the, see Chassidim.
Atonement, Day of, 212.
Augustus, 21, 22.
Austria, 292, 397, 412, 415;
anti-Semitic agitations in, 426, 429, 490.
Austrian Constitution grants full liberty to Jews, 309.
Avignon, Council of, 93–4, 186, 235.
Avitus, Bishop of Clermont, 56.

Baalshem, Israel, 326, 380, 381, 382.

Babylon, 1, 11, 55, 300;
Jews in, 35, 39.
Babylonian captivity, return from, 325.
Bacon, 272–4.
Balfour, Arthur, 460, 466, 467.
Balkan States, number of Jews in, 395.
Baltic provinces, 334–5;
Russification of, 336.
Barcelona, theological contest at, 98, 145, 147.
Bar-Cochba, 37.
Barth, Dr., publication in Die Nation by, 358.
Basel, Zionist congresses at, 501, 506, 511–6.
Basil, 51–2.
Bathori, Stephen, 237.
Bayezid (the Lightning), 180.
Beaconsfield, Lord, see Disraeli.
Beckmann, General, 360.
Bel, Temple of, 1.
Belisarius, 49, 54.
Benjamin, of Tiberias, 50.
Benjamin, of Tudela, 52, 89–90, 147, 486.
Bentwich, Herbert, 515.
Berlin, 292;
Congress at, 385, 398, 483;
Treaty of, 390, 391, 399, 401;
foundation of anti-Jewish society in, 421;
Jews’ Chace at, 423.
Bessarabets, the, anti-Semite paper, 358–9.
Bessarabia, 360, 361;
massacre of Jews in, 510.
Beth Din, the, 64, 141.
Beziers, 68–9;
massacre at, 92;
Council of, 100.
Bismarck, 307, 384, 385, 416, 420, 421, 424.
Black Art, Jewish professors of, 103, 222.
Black Death, 147, 158.
Black Sea opened to international commerce, 383.
Boccaccio, 187, 189.
Bodo, Bishop, apostacy of, 80–1.
Bologna, university of, 410.
Book of Maxims (Santob de Carrion), 147.
Bordeaux, internecine feud at, 294.
Boulanger, General, 432–3.
Bratiano, 383.
British East Africa, 511, 513, 515;
Commission sent to, 515, 516.
British Jews’ Society, 466.
Bucharest, 382, 429.
Buda-Pesth, outrages in, 426.
Bulgaria, 387, 395.
Bund, the, secret society, 376.

Cabbala, the, 194–5, 200, 225.

Caesar, Julius, 20–1, 302.
Caligula, 22, 23, 31.
Cambridge, 131, 133, 324.
Canada, emigration of Jews to, 403.
Cancionero, 147.
Captivity, The (Goldsmith), quoted, 299.
Cassius, Dion, 35.
Cassius, Quaestor, 20.
Castile, Civil war in, 148;
Holy Office established in, 156, 405.
Cathari, see Albigenses.
Catholicism, the poet of, 184;
warfare against, 187, 311.
Chamberlain, Joseph, 399, 511.
Chanukah, see Feast of Dedication.
Charlemagne, 78–9, 302, 409.
Charles II., 280, 281.
Charles the Simple, 81–2.
Charles X. of Sweden, 241.