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San Francisco (California USA) is a relatively compact city with a population of 884,000 and nine stroke centers within a 47 square mile area. Emergency Medical Services (EMS) transport distances and times are short and there are currently no Mobile Stroke Units (MSUs).
This study evaluated EMS activation to computed tomography (CT [EMS-CT]) and EMS activation to thrombolysis (EMS-TPA) times for acute stroke in the first two years after implementation of an emergency department (ED) focused, direct EMS-to-CT protocol entitled “Mission Protocol” (MP) at a safety net hospital in San Francisco and compared performance to published reports from MSUs. The EMS times were abstracted from ambulance records. Geometric means were calculated for MP data and pooled means were similarly calculated from published MSU data.
From July 2017 through June 2019, a total of 423 patients with suspected stroke were evaluated under the MP, and 166 of these patients were either ultimately diagnosed with ischemic stroke or were treated as a stroke but later diagnosed as a stroke mimic. The EMS and treatment time data were available for 134 of these patients with 61 patients (45.5%) receiving thrombolysis, with mean EMS-CT and EMS-TPA times of 41 minutes (95% CI, 39-43) and 63 minutes (95% CI, 57-70), respectively. The pooled estimates for MSUs suggested a mean EMS-CT time of 35 minutes (95% CI, 27-45) and a mean EMS-TPA time of 48 minutes (95% CI, 39-60). The MSUs achieved faster EMS-CT and EMS-TPA times (P <.0001 for each).
In a moderate-sized, urban setting with high population density, MP was able to achieve EMS activation to treatment times for stroke thrombolysis that were approximately 15 minutes slower than the published performance of MSUs.
In this study, we evaluated the efficacy, expressed as a mean weight decrease of the whole echinococcal cyst mass, of novel benzimidazole salt formulations in a murine Echinococcus granulosus infection model. BALB/c mice were intraperitoneally infected with protoscoleces of E. granulosus (genotype G1). At 9 months post-infection, treatment with albendazole (ABZ), ricobendazole (RBZ) salt formulations, and RBZ enantiomer salts (R)-(+)-RBZ-Na and (S)-(−)-RBZ-Na formulations were initiated. Drugs were orally applied by gavage at 10 mg kg−1 body weight per day during 30 days. Experimental treatments with benzimidazole sodium salts resulted in a significant reduction of the weight of cysts compared to conventional ABZ treatment, except for the (S)-(−)-RBZ-Na enantiomer formulation. Scanning electron microscopy and histological inspection revealed that treatments impacted not only the structural integrity of the parasite tissue in the germinal layer, but also induced alterations in the laminated layer. Overall, these results demonstrate the improved efficacy of benzimidazole salt formulations compared to conventional ABZ treatment in experimental murine cystic echinococcosis.
This chapter examines how the legal climate around prostitution in Baltimore changed in the wake of the Civil War. Growing fears about vagrancy following emancipation and the triumph of a free labor economy prompted crackdowns on streetwalkers and public sex workers, who found themselves incarcerated in the city’s growing network of carceral institutions. Meanwhile, real estate speculators’ growing disenchantment with brothels as investment properties and pressures from a growing urban middle class that expected the state to act as an active guarantor of their property rights brought challenges to the decades-old regime of toleration around indoor prostitution. Brothels, once regarded as a comparatively benign sexual labor arrangement because they kept illicit sexuality contained and out of sight, came to be firmly defined as threats to private property rights and to the future of the middle class. Authorities began to utilize the precedent set by an 1857 equity decision, Hamilton v. Whitridge, as they moved to crack down on sex workers and evict them from “respectable” neighborhoods. As they did so, they began to create informal red-light districts.
This chapter examines the growth of Baltimore’s casual sex trade in the early republic. At the turn of the nineteenth century, the sex trade in Baltimore emerged as part of the broader, mobile world of coastal and Atlantic commerce and labor and functioned as a survival strategy for women whose existences were governed by seasonal labor patterns and the uncertain rhythms of trade. Sex work was a loosely organized and casual affair that was part of poor women’s economy of makeshifts, and it was neither highly profitable nor spatially separated from the everyday world and social fabric of community life in maritime neighborhoods. Men and women, black and white, enslaved and free, sold and purchased sex in taverns, sailors’ boardinghouses, and local groggeries. They did so at significant legal risk and for little in the way of profit, for prostitution in the early city was little more than a subsistence trade.
This chapter examines the decline of the brothel as a commercial form in the latter decades of the nineteenth century and the recasualization of sex work in the context of women’s changing labor arrangements and the growth of urban leisure culture. Baltimore’s brothels, in keeping with patterns in other US cities, lost their prominence as a sexual labor arrangement as the result of changing land use patterns, new styles of courting, and evolving work and housing arrangements for young laborers. With the rise of new types of urban leisure, young women who sold or traded sex increasingly resorted to concert saloons, dance halls, and amusement parks to solicit men and to furnished room houses to carry out their trysts. Once-taboo forms of sexual exchange became incorporated into the courting and leisure culture of young working people. Brothels, which in many ways reflected an outmoded, domestic model of courtship, had to embrace niche sexual markets in a struggle to compete for labor and customers.
This chapter traces the expansion of Baltimore’s sex trade and the rise of brothel prostitution over the course of the antebellum period. Although prostitution is often called “the world’s oldest profession,” it resembled a “profession” in urban America only after the 1820s, when rapid changes to the structures of labor and increased mobility created both a supply and a demand for sexual labor beyond the structures of maritime neighborhoods. The sex trade’s geographies shifted toward new centers of business and trade, and labor patterns in the trade changed. In keeping with a broader trend of business specialization and capitalist labor practices, Baltimore’s sex trade came increasingly to revolve around brothels where madams dictated aspects of sex workers’ behavior, extracted surplus value from their labor, and commercialized both sex and intimacy to a much greater degree than before. Women involved in the sex trade adapted their ventures to cater to dominant cultural preferences, from the domestication of courting to the embrace of racially exclusionary labor practices.
This chapter traces the expansion of Baltimore’s sex trade during the Civil War and the reactions of civilian and military authorities to its growth. Baltimore was an occupied city and staging ground for Union troops for much of the war, and the presence of thousands of soldiers in and around the city swelled the demand for commercial sex. As the economic hardships that accompanied war drove more women into sex work, Baltimore’s prostitution trade expanded far beyond its antebellum scale. Prostitution drew the attention of military and civil authorities, who were fearful of the potential the brothels had to undermine military discipline, civilian relations, and the health of soldiers. Baltimore’s brothel keepers managed to keep Union officials at bay by cooperating with their efforts to round up errant troops and providing valuable intelligence gathered from their clients, and many managed to make small fortunes by catering to soldiers. However, the attention the war brought to the violence, disorderliness, and disease-spreading potential of the sex trade would have profound long-term consequences for Baltimore’s sex workers and their enterprises.
In December 1921, a twenty-nine-year-old black woman named Adelaine (sometimes spelled Adeline) Payne appeared before the Baltimore City Criminal Court on charges related to prostitution. At the time of her trial, Payne was living on North Dallas Street, a narrow road running up from Fells Point. She rented a house between the Washington Hill and Dunbar neighborhoods, not far from the old Orleans Street vice district. Payne was a divorced, single mother to her four-year-old daughter, Iona. Though she may have been fortunate enough to enjoy some family support, Payne almost certainly struggled with the burdens of raising a young child on only her own earnings. As a black woman living in a city that was increasingly segregated and rife with anti-black racism, she had limited options for well-compensated work, and at the time of the 1920 census she had no legitimate employment. Prostitution, if indeed she participated in it, probably helped her to pay her bills.
In 1846, Baltimore entrepreneur Johns Hopkins opened a “splendid” set of commercial buildings on the corner of Lombard and Gay Streets, just north of the Patapsco River. Hopkins, who made his fortune first as a country merchant and then as an investor in the railroad, intended the buildings to facilitate the trade that was central to both Baltimore’s economy and his personal wealth. The buildings were practical, but they were also a symbol of the city’s commercial pretensions. In addition to offices and commodious warehouses where merchants and dry goods dealers could keep the variety of products they imported from the countryside and exported through the port of Baltimore, Hopkins funded the construction of a beautifully designed corner hall. The three-story structure, described as one of the “handsomest buildings in the city,” was adorned with numerous ornaments, including a trident of Neptune and a Roman spade that symbolized Baltimore’s links to maritime commerce and agriculture.
This chapter traces efforts by Baltimore and its courts to grapple with the expanding prostitution trade in the decades before the Civil War. Initially, local officials and courts attempted to take a suppressive approach to prostitution, in keeping with long-standing common-law precedents that enabled the state to police urban disorder. However, efforts at suppression proved prohibitively taxing on city resources, which prompted the adoption of a bifurcated approach to commercial sex in which the local officials and magistrates continued to punish public prostitution while largely tolerating indoor prostitution. By the 1840s, Baltimore had developed a regulatory approach to the sex trade that was intended to ensure that it remained as contained and orderly as possible. This system continued to function for nearly two decades before a groundbreaking 1857 legal intervention allowed city residents to seek equitable remedies for the presence of brothels in their neighborhoods. The precedent set in Hamilton v. Whitridge would set the stage for the containment of brothels within red-light districts, although it would take the Civil War to usher in that new phase of spatial regulation.
This chapter traces how the rise of brothel prostitution embedded commercial sex into the world of urban real estate and urban commercial networks. As a portion of the sex trade moved out of the streets and taverns and into houses, the sex trade became a source of profit for urban real estate investors and speculators. Meanwhile, the conspicuous consumption required to sustain a high-end brothel and the costs associated with maintaining one ensured that money generated by sex work circulated throughout the city and extended its reach far beyond those directly involved in prostitution. Taking up calls by historians to examine the ways that women’s labor contributed to the capitalist economy, this chapter explores the networks of real estate investors, entrepreneurs, laborers, medicine dealers, and proprietors of entertainment establishments who profited from women’s entrepreneurship and sexual labor. Although women were increasingly defined in nineteenth-century America as nonproducing dependents, their labor as sex workers and the commercialized fantasies they created around prostitution contributed in important ways to the urban economy.