Throughout this course, I have learned a lot about epidemics, societies, and how they affect each other. Through completing the artifacts, I have gained much more insight into public health aspects of history and the present that I would not have known otherwise. In this reflective essay, I would like to address some of what I learned this semester.

In general, societies have been greatly impacted by epidemics. Societies have been impacted by epidemics from the beginning of what we consider civilization. One of the main influencers of the emergence of many diseases we know today is the sedentary lifestyle. When people began to get away from the nomadic lifestyle, settle down, and begin agriculture, disease started to emerge. The domestication of animals brought disease to people that previously had little close contact with animals. In addition, the emergence of towns and later cities brought about increasing amounts of waste and trash, which facilitated the spread of diseases. People began living in closer proximity, as well, which further expedited the spread of disease (Artifact 1 “Disease and Plagues—from Past to Present”).
There are many examples of how specific epidemics impacted societies. One outbreak that changed the course of civilization and history was the Bubonic Plague. The Plague influenced medical research, particularly by Guy de Chaliac, who published several volumes of medical literature post-plague that would be used for centuries. The Plague also brought about a greater emphasis on scientific study, as well as art. This led to the great period of innovation in history known as the Renaissance (Artifact 3 “Plague—Yesterday and Today”). Another outbreak that had a wide-reaching effect on societies was small pox. When the Spanish came to the New World, they brought smallpox with them. This eventually wiped out most of the Aztec and Incan population, allowing for the relatively easy settlement of the New World by the Spanish (Artifact 4 “Smallpox—Significance and Effects on History). Another specific outbreak that greatly influenced society forever was the Cholera outbreak in England. This brought about significant change in sanitation standards (Artifact 8 “Cholera Still King Today?”).

Societies have responded and continue to respond to outbreaks and epidemics in similar ways. During the Bubonic Plague, people tried to understand the disease. In this instance, they blamed it on miasmas. Another response was religious persecution and fanaticism. Many tried folk remedies that they believed might work. They also first began instituting quarantine and isolation of the sick (Artifact 3 “Plague—Yesterday and Today” and Bubonic Plague Film). During the Spanish Flu, people, again, tried home remedies and masks as an effort to fight the outbreak. Even today, people respond in similar ways, which can be influenced by misinformation (Artifact 2 “Outbreak Significance and Factors”). These examples of responses to outbreaks all have one aspect in common, and that is that the layperson will try anything that might have a chance of working to stop the disease. Throughout history and today, that is a common theme of outbreak response.

Societies have had a major impact on the diseases that have affected them. This began, as mentioned above, with the domestication of animals with the beginning of agriculture (Artifact 1 “Disease and Plagues—from Past to Present”). The threat of disease grew with the creation of cities and the filth that followed (Artifact 1; Artifact 3). An increase in globalization and global trade also greatly influence the spread of disease, specifically (Artifact 3 “Plague—Yesterday and Today”). As civilizations grew, they began to push deeper and deeper into the wild, bringing them into closer contact with animals and zoonotic diseases which were previously ‘out of range.’ Finally, some cultural practices, such as eating bush meat have been a societal influence on the emergence and spread of various diseases (Artifact 2 “Outbreak Significance and Factors”). Societies have had much to do with the beginning and spread of the diseases by which they were and continue to be affected.

Modern society has been, and will continue to be, impacted by established and emerging diseases. One impact is an increase in infectious disease research, as is the case with TB. We know so much more now about the disease than we knew even 60 years ago (Artifact 7 “History of Tuberculosis and its Threat Today”). That is not only the case with TB, but also numerous other diseases. The increase in knowledge about infectious diseases is a direct result of their prevalence and impact on the health of societies. There has also been an overall increase in health standards worldwide as a result of established and emerging diseases. One example is the campaign for sanitary toilets in India (#EveryWomansRight video). This may seem like a small example, but it is a simple solution to a potentially complex issue of infectious disease spread as a result of human waste. In addition to positive impacts on society, established and emerging diseases have had and continue to have negative effects. One surprising effect is potentially a lack of response. This was seen within the Reagan Administration during the HIV/AIDS epidemic in the 1980s, in which the President and his staff failed to address the issues at hand outright until much after the fact (Artifact 9 “Fighting the HIV Epidemic in the United States”). Another negative impact from established and emerging diseases is social stigma. Social stigmas are linked specifically with TB and HIV, both of which result in shunning patients and losing friends and family (Artifact 7 “History of Tuberculosis and its Threat Today;” Artifact 9 “Fighting the HIV Epidemic in the United States”). Established and emerging diseases have both positive and negative effects on society.

On the other hand, societies can have an influence on established and emerging diseases. One such factor has been the over prescription of antibiotics. This has led to resistant strains of several pathogens (Artifact 1 “Disease and Plagues—from Past to Present”). In addition, the negative stigma of TB, which influences underreporting of symptoms and patients not taking medications, has led to MDR-TB and XDR-TB. These are much more dangerous forms of TB (Artifact 7 “History of Tuberculosis and its Threat Today”). Finally, war has been a major influence on established and emerging diseases. War in Yemen, specifically, has led to the destruction to health and sanitation infrastructure. It has also led to the malnourishment of those living there (Artifact 8 “Cholera Still King Today?”). All of these factors influencing established and emerging diseases stem from societies, themselves.

The Epidemics and Society course has taught me so much about the history and current state of public health. There are a few specific examples of some of the more influential activities in which we participated that have contributed to this learning. First, while completing Artifact 1 “Disease and Plagues—from Past to Present,” I learned a lot about the emergence of disease and the factors that initially influenced its spread. It was interesting to see the ancient origins, such as agricultural lifestyle and the development of cities. I never knew about the emergence of the diseases which we often learn or hear about. While completing Artifact 5 “Ethics and Infectious Disease—Focus: Syphilis”, I increased my existing knowledge of the Tuskegee Syphilis Experiment. I had heard of it before, but I learned much more about the extent of the unethical treatment of the men involved in that study. It was helpful for me to see the ethics behind clinical research, especially as I prepare to enter into healthcare. Finally, while completing Artifact 7 “History of Tuberculosis and Its Threat Today,” I learned much more about TB. Before this class, I had only really heard of the disease and vaguely knew about its characteristics. I was particularly moved by the film which we watched in class. I did not realize the extent of the suffering experienced by TB patients. Completing these artifacts truly increased my awareness and knowledge about society, disease, and public health.

Overall, my experience in Epidemics and Society has been rewarding. I have learned a lot about disease on a larger scale than in previous biology classes, which I believe will be helpful in the future. As I move forward, I will leave this class with a better understanding of the interaction between the spread of disease, society, and the influence each has on the other.

Help Received: Artifacts listed (including all sources included on their Help Received statements), instructions from Canvas, https://i0.wp.com/schoolshistory.org.uk/topics/wp-content/uploads/2018/01/King_cholera_poster_1849.gif for image 1, http://bento.cdn.pbs.org/hostedbento-prod/filer_public/spillover/images/viruses/definitions/transmission.png for image 2, Spellcheck

HIV, unlike all of the other diseases we have looked at so far, is a relatively new disease for humans. Its recent emergence has caused quite a bit of controversy, but a response to help combat the disease is growing. Today, much progress has been made in the fight against HIV, but much work is still to be done to eventually rid the United States, and the World, of HIV.

Several social factors have caused the HIV epidemic as we know it today. One large contributing component was the anti-gay sentiment when this disease was first documented. Its discovery came during a time in US history when there was a new, increased expression of homosexuality. The disease was often linked to men who had sex with men. This created a negative stereotype of the gay population. The disease was attributed solely to that lifestyle (on the contrary, it was/is also found in heterosexual people and infants, as well). This stereotyping led to shame in the gay community. People did not want to be associated with this disease. Because of this, they were hesitant to get tested or report the results of their tests to others for fear of exclusion. This further added to the spread of the HIV epidemic.

In addition, there was an overall lack of knowledge about how HIV spread. Some people believed, and continue to believe, that HIV can be spread through the air, contact, etc. as other diseases are. In reality, HIV is spread through contact with body fluids, most commonly during sex or sharing of IV needles.

The government did not help matters. The Reagan administration was slow to respond to the HIV/AIDS outbreak. They did not officially approach the issue until 1987. They also did not calm the fears of the populace over the spread of HIV/AIDS. In a public address, President Reagan openly admitted that he did not believe the science was certain behind the spread of AIDS. This further contributed to the public’s irrational fear about HIV/AIDS exposure.

There was also a moral component that contributed to the HIV epidemic. People believed that HIV was only spread through immoral sexual acts. They did not realize that people who never had sexual contact could get it, including children and hemophiliacs. This contributed to the stereotype of HIV being a homosexual disease and opened new discrimination against recently infected hemophiliacs or children.

Overall, these factors changed peoples’ lives forever. It caused people to lose jobs and be shunned by friends and family. People were afraid to be around those infected, which hurt business, education, and relationships. The stigma against HIV/AIDS caused people to shy away from testing and reporting. All of these factors contributed to the HIV/AIDS epidemic we still have today.

With that said, however, there have been some factors that have hampered the deadly virus. An increased awareness of HIV/AIDS, as a whole, has done much to educate the public and slow the spread of the disease. Safe sex practices have been taught, which has contributed greatly to prevention. Awareness of the dangers of sharing needles has also become more prevalent. Also, new testing procedures have led to greater detection of the disease, so those infected can get help.

The HIV epidemic has had several impacts on society in the United States. The HIV/AIDS epidemic has led to increased knowledge about the disease. People now mostly understand how it is spread; however some myths still exist. There is also now a greater acceptance for those with HIV/AIDS because people understand that it can infect anyone. The prevalence of the disease has made the public more accepting of those who have it. Unfortunately, the epidemic has fostered myths about HIV/AIDS. It is hard to get rid of this misinformation. Finally, the epidemic has caused top government officials to take a closer look and develop a plan on how to stop it. The Trump administration is looking to end the HIV epidemic in the next 10 years. Only time will tell if this will pay off.

There has been significant progress in fighting the HIV epidemic in the US. Overall, there is increased testing and awareness. The rat of infection has also decreased in the last 20 years, and the transmission rate has decreased by 89%.

Despite these great advances, there are still some challenges associated with the HIV epidemic. Many people do not even know that they are infected. According to the CDC, an estimated 161,000 people do not know that they have HIV. Out of this number, many do not want to get tested or do not know how testing works. Some do not keep up with their medication. Out of those prescribed medication for their HIV, only about 40% take them regularly. In addition, infected people in poverty may not have access to healthcare.

There has also been progress made in prevention and treatment of HIV. In addition to the aforementioned increase awareness of how HIV spreads, there are two relatively new preventative medications. Pre-exposure prophylaxis (PrEP) can be taken by someone who has a good chance of becoming infected. It lowers their risk of infection but must be taken on a regular basis to be effective. In addition, Post-Exposure Prophylaxis (PEP) can be taken by someone who has been exposed to an infected person. It consists of antiretroviral medications that must be taken within 72 hours of exposure.

There are several aspects to the current status of HIV in the US. In the realm of prevention, there has been a push for safe sex practices or abstinence. In addition, PrEP and PEP have done a lot to prevent the spread of HIV. To prevent HIV spread through drug use, clean needle clinics are being tested in order to see their effects on the HIV infection among injection drug users. In the realm of detection, HIV is mainly detected today through measuring CD4+ cells. Physicians look for numbers less than 200/mm3 in a blood sample to diagnose HIV. In addition, physicians look for prevalence of opportunistic infections, such as Kaposi’s sarcoma and Pneumocystis pneumonia. ELISA tests have also been used to diagnose HIV. Some tests can even be done at home!

In order to overcome the HIV epidemic, there must be a large commitment from the government and the people. The Office of the Assistant Secretary of Health has come up with a general plan as to how the government can play a role in ending the HIV epidemic. According to their plan, areas where HIV/AIDS is prevalent need to be focused on. There needs to be an emphasis on early diagnosis. There needs to be access to early treatment. In addition, PrEP use will become more prevalent. Finally, the plan stresses early detection of new cases. On top of this, the public needs to get on board with ending the HIV epidemic.

HIV is a relatively new disease that we are just starting to understand. With time, money, and scientific research, we can learn a lot more. One day, hopefully soon, a cure will be found, signaling the beginning of the end for HIV.

Help Received: https://www.washingtonpost.com/news/arts-and-entertainment/wp/2015/12/01/a-disturbing-new-glimpse-at-the-reagan-administrations-indifference-to-aids/?utm_term=.4cc921e160ca, https://aidsinfo.nih.gov/understanding-hiv-aids/fact-sheets/20/48/the-basics-of-hiv-prevention, https://www.cbsnews.com/news/trump-hivaids-promise-during-state-of-the-union-2019-02-06/, https://www.cdc.gov/nchhstp/newsroom/docs/factsheets/challenges-508.pdf, https://www.cdc.gov/winnablebattles/HIV/pdf/hiv_prev_progress.pdf, https://www.cdc.gov/HIV/basics/prep.html, https://www.cdc.gov/HIV/basics/pep.html, https://en.wikipedia.org/wiki/HIV/AIDS_in_the_United_States, https://www.ucsfhealth.org/conditions/aids/diagnosis.html, Ending the HIV Epidemic: A Plan for the United States article from classThesaurus.com, Spellcheck, https://a57.foxnews.com/images.foxnews.com/content/fox-news/health/2015/04/24/indiana-hiv-outbreak-hepatitis-c-epidemic-sparks-cdc-alert/_jcr_content/par/featured-media/media-1.img.jpg/0/0/1445088195116.jpg?ve=1 for image 1, https://static2.businessinsider.com/image/594a8850e592ed234a8b5774-1190-625/this-map-shows-the-area-of-the-us-thats-home-to-the-most-people-living-with-hiv.jpg for image 2, direcly copied words from the artifact handout, HIV documentary from class

Cholera is a quick and nasty killer. Because of the watery diarrhea it causes, those infected can die the same day they fall ill. Cholera has a history of being a deadly disease and is still with us today when public sanitation infrastructure breaks down.

Historically, colonization, trade, and urbanization have played huge roles in the spread of cholera. Cholera was believed to have begun in the Ganges river in India. Through colonization and trade, it was able to spread rapidly. During the First Pandemic (1816-1823), cholera spread via trade routes and ended up in several Asian countries, Africa, and even began to creep its way into the Middle East and towards Europe. The British began to colonize India, which led to cholera making its way to the British Iles, and from there to the rest of the world. Urban environments were also growing around the time of the Second Pandemic (1829-1851). This led to overcrowded conditions in cities. The public infrastructure could not hold that many people, so it began to fail. There was also an overall lack of hygiene. Old practices of dumping human waste into the streets was still being practiced. This ended up contaminating water supplies and spreading diseases, such as cholera, to the local populace. The close proximity in which people lived to one another also contributed to the swiftness in spreading cholera.

Eventually, some factors helped to limit the ability of cholera to spread. There was a movement to increase the sanitation of cities through public health departments and the building of modern water treatment facilities. Also, customs such as dumping waste into the streets were discontinued. The increase in public sanitation, overall, helped to stem the spread of cholera and decrease the instances of outbreaks.

The existence of multiple strains of a disease is often a scary thought. This can be the case with cholera. A more lethal strain of cholera is known as El Tor. The fact that it can live longer in water makes it a more deadly type of cholera. In addition, those who get it may have mild to no symptoms. This leads to increased chances for spreading the bacteria because those infected may not know that they are infected. Little to no preventative steps may be taken in this case.

There are several major contributors to the knowledge of cholera that we have today. One of those contributors is Dr. John Snow. Dr. Snow is known for his work in studying the 1854 epidemic of cholera in London. He was one of the few to understand that the water supply had something to do with the spread of cholera. He famously charted deaths from cholera in Soho and displayed them on a map. He recommended that the Broad St. pump be put out of service due to his research in the area. Also involved with this movement was Henry Whitehead, a priest in the Church of England. He knew the people who lived in the area well and was able to aid Dr. Snow in his statistics on deaths from cholera. He was also able to convince local leaders that the Broad St. pump needed to be put out of service. Filippo Pacini was an Italian scientist who was the first to identify the bacteria that caused cholera. He did not initially get the credit, however. The man who was credited with discovering the bacteria that causes cholera first was Robert Koch. He also independently found these bacteria and was credited as the first. All of these men helped to contribute to the rejection of the idea of miasmas, which was a huge scientific breakthrough at the time.

One modern day outbreak of cholera occurred in Haiti during 2010-2011. This outbreak followed the major earthquake in 2010. The El Tor strain was identified as the cause. Eventually, the El Tor was traced back to having come from Nepalese aid workers, who came after the earthquake to help and did not know they were infected. These aid workers contaminated a local water supply, which began the outbreak.

Today, the cholera outbreak has died down, though there still exist a decent number of cases. According to the Ministry of Health in Haiti, there were 6760 cases of cholera in 2017. Several new preventative measures have been taken in order to reduce the number of cases in Haiti and worldwide. An oral cholera vaccine has been given out. Toilets and latrines are being built. More aid clinics are built and serve those who are ill. Finally, new water filtration methods are being used, such as using a sari.

The largest item that remains to be done in helping countries particularly effected by cholera is a comprehensive clean up, as well, as a rebuilding of their sanitation infrastructure. These measures would reduce the incidence of cholera dramatically.

Yemen is also a nation particularly effected by cholera at this time. It is a war-torn country, and their public infrastructure is destroyed. This has led to unsanitary conditions, particularly unsanitary water. Unsanitary water directly results in the cholera outbreaks that are ravishing the country. The people of Yemen are also already malnourished, which contributes to an even greater death toll caused by cholera. Much needs to be done to aid this country and others like it in order to end cholera.

Cholera has and will continue to plague humankind as long as unsanitary conditions still exist. It is our duty to help countries develop the correct infrastructure in order to ease the suffering of those who are ill.

Help Received:

Cholera ppt from Canvas, http://www.ijdh.org/wp-content/uploads/2012/03/Haiti-Cholera_Lancet-June-2017.pdf, Spellcheck, https://lewebpedagogique.com/asphodele/files/2013/01/cholera.jpg for image 1, https://media4.s-nbcnews.com/j/newscms/2017_30/2087151/170728-cholera-yemen-mc-11-46_7507baa34ffe3c6ea05285098176eb69.nbcnews-ux-1024-900.jpg for image 2

Tuberculosis, or TB, is caused by the bacteria Mycobacteria tuberculosis. Though not as prevalent as it was in the past, TB is still a major killer throughout the world. It is a horrible disease, which eats away at patients from the inside out. Efforts are being made to reduce the prevalence of TB, however, a lot must be done in order to move towards the end-goal of TB eradication.

Tuberculosis has quite a long history, with several different outbreaks through the ages. It seemed to really come to a head during the 19th and early 20th centuries at the same time as the Industrial Revolution in Western societies. With the Industrial Revolution came many jobs in large cities, which caused people to urbanize.

The great migration into cities from native citizens along with masses of immigrants (mainly into the US) created the perfect environment for TB. High population numbers and crowded conditions contributed to this deadly environment. Many immigrants were forced to live in tenement housing, adding to the perfect environment for TB. They were overcrowded, poorly constructed, and dirty. In addition, they had little to no ventilation. All of these factors, along with the lack of sanitation or pollution regulation created a cesspool of filth from which TB grew.

Many people, if they became infected with TB, never reported it. This impacted the speed at which the disease was spread from person to person because those who were sick were not being treated. Even if people did report their illness and were treated, many hospitals did not take later-stage infections for fear of wasting precious resources on someone with low survival odds. This only further contributed to the spread to TB.

In addition, there was little knowledge about the disease, how it spread, and how to treat it. For several decades, “Rest, sunshine, [and] fresh air” were prescribed treatments. Several different treatment facilities arose from the efforts to treat those infected and isolate them from healthy individuals. Barges were one such treatment facility, used to keep those with TB out of the cities. Sanatoriums began to open to provide treatment. Though a noble effort, these sanatoriums ended up having the same death rate as patients who stayed at home and were not treated. As another effort to treat TB, the plombage technique was developed. This included a surgical procedure to fill the holes in the lungs caused by TB. This technique was also unsuccessful and even led to secondary infections.

Only with the emergence of antibiotics did effective treatment for TB begin. Streptomycin discovered in 1943 and found to be effective against TB. However, with the use and overuse of antibiotics to treat TB, resistance started to emerge. This is the cause of many of the MDR-TB and XDR-TB problems we face today.

There are not only examples from the past that contributed to the spread of TB, but also many modern ones. One of the biggest factors in the spread of TB is poverty. Overall, poor living conditions foster many diseases. Poor housing, food, water, and infrastructure all contribute to poor living conditions. Most importantly, these conditions are not sanitary. As they did in the past, these same conditions lead to the perfect environment in which TB can thrive. As a result of poverty, malnutrition is also a contributor to TB. The poor food quality and selection for those in poverty, along with not getting the right amount and type of foods lead to a weak immune system.

There is a definite social stigma for those with TB today. Many infected with TB are shunned because people close to them are worried about becoming infected, themselves. TB patients often lose their jobs, friends, and family. Due to the social stigma, many people with TB do not report their illness, and thus continue to be a threat to those around them.

HIV is another factor in the spread of TB today. HIV is associated with a compromised immune system, so it would be easier to get diseases like TB. This disease also happens to be prevalent in areas where TB is also prevalent, leading to dual infection. In many ways, HIV and TB are linked.

Today, drug-resistant TB is an ever-increasing issue. There is Multi Drug Resistant TB (MDR-TB) and Extensively Drug Resistant TB (XDR-TB) which have arisen due to several factors. One factor is that people often do not complete their medication plan, take medication correctly, or take medication at all. This might be due to the arduous process that is TB treatment. The treatment protocol lasts a long time, there are a lot of drugs to take, and the side effects can be very adverse. Cost is also an issue for patients, especially in poverty-stricken countries. The result of TB patients not taking medication is the possibility of increased transmission and drug resistance. Finally, the overuse of TB drugs contributes to drug resistance. Drug resistance might not be tested often, leading to a continuation of treatments that might be leading to the TB bacteria becoming resistant.

Overall, I believe there are two major areas that need improvement in order to reverse the tide of TB. First, we need to do everything we can to alleviate poverty in countries effected with TB. Alleviating poverty would lead to more sanitary conditions, which would decrease disease, in general, but especially TB. This would also involve giving these people better access to healthcare. Better healthcare infrastructure would ensure those who are infected better treatment, leading to less TB transmission. Directly observed therapy would also need to be a part of this better healthcare infrastructure to make sure those with TB are actually taking their treatments. Finally, we would need to work against the TB stigma. This would take the form of TB education, showing people what TB truly is and how it affects those infected. Along with this, reporting cases needs to be encouraged in order to get those infected the help they need before they can infect others.

Tuberculosis is a disease with an extensive past and is an ever-present danger. Without addressing the factors leading to its spread and its increasing resistance to drugs, it will continue to exist as a global threat.

HR: TB PPT on Canvas, PBS American Experience: The Forgotten Plague, https://timesofindia.indiatimes.com/city/mumbai/rise-rise-of-mdr-tb-in-india-a-man-made-crisis/articleshow/68543639.cms, file:///C:/Users/John%20David/AppData/Local/Packages/Microsoft.MicrosoftEdge_8wekyb3d8bbwe/TempState/Downloads/TB%20building%20a%20tb%20free%20world%20Lancet%20Commission%20TB%20(1).pdf, Spellcheck, https://media.npr.org/assets/img/2013/06/06/3093183-1–f723a4bc373b17b3ff09717af1aee197562cb432-s6-c30.jpg for image 1, https://www.msf.org.za/sites/default/files/styles/standard_lg/public/msf177475_medium_1.jpg?itok=8OZaZfdB for image 2

The Irish Potato Famine was a devastating historical event. The island of Ireland was not prepared for such widespread hunger and disease. This event, though, is not isolated in the past. It causes us to consider the technology we have today that can prevent such a famine from happening again. But this technology must be carefully examined in a moral light.

The potato was an incredibly important crop to the Irish in the 1800s. It was a dietary staple of the Irish people. It was eaten for every meal. Unfortunately, only a few types were grown in Ireland at the time.

Societal and political factors played a role in setting the stage for the famine. The reason why Ireland was so dependent on the potato was because they were forced to export many of their other crops to England. This left almost exclusively the potato as the main food supply in Ireland. Also, the Irish were already living in poor living conditions prior to the famine, which eventually led to the associated diseases.

There were several biotic and abiotic factors that led to the potato blight. The blight, itself, is caused by the fungus Phytophthora infestans. The HERB-1 strain of P. infestans was thought to be the cause of the Irish Potato Famine. This strain was thought to most likely come to Europe from North America by ship. In addition, weather had a great deal to do with causing the blight. P. infestans needs warm temperatures with some rain, and Ireland had these conditions in 1845. The summer before the blight came to Ireland was recorded as having good weather with one week of cold rains. These were the exact conditions P. infestans needed to flourish.

The Irish Potato Famine had many devastating effects. In the first year of the blight, around one third to one half of the land planted with potatoes was affected. The following year in 1846, around 75% of potatoes were destroyed by the blight. Because the Irish depended so heavily on these potatoes, several negative consequences followed with the blight. There was mass starvation in Ireland from 1845 until 1852. Due to the lack of food and increasingly poor conditions, diseases outbreaks resulted. Some of these diseases included measles, tuberculosis, whooping cough, various parasites, and cholera. An estimated one million people died. An additional million immigrated to North America between 1846 an 1851. These immigrants brought diseases with them from Ireland and infected the ships on which they traveled and the tenements in which they settled. Overall, Ireland’s population dropped around 20% to 25% and recovered very slowly.

Diseases, such as the blight which caused the Irish Potato Famine, have inspired numerous biological technologies aimed at altering the genetic makeup of organisms to help prevent disease. One of those technologies is CRISPR. There are numerous benefits to being able to alter genomes through CRISPR. First, organisms can be made to resists different disease. As an example, scientists have made a strain of potato that can resist potato blight.

Also, plants and animals we eat as food can be altered to produce more of that food. There are strains of apples that are larger and more juicy than non-modified apples. The genetic makeup of chickens can be altered so that they have more muscle mass. There are many examples of how genetic modification has led to increased amounts of food.

Gene editing can also be used to exterminate different diseases. Recently, scientists have modified the genome of mosquitoes to cause their offspring to become infertile, which will stop the spread of malaria.

Along with theses benefits, there are also numerous risks. Most of these risks are unknown. Genetic modification has not been around long enough to observe any long-term effects. To use the genetically modified mosquitoes as an example, many scientists are wary of the risks of taking mosquitoes out of the ecosystem. They are afraid there are far reaching effects that we cannot see now.
This technology also has the opportunity to fall into the wrong hands. Though this technology can be used for much good, it can also be used for bad; it can become weaponized. With it, scientists can create super-diseases that cannot be cured with treatments we have now.

Using this technology, ultimately, sets a dangerous precedent. If gene editing can be proven effective and safe, should it be used on humans? Designer babies are already under ethical debate as this new technology is being increasingly used.

The Irish Potato Famine has had lasting historical affects. It is a painful reminder of our susceptibility to disease in ourselves and our food sources. Steps have been taken to create technology that can permanently change the genetic makeup of organisms that can eradicate diseases. However, we must tread carefully, as this technology can be used for as much bad as it can be used for good.

Help Received: Irish Potato Famine PPT on Canvas, “The Great Famine” Part Three: A Mass of Rottenness on Canvas, “The Great Famine” Part Four: The Epidemic on Canvas, https://www.npr.org/sections/goatsandsoda/2019/02/20/693735499/scientists-release-controversial-genetically-modified-mosquitoes-in-high-securit, https://www.npr.org/sections/goatsandsoda/2018/09/24/650501045/mosquitoes-genetically-modified-to-crash-species-that-spreads-malaria, https://en.wikipedia.org/wiki/Great_Famine_(Ireland)#/media/File:Skibbereen_by_James_Mahony,_1847.JPG for Image 1, http://www.beaumonthospitalschool.ie/2015/10/23/the-legacy-of-the-irish-potato-famine/ for Image 2, Spellcheck

Ethics in research, particularly biomedical research, has been a reoccurring issue since its inception and is closely examined in current studies. This topic is particularly examined due to the unethical conditions in which numerous studies have taken place, major examples being the Tuskegee Syphilis Experiment and the Guatemala Syphilis Studies. During these experiments, several ethical protocols were broken in the name of science. The horrific outcomes still influence us today.

In dealing with infectious diseases, several ethical issues come into play. First, the disease must be understood. In order to fully understand an infectious disease, research must be conducted by infecting living things. One ethical question that arises from this is: can humans be test subjects? Mice and other mammals are routinely substituted for human subjects, but do not always closely reflect the disease mechanism found in humans. This is one ethical consideration when studying infectious diseases.

Another ethical issue includes testing treatment options. Most drugs have detrimental side effects. What happens if the side effects are worse than the disease? What if the treatment kills the subject before the disease does? In addition, every scientific study requires a control group. This inherently means some people in the study do not get treated, even though they have the disease. Is this right? These are some ethical considerations regarding testing treatment.

Finally, if research is complete on a particular infectious disease and treatments are approved, treatments are sold commercially. This involves pharmaceutical companies in competition with one another to make money. What if the price for treatment is so high only a select few can afford it? Also, supplies are not infinite. What happens if stock runs out? Who gets treated? There are many ethical issues associated with infectious diseases, in general.

Two studies stick out as examples of unethical medical scientific studies. These include the Tuskegee Syphilis Experiment and the Guatemala Syphilis Studies. Both were rationalized in their own way.

The Tuskegee Syphilis Experiment was mainly rationalized through discriminatory ways. Scientists believed that Macon County, Alabama was an ideal location do run their experiment. The majority of the population did not have much education, syphilis was prevalent, and it was believed that the population often engaged in sexual activity. Not to mention, the majority of the population was African American. Scientists wanted to better understand the pathology of untreated syphilis and also wanted to see if African Americans had a different type of syphilis than whites. They also wanted to be better able to treat syphilis based on the results of this study.
As the study continued, researchers continued to justify its existence. Scientists wanted to see the conclusion of this experiment. They argued that they were getting valuable data about untreated syphilis. Towards the end of the study, researchers believed that too much damage had been done to the subjects that treatment would be ineffective.

The Guatemala Syphilis Studies were similar in rationalization. At the time of the study, there was a large push in the United States to get rid of STDs, especially in the military. To do this, researchers wanted to better understand how gonorrhea, syphilis, and chancroid affected the body. In their studies, research subjects included prisoners, Guatemalan soldiers, and prostitutes. These people were not valued. In addition, there was much political turmoil in Guatemala, so the government did not object to the American studies. Finally, some of the participants of the study were treated in the end. These are a few ways the Guatemala Syphilis Studies were justified.

There are many examples of how the Tuskegee Syphilis Study, in particular, was unethical. First, the study was discriminatory. The only participants selected were African American men. Second, researchers did not fully disclose their plan to the participants. Subjects were under the impression that they were being treated for “bad blood.” The researchers did not even clearly define what “bad blood” truly meant. Third, the study was not stopped once it was confirmed that the study was causing harm. Researchers kept the study going in order to see the full effects of untreated syphilis. Finally, the study was not stopped once an effective treatment was found. Penicillin was a new antibiotic at the time and was found to be effective against syphilis. Despite this treatment option, subjects were actively denied treatment for the purpose of the study.

The unethical practices of the Tuskegee Syphilis Experiment still effect perception of medical research and physicians today. There is an overall distrust of research scientists among the African American community largely due to the Tuskegee Syphilis Experiment. According to a study by Shavers et al. (2000), 51% of African Americans versus 17% of whites in Detroit did not trust research scientists after 81% of African Americans and 28% of whites said they knew about the Tuskegee Syphilis Experiment. In addition, 49% of African Americans versus 17% of whites said they would not volunteer for a medical study.

In addition to a distrust of scientists, there also exists a distrust of physicians. A study by Katz et al. (2008) found that this distrust was particularly prevalent in Macon County, Alabama and mostly in men. More than likely as a result of this distrust, there was a tuberculosis outbreak in Marion, Alabama in 2014.

Unethical studies, such as the Tuskegee Syphilis Experiment and the Guatemala Syphilis Studies, have greatly impacted both science and society today. From new ethical standards required and reviewed for scientific research to a culture of distrust, these studies still affect us today. These were horrific historical events in science that have led to current change in bioethics.

Help Received: Tuskegee Syphilis Experiment video from class, class discussion, Guatemala experiment article (Matthew Walter) from Canvas, Knowledge of the Tuskegee Study and its Impact on the Willingness to Participate in Medical Research Studies article on Canvas, In Rural Alabama, a Longtime Mistrust of Medicine Fuels a Tuberculosis Outbreak article from Canvas, Did Infamous Tuskegee Study Cause Lasting Mistrust of Doctors Among Blacks article from Canvas, http://media.urbantabloid.com/wp-content/uploads/2014/11/The-Tuskegee-Syphilis-Experiment.jpg for image 1, https://allthatsinteresting.com/wordpress/wp-content/uploads/2017/10/human-experiments-guatemala-lineup.jpg for image 2, Spellcheck

The deadly disease of smallpox is known for directing the course of history. It had a particularly large impact on the New World. From discovery and first settlements, to armed conflict and slavery, smallpox shaped the history of North, Central, and South America greatly.
When Spanish conquistadores under the command of explorer Hernan Cortés invaded the Aztec Empire in modern day Mexico, they brought violence and disease. Cortés attacked the Aztec capital city of Tenochtitlan and was met by a strong Aztec army. The Aztecs forced the Spanish to retreat, but by this time, the Aztecs were already exposed to smallpox. When Cortés had reorganized his men, they marched back to Tenochtitlan. This time, however, there was barely any fighting force defending the city. Smallpox had devastated most of the population. The Aztecs, as well as many other Amerindian tribes, were very susceptible to smallpox because up until this point, this disease known only to the Old World. The great epidemic that swept over the Aztecs contributed to the belief that the Spanish had supernatural ability, thus establishing their power. These events allowed the Spanish to dominate the Aztec Empire.

The Aztecs were not the only Amerindian tribe effected by the arrival of Europeans. The Incan people suffered a decimating outbreak due to exposure before explorers had even reached their land. By the time the explorer Pizzaro and his troops arrived in what is now Peru, the Incan Empire was in shambles. Most of the population had already been wiped out by smallpox. Events such as this happened throughout the New World, contributing to its colonization by European powers.
Indirectly, smallpox paved the way for slave trade in the New World. With the native population dying off from smallpox, colonists began to run out of a labor force for their growing plantations. The colonists turned to West Africa for their new source of labor. Many West Africans had already been exposed to smallpox, which made them even more valuable in the New World. This began the slave trade to the Americas, which would influence history through the present.
Many of these instances have involved what is now Central America, South America, and the Caribbean, however, the settlement of North America was also impacted by smallpox. The pilgrims that landed in Plymouth in 1620 found very few native people. This is because most had been killed by an outbreak resulting from colonists who had arrived three years earlier. During the Seven Years War, the British at Fort Pitt decided to gain an upper hand on their Native American adversaries by giving them blankets infected with smallpox.

Smallpox also played a role in the American Revolutionary War. During the occupation of Boston by British forces, George Washington and his men were camped outside of the city just after being beaten at Breed’s Hill and Bunker Hill. General Howe of the British Army, however, could not press the attack because there was an active outbreak of smallpox going on in Boston. Washington could not attack the city for fear of losing soldiers to smallpox. This resulted in a stalemate. Meanwhile, Washington had his men variolated. When the British left Boston, Washington sent 1,000 variolated troops to take back the city. In addition, smallpox impacted the Continental Army’s invasion of Quebec. General Benedict Arnold took 2,000 troops to attack the British force in Quebec. However, his men got sick, and many men could not fight. The British troops had been variolated, so they were not as affected by the sudden outbreak. In the end, General Arnold was forced out of Canada for good.

Smallpox had a profound impact on the discovery and development of the New World. Without its influence, much of what we know today may be different. It is hard to believe that one disease could do so much on the world stage. Without smallpox, the western hemisphere would be completely different.

Help Received: The Power of Plagues Chapter 9, History Channel documentary from class, class discussions, http://desertoss.pbworks.com/f/aztecsmallpox.jpg for image 1, http://www.indianz.com/News/2015/11/19/smallpoxblankets.jpg for image 2, https://www.history.org/Foundation/journal/Spring04/images/war_immunization.jpg for image 3, Spellcheck

The Bubonic Plague, or Black Death, was the quintessential disease epidemic. It ravaged Europe from the 14th century until the 18th century. It was extremely virulent and killed without discretion. Many social and cultural factors allowed it to do the damage it did, and it altered the course of history. But it is not only an epidemic of the past. There have been numerous plague outbreaks in modern times. The plague transcends time as a deadly disease.
During the plague outbreak known as the Black death during the 14th century, there were several societal factors that may have contributed to its spread and deadliness. One factor is war. At this time, the Mongol Empire was spreading from the Far East into Western Europe. Some historians and scientists believe that the plague was first spread to Europe during the Siege of Caffa. Legend goes that the retreating Mongol army launched corpses infected with plague over the city walls. More than likely, however, rats carrying infected fleas entered the city.
In addition to war, trade was another factor in the Black Death. Numerous trade routes were opened from the Mongol Empire from Asia into Europe. This facilitated the spread of the plague from Asia. Also, seafaring trade may have contributed to the spread of the plague through the rats aboard the ships.
Another factor in the deadliness of the Black Death was a lack of sanitation in European cities. There was a rise in major cities around this time, and many people came to live in these cities. They soon became crowded and filthy places, the perfect conditions for rats to live. And with the rats came fleas infected with Y. pestis.
When the outbreak of plague became evident, there were many assumptions about its nature. Many of the ‘educated elite’ believed it was the result of a miasma or the malalignment of the planets. Religious-minded people believed the plague was God’s curse on them for their great sin. Some even blamed the Jews, believing it would make God happy to get rid of them.

With the plague came several prevention strategies. This time period saw the rise of religious fanatics, most notably the flagellants, who believed suffering like Christ would appease God and end the plague. There were also several early medical remedies for the plague. These remedies included bloodletting, treatment with different herbs and spices, and even fire.
Some resorted to killing the Jews, who they believed were the cause of the plague. If they were not killed, many were forced to leave. Even non-Jews would leave their homes, especially the nobles, who would flee to their country estates to seclude themselves. Some would just abandon their families in an act of self-preservation.
The concept of quarantine was developed during this time. The word quarantine originally comes from Italian for 40. Ships were forced to stay at anchor for 40 days before coming to port. Lazarettos were created for people with the plague to all stay in one place to be treated. Some cities enacted ordinances to create a ‘Cordon Sanitaire,’ in which sick people were forcibly kept separate from the healthy.
When it was all said and done, the plague had many lasting impacts on society and culture. One effect was that many Jews were killed or scattered from their homes. Many went to Poland, where they were accepted.
In terms of religion, some say there was a “privatization of religion,” where the wealthy would hire private chaplains. For some, their faith in God increased after enduring this great trial. Others resorted to science.
In medicine, the physician Guy de Chauliac made major contributions, including his famous Chirurgia Magna. In this several volume collection, Guy de Chauliac records many of his medical observations, including his experience treating the plague. His work influenced medicine for hundreds of years afterward.
After the Black Death, the economy of Western Europe flourished. Many people had died, so there were less people to feed and compete with for business. This led to prosperity for those left alive.
The plague also impacted the established social order. Serfs could now make enough money to support themselves due to a bolstered economy. This, combined with the lack of a labor force due to the plague’s death toll forced many nobles to have to work for themselves. This also contributed to the violence which followed in an attempt by the nobles to forcibly obtain a work force and gain new land.
One final impact the plague had on society and culture was on education. The new economic prosperity after the plague brought more time for education. Both the arts and the sciences prospered. New inventions were created, many of which helped supplement the lacking work force. This time of learning and creativity ultimately resulted in the Renaissance, which brought about many advances in the arts and sciences.
Though the Black Death is long past us, the plague is still relevant today. We have been able to learn much about the plague and have witnessed several new outbreaks.
Today, we know a lot more about the plague. The plague bacteria Y. pestis was originally isolated by Yersin while in Beijing. We have learned that plague is spread by respiratory droplets and direct contact. There are three types of plague, including bubonic, pneumonic, and septicemic.
The plague is not just a foreign disease but is found here in the United States. It was first brought over from China, which led to much anti-Chinese discrimination. It has spread mostly throughout the southwest and regularly infects rodents such as prairie dogs and ground squirrels.
Several control measures have curbed the spread of the plague during modern outbreaks. One control measure is killing rats. During an outbreak in Philadelphia, the health department “went to war” with the rats in the city, employing people to collect rats and kill them. They were able to use the dead rats for dissection, where they were able to find if they were infected with Y. pestis. In addition to catching rats, quarantine was still practiced. Better sanitation also helped contribute to keeping the plague at bay. Finally, the modern use of antibiotics helped effectively treat plague victims.
In very recent memory, Madagascar was hit with an outbreak in 2009 after it resurfaced in the 1990s. There are several factors that affected this recent outbreak. One of those factors was a bad healthcare system. This was supplemented, however, with international help, including the World Health Organization. Widespread poverty also contributed to the outbreak of plague. Crowded cities helped facilitate the spread of plague, just as they did during the 14th century. Finally, traditional burial practices were putting family and friends at risk of infection.
The Black Death during the Middle Ages was the result of many cultural and societal factors coming to a head. In the end, it greatly impacted the course of history. Though this occurred so long ago, the plague is still present with us today. Continued research is needed in order to say ahead of the next plague outbreak.

Help Received: https://www.cdc.gov/quarantine/historyquarantine.html, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3559034/, https://www.britannica.com/biography/Guy-de-Chauliac, https://en.wikipedia.org/wiki/Guy_de_Chauliac, Bubonic Plague History Channel documentary from class, Plague PPT from class, Echoes of Ebola as plague hits Madagascar article, Spellcheck, https://fathertheo.files.wordpress.com/2013/05/black-death-in-tourinai-1349.jpg for image 1, https://www.urofrance.org/sites/default/files/fileadmin/medias/histoire/urologie-france/DE-CHAULIAC-Guy_500x600.jpg for image 2

Disease outbreaks have been in the news quite often over the past several years. There are many factors that have brought about this influx in disease outbreaks, including social and cultural influences. Human response to outbreak has not changed over the years, as evidenced by historical and modern-day examples. With these outbreaks, preparation steps are being taken to stay ‘ahead of the curve’ for the next one.
Emerging, re-emerging, and zoonotic diseases have great significance and relevance, especially today. We are seeing the emergence of several new diseases. With emerging diseases, many do not have treatments or cures. One example of this is the Nipah virus, which currently has no documented vaccine or treatment. These diseases are particularly dangerous due to their newness, which catches many healthcare workers off guard. There is no real way to prepare for emerging diseases until they strike.
In the same way, re-emerging diseases surprise many in healthcare and the general populace. These diseases include many that people though were endemic to limited areas or almost eradicated. An example of this is the recent outbreak of Measles in Washington state. This disease was on the downward trend, but relatively recent pushback against vaccines has made us susceptible to measles, once again.
Emerging and re-emerging diseases are not mutually exclusive, though. They are both influenced by a few, overarching factors. One is globalization. The increasing connectedness around the world today, from global travel, trade, and business is unprecedented. But, it comes with a price. Disease thrives on human interaction, which is what makes our global connectedness so dangerous. In addition, the huge global population lends itself to disease outbreaks. Diseases spread more easily with more people to infect and high population densities. These are just two factors that link the significance of emerging and re-emerging diseases today.

These diseases may include zoonotic diseases, which has been increasingly significant in the recent past. Interaction with animals is a daily occurrence in today’s society, especially in developing countries. Zoonotic diseases have come to the forefront of society more recently with outbreaks of influenza, Nipah, and Ebola. The Ebola outbreak, beginning in 2014, infected almost 29,000 people and killed over 11,000. These are confirmed cases and deaths by the CDC, but there are more than likely thousands more undocumented. With some of these zoonotic diseases, we do not have a cure. As an example, the CDC reported treatment for the Nipah virus is “supportive care.” Zoonotic diseases have become an important topic in healthcare.

In many cases, outbreaks in emerging, re-emerging, and zoonotic diseases stem from social and cultural issues. One such issue is eating bush meat. This practice exposes people to zoonotic diseases that are not normally found in humans. Even earing fruits and vegetables that we believe to be safe may have come into contact with animal carriers in the journey from field to supermarket. Another large social factor associated with major outbreaks is land development. Humans are increasingly encroaching on the wilderness. This brings us in closer proximity to potential zoonotic disease vectors or hosts that would have, otherwise, been left undisturbed. Land development has been linked to the recent emergence of some diseases. Social and cultural factors play into the significance of disease outbreaks.
When an outbreak does occur, people react in similar ways as they have done in the past. At first, people are not worried about getting the disease. It could not happen to them, right? That was the sentiment at the outset of the Spanish Influenza epidemic of 1918 and 1919. When an outbreak does start to affect us, we try to do anything we can to prevent it in ourselves, even if our ‘solutions’ do not work. During the Spanish Influenza epidemic, people began to wear masks and create home remedy medicine, which were ineffective. However, it helped people feel like they were contributing to ending the outbreak. Today, more information is available to the layperson to help diagnose and treat diseases. With that said, there is a lot of false information out there. This scares people. In an age of ‘fake news,’ people do not know who to believe. This leads to many misconceptions about outbreaks. For example, in class we discussed the possibility of a professor coming in contact with an Ebola patient and then coming to class. As long as the professor is not actively showing symptoms and contaminating the class with body fluids, there is no threat. Yet, probably every student in the class would be concerned about contracting Ebola. All of these human reactions to outbreaks are not new and will continue to occur.
The question to address now is, are we ready for the next outbreak? There are several measures that have been taken before and that are being taken now to help the world prepare for the next outbreak. In the Spillover video, contact tracers during the Ebola outbreak were able to stop the spread of Ebola. This method has been proven to be effective and could be implemented if there was another outbreak. In addition, there are research teams going around the world looking for incidence of known deadly disease before an outbreak can occur. Researchers are also actively trying to prevent outbreaks through genetic modification. For example, GMO mosquitoes are being released in Brazil to compete for mating with wild-type mosquitos to prevent them from living long enough to reproduce, thus curbing Zika. Finally, research needs to be continued to look for treatments and vaccines, especially for the diseases that currently do not have them. The problem is, that research requires money, and there is no money to be made preparing for a disease that is not currently a major problem.
Disease outbreaks are a very real threat, especially with the emergence of new disease, the re-emergence of old ones, and the increasing incidence of zoonotic diseases. We as people continue to influence the occurrence of outbreaks, but we are preparing for the future. Hopefully, we will be ready.

Help Received:
https://www.cdc.gov/vhf/ebola/history/2014-2016-outbreak/index.html
https://www.cdc.gov/vhf/nipah/treatment/index.html
Killer Viruses ppt
https://imgs.mongabay.com/wp-content/uploads/sites/20/2016/11/10220822/sabah_aerial_3034.jpg for image 1
https://static01.nyt.com/newsgraphics/2014/12/30/ebola-outbreaks/4ddf2d539da9e29a43144ed2f3a485a62bff7f30/animals.jpg
Spellcheck