Tuberculosis or TB is a chronic or acute infection caused by a bacterium called Mycobacterium tuberculosis. Affecting the lungs, kidneys, bones, lymph nodes, and the brain, this deadly bacterial infection is spread from one person to another through the air (Tuberculosis PPT, slide 3). Due to the easily transmissible nature of TB, the disease reached epidemic proportions during the 18th and 19th century (slide 35). In fact, various factors during this time period increased the susceptibility of TB, including immigration, malnutrition, crowding, and poverty (Artifact 7 handout). The high population density and the poor sanitary conditions characterized in most cities created the most fitting environment for its propagation (slide 35). In the 19th century, immigration soared in the United States. Immigrants took up residence in crowded tenements in the hub of Philadelphia, NYC, and Boston, aiding in the expansion of TB. In addition, immigrants worked under dire working conditions and resided in poorly constructed, badly ventilated and filthy tenements (slide 49).

Though malnutrition, poverty, social stigma are still prevalent factors in the susceptibility of TB, various contemporary problems, like the role of HIV, have been introduced (Artifact 7 handout). However, today, we face a bigger problem with TB becoming more resistant to drugs and treatment (slide 92). Treating TB is a time-oriented task. It is critical for those with TB to strictly adhere to a schedule of taking multiple drugs (slide 94). Currently, there are 10 drugs approved by the FDA (INH, RIF, EMB, and PZA) that active TB patients can take during the 6-9-month treatment process (slide 91). However, poor adherence to treatment will put you at risk of becoming resistant to those drugs. Inconsistency may result in delayed resolution or worsening of symptoms, transmissibility of resistant strains, increase in treatment costs, and an overall increase in the probability of death (slide 94).

There has been substantial progress in the number of patients diagnosed and treated, however, TB still remains a global public health emergency. It is responsible for more deaths than any other infectious disease (Reid, 2019, pg. 1). There has been slow progress of TB since 1993 as a result of various political, societal, scientific, and strategic shortcomings (pg. 6). To name several, there have been insufficient investments and political will due to the decline of TB in high income countries, failure to target resources at hot sports and high-risk populations and so much more (pg. 6-7). The adverse effects of TB extend well beyond one individual. Thus, it is crucial to implement quality improvement, assessing effective strategies, prioritize high risk active groups, etc. (pg. 15-17).

Help Received: Tuberculosis PPT, Supplementary readings – Building a TB free world Lancet Commission, Artifact 7 handout, Cadet Jones (structure and organization of information), Dictionary/Thesaurus

Part 1:

Between 1700 and 1840, there was an immense growth in the Irish population. Due to devolving economic relationships between Ireland and England, half of the Irish population were highly dependent on potatoes for substance (PPT: Potato blight and famine, slide 2). Potatoes are high yield crops that can be produced with little labor investment. Additionally, they hold substantial nutritional value and can be used in a multitude of ways (appetizer, dinner, and dessert), making it a staple food item in the Irish diet (PPT slide 3).

However, from 1845 to 1852, the Irish potato production was ravaged by blight (PPT slide 4). Accounting for a loss of 1/3 to ½ of all acreages in 1845, and ¾ of all potato crops in 1846, the potato blight resulted in mass starvation and disease. Considering 2/5 of the population were solely reliant on potato production, many experienced famine-induced ailments such as measles, diarrhea, TB and more. As a result, the famine wiped out 20-25% of Ireland’s population (PPT slides 4-5).

The potato blight, or phytophthora infestans, is a strain of P. infestans HERB-1 (PPT slides 26 and 31). The pathogen originated in Mexico, then migrated to North America and Europe (PPT slide 32). Doubt and panic prompted mass immigration (traditional route was the United States), which had profound social and political impacts (Sherman, pg. 30). First, Irish-Americans dominated key positions in railroading, mining, civil engineering, law enforcement, and politics. Second, there was an immense population of poor, unskilled Irish immigrants crowding the cities. Third, their social activism and unionization changed political party platforms (Sherman, pg 30-31).

Part 2:

Today, we are introduced to various threats. For example, climate changes increase risk to crop production through droughts and pests. With genome-editing technologies such as CRISPR, we show promise in addressing these challenges (Scheben and Edwards, pg. 1122). Our ability to modify genes of plants, animals, and so forth have brought out many benefits. For example, a benefit could be to boost crop production for the growing population. However, for every benefit, there is always a disadvantage. As of right now, the growth of genome-edited crops faces many sociopolitical challenges (i.e. government regulation, public acceptance, etc.) (Scheben and Edwards, pg. 1123). Though a scientific breakthrough, genome-editing may create harm, if used improperly (Jones).

Help Received: PPT: Potato blight and famine, Supplementary readings – Irish potato blight (Sherman), Genetically modified crops – Science article (Scheben and Edwards), Cadet Jones (structure and organization of information), Dictionary/Thesaurus

With no respect for social class, occupation, or age, smallpox killed and disfigured kings and queens, children and adults, rich and poor alike (Artifact 4 sheet). Similar to the plague, smallpox was indiscriminate, unforgiving, and ruthless. Intertwined with the war, exploitation, and migration, smallpox changed the course of world history; without it, outcomes of the world would have been unrecognizable. The disease affected the course of British, European, and American history, effecting immunologically virgin communities, trade, and battles (Artifact 4 sheet).

As Spanish conquerors invaded the New World in the 1500s, smallpox aided in the subjugation of the Amerindians. Unknown to the natives, exposure to this disease was deadly. And With no immunity towards it, smallpox drastically weakened the once powerful force; contributing to the settlement of North America (slides 15-16). The lost in accordance to the disease, sparked the need for a larger labor force, instigating the enslavement of West Africans who were regarded as ‘immune’ to the disease (slide 17).

In the early 1760s, smallpox was used as biological warfare. In hopes spreading the disease, the British gave gifts from smallpox infirmaries to nearby native tribes (slide 18). This caused prominent health issues during and after the Revolutionary war (slide 94), which hindered the Americans’ ability to conquer lands. As problems ensued because of bio-warfare, George Washington recommended inoculation for preventive measures (slides 95-96). Such procedures (and other various remedies) were conducted until the introduction of the smallpox vaccine in 1796, that inoculated a person with cowpox to gain immunity towards smallpox.

By striking at various important points in history, smallpox indisputably wreaked havoc for centuries. Tales of its horror have been documented in multiple countries and languages. Clearly insinuating the drastic effects, it had on our world. Though heartbreaking, without smallpox, or other diseases/viruses, our world would be drastically different. We would not be as aware or knowledgeable in this field and would not have developed our preventive measures.

Help Received: PPT (Smallpox – The Speckled Monster), Smallpox Documentary (Is Smallpox Still a Threat?), Cadet Jones (structure and organization of information), Dictionary/Thesaurus

There are numerous ethical issues associated with infectious diseases; including vaccines, isolation/quarantine, bias, experimental studies etc. (Artifact 5 sheet). Today, there have been frequent debates on the use of vaccines due to possible (negative) risks. Complications related to vaccines continue to instill fear among people, though immunization is still regarded as the most effective preventive measure for diseases. With that being said, vaccination is a choice; you cannot coerce another person in to getting vaccinated. Similar to the fact that no one can force you to participate in an experimental study (Jones).

The Tuskegee Syphilis Study highlighted many ethical concerns such as medical misconduct and an indifference towards human rights. The primary targets of the experiment were poor, African American sharecroppers (“expendables”), deceived by the promise of care (The Deadly Deception). Underestimation of those infected with syphilis, diverged the original focus of the study from a treatment plan to the research and collection of data on untreated syphilis. Unknowingly, individuals who were once patients were converted in to research subjects (The Deadly Deception).

At the time, there were no regulations or protective measures to ensure full disclosure or protection from unnecessary risks. Many subjects of human experimentation were primarily individuals who were medically and socially disadvantaged (had to comply to their owners) (The Deadly Deception). Unconcerned by their welfare, many participants were deceived in to partaking in ‘treatments,’ without ever being informed of the true nature of their illness, or the dangers they faced. Thus, gambling the lives of hundreds of men (The Deadly Deception).

This influenced the making of The Belmont Report; specific ethical principles and guidelines for research involving human subjects. The Belmont Report formed three basic principles: respect for persons (acknowledge autonomy and protect those with diminished autonomy), beneficence (maximization of possible benefits and minimal possible harms), and justice (equal treatment). acknowledge autonomy and protect those with diminished autonomy). They applied the general principles by requiring, informed consent, conducting proper risk/benefit assessments, and use fair procedures in the selection of research subjects (The Belmont Report).

Despite this, it does not excuse the methods that were taken place. The ideals and methods of this experiment were incredibly flawed and unjust. Instead of furthering ‘science,’ it created an ambivalence towards scientific research and an extreme distrust towards those in medical professions (within the African-American community) (The Deadly Deception).

Help Received: The Deadly Deception: Tuskegee Syphilis Experiment video (YouTube), Artifact sheet, The Belmont Report (HHH.gov), Cadet Jones (structure and organization of information), Dictionary/Thesaurus