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I have started the work. I have 2000 words about my topic (SE-Eleonora-Research-Proposal doc) I will add my document Essay

I have started the work. I have 2000 words about my topic (SE-Eleonora-Research-Proposal doc) I will add my document here as well .

I would like you to read carefully all the regulations how this work should looks like. Also, I would like you to read my 2000 words and correct the work and then continue working on it. I need 2000 words more

Iif you have any questions regarding the work just text me.

!!All the articles MUST be PEER REVIEWED

Guidelines and Tips for Writing a Good Academic Essay 1. An academic

Guidelines and Tips for Writing a Good Academic Essay

1. An academic essay should be an argument in defense of some claim. This claim is your thesis. For instance, Plato, Aristotle, and Augustine all see ethical action as a way to resolve the conflict between body and soul, or Socrates believes that one should never consider self-interest as more important than ethical considerations, (and Aristotle would agree/but Aristotle would disagree). Everything in your paper should ultimately contribute to proving the claim of your thesis.

2. A good essay will engage closely with the readings and will also draw on themes and ideas discussed in class. (Your grade will depend to a significant degree on this engagement!)

3. A good way to organize your paper is to begin with an opening paragraph which introduces the topic of your paper and clearly states your thesis. (This is very important: if your audience can’t tell what thesis you are arguing for, they certainly won’t be able to follow your argument.) Then, write several paragraphs which provide evidence in support of your claim. This evidence should include specific references to the text. Finally, conclude by re-affirming the claim that you are trying to defend in light of the evidence you’ve presented.

4. The MOST IMPORTANT QUALITY of a good essay is that it is clear. A good way to test the clarity of your essay is this: ask yourself, would this be understandable to a relatively bright 12-year-old? Keep it as simple as you possibly can without sacrificing the complexity of the ideas you are presenting; don’t use big words when simple words will do. And you should always make sure you are communicating precisely what you want to say.

5. Make sure you don’t skip steps in your argument – even if a point in your argument seems too obvious to mention, it may not be so to the reader, so you need to include it. For instance, don’t say “It’s raining, so it must be cloudy.” Say, “It’s raining. It only rains if it is cloudy. So it must be cloudy.” Another way to put this: imagine your paper is a jumbled up piece of string. You want to pull the string taut so that it will straight and neat (which also tends to make it longer!).

6. Relatedly, academic papers should generally make a narrowly-focused point. Don’t try to be too broad, unless you want to write a book!

7. Grammar, spelling, and punctuation matter. For a formal writing assignment, clarity is of the utmost importance (see #4 above). Therefore, it’s important that your writing be grammatically proficient, and that there be as few spelling errors, typos, etc. as possible, as errors of this sort compromise the clarity of your writing. The Purdue Online Writing Lab is a good resource for help with this stuff: https://owl.english.purdue.edu/owl/section/1/

8. Always cite direct quotes with the author’s last name and page number. This is the form you should use: “The moral law we arrive at through the exercise of our will requires that we treat humanity – in our own person and in others – never only as a means but as an end in itself” (Sandel, 131). Note that the author’s name and page number are inside parentheses and before the period, but outside the quotation marks. Also note that you are including page number, NOT the date of publication. If the quote is longer than 4 lines or so, use a block quote. Then include the bibliographical entry for all works you cite at the end of the paper. (Personally, I prefer that you include the references on the last page of your essay, rather than on a separate page – saves paper. Likewise, a title page is unnecessary. If you don’t have complete bibiographical information just include the author’s name and title of text, along with the location of the source, e.g. “on Blackboard”. In any case, all references MUST be listed.)

9. Your paper should always express your view, and can do so in your voice; but it should always be based on the texts you’ve read and the views of the philosophers you are discussing. In other words, don’t just say what you think; give reasons for what you think.

10. This is incorrect: “In Plato’s Timaeus, he states that…”

This is correct: “In Timaeus, Plato states that…”

The issue is that in the first statement, Timaeus is the subject of the sentence, not Plato. The following ‘he’ in the first statement is therefore mismatched with the subject. In the second statement, Plato is the subject of the sentence.

11. The past tense of ‘lead’ is ‘led,’ not ‘lead.’ 75% of the time people get this wrong. My theory is that the spelling of the past tense is evolving on the model of ‘read’/’read,’ and within a generation or two ‘lead’ as past tense will become institutionalized. But we’re not there yet! (On the other hand, ‘whom’ is already on the way out, so I wouldn’t worry too much about it. But for the record, only use ‘whom’ when referring to an indirect object.)

12. ‘I.e.’ means “that is.” ‘E.g.’ means “for example.” People often confuse these. But now that you’ve gone over this handy list of writing tips, you won’t!

13. Infer can, strictly speaking, be used to mean ‘imply.’ But why do that? It’s ambiguous. I say, use ‘infer’ to mean ‘to derive by reasoning; to surmise’ and imply to mean ‘to suggest without explicitly stating.’ Writers and speakers imply; readers and listeners typically infer.

14. Students often write “in which” when they just mean “which.” Perhaps it’s because “in which” sounds fancier, or more formal, or something? But sometimes “which” is the correct word. This is related to #4 above: don’t try to be fancier than you have to be.

15. Similarly, students often write “ideology” when they mean “theory” or “idea.” Ideology = the set of conscious and unconscious ideas which make up one’s beliefs, goals, expectations, and motivations. Unless you’re sure this is what you mean, you should probably use the word ‘theory’ or ‘idea.’ (E.g., “according to Kant’s theory, ethical action is rule-based,” not “according to Kant’s ideology…”.)

16. Try to avoid vague connectors like “relates to” or “is about.” Be precise about how the ideas in question are connected. For instance, don’t write “Mill’s utilitarianism is about the greatest overall happiness”; write “Mill’s utilitarianism defines ethical action as what produces the greatest overall happiness.”) This will also help you with #4 above.

“Improving Diagnostic Safety” Articles You Must use these two sources for this

I have started the work. I have 2000 words about my topic (SE-Eleonora-Research-Proposal doc) I will add my document Essay Business Assignment Help “Improving Diagnostic Safety” Articles

You Must use these two sources for this paper :

Gunderson, Bilan, V. P., Holleck, J. L., Nickerson, P., Cherry, B. M., Chui, P., Bastian, L. A., Grimshaw, A. A., & Rodwin, B. A. (2020). Prevalence of harmful diagnostic errors in hospitalised adults: a systematic review and meta-analysis. BMJ Quality & Safety, 29(12), 1008–1018. https://doi.org/10.1136/bmjqs-2019-010822

Singh H, Upadhyay DK, Torretti D. Developing Health Care Organizations That Pursue Learning and Exploration of Diagnostic Excellence: An Action Plan. Acad Med. 2020 Aug;95(8):1172-1178. doi: 10.1097/ACM.0000000000003062. PMID: 31688035; PMCID: PMC7402609.

YOU MAY USE OTHER SOURCES TO COMPLETE THE ESSAY, But it cannot be any of these sources below…

Abimanyi-Ochom, J., Bohingamu Mudiyanselage, S., Catchpool, M., Firipis, M., Wanni Arachchige Dona, S., & Watts, J. J. (2019). Strategies to reduce diagnostic errors: a systematic review. BMC medical informatics and decision making, 19(1), 174. https://doi.org/10.1186/s12911-019-0901-1

Singh, Hardeep MD, MPH; Graber, Mark L. MD; Hofer, Timothy P. MD, MSc. Measures to Improve Diagnostic Safety in Clinical Practice. Journal of Patient Safety: December 2019 – Volume 15 – Issue 4 – p 311-316

doi: 10.1097/PTS.0000000000000338. https://journals.lww.com/journalpatientsafety/Fulltext/2019/12000/Measures_to_Improve_Diagnostic_Safety_in_Clinical.15.aspx

Verna, R., Ph.D., M. D., Velazquez, A. B., Ph.D., & Laposata, and M. (2018, November 13). Reducing diagnostic errors worldwide through diagnostic management teams. Annals of Laboratory Medicine. Retrieved September 18, 2022, from https://doi.org/10.3343/alm.2019.39.2.121

Rajkomar A, Dhaliwal G. Improving diagnostic reasoning to improve patient safety. Perm J. 2011 Summer;15(3):68-73. doi: 10.7812/TPP/11-098. PMID: 22058672; PMCID: PMC3200103.

Fernandez Branson C, Williams M, Chan TM, et alImproving diagnostic performance through feedback: the Diagnosis Learning CycleBMJ Quality & Safety 2021;30:1002-1009.

Bergl, Paul A., Wijesekera, Thilan P., Nassery, Najlla and Cosby, Karen S.. “Controversies in diagnosis: contemporary debates in the diagnostic safety literature” Diagnosis, vol. 7, no. 1, 2020, pp. 3-9. https://doi.org/10.1515/dx-2019-0016

Murphy DR, Meyer AN, Sittig DF, et alApplication of electronic trigger tools to identify targets for improving diagnostic safetyBMJ Quality & Safety 2019;28:151-159. https://qualitysafety.bmj.com/content/qhc/28/2/151.full.pdf

Olson, A., Linzer, M., & Schiff, G. D. (2021). Measuring and Improving Diagnostic Safety in Primary Care: Addressing the “Twin” Pandemics of Diagnostic Error and Clinician Burnout. Journal of general internal medicine, 36(5), 1404–1406. https://doi.org/10.1007/s11606-021-06611-0

Liberman AL, Newman-Toker DESymptom-Disease Pair Analysis of Diagnostic Error (SPADE): a conceptual framework and methodological approach for unearthing misdiagnosis-related harms using big dataBMJ Quality & Safety 2018;27:557-566.

http://dx.doi.org/10.1136/bmjqs-2017-007032

Barwise, A., Leppin, A., Dong, Y., Chanyan Huang, D., Pinevich, Y., Herasevich, S., … & Kumbamu, A. (2021). What contributes to diagnostic error or delay? A qualitative exploration across diverse acute care settings in the US. Journal of patient safety, 17(4), 239. doi:10.1097/PTS.0000000000000817

Huang, C., Barwise, A., Soleimani, J., Dong, Y., Svetlana, H., Khan, S. A., … & Pickering, B. W. (2022). Bedside Clinicians’ Perceptions on the Contributing Role of Diagnostic Errors in Acutely Ill Patient Presentation: A Survey of Academic and Community Practice. Journal of patient safety, 18(2), e454-e462.

Katz, D., Blasius, K., Isaak, R., Lipps, J., Kushelev, M., Goldberg, A., … & DeMaria, S. (2019). Exposure to incivility hinders clinical performance in a simulated operative crisis. BMJ quality & safety, 28(9), 750-757. http://dx.doi.org/10.1136/bmjqs-2019-009598

Al-Khafaji J, Townshend RF, Townsend W, et alChecklists to reduce diagnostic error: a systematic review of the literature using a human factors frameworkBMJ Open 2022;12:e058219. doi: 10.1136/bmjopen-2021-058219

Rodziewicz, T. L., Houseman, B., & Hipskind, J. E. (2022, May 1). Medical error reduction and prevention – statpearls – NCBI bookshelf. National Library of Medicine. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK499956/

Singh, H., Mushtaq, U., Marinez, A., Shahid, U., Huebner, J., McGaffigan, P., & Upadhyay, D. K. (2022, August 11). Developing the SAFER DX checklist of ten safety recommendations for health care organizations to address diagnostic errors. The Joint Commission Journal on Quality and Patient Safety. Retrieved from https://doi.org/10.1016/j.jcjq.2022.08.003

Zwaan, L., El-Kareh, R., Meyer, A., Hooftman, J., & Singh, H. (2021). Advancing Diagnostic Safety Research: Results of a Systematic Research Priority Setting Exercise. Journal of General Internal Medicine, 36(10), 2943–2951. https://doi.org/10.1007/s11606-020-06428-3

Assignment 3 : Controlling Cost for Nursing Practice (18 points) For this

Assignment 3 : Controlling Cost for Nursing Practice (18 points)

For this assignment, students will discuss fiscal planning and cost containment financial factors that pertain to today’s professional nursing roles in leadership.

Assignment Criteria:

Develop a scholarly paper that addresses the following criteria:

Discuss the budgetary process

Types of budgets

Budgeting measures

Discuss health-care reimbursement

Medicare and Medicaid

Prospective payment systems

Managed care

Include cost containment and the role of the nurse

Balancing cost and quality of care

Discuss Health-Care Reform and the Affordable Care Act

Bundled payments

Hospital Value-Based Purchasing

Health Insurance Marketplaces

The scholarly paper should

4 to 6 pages, excluding the title and reference page.

Include an introductory paragraph, purpose statement, and a conclusion.

Include level 1 and 2 headings to organize the paper.

Write the paper in third person, not first person (meaning do not use ‘we’ or ‘I’) and in a scholarly manner. To clarify: I, we, you, me, our is not used. In addition, describing yourself as the researcher or the author should not be used.

Include a minimum of three (2) peer-reviewed scholarly journal references to support the paper (review in Ulrich Periodical Directory) and be less than five (5) years old.

APA format is required (attention to spelling/grammar, a title page, a reference page, and in-text citations).

Submit the assignment to Turnitin prior to the final submission, review the originality report, and make any needed changes

Assignment 3 : Controlling Cost for Nursing Practice (20 points)

Assignment Criteria

5 points

3 points

1 point

0 points

All topics/criteria addressed, and all questions fully answered.

All topics/criteria addressed, and most questions fully answered.

All topics/criteria addressed, and most questions partially answered.

One or more topics/criteria not addressed or completely answered.

Quality/Accuracy of Information

4 points

3 points

1 point

0 point

Information clearly relates to the main topic/criteria. It includes several supporting details and/or examples.

Information clearly relates to the main topic/criteria. It provides supporting details and/or examples.

Information clearly relates to the main topic/criteria. A few details and/or examples are given.

Information has little or nothing to do with the main topic/criteria.

Organization

5 points

3 points

1 point

0 point

Information is very organized with well-constructed paragraphs and levels of heading.

Information organized with well-constructed paragraphs and levels of heading.

There is an attempt at organization, but errors exist. No levels of heading.

The information or overall structure appears disorganized.

Sources

4 points

3 points

1 point

0 point

All references are from a relevant professional peer-reviewed scholarly journal, within a 5-year timeframe, or a classic/ historical source.

Most references are from a relevant professional peer-reviewed scholarly journal, within a 5-year timeframe or a classic/historical source.

Some references are from non-peer-reviewed scholarly sources or older than 5 years.

Most references are from non-peer-reviewed scholarly sources or older than 5 years.

Earned Points

Up to 10% of the assigned points (total points of assignment) can be deducted from the earned points for errors in APA style [title page, introduction, purpose statement, level heading, conclusion, references, citations, and format], spelling, and/or grammar.

Final Total

AMMED sources Source 1 Imada’s book, An Archive of Skin, an Archive

AMMED sources

Source 1

Imada’s book, An Archive of Skin, an Archive of Kin, puts forth a fundamental concern that all of us should be weary of, that is, the loss of civil liberities, and weather it’s morally right for extreme goverment intervention, i.e., forced seperation and confinement of citizens, as it pertains to a declared a major “health emergency.” In essence, Imada’s book is as much about how we contextualize people as being “dangerously” disable, those who have been deemed, for instance, as possessing the potential of horribly infecting the “normal,” and in this case, with the dreaded, disfiguring disease of leprosy (Hansen’s Disease), and the raw power of the government to curtail it.  Imada’s book not only does that effectively through her archival trove of photographs thorughout the text, but cautions a bit scary storyline if we really think about it, of the immense and unbridled power of  bureaucratic insitutions, especially with our own health decisions, in our lives.

She narrates the suspension of civil liberties, the loss of agency, of the “free people” of Hawai’i who had been designated by, from what I took as an being somewhat Orwellian, health committees to decide, almost in a Roman emperor’s decision of a “thumbs up or down,” as to who could continue their lives unabated and those who would be removed from home, from their friends, from their children and spouces…forever. To be given the latter judgment meant, in short, a death sentense, as Imada suggests. Removed from one of the other islands in the Hawaiian archipelago to a leper colony on Moloka’i, Imada refers to this “treatment facility” as a carceral comunity. These patients/inmates, ostensibly under the banner of treatment, were actually, involuntarily, put there as containment by the government. Racial undertones come to mind in this arrangment. As the majority of patients/inmates were Hawaiian, with the few exception of whites who were sent to the facility, their accomodations were separate, and the whites somewhat better. However, Hawaiians had seen racial injustices before, as their Kingdom had been overthrowed by the United States, being, as Imada remarked, “Illegally annexed.” (71) In another example of the racial inequalities suffered by Hawaiians were the  white ethnographers/doctors who took the pictures that Imada used in the book. Hawaiian women were photographically captured in various shades of nudity, while white women patients/inmates were more modestly framed. The pictures of the Hawaiians were eroticized, appealing to a perverse gawking by not only medical personnel but curious on-lookers who had a salacious appetite for the disable that leprosy had caused, e.g., acrotomophillia. Imada points out that historian  Andrew Zimmerman referred this as the “skin trade.” (46)

One bright spot, even though going to Moloka’i was a “death sentense,”  as Imada points out, was the wonderful self-sacrificing care given to the sick by indiviudals  known as the Kokua (123)  Building relationships of a sense of family with other lepers, these transplated Hawaiians tried to normalize a social sturcure that bridged the gap that having left their former lives created…this was the second part, and perhaps the more important of Imada’s book title, An Archive of Kin was created. She detailed the importance of these social networks in the daily lives of the sick, and the tragic temporality, since many of the sick would only live a very few years. In the latter chapters of her book, she attempts to share this sense of social isolation, as being a type of  social “otherness,”that the patients/inmates experienced, as even time itself was reconfigured,  resulting in “crip time” (161), framing her point through an intellectually interesting framework, “queer theory” (175). 

Source 2

This week’s reading, An Archive of Skin, an Archive of Kin, by Adria Imada, constructs a history of leprosy that allow a “person=first” view with the disability second. Much as Kim Nielson promotes in her “Historical Thinking and Disability, Imada tries to bring a focus that had been lost when society looked only at leprosy as a disease, not a disability (page 20). People with leprosy were treated as no other group with a disability before or since. Victims were gawked at and shamed wherever they went.

            Even though it was very costly at the time, each person suspected of having the disease was photographed. Then the Board of Health maintained a record of the severity of the patient. Furthermore,, the Board had the power to take persons deemed as having the disease and have them placed in “custody” much like prisoners (pages 74-75). At one time it was even shameful to admit being related to residents of Molokai (where people were exiled if discovered to have leprosy) (page 225). By Imada’s choice to build a chronicle using photographs and stories related to the social and historical factors of incarceration of these people, she gives a voice that seemed to have been stripped away by the criminalization of the disease.

            Our readings continue to connect the social and political factors of the time to reactions to disability and/or disease In “Bellevue,” yellow fever was blamed on race, class, gender, and status, causing the medical community to miss the actual source, Society blamed excessive alcohol use for Irish ill health. In “Archive of Skin,” society (and the medical professionals) saw Hawaiian women in particular as sources of infection for leprosy. An example was the laundress, who not only handled laundry with pus, blood, and germs but often had many sexual contacts (pages 129-133). The idea that sexual contact helped spread leprosy led to an attempt to the separation of the sexes. Yet, patients managed to slip out and meet lovers.

            As I finished reading “Archive of Skin,” as a mother I cannot help but focus on the epilogue. My heart aches for the families who were forced to give up their children, mothers who were never allowed to even touch babies, and couples who never had children at the settlement.. This theme was touched on throughout the book. As a result of the Progressive era, eugenic ideas were a factor in the committee set up to investigate conditions in the groups of people with leprosy. This committee recommended sex segregation and sterilization of parents. The author claims some patients admitted they were urged for the latter (pages 146-147). When babies were born, if they were healthy—and most were—they were put up for adoption.

            Also in the epilogue, the story of Ka’ohulani helping relatives search for graves was a refreshing addition to the history. The metaphoric birthing of the monk seal was hope for the future of the settlement, allowing growth in a dying population. I enjoyed learning the history of leprosy from this perspective.

Source 3.

This book reiterates the previously discussed themes of racism and imperialism in the history of medicine. Early in chapter one, we learn that the doctors studying the Hawaiian people were not interested in “whether Hawaiians were going to die, only how and why they would” (Imada 2022, 43). Since the Hawaiian people were “natural people” and not “cultural people,” their well-being mattered sufficiently less to doctors, and Arning conducted inoculation experiments on the Hawaiian lepers. He combined his research on leprosy with his “cultural” research, thus joining their disease to their race and further cementing what he believed to be their racial inferiority. 

This trend was passed on after Arning left Hawai’i, and as Imada points out, they were the foundations of racialized and segregated biomedicine. Photography was used not as a tool for diagnosing leprosy, but as a means of “biopolitical profiling” (Imada 2022, 78). This perpetuated the image of Native Hawaiians as the primary contractors of leprosy, despite “Chinese leprosy” being the official name in Hawai’i.

Patients at the Kalihi Hospital and Detention Station were treated like inmates and unable to go freely, and after they were photographed and cataloged, the Board of Health sent them to Molokai to live permanently. Their captors (be it the Europeans or the United States) stole the liberty of these Hawaiians because of their illnesses and disregarded their well being in these facilities because of their perceived racial/cultural inferiority. (Imada 2022, 75). These facilities also believed they were “civilizing” their patients., As seen with the “Part Hawaiian, Age 13” girl, they emphasized her improvements with treatment, despite the evident nodules on her face in the third photograph. The only significant difference was her clothing and appearance; her garments changed from traditional Hawaiian to modern European (Imada 2022, 94).

However, their clothing also gives us more insight into how the lepers were cared for. Western doctors who exiled these patients did not treat their open wounds or provide any care, and it was usually family members or close friends who helped them with bandages or their clothes. Missionaries came to assist as well, and while they were depicted as selfless appendages of God, the Native family members were considered pests and unwanted additions (Imada 2022, 123). Popular images of “the white man’s burden” come to mind, especially since the patients literally had no soap and were literally filthy in the eyes of wealthy white men and their missionaries.

For most of the exiled patients, the few family members that tagged along were all they had left. For others, the main source of kinship they developed with other patients was for the sake of survival. These patients had been stripped from their homes, and establishing close relationships with one another was all they had. In a way, it was a sort of rebellion. To experience connections with other human beings while society painted you as a sort of monster was no easy feat, but these patients did so and have now had their stories immortalized

AM med week 6 sources 1 Pox: An American History has been

AM med week 6 sources

1

Pox: An American History has been the most difficult read so far. While historian Michael Willrich made a well-researched case of smallpox to give a microcosm of Progressive Era political thinking in America, I felt overwhelmed by the inclusion of so much history. Even though the story of Bellevue traveled through 300 years, it seemed to flow much better. Nevertheless, I gained knowledge of a well-balanced history of smallpox, with reciprocal thought given to differing viewpoints on supporting the requirements of vaccines and empathizing with refusers. Willrich focused on the struggle between institutional powers (mainly state) and individual rights (civil liberty). He pointed out the many factors which led to social change.

            I didn’t have to read far to see a familiar theme: racism. In “Virgin Soils Revisited,” Jones cited theories again the American Indians, claiming they were a weak race. Likewise, many people in 1898—doctors included—maintained smallpox was a disease that affected only blacks. They even went so far as to call it “Nigger Itch” (page 16). Later, medical authorities broadened this to include poor people of all races, considering it a “filth disease” (page 26). The fact was that many of the victims were black or poor, only because they often lived in crowded conditions. As with former readings where we found a lack of understanding of germ therapy and bacteria, the closeness to the ill spread the disease.

            Because a vaccine existed for the variola (the virus causing pox), many in the medical field felt it should be mandated by the state. Yet there were those who disagreed. Although the vaccine was effective, there were plenty of risks. With the emergence of mostly the “mild” form of smallpox, the vaccine seemed more dangerous than the actual disease. After receiving the vaccine, one would develop a fever, pain, and sickness—or even death—causing wage earners to miss work, often for several weeks (pages 87-88). The fear of the vaccine and the concern for civil liberty caused many refusers. The measures that enforcers went to ensure compliance with mandated vaccination were astounding. For example, when the health officials tried to enforce the order to vaccinate in the Over the Rhine section in Middlesboro, Kentucky, the resisters were handcuffed and “vaccinated at gunpoint” (page 58). The use of some bad batches of “dry point” vaccines in 1898 and 1899 made matters worse. Rumors of resulting amputations, and even death, caused fear to spread (page 111). Resistance claimed legal mandates were plainly an installation of state power. Associating antivaccinationism with abolitionism, Fredrick Douglas claimed forced vaccination offended his “logical faculty” (page 253).

            After I finished reading the book, I explored a few web pages about the author. I was not surprised that Michael Willrich specializes in social and legal history, urban history, and the Progressive Era (Radcliff.harvard.edu). His passion is clear, especially in his chapter “Speaking Law to Power.” In fact, most of the chapter recounts the story of Jacobson Vs. Massachusetts, which the author claimed is the epidemic’s “most important legacy.” Pastor Henning Jacobson was informed by Dr. Edwin Spencer of the Cambridge, Massachusetts Board of Health that he and his family must submit to the vaccination law or be fined. After being summoned to court and appealed all the way to the Supreme Court, the Board of Health’s authority was upheld. Although Jacobson finally admitted defeat and paid the fine, he had no idea the impact this would have on the history of civil liberties

2

wo things stood out to me in this week’s readings, so I am going to try to touch on them both. The first thing that I noticed was how often public opinion opposed doctors and government officials when it came to vaccinations. I think that for the majority of Americans, that fear stemmed from the century of uncertainty and experimentation they had just witnessed. Medicine was still evolving, and for a generation that had seen medicine rapidly evolve before their eyes, uneasiness was to be expected. After all, vaccinations had only become widespread in the United States since the 1850s, and most of the laws requiring vaccinations were targeted towards children entering public schools (Willrich 2011, 38). Forcing people into vaccinations seemed like a smart option, as it dramatically reduced the number of smallpox cases and deaths; it worked well in Europe, especially Germany, and American health officials saw it as an opportunity to save lives. But vaccinations were hardly an exact science at this point, and they carried an abundance of risks, especially if a person had a suppressed immune system or the vaccine was tainted (Willrich 2011, 193).

Beyond that, Americans prided themselves with personal liberty, and they were not going to easily give that up. Especially not since doctors disagreed on the effectiveness and safety of vaccines, creating discord that fueled arguments on both sides of the spectrum. Religion, which had guided medical practice for centuries, was still being used to explain smallpox by some doctors (Willrich 2011, 18), and others were turning away from religion and trying to base their practices solely on the known science of the time. The disagreement among doctors hindered the case for vaccinations, as people who feared vaccines could back their claims with medical advice. 

The other thing I noticed relates directly to bodily autonomy and race in healthcare. We already established that the healthcare system in the first half of the 19th century advanced itself through experimentation on enslaved people. That became a trend even after the abolition of slavery, and Black people were experimented on in healthcare time and time again. These vaccinations were no different. Poor white people and African Americans were the most likely to contract smallpox (both because vaccination and healthcare were hardly accessible to them) and they were always blamed for outbreaks (Willrich 2011, 41-43). Because they were blamed for outbreaks, they were targeted during the night raids. Willrich explains that one month in New York more than 4,500 homeless people were vaccinated during health department raids and Italian immigrant neighborhoods were watched in case an outbreak started (Willrich 2011, 212-213). Forced smallpox vaccinations were racist and classist in nature, as they impacted Black people and poor immigrants more than anyone. While everyone was compelled to get the vaccine, only certain groups were coerced. Employers could dismiss any employee who refused vaccination, and children were forced to get vaccinations before they were permitted into schools. Still, arguments sprang up from parents that the government was taking their rights to protect their family’s wellbeing, and workers protested that they could not afford the illness a vaccine might bring. (Willrich 2011, 230-232). The government, and the private sector, disregarded these arguments and required vaccines anyway. These measures stripped people of their bodily autonomy and put general welfare over personal liberty. Since these matters affected people who sent their kids to public school or could not afford to lose their job, the forced vaccinations affected poorer populations more than the people who enacted the laws.

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Michael Willrich’s Pox provided an interesting look at smallpox epidemics that wreaked havoc in American cities around 1900. At the center of the book is an analysis of how Americans responded to state efforts to vaccinate whole communities and forced quarantines. I could not help but to think of the types of conversations I have heard over the last three years regarding COVID vaccines while reading this book. What I learned is that the efforts to control the spread of COVID was not nearly as forced as these smallpox outbreaks. Anyone who claimed that Americans have been under unprecedented tyranny lately could benefit from reading this book. Willrich tells of towns completely shut down by armed guards to attempt to control the spread of the disease. 

A theme that was threaded throughout all of Pox was the connection made between the spread of disease and people of color. Oftentimes, without any concrete evidence, towns determined that smallpox must have been brought by black travelers or workers. In many cases it was true that smallpox spread through African American populations within cities, and some believed that had to do with people of color’s “slight regard for cleanliness” (26). What actually caused the unchecked spread of this disease in black populations was a tendency for officials to ignore it if it was not reaching white neighborhoods and communities. The Atlanta Constitution assured its readers that “There is no danger of a spread of the disease among the white people” (66). Complicating the lack of attention towards black communities, many African-Americans opposed vaccination. After a long history of black bodies being abused and used without consent, many blacks had come to fear white medicine. African-American opposition to forced vaccination had its roots in the abolition movement, likening the loss of agency over one’s body to the tyranny by which the enslaved lived under (254). One of the more disturbing tales in the book recounted how African-Americans in Middlesboro, Kentucky were vaccinated at gunpoint. Yet, in instances where whites refused vaccination, authorities thought it wiser not to push the issue (92). The double standards and neglect of black bodies points to a broader historical trend that dates back many centuries in America. As we read in Deirdre Cooper Owens chapter a few weeks back, black body autonomy was often not respected. 

The chapter on the antivaccinationists was intriguing. Again, as our nation has been experiencing a vocal anti vaccination movement in the past few years, many of the arguments of old are heard today. The most genuine of all arguments against the smallpox vaccine was not against vaccination itself, but instead compulsory vaccination. Legitimate concerns over personal liberty and bodily choice were brought up (253). Parents did not appreciate governing bodies determining what goes into their children’s bodies. Considering today’s anti vaccination movement, new challenges exist that muddy the waters over what is fact versus fiction regarding vaccines. Specifically, social media has created a platform for disinformation that can spread quickly and reach many viewers. Although these types of claims do not sound serious, it is alarming how many people seem to believe some of even the most absurd claims. Absurdities can not be ignored when they actually affect people’s actions. It is hard to brush aside claims such as “the vaccine connects your body to the 5G network”, or “the vaccine changes your DNA” when people actually cite these as reasons that they hesitate to receive a vaccine. I have had students tell me with seriousness that I will die soon because I am vaccinated. 

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The fact that Willrich chose to focus on the smallpox epidemics in the United States around the turn of the 20th century throws insight into the restricted and xenophobic posture taken by medical authorities in elder America. The focus that Willrich places on the smallpox epidemics reveal, among other things, how marginalized individuals, such as newly arrived immigrants and the socially vulnerable, were excluded from society. Willrich identifies the economically disadvantaged as another marginalized group and people of color. The essay written by Willrich gives insight into the more extensive history of medicine. It serves as an example of how prejudice and discrimination are ever-present in the delivery of medical care. For example, when it came to transmission diseases like smallpox and typhoid, Willrich points out that class was a distinguishing element that divided persons who had these diseases from those who did not. Willrich devotes a significant portion of his work to illuminate the unusual dynamics, historical oddities, and unjust medical practices in early America. The emphasis that Willrich places on the legal, social, and political background provides more context to the already contextualized immediacy of establishments’ power over peripheral populations.

Willrich has done excellent historical work in his text/book. He asserts that during the Progressive Era, when medical professionals began to take on a more aggressive and authoritarian role in the management of people’s health as well as the health of society as a whole, there was a discernible shift in the path that the public health issue was headed in. Additionally, the reader will understand how immunizations were administered on an opt-in basis in the past to prevent the spread of infectious diseases. His commentary on local history within the larger themes of the book, for example, is specific to places like Kentucky (Middlesboro), as well as Lincoln County, in the state of Nebraska. In addition, Willrich illustrates how helpless and vulnerable the people subjected to discrimination were. They included the disadvantaged, whom he portrays as powerless in the narrative. Willrich further shows these outlier groups’ societal inequities by demonstrating that they lacked genuine political clout. This is another way in which Willrich brings attention to the issue. In addition, this book successfully illustrates how the law was used as a resource and instrument to deny oppressed people necessary medical care and to treat them unfairly.

The topic of Willrich’s response fits in well with the overall thrust of the assignment. His response is another piece of evidence supporting the conclusion I’ve drawn for the entirety of this period. Willrich (13) analyzes the misuse of authority to bring others into disrepute. The state’s bureaucracy is discussed in connection to how it dealt with a “medical emergency” in “minority groups.” Willrich highlights how the government was not devoted to eliminating diseases that harmed those with lower socioeconomic status. This interpretation by Willrich is consistent with what I have learned about the topic thus far in the class: the government at the time wanted to enact laws under the pretext of attempting to contain infectious diseases. These measurements, on the other hand, contained a latent bias based on racial and socioeconomic factors. Willrich, for example, brings up the topic of the forced vaccination of Puerto Ricans assisted by the military. This action was compelled by General Order No. 7, an order issued by the military. Willrich demonstrates that even the terminology used to describe the dreaded smallpox illness makes it impossible to differentiate the illness from a purely medical setting to a social one. Again, this is something that I learned in class. Willrich argues that this distinction is difficult to make. In general, the essay written by Willrich can be viewed as an illustration of the racial and ethnic discrimination that existed in the early medical practices of the United States.