The nineteenth-century invention of smallpox vaccination in Great Britain has been well studied for its significance in the history of medicine as well as the ways in which it exposes Victorian anxieties regarding British nationalism, rural and urban class struggles, the behaviors of women, and animal contamination. Yet inoculation against smallpox by variolation, vaccination’s predecessor and a well-established Chinese medical technique that was spread from east to west to Great Britain, remains largely understudied in modern scholarly literature. In the early 1700s, Lady Mary Wortley Montagu, credited with bringing smallpox variolation to Great Britain, wrote first about the practice in the Turkish city of Adrianople and describes variolation as a “useful invention,” yet laments that, unlike the Turkish women who variolate only those in their “small neighborhoods,” British doctors would be able to “destroy this [disease] swiftly” worldwide should they adopt variolation. Examined through the lens of Edward Said’s Orientalism, techno-Orientalism, and medical Orientalism and contextualized by a comparison to British attitudes toward nineteenth century vaccination, eighteenth century smallpox variolation’s introduction to Britain from the non-British “Orient” represents an instance of reversed Orientalism, in which a technologically deficient British “Occident” must “Orientalize” itself to import the superior medical technology of variolation into Britain. In a scramble to retain technological superiority over the Chinese Orient, Britain manufactures a sense of total difference between an imagined British version of variolation and a real, non-British version of variolation. This imagination of total difference is maintained through characterizations of the non-British variolation as ancient, unsafe, and practiced by illegitimate practitioners, while the imagined British variolation is characterized as safe, heroic, and practiced by legitimate British medical doctors. The Occident’s instance of medical technological inferiority brought about by the importation of variolation from the Orient, which I propose represents an eighteenth-century instance of what I call medical techno-Orientalism, represents an expression of British anxiety over a medical technologically superior Orient—anxieties which express themselves as retaliatory attacks on the Orient and variolation as it is practiced in the Orient—and as an expression of British desire to maintain medical technological superiority over the Orient.

The social determinants of health (SDOH) represent factors that impact the health and effectiveness/compliance of a treatment plan for a patient. The SDOH include such factors as economic stability, education, home and community context, access to healthcare, neighborhood and built environment, and personal behavior. The purpose of this study is to determine the extent of collection and integration of SDOH into clinical practice, and the usefulness of this information in medical decision making. Following a thorough literature review, an online survey was deployed to physicians and administrators around the country, with the aim of answering the following questions: 1) Do provider practices collect information on a patient's social determinants of health? 2) If yes, how is that information being used, if at all? 3) If not, what is preventing them from doing so? 4) Do the answers to questions 1-3 differ based on the type of payment model (Fee-for-Service or Capitation) to which the practice is subject? The results of the study suggest that fee-for-service payment environments present less incentive to use a patient's SDOH in medical decision making.