Explaining disease before germs

Big question: How did people make sense of what they couldn't see?

A unit from Hearth Learning, built on Once in a Lifetime in Hearth Library. Every source page has the original beside a plain English translation, notes on who made it and how far to trust it, and page images where they exist. Sources marked “Early version” have not yet been checked by a separate review.

Lesson plan

Day 1: Qi, seasons and spirits (45 minutes)

  1. 5 minutes: Pose the unit question: How did people make sense of what they couldn't see? Tell students that none of this unit's writers could see what caused the disease they describe.
  2. 10 minutes: Read passages [4] to [8] of Discourse on Epidemic Qi, and a Brother's Letter (Low intensity: deaths in a few lines, nothing graphic). Students name the two explanations and the evidence Cao Zhi gives for his own. Use the key terms for qi and yin and yang.
  3. 15 minutes: Run a short version of the source's hearing. One team argues for disordered seasons, one for ghosts and spirits, and a panel asks each team for its evidence, including Cao Pi's letter in [9].
  4. 10 minutes: Read passage 1 and article 6 of How to Care for the Sick in the Epidemic of 737 (Low intensity: symptoms described plainly). Ask what the Council of State thinks makes the sick worse, and which ideas come from heat and cold.
  5. 5 minutes: Exit note: one thing these writers could observe, and one thing they had to guess.

Day 2: Breath, demons and saints (45 minutes)

  1. 5 minutes: The Plague Comes to Messina and Catania is High intensity: symptoms in detail, the abandoned sick and the unburied dead. Before reading, tell students that 27.3 describes the sick closely and that its first two sentences carry today's point; they may skip the rest of it.
  2. 15 minutes: Pairs read 27.2–27.5, 28.6–28.8, 29.2–29.6 and 29.15. They sort the chronicler's explanations into natural ones (breath, touch, infected air) and religious ones (God's vengeance, demons, saints).
  3. 10 minutes: Discuss whether the chronicler sees the two kinds as competing. The History tab notes that he tells the marvels in the same plain voice as the deaths.
  4. 10 minutes: Read the encyclopedia article Corrupted air (miasma), linked under Go further. Students find the line about the duke who avoided towns, and add one more belief about air to their list.
  5. 5 minutes: Extension: groups may take one of the More sources for this unit. Aelius Aristides (Medium intensity) and Zhang Zhongjing (Low) need no special preparation. Procopius is High intensity, with detailed symptoms and bodies piled in towers; assign only 2.22.1–2.22.5 and 2.22.32–2.22.34, where he says no human reason can explain the disease.

Day 3: The pump in Broad Street (45 minutes)

  1. 5 minutes: Open The Pump in Broad Street, 1854 (Medium intensity: many deaths counted, none described in detail). Look at Snow's map at the top of the page together and find the pump, the workhouse and the brewery.
  2. 15 minutes: Read passages 2 to 5, 9 to 10, and 13 to 14. Pairs list Snow's evidence, and how he uses the workhouse inmates and brewery workers who lived near the pump but seldom died.
  3. 10 minutes: Read 16 and 17. Discuss the source's reliability question: the attacks had already fallen before the handle was removed, and many witnesses had died or fled. Ask how far that limits his conclusion.
  4. 15 minutes: Students answer the unit question in a paragraph, comparing how Cao Zhi, the Catania chronicler and Snow explained what they could not see. They cite at least two sources with passage numbers.

Sources

The Plague at My Country House, and a Life for a Life

Aelius Aristides, early 170s CE (plague events of the mid-160s, probably 165 or 166). Moderate.

  1. Comprehension. List the steps of Aristides's illness and recovery, from the first sick slaves to his return to the city. Who helps him at each step?
  2. Analysis. How does Aristides explain why he lived and Hermias and Philumene died? What does his explanation tell you about how he saw himself and the people around him?
  3. Analysis (reliability). Aristides wrote this years later, to show how the gods cared for him, and he admits his friends feared he was raving when he saw Athena. Which parts of his account would you trust as a witness's report, and which would you treat as his interpretation? Why?
  4. Connection. Thucydides (The Plague at Athens, and Pericles Answers the Athenians) also survived a plague. Compare how each writer explains the disease and his own survival. Which explanation would have been more comforting at the time, and which more useful to later readers?

Key terms: oracle (a shrine where a god was believed to answer questions, or the answer given there); seer (a person who reads signs from the gods, such as an animal's organs); aegis (the magic goatskin cloak or shield of the goddess Athena); humors (the body fluids (later fixed as four, blood, phlegm, yellow bile, and black bile) that doctors believed had to stay in balance); purge (to empty the stomach or bowels on purpose, as a treatment); foster-child (a child raised in a household that is not the child's birth family)

Activity: Aristides tells the story of Hermias and Philumene only as it concerns him. Students write a short letter from their mother, Callityche, to Aristides after reading his account. Then compare letters: what does each student think she would have said, and what in the text supports it?

Preface to the Treatise on Cold Damage

Zhang Zhongjing, c. 200–206 (within ten years of the start of the Jian'an era, 196). Moderate.

  1. Comprehension. What does Zhang say happened to his clan, and what did he do in response?
  2. Analysis. Zhang blames two groups for deaths that did not have to happen. Who are they, and what does he accuse each of doing wrong?
  3. Analysis (reliability). The preface survives only in copies and quotations made centuries after Zhang died, and scholars debate whether he wrote all of it. How should that affect the way we use his account of his family's deaths as evidence?
  4. Connection. Read Cao Zhi's Discourse on Epidemic Qi, and a Brother's Letter, about the epidemic of 217. Zhang blames learned men who chase rank and fame, and hasty doctors; whom or what does Cao Zhi blame? What does each writer think people should do, or stop doing?

Key terms: qi (the vital breath or energy that Chinese thinkers saw in the body and the world); Cold Damage (a Han-era name for a broad family of feverish illnesses believed to start when cold invades the body); Five Phases (wood, fire, earth, metal, and water, used to explain change in nature and the body); yin and yang (paired opposite forces, such as dark and light or cold and heat; their balance, and the right order of the seasons, was thought to keep the body and the world healthy); shaman (a religious healer who tries to cure illness by contacting spirits); pulse diagnosis (judging illness by feeling the beat of the blood at the wrist, neck, and foot); clan (a large extended family sharing one surname and ancestors)

Activity: Students write a short reply to Zhang in the voice of one of the "doctors of today" he attacks, defending their methods. Partners then trade papers and answer as Zhang.

Discourse on Epidemic Qi, and a Brother's Letter

Cao Zhi, 217 or soon after (the essay, on the epidemic of Jian'an 22); 218 (Cao Pi's letter). Accessible.

  1. Comprehension. According to Cao Zhi, who died in the epidemic of 217, who seldom fell sick, and what caused it?
  2. Analysis. Cao Zhi rejects one explanation and offers another. What evidence does he give for his own explanation, and what does he leave unexplained?
  3. Analysis (reliability). Cao Zhi was a prince, and his essay survives only in quotations made centuries later. Compare his claim that few of the rich fell sick with his brother's letter. How should the letter change the way we use the essay as evidence?
  4. Connection. Read Zhang Zhongjing's Preface to the Treatise on Cold Damage. Cao Zhi says the epidemic of 217 struck mostly the poor, while Zhang, writing of the decade after 196, says he lost two of every three members of his large clan, most of them to Cold Damage. These are different epidemics and different families. What does each account suggest about who died, and why might two writers of the same era place the blame so differently?

Key terms: qi (the vital breath or energy that Chinese thinkers saw in the body and the world); yin and yang (paired opposite forces, such as dark and light or cold and heat; their balance, and the right order of the seasons, was thought to keep the body and the world healthy); epidemic (an outbreak of disease that spreads quickly through many people at once); talisman (a written charm believed to keep away evil spirits or disease); commoner (an ordinary person, not a noble or an official); clan (a large extended family sharing one surname and ancestors); sable (the dark, costly fur of a small animal related to the weasel)

Activity: Students stage a short hearing set in 217. One team argues, as Cao Zhi does, that disordered seasons caused the epidemic; a second team argues for ghosts and spirits, as the people he mocks did. A panel of judges asks each team what evidence it has, including Cao Pi's letter, and who might disagree, then writes a one-paragraph verdict on which team used evidence better.

The Plague at Constantinople

Procopius, c. 550 (events of 542; Books 1–7 made public in 551 at the earliest). Moderate.

  1. Comprehension. How did the disease begin in a person, according to Procopius, and what different courses could it then take? What sign gave a sick person the best hope of recovery?
  2. Analysis. Procopius says the plague's cause can be traced only to God, yet he also says it seemed to spare the wickedest people. What, if anything, does he think the plague teaches? How does his own answer differ from those of the theorists he mocks in 22.1?
  3. Analysis (reliability). Procopius was in Byzantium when the plague arrived, but he wrote years later and modeled his account on Thucydides. Which details seem most likely to come from what he saw for himself, and which might be borrowed or exaggerated? Look closely at the daily death tolls in 23.2 and at the comment on the survivors in 23.16.
  4. Connection. Thucydides (The Plague at Athens, and Pericles Answers the Athenians) was Procopius's model. Thucydides saw the disease pass to those who nursed the sick (2.51); what does Procopius say about whether it passed from person to person (22.23), and what evidence does he give? Where else does his account follow Thucydides, and where does it part from it?

Key terms: bubo (a painful swelling of a gland in the groin, armpit, or neck; the mark of bubonic plague); carbuncle (a hard, dark, inflamed lump in the flesh); contagion (the spread of disease from person to person); delirium (a state of wild, confused thinking, often with frightening visions, brought on by illness); demon (an evil spirit; many Christians of Procopius's time believed demons could cause illness); faction (a rival group within a community; in Constantinople, the Blues and the Greens, clubs of chariot-racing fans); providence (God's care for the world and plan for what happens in it); sophist (a learned speaker or teacher; Procopius uses the word for clever people with empty explanations)

Activity: You are Theodore, the official Justinian put in charge of burying the dead. Using only details from the text, write a one-page report to the emperor on what you found, what you did, and what you still need. Then compare reports with a classmate and discuss what an official report would leave out that Procopius puts in.

How to Care for the Sick in the Epidemic of 737

Council of State, 737 (sixth month, twenty-sixth day). Moderate.

  1. Comprehension. Sort the seven articles into rules about food, rules about the body and bedding, and rules about medicine. Which instructions forbid something, and which offer help?
  2. Analysis. The order never mentions keeping the sick away from the healthy. What does that suggest about how its writers understood the disease?
  3. Analysis (reliability). This order tells us what the government wanted done. What can't it tell us about how the sick were actually cared for? What other evidence would you want?
  4. Connection. Read the Shoku Nihongi entries in The Great Epidemic of 735–737. The same government made offerings to the kami and ordered sutra readings. How do those responses fit with this order's practical advice?

Key terms: epidemic (an outbreak of disease that spreads quickly through many people at once); Council of State (the highest office of the Japanese government under the emperor); province (one of the regions into which the country was divided, each run by a governor sent from the capital); relief (food, goods, or money given by a government to people in need); relapse (falling ill again after seeming to recover); dysentery (severe diarrhea with blood or mucus)

Activity: In small groups, students act as a provincial governor's staff who have just received the order. They write a short notice, in plain words, to be read aloud in a village, and list what the province must supply so that poor families can follow it.

The Plague Comes to Messina and Catania

Anonymous of Catania, after April 1348 (events of October 1347 to April 1348). Moderate.

  1. Comprehension. Trace the plague’s path in these chapters. Where did it start, where did it spread, and how did people try to escape it?
  2. Analysis. The chronicler gives two kinds of explanation, natural (breath, touch, infected air) and religious (God’s vengeance, demons, saints). Find examples of each. Does he see them as competing?
  3. Analysis (reliability). The chronicler lived in Catania and disliked Messina. Which passages might that have shaped? Which details is he most likely to have seen for himself?
  4. Connection. Compare how Messina treated the Genoese with how Catania treated the people of Messina. What does each city’s choice tell you about fear and blame?

Key terms: chronicle (a record of events set down year by year); galley (a long ship rowed by oars, often with sails, used for war and trade in the Mediterranean); relic (the body, or part of the body, of a saint, or an object linked to a saint, kept and honored in a church); notary (an official who drew up and witnessed legal documents such as wills); excommunication (cutting a person off from the church and its sacraments); bubo (a painful swelling of a gland in the groin, armpit, or neck; the mark of bubonic plague)

Activity: In small groups, students choose one group in the chronicle (the Genoese sailors, the families of Messina, the notaries and priests, the townspeople of Catania, the patriarch). Each group writes a short statement explaining its choices in its own words, then the class discusses which choices were reasonable and which were cruel, and why.

The Pump in Broad Street, 1854

John Snow, 1855 (events of August–September 1854). Moderate.

  1. Comprehension. What did Snow find when he compared the places where people died with the pumps they used? Give two of his cases.
  2. Analysis. The workhouse inmates and the brewery workers lived or worked close to the pump, yet few of them died. How does Snow use them to support his argument?
  3. Analysis (reliability). Much of Snow’s evidence came from relatives and neighbors, and many people had died or fled. He also says the attacks had already fallen before the pump handle was removed. How do these limits affect how far we can trust his conclusion?
  4. Connection. Read The Government Explains the Flu, 1918. Neither Snow nor the Public Health Service could see the germ they were dealing with. Compare the evidence each uses and the action each asks people or officials to take.

Key terms: outbreak (a sudden rise in cases of a disease in one place); mortality (the number of deaths); General Register Office (the government office that recorded births, marriages and deaths); Board of Guardians (the local board that ran help for the poor, including the workhouse); workhouse (a building where poor people who could not support themselves lived and worked); organic (coming from living things, such as plants, animals or waste)

Activity: Students plot Snow’s cases on a copy of his map (the pump, the workhouse, the brewery, the children at school, the widow in Hampstead). In pairs, they write a short note to the Board of Guardians, as Snow did on September 7, 1854, using only the evidence on the map to argue for or against removing the pump handle, and then discuss what Snow’s own figures for the days after September 8 show.

Standards

Printable worksheet for any source: https://hearthinteractive.com/learning/worksheet.html

Translations drafted by Claude (Anthropic). Free to use in class. Hearth Learning, https://hearthinteractive.com/learning/