From inoculation to vaccine

Lesson plan

4 class periods of about 45 minutes.

1. Day 1 · 45 min

   Planting and engrafting

   1. 5 minutes: Write the word inoculation on the board with its meaning: giving a healthy person smallpox on purpose, from a mild case, so that the illness is mild and never comes again. Students say in one sentence what a parent risked by choosing it.
   2. 15 minutes: Read Planting Smallpox by Wu Qian, passages [4], [5] and [8], on the Read tab. Students list the four methods the editors describe, which two they rank first and second, and why they reject the other two.
   3. 15 minutes: In pairs, read passages 3 and 4 of Engrafting against Smallpox by Lady Mary Wortley Montagu. Students describe engrafting step by step: who does it, when, how, and what happens to the children afterward.
   4. 10 minutes: Start a chart with two columns, China 1742 and Adrianople 1717. For each, note how the matter goes into the body and what the writer says makes it safe. Add from the History tabs that the Chinese editors say the method was taught mostly by word of mouth, and that Lady Mary reports what people around her told her.

2. Day 2 · 45 min

   Boston and London argue

   1. 5 minutes: Before reading, tell students that the Boston pamphlet calls the Africans who taught its writers “poor creatures” who speak “like idiots,” and that the class will discuss this language.
   2. 15 minutes: Read passages 3 to 6 of What the Africans of Boston Knew about Inoculation by Cotton Mather and Zabdiel Boylston. Students note what the Africans report, what Boylston says about his own patients, and why Mather says the Africans' broken English makes their story more believable.
   3. 10 minutes: Using the History tab, students make a chain of knowledge with a card for Onesimus, the other Africans in Boston, Mather and Boylston. Each card says what the person knew, how they learned it, and whether the pamphlet names them.
   4. 15 minutes: Read passages 3, 4 and 5 of A Sermon against Inoculation by Edmund Massey aloud, a few sentences at a time. Students find his three reasons that inoculation is wrong and put each in their own words.

3. Day 3 · 45 min

   Jenner's cowpox

   1. 5 minutes: From the History tab of Instructions for Vaccine Inoculation, students note what Edward Jenner did in 1796 and what he did not know: why cowpox protected against smallpox.
   2. 20 minutes: Students work in pairs as a vaccinator and an observer. The vaccinator explains each step in passages 1 to 6 aloud; the observer checks it off and writes down every word or judgment that would need a teacher or more experience.
   3. 10 minutes: Students set Jenner's steps beside the water-seed method in Planting Smallpox, passage [7], and list what stayed the same and what changed.
   4. 10 minutes: Read passage 7 of Jenner's sheet together. Students explain what he tells a doctor to do when a vaccination does not take, and why smallpox matter is still his last resort.

4. Day 4 · 45 min

   Impact, influence, change

   1. 10 minutes: Put the five sources on a timeline: Lady Mary's letter (1717), the Boston pamphlet (1721), Massey's sermon (1722), the Chinese book (1742) and Jenner's sheet (about 1799–1801). Add two facts from the History tabs that show the idea moving: Lady Mary had her daughter inoculated in London in April 1721, and the Boston pamphlet sums up reports from the Ottoman Empire.
   2. 15 minutes: Groups take one word each. Impact: what the method did for the people who tried it, in the writers' own words. Influence: who passed the idea on, and to whom. Change: what Jenner's cowpox replaced and what it kept. Each group finds two quotations as evidence.
   3. 10 minutes: Groups report. The class then lists the reasons people resisted, with a source for each: Lady Mary's guess about doctors' income (passage 4), Massey's religious and moral case, the objection in Boston that the method came from the heathen (passage 7), and the “rage of unadvised people” Boylston mentions (passage 6).
   4. 10 minutes: Each student writes a paragraph answering the unit question, citing at least two sources by title and passage number. The encyclopedia article Smallpox, from inoculation to eradication carries the story forward for students who want to go further.

Read these sources

In this order. Each opens in Hearth Library with the original beside plain English, and a History tab on who made it and how far to trust it.

1. 1

   Planting Smallpox

   Wu Qian, 1739–1742. Challenging.

   Dense medical prose; the fetal poison, qi, and yin and yang need the notes, but the step-by-step methods are easy to follow.

   Questions, key terms and an activity

   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, whose balance was thought to keep the body healthy

   inoculation

   giving a healthy person smallpox on purpose, from the matter of a mild case, so that the illness would be mild and never come again

   pustule

   a raised spot on the skin filled with fluid

   scab

   the dry crust that forms over a healing spot or wound

   compendium

   a large book that gathers the knowledge of a whole subject

   chancellor

   the emperor’s chief minister

   1. Comprehension What four ways of planting smallpox do the editors describe? Which do they rank first and second, and why do they reject the other two?
   2. Analysis The editors argue that planted smallpox is safer than catching it naturally. What reasons do they give? Which rest on what doctors could see, and which on ideas about the fetal poison and qi?
   3. Analysis (reliability) The editors admit the method was known only from a story and had been taught mostly by word of mouth, and they also say the dry method they ranked second was widely used in their day. What does this suggest about how far an official book like this shows what ordinary doctors actually did?
   4. Connection Read Lady Mary Wortley Montagu's Engrafting against Smallpox and Edward Jenner's Instructions for Vaccine Inoculation. Compare how the matter is put into the body in each, what each writer says makes the method safe, and what Jenner’s cowpox changed.

   Activity Students turn the water-seed method into a one-page instruction card for a doctor in 1742, keeping only steps the text gives. In a second column they note, for each step, the reason the editors give or the idea behind it (qi, the fetal poison, yin and yang, or careful watching). They then set the card beside Jenner’s Instructions for Vaccine Inoculation and list what stayed the same and what changed.

   For teachers · Worksheet for this source

2. 2

   Engrafting against Smallpox

   Lady Mary Wortley Montagu, 1717. Moderate.

   Eighteenth-century English with long sentences; a few old words (distemper, wight, apropos) are glossed in the notes.

   Questions, key terms and an activity

   engrafting

   putting matter from a smallpox sore into a small cut to cause a mild case and lasting protection; also called inoculation

   distemper

   an old word for a disease or illness

   apropos

   speaking of; on the subject of (from French à propos)

   ambassador

   an official sent by one government to live in another country and speak for it

   Ottoman Empire

   the large Muslim empire ruled by the Turkish sultans from Constantinople (Istanbul)

   revenue

   income; the money someone earns

   1. Comprehension Describe engrafting step by step as Lady Mary tells it: who performs it, when, how, and what happens to the children afterward.
   2. Analysis Lady Mary says she will try engrafting on her son, but doubts that English doctors will welcome it. What reason does she give for their resistance, and what does that tell you about how she expected new ideas to be received at home?
   3. Analysis (reliability) She says no one has ever died of engrafting, admits she was kept in the dark about the plague, and later reworked her letters into a book. Which of her statements did she see for herself, and which did she only hear? How should that shape the way we use the letter as evidence?
   4. Connection Read Mather and Boylston's What the Africans of Boston Knew about Inoculation. In Boston in 1721 the same practice was argued for from what enslaved Africans reported. Compare where Lady Mary and the Boston writers got their knowledge, and how each describes the people who taught them.

   Activity Students write the letter Lady Mary might have sent to an English doctor on her return, in 1718, asking him to try engrafting. They must use only what she knew from this letter, answer one objection she expects, and decide what she should and should not claim. Classmates then reply as a doubtful doctor, naming what evidence would change his mind.

   For teachers · Worksheet for this source

3. 3

   What the Africans of Boston Knew about Inoculation

   Cotton Mather and Zabdiel Boylston, 1721. Moderate.

   Eighteenth-century English with old spellings and long sentences; Mather’s rendering of the Africans’ speech needs a short introduction.

   Questions, key terms and an activity

   inoculation

   giving a healthy person smallpox on purpose through a small cut, so that the illness is mild and never comes again

   enslaved

   held as property and forced to work without pay or freedom

   testimony

   what a witness says happened

   heathen

   an old word, used by Christians, for people who were not Christians

   credible

   believable

   pamphlet

   a short printed booklet, often written to win an argument

   1. Comprehension What do the Africans in Boston say about smallpox and inoculation in Africa, and what does Boylston report about his own patients?
   2. Analysis The pamphlet relies on African knowledge and also calls the Africans “Poor Creatures” who speak “like Ideots.” Why does Mather say their broken English makes their story more believable? What does that argument show about how he valued them?
   3. Analysis (reliability) Onesimus taught Mather about inoculation, but the pamphlet never names him, and it was printed under Boylston’s name although Mather wrote much of it. Whose voices reach us in this source, whose are hidden, and how can historians recover the hidden ones?
   4. Connection Read Lady Mary Wortley Montagu's Engrafting against Smallpox. She learned of engrafting from old Greek women at Adrianople; Mather learned it from enslaved Africans in Boston. Compare how each writer describes the people who taught them, and why both expected doctors at home to resist.

   Activity Students make a “chain of knowledge” for inoculation in Boston, 1721: a card for each person or group who passed it on (Onesimus and the other Africans, Timonius and Pylarinus, the Royal Society, Mather, Boylston, Douglass), with what each knew, how they learned it, and whether this pamphlet names them. They then rewrite the pamphlet’s opening line so that it gives credit where the evidence shows it is due.

   For teachers · Worksheet for this source

4. 4

   A Sermon against Inoculation

   Edmund Massey, 1722. Challenging.

   Hard eighteenth-century English with long sentences and many Bible references; the notes explain them, and short passages read aloud work best.

   Questions, key terms and an activity

   inoculation

   in 1722, putting matter from a smallpox sore into a small cut to cause a milder case; now called variolation

   Providence

   God’s care for the world and plan for what happens in it

   distemper

   an illness

   sermon

   a talk on a religious subject given by a member of the clergy, usually in church

   physic

   medicine; the work of physicians

   presumption

   taking on more than one has a right to

   1. Comprehension Massey gives three reasons inoculation is wrong. Find each one and put it in your own words.
   2. Analysis Massey says the fear of smallpox keeps many people from vice. What does this tell you about what he thought disease was for?
   3. Analysis (reliability) Massey says inoculation caused more deaths than smallpox caught in the ordinary way. Where might he have got that idea in 1722, and what would you need to know to test it?
   4. Connection Read What the Africans of Boston Knew about Inoculation, by Cotton Mather and Zabdiel Boylston. Cotton Mather, a minister like Massey, supported inoculation. Compare how each uses religion to argue about the same practice.

   Activity Students hold a public meeting set in London in the summer of 1722. One group speaks for Massey, one for the surgeon Charles Maitland, and one plays parents deciding whether to have their children inoculated. Each speaker may use only evidence available in 1722. The parents then explain in writing what they decided and which argument weighed most.

   For teachers · Worksheet for this source

5. 5

   Instructions for Vaccine Inoculation

   Edward Jenner, 1799–1801. Moderate.

   A working doctor’s instructions, plain in order but with medical words of the time; the notes explain them.

   Questions, key terms and an activity

   vaccine

   in Jenner’s time, of cowpox (from Latin *vacca*, cow); matter from a cowpox sore used to protect against smallpox

   pustule

   a small raised spot on the skin filled with fluid

   efflorescence

   the red ring of inflammation that forms around the pustule

   lancet

   a small, sharp, two-edged surgical knife

   virus

   in 1801, any poisonous or infectious matter, here the fluid from the pustule

   variolous

   of smallpox; variolous matter came from smallpox sores

   1. Comprehension Put Jenner’s steps in order, from choosing the pustule to keeping the fluid for later. What does he say should happen on the third, tenth, and sixteenth days?
   2. Analysis Jenner tells the vaccinator to judge the pustule by eye again and again. Find three places where success depends on what the vaccinator notices. Why might that have made it hard to spread the method widely?
   3. Analysis (reliability) These are rules written by the inventor of the method for other doctors. What can they tell us about how vaccination was meant to be done, and what can they not tell us about how it was done in practice?
   4. Connection Read Edmund Massey’s A Sermon against Inoculation. Massey feared that removing the danger of smallpox would make people careless and sinful. Jenner never mentions religion or morals. What does each writer think the question about smallpox prevention is, and why might their answers have been so far apart?

   Activity Students work in pairs as a vaccinator and an observer. Using only the sheet, the vaccinator explains each step aloud while the observer checks it off and writes down every word or judgment that would need a teacher or more experience to understand. The class then drafts a short list of questions a country doctor in 1801 might have sent to Jenner after reading the sheet.

   For teachers · Worksheet for this source

To finish

Come back to the question: How did a new way to prevent smallpox spread, and why did people resist it? Ask students to answer it with evidence from at least two of the sources, and to say which source they trust most and why.

Standards

Students write Lady Mary's letter to a doubtful doctor, trace who passed inoculation to Boston and who goes uncredited, argue a 1722 London meeting for and against Massey, and test whether Jenner's sheet could be followed without a teacher.

Go further

Other units

Counting and mapping disease · Imagining space travel · New ways to travel, eat and shop · Fixing the calendar

Encyclopedia

Corrupted air (miasma) · Smallpox, from inoculation to eradication

Collection

Every source in Innovation in History