Explaining disease before germs

Lesson plan

3 class periods of about 45 minutes.

1. Day 1 · 45 min

   Qi, seasons and spirits

   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.

2. Day 2 · 45 min

   Breath, demons and saints

   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.

3. Day 3 · 45 min

   The pump in Broad Street

   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.

Read these sources

The sources the lesson plan uses, in its 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

   Discourse on Epidemic Qi, and a Brother's Letter

   Cao Zhi, 217–218. Accessible.

   Very short and plain; needs only the notes on qi and yin and yang.

   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; 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

   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?

   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.

   For teachers · Worksheet for this source

2. 2

   How to Care for the Sick in the Epidemic of 737

   Council of State, 737. Moderate.

   Short numbered articles in plain language; a few foods and medical words are glossed in the notes.

   Questions, key terms and an activity

   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

   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?

   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.

   For teachers · Worksheet for this source

3. 3

   The Plague Comes to Messina and Catania

   Anonymous of Catania, 1348–1361. Moderate.

   Plain storytelling, but long and full of places and church terms; the notes explain the ones that matter.

   Questions, key terms and an activity

   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

   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?

   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.

   For teachers · Worksheet for this source

4. 4

   The Pump in Broad Street, 1854

   John Snow, 1854–1855. Moderate.

   Long Victorian sentences and some medical words (irruption, flocculent, consecutive fever), but the argument is easy to follow, and the map helps.

   Questions, key terms and an activity

   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

   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.

   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.

   For teachers · Worksheet for this source

More sources for this unit

• The Plague at My Country House, and a Life for a Life Aelius Aristides, 170–175. Moderate. For teachers
• Preface to the Treatise on Cold Damage Zhang Zhongjing, 200–206. Moderate. For teachers
• The Plague at Constantinople Procopius, 550–551. Moderate. For teachers

To finish

Come back to the question: How did people make sense of what they couldn't see? 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 set natural and religious explanations side by side, test the evidence each writer offers, and ask what a writer's world let him see.

Go further

Other units

Who gets blamed? · The healer's burden · Governments, quarantine, and consent · Faith and catastrophe · After the plague · Case study: smallpox · Reading sources critically

Encyclopedia

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

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