Case study: smallpox

Lesson plan

3 class periods of about 45 minutes.

1. Day 1 · 45 min

   Japan, 735–737

   1. 5 minutes: Pose the unit question: How did a terrifying disease become the only one ever eradicated? Explain that the unit follows smallpox from Japan in 735 to its end, and that the last part comes from an encyclopedia article on day 3.
   2. 15 minutes: Read entries 2, 4, 10 and 27 of The Great Epidemic of 735–737 (Medium intensity: a steady list of deaths and one order to bury the dead, nothing graphic). Students note what the records call the disease and whom it struck.
   3. 10 minutes: Read the What we know now section of its History tab together: most historians identify the disease as smallpox, and they estimate that it killed about 30 percent of the people of Japan.
   4. 15 minutes: Read passage 1 of How to Care for the Sick in the Epidemic of 737 (Low intensity: symptoms described plainly). Students list the stages of the disease the order describes, then discuss why it never mentions keeping the sick apart.

2. Day 2 · 45 min

   Planting smallpox in China

   1. 5 minutes: Read the History tab of Planting Smallpox (Low intensity: sick children, pustules and scabs described plainly; no deaths). Explain that this is the Chinese form of inoculation, from a court medical book completed in 1742.
   2. 15 minutes: Read passages [1] to [5] aloud, since the prose is dense. Students find the four methods the editors describe, how they rank them, and why.
   3. 15 minutes: Run the first part of the source's activity: pairs turn the water-seed method in [7] into a one-page instruction card, with the editors' reason or idea for each step beside it.
   4. 10 minutes: Read the What we know now section: planting gave a real, usually milder infection, killing about 0.5 to 2 percent against about 30 percent for natural smallpox, and a planted child could pass smallpox on. Ask what that risk meant for the people around a planted child.

3. Day 3 · 45 min

   From vaccine to eradication

   1. 15 minutes: Read the encyclopedia article Smallpox, from inoculation to eradication, linked under Go further. Students mark three steps: inoculation, Jenner's cowpox vaccination in 1796, and the World Health Organization's intensified campaign from 1967.
   2. 10 minutes: Ask what each step changed. Point out that inoculated people could still spread full smallpox, while vaccination rarely spread to others, and that the last natural case was in 1977.
   3. 5 minutes: Return to 737. List what the court and the Council of State lacked that later doctors had.
   4. 15 minutes: Students answer the unit question in a paragraph, using at least two of the sources they read and the article, 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

   The Great Epidemic of 735–737

   Shoku Nihongi, 735–797. Moderate.

   Plain sentences, but many names and offices; the notes on kami and the ruler's virtue carry the context.

   Questions, key terms and an activity

   epidemic

   an outbreak of disease that spreads quickly through many people at once

   kami

   the gods and spirits of Japanese tradition, worshiped at shrines

   sutra

   a Buddhist scripture, often read aloud for protection or blessing

   edict

   a formal order or announcement from a ruler

   amnesty

   a pardon granted to many prisoners at once

   relief

   food, goods, or money given by a government to people in need

   court rank

   an official's place in the order of the court, which decided pay and privileges

   virtue

   moral goodness; here, the goodness a ruler was expected to show, believed to keep the realm in order

   1. Comprehension List the things the court did in response to the epidemic between 735 and 737. Which were religious, which were practical, and which fit neither group?
   2. Analysis In his edicts of the fifth and eighth months of 737, the emperor says that his own lack of virtue brought the disaster. Why might a ruler say this, and what did he do in response?
   3. Analysis (reliability) These records were kept by government officials and edited into a history sixty years later. Whose experiences do they record in detail, and whose do they leave out? What can and can't they tell us about how ordinary people suffered?
   4. Connection Read The Government Explains the Flu, 1918, a U.S. Public Health Service pamphlet. Compare what each government believed it could do against an epidemic and whom each expected to act.

   Activity Students build a timeline of the entries from 735 to 737 on a long strip of paper, marking each entry as a religious response, practical relief, an amnesty, a death, or a report. In small groups they then write a short memo as officials in the eighth month of 737, advising the emperor what to do next and pointing to the record so far as their evidence.

   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

   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

More sources for this unit

• Engrafting against Smallpox Lady Mary Wortley Montagu, 1717. Moderate. For teachers
• What the Africans of Boston Knew about Inoculation Cotton Mather and Zabdiel Boylston, 1721. Moderate. For teachers
• Instructions for Vaccine Inoculation Edward Jenner, 1799–1801. Moderate. For teachers

To finish

Come back to the question: How did a terrifying disease become the only one ever eradicated? 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 timeline a court's responses in 735–737, ask whose experiences official records omit, and name the other evidence they would want.

Go further

Other units

Who gets blamed? · The healer's burden · Governments, quarantine, and consent · Explaining disease before germs · Faith and catastrophe · After the plague · Reading sources critically

Encyclopedia

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

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