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Lesson Plan: Public Health

For Teachers - An Introduction:
This lesson is designed to introduce your students to historical research with primary sources. They will be presented with a set of six primary sources relating to a milestone in Minnesota history. Students will be provided with source data, online activity questions to direct their study, and a worksheet designed to help them draw conclusions about the sources they have seen and about primary source research in general. The sections of this site are not intended to be complete histories of the people or events involved, but rather serve as examples of what students might find in their own research attempts.

What were the origins of public health in Red Wing?
After working as a surgeon in the Civil War, Dr. Charles Hewitt came to Red Wing and became a pioneer in public health and immunization. He manufactured smallpox vaccines in his Red Wing laboratory and worked to improve the unsanitary conditions of soldiers during the Civil War in an effort to prevent the spread of disease. Smallpox was epidemic in Red Wing during some periods, and the work of the city and the State Board of Health served to encourage immunization, prevention and treatment of the disease. Hewitt also fought epidemics of diptheria, measles, cholera and typhoid.

What You Will Need for This Lesson:

  • Access to a computer lab with Internet capability for at least one 40 minute class period.
  • Photocopies of the worksheet and a printed key (download both in the Student Materials section of the site).
  • If you have not already done so, we encourage you to explore the site for yourself ahead of time to become familiar with the navigation and features available to you and your students.

Skills Objectives:
The student will be able to:

  1. access primary sources online for research and study
  2. identify and summarize the different kinds of sources in the exercise
  3. identify advantages and disadvantages to using particular primary sources
  4. explain and synthesize source information to evaluate its usefulness and reliability

Using this Lesson in Your Classroom:
When the students are in the computer lab, lead them through the following sequence (you may wish to use an overhead projector screen):

  1. Go to the Communities web site.
  2. Click on Communities on the left hand side of the screen.
  3. Click on Red Wing.
  4. Click on Public Health.
  5. Read the introductory material on the Public Health and click Enter.
  6. This will bring you to a screen with a photograph of a man with smallpox. This is the first primary source the students will encounter. Let them know that they can see a larger version of this photograph by clicking on the View button underneath the thumbnail image. Show students the Activity button and have them click on it to view questions and possible answers about each source.
  7. Once students have studied this photograph and read the appropriate questions about it in the Activity section, direct them to the other sources that are accessible through the blue menu bar running across the top of the page. Each of these buttons will take them to another source to explore.
  8. Remind students to use the Activity button on each source to help direct their research.
  9. When the students have completed studying each source and reading the questions for each item, they should be able to complete the worksheet they were given (see below).

What Your Students Will See In This Lesson Online:
Below is a listing of each source provided on the Public Health section of the web site and a transcript of the activity questions for each source. (The questions are found on the site by clicking on the Activity button.)

Photo 1
Click on the Photo 1 button to view the source.
This is a photograph of a man with smallpox.

    1.1) What can we learn about this man from the photograph and caption beneath it?

    Possible Answer: We can guess that he is an immigrant from Scotland, since that is where he was first vaccinated.

    1.2) Why was this man's case of smallpox less severe than other cases they had seen?

    Possible Answer: Since he had been given the vaccine as a child, his case was less severe.

    1.3) How did this man get smallpox in the first place?

    Possible Answer: The caption suggests that he was a renter in the same house where the first case of smallpox in the area appeared and probably caught it from exposure to that person.

    1.4) Since this photograph has a descriptive caption on it, what might we guess about its use?

    Possible Answer: This photograph could be one in a series of photographs collected by health department workers or doctors who wished to present their findings to another group of doctors or officials for study.


Document 1

Click on the Document 1 button to view the source.
Certificates like this one were given to those who got vaccinated for smallpox.

    2.1) Why might it be important for doctors to have a record of who has been vaccinated?

    Possible Answer: Doctors would be more able to keep track of how many people were left to be vaccinated and how many vaccinations actually worked. If they knew that someone had already been vaccinated, it might help them diagnose a similar condition (such as chickenpox) correctly.

    2.2) How long did the patient have to wait to find out if the vaccination worked?

    Possible Answer: This patient was given the vaccine on July 16th, and checked again on July 22nd, so the time period was about a week long.

    2.3) What can this document tell us about where the vaccine came from?

    Possible Answer: The note mentions that the vaccine was taken from calf No. XXXVIII. The doctors probably had specifc records on each calf that was injected with the vaccine.

    2.4) What do you think might happen if someone were exposed to smallpox right after they were vaccinated--before the vaccine had enough time to work in the body?

    Possible Answer: This happened occasionally because it took the vaccine some time to be effective in the body. Patients who got smallpox after the vaccine would have to be vaccinated again at a later date.

Document 2
Click on the Document 2 button to open the primary source.
This death certificate describes a victim of smallpox.

    3.1) What was Marion Flynn's occupation and why might this have put her at risk?

    Possible Answer: She was a nurse and therefore would probably be exposed to smallpox at work.

    3.2) How old was she when she was taken sick?

    Possible Answer: She was 19 years old, which might seem young to be a nurse today, but the medical and educational requirements were not as demanding at that time and people needed to work to make money.

    3.3) What might have prevented her case of smallpox?

    Possible Answer: She had never been successfully vaccinated for the disease.If she had been, then she might not have caught it.

    3.4) How long did it take after she contracted smallpox before she died?

    Possible Answer: She became sick on June 3rd and died on June 10th, so it took seven days. Smallpox moved quickly to harm the body, so it was (and still can be) a very dangerous and frightening disease.

News 1
Click on the News 1 button to open the primary source.
Newspaper articles like this one blamed the spread of smallpox on those who had not been vaccinated.

    4.1) Why is it important that those who are not vaccinated are encouraged to do so quickly?

    Possible Answer: Any reduction in the spread of the disease is very important. The sooner everyone would be vaccinated, the sooner the disease would disappear.

    4.2) Who did the study that found 22,000 to 28,000 people in the area were unvaccinated?

    Possible Answer: A Dr. Pierce from the United States Public Health Service came to town to do the survey and determine the needs of the city in fighting smallpox. We can guess that he probably was traveling all over the country doing these kinds of studies.

    4.3) Why do you think some people would not feel the need to be vaccinated?

    Possible Answer: Some might feel that they wouldn't get smallpox anyway, or they simply didn't know about the vaccinations. Many of the unvaccinated people were immigrants who probably couldn't read or understand English and therefore might not have heard about the need for the vaccine.

    4.4) What effect do you think an article like this on the front page of the paper might have on some readers?

    Possible Answer: Readers who had not been vaccinated might decide to get the vaccine after reading an article like this. Readers who had already been vaccinated might try to organize efforts to get the vaccine to others quickly.

Document 3
Click on the Document 3 button to open the primary source.
Dr. Charles Hewitt of Red Wing wrote these notes about medicine and hygeine.

    5.1) Hewitt gave this speech to members of a medical society. What arguments had been made against the medical profession at that time?

    Possible Answer: Hewitt suggests that some people did not think of doctors as "workers for social health," but only as people who were looking for a way to improve their social status.

    5.2) What does Hewitt think the physician should do?

    Possible Answer: Hewitt believes that a doctor should be a "social force" for hygeine and cleanliness in his community and convince his patients to appreciate the value of cleanliness.

    5.3) What social ills does Hewitt think that clean soil, water, homes, and sunlight will be able to cure?

    Possible Answer: "Disease, vice, and physical degeneracy" are all things that Hewitt thinks will improve when people live in a clean environment.

    5.4) How do you think the doctors who listened to Hewitt's speech felt about what he said?

    Possible Answer: Hewitt was a well-respected doctor in the state and had done much during the Civil War to clean up army camps and prevent the spread of disease, so it is likely that his words were accepted, although some of his suggestions about how hygiene could cure social ills might have sounded a little extreme to some.

Document 4
Click on the Document 4 button to open the primary source.
This is a report from the Board of Preventable Diseases about a smallpox epidemic in Red Wing.

    6.1) What information does this chart give you about the people who had smallpox in Red Wing at this time?

    Possible Answer: This chart tells us their age, gender, when their first symptom arrived, and information about whether or not they had been vaccinated in the past.

    6.2) What might be alarming to a doctor about the fact that the last fives cases on the list attended school before they were diagnosed?

    Possible Answer: They could easily have spread the disease throughout the other students at the school and infected a large number of people.

    6.3) What does the author of this report suggest be done about the situation?

    Possible Answer: It is suggested that children who have not been vaccinated be excused from school until they are vaccinated and that the schools be cleaned to prevent the spread of the disease.

    6.4) Why might it be simple for a doctor to mistake a case of chickenpox for a case of smallpox?

    Possible Answer: The symptoms of the two illnesses are similar in appearance, and the doctors might not have seen cases of smallpox in their town before.

Thought Questions for online Exploration:
During the online lesson, your students should complete the accompanying worksheet for this section. (Download from the student materials the pdf file containing the worksheet and key.) The questions for this worksheet are provided below. Since questions relating to specific sources are used during the online activity, the following worksheet questions are designed to help students synthesize and apply the material they have learned from the online activity and to analyze the kinds of information and the credibility of various types of primary sources when taken as a whole.

  1. Records for the Board of Health were kept for a number of reasons. Why do you think keeping these records was important at the time? What can they teach us now? Why is it important today that your doctors keep a record of your visits?

  2. Articles about issues important to the community are often found in newspapers and serve to motivate people to action. The article about unvaccinated residents is one example. What articles have you seen in your local newspaper that might motivate readers to take action? How effective do you think these articles are? As a historian, how would you evaluate these articles as sources?

  3. The report from the Board of Preventable Diseases shows how the state government was asked for help by local doctor. What information might a state board member have that a local doctor might not? What might be an advantage to having someone from "outside" the community come in to evaluate a situation like the smallpox epidemic in Red Wing? Why might having an "outside source" provide his or her opinion NOT be a good thing?

  4. How can the birth and death certificates of a person be useful sources for us as historians? How accurate can we assume them to be? What information could these provide that we might not be able to find anywhere else?

Extending the Lesson: Historical Themes Public Health
You can also use the sources provided on this site to encourage higher-order thinking about a number of historical themes and issues that relate to Public Health in Minnesota. Below are possible activities and discussion starters to extend student application of the content material provided in the sources. The information provided in the sources about Public Health does not give us a comprehensive picture of these issues, but it can serve as an introduction to a theme or as supplementary material to enhance your work with a theme that is already part of your curriculum.

Possible Themes:
Health and your community
Medicine, the medical profession, and public health

Theme One:
Health and your community

Objective:
The student will be able to:

  1. Describe, identify and evaluate ways in which their community works to maintain public health
  2. Define and utilize ways to improve his or her own health
Class Discussion:
Allow students time to discuss these questions in small groups or as a class.

  • List the things in your community that help keep it safe and healthy. What businesses, county departments, and other structures help keep your water, food, and roads safe for your use? What else might be done in your community to make it safer? What can you as a student do to improve safety in your home or neighborhood? Create a list of these safety techniques with the students and post it in the classroom.

  • When students start school in the U.S. they are required to get immunized against a number of childhood diseases. Discuss in class the value of these immunizations and how they help to keep children safe from diseases that could be very dangerous. Ask students if they agree or disagree with requiring immunizations before the start of public school and debate the possible issues on each side.
Optional activities:
  • Have students make their own lists of things they can do to prevent getting ill. These may be things as simple as washing their hands, not sharing hats or gloves or drinking glasses with other students, taking a daily vitamin, or getting plenty of rest. Compare these lists and encourage students to use them to help them prevent illness.

  • Ask students to research public health measures in other countries. They may be able to find magazine or newspaper articles about health issues in developing countries and what measures are taken to prevent the spread of disease. Some of the diseases that are commonly cured or vaccinated against in the U.S. are still deadly and epidemic in some other countries. Ask students to consider what efforts might help other countries with disease prevention and cure.

  • Have students study the ways their community works to promote public health. They might interview public health nurses for information about the programs they provide, or discuss the role of good sanitation in promoting a healthy community. You may wish to have students compare the effectiveness of current methods of disease prevention with methods used in your community in the past.

  • Ask students to research old wives' tales about curing a cold or flu. You might assign one cure to each group. Ask them to evaluate the myth for any basis it might have in fact, its history (often dictionaries of word origins will have this information), how prevalent it seems to be today, and whether or not it might work or be harmful to the patient. Students could present their information on a bulletin board.

Theme Two:
Medicine, the medical profession, and public health

Objectives:
The student will be able to:

  1. Research, evaluate, and describe the role of medical professionals in your community
  2. Describe and compare past medical practices and beliefs to those of today
Class Discussion:

  • Ask students to list on the board common diseases we can now prevent. Discuss what happened to patients who suffered from these diseases before we knew how to prevent them. How were these preventions discovered? Have any of these treatments or prevention efforts affected the lives of those around you (e.g., grandparents or friends who are alive because a disease is now preventable or was diagnosed early enough for treatment)? What role has medical research played in the prevention of such diseases?

Optional activities:

  • Ask students to research a disease or ailment from years past. What was the treatment? Were there any cases in which the treatment did more damage than the disease? Why might that treatment have been chosen at the time (why did doctors think it might work)? What improvements have been made in the treatment of that disease? Have students report to the class.

  • Invite the school nurse to class to discuss what efforts are made in your school for the prevention of illness. You may wish to ask the nurse how these efforts today might be different from efforts that were made 5, 10, 20, years ago in schools.

  • Have students research Board of Health statistics for your state. Discuss which diseases were most prevalent during which time periods and why this might have been true. You may wish to assign each student to a time period or a disease and ask them to prepare a report about how that disease is treated today, or how it was treated in the time period studied.

  • Students can create a classroom museum exhibit describing common diseases and their cures or treatments today. You might include a newspaper article about a new treatment for a disease, an empty aspirin box, a copy of a medical journal, a box of tissues, a can of chicken soup, or a flyer from a charity event to fund research. You may wish to make this a kind of "time capsule" activity and ask students about what they think would change if they were to do this activity again in 10, 25, or 50 years.


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