History of Miasma Theory

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People have tried to explain the cause of diseases so as to cure and prevent them from the very beginning of human history. Some explanations were pretty superstitious and absurd, such as demonic possession or the wrath of a god. Other explanations, such as miasma theory, were plausible and were accepted for a long time before modern discoveries of microbes made them obsolete. Miasma theory was the prevailing belief that bad airs, noxious odors, ulcers, and “foul” animals, especially those connected with decaying matter, caused disease.[1] Though we moderns may find miasma theory primitive or ridiculous keep in mind that it made sense to people without microscopes, who drew the connection between decay and poor hygiene to disease.

Europeans accepted miasma theory since antiquity. The Greek physician Hippocrates believed that bad air caused pestilence, even calling bad air a pestilence itself.[2] The Roman architect Vitruvius held similar beliefs, which were expanded upon since Hippocrates by future physicians such as Galen. He wrote in his book On Architecture that neighborhoods in marshy places should be avoided as their mists fogs, fused with the breaths of swamp animals, will spread throughout the city, causing disease. He suggested the best places to erect city walls would be on high ground to avoid fogs and rains as long as the temperature was not extremely hot or cold.[3]

Miasma theory held well into the Middle Ages and was even popular in Asia. Medieval writers often corrupted or putrefied air as the cause of disease. Spanish physician Jacme d’Agramont in his “plague tract”, or pamphlet to educate the general public about diseases states that most diseases came from “corrupt air” and elaborates on various types of air and the different ways they become corrupted.[4] He advises his readers to use fragrances and incense to negate the foul air and take away its stench.[5] Like his Greek and Roman predecessors, d’Agramont blamed swamps, marshes, and southern winds for bad air causing disease.[6]

Interestingly, ancient China had similar explanations for disease. They believed disease was caused by poisonous gasses coming from parts of Southern China, specifically by the humid, dead air from the Southern Chinese Mountains.[7] Fear of Southern Chinese marshes deeply influenced Chinese society and history. The Chinese government often banished criminals and other exiles there.[8] Fewer Chinese people immigrated to the south because of their fear, which halted the development of Southern China. Thus, dynasties resided in Northern China for much of early China’s history.[9]

Miasma theory remained popular in Europe late into the 19th century. Though miasma theory was eventually proven false it spurred city reformers, who saw the connection between poor sanitation in city slums and disease, to clean up the city and improve city infrastructure. For example, reformers improved the city’s sewers by building separate drainage systems for houses, separating waste from the rest of the water supply. The reform prevented noxious gases leaking into homes, decreasing episodes of cholera, which led credence to miasma theory.[10]

Politicians, public servants, and reformers, especially those from New York City and Paris, made great efforts to change their cities. Through the Public Health Acts of 1848 and 1858 and the Local Government Act of 1858, Parliament licensed investigations of cities’ sanity regulations. Investigators searched into “the causes of infant mortality, the density of population, condition of sewage, sickness of cattle, and the causes of disease and death throughout the kingdom”. Inspectors were given the warrant to enter homes if they suspected a “nuisance” to exist. If inspectors declared a house unsanitary, they evacuated the inhabitants until they cleaned the house up.

If gases escaped into drains or people’s water supply, proprietors were fined £200. If a person who sold or gave food made it dirty, unfit for human use, the inspector would seize it and charge the owner £10 for each defective item. Keep in mind that money in England had a much greater value in the 19th century than in the 21st. Adjusted for inflation the fines for gases were about £19,000 while fines for bad food were about £960 for each item. (That is about $29,491 and $1,490 respectively.) Health Officers, recognizing that density reduced sanitation, recommended 500 cubic feet for each adult and 300 cubic feet for each child. Apartment tenants were fined if they threw water, furniture, foul liquid or waste, out of the window instead of disposing of them properly. Inspectors even had the power to burn people’s clothes that were considered infected by disease.[11]

Eventually, miasma theory was challenged by the emerging germ theory in the late 19th century. The English physician John Snow challenged miasma theory by proposing that a contaminating substance in the water supply, not in the air caused disease, especially regarding the cholera outbreak in London in 1854. He argued that the molecular changes in the materies morbi, the matter with the disease, were similar to those of the molecules of plants and animals. Furthermore, the molecules behaved exactly like animal and plant matter in that it multiplied its own kind. He even argued that the matter went through periods of incubation after being introduced to an animal. The matter would lay dormant to reproduce more of its kind before attacking the animal, beginning the illness.[12]

Snow’s theory was not unprecedented. The Italian anatomist, Fillipo Pacini, discovered the vibrio cholera, the bacterium that caused the London cholera outbreak the same year. Unfortunately, since so many people believed in miasma theory, his discovery was ignored.[13] The English epidemiologist, William Farr, a big supporter of Miasma Theory at the time, rejected Snow’s theory. He reasoned there was not enough evidence to support the idea that microbes contaminated the water supply. He also stated that the people who drank from the contaminated water supply did not suffer from disease in any greater proportion than the people who drank from other supplies. However, in 1866, eight years after Snow’s death, Farr acknowledged miasma theory was wrong by using statistics on London’s death rate.[14]

The French chemist and microbiologist Louis Pasteur and the German physician and microbiologist Robert Koch would also vindicate Snow and Pacini. Between 1860 and 1864 Pasteur examined a woman seriously infected with puerperal fever. He took a culture from the woman’s lochia, discovering it was fetid with microbes. After the woman’s death he conducted on autopsy on her corpse, drawing samples from her body’s veins, cervical mucus, and uterine mucus, identifying in each sample the same organisms as in the lochia.[15]

In 1876 Robert Koch, building on Pasteur’s work on germ theory, proved that the bacterium bacillus anthracis caused anthrax. He extracted the anthrax bacterium from sheep that died from anthrax and injected them in mice, all of which caught anthrax and died. He repeated the process with over twenty generations of mice to confirm his hypothesis. By improving methods of growing and staining bacteria cultures, Koch identified the bacteria that caused tuberculosis and cholera as well.[16] With his discoveries Koch put the death knell on miasma theory once and for all.

Works Cited

“Competing Theories of Cholera.” UCLA Department of Epidemology, n.d. Web. 20 Sept. 2015.

“Robert Koch (1843-1910).” Science Museum, n.d. Web. 20 Sept. 2015.

d’Agramont, Jacme. 1348. Regimen of Protection Against Epidemics or Pestilence and Mortality. Lerida, Spain. Translated by M. L. Duran-Reynals and C.-E. A. Winslow. Bulletin of the History of Medicine, 23 (1949)

Byrne, Joseph P. 2004. The Black Death. Westport, CT: Greenwood Press

C.L.B. “EUROPEAN SANITARY REFORM; The British Sanitary Legislation.” http://www.nytimes.com/1865/07/31/news/european-sanitary-reform-the-british-sanitary-legislation.html?pagewanted=1. Originally published, July 1865. The New York Times Company, Web. 2015

Fang, Chao Yuan essays, “Nested Treated Patients” (Taipei: National Institute of Chinese Medicine, 1996), pg. 30,47-51

Gongsheng Sheng, “Geographical Journal”, vol. 48 No. 4, (Xi’an: Shaanxi Normal University Institute of Geography, Chinese History, 1993), Medical Faculty of the University of Paris. 1348/2004. Compendium de epidemia, Book 2. Translated by Jeffrey Williams. In The Black Death, by Joseph P. Byrne. Westport, CT: Greenwood Press: 160.

Vitruvius, De Architectura, http://penelope.uchicago.edu/Thayer/L/Roman/Texts/
Vitruvius/1*.html#4.1

Snow, John. On Continuous Molecular Changes, More Particularly in Their Relation to Epidemic Diseases. Originally published Mar. 1853. The John Snow Archive and Research Companion. Web. Sept. 2015.

Waley, Arthur and Ching, Shih trans. Chinese Poems. Londen: Lowe Bros., 1916. Print.

Whorton, James. ““The Insidious Foe”—sewer Gas.” Western Journal of Medicine. Copyright 2001 BMJ Publishing Group, Dec. 2001. Web. 20 Sept. 2015.

[1] L Demaitre, ‘Air, miasma and contagion – Epidemics in antiquity and the Middle Ages’, Bulletin of the History of Medicine, 78/2 (2004), pg. 466-468
[2] Byrne, Joseph P. 2004. The Black Death. Westport, CT: Greenwood Press, pg. 42
[3] Vitruvius, De Architectura I.4.1

[4] d’Agramont, Jacme. 1348. Regimen of Protection Against Epidemics or Pestilence and Mortality. Lerida, Spain. Translated by M. L. Duran-Reynals and C.-E. A. Winslow. Bulletin of the History of Medicine, 23 (1949) pg. 57-89
[5] Medical Faculty of the University of Paris. 1348/2004. Compendium de epidemia, Book 2. Translated by Jeffrey Williams. In The Black Death, by Joseph P. Byrne. Westport, CT: Greenwood Press, pg. 160
[6] Duran-Reynolds and Winslow, pg. 757
[7] Fang, Chao Yuan essays, “Nested Treated Patients” (Taipei: National Institute of Chinese Medicine, 1996), pg. 30,47-51
[8] Waley, Arthur and Ching, Shih trans. Chinese Poems. Londen: Lowe Bros., 1916. Print. pg. 1
[9] Gongsheng Sheng, “Geographical Journal”, vol. 48 No. 4, (Xi’an: Shaanxi Normal University Institute of Geography, Chinese History, 1993), pg. 305-312

[10] Whorton, James. ““The Insidious Foe”—sewer Gas.” Western Journal of Medicine. Copyright 2001 BMJ Publishing Group, Dec. 2001. Web. 20 Sept. 2015.
[11] C.L.B. “EUROPEAN SANITARY REFORM; The British Sanitary Legislation.” http://www.nytimes.com/1865/07/31/news/european-sanitary-reform-the-british-sanitary-legislation.html?pagewanted=1. Originally published, July 1865. The New York Times Company, Web. 2015
[12] Snow, John. On Continuous Molecular Changes, More Particularly in Their Relation to Epidemic Diseases. Originally published Mar. 1853. The John Snow Archive and Research Companion. Web. Sept. 2015.
[13] Pacini, Fillipo “Osservazioni microscopiche e deduzioni patologiche sul cholera asiatico” (Microscopic observations and pathological deductions on Asiatic cholera), Gazzetta Medica Italiana: Toscana, 2nd series, 4(50). Originally published 1854. pg. 397-401 ; 4(51): 405-412.

[14] “Competing Theories of Cholera.” UCLA Department of Epidemology, n.d. Web. 20 Sept. 2015.
[15] Pasteur, Louis. Trans. Ernst, H.C., M.D. On the Extension of the Germ Theory to the Etiology of Certain Common Diseases. U of Adelaide Library, 2009. Print.
[16] “Robert Koch (1843-1910).” Science Museum, n.d. Web. 20 Sept. 2015.

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