The miasma theory (also called the miasmatic theory) is an
obsolete medical theory that
held
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that
disease
A disease is a particular abnormal condition that negatively affects the structure or function of all or part of an organism, and that is not immediately due to any external injury. Diseases are often known to be medical conditions that a ...
s—such as
cholera
Cholera is an infection of the small intestine by some strains of the bacterium ''Vibrio cholerae''. Symptoms may range from none, to mild, to severe. The classic symptom is large amounts of watery diarrhea that lasts a few days. Vomiting and ...
,
chlamydia
Chlamydia, or more specifically a chlamydia infection, is a sexually transmitted infection caused by the bacterium ''Chlamydia trachomatis''. Most people who are infected have no symptoms. When symptoms do appear they may occur only several wee ...
, or the
Black Death
The Black Death (also known as the Pestilence, the Great Mortality or the Plague) was a bubonic plague pandemic occurring in Western Eurasia and North Africa from 1346 to 1353. It is the most fatal pandemic recorded in human history, causi ...
—were caused by a ''miasma'' (,
Ancient Greek
Ancient Greek includes the forms of the Greek language used in ancient Greece and the ancient world from around 1500 BC to 300 BC. It is often roughly divided into the following periods: Mycenaean Greek (), Dark Ages (), the Archaic peri ...
for 'pollution'), a noxious form of "bad air", also known as night air. The theory held that
epidemics
An epidemic (from Greek ἐπί ''epi'' "upon or above" and δῆμος ''demos'' "people") is the rapid spread of disease to a large number of patients among a given population within an area in a short period of time.
Epidemics of infectious d ...
were caused by miasma, emanating from rotting organic matter. Though
miasma theory is typically associated with the spread of contagious diseases, some academics in the early nineteenth century suggested that the theory extended to
other conditions as well, e.g. one could become obese by inhaling the odor of food.
The miasma theory was advanced by
Hippocrates
Hippocrates of Kos (; grc-gre, Ἱπποκράτης ὁ Κῷος, Hippokrátēs ho Kôios; ), also known as Hippocrates II, was a Greek physician of the classical period who is considered one of the most outstanding figures in the history of ...
in the fourth century B.C. and accepted from ancient times in Europe and China. The theory was eventually abandoned by scientists and physicians after 1880, replaced by the
germ theory of disease
The germ theory of disease is the currently accepted scientific theory for many diseases. It states that microorganisms known as pathogens or "germs" can lead to disease. These small organisms, too small to be seen without magnification, invade h ...
: specific germs, not miasma, caused specific diseases. However, cultural beliefs about getting rid of odor made the clean-up of waste a high priority for cities.
Etymology
The word ''miasma ''comes from ancient Greek and means 'pollution'.
The idea also gave rise to the name
malaria
Malaria is a mosquito-borne infectious disease that affects humans and other animals. Malaria causes symptoms that typically include fever, tiredness, vomiting, and headaches. In severe cases, it can cause jaundice, seizures, coma, or death. S ...
(literally 'bad air') through medieval Italian.
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Miasma was considered to be a poisonous vapor or mist filled with particles from decomposed matter (miasmata) that caused illnesses. The miasmatic position was that diseases were the product of environmental factors such as contaminated water, foul air, and poor hygienic conditions. Such infection was not passed between individuals but would affect individuals within the locale that gave rise to such vapors. It was identifiable by its foul smell. It was also initially believed that miasmas were propagated through worms from ulcers within those affected by a plague.
Europe
In the fifth or fourth century BC, Hippocrates wrote about the effects of the environs over the human diseases:
In the 1st century BC, the Roman architectural writer
Vitruvius
Vitruvius (; c. 80–70 BC – after c. 15 BC) was a Roman architect and engineer during the 1st century BC, known for his multi-volume work entitled ''De architectura''. He originated the idea that all buildings should have three attribute ...
described the potential effects of miasma (
Latin
Latin (, or , ) is a classical language belonging to the Italic branch of the Indo-European languages. Latin was originally a dialect spoken in the lower Tiber area (then known as Latium) around present-day Rome, but through the power of the ...
''nebula'') from fetid swamplands when visiting a city:
The miasmatic theory of disease remained popular in the
Middle Ages
In the history of Europe, the Middle Ages or medieval period lasted approximately from the late 5th to the late 15th centuries, similar to the post-classical period of global history. It began with the fall of the Western Roman Empire a ...
and a sense of ''effluvia'' contributed to Robert Boyle's ''
Suspicions about the Hidden Realities of the Air''.
In the 1850s, miasma was used to explain the spread of
cholera
Cholera is an infection of the small intestine by some strains of the bacterium ''Vibrio cholerae''. Symptoms may range from none, to mild, to severe. The classic symptom is large amounts of watery diarrhea that lasts a few days. Vomiting and ...
in
London
London is the capital and largest city of England and the United Kingdom, with a population of just under 9 million. It stands on the River Thames in south-east England at the head of a estuary down to the North Sea, and has been a majo ...
and in
Paris
Paris () is the capital and most populous city of France, with an estimated population of 2,165,423 residents in 2019 in an area of more than 105 km² (41 sq mi), making it the 30th most densely populated city in the world in 2020. S ...
, partly justifying
Haussmann's later renovation of the French capital. The disease was said to be preventable by cleansing and scouring of the body and items.
Dr. William Farr, the assistant commissioner for the 1851 London census, was an important supporter of the miasma theory. He believed that cholera was transmitted by air, and that there was a deadly concentration of ''miasmata'' near the
River Thames
The River Thames ( ), known alternatively in parts as the The Isis, River Isis, is a river that flows through southern England including London. At , it is the longest river entirely in England and the Longest rivers of the United Kingdom, se ...
' banks. Such a belief was in part accepted because of the general lack of air quality in urbanized areas.
The wide acceptance of miasma theory during the cholera outbreaks overshadowed the partially correct theory brought forth by
John Snow
John Snow (15 March 1813 – 16 June 1858) was an English physician and a leader in the development of anaesthesia and medical hygiene. He is considered one of the founders of modern epidemiology, in part because of his work in tracing the so ...
that cholera was spread through water. This slowed the response to the major outbreaks in the Soho district of London and other areas. The
Crimean War
The Crimean War, , was fought from October 1853 to February 1856 between Russia and an ultimately victorious alliance of the Ottoman Empire, France, the United Kingdom and Piedmont-Sardinia.
Geopolitical causes of the war included the de ...
nurse
Florence Nightingale
Florence Nightingale (; 12 May 1820 – 13 August 1910) was an English Reform movement, social reformer, statistician and the founder of modern nursing. Nightingale came to prominence while serving as a manager and trainer of nurses during t ...
(1820–1910) was a proponent of the theory and worked to make hospitals sanitary and fresh-smelling. It was stated in 'Notes on Nursing for the Labouring Classes' (1860) that Nightingale would "keep the air
he patientbreathes as pure as the external air."
Fear of miasma registered in many early nineteenth-century warnings concerning what was termed "unhealthy fog". The presence of fog was thought to strongly indicate the presence of miasma. The miasmas were thought to behave like smoke or mist, blown with air currents, wafted by winds. It was thought that miasma didn't simply travel on air but changed the air through which it propagated; the atmosphere was infected by miasma, as diseased people were.
China
In China, miasma (; alternative names , ) is an old concept of illness, used extensively by ancient Chinese local chronicles and works of literature. Miasma has different names in Chinese culture. Most of the explanations of miasma refer to it as a kind of sickness, or poison gas.
The ancient Chinese thought that miasma was related to the environment of parts of Southern China. The miasma was thought to be caused by the heat, moisture and the dead air in the Southern Chinese mountains. They thought that insects' waste polluted the air, the fog, and the water, and the virgin forest harbored a great environment for miasma to occur.
In descriptions by ancient travelers, soldiers, or local officials (most of them are men of letters) of the phenomenon of miasma, fog, haze, dust, gas, or poison geological gassing were always mentioned. The miasma was thought to have caused a lot of diseases such as the cold, influenza, heat strokes,
malaria
Malaria is a mosquito-borne infectious disease that affects humans and other animals. Malaria causes symptoms that typically include fever, tiredness, vomiting, and headaches. In severe cases, it can cause jaundice, seizures, coma, or death. S ...
, or dysentery. In the medical history of China, malaria had been referred to by different names in different dynasty periods. Poisoning and
psittacosis were also called miasma in ancient China because they did not accurately understand the cause of disease.
In the
Sui dynasty
The Sui dynasty (, ) was a short-lived imperial dynasty of China that lasted from 581 to 618. The Sui unified the Northern and Southern dynasties, thus ending the long period of division following the fall of the Western Jin dynasty, and layi ...
, doctor
Chao Yuanfang
Chao Yuanfang () was a Chinese physician and medical author who was court physician at the Sui Dynasty (581–618 CE) between the years 605 and 616. Traditionally, he had been attributed the co-authorship or authorship of the Chinese medical clas ...
mentioned miasma in his book ''On Pathogen and Syndromes'' (
諸病源候論). He thought that miasma in Southern China was similar to
typhoid fever
Typhoid fever, also known as typhoid, is a disease caused by '' Salmonella'' serotype Typhi bacteria. Symptoms vary from mild to severe, and usually begin six to 30 days after exposure. Often there is a gradual onset of a high fever over several ...
in Northern China. However, in his opinion, miasma was different from malaria and
dysentery
Dysentery (UK pronunciation: , US: ), historically known as the bloody flux, is a type of gastroenteritis that results in bloody diarrhea. Other symptoms may include fever, abdominal pain, and a feeling of incomplete defecation. Complications ...
. In his book, he discussed dysentery in another chapter, and malaria in a single chapter. He also claimed that miasma caused various diseases, so he suggested that one should find apt and specific ways to resolve problems.
The concept of miasma developed in several stages. First, before the Western
Jin dynasty, the concept of miasma was gradually forming; at least, in the Eastern
Han dynasty
The Han dynasty (, ; ) was an imperial dynasty of China (202 BC – 9 AD, 25–220 AD), established by Liu Bang (Emperor Gao) and ruled by the House of Liu. The dynasty was preceded by the short-lived Qin dynasty (221–207 BC) and a warr ...
, there was no description of miasma. During the Eastern Jin, large numbers of northern people moved south, and miasma was then recognized by men of letters and nobility. After the Sui and the
Tang dynasty
The Tang dynasty (, ; zh, t= ), or Tang Empire, was an Dynasties in Chinese history, imperial dynasty of China that ruled from 618 to 907 AD, with an Zhou dynasty (690–705), interregnum between 690 and 705. It was preceded by the Sui dyn ...
, scholars-bureaucrats sent to be the local officials recorded and investigated miasma. As a result, the government became concerned about the severe cases and the causes of miasma by sending doctors to the areas of epidemic to research the disease and heal the patients. In the
Ming dynasty
The Ming dynasty (), officially the Great Ming, was an Dynasties in Chinese history, imperial dynasty of China, ruling from 1368 to 1644 following the collapse of the Mongol Empire, Mongol-led Yuan dynasty. The Ming dynasty was the last ort ...
and
Qing dynasty
The Qing dynasty ( ), officially the Great Qing,, was a Manchu-led imperial dynasty of China and the last orthodox dynasty in Chinese history. It emerged from the Later Jin dynasty founded by the Jianzhou Jurchens, a Tungusic-speak ...
, versions of local chronicles record different miasma in different places.
[牟重行,王彩萍,〈中國歷史上的「瘴氣」考釋〉,《國立臺灣師範大學地理研究報告》,(第38期,台北:國立臺灣師範大學地理學系,2003),頁25。 ]
However, Southern China was highly developed in the Ming and Qing dynasties. The environment changed rapidly, and after the 19th century, western science and medical knowledge were introduced into China, and people knew how to distinguish and deal with the disease. The concept of miasma therefore faded out due to the progress of medicine in China.
[牟重行,王彩萍,〈中國歷史上的「瘴氣」考釋〉,《國立臺灣師範大學地理研究報告》,(第38期,台北:國立臺灣師範大學地理學系,2003),頁25–26。 ]
Influence in Southern China
The terrifying miasma diseases in the southern regions of China made it the primary location for relegating officials and sending criminals to exile since the Qin-Han Dynasty. Poet
Han Yu
Han Yu (; 76825 December 824), courtesy name Tuizhi (), and commonly known by his posthumous name Han Wengong (韓文公), was a Chinese essayist, poet, philosopher, and politician during the Tang dynasty who significantly influenced the devel ...
() of the
Tang dynasty
The Tang dynasty (, ; zh, t= ), or Tang Empire, was an Dynasties in Chinese history, imperial dynasty of China that ruled from 618 to 907 AD, with an Zhou dynasty (690–705), interregnum between 690 and 705. It was preceded by the Sui dyn ...
, for example, wrote to his nephew who came to see him off after his banishment to the Chao Prefecture in his poem, ''En Route''
左遷至藍關示姪孫湘:
The prevalent belief and predominant fear of the southern region with its "poisonous air and gases" is evident in historical documents.
Similar topics and feelings toward the miasma-infected south are often reflected in early Chinese poetry and records. Most scholars of the time agreed that the geological environments in the south had a direct impact on the population composition and growth. Many historical records reflect that females were less prone to miasma infection, and mortality rates were much higher in the south, especially for the men. This directly influenced agriculture cultivation and the southern economy, as men were the engine of agriculture production. Zhou Qufei (), a local magistrate from the
Southern Song Dynasty
The Song dynasty (; ; 960–1279) was an imperial dynasty of China that began in 960 and lasted until 1279. The dynasty was founded by Emperor Taizu of Song following his usurpation of the throne of the Later Zhou. The Song conquered the rest ...
described in his treatise, ''
Representative Answers from the South'': "... The men are short and tan, while the women were plump and seldom came down with illness," and exclaimed at the populous female population in the
Guangxi
Guangxi (; ; Chinese postal romanization, alternately romanized as Kwanghsi; ; za, Gvangjsih, italics=yes), officially the Guangxi Zhuang Autonomous Region (GZAR), is an Autonomous regions of China, autonomous region of the People's Republic ...
region.
This inherent environmental threat also prevented immigration from other regions. Hence, development in the damp and sultry south was much slower than in the north, where the dynasties' political power resided for much of early Chinese history.
[龔勝生,〈2000年來中國瘴病分布變遷的初步研究〉,《地理學報》,第48卷第4期,(西安:陜西師範大學中國歷史地理研究所,1993),頁305–312。]
India
In
India
India, officially the Republic of India (Hindi: ), is a country in South Asia. It is the seventh-largest country by area, the second-most populous country, and the most populous democracy in the world. Bounded by the Indian Ocean on the so ...
, there was also a miasma theory and the Indians take credit for being the first to put this miasma theory into clinical practice. The Indians invented ''paan'', a gambir paste, that was believed to help prevent miasma; it was considered the first antimiasmatic application. This
gambir tree is found in Southern India and Sri Lanka.
Developments from 19th century onwards
Zymotic theory
Based on
zymotic
Zymotic disease was a 19th-century medical term for acute infectious diseases, especially "chief fevers and contagious diseases (e.g. typhus and typhoid fevers, smallpox, scarlet fever, measles, erysipelas, cholera, whooping-cough, diphtheria, etc. ...
theory, people believed vapors called ''miasmata'' (singular: ''miasma'') rose from the soil and spread diseases. Miasmata were believed to come from rotting vegetation and foul water—especially in
swamp
A swamp is a forested wetland.Keddy, P.A. 2010. Wetland Ecology: Principles and Conservation (2nd edition). Cambridge University Press, Cambridge, UK. 497 p. Swamps are considered to be transition zones because both land and water play a role in ...
s and urban
ghetto
A ghetto, often called ''the'' ghetto, is a part of a city in which members of a minority group live, especially as a result of political, social, legal, environmental or economic pressure. Ghettos are often known for being more impoverished t ...
s.
Many people, especially the weak or infirm, avoided breathing night air by going indoors and keeping windows and doors shut. In addition to ideas associated with zymotic theory, there was also a general fear that cold or cool air spread disease. The fear of night air gradually disappeared as understanding about disease increased as well as with improvements in home heating and ventilation. Particularly important was the understanding that the agent spreading
malaria
Malaria is a mosquito-borne infectious disease that affects humans and other animals. Malaria causes symptoms that typically include fever, tiredness, vomiting, and headaches. In severe cases, it can cause jaundice, seizures, coma, or death. S ...
was the
mosquito
Mosquitoes (or mosquitos) are members of a group of almost 3,600 species of small flies within the family Culicidae (from the Latin ''culex'' meaning " gnat"). The word "mosquito" (formed by ''mosca'' and diminutive ''-ito'') is Spanish for "li ...
(active at night) rather than miasmata.
Contagionism versus miasmatism
Prior to the late 19th century, night air was considered dangerous in most Western cultures. Throughout the 19th century, the medical community was divided on the explanation for disease proliferation. On one side were the contagionists, believing disease was passed through physical contact, while others believed disease was present in the air in the form of miasma, and thus could proliferate without physical contact. Two members of the latter group were Dr. Thomas S. Smith and Florence Nightingale.
Thomas Southwood Smith
Thomas Southwood Smith (17881861) was an English physician and sanitary reformer.
Early life
Smith was born at Martock, Somerset, into a strict Baptist family, his parents being William Smith and Caroline Southwood. In 1802 he won a scholarshi ...
spent many years comparing the miasmatic theory to contagionism.
Florence Nightingale
Florence Nightingale (; 12 May 1820 – 13 August 1910) was an English Reform movement, social reformer, statistician and the founder of modern nursing. Nightingale came to prominence while serving as a manager and trainer of nurses during t ...
:
The current germ theory accounts for disease proliferation by both direct and indirect physical contact.
Influence on sanitary engineering reforms
In the early 19th century, the living conditions in industrialized cities in Britain were increasingly unsanitary. The population was growing at a much faster rate than the infrastructure could support. For example, the population of Manchester doubled within a single decade, leading to overcrowding and a significant increase in waste accumulation.
The miasma theory of disease made sense to the sanitary reformers of the mid-19th century. Miasmas explained why
cholera
Cholera is an infection of the small intestine by some strains of the bacterium ''Vibrio cholerae''. Symptoms may range from none, to mild, to severe. The classic symptom is large amounts of watery diarrhea that lasts a few days. Vomiting and ...
and other diseases were epidemic in places where the water was stagnant and foul-smelling. A leading sanitary reformer, London's
Edwin Chadwick
Sir Edwin Chadwick KCB (24 January 18006 July 1890) was an English social reformer who is noted for his leadership in reforming the Poor Laws in England and instituting major reforms in urban sanitation and public health. A disciple of Uti ...
, asserted that "all smell is disease", and maintained that a fundamental change in the structure of sanitation systems was needed to combat increasing urban mortality rates.
Chadwick saw the problem of cholera and typhoid epidemics as being directly related to urbanization, and he proposed that new, independent sewerage systems should be connected to homes. Chadwick supported his proposal with reports from the
London Statistical Society which showed dramatic increases in both morbidity and mortality rates since the beginning of urbanization in the early 19th century.
Though Chadwick proposed reform on the basis of the miasma theory, his proposals did contribute to improvements in
sanitation
Sanitation refers to public health conditions related to clean drinking water and treatment and disposal of human excreta and sewage. Preventing human contact with feces is part of sanitation, as is hand washing with soap. Sanitation systems ...
, such as preventing the reflux of noxious air from sewers back into houses by using separate drainage systems in the design of sanitation. That led, incidentally, to decreased outbreaks of
cholera
Cholera is an infection of the small intestine by some strains of the bacterium ''Vibrio cholerae''. Symptoms may range from none, to mild, to severe. The classic symptom is large amounts of watery diarrhea that lasts a few days. Vomiting and ...
and thus helped to support the theory.
The miasma theory was consistent with the observation that disease was associated with poor sanitation, and hence foul odours, and that sanitary improvements reduced disease. However, it was inconsistent with the findings arising from
microbiology
Microbiology () is the scientific study of microorganisms, those being unicellular (single cell), multicellular (cell colony), or acellular (lacking cells). Microbiology encompasses numerous sub-disciplines including virology, bacteriology, prot ...
and
bacteriology Bacteriology is the branch and specialty of biology that studies the morphology, ecology, genetics and biochemistry of bacteria as well as many other aspects related to them. This subdivision of microbiology involves the identification, classificat ...
in the later 19th century, which eventually led to the adoption of the
germ theory of disease
The germ theory of disease is the currently accepted scientific theory for many diseases. It states that microorganisms known as pathogens or "germs" can lead to disease. These small organisms, too small to be seen without magnification, invade h ...
, although consensus was not reached immediately. Concerns over
sewer gas
Sewer gas is a complex, generally obnoxious smelling mixture of toxic and nontoxic gases produced and collected in sewage systems by the decomposition of organic household or industrial wastes, typical components of sewage.
Sewer gases may inc ...
, which was a major component of the miasma theory developed by
Galen
Aelius Galenus or Claudius Galenus ( el, Κλαύδιος Γαληνός; September 129 – c. AD 216), often Anglicized as Galen () or Galen of Pergamon, was a Greek physician, surgeon and philosopher in the Roman Empire. Considered to be one of ...
, and brought to prominence by the "
Great Stink
The Great Stink was an event in Central London during July and August 1858 in which the hot weather exacerbated the smell of untreated human waste and industrial effluent that was present on the banks of the River Thames. The problem had bee ...
" in London in the summer of 1858, led proponents of the theory to observe that sewers enclosed the refuse of the human bowel, which medical science had discovered could teem with
typhoid
Typhoid fever, also known as typhoid, is a disease caused by '' Salmonella'' serotype Typhi bacteria. Symptoms vary from mild to severe, and usually begin six to 30 days after exposure. Often there is a gradual onset of a high fever over several ...
, cholera, and other
microbes
A microorganism, or microbe,, ''mikros'', "small") and ''organism'' from the el, ὀργανισμός, ''organismós'', "organism"). It is usually written as a single word but is sometimes hyphenated (''micro-organism''), especially in olde ...
.
In 1846, the Nuisances Removal and Diseases Prevention Act
was passed to identify whether the transmission of cholera was by air or by water. The act was used to encourage owners to clean their dwellings and connect them to sewers.
Even though eventually disproved by the understanding of
bacteria
Bacteria (; singular: bacterium) are ubiquitous, mostly free-living organisms often consisting of one biological cell. They constitute a large domain of prokaryotic microorganisms. Typically a few micrometres in length, bacteria were among ...
and the discovery of
virus
A virus is a submicroscopic infectious agent that replicates only inside the living cells of an organism. Viruses infect all life forms, from animals and plants to microorganisms, including bacteria and archaea.
Since Dmitri Ivanovsky's 1 ...
es, the miasma theory helped establish the connection between poor sanitation and disease. That encouraged cleanliness and spurred public health reforms which, in Britain, led to the Public Health Acts
of 1848 and 1858, and the Local Government Act of 1858. The latter of those enabled the instituting of investigations into the health and sanitary regulations of any town or place, upon the petition of residents or as a result of death rates exceeding the norm. Early medical and sanitary engineering reformers included Henry Austin,
Joseph Bazalgette
Sir Joseph William Bazalgette CB (; 28 March 181915 March 1891) was a 19th-century English civil engineer. As chief engineer of London's Metropolitan Board of Works, his major achievement was the creation (in response to the Great Stink of 1 ...
,
Edwin Chadwick
Sir Edwin Chadwick KCB (24 January 18006 July 1890) was an English social reformer who is noted for his leadership in reforming the Poor Laws in England and instituting major reforms in urban sanitation and public health. A disciple of Uti ...
, Frank Forster,
Thomas Hawksley
Thomas Hawksley ( – ) was an English civil engineer of the 19th century, particularly associated with early water supply and coal gas engineering projects. Hawksley was, with John Frederick Bateman, the leading British water engineer of the ...
,
William Haywood,
Henry Letheby
Henry Letheby (1816 – 28 March 1876) was an English analytical chemist and public health officer.
Early life
Letheby was born at Plymouth, England, in 1816, and studied chemistry at the Royal Cornwall Polytechnic Society. In 1837 he commenc ...
,
Robert Rawlinson
Sir Robert Rawlinson KCB (28 February 1810 – 31 May 1898) was an English engineer and sanitarian.
Early life
He was born at Bristol. His father was a mason and builder at Chorley, Lancashire, and he himself began his engineering educatio ...
,
John Simon,
John Snow
John Snow (15 March 1813 – 16 June 1858) was an English physician and a leader in the development of anaesthesia and medical hygiene. He is considered one of the founders of modern epidemiology, in part because of his work in tracing the so ...
and
Thomas Wicksteed.
Their efforts, and associated British regulatory improvements, were reported in the United States as early as 1865.
Particularly notable in 19th century sanitation reform is the work of Joseph Bazalgette, chief engineer to London's
Metropolitan Board of Works
The Metropolitan Board of Works (MBW) was the principal instrument of local government in a wide area of Middlesex, Surrey, and Kent, defined by the Metropolis Management Act 1855, from December 1855 until the establishment of the London County ...
. Encouraged by the Great Stink, Parliament sanctioned Bazalgette to design and construct a comprehensive system of sewers, which intercepted London's sewage and diverted it away from its water supply. The system helped purify London's water and saved the city from epidemics. In 1866, the last of the three great British cholera
epidemics took hold in a small area of
Whitechapel
Whitechapel is a district in East London and the future administrative centre of the London Borough of Tower Hamlets. It is a part of the East End of London, east of Charing Cross. Part of the historic county of Middlesex, the area formed ...
. However, the area was not yet connected to Bazalgette's system, and the confined area of the epidemic acted as testament to the efficiency of the system's design.
Years later, the influence of those sanitary reforms on Britain was described by
Richard Rogers
Richard George Rogers, Baron Rogers of Riverside (23 July 1933 – 18 December 2021) was a British architect noted for his modernist and Functionalism (architecture), functionalist designs in high-tech architecture. He was a senior partner a ...
:
The miasma theory did contribute to containing disease in urban settlements, but did not allow the adoption of a suitable approach to the reuse of excreta in agriculture.
It was a major factor in the practice of collecting human excreta from urban settlements and reusing them in the surrounding farmland. That type of
resource recovery
Resource recovery is using wastes as an input material to create valuable products as new outputs. The aim is to reduce the amount of waste generated, thereby reducing the need for landfill space, and optimising the values created from waste. Resou ...
scheme was common in major cities in the 19th century before the introduction of sewer-based sanitation systems. Nowadays, the reuse of excreta, when done in a hygienic manner, is known as
ecological sanitation
Ecological sanitation, commonly abbreviated as ecosan (also spelled eco-san or EcoSan), is an approach to sanitation provision which aims to safely reuse excreta in agriculture. It is an approach, rather than a technology or a device which is ch ...
, and is promoted as a way of "closing the loop".
Throughout the 19th century, concern about public health and sanitation, along with the influence of the miasma theory, were reasons for the advocacy of the then-controversial practice of
cremation
Cremation is a method of Disposal of human corpses, final disposition of a Cadaver, dead body through Combustion, burning.
Cremation may serve as a funeral or post-funeral rite and as an alternative to burial. In some countries, including India ...
. If infectious diseases were spread by noxious gases emitted from decaying organic matter, that included decaying corpses. The public health argument for cremation faded with the eclipsing of the miasma theory of disease.
Replacement by germ theory
Although the connection between germ and disease was proposed quite early, it was not until the late 1800s that the germ theory was generally accepted. The miasmatic theory was challenged by
John Snow
John Snow (15 March 1813 – 16 June 1858) was an English physician and a leader in the development of anaesthesia and medical hygiene. He is considered one of the founders of modern epidemiology, in part because of his work in tracing the so ...
, suggesting that there was some means by which the disease was spread via a poison or morbid material (orig: ) in the water. He suggested this before and in response to a cholera epidemic on Broad Street in central
London
London is the capital and largest city of England and the United Kingdom, with a population of just under 9 million. It stands on the River Thames in south-east England at the head of a estuary down to the North Sea, and has been a majo ...
in 1854. Because of the miasmatic theory's predominance among Italian scientists, the discovery in the same year by
Filippo Pacini
Filippo Pacini (25 May 1812 – 9 July 1883) was an Italian anatomist, posthumously famous for isolating the cholera bacterium ''Vibrio cholerae'' in 1854, well before Robert Koch's more widely accepted discoveries 30 years later.
Pacini was born ...
of the
bacillus
''Bacillus'' (Latin "stick") is a genus of Gram-positive, rod-shaped bacteria, a member of the phylum ''Bacillota'', with 266 named species. The term is also used to describe the shape (rod) of other so-shaped bacteria; and the plural ''Bacilli ...
that caused the disease was completely ignored. It was not until 1876 that
Robert Koch
Heinrich Hermann Robert Koch ( , ; 11 December 1843 – 27 May 1910) was a German physician and microbiologist. As the discoverer of the specific causative agents of deadly infectious diseases including tuberculosis, cholera (though the Vibrio ...
proved that the bacterium ''Bacillus anthracis'' caused
anthrax
Anthrax is an infection caused by the bacterium ''Bacillus anthracis''. It can occur in four forms: skin, lungs, intestinal, and injection. Symptom onset occurs between one day and more than two months after the infection is contracted. The sk ...
, which brought a definitive end to miasma theory.
1854 Broad Street cholera outbreak
The work of
John Snow
John Snow (15 March 1813 – 16 June 1858) was an English physician and a leader in the development of anaesthesia and medical hygiene. He is considered one of the founders of modern epidemiology, in part because of his work in tracing the so ...
is notable for helping to make the connection between cholera and typhoid epidemics and contaminated water sources, which contributed to the eventual demise of miasma theory. During the
cholera epidemic of 1854, Snow traced high mortality rates among the citizens of
Soho
Soho is an area of the City of Westminster, part of the West End of London. Originally a fashionable district for the aristocracy, it has been one of the main entertainment districts in the capital since the 19th century.
The area was develop ...
to a water pump in
Broad Street. Snow convinced the local government to remove the pump handle, which resulted in a marked decrease in cases of cholera in the area. In 1857, Snow submitted a paper to the
British Medical Journal
''The BMJ'' is a weekly peer-reviewed medical trade journal, published by the trade union the British Medical Association (BMA). ''The BMJ'' has editorial freedom from the BMA. It is one of the world's oldest general medical journals. Origi ...
which attributed high numbers of cholera cases to water sources that were contaminated with human waste. Snow used statistical data to show that citizens who received their water from upstream sources were considerably less likely to develop cholera than those who received their water from downstream sources. Though his research supported his hypothesis that contaminated water, not foul air, was the source of cholera
epidemics, a review committee concluded that Snow's findings were not significant enough to warrant change, and they were summarily dismissed. Additionally, other interests intervened in the process of reform. Many water companies and civic authorities pumped water directly from contaminated sources such as the Thames to public wells, and the idea of changing sources or implementing filtration techniques was an unattractive economic prospect. In the face of such economic interests, reform was slow to be adopted.
In 1855,
John Snow
John Snow (15 March 1813 – 16 June 1858) was an English physician and a leader in the development of anaesthesia and medical hygiene. He is considered one of the founders of modern epidemiology, in part because of his work in tracing the so ...
made a testimony against the Amendment to the "Nuisances Removal and Diseases Prevention Act" that regularized air pollution of some industries. He claimed that:
In the same year,
William Farr
William Farr CB (30 November 1807 – 14 April 1883) was a British epidemiologist, regarded as one of the founders of medical statistics.
Early life
William Farr was born in Kenley, Shropshire, to poor parents. He was effectively adopted by ...
, who was then the major supporter of the miasma theory, issued a report to criticize the germ theory. Farr and the Committee wrote that:
Experiments by Louis Pasteur
The more formal experiments on the relationship between germ and disease were conducted by
Louis Pasteur
Louis Pasteur (, ; 27 December 1822 – 28 September 1895) was a French chemist and microbiologist renowned for his discoveries of the principles of vaccination, microbial fermentation and pasteurization, the latter of which was named afte ...
between 1860 and 1864. He discovered the pathology of the
puerperal fever
Postpartum infections, also known as childbed fever and puerperal fever, are any bacterial infections of the female reproductive tract following childbirth or miscarriage. Signs and symptoms usually include a fever greater than , chills, lower ab ...
and the pyogenic vibrio in the blood, and suggested using
boric acid
Boric acid, more specifically orthoboric acid, is a compound of boron, oxygen, and hydrogen with formula . It may also be called hydrogen borate or boracic acid. It is usually encountered as colorless crystals or a white powder, that dissolves ...
to kill these microorganisms before and after confinement.
By 1866, eight years after the death of John Snow,
William Farr
William Farr CB (30 November 1807 – 14 April 1883) was a British epidemiologist, regarded as one of the founders of medical statistics.
Early life
William Farr was born in Kenley, Shropshire, to poor parents. He was effectively adopted by ...
publicly acknowledged that the miasma theory on the transmission of cholera was wrong, by his statistical justification on the death rate.
Anthrax
Robert Koch is widely known for his work with
anthrax
Anthrax is an infection caused by the bacterium ''Bacillus anthracis''. It can occur in four forms: skin, lungs, intestinal, and injection. Symptom onset occurs between one day and more than two months after the infection is contracted. The sk ...
, discovering the causative agent of the fatal disease to be ''
Bacillus anthracis
''Bacillus anthracis'' is a gram-positive and rod-shaped bacterium that causes anthrax, a deadly disease to livestock and, occasionally, to humans. It is the only permanent ( obligate) pathogen within the genus ''Bacillus''. Its infection is a ...
''.
He published the discovery in a booklet as (''The Etiology of Anthrax Disease, Based on the Developmental History of Bacillus Anthracis'') in 1876 while working in Wöllstein. His publication in 1877 on the structure of anthrax bacterium
marked the first photography of a bacterium.
He discovered the formation of
spores
In biology, a spore is a unit of sexual or asexual reproduction that may be adapted for dispersal and for survival, often for extended periods of time, in unfavourable conditions. Spores form part of the life cycles of many plants, algae, f ...
in anthrax bacteria, which could remain dormant under specific conditions.
["Heinrich Hermann Robert Koch." ''World of Scientific Discovery.'' Gale, 2006. Biography in Context. Web. 14 April 2013.] However, under optimal conditions, the spores were activated and caused disease.
To determine this causative agent, he dry-fixed bacterial cultures onto glass slides, used dyes to stain the cultures, and observed them through a microscope.
["Robert Koch." ''World of Microbiology and Immunology.'' Ed. Brenda Wilmoth Lerner and K. Lee Lerner. Detroit: Gale, 2006. Biography in Context. Web. 14 April 2013.] His work with anthrax is notable in that he was the first to link a specific microorganism with a specific disease, rejecting the idea of
spontaneous generation
Spontaneous generation is a superseded scientific theory that held that living creatures could arise from nonliving matter and that such processes were commonplace and regular. It was hypothesized that certain forms, such as fleas, could arise fr ...
and supporting the
germ theory of disease
The germ theory of disease is the currently accepted scientific theory for many diseases. It states that microorganisms known as pathogens or "germs" can lead to disease. These small organisms, too small to be seen without magnification, invade h ...
.
["Germ theory of disease." ''World of Microbiology and Immunology.'' Ed. Brenda Wilmoth Lerner and K. Lee Lerner. Detroit: Gale, 2007. Biography in Context. Web. 14 April 2013.]
In popular culture
*In ''
Inuyasha
is a Japanese manga series written and illustrated by Rumiko Takahashi. It was serialized in Shogakukan's ''shōnen'' manga magazine ''Weekly Shōnen Sunday'' from November 1996 to June 2008, with its chapters collected in fifty-six '' ...
'', Naraku has the power of the miasma.
*In ''
Inuyasha the Movie: Swords of an Honorable Ruler'', as Sō'unga killed it the ogres, and according to Saya their corpses contained the miasma.
*In Episode 44 of ''
Yashahime: Princess Half-Demon'', the Grim Comet has the miasma.
*The video game ''
Dwarf Fortress
''Dwarf Fortress'' (officially called ''Slaves to Armok: God of Blood Chapter II: Dwarf Fortress'') is a construction and management simulation and roguelike indie video game created by Bay 12 Games. Available as freeware and in development sin ...
'' features miasma as a literal fog that emerges from rotten items and corpses. It reduces the happiness of the dwarves, though it doesn't necessarily cause them to fall ill.
See also
*
Germ theory of disease
The germ theory of disease is the currently accepted scientific theory for many diseases. It states that microorganisms known as pathogens or "germs" can lead to disease. These small organisms, too small to be seen without magnification, invade h ...
*
Airborne disease
Airborne or aerosol transmission is transmission of an infectious disease through small particles suspended in the air. Infectious diseases capable of airborne transmission include many of considerable importance both in human and veterinary ...
*
Homeopathy
Homeopathy or homoeopathy is a pseudoscientific system of alternative medicine. It was conceived in 1796 by the German physician Samuel Hahnemann. Its practitioners, called homeopaths, believe that a substance that causes symptoms of a dis ...
References
Further reading
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External links
Prevailing theories before the germ theoryTerm definition
{{DEFAULTSORT:Miasma Theory Of Disease
Obsolete medical theories
Superstitions
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