Miasma theory

"Bad air" redirects here. For the condition of air that does not meet the requirements of one or more biotic species, see Bad air quality.

The miasma theory (also called the miasmatic theory) held that diseases such as cholera, chlamydia or the Black Death were caused by a miasma (Μίασμα, ancient Greek: "pollution"), a noxious form of "bad air".

The miasma theory was accepted from ancient times in Europe, India and China. The theory was eventually displaced in the 19th century by the discovery of germs and the germ theory of disease.

Etymology

The word "miasma" comes from ancient Greek and means "pollution".^[1] The idea of bad air also gave rise to the name malaria through medieval Italian.

Miasma in the West

A representation of the cholera epidemic of the 19th century depicts the spread of the disease in the form of poisonous air.

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 who resided within the particular locale that gave rise to such vapors. It was identifiable by its foul smell.

In India, 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 as the first antimiasmatic application. This gambir tree is found in Southern India and Sri Lanka.^[2] In the 1st century AD, the Roman architectural writer Vitruvius described the potential effects of miasma (Latin nebula) from fetid swamplands when siting a city:

For when the morning breezes blow toward the town at sunrise, if they bring with them mist from marshes and, mingled with the mist, the poisonous breath of creatures of the marshes to be wafted into the bodies of the inhabitants, they will make the site unhealthy.^[3]

The miasmatic theory of disease remained popular in the Middle Ages 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 in London and in Paris, partly justifying Haussmann's latter 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' banks. The wide acceptance of miasma theory during the cholera outbreaks overshadowed the partially correct theory brought forth by John Snow 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 nurse Florence Nightingale (1820–1910),^[4][5][6] 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 [the patient] breathes as pure as the external air."^[7]

Contagionism versus Miasmatism

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.

Dr. Thomas Southwood Smith spent many years comparing the Miasmatic theory to Contagionism.

“

To assume the method of propagation by touch, whether by the person or of infected articles, and to overlook that by the corruption of the air, is at once to increase the real danger, from exposure to noxious effluvia, and to divert attention from the true means of remedy and prevention.

”

Florence Nightingale:

“

The idea of "contagion", as explaining the spread of disease, appears to have been adopted at a time when, from the neglect of sanitary arrangements, epidemics attacked whole masses of people, and when men had ceased to consider that nature had any laws for her guidance. Beginning with the poets and historians, the word finally made its way into scientific nomenclature, where it has remained ever since. . .a satisfactory explanation for pestilence and an adequate excuse for non-exertion to prevent its recurrence.

”

The current germ theory accounts for disease proliferation by both physical and non-physical contact.^[8]

Miasma in China

In China, miasma (Chinese: 瘴氣; pinyin: Zhàngqì; alternate names 瘴毒, 瘴疠) 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, water, and the virgin forest harboring a great environment for miasma to occur.

In the descriptions of 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 caused a lot of diseases such as the cold, influenza, heat strokes, malaria, or dysentery. In the medical history of China, malaria had been referred to by different names in different dynasty periods. Poisoning, psittacosis, and acclimatized were also called miasma in ancient China because they did not accurately understand the cause of the disease.

In Sui dynasty, doctor Tsao Yuan-fung mentioned miasma in his book ^[9] (諸病源候論). He thought that miasma in Southern China is similar with typhoid fever in Northern China. However, in his opinion, miasma is different from malaria and dysentery. In his book, he discussed dysentery in another chapter, and malaria in a single chapter. And he also found that miasma caused different diseases, so he suggested that one should find apt and specific ways to resolve problems.^[10]

The knowing of the concept of miasma can be separated into several steps. First, before Western Jin Dynasty, the concept of miasma was gradually forming; at least, in Eastern Han Dynasty, there was no character of miasma. In Eastern Jin, large amounts of northern people moved toward south, miasma was recognized then in the group of men of letters or nobility. After Sui and Tang Dynasty, scholars-bureaucrats traveled and were sent to be the local officials recorded and investigated the miasma. As a result, the government became concern of the severe causes of the cause of miasma by sending doctors to the area of epidemic to research the disease and heal the patients. In Ming and Qing Dynasty, the edition of the local chronicles record the different miasma in different places.^[11]

The northern boundary of the distribution of miasma were at first Qinling Mountains and Huaihe River in Han Dynasty, then, Daba Mountains and Yangtze River in Sui and Tang Dynasty, and Nanling Mountains in Ming and Qing Dynasty. Nowadays, in 20th century, miasma occurs only in inland mountains in China.^[12]

However, Southern China was highly developed in Ming, Qing Dynasty. The environment changed rapidly, and after 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 fading out of throughout history from the progression of the medicine in China.^[11]

The influence of miasma: sanitary engineering reforms in the West

The theory of miasma disease made sense to the English sanitary reformers of the mid-19th century. Miasma explained why cholera and other diseases were epidemic in places where the water was undrained and very foul-smelling. As sanitary reform’s engineering leader, London’s Edwin Chadwick, put it, “all smell is disease.” The theory led to sanitation improvements, such as preventing the reflux of noxious air from sewers back into houses by separate drainage systems in the sanitation designs, which incidentally led to decreased episodes of cholera, and thus helped to support the theory.^[13]

The miasma theory was consistent with the observations that disease was associated with poor sanitation (and hence foul odours) and that sanitary improvements reduced disease; it was not consistent with the observations of microbiology however, that led to the later germ theory of disease. The introduction of medical bacteriology in the 1870s and 1880s rang miasma’s death knell, but the theory did not die without a struggle. It passed through a long stage of denial, hope for survival being sustained by sewer gas, which was a major component of the miasma theory developed by Galen and brought to prominence by the Great Stink. After all, sewers enclosed the refuse of the human bowel, evacuations that, medical science had discovered, could teem with typhoid, cholera, and other microbes.

Even though later disproven by the influence of bacteria and the discovery of viruses, the miasma theory helped make the connection between poor sanitation and disease. This caused public health reforms and encouraged cleanliness, which led to the legislation of the Parliament, which approved the Public Health Acts^[14] of 1848 and 1858 and the Local Government Act of 1858. The latter of these confers the power of instating investigations into the health and sanitary regulations of any town or place, upon the petition of residents or death rates exceeding the norm. Early medical and sanitary engineering reformers included Henry Austin, Joseph Bazalgette, Edwin Chadwick, Frank Forster, Thomas Hawksley, William Haywood, Henry Letheby, Robert Rawlinson, Sir John Simon and Thomas Wicksteed.^[15] These and later British regulatory improvements were reported in the United States as early as 1865.^[16]

Years later, the influence of these sanitary reforms on Britain was described by Sir Richard Rogers:^[15]

“

London was the first city to create a complex civic administration which could coordinate modern urban services, from public transport to housing, clean water to education. London's County Council was acknowledged as the most progressive metropolitan government in the world. Fifty years earlier, London had been the worst slum city of the industrialized world over-crowded, congested, polluted and ridden with disease…

”

The influence of miasma: 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 Qing-Han Dynasty. Poet Han Yu (韓愈) of the Tang Dynasty, for example, wrote to his nephew who came to see him off after his banishment to the Chao Prefecture in his poem, En Route^[17] (左遷至藍關示姪孫湘):

“

At dawn I sent a single warning to the throne of the Nine Steps; At evening I was banished to Chao Yang, eight thousand leagues. Striving on behalf of a noble dynasty to expel an ignoble government, How should I, withered and worn, deplore my future lot? The clouds gather on Ch'in Mountains, I cannot see my home; The snow bars the passes of Lan, my horse cannot go forward. But I know that you will come from afar, to fulfil your set purpose, And lovingly gather my bones, on the banks of that plague-stricken river.

”

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 (周去非), a local magistrate from the Nan-Sung Dynasty described in his treatise, Representative Answers from the South (嶺外代答): "... The men are short and and tan, while the women were plumb and seldom came down with illness,"^[18] and exclaimed at the populous female population in the GuangXi 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.^[12]

From miasma to germ theory: the debates on Cholera

Although the connection between germ and disease was proposed quite early, it was not until late-1800s that the germ theory was generally accepted. The miasmatic theory was first disproved by John Snow following an epidemic in Soho, central London in 1854.^[19] Because of the miasmatic theory's predominance among Italian scientists, the discovery at the same year by Filippo Pacini of the bacillus that caused the disease was completely ignored, and the bacteria had to be rediscovered thirty years later by Robert Koch.

At 1846, the Nuisances Removal and Diseases Prevention Act^[14] was passed to identify whether the transmission of Cholera is by air or by water. The bill supported the Germ theory, and was used to encourage the owner to clean their dwelling and connect them to sewers.

Some years later in 1855, John Snow made a testimony against the Amendment to this bill that regularize air pollution of some industries. He claimed that:

“

That is possible; but I believe that the poison of the cholera is either swallowed in water, or got directly from some other person in the family, or in the room; I believe it is quite an exception for it to be conveyed in the air; though if the matter gets dry it may be wafted a short distance.[20]

”

At the same year, William Farr, who was then the major supporter of the Miasma Theory, issued a report to criticize the germ theory. Farr and the Committee wrote that:

“

After careful inquiry, we see no reason to adopt this belief. We do not feel it established that the water was contaminated in the manner alleged; nor is there before us any sufficient evidence to show whether inhabitants of that district, drinking from that well, suffered in proportion more than other inhabitants of the district who drank from other sources.[21][22]

”

The more formal experiments on the relationship between germ and disease was conducted by Louis Pasteur between 1860 and 1864. He discovered the pathology of the puerperal fever^[23] and the pyogenic vibrio in the blood, and suggest using boric acid to kill these micro organisms before and after confinement.

By 1866, eight years after the death of John Snow, William Farr publicly acknowledged that the miasma theory on the transmission of cholera was wrong, by his statistics' justification on the death rate.^[21]

See also

• Night air
• Polizeiwissenschaft ("Science of police")
• Germ theory of disease

References

1. ^ Miasma in Webster Dictionary
2. ^ Miasma Analysis
3. ^ Vitruvius, De architectura I.4.1, Latin text at LacusCurtius.
4. ^ BRIEF HISTORY DURING THE SNOW ERA (1813-58)
5. ^ Who was William Farr?
6. ^ Development of the Germ Theory of Disease
7. ^ The Invisible Giant
8. ^ The Invisible Ghost
9. ^ On Pathogen and Syndromes
10. ^ (隋)巢元方撰，曹赤電炳章圈點，《巢氏諸病源候論》，(台北：國立中國醫藥研究所，1996)，頁30、47-51。
11. ^ ^{a b} 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。 [1]
12. ^ ^{a b} 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。
13. ^ James Whorton: West J Med. 2001 December; 175(6): 427–428. “The insidious foe”—sewer gas , [2]
14. ^ ^{a b} the Nuisances Removal and Diseases Prevention Act
15. ^ ^{a b} SULAIR: British and Commonwealth Literary Studies
16. ^ EUROPEAN SANITARY REFORM.; The British Sanitary Legislation, The New York Times, July 31, 1865
17. ^ [3], Translated by Arthur Waley in Chinese Poems.
18. ^ [4], 宋周去非, 嶺外代答, 卷十, 276.
19. ^ http://www.york.ac.uk/depts/maths/histstat/snow_map.htm
20. ^ Snow's Testimony
21. ^ ^{a b} Competing Theories of Cholera
22. ^ Report of the Committee on Scientific. Inquiries in Relation to the Cholera Epidemic
23. ^ On the extension of the germ theory to the etiology of certain common diseases

External links

• Prevailing theories before the germ theory
• Cholera theories
• Term definition