Miasma Theory and the Evil Air

asthma theory, which this is. This is something that has has long fascinated me just as a if nothing else, just as an idea that I'm just struck by this vision of bad air rising up out of some Gothic cemetery and uh, and in fearful humans running for their lives to avoid that air touching them and turning them

into Google's or something. You know. Yeah, So, if you're not familiar with this, uh, this long running hypothesis in human history, I think we should set the scene for you at the time of the Black Death in Europe. All right, let's go there, Okay, bring bring them out. So in the late thirteen forties, the first outbreak of the Black Death fell on Europe, and it was I think we can say, without a doubt the greatest human

disaster that had ever come to the continent, right. Uh. Somewhere between a third and two thirds of the entire population died. Communities and entire towns were depopulated. People didn't know what to do with all of the dead and dying people around them, And perhaps the worst part was

nobody knew what caused it. Now, when we have a you know, a pandemic, at least we can we feel like we have some sense of control, you know, I mean, just many people can still die from pandemics, but you can understand, Okay, there there is an organism causing this disease. Maybe medical science can do something about it. We're working

on the problem. But at the time, you just you had a limited understanding of how us a disease work, and beyond that you would have to term to supernatural explanations or perhaps the appearance of of knotted rats in the ruins of the house, that sort of thing. Yeah, you know, Actually, what might be worse than people not knowing what caused the plague was that many people thought

they knew, and almost all of them were wrong. A little knowledge is a dangerous thing, right, Yeah, So, as you might expect, some people simply chalk the disease up

to magical punishments sent by God. So in thirteen forty nine, Archbishop Zusch of York wrote an open letter to his diocese that read as follows quote, there can be no one who does not know, since it is now public knowledge, how great mortality, pestilence, and infection of the air are now threatening various parts of the world, and especially England. And this is surely caused by the sins of men who, while enjoying good times, forget that such things are the

gifts of the most high giver. Now, one could be optimistic and say, well, we don't think that anymore, but I still see frequent eclips from television shows of of of individuals speaking to their congregation, for instance, and saying, oh, well, clearly this is because of our sin, either this disease outbreak or this natural disaster. Clearly this is the reason that we are suffering. But that's kind of a side tension. Now. I think you're going to have two persistent facts throughout

history and continuing into the future. One is the fact that you know, great calamities befall humankind, and the other is the fact that people are always doing something that other people don't like, and so anytime people can connect

the two, they're gonna try, right. And then also this this comment, this this confusion of teleological explanations and causitive explanations, right, trying to explain why this happened, why this, uh, this, this calamity occurred based on a cause and effect scenario, and then also trying to work it into your worldview in which there is some sort of divine infrastructure in place. Yeah. But then, of course, even at the time you had some people who tried to come in with their idea

of a scientific explanation. They wanted to get to the root cause, right. So in thirteen forty eight, King Philip the sixth of France wanted to get to the bottom of what was causing the terrible disaster. So he gathered the most learned scholars of the medical faculty of the University of Paris, and he charged them with explaining the origins of the great death and coming up with solutions to fight it. They came back to him with an answer.

On March twenty five, at about one o'clock in the afternoon, something crucial and devastating had happened Mars Jupiter and Saturn all lined up in conjunction within the House of Aquarius, and this event heralded exactly what France was undergoing at the time, because the conjunction of Jupiter and Saturn was known to cause death and calamity. The conjunction of Jupiter and Mars was known to bring a pestilence on the wind, and here you were getting both conjunctions at the same time.

In the words of the historian Old Age Jurgen Benedicto in his book The Black Death thirteen to thirteen fifty three quote. In this astrological theory of epidemiology, Jupiter was assumed to be warm and humid and to draw malignant vapors both from the ground and from water, while Mars was assumed to be hot and dry and therefore had the capacity to kindle such malignant vapors into infective fire.

So they're postulating a cause and effect. The planets lined up, and that did something to the Earth that caused these infective vapors to appear, and this was what was causing the plague. Uh so so so basically situations were astrologically just right to draw some sort of disease causing vapor out of the bowels the Earth. Right, So notice how under this theory there's really not much you can do to stop the spread of the disease. Yeah, you can't

change the the movement of the spheres. That can't eradicate the sickness living in the earth. You just left to suffer whatever occurs. Yeah, this is even worse than like the theological judgment, right, because at least in that case you'd think, well, maybe we can pray and petition God to not do this to us anymore. Right, you can appeal to God, you can't appeal to the clockwork movements of the of the solar system. Right. It is a

is a pitiless astrological verdict. But but also despite being a death by pure active fate, Benedictive notes that since this theory entailed the more proximate cause of the disease to be something more in the form of malignant vapors rather than just straight up curse from God, some thought that they could help avoid the disease by avoiding those

malignant vapors. So, like the planets cause the Earth to release malignant vapors, or release malignant vapors on the Earth, So if you can just avoid breathing this stuff in or being exposed to it, then you can avoid the plague. So just don't go to places where they're bad smells, and therefore you might avoid the particular bad smells that

cause disease. Yes, and so this was a thing that you see throughout history, the linking of disease with foul smelling objects and things like filth and rotting organic matter, which in itself, this kind of avoidance behavior may have sometimes helped people avoid infection, though not necessarily for the reasons they believed. Now, of course, we know today that the Black Death was caused by infectious disease caused by germs.

In fact, there is actually still an interesting debate. Almost all scientists, I think, agree that the Black Death was caused by bubonic plague or your Cinea pestis, but there have been some rival hypotheses in the past few decades that it was something else, like maybe some kind of viral hemorrhagic fever. Uh, and that topic might be worth a look on its own for a different episodes. And yeah,

well there's always room to discuss more death. But the confusion over the cause of the outbreak contu it really it caused this sense of horror and despair, and many writers of the time, like Petrarch has all this great plague poetry is just about like, oh, how much worse can things get? Is just going on and on lamenting. I don't know why I sound like that, Like I'm like calling him out for lamenting the plague. I mean

the plague was really awful. Uh, there there was sometimes there were more bodies than anybody could figure out where to put them, and so like to bring out your dead scenario is literally mirroring things that happened in the past. But I want to take you to another setting during the Black Death of the forties, that of Catholic Pope Clement the Six, who was living in Avignon at the time. Now you might wonder, wait a minute, why is the Pope living in Avignon. Shouldn't he be, you know, at

the Vatican. Shouldn't be at Rome For some complicated political reasons having to do with the French monarchy. There were several popes in the fourteenth century who lived in Avignon, and so he so Pope Clement the Six was pope from thirteen forty two until his death in thirteen fifty two, which means he was pope when the first large outbreak of black death hit hit Europe in thirteen forty eight, and he was notable for granting remission of sins to

those who died of the plague. But he himself survived the plague. So what did he do? Well? Clement consulted his surgeons and he wanted to know what's what's what's the plan? Okay, give me a strategy. And because many experts believed the bad air was to blame, they recommended, for example, fleeing to the mountains or somewhere else with pure air. But if you're pope, you can't just run

off in the wilderness, can you. So instead, on the advice of his surgeons, Clement barricaded himself inside his palace in Avignon and sat surrounded by torches and fires, constantly burning fires under the belief that fire would somehow clear en or purify the air. It would get these bad vapors out of it. And whether or not the method had anything to do with it, Clement survived the plague. Huh. And it's kind of ironic to given that the first

bit of advice go into the middle of nowhere. It's probably pretty good advice as well, assuming that this was was definitely a case of ubonic plague, that it was the fleas on rats that are living in a cramped urban environment. Yeah, it would make sense to become a

hermit pope in the woods. But I love this idea that this is an amazing image the Pope of Fire, the hermit Pope of fire, barricaded in his castle, surrounded by fire at all times, sitting locked in this flaming court because he's essentially making his court mars right, his his his his environment is the mars that is burning away the vapors that would otherwise invade his, his abode,

and his body. Yeah, So for the rest of the episode today, we're going to be exploring this idea of the mi asthma hypothesis, or as it's often called, me asthma theory. We just recently had some discussions online about use of the word theory and hypothesis, so I'm sure it's not possible to to do it always right here, but but it's often called me asthma theory, even though it's not a very well evidence theory. All right, well,

let's let's let's jump into the ne asthma. Let us allow the mi asthma to roll over us and and hopefully it won't turn us inside out or anything. Okay, oh yeah, that fog. Just one sniff of that fog and your inside out. You know, I could, I couldn't help, but think of our various fictions about fogs that turn you inside out, or or fogs that contain either space monsters or pirate zombies. Uh. We have a lot of interesting cultural ideas about the dangers of of strange gaseous

bodies moving into our habitats. Well, there are good reasons to be afraid of fog, well, some types of fog. I mean, there was like the Great smog that killed so many people in London. That's just through you know, breathing bad particulates and stuff. But also of course it's a driving hazard and all that. I guess these are features of the modern world, not that's the medieval world.

And if we're talking about the modern world, you also have to consider the Great War, World War One, in which we weaponized various gaseous agents, mastering this chemistry of death, uh, to to create a very real sort of miasma that would roll in and just feel you're dead in horrific ways. It's almost like, right after miasthma theory became obsolete, we started actually creating real miasmas. But we're getting ahead of

ourselves here. So going back to history, throughout much of history, especially in the medieval period through like the mid nineteenth century in Europe, many supposed experts were absolutely convinced that the cause of the spread of disease was not tiny organisms, not germs, but the inhalation of something called night air or just bad air. There are million different names for it, the miasma containing the MIAs mata, so it was known as the miasma theory of disease, miasma coming from a

Greek word that means to soil, corrupt, or pollute. Yeah, and this was this was a cornerstone. This is this wasn't just like popular idea of the time. This was the cornerstone upon which a lot of additional understanding of the natural world was based. Yeah, this is what many experts believed. And the idea was so influential in the history of epidemiology and study of disease that it still

lingers in some of our modern terminology. Like think about the roots of the word malaria, mal meaning bad area, meaning air. The word malaria is made right out of the concept that the disease was caused by being exposed to certain types of air. Now, of course, we know today that malaria is a protozoan parasite. It's spread by

mosquito bites, it gets in the blood. In fact, Charles Louis Alphonse lave Iran, the French physician who discovered the fact that malaria was caused by a parasitic organism in the blood, hated the word malaria, which in light of his discoveries, he considered to be totally an unscientific word that you shouldn't use. Instead, he liked the term palludism, meaning that's from Latin palace meaning swamp or marsh, making it something means something more like marsh disease or swamp syndrome.

And in fact paludisma is still the French word for the disease. It's at least a local victory for him on that front. Yeah, but here we are still like propagating mi asthma theory every time we say malaria. But some scholars believe the bad air, So like, where did

the bad air come from? We've heard the idea that it was astrological forces in the heavens, but there was also this idea that the bad air lay inside the earth, or in the soil or in the water, and they thought it could be released by volcanic eruptions or earthquakes

or other types of things. In fact, there's a great passage where Shakespeare writes about the astrological version of the of the Miasma and troy Less and Cressida, where he says, quote a planetary plague, when Jove, meaning the planet Jupiter, will or some high vised city hang his poison in the sick air, when the planets an evil mixture to disorder? Wander what plagues? What portents? What mutiny? What raging of

the sea? Shaking of earth? Commotion in the winds, frights, changes, horrors, diverting, crack, rend and derascinate the unity and married calm of states quite from their fixture. It's a total unity of destructive forces here, right, So he's combining this kind of like political chaos and disruption with the idea that the planet Jupiter will do something to the air to put vapors

in it and poison people and bring plagues. But the most common version we see throughout his story is not so much the idea that it's something deep in the earth that gets released or something that gets you know, poorted down from the sky from Jupiter or Mars, or Jupiter Mars interacting, but it's the idea that the particles in the air, the miasma, are caused by decay, it's decomposition.

Any rotting or decomposing organic matter was believed by miasma theorist to release these tiny particles of pollution or miasmata, which could be identified by the presence of a foul smell.

In fact, this idea was so influential that there were places where there was this miasthma that informed things like where you would put cities like the first century BC Roman architect Vitruvius wrote a treatise on architecture, including a section on how to site the founding of a new town, and he took miasma theory into consideration as a public health concern when thinking about where you should put your towns.

He wrote, quote in setting out the walls of a city, the choice of a healthy situation is of the first importance. It should be on high ground, neither subject to fogs nor rains. Its aspects should be neither violently hot nor

intensely cold, but temperate. In both respects. The neighborhood of a marshy place must be avoided, for in such a sight, the morning air uniting with the fogs that rise in the neighborhood will reach the city with the rising sun, and these fogs and mists, charged with the exhalation of the finny animals, will diffuse and unwholesome effluvia over the bodies of the inhabitants and render the place pestilent. Well

that's just common sense. But again we given the idea that this was a kind of a corner stone understanding of the world, and you can definitely see. I mean, even even Lavaron wanted it to be called wanted malaria to be called something like marsh sickness or swamp disease, not because he thought it was caused by bad air coming off the swamps, but knew that it was. You know where these mosquitoes that delivered the disease dwell that it is most likely to infect you. So there they

were identifying some kind of relevant factors there. It is probably good if you are taking public health into consideration, not to build your city in a swamp or next to a marsh where it's going to be having all these mosquitoes come in to give you the marsh fever, but they didn't have the mechanism correctly identified. All right, on that note, we're gonna take a quick break, and when we come back, we're going to continue to discuss the history of my asthma theory. Thank alright, we're back.

So I wonder if mi asthma beliefs might be older than history itself, because you find me asthma type writings when you go way back into history, it seemed like it was already established this idea that certain types of air and vapors caused diseases. Like around four b C. The Greek physician Hippocrates was writing about malaria, which was, as we've said, was already you know, named after bad air uh, and it was known by many different names back then, such as like the marsh fevers or the

agg use. And in a text called on Airs, Waters and Places, Hippocrates wrote about how certain environments and seasons carried air that could communicate different diseases. Well, yeah, I mean I think I think something worth driving home is that the truthiness of the theory does seem to closely align with our basic instincts to feel discussed and avoid certain odors, at least until the source of those odors are better understood. I mean, don't hang around the latrine

fields is solid advice? Were repelled? Uh, And that repulsion serves as a sort of physiological safety net. But the bad air that communicates to us the potential dangers of such a place are not necessarily the cause of the dangers. Sort of like blaming your phone for all the robo calls you're getting. Science, you know, often challenges us to think in a way that goes beyond the evolved reactions

of the biological human. Yeah, exactly. Blaming the air is kind of a shooting the messenger thing, Yeah it is. But of course, as we've been discussing here, this was an idea that not only gained traction but remained in play for a very long period of time. I was reading from a book titled The Scented Ape, The Biology and Culture of Human Odor by David Michael Stoddart and the author in this point uh to the the idea that bad odors, you know, causing disease. That this goes back,

he says, through two key physicians. There's the Arabian physician have A Sina who lived nine eight through ten thirty seven, who noted that the odor of urine changed during sickness and could be used to diagnose the illness. And of course this is sound, but the observation caused others of the time to develop the idea that these odors were the cause of the disease and their expulsion was the illness leaving the body. So the strange smell in the

urine that was the sickness leaving the patient. Yeah, you can find parallels to this type of thinking and all kinds of things, like what about the idea that sometimes illnesses cause diarrhea and vomiting. That you could look at that and say, oh, okay, so and so is sick. What we need to do is give them enemas and induced vomiting to purge all that stuff out that's making them sick. But in fact that doesn't always help somebody who's sick. Most of the time, you don't want to

do that. Yeah, you're you're taking Yeah, you're you're, you're you're recognizing like an actual bodily function and the purpose behind that bodily function. But then you're you're taking it

too far, your misunderstanding the cause now. Startard also points to the Greek physician Galen several hundred years earlier, who correctly judged that odors were perceived in the brain, but he also incorrectly judged that they gained direct accents access to the center of the brain via hollow olfactory nerves, despite Aristotle's previous argument that scent receptors were in the

lining of the nose. Galen's theory survived for more than a millennium, and Studdard also points out that English judges as late as the nineteenth century would still take bunches of sweet smelling flowers with them on jail visits to ward off jail fever, which was what they called typhus. But typhus incidentally is caused by a bacterium spread by

body lice, fleas, or chiggers to the plague. Yeah so, but it's another example of people, even in the nineteenth century still having a miasmic understanding, or at least on a superficial level um of disease. No, miasma theory was still absolutely in full swing in Europe in the nineteenth century. I mean, it wasn't untill late in the nineteenth century that we really we really got a beat down on it. Now.

In researching this, I also looked back to Virginia Smith's excellent book clean A History of Personal Hygiene Impurity, which is a faculous read. She'd basically throughout the book charts how humans have always had this this understanding of what is personal hygiene and then what is sort of moral or spiritual hygiene, uh, and and how these become just entertangled throughout history. Cleanliness is Godliness, yeah, exactly, And it's it's a delightful book along those lines. But she talks

a little bit about miasthma. The idea that it's was seen by the Greeks is this this dirt that caused disease,

the dirt of destruction. Uh. And it could be supposedly generated in any place at any time, for any divine reason, but was generally associated with like a foul setting, you know, be at a place of the dead or a place of of decay, and the Greeks believe that these seeds of disease or miasmin quote, wafted down from the outer universe in billowing clouds of people, of polluted air, and whatever it touched its stained, and the staining of a

fabric was a key example of the process. And I believe we We've already mentioned that the Greek word uh me anno is even defined as uh as you know, to die with another color, to stain uh, as well as to defile, pollute, sully, contaminate, to soil, but also to defile with sins. Again coming back to that idea that humans cannot help but complicate their understanding of bodily, physical, or even biological cleanliness with some sort of a moral

or spiritual component. Yeah, we've always got this metaphor in our language, don't we. I mean I am soiled with sin. Yeah, I'm gonna get clean. I'm going to cleanse myself. It's it's very difficult to separate the two and with I mean putting a third thing in there, with health, get a clean bill of health, or like or if you have an addiction or something, people might say, I'm gonna get clean. Yeah. Interesting, this trifecta of of health, of hygiene,

and of moral rectitude. Yeah, think clean thoughts, but you know, without realizing, yeah, you can, you can have very dirty thoughts that are extremely hygienic. It's it's entirely possible now. As we've been exploring, and we'll continue to explore. European thinkers really went whole hog on mi asthma theory. But it's not confined to Europe. This is a thinking this common throughout the world. There was mi asthma thinking in

ancient China, there's mi asthma thinking in India. It's something that's very natural, I think for people to conclude, and thus I think is almost maybe a cultural universal Well,

it really begins to feel like a necessary step. You know, if this were a civilization video game or or say, you know, science fiction novel like something for me and in banks, it would seem like that would be a necessary stage of development that a culture would have to go through before they got to the germ theory of disease. And I think we should point out that, um, it wasn't always throughout history that you had this misguided me asthma hypothe the system against a clear and correct germ

theory contagion hypothesis. Sometimes the options seemed to be you had a miasma theory of disease, in which epidemics were spread ambiently through the air, and a contagion theory of disease, where epidemics were spread by physical contact. Most of the time, neither of these is exactly correct, but each one has got a part of the truth right, right, And and it's realizing that something is happening in the physical world, be it with you know, physical touch, or it's conveyed

through the vapors and the gases around us. Yeah. But by the seventeenth century, is pointed out by by Smith, miasma theory was quote held to be true beyond doubt. Again, it was a cornerstone of science, um though the actual arcana and mechanisms had yet to be found. But but she adds that there were there were at least a three things you can point to that show how the how miasma theory is remaining alive. She says that Venetian

physician Sentorio Sentaorio, he's a Josh and Chuck favorite. Oh yeah, is he? Yeah? Got there into him. I can't remember which one called him the guy so nicely named him twice. Well, yeah, Sentario Sentario through sixteen thirty six. So he'd proven that the body breathed out a miasma of perspiration. Uh. Then you also had chemist discovering gases even though they had not yet discovered oxygen, and scientists were in the process

of discovering that plants breathed as well. But of course this wasn't just about figuring out how the world worked. It was also about combating the plague. And if you've ever seen a plague doctor mask, which I'll make sure to at least include an image of an illustration of this on the landing page for this episode of Stuff to Buy Your Mind dot com. If you look at one of these masks, you can see the emphasis put

on air circulation. Man, no sketchy website is complete without some clip art of a plague doctor mask, you know what I mean. It's like, that's like the stock photo that's like in every creep corner of the Internet as the plague doctor mask, I know, And there are only so many like widely distributed illustrations of it that on one level they begin to feel less special. And yet every time I look at one at one, I still get wrapped up in the excitement of everything that's going

on with it. Well, it is really interesting to plumb the frame of mind that designed it, right, Yeah, I mean it's essentially a hazmat suit for the play gears to avoid bad smells. So, as a Stoddard points out in the center date, Uh, these were doctors who wore long leather coats rubbed with bees wax. They wore gloves and long bird like masks, and the mask themselves, the snout of it was filled with with herbs and dried petals. And then they used a cane to probe the patient's

armpits and growing for signs of infection. And they used a sounding stick so they could listen to the patient's pulse without actually coming into physical contact. Now my understanding though, this would this would differ depending on who were examining. Maybe we're examining a peasant versus examining royalty, so you wouldn't necessarily, you know, poke the keen with the stick,

but you would definitely poke the peasant. So like if Pope Clement the sixth were too, maybe wonder if he had the plague and had a physician come in and look with look at him. He wouldn't have put up with the stick, right, Yeah, you would get a stick free evaluation. Sometimes there were scented substances in the tip of that dust stick or cane and uh. I've also read that the bird like appearance of the plague doctor maybe why we sometimes call a bad doctor a quack

because they look like a duck um. But at Yeah, it's all about distancing the know who's uh from the smell uh. And another controversial treatment method of the day, if we can call it a treatment, was quote aerial quarantine. So you don't want your home to catch plague, simply box it up, shutting out all the plague gear, like it's a night of the living dead and you just want to keep the evil out. Then you can just

purify it with good odors within. It's kind of basically what what we were talking about earlier with the with the Pope of Fire. Yeah, and some some of the things you read about where people went to I don't know why I was about to say great links, not actually great links, kind of normal lengths to avoid the night air was like they close all the windows at night, you know, because you didn't want that bad night air

getting in. Yeah, But at the same time, it was still obvious to many people of the day that ceiling up a body of air didn't necessarily seem to help matters. Uh and and since seventeen century, riders had observed that

a change of air was helpful. Um. You know, I think we've we've all encountered situations where we are boxed in somewhere with a bad smell, be it a smelly dog in a car, or a you know, a very small child with a soiled diaper in a closed room and changing the air a change podcast studio, or some some sweaty hosts of been in there for a few hours before you exactly, yeah, some a circulation of the air is u is sometimes desirable And and they were not blind to this, you know, they they too had

experienced sweaty rooms and uh and and soiled infants before. Can you imagine how rough it would be for a mi asthma theorist at like a festival or concert outdoors where you gotta go use the porta John's but you know, like you gotta hold your breath the entire time you're in there. You'll get the plague. I don't know. That is an interesting question. What would a denizen of the seventeenth century make of a modern porta potty? I feel

depending on who you're asked. In some cases they might think this is amazing, this is this is a vision of the future I didn't even dare hope for whereas other porta potties they might say, yeah, this is this is horrible. Why would you use the restroom here and not behind that tree over there? All right, so I guess we need to discuss what happened to miasthma theory,

Like how did it go away? Yeah? Like I mean is generally what seems to be the case is that you have new signs that comes along and knocks a previous theory out of contingent. Yes, Now, there was no single cause for the demise of miasthma theory. As we said, it was sort of um one side of a long running and confusing debate where the different sides would sort of bleed into each other. But it got chipped away

at by many lines of evidence over the centuries. One of the greatest and most important final blows to me asthma theory came from the work of an English doctor, an epidemiologist named John Snow, not to be confused with Game of Thrones John Snow right spelled differently John with an H, but still a hero very much. So John Snow is a cool guy from history. He So, I've got a couple of sources I'm going to be referring

to for the story of John Snow. One is an article called John Snow, m d. And Anesthetist to the Queen of England and Pioneer Epidemiologists by Michael A. Ramsey, and the other is an article by Stephen Halliday from two thousand one from the British Medical Journal. So these are about the life of John Snow. So. John Snow was born in March eighteen thirteen in the city of York in northern England, and he was the oldest of

nine children. His father was a manual laborer and his family lived in Micklegate, which was one of the poorest and most unsanitary parts of York at the time. People who lived there got their water from natural sources like wells, or from the two nearby rivers, which were the Swale and the Ooze. Well, that doesn't that doesn't sound good, not like T M and T use but so U s e oh okay, but it's it sounds like secret.

But have you ever seen a turtle get down? I have at the zoo, but not not in the way that you mean it. Okay. Anyway, Unfortunately, this water that the people of Michelegate were getting at the time was often just filthy. It contained way ston runoff from quote and as as Ramsey says, quote market squares, cesspools, cemeteries, and dung hills. So just imagine your water goes through all that before you get it to drink. Ah, the

delicious necro water. Yeah. So Snow became apprentice to a surgeon apothecary in eighty seven and he enrolled in the hunter Rion School of Medicine in London. While he was there, he also got experience working at Westminster Hospital, which had a problem. Actually, the hospital had what's known as a dead room, where students could perform post mortem dissections of patients who died in the wards. Unfortunately, a lot of

the students who performed these dissections would get sick. Eventually, Snow was able to figure out through experiments what was going on, what was making the medical students sick was not the bodies themselves, but a preservative used to keep them from decaying arsenic. The bodies were embalmed with arsenic, then the students performed the dissections, they inhaled arsenic vapor,

and then they got sick. So Snow's research led to different preservation practices for cadavers, but it also was the end of It also led to the end of the manufacture of candles made with arsenic, which apparently burned very brightly but put off toxic arsenic fumes. Other claims to fame.

After Snow completed his medical education in London in the eighteen thirties and forties, he became an expert in respiration and asphyxiation, and he also became one of the world's leading anesthetists, studying the medical use of ether and chloroform to anesthetize people for surgery. Uh Snow played a very important role leading to the acceptance of anesthetics for pain relief and childbirth. Like at the time, a lot of people thought that it was for some reason immoral for

women to have pain relief while giving birth. That's because of the whole biblical description right of the punishment. It seems like there was a link there, like leaders of the Anglican Church preached against pain relief for for women in childbirth from the pulpit. But then Ramsey writes quote. However, on April seventh, eighteen fifty three, Queen Victoria asked John Snow to administer chloroform analgesia for the delivery of her

eighth child, Prince Leopold. This was such a success that it was repeated for the delivery of Princess Beatrice three years later. Obstetrical anesthesia now had the royal blessing, and medical and religious acceptance soon followed. But John Snow's real claim on history came the interaction between miasthma theory, germ

theory and cholera. So the first pandemic of Asian cholera in England occurred in Newcastle in eighteen thirty one while John Snow was working as a surgeon's apprentice, and the second pandemic of Asian cholera hit London in the fall of eighteen forty eight. Now, the prevailing theory about the spread of cholera at the time was sort of a mixture of a dash of contagion theory with a huge

helping of me asthma theory. Basically, most people at the time believe that cholera was an infection that spread through particles disseminated ambiently in the air, which would then settle in the atmosphere in low lying areas, and proponents of miasma theory laid blame for the disease on workers in industries that produced nasty odors, including slaughter houses, rendering plants, and as as Ramsey notes, quote bone merchants and the miasma theory of disease was not the only odd idea

about the power of smells in Victorian Britain. For example, Professor H. Booth, writing and builder in eighteen forty four wrote, quote from inhaling the odor of beef, the butcher's wife obtains her obesity that that seems quite a stretch, but Holiday actually notes a lot of interesting beliefs about miasma

theory at the time, and especially about bad smells. So Sir Francis Head, he notes, was a colonial governor who served in Canada, and in eighteen forty two had argued that quote some settlements in the America's had been rendered dangerous by the plowing of virgin soil, which had exposed decaying vegetable matter and the miasms that rose from it. Also in eighteen forty two, the English social and public health reformer Edwin Chadwick, who lived from eighteen hundred eighteen ninety.

He wrote an eighteen forty two report on the sanitary condition of the laboring population of Great Britain. So Chadwick wanted to make people's lives better. He was a social reformer, but he argued that what we should do is improve sewage and drainage systems in housing to remove dangerous foul smells.

He later told a parliamentary committee in eighteen forty six quote, all smell is if it be intense, immediate acute disease, And eventually we may say that by depressing the system and rendering it susceptible to the action of other causes, all smell is disease. Oh wow again shooting the messenger here. Yeah.

So in eighteen ninety, at a Royal Society of the Arts meeting on sewage and waste disposal, Chadwick gave a talk and The Builder the same magazine again reported quote Sir Edwin concluded his somewhat prolox communication by by advocating the bringing down of a fresh air from a height by means of such structures as the Eiffel Tower and distributing it warmed and fresh in our buildings. Now, wouldn't that be a great addition to our public health infrastructure.

I would towers to suck the sky are down. I'm surprised I haven't seen Maybe I have seen this and just haven't zeroed in on the detail. But you see these sort of these, these these older visions of an advanced future with archaic flying machines and towers. I wonder if this uh works its way into any of those visions, you know, the use of towers to grab clean air and bring it back down for the masses. Yeah, would that show up in like H. G. Wells or something.

I don't know. I'm gonna to look at particularly some of the French illustrations again, it might show up there. Well. At least here you can see a departure from the ideas that we talked about earlier, like during the plague, where they thought that maybe bad noxious air would come down from outer space or from the planets or something. I hear the ideas that the bad air is low lying, and it settles in low lying areas, what you need to do is bring down fresh, clean air from up

above to sort of air it out. But one of the unfortunate side effects of Chadwick's proposal, I mean, obviously, nobody's going to really protest the idea of removing sewage from the houses and stuff. That seems like a good idea. But Chadwick's proposal, uh led to the idea that foul smelling ways should be efficiently funneled away from houses and neighborhoods and down to the river from which many people were still drawing their water. So this in they're trying

to prevent color exactly. Yeah, So we'll get to that

in a minute. Uh. In eighteen forty four, the physicis shan Neil Arnott, who lived eighteen seventy four told a Royal Commission quote, the immediate and chief cause of many of the diseases which impair the bodily and mental health of the people and bring a considerable proportion prematurely to the grave is the poison of atmospheric impurity, arising from the accumulation in in and around their dwellings of the decomposing remnants of the substances used for food and from

the impurities given out of their own bodies. So he's saying human excrement and rotting food waste release particles into the air that wind breathed in are the cause of disease. And crazily enough, Florence Nightingale was even convinced of the miasmata. She believed that scarlet fever, measles, and smallpox could all be caused by bad odors, especially those emanating up from the drains underneath housing, and she tried to encourage good

health by making hospitals sweet smelling. I think sweet smelling medical facilities are kind of disturbing. Actually, you don't want to smell a sweet smell. I think medical facility should smell like cucumbers. It's like when you encounter, you know, a really obnoxious air freshener. You know it's um It can be almost like a chemical assault on your senses. And then also there is the question what is this

covering up? This was deployed for some reason and it's probably horrible, but anyway, so all this stuff was in the air, right, all in the air, so to speak. The idea of me as mata was everywhere all the pretty much all the experts believed in it, but John Snow was not convinced. Because he'd done a lot of work with inhaled things, right, so he'd work closely on

cases where people were subject to toxic inhalence. He even worked on a case where a young woman died from an overdose of chloroform from a rag because it hadn't been administered properly. And from his experience with arsenic vapors and all that, he knew that the potency of airborne toxins was directly linked to their concentration in the immediate

vicinity of the victim. If slaughter houses and bone merchants and all the other sources of waste and food waste and animal parts and stuff like that, if that was what was producing the miasma that caused the disease, shouldn't the people closest to these places and the people who worked in them be the most affected by the disease? Yeah, And that the bone merchants would be the ones that were like essentially wiped out by cholera. Yeah, And yet

Snow noticed this was not the case. So to prove his case, he gathered evidence showing that cholera could only infect someone if they swallowed quote morbid matter from an infected person, often meaning particles of their excrement particles of their poop. So essentially he showed that the disease was at least partially waterborne. And and what did this evidence

consist of? Well Snow put together a geographical model of cholera infection in London by determining how many people had died from the disease in thirty two different subdistricts of the city, and he found in the first instance that families who drew their water from sources supplied by parts of the Thames River above London higher upstream had very few infections of cholera, whereas people who drew their water from sources supplied by the lower Thames lower down in

the in the river where more things had been entering the river above the water source, they had lots of cases of cholera. And the cause for this was that cholera has spread by oral ingestion of fecal matter from other people infected by the disease, so as the sewage

produced by cholera patients in London was disposed of. It generally made its way down into the Thames, and then water companies drew the water back from sections of the river directly below that and redistributed the filthy water contaminated with fecal matter to families for drinking and home use. Uh. And I've got this great illustration here. In the year eighteen fifty, the magazine Punch published a cartoon of what they thought a drop of the water from Thames must

from the Tims must look like up close? You know what do we see here, Robert? Oh, Well, it just looks like it's loaded with sort of a hybrid of cartoon characters and microscopic organisms. Just like it's almost like a like a Bosch painting exactly. That's what I was thinking of. Yeah, it's hieronymous bosh and a drop of water. I'll try to include this image on the landing page for this episode of Stuff to Bulive dot Com so

that everyone else can see it as well. Yeah, So, what was John Snow's recommendation for avoiding the cholera outbreaks? It was, can you guess clean water exactly? Draw your water from distant sources from clean sources far away rather than polluted parts of the river nearby, and Snow's ideas

were not initially accepted by everyone. Snow was criticized by miasma theorists the Lancet Ran an article of viscerating his waterborne infection theory, and most experts still favored some version of the explanation from bad air particles in the air. So then, cholera struck London yet again in eighteen fifty four,

and Snow went back to work on it. He conducted more epidemiological research linking rates of cholera infection directly to sources of water, and most famously, he isolated a single water pump on Broad Street as the source of a huge number of cases of cholera and subsequent deaths. Like locals had been complaining that the water coming out of the pump smelled bad, and Snow followed up by collecting information about who had died from cholera in the Soho

area where the pump was. There were a staggering number of cholera deaths centered just around this one water pump, and Snow was able to convince the local board of governors of his theory, and they removed the handle from the Broad Street pump. The local outbreaks seemed to go away after this, but Snow's critics argued, well, maybe it had been on the wane anyway, and then the handle

was replaced. Holliday writes, quote Snow's conclusions were dismissed by the members of the Committee of Inquiry appointed by Parliament to inquire into the eighteen fifty four cholera epidemic. Commenting on Snow's hypothesis that deaths had resulted from the consumption of contaminated water drawn from the Broad Street pump, the committee concluded, quote, after careful inquiry, we see no reason

to adopt this belief. The committee came down firmly in favor of the supposition that the coloradic confection multiplies rather in air than in water. You know, I'm reminded again of Game of Thrones John Snow, because it's somewhere scenario, you know that John Snow and Game of Thrones is saying, look, the White Walkers are a threat. You've gotta you've gotta realize this. You gotta do something about it. You know, like, no, no, no,

that's ridiculous. We know how the world works. Right, and this is it, and he's coming up against similar opposition is saying no, no, no, don't try and rewrite me asma theory. This is the way disease works exactly. But unfortunately, and now we know that ultimately Snow was proved right or at least partially right, that that colera is definitely spread through water, can also be spread through food and

other things. But unfortunately Snow never lived to see his theories gain wide acceptance, since he died of a stroke in eighteen fifty eight at the young age of forty five. But we now know that Snow's theory was mostly correct.

Cholera is caused by a bacterium Vibrio colorae. Colorae infects the body by being ingested, as we've said, where it reproduces and creates toxins that attack the gut and cause watery diarrhea, and then this diarrheal discharges prolific and of course it can easily kill a person infected with the

disease through dehydration within hours if they're not treated. Lots people die of cholera uh and the cycle of infection occurs when the infected person's fecal matter gets back into water sources that people drink from, or ends up on food that people eat. And fortunately, cholera has been mostly eliminated in wealthier nations through sanitation, sewage disposal, and water treatment, but it still affects a lot of the world today.

There's still a lot of work to do on cholera. Uh. The w h O sites research from indicating that there are somewhere between one point three to four million cases of cholera infection worldwide every year and between twenty one thousand and a hundred and forty three thousand deaths. So

this is like a major world disease. Yeah, it's so easy to take it for granted, especially in in countries like the United States where generally you're using a If you use bathroom facilities, you are you have drinking water coming out of the saint drinking water coming out of the showerhead, drinking water filling the toilet into which you are going to urinat or defecate. Yeah, and that's actually one of the things that led to the understanding that

snows theories were correct. Other people began to accept Snow's theory after he died, once they saw what a difference it made to keep drinking water separate from sewage disposal. So in the second half of the nineteenth century, uh Snow's theory of cholera and German theory in general started to get this wide acceptance, and it was due to multiple factors in Great Britain, specifically Snow's former critics, including the Registrar General William Farr, who had been a miasma

theory guy. He he later became convinced to the role that water and drainage played in the cholera outbreaks after a subsequent epidemic in eighteen sixty six, because in the years just before this epidemic, the engineer Sir Joseph Basil gets plans for a contained sewer and drainage system had been put in place in a lot of parts of London.

Construction was still going on until eighteen seventy five. But like we were just saying, the main benefit of the sewer system was that it would keep sewage separate from the water supply, and the eighteen sixty six epidemics shows the areas that were well drained did not suffer cholera outbreaks, but neighborhoods with lingering defective drainage were still hit yet again with cholera, and then also in eighteen two, Hamburg was struck with cholera, but the now well drained London

was not. In London, of course stank at the time in eighteen ninety two, if you were still thinking maybe it's the stinks that call as cholera, London smell bad. Holiday attributes the lingering sting mainly to horse maneuver and stuff like that in the streets. But yeah, it's still smelled bad. But people weren't getting colera anymore because they were keeping their water clean. The incoming water was clean

and the disposed of water was separately removed. Of course, a bigger part of the puzzle was the increasing isolation and identification of specific microbial life forms with their corresponding diseases, like Fibrio colorade, identified by Felippo Paccini and later by Robert Coke is the cause of cholera, uh the identification of Bacillus and Thracis by Robert Coke in the eighteen

seventies is the cause of anthrax, and so on. Once you could link these individual germs to the diseases, they caused miasma theory didn't have much of a place anymore. All Right, we're gonna take a quick break, and when we come back, we will continue our discussion of miasma theory. Than alright, we're back. Okay, so we've discussed how miasma theory got finally knocked out. But you know, I think about how miasthma theory was wrong, but it might have

done us a lot of good. Right, Yeah, Yeah, I think you can certainly make a case for for it being a perhaps a necessary step in our understanding of the world. Yeah, because, specifically, as we've pointed out, versions of the theory that linked disease to foul smelling air would be somewhat useful because air, the matter that causes air to smell foul, can itself also carry and allow

the growth of harmful bacteria, sewage, dead bodies, spoiled food. Um. And if you think about specific cases, you think about the Pope of Fire, Clement the sixth. He didn't become infected with the plague. Now we don't know whether the fire actually saved him. It's possible, it's impossible to know for sure. But one thing that we would later discover is that you can sterilize your environments with heat. Yeah.

And also, as Virginia Smith points out in her book, we do kind of go from obsession with the asthma and filth diseases too, obsessions with something called autointoxication, which I'll get into in a bit, and uh, an obsession with bacteria living in our bowels, and from their interest in bacterial fermentation, which quote proves to be a fruitful lead towards GM germ theory. And of course greatly improved

microscopes also helped. But again I'm stuck with this idea that this is maybe just a necessary step in the technology tree, uh, that the humanity used to get to our modern understanding of illness. Yeah, well wait a minute, but I want to know more about the auto intoxication. So this is this was really interesting. I was reading up on this, Uh, auto intoxication. Uh, this peaked as

a health buzzword in the nineteen hundreds. And as Mary Roach pointed out in her Salon article Passing Gas and in her excellent book Gulp, which is all about, um, the science of human digestion and the quest for an understanding of how digestion works, Uh, it was a it was just a natural offshoot of myasthma theory. Roach says, quote, if one bought into the dangers of miasthma's, it wasn't much of a leap to buy into the dangers of

one's own internal sewage. Purveyors of laxatives and intimate devices played up the connection, referring to the colon as quote, the human privy an obstructed sewer, and this cesspool of death and contagion. Yeah. So, like the idea is that if bad smelling stuff comes out of you, there's bad stuff inside of you, and you need to get rid of it as much as possible. Yeah, the poisonous gas was coming from inside the colon, for instance, as a Dr Walter C. Alvarez wrote in the nineteen nineteen essay

in the Journal of the American Medical Association. UH. He wrote that this intuitive sense in this theory really resonated with folks. Quote they reasoned that if feces are foul, then the body must be in the best condition when freest from such material. And this essay, by the way, he was this played a big role in turning the tide against um this idea of auto intoxication. UH. The whole essay is pretty great, but I want to read

just this bit from the intro. The caveman of the glacial period and the savage of today would doubtless agree that practically all diseases due to the malevolence of evil spirits. The idea constituted the first system of medicine. The next one appeared with the dawn of civilization, when men awoke to the possibility that some diseases might arise from spontaneous derangements of the bodily functions, particularly those concerned in excretion.

They reason that if feces are foul, then the body must be in the best condition when free is from such material. The idea, which is based on what appears to be an obvious truism, has always been an attractive one, particularly to the lay mind. The ancient Egyptians purge themselves at certain times in the moon's cycle, just as many people now take caluml in the spring. For thousands of years, physicians have been in the habit of purging their patients

when they have not known what to do. We see then that the present day dread of stasis and autointoxication is nothing new. In the eighteenth century, the high priest of the cult was Joe was Johann comp who believed that all disease was due to impacted feces. Under his teaching, the use of large medicated enemies became immensely popular and the apothecaries fattened off the hypochondriacs. Then, just as the quote internal bath specialists do today internal bath. Yeah, that

is the worst term ever, internal bath. So you had this, uh, this one company that the Tyrrell Hygienic Institute Tyre, the Tyrell Corps has nothing to do with with replicants, but this was This was the organization created by Charles Alfred Tyrell Um. He was essentially the Colon Klin's expert of the day, and the chief produ was the JB. L. Cascade Colonic Irrigator. J B L, by the way, stood

for Joy Beauty Life. Wait, isn't that also a brand of speaker it Maybe I don't know if that stands for Joy Beauty Life as well, but uh, it might have a slightly different connotation. Yes it is. It's a it's a brand of speakers. All right. Well, I'll leave our our listeners to explore what that stands for. Unless you have a quick answer for us, Well, I don't know, Joy Beauty Life. Maybe one product was developed from another,

like we're listening to our favorite music through colonic irrigators. Well, in addition to create putting out this product, they also put out thousands of promotional pamphlets for doctors to give their patients. And not everyone was won over by this fake disease and it's fake treatments. And you might well be thinking, hey, isn't this a problem worth sewing a few dog anuses shut over? What? No, I'm not thinking that.

So it was indeed, because it's Mary Roach points out in nine quote physician and otto intoxication doubter Arthur Donaldson artificially and incontrovertibly constipated three dogs by temporarily sewing shut their anus. That is horrible. And in this experiment he observed quote no physical symptoms beyond a mild loss of

appetite occurred and there was no internal poisoning. He also checked their blood and so this provided uh some additional ammo against this idea of auto intoxication, which itself was a child of mi asthma. And I might add that this is a child of miasma, that is that still lives in our world. You will still see plenty of of of of agents of Tyrrell at work in the world.

You mean, all the like the pseudoscience and the clan's culture. Yeah, and filth building up in the colon and become This is the kind of thing that I find that I encounter in an uh little clickbait images at the bottom of various blog posts, was like this famous actress removed this from her colon and now she will live to

be a hundred and fifty. That's sort of thing. Yeah. Yeah, and it's some sort of grotesque picture that you still feel obligated to click on just to figure out what you're looking at, and then you find no answers in the in the clickbait content, of course. Cleanse your toxins. Yeah, so that's auto intoxication in a nutshell. If you want to know more about that, again, I highly recommend Mary roaches salon article or her book Gulp, It's it's miasma theory on the inside. Yeah, so there you have at

miasma theory in a nutshell. I would say one thing you should take away from this episode is if you are lucky enough to have access to clean water that is separate from your sewage disposal system. You should recognize that this is a thing that you're very fortunate to experience. You should be thankful for it. It's something we take for granted in our lives, but it's a huge part of what makes like city life livable. Indeed, all right, if you want more episodes of Stuff to Blow your mind,

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and Instagram. On Facebook, you will also find that discussion group, the discussion module where you can engage with with Joe and myself as well as various other listeners who have lots of intriguing thoughts on topics we are discussing, topics we should discuss, et cetera. Oh yes, so big, thanks as always to our audio producers Alex Williams and Tory Harrison. And if you want to get in touch with us to let us know feedback on this episode or any other, or to let us know a topic you'd like to

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