Under the Weather: Climate and Disease, 1700-1900
Climate, disease and the relationship between them fascinated 18th-century observers on both sides of the Atlantic. Ronald Rees explores the debate and its significance.
Today medicine is such a solid, scientifically-based structure that it takes a disarming colloquialism to remind us that only within the past century or so have its underpinnings been made secure. Until Pasteur demonstrated, in the 1860s, that the instruments of disease were micro organisms with antecedents, few doubted that the agents of disease (or pathogens) were air or wind-borne poisons (called miasmas) generated spontaneously either in chambers beneath the earth's surface or in fetid places above.
Earthquakes, volcanic eruptions and storms, as Charlotte Bronte's Lucy Snowe reminds us in Villette (1853), were commonly regarded as the precursors of epidemics and plague:
Epidemic diseases, I believed, were often heralded by a gasping, sobbing, tormented, long-lamented east wind ... I fancied, too, ... that we often at the same time hear of disturbed volcanic action in distant parts of the world; of rivers suddenly rushing above their banks; and of strange high tides flowing furiously in on low sea coasts. 'Our globe', I had said to myself, 'seems at such periods torn and disordered; the feeble among us wither in her distempered breath, rushing hot from steaming volcanoes'.
To confirmed miasmatists even conservatories were suspect. Robert Kerr, in The Gentleman's House of 1846, warned of the dangers that stalked a living room located next to a conservatory:
To be too directly attached to a Dwelling Room is inadvisable ... the warm moist air, impregnated with vegetable matter and deteriorated by the organic action of plants, is both unfit to breathe and destructive of the fabrics of furniture and decoration.
To protect lungs and furnishings from the rotting effects of warm moist air, Kerr and others advised conservatory owners to surround living areas with corridors, vestibules and galleries. Absolute safety required that conservatories be entered from the garden only.
The idea of a spontaneous generation of poisons creating a malignant or 'epidemic atmosphere' now seems fanciful, but the facts then available left little room for any other conclusion. Observers from Hippocrates onward had noted that intestinal diseases and fevers, agues or sweats were associated with warm seasons and, in the case of fevers, with wet, poorly drained places in which the air was thick, dank and malodorous. Such places were also the haunts of insects and flies, the vectors or transmitters of disease, but without the benefit of microscope and laboratory analysis who could have known that the pathogens were invisible organisms, in some cases mosquito-borne, not bad air (or mal aira ).
Yet despite the invisibility of microbes and bacteria, ideas of contagion had long been in the air. As early as the first century BC Varro referred to certain minute animals, invisible to the eye, which entered the body via the mouth and nose and caused troublesome diseases. A millennium-and-a-half later, in 1546, the Italian physician and poet Girolamo Fracastoro anticipated Pasteur's 'germ theory' by suggesting (in De contagione ) that infection might be the work of living organisms, which he called 'seminaria', passed from body to body either by direct contact or through the air. In the seventeenth century the Dutch pioneer microscopist Antony Leeuwenhoek saw and described organisms we know now as bacteria and protozoa, but neither he nor the members of the Royal Society to whom he communicated his findings grasped their significance. So confirmed was the belief in the miasmatic origins of disease that contagionists were sometimes pilloried. John Crawford, a reputable Baltimore physician and an early promoter of contagion theory in America, lost both his reputation and his practice for maintaining, in 1806/7, that disease was spread by microscopic insects or 'ani-malculae'.
Although no one could explain why, as one contagionist put it, there were marshes without malaria, and malaria without marshes, miasmatic or exhalation theory was the ruling orthodoxy for most of the nineteenth century. In its 1849 report, Britain's General Board of Health pronounced that epidemic diseases have their 'primary and essential condition' in an 'epidemic atmosphere'. To eliminate the costly practice of quarantine, the Board ruled that ships stricken with typhus, cholera or yellow fever were to be regarded not as engines of infection but as vessels unfortunate enough to have passed through a poison-charged layer of air.
So entrenched was the belief in the miasmatic origins of disease that it survived the announcements of Pasteur's germ theory - that linked diseases to specific pathogens - in 1864, and Robert Koch's isolation of the anthrax bacillus in 1876 and the tubercle bacillus in 1882. In a history of epidemics, published in 1883, Charles Creighton, an eminent English epidemiologist, reiterated the ancient belief that infections were spawned in subterranean chambers and escaped in rising groundwater and through fissures and vents made by earthquakes and volcanoes.
To physicians prescribing treatment, a belief that infection was caused by some vague, intangible condition of the atmosphere, a 'something in the air', was of little use. Without specific knowledge of the causes of disease, and of ways in which diseases were transmitted, treatment could only be experimental and speculative. Quackery prevailed. More people, remarked the American physician William Douglass in 1760, die of the practitioner than the disease.
Honest practitioners acknowledged their limitations by looking beyond the patient to the habitat, urging both governments and individuals to attack the disease-producing environments. The 'Hydras of disease', exhorted the Philadelphia physician Charles Caldwell in 1802, could best be combated by removing wastes and refuse, by building houses on well-ventilated hillsides and by defending them against the exhalations of mill ponds and neighbouring marshes with pallisades of trees. They were, of course, wrong in their assumptions about the causes of disease, but their instincts were sound. Refuse heaps, filthy streets, cess pools and swamps were, especially in warm weather, natural habitats for microbes and bacteria and breeding grounds for flies, mosquitoes, rodents, lice and fleas - the vectors of disease.
The attack on pathogenic environments, the 'medicine of the environment' as the historian James Riley put it, began in earnest in the eighteenth century. In addition to medical backing it had the support of Enlightenment philosophers who believed that nature was balanced and orderly and that evident disorders, such as epidemic diseases, could be corrected by rearranging the habitat. In country districts, marshes and bogs were drained, or flooded, and dank woods cut down. Europeans, who had disposed of most of their forests, concentrated on draining. Even moats, suspected of emitting 'mephitic exhalations', were drained or allowed to become dry. When the revolutionaries stormed the Bastille in 1789 they gained the walls without wetting their feet.
A French edict of 1764, granting the initiators of drainage projects a twenty-year exemption from taxes and church tithes, is said to have galvanized 'innumerable' landowners. In Italy Pope Pius VI revived an ancient programme for draining marshes in the vicinity of Rome, while Venetian authorities attempted to remove standing waters from parts of the republic. In 1762 the Journal oeconomique urged drainage of the Pontine marshes in Italy both for reasons of economy and health. Removal of the fetid waters would destroy 'the source of the noxious exhalations that corrupt the air of the most pleasant and fertile plain in Europe'.
In America, where there were woods to spare, colonists combined deforestation with drainage. Though they needed neither medical nor philosophic sanction to cut down trees, (east of the Mississippi the continent was one vast woodland) writers of medical meteorological journals urged them to do so. Clearing allowed soils damp with 'putrid moisture' to dry out, and shallow and stagnant waters to evaporate. Inspired by the dyking and draining of Holland, which was thought to have eliminated marsh miasma, the Philadelphia physician William Currie in 1791 advocated both the clearing of woods and the draining or drowning of extensive marshes. A product of the Enlightenment, he thought the most unwholesome situations and the most unproductive soils could be rendered salutary by industry and art.
In country districts miasmatists targetted mists and fogs; in towns they attacked smells. The virulence of a miasma was thought to be in direct proportion to the offensiveness of its odour. Cesspools were pumped out, backfilled and replaced by sewage systems. Streets were widened, paved, cleared of refuse and, in some cases, flushed. Flushing, or 'lavation', was the urban counterpart of the draining or drowning of swamps and marshes. Wider streets, too, were better ventilated and less likely to harbour miasma. Individual buildings were also opened up and, in some cases, blown out. Hand-driven bellows and wind-powered fans were used to rid prisons of gaol fever, and hospitals and naval vessels of disabling or deadly miasma. On both British and French warships, wind sails and canvas tubes directed air from above decks to the fetid crew's quarters below. Some miasmatists maintained that it was better ventilation and improved sanitation, not lime juice, that kept Captain Cook's crew scurvy-free on his voyage to New Zealand and the south Pacific in 1772-1775. Conversely, they attributed the high morbidity among George Washington's troops in 1776 to improper ventilation of their quarters.
Yet not all sites responded to sanitary reforms. When cleaning, flushing and draining failed to eliminate disease, reformers resorted to vapours and odours. Hydrochloric acid, simmering vinegar and the fumes from smouldering sulphur, tar and tobacco were all seen as potential destroyers of miasma. Industrial districts had their own, built-in vaporizers. Smoke and fume from brickyards and copper works, some physicians argued, had disinfectant or prophylactic powers. Copper smoke, acidic enough to scour window glass and kill plants within a matter of hours, could also - so Swansea's doctors argued - destroy the miasmas that produced typhus and cholera,; while the milkmaids of Gower were cut down by soft but deadly zephyrs from the south and west, workers in the copper smelting districts of Wales luxuriated in miasma-free, if fume-laden, air. Even the mountains of furnace waste or slag that then filled the Tawevalley were regarded as a boon. Too porous to hold water, they - 'like the desert sands' - sucked moisture and miasma out of the air above them. 'Pulverulent', wrote Dr Thomas Williams in an 1854 report dedicated to the President of the General Board of Health:
... these mountains (slag heaps) rapidly absorb all surface moisture. They offer always, in the wettest weather, a dry surface ... They are impregnated with nothing capable of assuming a gaseous form ... They suppress malaria.
When burning, draining and flushing failed to decontaminate disease-ridden environments then the only alternative - given the impotence of physicians before even elementary forms of sickness - was escape. In Europe, where there were no new lands to settle, only the rich could get away. The poor were trapped, and in the large industrial and port cities this frequently meant in low-lying sites alongside rivers, canals and docks. The English word slum may be a derivative of 'schlamm', the German word for bog.
But the rich, in the fever season, could escape to miasma-free environments on high ground or beside the sea. In inland spas and at seaside resorts they breathed pure, well-ventilated air and drank, or bathed in, health-giving waters. In the absence of effective medicines, both mineral and salt waters were accorded extensive healing powers. From the middle of the eighteenth century, well-to-do Britons - many of them armed with Dr Richard Russell's Dissertation on Seawater (1750) - rushed headlong to the sea. Salt water, imbibed or merely bathed in, was the latest cure-all and those with means looked for pleasant coastal places in which they might spend the summers. As the incomparable William Cowper put it:
But now, alike, gay widow, virgin, wife
Ingenious to diversify dull life,
In coaches, chaises, caravans, and hoys,
Fly to the coast for daily, nightly joys.
And all, impatient of dry land, agree
With one consent to rush into the sea
By the end of the eighteenth century the British, thanks largely to the proselytizing of Dr Tobias Smollett, had also discovered the Mediterranean. In his Travels Through France and Italy (1776) Smollett, who suffered from undefined pulmonary illnesses, had put the Riviera on the British medical map by propagating its healing powers. The combination of warm seawater and - except for high summer - mild, dry air was irresistible to health-seekers. Smollett's preferred locations were Nice for the winter, where the weather was 'remarkably mild and agreeable', and, for the summer, mountains near the sea where he could enjoy cool air and freedom from the 'flies, gnats, and other vermin' that rendered the lower parts almost uninhabitable.
For ordinary people, however, salubrity was out of reach except in frontier societies where there were new lands to settle. In America, health was a concern almost from the outset but the dilemma for Americans was that there were few places to escape to; most of the country (as then known) was miasmatic. Only in the cool north east and in high, dry parts of the Appalachians could there be any expectation of safety. In his Medical Topography of America , (1791) William Currie dismissed the southern seaboard as a place where fevers and fluxes were 'epidemic, violent, and obstinate'. The most dangerous season was after the rice and indigo harvests in August and September when the waters were 'low, stagnant and corrupt' and the air made noisome with indigo plants hauled out of the water and left to rot in the fields.
Conditions were no better inland. Across the Alleghenies, in the Mississippi Valley, settlement was carried on, as one observer put it, 'to the almost universal accompaniment of fevers'. With most of the valley lying below the 'fever line', malaria was so prevalent that remote villages are said to have rung their church bells at noon to remind people to take their quinine. European travellers were stunned by the number of sick people they encountered. Dickens described the Mississippi as 'an enormous ditch ... running liquid mud' which was 'a breeding-place of fever, ague, and death'. John McCulloch, an English authority on malaria, thought it unlikely that the Mississippi Valley would ever be permanently settled: 'no changes and no cultivation', he pronounced in 1829, 'will ever bring it into a state of salubrity'.
Aware of the valley's reputation for fevers, cautious immigrants weighed the salubrity of each locality. The most dangerous areas were bottomlands near the rivers where shallow waters and bayous were impounded by the high banks or levees. Prospective settlers were constantly warned not to build houses next to bayous and rivers, yet so rich were bottomland soils that, as one writer remarked, other types of terrain would 'never draw inhabitants ... while a foot of cane brake or river bottom remains to be settled'. For migrants it was a Hobson's choice of poor soils and health, or fertile soils and fever and most land seekers opted for good soils. The dry, spruce and pine barrens of Pennsylvania, as William Currie noted in his 1791 journal, may have been renowned for their robust, prolific women but there is no evidence that fever-threatened Philadelphians or lowland farmers ever considered moving onto them.
Although economic advantage usually determined where people would settle, some westward migrants opted for locations that were high and dry - that is, in rolling, and usually poorer, country at some distance from the rivers. Some, too, went back east. In 1818 Thomas Nuttall met a group of people near Georgetown, Pennsylvania, returning from the western county 'in search of a situation which might afford them health'. The following year William Faux passed five or six huge wagons laden with goods and families 'all returning from the Missouri territory to ... Kentucky ... being scared out of Missouri by sickness'. And William Forster, travelling in Indiana in 1821, noted that there was considerable traffic on the roads, 'some going out to Illinois and Missouri and nearly as many returning to their former residences, discouraged by sickness'.
So notoriously unhealthy was the Mississippi Basin that Canada, hungry for immigrants, tried to turn to advantage its equally invidious reputation for cold. At every turn promoters advanced the healthiness of Canada against the unhealthiness of the fever-ridden American Midwest. Charles Mair, a fervent Canadian nationalist, stopped just short of recommending barriers and plague masks as protection against miasma-laden southerly winds. Air from the south, he warned, had 'danger on its breath' and brought with it 'the dim edge of fever, the dread of pestilence and famine'. The American South and Midwest he excoriated as regions of effeminacy and disease, the 'bracing' Canadian West as a 'recuperator of decayed function'.
Subsequent promoters of Canada sustained the attack on the fetid American atmosphere. The Marquis of Lome, Governor General of Canada from 1878 to 1883 and a son-in-law to Queen Victoria, advised immigrants to avoid regions notorious for their cyclones, snakes and centipedes, and for ague and fever, and bade them remember how healthy were the conditions of the north, and to what a great age men usually lived there. Alexander Begg, head of the Canadian Pacific Railway's immigration department, adopted a milder, more philosophical tone:
What use to the immigrant [to the United States] are fair fields and meadows, beautiful crops and the acquisition of wealth if, to obtain them he is obliged to sacrifice his own health and that of his family?
Safer by far to settle in Manitoba where 'the almost total absence of fog or mist; the brilliance of the sunlight ... all combine to make Manitoba a climate of unrivalled salubrity'. One of the boasts of Manitoba's Red River settlers was that 'a cough is scarcely ever heard among us'.
Thousands of Americans did migrate to the Canadian prairies but for most the lure was the last free land on the continent, not health. Rather than go north, well-to-do American health seekers followed European precedent and removed themselves to spas and resorts above the fever line or along the cool north Atlantic coast. By the middle of the last century, responsible American practitioners readily admitted the failure of formal medicine. 'Every practical physician', wrote the admirable Daniel Drake, physician and medical historian of the Mississippi Basin, 'is aware of the frequent failure of all kinds of medication ... and of the great value of cool and fresh air ... united with active exercise ... new scenery, and the disuse of all medicine'. Seasonal movements to benefit from cool, fresh and fever-free air began in the 1760s when rich planters from the South and the West Indies sailed to Newport and Cape May, and occasionally as far north as Quebec City and Montreal. Those who preferred mountains and mineral waters opted for spas in the Appalachians, the Alleghenies and the Ozarks.
The latter half of the nineteenth century also saw a large-scale movement of health seekers onto the high plains and the deserts and semi-deserts of the West and Southwest. The praises of Western and Southwestern climates had long been sung by Easterners with pulmonary' illnesses who had made miraculous recoveries in the dry, clear air. But until transcontinental railways had been built, the Plains Indians subdued, and the Civil war resolved, the West's 'champagne' air had refreshed the lungs only of traders, adventurers and a handful of determined invalids. The best known of them was Josiah Gregg, a medical student in the East, but in the West a pioneer trader and founder of the Santa He Trail. Susan Magoffin, the delicate bride of a Santa Fe trader, confided to her diary that she would never have consented to move onto the plains had it not been 'with the view and a hope that it would prove beneficial [to her health]'.
The opening of the West, in the late 1860s, coincided with the growth of the eastern cities and the concomitant growth, to epidemic proportions, of the deadly pthisis. Better known today as consumption or tuberculosis, pthisis thrived in crowded slum and tenement districts and, being highly contagious, spread from these incubators to other parts of the city. Physicians were helpless before it and admitted, at an international convention on tuberculosis in 1900, that climatic therapy offered the only hope of recovery in the early, curable stages of the disease. In Europe, well-to-do sufferers fled to sanatoria in Switzerland where they hoped that sunshine, clean air and lower atmospheric pressure - allowing freer breathing - would encourage delicate lung tissue to heal.
In America, where movement both socially and geographically was so much less restricted than in Europe, consumptives moved en masse to the West. At a conservative estimate, about one third of the population of Colorado in 1880 consisted of 'reconstructed invalids'. In Denver alone there were about 30,000 consumptives, 'the one lung army', who made up more than a fifth of the city's population. Tuberculosis is also said to have 'made' the cities of Albuquerque and Santa Fe, in New Mexico, and Santa Barbara and San Bernardino in California. Southern California, according to one observer, was nothing but a giant sanatorium.
Until hotels, hospitals and sanatoria could be built, consumptives put up in crudely converted houses and farmhouses and even in shacks and tents. Invalid villages made up of long rows of tents and makeshift shacks grew unprepossessingly around many Western and Southwestern towns and cities. The shacks were little more than screened porches just large enough for a bed, a washstand, and the few belongings of its resident 'lunger', 'cougher', or 'hacker'. Frontier language was uncompromising.
Tent communities, according to John L Cowan, were scattered in and around San Bernardino as late as 1910:
There are tents in front yards and back yards, in vacant lots, by country roadsides, on farms and ranches, in secluded canyons ... and away up in the mountains. They are the camps of the Arabs of the Southwest - a forlorn, homeless and almost hopeless multitude of wanderers, chasing the phantom, Health.
Many had begun the chase too late to be saved. In Santa Barbara in 1893 the suicide rate, at thirty per hundred thousand, was among the highest in the world. That same year one out of every three deaths in the town was due to tuberculosis.
Although Robert Koch's discovery of the tubercle bacillus in 1882 had no immediate effect on the treatment of tuberculosis, the knowledge that diseases were caused by specific organisms and not by some abnormality of the atmosphere inevitably changed perceptions of both the diseases and the diseased. No longer passive victims of epidemic atmospheres, but bearers of deadly bacteria, consumptives more and more frequently found themselves rejected. There was little support for the suggestion that they be made to wear warning bells, but hotels that had once welcomed them now demanded - if they were accepted at all - that medicines betaken in private rooms. Railway passengers, too, demanded the routine fumigation of cars used by consumptives.
For want of a vaccine for the tubercle bacillus, climatic therapy, or climatotherapy, continued to be recommended as the standard treatment for its victims, but as a general cure-all climatotherapy quickly lost ground. Fresh air, exercise and outdoor games were regarded as important adjuncts to general health, but progressive physicians denied that climate had any specific curative quality. To combat disease, medical researchers gave their entire attention to bacteriology, first identifying the offending bacteria, then developing immunities against them. The bacilli that cause plague, dysentery, diphtheria, typhoid fever, cholera and tetanus had been isolated before the end of the nineteenth century. Notable scalps early in this century were the bacteria producing infectious jaundice and yellow fever. By the 1890s, due largely to Koch's 'plate-method' of separating and cultivating bacteria, both the principles and the practice of protective inoculation had been mastered. Attenuated forms of bacteria were used in large scale inoculations against cholera in 1893 and plague in 1896. Typhoid vaccines were first used successfully in the Boer War.
In the process of controlling infectious disease, climatotherapists complain that modern medical research has turned its back on two thousand years of medical thought and practice. Much of this, of course, was misguided and patients are no longer recommended - for want of effective treatment - to take particular airs or waters. But although climate may not produce the microbes that kill, it does affect the numbers, the survival rates and, in some cases, the movements both of the microbes themselves and of the vectors that carry them. Insects, for example, may be wind-borne, and for microbes that move through the air in suspended water droplets a humid atmosphere is a virtual swimming pool. Medical geography, the study of the geographical incidence of disease, may not be at the leading edge of medical science but it is an acknowledgement that climate, though not the arbiter of life and death it was once thought to be, still affects human health.
- Frederick Sargent, Hippocratic Heritage: A History of ideas about Weather and Human Health (Pergamon, 1982)
- James C. Riley, The 18th Century Campaign to Avoid Disease (Macmilian, 1987)
- Clifford Allchin Gill, The Genesis of Epidemics and the Natural History of Disease (Ballierc, Tindall & Cox, 1928)
- William A.R. Thomson, A Change of Air: Climate and Health (Scribner's 1974)
- Richard Harrison Shryock, Medicine and Society in America, 1660-1860 (New York University Press, 1960)
- Edwin Ackerneckt, Malaria in the Upper Mississippi Valley, 1760-1900 (Arno, 1977)
- Billy M. Jones, Health-Seekers in the Southwest, 1817-1900 (University of Oklahoma Press, 1967).
About the Author:
Ronald Rees is Adjunct Professor of Geography at Mount Allison University, New Brunswick, and the author of Interior Landscape: Gardens and the Domestic Environment (Johns Hopkins, 1993).