On Monday, September 9, 1776, John Adams and Benjamin Franklin were headed to Staten Island. They spent the night in an inn in New Brunswick. However, Adams wrote in his autobiography that all the taverns were full, so he and Franklin were forced to share a small room together. That would have been fine except for the window.
The room had only one small window, which Adams closed, because it was cold outside and he didn’t want to get sick. However, Franklin insisted that they leave the window open.
Oh! says Franklin don’t shut the Window. We shall be suffocated. I answered I was afraid of the Evening Air. Dr. Franklin replied, the Air within this Chamber will soon be, and indeed is now worse than that without Doors: come! open the Window and come to bed, and I will convince you: I believe you are not acquainted with my Theory of Colds. Opening the Window and leaping into Bed, I said I had read his Letters to Dr. Cooper in which he had advanced, that Nobody ever got cold by going into a cold Church, or any other cold Air: but the Theory was so little consistent with my experience, that I thought it a Paradox: However I had so much curiosity to hear his reasons, that I would run the risque of a cold. The Doctor then began an harrangue, upon Air and cold and Respiration and Perspiration, with which I was so much amused that I soon fell asleep.
Although Franklin failed to convince the future president on this occasion, Adams said that “I have often conversed with him since on the same subject: and I believe with him that Colds are often taken in foul Air, in close Rooms: but they are often taken from cold Air, abroad too.”
Although Franklin won that argument, and the window remained open all night, Adams gets the last word, claiming that it was the cold which led to Franklin’s death:
And I have heard that in the Opinion of his own able Physician Dr. Jones he fell a Sacrifice at last, not to the Stone but to his own Theory; having caught the violent Cold, which finally choaked him, by sitting for some hours at a Window, with the cool Air blowing upon him.
We’ve all had that discussion with someone, about whether to leave the window open to allow in fresh air, or keep it closed because it is too cold outside. When we say the room is too stuffy and we need some fresh air, we are also often thinking that it is easier for germs to spread between people in a closed space, and that leaving the window open will limit the amount of disease we may catch directly from the other person.
But Adams and Franklin lived decades before Louis Pasteur took the first tentative steps into germ theory in the 1850s, or when Robert Koch extended and refined the theory in the 1880s.
The two Founding Fathers argued about the dangers of cold air. But, according to Adams, both he and Franklin agreed that the main cause of disease was foul air.
I have often conversed with him since on the same subject: and I believe with him that Colds are often taken in foul Air, in close Rooms: but they are often taken from cold Air, abroad too.
The belief that foul air is the cause of disease is known as miasma theory. Since the late 19th century, doctors and scientists gradually came to understand that germ theory was a better explanation for disease. But for over 2,000 years, most people believed that bad air was poisonous and caused disease and death.
Hippocrates, wrote about miasma, which means “pollution” in Ancient Greek, in about the fifth century BCE:
Whoever wishes to investigate medicine properly, should proceed thus: in the first place to consider the seasons of the year, and what effects each of them produces for they are not at all alike, but differ much from themselves in regard to their changes. Then the winds, the hot and the cold, especially such as are common to all countries, and then such as are peculiar to each locality.
At about the same time, the historian Thucydides wrote an account of the plague of Athens, and he suggested that disease could spread from one person to another. He wrote, “There was the awful spectacle of men dying like sheep, through having caught the infection in nursing each other. This caused the greatest mortality.”
Thucydides was definitely on the right track, and had medicine been based upon his ideas, millions of lives may have been saved.
Instead, the history of medicine followed Hippocrates’ theory, The treatment for stopping plagues and infection was to keep out the imagined poisoned air which they thought caused the disease.
There were a few individuals who realized this theory was mistaken. Perhaps most famous was John Snow (no not that John Snow).
In the 1840s, cholera reached London. If you were transported back in time to that capital, you would have found the stench of horse manure lining the streets, the smell of people who bathed infrequently in the most populous city in the world, and the raw sewerage being pumped into the Thames, would probably encourage you to wear a clothespin on your nose (or to jump straight back into your time machine and find an era with a more pleasant odor).
In February 1848, John Sewell, a surgeon on the South Bank of the Thames reported to the Central Sanitary Committee of the Parish of Lambeth that cholera had come to London, ‘From the open ditches, bad drainage, filthy state of the streets, and want of cleanliness in the houses of the poor generally.”
In 1849, a major cholera outbreak killed about 15,000 people in London alone.
Five years later, an outbreak of cholera was centered around Broad Street in Soho. The influential Dr William Farr, the commissioner for the 1851 London census believed it was caused by miasma coming from the soil along the banks of the Thames.
Snow disagreed. His observations led him to the conclusion that it was not bad air causing the plague, but that some source was transmitting the disease to the people.
In his 1849 essay, “On the Mode of Communication of Cholera” he wrote:
Reasoning by analogy from what is known of other diseases, we ought not to conclude that cholera is propagated by an effluvium…
This led him to the conclusion that:
The disease is communicated by something that acts directly on the alimentary canal, the excretions of the sick at once suggest themselves as containing some material which being accidentally swallowed, might attach itself to the mucous membrane of the small intestines, and there multiply itself.
Snow spoke to local residents and was able to trace the cholera outbreak to a public single pump on Broad Street. He removed the handle from the pump, and soon afterwards there was no more cholera in the area. But by then, a total of 616 people living on or near Broad Street were dead.
Some of the victims of the Broad Street outbreak were taken to Middlesex Hospital were a nurse named Florence Nightingale treated many of them.
Nightingale later improved survival rates for soldiers being treated in field hospitals during the Crimean War by improving the sanitary conditions there. However, she held that the miasma theory was correct and fundamentally agreed with Franklin that the most important cure was to keep the windows open and allow in fresh air. She wrote in, “Notes on Nursing” that:
The air as stagnant, musty, and corrupt as it can by possibility be made. It is quite ripe to breed small-pox, scarlet fever, diphtheria, anything else you please.
She stressed that it was important, “To have the air within as pure as the air without.”
Gradually, experiments and observations proved that disease transmission came from germs, and not from noxious gases. Miasma theory sounds quaint to us today.
Yet in the time of the Talmud, it was the prevalent theory.
In the third century, Abba Aricha, better known as Rav, established and headed the Yeshiva in Sura, on the banks of the Euphrates in modern-day Iraq. The Talmud (Bava Kama 50) records a dispute between him and Shmuel, head of the Nehardea Yeshiva and renowned as a doctor.
If someone digs a pit in a public place, he is liable to pay compensation if an animal falls into it and is injured or dies. Rav said that the person is only liable for damage caused by the miasma of the pit, but not for damage caused by impact with the ground. He points out that the ground was there before the pit was dug, and is not owned or created by the person who dug the pit.
Shmuel disagrees and states that the person who dug the pit is liable to pay for damage caused by both the noxious miasma and the ground.
The practical case where they disagree would be if someone built a ramp, and the animal walked up the ramp and then fell off the end. According to Shmuel, the person who built the ramp would be liable for damages since he caused the animal to hit the ground. But Rav holds that the person would be exempt from payment, since the ground was there all along, and building the ramp does not create dangerous, toxic miasma.
Conversely, according to both opinions, even if a pit is filled with soft spongy material, if the animal falls into it and is injured or dies, the person who dug the pit is responsible to pay restitution because he created the noxious fumes that caused the damage.
This idea that the miasma of the bit causes damage is codified in halacha by Maimonides (Hilchot Nizkei Mamon 12:13-14) and Rabbi Yosef Karo (Shulchan Aruch, Chosen Mishpat siman 410:16-17).
The concept of miasma is also relevant to a dispute between Rabbi Yochanan and Reish Lakish, two Israeli contemporaries of Rav and Shmuel. The Talmud (Zevachim 113a) records a discussion between them about the purity of the Land of Israel. Rabbi Yochanan claims that one can assume there are no unknown corpses making the land impure. Reish Lakish asked about the bodies of those who died in Noah’s flood – wouldn’t they have defiled the land?
Rabbi Yochanan answered that the waters of the flood did not fall on the Land of Israel. Reish Lakish challenged him from the verse in this week’s Torah reading, ‘Everything with the spirit of life in its nostrils, everything on dry land, died,’ (Genesis 7:22).”
Rabbi Yochanan answered that the people and animals in Israel died not of the flood waters, but of the toxic miasma that accompanied the floodwaters.
The Hebrew word for miasma is hevel – which is the same as the Hebrew name for Abel, who was murdered by his brother Cain.
The flood was the ultimate punishment for the crime of Cain. Almost all his descendants were wiped out because, like their progenitor, they also committed horrific crimes. It is ironic and perhaps fitting, that the hevel of the flood avenged the death of Hevel.
As if to make this point clearly, after the flood, Noah emerged from the ark and offered a similar sacrifice to the one that Abel brought all those generations ago. Not produce from the ground, as Cain had brought, but the choicest animals, Abel’s offering.
Our understanding of the world advances as we learn more about the world around us. The miasma theory was replaced mainly by the germ theory. But scientists are always learning more. Every day we see advances in how scientists and doctors perceive things. New cures are trialed and more lives are saved.
At the same time, the fundamental value of being a good person who does good things remains unchanged. Cain murdered his brother, his descendants filled the world with cruelty. The vapor of Hevel, the innocent victim, ultimately triumphed over them all.
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