MIASMA,

CONTAGION, AND
THE EXPANSION
OF THE MEDICAL
SPACE

Mauro Capocci
University of Pisa
Medical Theories
Humours Individual
V century B.C.E. II century C.E.
(Choleric)
FIRE
YELLOW BILE
Dry Hot

BLACK BILE BLOOD

EARTH AIR
(MelancHolic) (Sanguigno)
Cold Wet
PHLEGMA
WATER
(Phlegmatic)

«What is in the world cometh from the concatenation of

the elements, from them everything created is formed.» Miasma Epidemics
In humoral medicine, there’s no room for
contagion.
Epidemics’ medicine looks at the environment:
wind, climate, water, institutions, lifestyle.
Physician investigates the correlation between
environment and disease, and his primary goal is
to manage humoral balance.

“The year was southerly and rainy, with no winds throughout. About the rising of Arcturus, while
during the immediately preceding period droughts had prevailed, there were now heavy rains, with
southerly winds. Autumn dark and cloudy, with abundance of rain. The winter southerly, humid,
and mild after the solstice…. Early in the spring, at the same time as the cold snaps which occurred,
were many malignant cases of erysipelas, some from a known exciting cause and some not. Many
died, and many suffered pain in the throat.” Epidemics, 3.2.2-3

«Whoever wishes to pursue properly the science of medicine must consider […] the mode of life also
of the inhabitants that is pleasing to them, whether they are heavy drinkers, taking lunch and
inactive, or athletic, industrious, eating much and drinking little.» On Airs, Waters, and Places, 1

Hippocrates, Collected Works, ed by. W. H. S. Jones. Harvard University Press, 1868

http://www.perseus.tufts.edu
Polybus (but in the CH). Loeb Classical Library, vol. IV. www.archive.org
Medicine, and Politics, and Anthropology

Miasma/Infection: to soil, to
corrupt.

From moral stain to physiological

contamination/corruption.
Contagion is considered
irrational, unnatural.

It is close to religious
medicine.
Hence, it must be refuted.

Galen: miasmatist, follows

the hippocratic tradition.
1850ca.
 VS.
It’s a matter of causality: what do we
admit as possible causal agent, when we
analyze the world?

E.G.: supernatural medicine.

Who then of the gods was it that brought these two together to contend? The son of Leto and Zeus;
for he in anger against the king roused throughout the host an evil pestilence, and the people began
to perish,… Down from the peaks of Olympus he strode, angered at heart, bearing on his shoulders his
bow and covered quiver. The arrows rattled on the shoulders of the angry god as he moved, and his
coming was like the night. Then he sat down apart from the ships and let fly an arrow: terrible was the
twang of the silver bow. The mules he assailed first and the swift dogs, but then on the men
themselves he let fly his stinging shafts, and struck; and constantly the pyres of the dead burned
thick. For nine days the missiles of the god ranged among the host, but on the tenth Achilles called
the people to assembly: […] let us ask some seer or priest, or some reader of dreams—for a dream too
is from Zeus—who might say why Phoebus Apollo is so angry, whether he finds fault with a vow or a
hecatomb; in hope that he may accept the savour of lambs and unblemished goats, and be willing to
ward off the pestilence from us.”
«Special care should be taken, in locating the steading, to place
it at the foot of a wooded hill, where there are broad pastures,
and so as to be exposed to the most healthful winds that blow
in the region. A steading facing the east has the best situation,
as it has the shade in summer and the sun in winter. If you are
forced to build on the bank of a river, be careful not to let the
steading face the river, as it will be extremely cold in winter,
and unwholesome in summer. Precautions must also be taken
in the neighbourhood of swamps, both for the reasons given,
and because there are bred certain minute creatures which
cannot be seen by the eyes, which float in the air and enter the
body through the mouth and nose and there cause serious
diseases.» […] «See that the steading does not face in the
direction from which the infected wind usually comes, and do
not build in a hollow, but rather on elevated ground, as a well-
ventilated place is more easily cleared if anything obnoxious is
brought in. Furthermore, being exposed to the sun during the
whole day, it is more wholesome, as any animalculae which are
bred near by and brought in are either blown away or quickly
die from the lack of humidity.»

Loeb Classical Library,

Marcus Terentius Varro
Varro, De Re Rustica, 1, 12 https://penelope.uchicago.edu 116–27 BCE
/Thayer/E/Roman/home.html
«If the healthfulness of the region and the somewhat elevated position of its
banks allow the placing of the villa above flowing water, care must still be
taken that it have the stream at the rear rather than in front of it, and that
the front of the structure face away from the harmful winds peculiar to the
region and towards those that are most friendly; for most streams reek with
mists, hot in summer and cold in water, and these, unless dispersed by the
greater force of winds that blow upon them, are the cause of destruction to
man and beast. […] And neither should there be any marsh-land near the
buildings, and no military highway adjoining; for the former throws off a
baneful stench in hot weather and breeds insects armed with annoying
stings, which attack us in dense swarms; then too it sends forth plagues of
swimming and crawling things deprived of their winter moisture and L. G. Moderatus
infected with poison by the mud and decaying filth, from which are often Columella
contracted mysterious diseases whose causes are even beyond the (4-70 CE)
understanding of physicians; and at every season of the year rust and
dampness play havoc with farm implements and equipment, and with
unstored and stored produce; the highway, moreover, impairs an estate
through the depredations of passing travellers and the constant
entertainment of those who turn in for lodging.»

Columella, De Re Rustica, I, V
Loeb Classical Library,
https://penelope.uchicago.edu/Thayer/E/Roman/home.html
“Cum huiusmodi signa in iumento unum
vel plura conspexeris, statim illud
separabis a ceteris, ut contagionem non
inferat proximis et facilius in solo iam
causa morbi possit agnosci.”

Publius Vegetius Renatus,

Mulomedicina Chironis , I, 3
(V sec. CE)

Before them, Thucydides…

The farther from medical authority, the

greater freedom is enjoyed: it is possible
to discuss contagion.
REACTIONS TO EPIDEMICS

1. Enemy
2. Unburied corpses
3. Lawlessness
4. Social disruption

WAR
1+2+3+4 = ________________

5. Medical impotence
Thucydides, The plague in Athens (430 BCE)
The Peloponnesian War, Book II, 47-49.
trans. By R. Warner, Penguin, 1916. www.archive.org
 Admissible medical theories direct:

Prevention and Duties,rights,

therapies expectations
The actors involved

Ever since Antiquity,

there’s a rich and diverse
medical market,
involving different actors
and practices, according
to the accepted
epistemologies.

1100 -> new professional

After Nicolas de Larmessin
status for physicians; The Personification of Medicine, Pharmacy and
university. Surgery (1690 ca.)
The Plague!
• 1st pandemic: Justinian
Plague 541-2 → 750 CE 25
mln deaths
• 2nd pandemics: “Black
death”, In Europe 1347-
1771. 75-200 mln deaths
• 3rd pandemics: 1855-1959.
Mostly Asia (India, China).
12 mln deaths.
Yersinia pestis
CITE, LONGE, TARDE
Consequences

MORTALITY: Labour cost, lifestyle, market

CULTURE OF DEATH: the creation of a memory of the
plague; always ready for the next one
PUBLIC HEALTH AUTHORITIES: Became integral to city
and state management.

Commercial Weapon

A test for: State structure, social

contract.
 A. Lorenzetti,
Gli effetti del
buongoverno in
città, 1338-9

Since 14th century: data collection by health officers: taxes and public health.
Plague prevention: Furthermore: A strong and
Surveillance, Waters, foods, animals, sanitation, waste structured State
isolation, quarantine, collection, beggars, prostitution, drugs, is able to enforce
lazarettos, etc. hygiene in housings and workplaces, etc. the laws.
New deontological duties for physicians, paid by public authorities

“Every man that undertakes to bee of a profession or takes upon him any office must take all
parts of it, the good and the evill, the pleasure and the pain, the profit and the inconvenience
altoghether, and not pick and chuse; for ministers must preach, Captains must fight,
Physitians attend upon the sick, etc.” (Boghurst, Loimographia, 1665)

Contagio vs. Miasma

A false dichotomy?
Similar practices, different
epistemologies.

The return of the epidemic

constitutions: data, norms,
attempts at prediction,
disease classification.
Globalization of Commerce: A new diplomacy for sanitary borders

The «cordon sanitaire»

Epidemics become a leading cause for border control, where

trading goods and humans travels.
“The drawing up of ‘tables’ was one of the great problems of the scientific,
political and economic technology of the eighteenth century: how one was to
arrange botanical and zoological gardens, and construct at the same time
rational classifications of living beings; how one was to observe, supervise,
regularize the circulation of commodities and money and thus build up an
economic table that might serve as the principle of the increase of wealth;
how one was to inspect men, observe their presence and absence and
constitute a general and permanent register of the armed forces; how one
was to distribute patients, separate them from one another, divide up the
hospital space and make a systematic classification of diseases: these were
all twin operations in which the two elements – distribution and analysis,
supervision and intelligibility – are inextricably bound up.
In the eighteenth century,the table was both a
technique of power and a procedure of knowledge. It
was a question of organizing the multiple, of
providing oneself with an instrument to cover it and
to master it; it was a question of imposing upon it an
‘order’.”
M.Foucault, Discipline and Punish.

Wang, et al. (2017). Classification of common human diseases derived from shared genetic and
environmental determinants. Nature Genetics, doi:10.1038/ng.3931
«Against the plague, which is a mixture, discipline brings into play its power, which is one
of analysis. A whole literary fiction of the festival grew up around the plague: suspended
laws, lifted prohibitions, the frenzy of passing time, bodies mingling together without
respect, individuals unmasked, abandoning their statutory identity and the figure under
which they had been recognized, allowing a quite different truth to appear. But there was
also a political dream of the plague, which was exactly its reverse: not the collective festival,
but strict divisions; not laws transgressed, but the penetration of regulation into even the
smallest details of everyday life through the mediation of the complete hierarchy that
assured the capillary functioning of power; not masks that were put on and taken off, but
the assignment to each individual of his ‘true’ name, his ‘true’ place, his ‘true’ body, his
‘true’ disease. The plague as a form, at once real and imaginary, of disorder had as its
medical and political correlative discipline. Behind the disciplinary mechanisms can be
read the haunting memory of ‘contagions’, of the plague, of rebellions, crimes,
vagabondage, desertions, people who appear and disappear, live and die in disorder.»

Michel Foucault. «Discipline and Punish: The Birth of the Prison»

 The Enemy
sanitary

moral

external
internal

Epidemics are perfect events to enforce

new or emergency rules, that may
become the «new normal». Quarantine,
health patents, surveillance, fingerprints,
migrant control, app…
 Surveillance, power
Plague balance

Urban regeneration,
Cholera infrastructures

Empire expansion and

steamboate navi a vapore:
international coordinated control
and debate on the aptest
measures.

Hygiene or quarantine?
New Sites of Interactions

1851: 1st international

Sanitary Conference

Conseil Sanitaire, Maritime et Quarantinaire

(Alexandria and Constantinople)
Ottoman Empire «suspended»
 Malaria
Land reclamation

Different diseases,
Different policies

Leonardo’s
project for
the
reclamation
of the Valley
of the
Chiana

Smallpox: the greates killer in history.

Private disease, mass vaccination for society
Reactions to epidemics [before the medical solution]:
Control of the public space, expansion of the «state managed
space» and of the tools for such control.

Medicine provides tools,

ideas, and metaphors for
medicine control: miasma, contagion,
Pasteur…
individual society Medicine frames and
analyzes what is within this
public space.

What is «medical» is at the same time

what is private and political.
Medical practices interact with
political practices, and translate
into medical-political practices.

Epidemics are the perfect

chances when medicine and
politics collapse, providing
reciprocal justification.
In search of the Aryan-German nose

CAVEAT!
Biomedicine alone is not self-sufficient in defeating diseases!