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'Bad Air' and the spread of disease in Tudor England

Curator Rosalyn Sklar examines how the Tudor belief that 'bad air' caused disease is deeply ingrained in how we react to the threat of illness today.

Rosalyn Sklar

In this new world we find ourselves in where we venture forth wearing our masks into public spaces - what are you keeping an eye out for to protect yourself? The tiny particles of another person’s outward breath are, of course, invisible. We cannot see coronavirus any more than we can see the common cold or any number of other infectious illnesses. But in these modern times we know so much more about what causes disease. We know about viruses and bacteria, how they are spread and how they operate in the body to make a person ill. How does this knowledge work in practice though? Wearing masks has been unpopular in some quarters; people have railed against it as an encroachment on their freedom to make their own choice. What makes people feel safe and protected? Often it is familiarity - the thought, however deeply buried in the subconscious - that you won’t catch the virus from someone you know or by going somewhere you are familiar with. You wear your mask to the supermarket but immediately pull it down below your chin when speaking to a friend you meet in the car park. There is perhaps a persistent idea that illness and disease is linked to the dirty and the smelly, perhaps even the unfamiliar. 

This concept of disease is very ingrained in our past and was part of the dominant medical opinion for at least 2000 years. It has been reinforced in some ways by the discovery of bacteria - cleaning will remove bacteria therefore dirty = disease. It’s not surprising that the idea is so deeply rooted in our collective psyche.

In Tudor England, medical theory was predominantly governed by the writings of Roman physician, Galen, and the Greek medic Hippocrates. These texts had formed the bedrock of medical theory and practice since the early 100s. They had been added to, translated, re-translated and spread across the world. 

“Hippocratic medicine imagined the body worked by way of fluid exchange. These bodily fluids, known as humours, needed to be kept in balance to maintain health...There were thought to be four main...humours in the body [blood, yellow bile, black bile and phlegm] and it was believed that these were connected to the four elements of the earth [air, fire, earth and water; spring, summer, autumn and winter)...Under this system someone’s personality was [also] linked to their humoural makeup.”  [Evans, Jennifer & Read, Sara (eds)., Maladies & Medicine: Exploring Health & Healing 1540 - 1750 (Barnsley, 2017)]

People could look after their health by managing the ‘non-naturals’ that affected the body - these were air, food and drink, motion and rest, sleep and waking, repletion and evacuation, and emotions (or passions). Medical interventions sought to regain a person’s natural humoural balance - for example, an illness caused by an excess of blood would be treated by letting blood from the patient to bring back the usual order to the body. Everybody had their own unique humoural makeup so medicine was specific to the patient rather than the illness. 

Let’s examine the first non-natural in the list above - air. Belief in “bad air”, or miasma, dates back hundreds of years and writers in ancient Rome and China mentioned it with regards to town planning and the spread of illness. It was often spoken of in the context of moisture, heat and decomposing matter coming together to create poisonous air that carried particles with it that caused disease. This was over a thousand years before bacteria was first observed under a microscope. Malaria literally translates as ‘bad air’ in Italian and was used to describe ‘unwholesome air’ well before it was used to describe a specific disease. 

Aromatic container SBT 1994-42
Aromatic container for purifying the air, 16th Century, eartheware

It may seem to us that our ancestors were very close to understanding the spread of disease when they speak of bad air and infected particles but, unfortunately, their approaches to countering the negative effects of miasmas relied on superficially purifying the air rather than tackling any microbes that existed within it (germ theory would not become prevalent over miasma theory until the late 1800s). The methods used to tackle bad air were aimed at pleasing the senses. Bad smells were overpowered by good smells. The aromatic container (pictured above) in our collection would have been used in the home. It is about the size of a large cereal bowl and has holes punctured at regular intervals along the sides in concentric rings. It would have been filled with sweet smelling herbs or flowers. Some containers like this one incorporate a well underneath for a flame so that the contents could be heated, encouraging the spread of the pleasant smells through the air. It was also common practice to scatter wildflowers and sweet smelling herbs amongst the rushes on the floor. Small hand held items such as pomanders were popular with the elite living in crowded cities and ‘sweet purses’ or bags could be carried and used in the same way - to hold under the nose to guard against bad smells. 

Sweet Bag
Sweet purse, silk with guilt metal thread, 16th Century

Perhaps a more effective method of fighting disease based on miasma theory was the impact it had on town planning. Theories are not always put into practice but people did understand that it was not wise to build a domestic dwelling right next to stagnant water or allow the build up of rubbish next to houses. In 1552 William Shakespeare’s father, John, was fined for his contribution to a ‘midden heap’ on Henley Street along with two other men. John Shakespeare was a glover and whittawer (a curer of white leather). Members of these professions ‘were notorious for polluting water and land, thus causing great stinks.’ The midden heap, or muck heap, perhaps included scrapings from animal skins and seems to have been closer to the dwelling than the designated ‘muck hill’ at the end of the street. In his ‘Compendyous Regyment or Dyetary of Health’ Andrew Boorde (c.1490 - 1549) encourages people to choose the site for their house ‘where there is plenty of wood and water and “elbow-rome”, as well as abundance of fresh air’. There must be ‘no stinking ponds, nor corrupt dunghills in the vicinity’.

Miasma theory collapsed in the 19th century but not without a fight. The entrenched belief that cholera was caused by bad air meant that authorities were slow in accepting the physician John Snow’s findings that it was water that was at the heart of a cholera outbreak in Soho in 1850s, something Snow had been writing about for at least five years by the time of the 1854 outbreak. It can take time for medical and scientific knowledge to develop and even longer for public perception to change. We are, in some ways, just as vulnerable to infection as our Tudor ancestors if we rely on our sensory instincts to protect us against disease rather than following the medical advice. Fortunately there is a much better understanding among the general public of how viruses and bacteria are spread and significant scientific developments in how we identify and treat illnesses.   

The Breviary of Health, Andrew Boorde, 1557
Title page of Andrew Boorde's 'Breviary of Health' (1557). This book attempted to make medical knowledge more accessible to non-medical readers.

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