All smell is disease

I am reading The Illustrious Dead by Stephan Talty, an account of the role typhus played in Napoleon's catastrophic invasion of Russia in 1812. We had our critical War of 1812 in which we suffered 2,300 KIA and 15,000 died from other causes over 32 months. Large as that looms in our history, in contrast, on the other side of the globe, Napoleon invaded Russia with an army of some 700,000 men. The six month campaign resulted in some 600,000 French and Russian military deaths and perhaps as many again Russian civilian deaths.

Talty is in places a clunky writer and there is a straining to make typhus THE cause of defeat, rather than simply one (though a critical one) among several contributing factors to this nearly incomprehensible disaster. That said, it is a good read, full of interesting asides and insights.

He does a good job of recalibrating our modern mind, with all its knowledge and assumptions, to the realities of the time. Page 50.

To understand what the Grand Armee's doctors were thinking as they tried to save these dying men, one must understand the complex and often contradictory state of medical thought on disease in the early nineteenth century. The theory of humors developed by Hippocrates in the fifth century B.C. was still the dominant mode of understanding health and sickness. According to it, black bile, yellow bile, phlegm, and blood were perfectly balanced in the healthy person. When diet or routines introduced an excess or a shortage of one of the humors, disease appeared.

But competing theories, superstitions, and straight-out quackery were layered over this belief. Medicine was very much an intuitive art as opposed to a rigorous science, and what treatment one received could vary widely, depending on what school of thought one's physician favored. There was no universal cure for certain diseases. Age, occupation, living situation, physical build, and even temperament were key factors in determining the cause and cure for diseases. In addition, one had to consider the circumstances under which the victim had fallen ill: Was a northwest wind blowing? Was he depressed? Had he been exhausting his vitality by drinking to excess? Each patient was a world unto himself. This was a concept called "specificity."

Specificity was fatal to the idea of common diseases and common treatments. One man's cure was considered useless for the next patient, who had a different set of life factors to consider.

When it came to infectious diseases, there were two working theories: miasma and contagion. Miasma remained the dominant disease theory of the seventeenth through the nineteenth centuries. The influential English doctor Thomas Sydenham championed the idea beginning in the mid-1600s and developed the notion that noxious vapors emerged from the earth's rotting center and infected the air of towns and villages, which were then struck by epidemics. It was dark view of Mother Earth, much different from our own. Odor was a telltale sign of danger to one's health. "All smell is disease," wrote the English sanitary activist Edwin Chadwick.

The theory dissipated through European and American life. In Jane Eyre, the orphan asylum where Jane and her sisters live sits in a forest dell that is a "cradle of fog and fog-bred pestilence" and that eventually causes a typhus epidemic that kills a number of the girls. Edgar Allan Poe's 1839 short story "The Fall of the House of Usher" contains perhaps the most palpable description of miasma in modern literature. The twenty-first-century reader might interpret the passage as a gothic premonition of death, but the nineteenth-century one would also see something else - a realistic portrayal of airborne disease:

But the under-surfaces of the huge masses of agitated vapor, as well as all terrestrial objects immediately around us, were glowing in the unnatural light of a faintly luminous and distinctly visible gaseous exhalation which hung about and enshrouded the mansion. "You must not - you shall not behold this!" said I, shuddering, to Usher, as I led him, with a gentle violence, from the window to a seat. ". . . The air is chilling and dangerous to your frame."

The doctors who advocated miasmism weren't only following tradition, they were obeying common sense. Who could believe disease was spread by invisible organisms that somehow floated from body to body, instead of the odors from rotting corpses that one could smell and even taste on the tongue? Which made more sense? The idea of contagion was more radical in its view of a hidden world of germs. The miasma theory fell in easily with centuries of folklore about the dangerousness of swamps and bogs, and it chimed with the evidence of one's own senses. It's no wonder that it proved remarkably resilient.

Contagion - the idea that disease spreads by direct contact or indirect contact - was the father of modern germ theory. Its roots went back to the Muslim statesman and medical thinker Avicenna in the eleventh century. By the nineteenth century, it had many supporters but just as many detractors.