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Death and miasma in Victorian London: an obstinate belief

BMJ 2001; 323 doi: (Published 22 December 2001) Cite this as: BMJ 2001;323:1469
  1. Stephen Halliday (, principal lecturer
  1. Buckinghamshire Chilterns University College, Chalfont St Giles, Bucks HP8 4AD
  • Accepted 23 October 2001

“From inhaling the odour of beef the butcher's wife obtains her obesity.”

Professor H Booth, writing in the Builder, July 1844

This assertion is perhaps the most extravagant manifestation of a belief that prevailed in the medical profession for much of the 19th century and survived in some quarters into the 20th century. This belief held that most, if not all, disease was caused by inhaling air that was infected through exposure to corrupting matter. Such matter might be rotting corpses, the exhalations of other people already infected, sewage, or even rotting vegetation. The “miasmatic” explanation of the cause of disease figured prominently in the long debates among the people who were responsible for combating the cholera epidemics that afflicted Britain, and particularly London, between 1831 and 1866.

Summary points

In the Victorian period the “miasmatic” theory of disease causation took some strange forms among influential people

Dr John Snow's hypothesis of polluted water being a cause of cholera was not accepted in official circles at the time of his death in 1858

In 1858 the “Great Stink” concentrated the minds of legislators on the problems of metropolitan sewage

As a result of this, Joseph Bazalgette was finally allowed to proceed with his plan for the main drainage of London

London's final cholera epidemic, in 1866, in an area not yet protected by Bazalgette's system, helped to ensure that John Snow's hypothesis gained acceptance in official circles


In his letter to the Builder quoted above, Professor Booth expressed the orthodoxy of his time.1 Edwin Chadwick's (1800–90) Report on the Sanitary Condition of the Labouring Population of Great Britain, published in 1842, argued for the improvement of house drainage to remove noxious smells from dwellings.2 In the same year Sir Francis Head, a colonial governor who had served in …

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