November 27, 2007

Our Enemy Hands



IT’S hard to see Americans as under-washed. Sales of antibacterial soap, tooth whiteners and “intimate hygiene” products (wipes and sprays) are skyrocketing. Scientists actually connect the rising rates of asthma and allergies in the West to our overzealous cleanliness. And yet, in a compulsively sanitized culture, cleaning one part of the body — the hands — seems to be more honored in the breach than the observance. Studies show that hospital doctors resist washing their hands, and gimlet-eyed researchers report that only about 15 percent of people in public restrooms wash their hands properly.

Our ancestors would have been bewildered by this discrepancy between relentlessly scrubbed bodies and neglected hands. Depending on their era and culture, they defined “clean” in a wide variety of ways. A first-century Roman spent a few hours each day in the bathhouse, steaming, parboiling and chilling himself in waters of different temperatures, exfoliating with a miniature rake — and avoiding soap. Elizabeth I boasted that she bathed once a month, “whether I need it or not.” Louis XIV is reported to have bathed twice in his long, athletic life, but was considered fastidious because he changed his shirt three times a day.

But through all these swings of the hygiene pendulum, one practice never went out of style — humble, ordinary hand-washing. Which was fortunate, because hand-washing is the one cleansing practice canonized by modern science, a low-tech but effective way to prevent getting and passing on the common cold and infections from Clostridium difficile to MRSA, SARS and bird flu.

Hand-washing made sense in the ancient world, when food was eaten in the hands. Theophrastus’s “Characters,” written in the fourth century B.C., paints a portrait of a hairy, scabby sloven named Nastiness, who doesn’t wash his hands after dinner. But hand-washing was more than pragmatic: it was also a sign of honor and civility, something you offered your guests, via a basin and towel, as soon as they arrived. Since the Greeks believed that any respectful relationship, with gods as well as humans, demanded cleanliness, washing was a necessary prelude to prayer, and sanctuaries usually had fonts of water at their entrances.

For the Romans and Greeks, well-washed hands were a natural accompaniment to fairly clean bodies. The medieval and Renaissance focus on clean hands is more surprising, because those ages had little interest in washing beyond the wrist. It’s true that the Crusaders imported the idea of the Turkish bath into Europe, but even if your town had a bathhouse, it merited a visit only once every week or two.

Clean hands were a different story. Monastery cloisters featured a stone trough for hand-washing, and medieval paintings of interiors often show a ewer, a basin and a cloth for drying hands in a corner of the room. Etiquette books ordered hand-washing before and after meals, and people who neglected it inspired scorn: Sone de Nansay, the wandering hero of a 13th-century French poem, noted with dismay that Norwegians did not wash at the end of a meal.

Among the most fervent hand-washing advocates were medieval poets, who found it difficult to describe a banquet without affirming that everyone present washed his hands before eating, then once again afterward. Unless you washed your hands, you had no claim to gentility.

That belief persisted through the 17th century, even as bodily griminess reached new heights. Doctors assured people that they were more susceptible to the plague if they opened their pores in warm water, and terrified Europeans shunned water and washing, except for their hands. Since forks were not in general use until the 18th century, hand-washing still had a practical function as well as a symbolic one: the Dutch in the age of Rembrandt scandalized French visitors by eating without first washing their hands.

By the mid-19th century, people were timidly experimenting with bathing, but scientists still believed that disease spread through decaying matter and bad smells. When Ignaz Semmelweis insisted that Viennese doctors wash their hands in between performing autopsies and delivering babies, he was ridiculed, even though the practice greatly reduced death from puerperal fever. Semmelweis’s simple but radical idea gained currency only in the 20th century. The germ theory slowly triumphed — but until the development of sulfa and antibiotics, almost the only way to fight microbes was by washing them off.

Even with antibiotics, washing off microbes remains an excellent idea. This ancient mark of courtesy is now celebrated in public health campaigns, and the Centers for Disease Control and Prevention has anointed it as “the single most important means of preventing the spread of infection.” So, learn from science as well as the wisdom of our ancestors, and wash your hands.

Copyright 2007 The New York Times Company