( Originally Published 1923 )
IN the third year of the late war I was ordered by my superiors to take measures to check an epidemic of typhoid fever that had broken out in Uzsok, in the Carpathians, the scene of the great battle between the Russian and Austro-Hungarian forces. The task that lay before me was to prevent the spread of the infection by all means at my disposal. With this end in view I gave to all the troops under my command as sanitary officer strict orders that each man should wash his hands thoroughly before and after each meal. This order was based upon the fact that, as proved by the researches of bacteriologists, the germs that give rise to typhoid and certain other infectious diseases, such as cholera and dysentery, contaminate the hands and are conveyed by them to the mouth and digestive tract, thus bringing on the diseases mentioned.
Ages ago, thousands of years before science had proved with the aid of the microscope the existence of microbes that carry infection by direct contact, there were great, wise men, such as Moses and Mohammed, who had a kind of presentiment of the existence of such noxious germs, and who seem with prophetic vision to have suspected that probably all infections took place through such agencies.
At least, the Old Testament mentions a fact which permits us to suppose that the great prophet of the Israelitic faith, who is also revered by the Mohammedan creed as one of their saints, viz., Moses, suspected the connection between direct con-tact and subsequent infection. He issued the order that the dejecta of each person should be buried outside the camp, and that in case an epidemic broke out in one place, nobody from that place should be allowed to visit another camp. He also gave instructions as regards the frequent cleansing of the body through the ritual ablutions. Like so many others of the best teachings of Moses and of Jesus Christ, Mohammed took these over into the creed founded by him and even improved upon them by commanding the faithful to carry out a whole series of ablutions each day. I remember having seen among the attendants of the Shah of Persia, Muzaffer Eddin, whom I treated in 1902 in Carlsbad and rather often accompanied on his walks, a man who always carried with him a silver receptacle filled with water and a clean towel. Each time the Shah partook of any food on the way or left off his journey for any other purpose this man stepped forward and the Shah washed his hands.
Aside from the infectious diseases already mentioned, many others may be transmitted with the dirt on the hands and lead to premature death.
Many persons have the habit, beneficial for the circulation of blood in the nose but repulsive from the esthetic standpoint, of digging around in their noses with their fingers. A small wound or abrasion at the nasal orifice may readily be produced in this way. Now if the germ of erysipelas is present on the soiled fingers this disease may become established. In the face such an occurrence is especially serious by reason of the fact that the infection may extend to the scalp and this, in turn, lead to an almost invariably fatal inflammation of the brain membranes through passage of the agent of the inflammation through the scalp and the bony plate covering the brain.
Some years ago one of my colleagues in Carlsbad scratched open a small incised boil on his neck. Erysipelas set in, and subsequently meningitis, and the victim succumbed, though in the prime of life.
While erysipelas, fortunately, does not always result from such practices, yet the scratching of the skin with soiled hands on account of itching very often gives rise to troublesome furuncles or inflammation of the cellular tissues, and indeed, not very rarely to pyemia or septic poisoning, with fatal termination. My own mother's life, unfortunately, was lost in this very way; she died when only fifty-three years of age.
From all this we see how absolutely necessary it is to keep one's hands always clean and wash them frequently during the day. When I was in charge of a section of the military hospital at Ungvár, Upper Hungary, in 1916, many soldiers came for treatment on account of boils, cellulitis, and open sores. Where large numbers of vigorous young men are quartered in old buildings which have previously been used by others for hospital purposes it often happens that they are attacked by blood-sucking insects such as fleas and bedbugs.. The violent itching that results leads to much scratching, and on account of the dirty hands collections of pus in the tissues of the skin and the underlying cellular tissues are formed. I gave orders that all such soldiers as were found in the clinic or at the frequent daily examinations with dirty hands or feet should be reported for punishment. The result was that after that fresh boils or abscesses were reduced to a very low number.
Every person should be taught the need of habitually keeping his hands clean, from childhood on. As I personally observed, in the educational institution for children in Milan, conducted according to the teachings of Dr. Montessori, each child takes daily turns in washing the hands of the other children, thus becoming all the more accustomed to frequent washing of his own hands.
Frequent washing of the feet, at least once a day, is also to be regarded as necessary. Where it is not practicable for every person to take a full bath each day, he should at least bathe his feet immediately after rising or before going to bed. If there is not enough hot water at his disposal for the purpose, he should at any rate rub them down with a wet towel. In the Orient, washing of the feet has been practised from the earliest times, as we may read in the Scriptures, which describe how a foot bath is offered the first thing to every newly arrived guest.
Among the ancient Egyptians it was likewise the custom to have the feet of every guest washed before beginning a meal. Even though this was very appropriate in view of the habit prevailing in those times of going bare-footed or wearing sandals, it seems really all the more necessary now because of the fact that on account of wearing socks and air-tight leather footgear all the greater opportunity is given for the accumulation of dirt, and proper airing of the feet, which are abundantly supplied with sweat glands and sebaceous glands, is rendered impossible.
Nature herself actually teaches man cleanliness in the examples of it afforded in the lower animals.
Thus, we note how the cat licks her coat and carefully cleans the coats of her young almost daily.
This form of self-cleansing of the body may be observed in many species of animals. Even flies, which often seek their food in most disgusting filth, take care to cleanse their feet, with which they may do much harm, even to human beings, in the hygienic sense.
For the benefit of people who keep their houses in an unclean condition, I might mention by way of contrast the birds, which, like the swallows, carefully remove all dirt from their nests, and many species of birds that have shallow nests even teach their young to eliminate their excreta to the exterior.
Uncleanly persons may learn a very great deal from the bees. Bees tolerate no dirt in their habitations and carry all forms of excreta, moulds, and dead bees outside of the hive.
Before the bees take up a new dwelling place, the first thing they do is to clean it thoroughly and free it of all dirt and dust. To all those persons who never air their living rooms and are always breathing the corrupted air in them, thus exposing themselves to life-shortening diseases due to bacteria, such as tuberculosis, the bees also afford a wholesome example. In every hive certain bees are charged with the duty of securing ventilation, which they do by executing fanning movements with their wings, often continuously for as long as twenty-five minutes, in order to keep the air fresh and prevent its becoming overheated. Among the bumble bees, again, a worker stands at one of the ventilating openings in the roof of the nest first thing in the morning and fans out the foul air that has accumulated in the structure overnight. The bees and bumble bees have an even more delicate and sensitive olfactory apparatus than man, and this apparatus is more readily offended by foul odors than the organ of smell of many human subjects, which is less sensitive and therefore more tolerant of them.
Keeping the body clean and living in pure, wholesome air is absolutely necessary if we are to avoid exposing ourselves to any of the numerous infectious diseases, the germs of which occur in myriads everywhere over unclean skin or in contaminated air.
How greatly the keeping of the body clean is capable of warding off all manner of infections, even after wounds, was shown by experiences in the late war. It is also related of the Japanese in connection with the Russo-Japanese war that they seldom became infected after wounds because the soldiers were compelled to bathe before every battle and their uniforms were kept clean. Similar reports are made of the Turkish soldiers during the world war, their wounds healing quickly. In this case, of course, aside from cleanliness, the results were also promoted by the important circumstance that the devout Mussulmans followed the wise direction of their prophet not to take any spirituous liquors. Such liquors, if taken daily or frequently, reduce the intrinsic resisting power of our bodies against infection, a power conferred upon us by beneficent Nature.