Keeping Clean

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An English early 20th Century bathroom

 

Dirty water has killed more humans than all the wars of history combined, but in the last 150 years a series of new ideas and innovations have changed our world and the way we live; including John Leal MD, who added chlorine to the 1) ___ water supply of 200,000 people but transformed the way we live. In 1908 the consensus was that chlorine was lethal but he believed differently. Without authorization Leal added it to the water supply and made it safe to drink.

 

The germ theory of disease states that some diseases are caused by microorganisms. These small organisms, too small to see without magnification, invade humans, animals, and other living hosts. Their growth and reproduction within their hosts can cause a disease. “Germ“ may refer to a virus, bacterium, protist, fungus, or prion. Microorganisms that cause disease are called pathogens, and the diseases they cause are called infectious diseases. Even when a pathogen is the principal cause of a disease, environmental and hereditary factors often influence the severity of the disease, and whether a particular host individual becomes infected when exposed to the 2) ___.

 

The germ theory was proposed in the mid-16th century and gained widespread credence when substantiated by scientific discoveries of the 17th through the late 19th century. It supplanted earlier explanations for disease, such as Galen’s miasma theory. Since the germ theory of disease, cleanliness has come to mean an effort to remove germs and other hazardous materials. A reaction to an excessive desire for a germ-free environment began to occur around 1989, when David Strachan put forth the “hygiene hypothesis“ in the British Medical Journal. In essence, this hypothesis holds that dirt plays a useful role in developing the 3) ___ system; the fewer germs people are exposed to in childhood, the more likely they are to get sick as adults. The valuation of cleanliness, therefore, has a social and cultural dimension beyond the requirements of hygiene for practical purposes.

 

Cleanliness customs swing back and forth like a pendulum over the ages, from society to society and century to century. The thought of a daily shower would have filled the 17th century Frenchman with fear. To open your 4) ___ and leave your body vulnerable to all that disease, would be asking to get sick. Our bathing habits would have disgusted him, much like his habits disgust us: never washing his body with water or soap, for instance. Or changing his linen shirt to get clean.

 

Habits of cleanliness go from ancient Roman afternoons at the public baths to today’s obsession with hand sanitizer and teeth-whitening strips. Contemporary cleanliness has more to do with appearances than hygiene. If you were a man in ancient Rome, you would take off all your clothes, put a little oil on your body, rub it with dust and go out into the playing field to work up a sweat. Then you would get somebody to scrape off your perspiration with an instrument that looks like a little tiny rake, called a strigil. You would get into a tepid bath, then a hot bath, then into a cold bath. They never used any soap, and it was all done in public. 5) ___ was a combination of animal fat and lye. The Egyptians, (wealthy Egyptians cleaned themselves with fresh limes) went to great lengths to make a soap that was mild enough to use on bodies, but many cultures, including the Romans and Greeks, didn’t. So they scraped themselves. Basically, it was a kind of drastic exfoliation. They probably got as clean as soap makes you. Most people, except very rich people, didn’t use soap until about the second half of the 19th century; that’s like two thousand years.

 

The Romans had amazing technology. The great imperial baths were fed by the 6) ___ to enormous tanks called castella. Romans heated the bathhouse with impressive underfloor heating and heating within the walls. Public baths went out of fashion, probably because the infrastructure to run them – the mechanisms that brought them water, that heated their water, that separated out the different heats of the various pools – required an enormously sophisticated and complicated infrastructure, which the Roman Empire had. But when the empire started to fall apart, people couldn’t maintain that, and the invading barbarians disabled the aqueducts. There was never an empire large enough to support that again.

 

For more than 1,000 years, cleanliness was not a priority. Attitudes about which cleans better, cold water or hot water, haven’t changed much. People who support cold-water bathing, think it’s virile and virtuous, and think those who bathe in warm or hot water are feminine and not masculine. Europe suffered a hiatus in cleanliness for centuries. When the great plagues came with the Black 7) ___, in the 14th century, the king of France asked the medical faculty at the Sorbonne in Paris, “What is causing this hideous plague that is killing one out of every three Europeans, and what can we do to prevent it?“ The 14th century doctors said that people who were at risk for getting the plague had opened their pores in warm or hot water, in the baths, and they were much more susceptible. In France and England and most European countries, for about five centuries, people really believed that it was dangerous to get into water. This strong belief broke down in the 19th century.

 

There was nothing that corresponded to that belief, in Asia or in India, where they had an unbroken tradition of cleanliness. They also had religions, like Islam and Hinduism, that took cleanliness very seriously. And, yet, in some societies, the holier you were – and this really applied to monks and hermits and saints – the less you would wash. And the more you smelled, the closer to God people thought you were. In the U.S., this meant your clothes were dirty, and you needed to wash them. But the 17th century looked at the ring around your cuffs and collar and thought linen was like a wick that drew out the dirt. They believed, not only was it safer to change your linen shirt, but that it actually cleaned you better. They thought the flax in the linen exerted a kind of magnetic attraction to the sweat and drew it out of your body. So, at that time, changing your 8) ___ was the cleanest thing to do.

 

During the 17th century, people put on perfume so they wouldn’t smell their neighbors. Madame de Montespan, one of Louis XIV’s mistresses, wore clouds of self-defensive perfume so that she wouldn’t smell the king’s halitosis. She didn’t like the way he smelled, and he hated the way she smelled, because perfume gave him headaches. By about the 1840s in America, architects who made pattern books – books that everybody could buy and then build according to the patterns in the book – added a little room that was called a “bathing-room or bath-room“ for the first time, since the ancient Romans, which meant that, eventually, there would be fixed plumbing in that room. But for a long time, well into the 1920s in rural places, you would just move a tin tub into the kitchen on Saturday night and fill it with warm water, and then everybody in the family, one by one, would get into the same water, starting with the father, considered to be the most important, and going down to the daughter-in-law, who was the least important.

 

Very gradually. One of the things that probably enabled indoor bathing to happen was the fashion for spas in naturally occurring springs all over Europe. The Romans always situated their baths near a mineral spring if they could, because their doctors believed there were health-giving properties in them. Even when people were afraid to get into 9) ___ on a regular basis, if you were sick, if you had arthritis or were infertile or had some medical condition, under your doctor’s care you would go to some place like Baden in Switzerland or Bath in England and take the treatments, which included getting into water. Perhaps, because only wealthy people could afford to go to these spas, bathing eventually became chic. About a third of London houses had in-house plumbing by the 1830s, which was far above what the people had in Paris. The water inspector for Paris said the Parisians would never want this, and it would render their houses damp forever.

 

By the mid-18th century, doctors had a little bit more understanding of physiology, and that your pores needed to be open so that they could let out sweat and other things. They thought you let out an awful lot more through your pores than people actually did. It gradually began to be thought of as healthy to clean your pores and let yourself perspire, but it took a long time. Perhaps the American obsession with cleanliness, is a continuation of something that started with the Civil War, when the Americans had surprising success with the Sanitation Commission, which was headed by Frederick Law Olmsted, the architect of Central Park. It achieved an enormous success in limiting deaths just by washing the patients, their linen, the walls of their rooms. It drastically cut into the deaths by disease and infection. Now, we know that just washing hands often, whether in a hospital or not, kills germs that matter.

 

Before the Civil War Americans had been just as dirty as Europeans, and they came out of the war thinking cleanliness is democratic because it doesn’t cost much money. It’s progressive. It’s forward-looking. It has wonderful results. They quickly thought this is yet another way in which life in the New World is so much better than life in the Old World. The invention of modern sophisticated advertising, which began in America at the end of the 19th century, achieved an enormous success, often by advertising things like toilet soap and deodorant.

 

And yet, Charles P. Gerba MD (Univ Arizona), sent his researchers into public washrooms and found that only about 15% of people there actually wash long enough and with soap, demonstrating that our current interest in cleanliness is really about appearance and not ever smelling like a human being. If we smell like mangoes or vanilla and our face looks clean and our teeth are paper white, that’s good enough. But really the one seriously disease-preventing practice of hand washing is not done enough. On the other hand, it’s increasingly believed by a large number of doctors and scientists, that we’re not giving part of our immune system enough of a challenge, with dirt and germs to deal with, overcome and get stronger (as a result). As a result we’re enabling a part of our immune system, the one that gets allergies and asthma, to take over.

 

It’s like a see-saw: The one that really can work on dirt and bacteria has nothing to do, and so it becomes unexercised (don’t use it, you lose it), and it stays on the ground. The other part is up in the air. Scientists couldn’t understand why we had these skyrocketing rates of asthma and allergies. Now the hypothesis is that we are oversanitized to the point of making our children sick. Bathing is now thought by many doctors to be a social convention. However, doctors make it clear that it’s very important to wash 10) ___. About a quarter of U.S. houses built in 2005 had three or more bathrooms. Has this room where you bathe become a status symbol?

 

In the 19th century, Harriet Beecher Stowe, who wrote “Uncle Tom’s Cabin,“ said she dreamed of a time when there would be one bathroom in an American house for every three or four bedrooms. People at the time thought this was utopian thinking, compared to what they were used to. Now a luxury apartment in Manhattan, has more bathrooms than bedrooms. We’ve never needed to wash less in the developed Western countries, and we’ve never had more pressure to wash more. If your job is in front of your computer, and if you have a house full of labor-saving devices, you’re not scrubbing floors very often, and if you have access to a car or public transit where you live, you’re not sweating the way people did 50 years ago. However, a daily bath is the minimum. More and more people now take two showers a day. Advertising has pushed psychological hot buttons, and convinced Americans that they will be more popular and successful if they buy the myriad cleansing and beautifying products on the market. Caveat Emptor! Or, beware of what you wish for.

 

ANSWERS: 1) New Jersey; 2) pathogen; 3) immune; 4) pores; 5) Soap; 6) aqueducts; 7) Death; 8) shirt; 9) water; 10) hands

 

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