March 2010

The Nation Reviewed

Close at hand

By Kate Rossmanith
Illustration by Jeff Fisher.

One morning in 1683, Antonie van Leeuwenhoek, a merchant and amateur scientist in the Dutch city of Delft, set about the daily ritual of cleaning his teeth. Proud of his teeth, but perturbed by the solid white growth he could see between them, he scraped off some offending matter, mixed it with rainwater, and looked at it under a self-made microscope. Van Leeuwenhoek’s curiosity led to one of the greatest single advances in the history of medical knowledge. Through the lens he saw a miniature world of “small living animals, which moved very prettily”. What he soon realised, and what others would later accept, was that the world is teeming with microbial life, and that previous estimates about the amount of life on Earth were wildly inaccurate. Eventually, two centuries later, the complex connection between disease and the trillions of microbes around us would become accepted wisdom.

We know about germs, but even the best of us need reminding. Late last year, research conducted in New South Wales public hospitals found that only 39% of doctors routinely wash their hands while on duty. The NSW Department of Health is considering introducing punitive measures, but given that doctors deal with vulnerable people and are keenly aware of the importance of hand hygiene in reducing infection rates, perhaps the significant thing to consider is why they are not regularly washing. The low rate of hand-washing has been attributed to the frantic time pressures that health workers face, as well as inadequate supplies of alcohol-based rub. A more telling explanation, though, was offered by the Australian Medical Association’s Brian Morton, who said there was a perception among doctors “that not every time you touch a patient, [do] you pick up a handful of germs”.

Perhaps doctors are lax about hand hygiene because they share the same sticky, paradoxical relationship with microbes as the rest of us. Less than 1% of bacteria, and only some viruses, fungi, protozoa and helminths cause disease – and we think we can accurately guess where germs reside. By inoculating ourselves we consequently assume that we can control what pathogens we absorb. But by instinctively assessing risk – that, say, we won’t catch germs by taking someone’s pulse or by sitting in our lounge room, yet we might if we test a person’s urine or use a public bathroom – we are betting against the most abundant forms of life on Earth. In an act of stunning blindness, we work at safeguarding ourselves from nasty germs ‘out there’ without recognising that we should be protecting other people from the countless harmful microbes constantly on us and inside us.

Uncomfortable as it is to admit, we are laden with a curious hangover from the way people once behaved around illness. We smile now at the quaint logic of our 18th- and 19th-century forebears, who did not necessarily believe that sickness could be passed from one person to another and instead understood the causes of illness to be a disturbance in the body’s fluids or ‘humours’, or the effect of poisons or ‘miasmas’ floating in the atmosphere around sewers, swamps and other foul-smelling places. Yet we often still behave as if microbes don’t exist. Of course, we’re aware of germs and the antibacterial agents that combat them, but we rarely imagine tiny organisms attaching themselves to us whenever we touch anything.

This may be because we share with past generations some of the same experience of what it is to be, and have, a body. Until the nineteenth century, common-sense understanding of illness relied on just that: the senses. Disease was attributed to what people could see, smell and taste: toxic air, excessive sweat, yellow phlegm. Without a microscope, people in the eighteenth and nineteenth centuries could not see or sense infectious agents – and neither can we. This is why it’s impossible for us to remain always aware of the presence of bacteria and viruses, and why the World Health Organization felt compelled to institute the annual Global Handwashing Day.

Our senses encounter the visceral indices of microbial life when we hear someone cough or see a runny nose; yet these betray us twice. Not only are we unable to detect the infectiousness of other people unless they’re symptomatic, but we also can’t comprehend that we ourselves are teeming with germs. Pathogenic micro-organisms are constantly forming colonies on our skin and hair, and in our noses, intestines, anuses and bowels. If they grow too large in number we can become unwell, but most of the time we produce enough antibodies to combat them before we experience an infection. This is the principle of inoculation: by mimicking specific infections, vaccines teach the immune system to create particular antibodies (it is also the logic of a friend of mine’s father-in-law, who purposely uses unclean cutlery in restaurants). In other words, we carry all manner of germs and we pass them on through physical contact, the sharing of body fluids and objects, and even through talking and singing.

However, like our doctors and the doctors before them, our experience of germs is alarmingly selfish. Around 150 years ago, Hungarian obstetrician Ignaz Semmelweis outraged the medical community by suggesting that physicians were responsible for the spread of puerperal fever. He observed medical students who went straight from the autopsy room to the maternity ward. In a dramatic step, he ordered his staff to wash their hands in chlorinated water before deliveries, and the number of deaths from childbed fever suddenly decreased. Semmelweis’ colleagues were hostile to his findings largely because they could not fathom that healthy people – physicians at that! – carried disease-causing agents on their hands. Last year’s study found that doctors tend to wash their hands after seeing a patient, indicating their concern for what they might contract, rather than what they could pass on.

The problem is that we’re only taught to guard ourselves from germs on and in other people and places. “What we’re not taught, and yet what should be obvious, is for us to wash our hands to protect others from our germs,” explains Mary-Louise McLaws, a Sydney academic and co-author of the report. “Whoever washes their hands before using a public toilet? Our own wellbeing is important, but equally important is the health of everyone else.” The problem also is that we in the West experience our bodies as neatly bounded by smooth skin, vulnerable to outside attack from invisible invaders. This overlooks the bacteria and viruses that call our flesh home – many of which are transmitted to other people – as well as the unnerving fact that we are always leaving traces of ourselves behind: each day, as we distribute billions of microbes, we also shed tens of millions of skin cells.

Examining my own hand under the little microscope my parents keep among their books, I find that the skin on my palm is an unpredictable topography of ridges and valleys. It shimmers like the scales of moths’ wings. Two-and-a-half millennia ago, Sophocles wrote in Oedipus Rex that the plague in Thebes was a “black stain spreading everywhere, spreading”. It’s not contagion alone that spreads among us. Dry, golden particles of our materiality scatter through the world for others to breathe in and wear on their hands, feet and face. We worry about disease and dying, but we are already dust.

Kate Rossmanith
Kate Rossmanith is a non-fiction writer and lecturer in cultural studies at Macquarie University. She has been published in Best Australian Essays 2007.

Cover: March 2010
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