Hygiene

The concept of global hygiene is as ancient as the term itself, based on Hygeia, the Greek goddess of Hygiene and granddaughter of Apollo. Gustav Klimt's painting of Hygeia portrays her as a powerful dominating figure in dark red looking directly at us from across the centuries. Her father was god of medicine, and for the Greeks and Romans, father and daughter became the epicenter of medical matters, health, cleanliness, and sanitation. Hygiene dominated the globe at that time, represented by these two superpowers.

The application of these principles of hygiene is now returning on a global scale. It is salutary that after each natural disaster, as with epidemics after the floods in Pakistan, the outbreak of cholera after the earthquake in Haiti, and the diseases spread following the Southeast Asian tsunami in 2003, the infectious events of the aftermath can be even more deadly than the sharp happenings in the first days of the event itself. Even today infection is always waiting on the wings as one of the four horses of the apocalypse. It was no coincidence that Hygeia was pushed into prominence after the plague outbreaks in Rome and Athens between 429 and 293 CE. Doctors and hygienists at the time, even with no grasp of microbiology, understood that our own thoughtful interventions could break a chain of disease transfer from person to person. In our own global world, until recently, the concept of hygiene had been pushed aside by the drama of antibiotics and molecular vaccines. It took the emergence of A/California/07//09 H1N1 virus, swine influenza, to remind us of the antimicrobial power of the principles of hygiene and how the science could be applied on a truly global scale.

The threat of infection is a continuous and dominating problem in our world. We still depend on the three-layer defense system that was well known to our ancestors in their iron-age fortresses, and our Norman conquerors in their castles, with the outer and inner walls and final inner redoubts and keeps. With the influenza pandemic, our defense zones had been well prepared: the outer protective zone of vaccine, the antiviral (Tamiflu and Relenza) wall, and finally the home front. This last zone is still underestimated, but it remains preeminent. In 1940, Britain had the three zones: the navy, the air force, and the home front. If the last is not solid, then efforts elsewhere begin to crumble. From the viewpoint of infection, the home front is made up of hygiene principals of cleanliness, disinfectants to kill pathogenic microbes, and social distancing. Personal responsibility is the key here both to protect oneself and to protect others.

Almost coincident with the discovery of bacteria in Europe toward the end of the 19th century, phenol disinfectants were formulated to kill the newly discovered microbes both at home and in hospitals and particularly in operating theaters. Joseph Lister showed this clearly with his phenol sprays. Disinfectants are still at the heart of hygiene principles today. But it is a fact that the discovery of penicillin in a small room off Praed Street at St. Mary's Hospital in London and the isolation of streptomycin by Selman Waksman in the United States led to an abrupt fall from the principles of those early Greeks and Romans. Why should highly trained nurses be spending time on hand washing or cleaning surfaces when the new science of antibiotics had arrived that obviously signaled the end of pathogenic bacteria? But as we now know, using that most powerful of medical/scientific instruments, the retro-spectroscope, these events were sadly misjudged. We have been involved in a cataclysmic series of misjudgments, and the legacy of those scientific discoveries of the 1940s has been dissipated. The world now finds itself sharing the planet with microbes resistant to every known antibiotic (Kumarasamy et al., 2010; Livermore, 2009).

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