What we can learn from pre-scientific societies’ responses to the risk of contagion
Last week, I came across a video of a heated argument between an unmasked woman and store employees. While the woman sounded fed up and defiant about all the restrictions that have become the new normal, the employees were rightly concerned for their health and their livelihood. On my daily walk, if I see someone walking towards me, I cross the street in the interest of keeping a safe distance . When crossing the street is not an option, I stand still with my back to the walkers until they have passed behind me. When at the grocery store, I carefully clean the shopping cart with hand sanitizer.
To an extra-terrestrial (or a Rip Van Winkle who fell asleep pre-Covid and is just waking up), actions like these would surely seem bizarre. Maybe they indicate belief in a ritual with an unfathomable metaphysical meaning. Or, they simply suggest a fundamentally unfriendly and rude culture.
As I ponder the new etiquette, my mind flies back to the mores that were prevalent when I was a child. I grew up in Mumbai during the 1960s. As the biggest, most cosmopolitan, and the most commercially developed city in India, it was far from a backwater. In an India that was emerging from the long shadow of foreign rule and social and cultural closed-mindedness, middle class families like mine believed in Science. While we had easily — even eagerly — jettisoned religious dogma and ritual, we continued to follow the social and cultural practices that did not obviously contradict science.
This was most apparent in customs relating to every day life. Reflecting on them with fresh eyes. I realize that the everyday hygiene practices were meant to promote public health.
Cooking, Serving, Eating
When preparing food, the cook was not supposed to let her (for food was mostly prepared by the women of the family) hands touch the food being prepared. She also could not sample the food by dipping her finger in the cooking pot or tasting directly from the ladle. To taste the food, she used a fresh spoon, and then rinsed it off or dropped it in the pile of dishes to be washed.
As for food consumption, a person could not drink from a cup or eat out of a plate that another had used. People ate with their fingers and so there was no question of sharing eating utensils. Only the right hand could be used for eating. Double dipping was simply out of the question. When serving food, the serving spoon could not touch the dish of the person being served. Only the left hand, not having touched any food, could be used when taking or serving seconds.
At the end of the meal, it was customary to wash hands with soap and water. So was gargling in order to remove any remaining food particles from the mouth.
Before the advent of dining tables and raised cooking counters, the preparation and consumption of food took place at the ground level. To prevent food crumbs being carried to other parts of the house, the kitchen floor was cleaned and mopped with a damp cloth after each meal.
In a country with a tropical climate where germs and insects were ubiquitous, these simple habits served to (and still do) limit contagion.
Birth and Death
After her baby’s birth, a new mother was kept isolated for several months. Relatives living under the same roof were allowed to visit the new mother after a few weeks. Others were permitted to visit her gradually over the ensuing weeks and months. These customs protected the mother and her newborn and they facilitated contact tracing.
Cremation, practiced even today, reduces the dead body to its most inorganic form (ash). The process destroys any bacteria and viruses residing in the body.
The Namaste greeting, with palms brought together avoids all physical contact. Hugs were (and are) very uncommon, except between parents and their pre-teen children.
Footwear is removed outside the home or just inside the front door. Upon returning home it is customary to wash one’s hands and feet. It is also common to change out of one’s “outdoor” clothes and into the “home” clothes.
Scarcity of water notwithstanding, people bathed every day. In a newly industrializing society, electric appliances were few and far between. My middle class family had cooling fans, a radio, and electric lights, but no appliance for heating bath water. The bucketful of water for bathing (which was all that a person could have) was heated using a small indoor charcoal furnace. These daily hot water baths did their part in limiting disease spread.
Religion is a great source of comfort, inspiration, and spirituality in the lives of devotees. However, the grace and punishment associated with performance of religious rituals serve an important purpose (beyond religious salvation).
Customs like the ones described above were associated with devotional religious practice. For example, a person had to have bathed before starting to cook and before visiting the temple. Believers were assured that, by following these rules, they were amassing virtue (Sanskrit punya or the positive column in the heavenly ledger). This ensured widespread compliance
Being clean was seen as a sign of spiritual purity or goodness in several religions. It is worth noting that the phrase, cleanliness is next to godliness, was mentioned in a sermon by John Wesley back in 1778. Indeed, the idea is much older — it has been found in ancient Babylonian and Hebrew religious tracts.
The highly globalized era dawned during the early 1990s and gathered steam over the ensuing three decades. We now take for granted the ability to zip across the globe at short notice. We simply don’t worry about susceptibility to disease. However, this was not the case as little as a decade earlier.
For example, when I traveled from India to the UK during the early 1980s, I was required to take a whole slew of vaccinations before I could apply for a visa. A few years after that, when I traveled back to India from the US with my young children, I made sure to give them shots against tropical diseases like typhoid to which their young immune systems were susceptible.
But, what of the times before such vaccines became available? People arriving on Ellis Island were subjected to several health examinations before being admitted into the country. According to an article in the AMA Journal of Ethics:
After an arriving ship passed the quarantine inspection in New York Harbor, … examiners boarded and examined all first- and second-class passengers as the ship proceeded up the harbor. Upon docking, … officers transferred steerage or third-class passengers to Ellis Island by barge. Proceeding one after the other and lugging heavy baggage, prospective immigrants entered the station and moved slowly through a series of gated passageways resembling cattle pens. As they reached the end of the line, they slowly filed past one or more PHS officers who, at a glance, surveyed them for a variety of serious and minor diseases and conditions, finally turning back their eyelids with their fingers or a buttonhook to check for trachoma.
Which brings us to the peril of social distancing based on class and health status.
Unfortunately, human nature is such that even the best-intentioned rules sometimes get twisted into inhumane and unjust practices. At least some of the underpinning of the Indian caste system is the fear of contagion.
Even today, members of the “higher” castes have a strong preference to congregate, marry, and do business with others of the same caste. At some point in antiquity, this may have been adopted as a way to fight a particular plague or virus that was afflicting a certain “other” segment of the population. Over the ensuing centuries, the rationale was forgotten and what was left was the rigid unthinking preference to segregate oneself and one’s own “kind” from those who were deemed “unclean.”
Members of the so-called “lower” castes typically worked with animals and animal products, for example as butchers and in leather industries. By their very nature, these materials were susceptible to disease. As a result, and given the lack of scientific knowledge and means of decontamination, prevention, and cure, the workers themselves came to be considered “unclean” and, unfortunately, irredeemably so. Soon, they were relegated to socializing only among others like themselves. They were kept at more than arm’s length by members of the “higher” castes, that is, people who made their living by other, more hygienic means, such as teaching, administration, and book-keeping.
Another example of this is people who work with human waste. Before indoor plumbing became he norm, scavengers performed an important, actually indispensable, function. However, they were treated as equivalent to their work — unclean and disposable — and were also banished to the “lowest” castes.
The age of coronavirus has highlighted social distancing as a practical and relatively painless, means to limit transmission of the virus. It is important to make sure this does not devolve, in an abundance of caution at best and under the weight of superstition and ignorance at worst, into an unbridgeable and permanent separation between individuals and communities based on their class and health status.
For this to happen, we need reliable, inexpensive, and widely available testing, vaccines, and curative medicines. Ergo, Science.
Thanks to the scientific method and centuries of accumulated knowledge, multiple vaccines have been developed and made available in record time. Widespread administration of these vaccines is sure to inoculate individuals, communities, and entire societies against more than COVID-19.
Success of the vaccines will also inoculate us against superstition and irrational thinking about the causes of COVID-induced illnesses. And, it will inoculate us against the tendency to segregate and mistrust people based on their class, susceptibility illness, and health status.
Science is the best tool not just for destroying disease, but also for building cohesive and equal societies.