When the Chinese gift of Coronavirus infections – known as COVID-19 came, the media were awash with images of well known western leaders avoiding handshakes, but using the ancient Indian greeting of “namaste” instead. Suddenly there is new awareness across the world of an ancient hygienic practice followed in India. People point out that even shaking hands can transfer bacteria from one person to another and for that reason a “namaste” greeting without touching anyone is good practice.

Many of us do not realize the legacy that Indian culture leaves us regarding cleanliness and hygiene. Washing one’s hands is the most basic act in preventing the spread of diseases. We now know that many diseases are caused by bacteria or viruses. These microscopic organisms have no legs or wings to help them move from one victim to another – so they have evolved amazing ways to spread from one human to another. A person with a cold throws out cold-causing viruses every time he sneezes or coughs. Those viruses float around in the air and later settle on everyday objects. People nearby may breathe in the viruses or may touch an object such as a table, tap or a cellphone with viruses on it and then brush their hands against their nose or eyes and get infected. People wonder how anyone can get a cold, flu or COVID-19 from touching the eyes. This can happen because tears from the eyes wash down into the nose, carrying viruses down into the nose.

For the same reason we do not share unwashed drinking glasses or plates that have been used by somebody else. Saliva from an infected person that smears the food in a common plate via his hands or a spoon can transmit infections to a non-infected person. Not sharing food from a common plate or glass is a deeply embedded Indian cultural meme. The Hindi word “jootha” describes such contamination. The Kannada word for the same – “yenjilu”, literally means spit or saliva indicating that there is a traditional awareness of how saliva from one person can be shared via food. This awareness is completely absent in European and middle eastern cultures. After the onset of the COVID pandemic, the Catholic Church revised its guidelines about receiving holy communion (bread or wine). Instead of being placed on the tongue, which can cause the spread of infected saliva from person to person, the Kerala church requested followers to receive communion on clean and sanitized hands.

Another borrowed custom that must be discouraged is the blowing out of candles placed on a birthday cake. When one blows our air from the mouth a spray of saliva goes out with the breath and this settles on the birthday cake. Any infection in the saliva from a coronavirus or flu carrier who does not have symptoms can spread to people who eat the birthday cake.

In my first hospital job in the UK I was surprised to find that toilet paper in the hospital toilets had the words “Now wash your hands please” printed on it in bold letters. This was in 1984, decades before smartphone cameras and Instagram, or I would have had a photographic record of that. Washing one’s hands after using a toilet, and always washing hands before and after meals is drilled into Indians from our youngest days. I could not imagine that here was a developed nation in which people did not know that they had to wash their hands after using the toilet. In fact most toilets did not have any washbasins nearby so the question of washing hands did not arise.

The bacteria or viruses that cause typhoid or jaundice appear in the motions (stools) passed by the infected person. Those bacteria enter the water supply in streams or lakes. If someone drinks contaminated water from these sources, or eats uncooked fruit or vegetables washed in such water they could get jaundice. This is how infections can spread from the food sold by roadside fruit and vegetable vendors who may not have access to clean water or clean toilet facilities as they spend all day in a public place.

Another commonly followed custom in India is to bathe and change one’s clothes after paying one’s respects to a person who has died, or helping to carry that person at a funeral. In the old days before vaccination and antibiotics, a very large number of people were dying from contagious diseases like smallpox and plague which can be spread by contact with people who have had the disease. Having a bath and washing one’s clothes after a funeral was good practice to reduce the risk of spread of infection. Hindu funeral practices are an example of mechanisms evolved to combat the spread of infection. People may have noted that when the Chinese city of Wuhan was overwhelmed with deaths from COVID-19, mandatory cremation of bodies was undertaken. Cremation destroys all infection and should be the preferred method of disposal of bodies carrying communicable diseases. There still exists a fear that the deadly disease smallpox could re-emerge if somebody digs up an old grave of a person who had died from smallpox.

The fact that touching can cause contamination and can spread bacteria was practised by my Brahmin grandmother in a ritual called “madi” in Kannada where she would have a bath and put on clean clothes and no one was allowed to touch her after that, while she entered the kitchen to cook for us. Few people know that an exactly analogous practice is followed in every single surgical operating theatre in the world. The surgeon washes himself (“scrubs up”) and puts on clean clothes and no one who is not similarly prepared can touch him after that. The practice called “madi” that is thousands of years old is exactly the same as that followed for safety in operating theatres.

Indians who visit Western countries are often surprised at the way people put up their feet on sofas, tables and beds without taking off their shoes. In India this is disallowed – in fact in India we take off our shoes before entering a house and many shops. The same practice is followed in modern operating theatres and Intensive Care Units. One must remove one’s shoes before entering these areas because footwear can carry infection-causing bacteria from the outside into a clean area. Knowing this, it becomes clear that the habit of removing footwear before entering a house is a good method of reducing contamination of the house with dirt. In fact when I was a boy we had to wash our feet and hands when we came in from outside. This is an excellent and hygienic practice but was more important in the days when people would sit on the floor and all eating and cooking was done at floor level.

When foreign visitors come to India they often see us boiling our milk and ask, “Why do you boil milk?”. The answer is very simple and there are two good reasons for boiling milk. Fresh milk is always contaminated by bacteria from the cow. Occasionally, if the milkman is unhygienic we can get dangerous diseases like tuberculosis, jaundice and typhoid from unboiled fresh milk. Boiling simply kills all the bacteria in milk and the risk of infectious disease is eliminated. This was not understood in the west till less than 100 years ago when milk started being “Pasteurized”. Pasteurization serves the same purpose as boiling – it kills the bacteria. There is another good reason for boiling milk. Once all the bacteria are killed – the milk will not get spoiled quickly because spoiling is caused by bacteria. In these days we use refrigeration, but in the old days, boiling helped milk to stay longer.

Finally there is the custom of cleaning oneself with the left hand, but handling food only with the right hand. This makes perfect sense in reducing the risk of spread of infection. In fact even in hospitals a similar technique is followed using instruments with designated “clean” and “contaminated” ends. A special pair of grasping tongs called Cheatle’s forceps is used. One end of the forceps can be held with bare hands. The other end is clean and sterile and can be used to pick up and hand instruments to a surgeon without risk of contamination. The only difference is that the Indian habit is 5000 years old, while the modern hospital practice was instituted just a 100 or so years ago.

Only in the last 200 years or so has modern Medical science discovered things like washing hands and not doing anything where one’s saliva is shared. It is amazing to think that many of these hygienic practices were well known and used in India for thousands of years. An ancient Indian technique for vaccination against smallpox has been documented. How our ancestors discovered all this without the use of the modern techniques of pathology, microbiology and microscopy is a topic that should be an interesting lesson for all scientists. But that is a separate subject which could fill a book.

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