In times long ago, life-threatening diseases were attributed to miasma — noxious vapours that arose from the decomposition of widespread human and other waste. During plagues such as the Black Death, well-to-do town dwellers either bolted to the relative safety of their rural estates to escape the dreaded miasma, or shut out its fumes with heavy drapes. As so often happens, the poor were left to fend for themselves.
Eventually, Louis Pasteur and Robert Koch dispelled the myth of miasma and replaced it with bugs. But our fear of disease that started with miasma continues in modern times, and is reflected in our ongoing battle with legions of these bugs.
The United Kingdom Department of Health recently introduced a hospital dress code for those engaged in clinical work. Its regulations effectively banished the traditional white coat and introduced a “bare below the elbows” policy, mandating short sleeves and banning watches, rings, bracelets and ties. Despite clamorous protests and calls for the evidence, this policy was enacted with the aim of reducing hospital-acquired infections.
Significantly, the suspected sources of infections, which continue to confound us, have changed often since the days of miasma. At the beginning of the 20th century, “dirty money” was thought to be a culprit. An editorial at that time in JAMA noted:
*Tainted money [editorial]. JAMA 1908; 50: 1269.
“Indeed, it would be difficult to find ... so much a menace to the public health as is most of our paper currency ... In our fight against [threats to public health] we should not neglect currency, which when soiled is a possible means of propagating disease ...”*
Unhappily, just when we believed that our move towards a cashless society would serve to mitigate this menace, the humble computer keyboard has emerged as another potential hazard. It seems wily microorganisms will continue to bedevil us, by adapting to whatever changes modernity brings.
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