At the moment, many people are concerned about their health and wellbeing and try to avoid places like hospitals, care facilities and clinics. People generally don’t like these places because the circumstances that lead to them being there are usually unpleasant, often painful, and sometimes with fatal outcomes. And, as anyone who has ever been inside such a facility can tell you, you can tell where you are even with your eyes closed and without touching or hearing anything. In these circumstances, with our other senses restricted by masks, gloves and screens, our least prominent but most primal sense, smell, comes to the fore. People can smell they are in a hospital because certain smells are associated with illness and death, while other smells – the opposite usually – are associated with health and life. This is interesting because even a “healthful” fragrance, such as lavender, can become repulsive and smell “off” if it is too strong.
Prior to the discovery of the bacteria and viruses that cause illness, people thought the bad smells associated with illness were “humours” or bad vapours in the air – the “miasma theory” of disease. It held that diseases such as cholera, chlamydia infection, or the Black Death were caused by a miasma (μίασμα, Ancient Greek meaning “pollution”), a noxious form of “bad air” emanating from rotting organic matter. A pong, in other words. Miasma was considered to be a poisonous vapour or mist filled with particles from decomposed matter (miasmata) that was identifiable by its foul smell.
The bad old stinky days (up to the 19th century)
In the days when people were fighting off miasmas, the relation between hygiene and infection had not been established yet. That idea only gained traction in the medical community in late 1850s with the work of Louis Pasteur, and later Robert Koch in the 1880s, who established the Germ Theory of Disease. Viruses were initially discovered in the 1890s and the science of bacteriology was established. But in the prior centuries, people died like flies and the only thing “doctors”, or the like, could associate with those events were bad smells. It followed that people had to avoid bad smells. Considering that much of the world had not yet developed sewerage systems like we have today, and the streets of most cities where literally running with excreta and household waste, one can say with certainty that cities in Europe and North America stank to high heaven.
Except in Japan
This was in sharp contrast to the conditions in Japan. In April 1600 the first Englishman, William Adams, set foot on the shore of Japan, near the current city of Oita. After two years on a ship (called ironically, Liefde, Dutch for “love”), Adams was one of only 24 scurvy-ridden survivors of a Dutch merchant fleet of five ships. Nicknamed “Samurai William” during his lifetime, Williams adapted so successfully to Japan because from the outset he had decided to go native to survive in this strange new world, so far away from England that England might as well not have existed. On the advice of the local Portuguese Jesuits, he learned Japanese, he dressed like the locals, he minded his manners and became cultured. Importantly, he got clean. He adopted the personal hygiene habits of his fellow citizens, which was a distinct step up from the world of 17th century Limehouse and London. The Japanese were horrified by the crude manners and filthiness of the Westerners – first the Portuguese, then English, the Dutch, Spaniards and everyone else – who arrived on their shores looking for trade. These men ate with their hands, they never bathed, their clothes were disgustingly dirty, and their teeth were worse.
“Padre Joao Rodrigues noted their [the Japanese’s] disdain in his book, Historia da Igreja do Japao [João Rodrigues, in Noticias de Macau, 1956, Japan] in which he wrote with passion about Japanese cleanliness and bathing habits. ‘They are greatly astonished by eating with the hands,’ he wrote, and said that the sight of filthy clothes and food-stained table coverings ‘causes both nausea and disgust’. Even in a provincial backwater like Hirado, the nobility were scrupulously clean and prided themselves on their scrubbed and scented skin. ‘All the houses of the nobles and gentry have bathrooms for guests,’ noted Rodrigues. ‘These places are very clean and are provided with hot and cold water, because it is the general custom in Japan to wash the body at least once or twice a day’”. (Giles Milton, Samurai Williams, Hodder and Staughton, London, 2002, pp. 222 – 223)
Great-great-great-great Grandma’s Handbook on How to Avoid Humours
In order to cover up bad smells, people carried good smells with them. We now know that better personal hygiene would’ve been a more effective deterrent to germs.
They held perfumed handkerchiefs to their faces – though they did not use handkerchiefs to blow their noses in. They blew their noses on anything, including their sleeves, until the sleeves became ornate with buttons and lace and it hurt a bit to wipe your nose on your sleeve. That led to the use of hand-kerchiefs. In the 16th century, people in Europe began to carry kerchiefs, small squares of fabric, in their pockets, or on their heads, to wipe their forehead or their nose. King Richard II of England, who reigned from 1377 to 1399, is widely believed to have invented the cloth handkerchief, as surviving documents written by his courtiers describe his use of square pieces of cloth to wipe his nose. Unfortunately, those handkerchiefs, like much of everything else, were just filthy. Imagine the glamour of those days, with the people at court made up to the nines, with dressed hair, gowns and jackets in fancy fabrics decorated with real gold or silver thread – but with gruesome teeth, skin pockmarked from infectious diseases, bad breath, probably riddled with head lice, and stinking like a mismanaged long-drop, which the perfume they wear fail to disguise. It’s a good job that historical film and books cannot convey smells.
People who went around ministering to the sick – not strictly speaking “doctors” at that time – used face masks filled with miasma-fighting substances. European plague doctors at the end of the 19th century, when the Miasma Theory of Disease was prevalent, wore masks shaped like a bird’s beak. The purpose of the mask was to keep away the bad smells, the miasma. Doctors believed the herbs would prevent them from becoming infected. The mask had glass openings in the eyes and a curved beak with straps that held the beak in front of the doctor’s nose. The mask had two small nose holes and was a type of respirator which contained aromatic items. The beak would more than likely have held lavender, but also dried flowers like roses and carnations, herbs including eucalyptus leaves and peppermint, as well as spices, camphor, or a vinegar sponge.
The bad smells that signify danger
These natural botanical materials, flowers and herbs, were used because they smell the opposite to disease and death. They can be described as floral, citrussy, herbal or aromatic. On the other hand, medical professionals can tell you that certain physical conditions, particularly post-mortem, and health problems, have specific unpleasant, clearly recognizable smells. We’re instinctively programmed to stay away from the smells of ill and dead things, like dead fish for instance, because it helps keep us from eating spoiled or dangerous food or coming into contact with disease. There’s a reason we instinctively sniff at something to test if it is still “good”.
Here is a list of the kinds of smells that medical and care personnel are exposed to:
- Formaldehyde – It is very widely used in the process of embalming. It is a fixative, and kills bacteria, fungus, and insects. Formaldehyde is a good antiseptic, but its fumes are both bad-smelling and toxic if inhaled. People say it smells like the inside of a new car, or new furniture or flooring – it has strong pickle-like or acidic, bitter odour. (The reason we like new car smells is that we associate them with having a new car. The smells themselves are not really nice.) These objects smell like formaldehyde because they contain formaldehyde as one of a number of Volatile Organic Compounds (VOCs), and when the chemical starts breaking down at room temperature, a process called “off-gassing”, you can smell it. People also say formaldehyde smells like dead fish, or salty and bitter, like ammonia, or that it also smells like methanol, of alcohol and burned wood. All in all, formaldehyde stinks.
- Phenol – This is a disinfectant that functions as an antibacterial and antifungal agent, and it is also used in embalming. It smells sickeningly sweet and tarry. Sometimes red wines like Pinot Noir are described as “phenolic” – they have a sweet medicinal smell, almost like mothballs (naphthalene) – no good thing. Phenol was a key ingredient in carbolic soap, which was used as an antiseptic agent in popular soaps, until 2006 when it was banned in the EU. Apparently, phenol also smells a bit like wet dog, or rather, a wet dog might smell of phenol, amongst other things.
- Methanol – This is another disinfectant and embalming chemical, so you’ll find it in a mortuary. It helps regulate the osmotic balance of the embalming fluid, and it is an anti-refrigerant. It is extremely toxic to humans.(Well, yes, it’s not used on living humans.) It has a strong, unpleasant chemical odour that is also very slightly sweet. People who drive racing cars that use methanol know that smell. We’re not kidding: car fanatics have certain smells that they love, including methanol. What that says about petrolheads, I would not dare guess. But if they have smelled it, they should get away from it asap, or they will end up in hospital.
- Death. Period.
“In addition to various gases, a dead human body releases around 30 different chemical compounds. The gases and compounds produced in a decomposing body emit distinct odors. While not all compounds produce odors, several compounds do have recognizable odors, including:
Cadaverine and putrescine smell like rotting flesh
Skatole has a strong feces odor
Indole has a mustier, mothball-like smell
Hydrogen sulfide smells like rotten eggs
Methanethiol smells of rotting cabbage
Dimethyl disulfide and trisulfide have a foul, garlic-like odor”
- Human excretions – Human excretions, like sweat, saliva, faeces, urine, and excretions from infections with different forms of bacteria, can all carry odours that are signs of ill-health.
- Gastrointestinal bleeding – This occurs in the presence of issues like ulcers or tumours. The smell has been ranked among the worst in any hospital.
- Diseased human tissue in general – The smell of tissue when exposed to bacteria, or during certain surgical procedures such as amputations, can become overwhelming.
- Aging – Whether you want to know this or not, there is a real thing known as “Old person smell”. This is the characteristic odour of elderly humans; sweaty, stale and musky. It’s a stale armpit or body odour, but it’s not due to lack of hygiene. Some people say that this smell, which definitely exists though most would rather not mention it, results from chemical changes initiated through the aging process. Most people would recognize the unpleasant smell when they walk into an old age home. Old person smell is known as kareishū (加齢臭) in Japan, where much social value is placed on personal grooming and specific upmarket odour-eliminating soaps are targeted at more elderly consumers.
- Blood – By most accounts, human blood has a particular, instinctively recognizable smell, and large quantities of spilled blood smell particularly bad. Blood can be described as smelling like iron or copper, or just “metallic”. Most people do not even have to see blood to want to get away from it – the smell is enough.
“The smell of blood is potentially one of the most fundamental and survival-relevant olfactory cues in humans. This experiment tests the first human parameters of perceptual threshold and emotional ratings in men and women of an artificially simulated smell of fresh blood in contact with the skin. We hypothesize that this scent of blood, with its association with injury, danger, death, and nutrition will be a critical cue activating fundamental motivational systems relating to either predatory approach behavior or prey-like withdrawal behavior, or both.”
“The scent of blood is a complex stimulus. It involves both the blood itself, as well as its reaction with surrounding substances. Volatiles within the blood can vary across species as well as from person to person. In fact, the variability of blood scent, and the difficulty of quantifying it via subjective assessment was a major theme in 19th Century forensic medicine. […] We take a different approach in operationalizing the scent of blood, by looking at its oxidization. In the case of a wound, blood reacts with fat lipids on the surface of the skin. An empirical test of the reaction of blood on the skin by Glindemann and colleagues showed that a distinctive ‘metallic’ smell was produced, which was attributable to the oxidization of the hemoglobin’s iron molecules in the reaction with fat lipids in the skin. Gas chromatograph analysis of this reaction revealed the following volatile compounds: Hexanal, heptanal, octanal, nonanal, decanal, 1-octen-3-one.” (The Scent of Blood: A Driver of Human Behavior?, James K. Moran, et al, Ref. PLoS One. 2015; 10(9): e0137777. Published online Sept. 23, 2015)
The Defence Against the Dark Smells League (sorry J.K. Rowling)
The human body is wonderful but when things go wrong in it, the results are often smelly. That is why hospitals use disinfectants and odour-masking agents to cover these smells or deal with them at the cause. Sometimes this masking scent – usually minty, citrus-like, herby, or lightly floral – is enough to keep people from being upset. In fact, one expects public health facilities to smell like a combination of dish soap and toilet cleaner. In a recent study, it was found that putting a picture of a man’s intense staring eyes above a hand-wash station in a hospital helped to increase the number of times staff washed their hands at the station. But having a clean, citrusy smell being emitted from the station was found to substantially improve hand-washing and so cut the risk of hospital infections.
“One nurse commented that, to handle the overwhelming smells in a hospital, staff resort to creative tactics. Nurses have to become pros as managing this obstacle in order to provide patients with compassion and the best possible care. After all, studies have shown that compassionate care can improve patient outcomes. ’The human condition is one that is truly resilient,’ Valery said when asked how she copes. “We adapt like crazy.” But when the smells become overwhelming, Valery shared her favorite tool for stifling the stench. ‘One of the famous ways to do it is to wear surgical masks,’ Valery said. ‘Smear toothpaste on the inside of the mask and it acts like a barrier.’ In lieu of toothpaste, Valery also recommends dabbing lavender, eucalyptus, or peppermint oils on the inside of your mask.” (Source: Atlanta Journal-Constitution, rtrvd. June 11, 2020)
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