Disease Etiquette

In July of 2014, it was reported that scientists had discovered that we would all be healthier if we started using the fist bump instead of the handshake to greet or say goodbye to one another.  Such deadly diseases as MRSA and influenza would be much less likely to spread from one person to another, if the fist bump were employed as the standard means by which we physically express our affection or friendship for others.  Actually, there is no need for any physical contact at all.  Smiling and saying hello or goodbye should be adequate, and that would be even better than the fist bump as far as hygiene is concerned.  But first things first. We cannot expect people to give up the primitive act of physically expressing their warm regard for their fellow man all at once.  The fist bump would be a good first step.  Later, we could eliminate that too, letting words and facial expressions do the job.  At least, so it would be were it not for a countervailing consideration.

As a result of this scientific report, one might have expected doctors to take the lead with the fist bump, thereby setting the example for the rest of us. If so, those expectations were surely dashed when the very next month we saw pictures of Dr. Kent Brantly being hugged again and again by doctors and nurses alike after being released from Emory Hospital where he had been treated for Ebola. The scientific study in question did not measure the likelihood of disease transmission by hugging as opposed to shaking hands or fist bumping, but my layman’s intuition tells me that hugging would be worse.

The ostensive purpose of the hugging was to express a degree of warmth and affection that could not be captured by a mere handshake, let alone a fist bump.  But the real purpose was to advertise the confidence the healthcare professionals had that Brantly was no longer contagious. It was not enough merely to announce it.  They had to demonstrate it with an embrace. Never mind that someone in the group might have the flu, or, which is far more likely given the hospital setting, MRSA.  At that moment, hygiene had to take a backseat to etiquette.  It would have been quite ironic if, as a result of all the hugging, Brantly had immediately come down with MRSA and died from that after having beaten the odds against Ebola, but it had to be done.

Something similar occurred about thirty years ago.  When AIDS was first discovered in the early 1980s, no one knew how contagious it was.  For all we knew, it might have been transmitted by saliva or by mosquitoes.  There was even a joke going around in which a doctor calls up his patient and tells him that he has AIDS.  “As a result,” the doctor continues, “we are going to have to put you on a diet of pancakes and eggs over easy.”  Puzzled, the patient asks, “Will that cure me?”  “No,” says the doctor, “but it is the only thing that we can slide under the door.”

When it was determined a few years later that AIDS was primarily transmitted by blood and semen, and thus was not communicable through ordinary contact, it became de rigueur to hug people who had AIDS, mostly in front of television cameras, not so much in everyday life. Once again, the hugging served a twofold purpose:  to express affection and to demonstrate physically that it was safe to be in a room with someone who had the disease.

The etiquette regarding AIDS was also important in overcoming the moral taint of the disease. At first, all that was known was that there were four groups of people who had AIDS: homosexuals, intravenous drug users, hemophiliacs, and Haitians.  Because homosexuality turned out to be a major factor in contracting this disease, the stigma that was then associated with this sexual orientation made the disease shameful instead of just scary. There was a gay comedian who had AIDS at that time, and when asked what the hardest part about having the disease was, he answered, “Convincing your parents that you’re Haitian.”  Therefore, the hugging served the additional purpose of showing that one did not morally condemn the person who had AIDS.  In the movie Philadelphia (1993), which is a movie about a man who has AIDS, we see several instances of this obligatory hugging.

Of course, venereal diseases had had a moral dimension long before that, causing feelings of ambivalence.  In Dr. Ehrlich’s Magic Bullet (1940), the title character discovers a treatment for syphilis.  On the one hand, he wishes to overcome to the stigma attached to this disease, and yet he belies this enlightened attitude when he emphasizes that it can be transmitted by touching an inanimate object, like a drinking cup.  I guess the Production Code did not allow him to mention the old excuse of toilet seats.  In any event, the drinking cup vector is obviously meant to provide a moral excuse for the person who has syphilis, and so he implies the shameful nature of the disease in the very act of apologizing for it.

When I joined a fraternity in 1964, the pledges were given a booklet describing what was expected of them.  One of my fellow pledges was distressed by something he read.  “This booklet says we are not supposed to associate with people who have syphilis or gonorrhea,” he said at the next meeting for pledges.  “Now, you can’t tell whether somebody has a venereal disease just by looking.  I mean, a guy can’t help it if some girl gives him a dose.  Besides,” he continued, “a shot of penicillin will fix him right up, so what’s the big deal?”  The sexual revolution had not quite started yet, but this guy was clearly ahead of his time.

The active member who was presiding over the meeting assured him that the purpose of the passage was to express disapproval of promiscuous behavior and the frequenting of prostitutes, activities which would be likely to communicate the diseases in question.  Promiscuous behavior!  If only that were my problem, I thought, for I was still a virgin, and that state of innocence so exasperated me that I was almost envious whenever I heard that someone had gotten the clap.

A few weeks later, another active member was explaining to me the proper behavior for a fraternity man, especially regarding other members of the fraternity.  “For example,” he said, “I know that I can trust you with my sister.”  That was news to me.  There were plenty of other girls on campus, of course, but I just did not like the idea that any girl was off limits to me as a matter of principle.  I mean, I had not known about this when I pledged. Besides, I thought, I’d be the one taking a chance.  For all I knew, she might have syphilis, and they would throw me out of the fraternity.  I decided not to express my feelings on the subject, and so I just nodded my head, knowing full well that if his sister were up for it, we’d figure it was none of his business.

The sexual revolution began soon after that, and by 1969, an entirely different attitude was being promoted, as evidenced by the notorious public service commercial, in which the song VD Is for Everyone is sung while we see pictures of the most wholesome, middle-class people you ever saw.  At least, they looked a lot more wholesome than some of my fraternity brothers.

It is said that the sexual revolution was made possible, in large part, by the pill.  A big advantage of the pill is that it precludes the need to use a condom to avoid pregnancy.  But that is also one of its drawbacks.  It definitely creates a problem for a guy when he is about to have sex with a woman for the first time, and when he whips out a condom, she says, “You don’t need that.  I’m on the pill.”  Now, as we all know, the pill provides no protection against sexually transmitted diseases.  Prudence, therefore, dictates that he put the condom on anyway.  But what can a man say at such a moment?  Is he going to ruin the mood by saying, “But Honey, I don’t know where you’ve been”? He could be a gentleman by taking the odium on himself, saying, “Well, last month I had sex with a woman of ill repute, and if she gave me syphilis or something, I don’t want to give it to you.”  Either way, such a breach of etiquette by bringing up the possibility of disease at that delicate moment will probably be the ultimate prophylactic, in that it will result in there not being any sex at all.  As every man knows, once a woman says she is on the pill, bedroom etiquette requires that he put the condom away and heedlessly plunge right in.

In the movie Pretty Woman (1990), Julia Roberts is a prostitute.  She has dinner with Richard Gere, after which she flosses her teeth.  Clearly, the point of this absurd scene is to alleviate our fears about venereal disease. “Any woman who would floss on a date,” the movie is conveying, “could not possibly have an STD.”  Otherwise, we would spend the rest of the movie wondering how long it would take Richard Gere to discover he had the crabs.

In the movie Looking for Mr. Goodbar (1977), Diane Keaton makes fun of a man who is about to put on a condom.  “Is that for you or for me?” she laughs. Here the poor guy is trying to do the right thing, and he becomes an object of ridicule.  And if he is anything like me, such ridicule will immediately bring about a state of flaccidity.  This is not true for everybody, of course.  I had friend in high school that joined the Navy after graduating. When he came back for a visit, he had a harder bark on him than when he left.  He told about how one night when they had docked in some port on the west coast, he picked this woman up in a bar and they went to a hotel. “As soon I closed the door,” he said, “I just started taking off my clothes. When I took off my skivvies, she said, ‘Just who do you plan to satisfy with that?’  And I said, ‘Me, bitch, me.’”

And then they proceeded to have sex!  Now, is that hardboiled or what?  In any event, I would have been more like the hapless fellow in the movie who was devastated by Diane Keaton’s derision.  I like to think that the reason she was murdered at the end of the movie was that it was punishment for her being mean to some poor guy trying to reach a reasonable compromise between carnal desire and fear of disease.

In general, it is rude to suggest that someone might have cooties.  So don’t expect the fist bump to become a socially accepted means of avoiding disease any time soon.  The rule of etiquette today is the same as it has always been: better to be polite and risk getting sick than to insult someone by indicating that you don’t want his germs.

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