In this article it is intended to show how scrupulous standards of personal hygiene are attained by the Muslim following the injunctions of the Qur'an and the example of Allah's Prophet, Muhammad-upon whom be peace.

Many of these injunctions are often obeyed by the Muslim with the intention merely of per- forming certain ritual duties. The making of wudu for example is often seen simply as a necessary prelude to the performance of prayer and a condition for its validity. While this is certainly the case, there seems to be a wider significance to these 'rituals' and 'habits' which become clearer on reflection, especially in the light of the present knowledge of medicine.

By reflecting thus, we can appreciate some of the underlying secrets of these Islamic teachings and something of the wisdom and blessed guidance of Allah, praised and exalted be He. We shall first quote some of the verses of the Qur'an and the ahadith of the Prophet with regard to cleanliness and personal hygiene in order to establish the authoritative precedents on which Muslims base their actions. Allah says in the Qur'an:

"Surely Allah loves those who repent and He loves those who keep themselves clean."

O you who believe! When you rise up for your prayers wash your faces and your hands up to the elbows and lightly rub your heads and wash your feet up to the ankles, and if you are unclean purify your- selves. And if you are sick or on a journey or one of you come from the closet or you have had contact with women and you find not water, then go to clean high ground and rub your faces and your hands with some of it. Allah would not place a burden on you but He would purity you and would perfect His grace upon you that you may be thankful."

And the Messenger of Allah, peace be upon him, said:

"Keeping clean (pure) is half of Faith."

"Cleanliness is part of Faith."

"One who makes wudu and thoroughly cleanses his body with water, then goes to perform the compulsory salat and prays together with people in a mosque, Allah forgives his sins."

"When one of you rises from sleep, he should clean his nose three times for the devil spends the night in the cavity of the nose."

"When one of you gets up from sleep, he should not touch any utensil unless he washes his hands three times, for he does not know where his hands had been during the night."

"it is essential for every mature person to take a bath on Friday, to brush his teeth and also to use perfume if he can afford it."

"If a man and woman get so close that their private parts come into contact, then taking bath is obligatory."

"None of you shall urinate in stagnant water nor shall he use it for bathing."

The Messenger of Allah,peace be upon him, was in the mosque when a man entered whose beard and hair of the head were dishevelled. The Prophet made a gesture to him which meant, 'Go and brush your beard and head.' So the man left and returned after doing that and the Prophet said, 'Is it not better than as if one is a devil.'?

The Messenger of Allah prescribed forty nights within which a man should shave the unwanted hairs of his body, trim the moustache and cut the nails (i.e. these are not to be left unattended for more than forty nights).

Our mother Ayesha said,

"Allah's messenger used his right hand for his ablution, water and his food, and his left hand for evacuations and anything objectionable."

The above are a very short selection indeed of the many sayings and practices of Sayyiddina Muhammad, peace be upon him, with regard to cleanliness. Some of the points contained in them may be summarised as follows:

1. Muslims are asked to clean the pereneal region by washing with water when water is available, after urination and defecation,

2. To get rid of the unwanted hairs of the body by shaving within forty days.

3. To cut the nails of the fingers and toes regularly.

4. To take a bath when one is unclean and before Friday prayers.

5. To wash the hands, clean the nose and rinse the mouth after rising from sleep.

6. To wash the hands before eating.

7. To clean the teeth after meals and in between.

8. To be in a state of wudu for the five times daily prayers by rinsing the mouth, cleaning and douching the nose, washing the face, the arms, rubbing the head, cleaning the ears and rubbing the neck and then by washing the feet-sequence taught by the Prophet.

One fact which emerges from the above is the emphasis placed on the use of water for maintaining cleanliness and ritual purity. This emphasis is all the more pronounced when one remembers that the instructions were given first to a people who lived in the desert, in a place where there was little water, not sufficient even for the cultivation of crops.

For a Muslim these instructions are turned into a habit from early childhood even in the simplest of Muslim homes. Let us now consider the blessings that arise from these practices.

THE PERFORMANCE OF WUDU

Washing the hands

The hands are used for multifarious purposes and become dirty very quickly. Washing the hands regularly therefore is a must and the practice of wudu ensures that this is done. Attention must also be paid to the nails of the fingers. Dust accumulated under the nails is difficult to get rid off. Surgeons when washing up for operations devote much time to brushing the tips of the fingers. Washing the hands is as essential in tropical countries as it is in non-tropical but industrialised countries.

Muslims because of the habit of eating with their hands-which incidentally has much to recommend it as against the use of knife and fork-are used to washing their hands before eating. The Prophet of God, peace eb upon him, also taught Muslims to wash their hands after rising from sleep. This principle of hygiene is perhaps not even appreciated even by teachers of hygiene.

Rinsing the mouth

Muslims can make wudu five times a day and each time they rinse the mouth three times. They also rinse the mouth after each meal or after eating anything ... in between meals. Thus they rinse their mouth nearly eight times in sixteen hours-that is, roughly every two hours.

By rinsing in the manner prescribed, any food or particle accumulating in the inter- dental spaces are washed away. The regular rinsing of the mouth is recommended in the prevention and treatment of diseases of the teeth, gums and the mouth.

In addition to rinsing the mouth, Muslims have a tradition based on the practice of the Prophet-peace be upon him of cleaning their teeth with miswak which is the forerunner of the present-day toothbrush. Muslims also have the practice of cleaning the interdental spaces with wooden pins. This is highly desirable with the type of food eaten which makes full use of the teeth.

It is no doubt the result of such meticulous care of the teeth that caries of the teeth is uncommon in Muslim countries. Children in some poor countries may suffer from obvious bone diseases but have beautiful teeth.

Douching the nose

The Prophet-peace be upon him-instructs Muslims to clean their noses by douching after rising from sleep and every time they make wudu. An ordinary face wash only cleans the outer part of the nose. Douching the nose is the only way to clean it from inside. This helps to wash away the dried secretion inside the nose stuck to the lining. The inner lining of the soft part of the nose is the skin which has hair follicles. These hairs trap the dust particles going inside and the secretion blowing out through the nose. They can thus become coated with the nasal secretion and dust.

Rubbing the inside of the nose with the little finger-which is ideally situated opposite the thumb-is the only way of making sure that the area is cleaned. Muslims also regularly trim the hair inside the nose.

Cleaning the nose in the manner of the Prophet is thus very useful in preventing the infection of nose sinuses (cavities inside the bones of the face), boils in the hairy part of the nose and nose bleeding. Also the lining of the nose has a tendency to get dry in hot and in cold, humid countries. In this respect douching is useful to wet the nasal lining: cold water run into the nose, like cold air shrinks the lining of the nose. It is the safest form of shrinking agent for blocked noses.

A clean and free nose does smell better than a blocked one. Keeping the nose clean also prevents the infection of the ears and throat. The use of the handkerchief to blow the nose instead of cleaning the nose with water is not hygienic. The dirty handkerchief is carried in the pocket and while perhaps the handkerchief is changed the next day, the pocket is not! it is better to carry disposable tissues. Blowing the nose properly and thus keeping it clean is often considered antisocial. Even people who instruct others to blow their noses do not do it themselves in company-so great is the social pressure.

Washing the face

In this process the part of the face from the forehead to the chin between the two ears is washed, The important part in this area, apart from the nose and mouth, is the eyes. The face, being one of the exposed parts is liable to get dust laden. Washing the face cleans it and gives a relaxed feeling, keeping away the feeling of tiredness. Keeping the face clean is helpful in preventing certain skin diseases.

The eyes are always washed along with the face but especial effort is to be made to clean the inner corner of the eyes with the index finger as the hand is carried from forehead to the eyes. The inner corner of the eye is the region where secretion often accumulates.

Secretion left in this region not only gives an impression of untidiness but is also a source of infection. In washing the eyes, the lids, the eye ashes, the conjunctiva (the transparent covering of the globe for the passage of tears) are washed. Washing these structures is essential in preventing and treating certain diseases and indirectly and in some respects directly helps in maintaining sight. Washing the eyes especially with cold water shrinks the inner lining of the lids and removes itching and soreness.

In desert and dusty atmospheres, the washing of the eyes is extremely essential. It is equally essential in the industrialised societies with dirty atmospheres and artificial lighting which often produces much harmful glare.

Head

The skin of the head (scalp) is covered with hair which, with the industrial dust in the air, becomes dust laden. Incidentally, covering the head not only prevents it becoming dirty but also protects it from extremes of temperatures. As custom has it, the majority of people in industrialised societies remain bareheaded. In some countries people are not allowed to swim in a public pool without a head cap.

A scaly condition of scalp-polyriasis Capitae (dandruff) is very common in the West not only in the westerners but also in the easterners who adopt western culture. Predisposing conditions are skin, application of chemicals to the hair and emotional factors.

It is desirable to avoid application of chemical creams. Pure, natural oils like coconut oil as used in the east are more to be recommended. In the circumstances it would be correct to assume that rubbing the scalp with wet hands five times a day should be beneficial to the maintenance of a clean and healthy-feeling scalp. Also recommended in this regard, incidentally, are adequate diet and rest.

Ears

Without the conception of wudu, the ears would be left out from the process of washing the face. In making wudu, the ears are cleaned by force of habit. The outer ear of pinna is not a uniform surface but has deep grooves due to the structure of underlying cartilage. These deep grooves are the ideal place for dust to accumulate. The only way to clean the ear is to run the moist index finger through these grooves. The outer orifice of the outer ear can ideally be cleaned by a moist index finger. The part of the ear most likely to be forgotten is the back of the pinna. There is a deep groove here and again it is an ideal place for dirt to accumulate.

The deeper part of the outer canal can be cleaned satisfactorily only by an ear specialist. But one can attempt to clean it by winding cotton wool on a match stick. Cleaning the outer ear in the above manner prevents its being infected. I saw fewer cases of infections of outer ear during my two years stay in Saudi Arabia where the treatment is free and the atmosphere dusty, than I have seen during my practice in England.

The custom of carrying a perfume laden cotton wool in the ear in Muslim countries is certainly the only way of carrying it without further. I think it has the advantage of masking the smell of any discharge from the deeper part of the outer ear canal.

Neck

People living in London, Manchester, Birmingham, Glasgow and other industrial towns know how much the collar of the shirt gets dirty in a single day. In addition to accumulating dirt, the neck perspires under the collar. Cleaning the neck five times a day keeps it clean and prevents the collar being dirty and keeps away the perspiration.

The Feet

Most of the day the feet are covered with socks and remain inside a tight shoe. The spaces between the toes perspire and the perspiration does not evaporate. Thus the skin between the toes become moist and is liable to become infected. A condition known as athlete's foot-epidae morphytose-is very common among the sock users in humid climates. The predisposing factors are humidity non-permeable socks, orthopaedic defects and unsuitable footwear. When the feet are washed special attention should be given to cleaning the spaces between the toes and in cold and humid climates, to dry up the skin before putting on the socks.

Taking off the shoe and socks and washing the feet gives a very relaxed and refreshed feeling. It also removes the smelly perspiration and therefore the smell of the socks. Also, one of the reasons that people are not so regular in cutting the nails of the toes is that they do not see the nails most of the time, The saying, 'out of sight, out of mind' holds true in this regard. Washing the feet is a useful reminder to attend to the nails.

From the above it can be seen that in wudu the part of the body which perspire most and give rise to offensive odour are cleaned. The cavities of the body like the mouth and the nose which are rich in bacteria are cleaned. Wudu thus prevents infection of these parts and prevents body odour. It gives the confident feeling which the manufacturers of deodorants advertise-without any cost. It has the additional advantage over deodorants that it removes the cause of body odour instead of masking it. And if perfume is used in addition to this, as is the Islamic custom, one can imagine the fragrance of Muslim societies.

Wudu is also an excellent prescription for relaxing the tight garments, although tight garments are not recommended for the Muslim man or woman. In the process of making wudu, the tie, tight trousers, and tight socks are loosened or removed for sometime. The act by itself gives a feeling of relief. Washing the face and feet, and blowing the nose and cleaning the mouth is very refreshing.

It requires five specialists-Ear-nose-throat, eye, dental surgeon, chiropodist and general surgeon-to give the complete picture of personal hygiene. Even they cannot co-ordinate and integrate it in the simple, practical and effective way which the Prophet, following llah's instructions, set for the daily routine of a Muslim's life. And this was 1400 years ago, long before many peoples even began to concern themselves with these matters. There may be other secrets for mankind in the Muslim principles which will be discovered with the advance in scientific knowledge, but for myself as a Muslim and incidentally as an ENT surgeon the present facts are enough to convince me of the genuineness of the Prophetic mission of Muhammad and the unparalleled nature of his work.

Of course this assertion does not reflect the idea of using scientific knowledge as the criterion of good and bad, or right and wrong. It is only an exercise in trying to understand the ways of Allah. For the Muslim's belief in religious principles is not conditional on being proved or disproved scientifically. In fact, scientific observations cannot be used as a criterion for they are ever changing.

We may now deal with some other Muslim habits and practises which go to make up the Muslim conception of personal hygiene. This concept embraces two aspects: the aspect of being clean in the sense of being free from dirt and dust and the other of being clean in the sense of being pure-a condition akin to surgical asepsis wherein the body and its covering garments are free from any stains of body excreta and other similar unclean substances, most of them teaming with bacteria.

Pereneal toilet

Muslims are asked to clean the perineal region and the region between the thighs by washing with water especially after defecation or urination. In the absence of water, the instructions are based on the surgical principle of cleaning away from the cleaner to the dirtier area.

The habit of cleaning the pereneal region with tissue paper alone does not in fact clean the area; it only wipes off the faeces and spreads a thin film of faecal matter over the area. The combination of modern scientific knowledge which makes tissue paper commercially available and Muslim cultural practice would produce the best results. Thus tissue paper can be used first and water afterwards, The same principle can be applied to other fields end thus a society better than the present one can be produced.

Method of defecation

Muslims adopt a squatting position and according to the hadith they have to lean heavy on the left foot. They also use the left hand in the toilet of the region. These ail seemed to be based on anatomical knowledge. Professor Ian Bird in his text-book of Surgery writing about appendicitis states that the squatting position helps complete evacuation of the colon and thus avoid stagnation at the tail end of the gut.

The last part of the digestive tract where faeces accumulates is in the left side; hence the leaning on that foot is helpful. Similarly the use of the left hand help to press the left thigh against the left side of the abdomen. In spite of this method (squatting) being superior to the sitting position, most of the toilets in new governmental buildings in Muslim countries have western type of toilets-which people, it is interesting to note, use in the eastern way. In cold countries where splashing of water has to be avoided some research on this line can produce a design of toilet meeting both requirements.

Muslims have to clean the area between the thighs and the groin by washing thoroughly with water after urination. Here again, the etiquette while urinating is to adopt a squatting position. This also has an anatomical basis being the only way of evacuating the passage from the bladder completely. Further, it helps to avoid splashing of urinary droplets over the body or clothes, though this can be achieved by building receptacles at higher level.

It should be remembered that urine and faeces are unclean substances teeming with bacteria. The habit of washing the pereneal region along with the habit of shaving the hair In this region enables the Muslim to keep this region which is the greatest source of body odour, clean and free of smell.

Circumcision which is practised by Muslims is in line with this objective. The medical advantages enjoyed by Muslim men as a result of practising this custom-apart from cleanliness of the area is freedom from strains of urine, i.e. the lessening of near absence of uretheretes, paraphysinosis and carcinoma in the region in man. In woman, writing about the incidence of diseases of the cervix in "Pill on Trial", Paul Vaughan and Dr, S. 1. Macmillan noted: "None of these diseases produce the evidence indicating the relation between the customs of circumcision and a carcinoma of the cervix." Yet it is surprising that in scientifically minded England, it is getting more difficult to have a child circumcised under the National Health Service.

In cases where the toilet of the lower part of the body-between the umbilicus and the knee is neglected a host of unpleasant effects and diseases can arise:- body odour, boils or absess in the region, skin diseases in the region and infections of the various parts of the area, In cold climates where woollen garments are used, it is especially essential to keep the area clean as the garment is not changed frequently.

Even the use of underpants does not solve the problem. Underpants should be used in addition to and not in place of. People who do not pay attention to these hygienic principles are carrying on their body bacteria laden clothes.

Bathing

Every Muslim and Muslimah-after puberty- has to take a bath. When married, a bath is necessary when the spouses have sexual contact. Women have to take a bath after their cycle. Unmarried men have to take a bath after ejaculation. in addition Muslims have to take a bath before the Friday prayers.

Taking a bath on Friday, putting on clean clothes and using perfume are all recommended and are important measures for having a fragrant congregation on Jum'a day instead of a smelly one. In huge crowds a stuffy atmosphere is likely to develop when people perspire more both in hot and in cold countries.

Method of Taking bath

Muslims are not allowed to take a bath in stagnant water. Further, the dirty parts of the body are washed first and then the cleaner. The habit of taking a bath in the tub is not hygienic. While sitting in the tub full of water, all the dirt from the body floats over the water and sticks to the margin of the tub. When the water is allowed to drain away the level of the dirt can be seen sticking to the lower part of the body.

Even when the tub is filled with clean water the dirt that has stuck to the body and the sides of the tub contaminates the water. If the tub has to be used, the best way is to wash the lower part of the body and the arm pits first. Then after cleaning the tub again fill it with water and stay in it as long as is desired. Lastly, wash the whole body with running water.

The mere awareness of these hygienic principles is often not enough. My wife was astounded at the practice of taking a bath in the tub, even in hospitals and especially after delivery. She has had her three children delivered at three different hospitals in England and on every occasion she was asked to have a bath in the tub. She tried to point out that taking a bath in the tub was bad enough but was especially so after delivery.

Taking a bath or making ghusl involves the preliminary of performing wudu: washing the hands, mouth, nose, face including eyes, rubbing the head, ears, neck, and washing the feet. Thereafter the whole body is washed, the right side first and then the left.

This article has been written partly to make Muslims realise the richness of their culture. One would expect the scientifically advanced people to be more appreciative of certain hygienic principles but often this is not so.

The advance of scientific knowledge by itself cannot and does not ensure that people would make use of this knowledge. A Muslim, however when adopting and carrying out the principles of Islam does so with the conviction of their usefulness and great benefit, and also with the feeling of moral obligation that they must be carried out. In the case of personnel hygiene, this attitude ensures that the principles are moulded into a set pattern of habits and behaviour.

Two distinct advantages of Islamic culture are its direct approach-in this case to remove the cause of uncleanliness-and its universality which implies that it can be practised in the poorest of societies.

The believers in the days of the Prophet, peace be upon him, and for a long time afterwards perhaps did not understand the entire significance of the Prophet's teachings, but believed in them nevertheless. Today, the scientific mind tries to understand this significance and the inner meaning behind certain habits and practices. This indeed is a healthy attitude, so long as one remembers the limitations of the knowledge of the day, and the completeness of truth embodied in the religion of Islam.

The Muslim
March - April 1971