A Brief History of Handwashing

Person washing hands in a sink

Guido Mieth / Getty Iages

On Tuesday afternoons in winter I teach sustainable design at Ryerson School of Interior Design at Ryerson University in Toronto. We have covered many of these themes on TreeHugger, but I recently turned a lecture into a post, which turned out to be popular here. It also was a great dress rehearsal for me. This week I am lecturing on the bathroom, and in light of the Covid-19 event, started it with the history of handwashing.

Let's have a clap of clean hands for Ignaz Semmelweis.

Everyone is singing songs and washing their hands these days, as if it is the most common thing in the world, but it's not. In fact, doctors and scientists thought it was useless. Look at most men coming out of public washrooms; you get the sense that a lot of people still do. And look at the struggles doctors have had convincing us otherwise, starting with Ignaz Semmelweis.

Statue of Ignaz Semmelweis
Imagno / Getty Images

Vienna's Puerperal Fever Outbreak

When Semmelweis was working as a doctor in Vienna in the mid 1800s, he wondered why so many women were dying of childbed fever, now known as puerperal disease. The disease was rare before the 18th century, because women didn't go to the hospital to give birth. Even in the early 19th century, the rate was low, between one and two percent.

Then, after 1823, the rate at the Vienna hospital exploded to as high as 9.2 percent. According to the Encyclopedia Britannica, those who had to seek hospitalization because of poverty, illegitimacy, or obstetrical complications faced mortality rates ranging as high as 25–30 percent. Semmelweis noted that mothers who were tended by midwives had a far lower rate of death and fever than those tended by doctors.

Raquel Kahler explained in an essay that this was the era of pathological anatomy, a "golden age of medicine" where doctors started trying to learn what caused illness by doing autopsies. These started in Vienna hospitals in 1823.

Because doctors who performed autopsies were in the field determining the cause of sickness, they were revered among their colleagues and society. This led to the belief that the dirtier the doctor, the better the doctor. It was a point of pride for doctors to walk around in their coats stiff with blood from the last autopsy or surgery they performed, after which they headed straight to the maternity ward to do their shift delivering babies.
Semmelwies washing hands
Public Domain

The First Handwashing Regulations

Semmelweis introduced rules for doctors to wash their hands in a chlorine and lime solution, and the rate of death dropped dramatically. But other doctors were not impressed and, according to an article from the Global Handwashing Partnership,

The innovation was not popular with everyone: some doctors were disgruntled that Semmelweis was implying that they were to blame for the deaths and they stopped washing their hands, arguing in support of the prevailing notion at that time that water was the potential cause of disease. Semmelweis tried to persuade other doctors in European hospitals of the benefits of handwashing, but to no avail.

Semmelweis kept pushing his theory; some say he was obsessed. Eventually he was taken to a mental institution where he was beaten and died two weeks later from a blood infection. One source says he got it from a wound in the beating; another says, "Ironically, his illness and death were caused by the infection of a wound on his right hand, apparently the result of an operation he had performed before being taken ill. He died of the same disease against which he had struggled all his professional life."

Hand Hygiene in the States

Semmelweis was not alone in this. In the USA, Oliver Wendell Holmes (the father of the famous Supreme Court jurist) linked doctors doing autopsies to the disease, but his work was also ignored by leading obstetricians. Florence Nightingale also figured this out during the Crimean war.

Illustration of Florence Nightingale with her candle in a hospital
Illustrated London News/Hulton Archive/Getty Images
Nightingale believed that the body releases its waste through the pores of the skin and the lungs, which then enters into the sheets; therefore she had the nurses changed the linens daily and provide frequent baths. Strict hand hygiene was practiced to prevent the spread of microorganisms being transmitted from person to person. She maintained the health of the hospital condition by having nurses scrubbed the floors and ceiling on a daily basis.

Finally, when Robert Koch and Louis Pasteur figured out germ theory, it became accepted that miasmas didn't carry disease, germs did, and that they could be killed. Long after the death of Semmelweis, Pasteur credited him in his work connecting germ theory to disease.

Joseph Lister applied Pasteur's ideas and started using phenol, or carbolic acid, to disinfect hospitals, wounds, instruments and hands. He even sprayed it into the air, which was proven unnecessary. He was criticized at first, until he treated Queen Victoria. Then everybody was convinced that killing bacteria was a good idea.

So did this all make a difference? Did people start washing their hands? Nope. According to the Global Handwashing Partnership,

Sadly, the hand hygiene practices promoted by Semmelweis and Nightingale were not widely adopted. In general, handwashing promotion stood still for over a century. It was not until the 1980s, when a string of foodborne outbreaks and healthcare-associated infections led to public concern that the United States Centers for Disease Control and Prevention identified hand hygiene as an important way to prevent the spread of infection. In doing so, they heralded the first nationally endorsed hand hygiene guidelines, and many more have followed.
Kids washing hands in the 1940s
US Department of Agriculture / Public Domain

In an earlier post, Melissa Breyer described the many benefits of washing hands, and notes that if everyone did it routinely, a million deaths a year could be prevented. These days, it may well be a much larger number. She also recommends singing Happy Birthday; I prefer the Talking Heads. Whatever you like to sing, wash your hands!

As Ryerson University is asking us to teach virtually, I have taped my lecture; here is part 1 where I discuss Semmelweis and the background on bathing and toilets. There some famous old paintings of people bathing and may not be suitable for children.