27 September 2023

Cleaning up: The shockingly recent history of handwashing

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Emily Sohn* says while it has become vital to the fight against COVID-19, handwashing as a habit took a surprisingly long time to catch on.

It has become a ubiquitous mantra in the time of COVID-19: Wash your hands.

Cheap and easy to do, it’s one of the few pieces of advice that is essentially without controversy.

And yet, handwashing is a more recent development than you might expect, and the habit did not catch on quickly.

Instead, the shift took many decades, and it occurred in the context of a variety of society-wide changes — among them: the discovery of germs, a wholesale shift in disease theory, heavy marketing by soap manufacturers, and the rise of a scientific infrastructure that allowed researchers to document discoveries and share ideas.

In the maternity ward of the Vienna General Hospital in the 1840s, the period after childbirth was a particularly fraught time.

To put it bluntly: Women were dying in droves.

Regardless of their social status or how healthy they were to begin with, mothers who had recently had babies often developed a rapid heart rate, fever, shivering, and extraordinary abdominal pain that was often followed by death.

The condition, known as “childbed fever”, would sometimes occur in clusters.

During epidemics, mortality rates spiked as high as 80 percent.

Nobody knew why.

A Hungarian obstetrician named Ignaz Semmelweis conducted a series of investigations that suggested patterns of transmission.

He proposed doctors washing hands to save the lives of new mothers.

Although few people took his advice at the time, he is often credited as the father of handwashing.

The true story of Semmelweis is more complex.

But his thought processes offer a window into a widescale cultural transition in the way people think about the connection between cleanliness and health.

“Germ theory”, the idea that tiny organisms get into our bodies and make us sick, had yet to take hold, and among the many hypotheses for how diseases spread at the time, one dominant idea was that diseases came from miasmas, or toxic odours emitted by decomposing organic matter.

There was a belief that in cases of overcrowding or poor hygiene, miasmas could cling to people like smoke, allowing for diseases to spread more rapidly, including from doctors to patients, says Dana Tulodziecki, PhD, a philosopher of science at Purdue University.

Semmelweis was not the only person who believed in the contagiousness of disease.

The idea had been around for centuries.

In 1795, British obstetrician Alexander Gordon proposed that puerperal fever could be transmitted from doctors and midwives to patients.

During the Crimean War in the 1850s, the renowned British nurse Florence Nightingale was a major proponent of handwashing.

And in 1843, the Boston physician Oliver Wendell Holmes published an essay called “The Contagiousness of Puerperal Fever”, where he also proposed handwashing as a solution to person-to-person transmission.

Meanwhile, scientific methods were becoming more sophisticated.

Within that context came a series of advances by researchers such as French biologist Louis Pasteur, who helped link microorganisms to disease; and British surgeon Joseph Lister, who pioneered the use of antiseptic in surgeries.

Cultural developments also changed the way people thought about hygiene.

The work of Semmelweis, Pasteur, and others was simultaneous with the rise of Big Soap.

In the late nineteenth century, Proctor & Gamble, Colgate Palmolive and other businesses launched major marketing campaigns for their soap products.

Originally, soaps for body care were made by separate companies that promoted the role of soap for beauty purposes and targeted middle and upper-class markets.

While public health officials promoted personal hygiene for health on a smaller scale, soap companies tapped into mass media to spread their messages about soap’s benefits.

Their popularisation of personal hygiene and domestic cleanliness reached into all segments of society.

Progression from Semmelweis’s time to the present has not been a steady march so much as a series of steps forward and then back.

And although current generations wash their hands more than their predecessors, it wasn’t until the 1980s that America’s Centers for Disease Control (CDC) published the first national guidelines on hand hygiene.

In 1995, it began to recommend that healthcare providers clean their hands with antimicrobial soap or a waterless antiseptic agent when they leave the rooms of patients with bacteria and other microorganisms that are resistant to medications.

In the privacy of people’s homes, too, the routine washing at multiple times throughout the day is relatively new.

It’s only within our lifetimes that the habitual washing of hands has become a universal practice.

Scientists are also still adding new insights into what handwashing, among other hygiene practices, can and cannot accomplish.

In one 2017 meta-analysis, researchers found that handwashing with soap or hand-sanitiser was more effective than coughing etiquette (like coughing into an elbow) or wearing face masks at preventing the transmission of influenza.

One study found that influenza infection rates dropped with every 10 per cent increase in adherence to hand-hygiene recommendations among healthcare workers.

Nobody can say how many illnesses are stopped by handwashing, says Patrick Saunders-Hastings, an epidemiologist and one of the authors of the meta-analysis.

But the spread of disease would certainly be worse without it.

In Semmelweis’ time, a dirty and bloodstained lab coat was a badge of honour, Saunders-Hastings says.

And while that ethic has changed, handwashing has faced backlash in recent years.

Too much cleanliness, suggests some research, has been responsible for increasing rates of allergic diseases and asthma.

Even healthcare workers, studies show, aren’t all that great at washing their hands.

“Despite the protective effects of handwashing, rates of compliance, both in the public and in healthcare settings, remains low,” Saunders-Hastings says.

Perhaps COVID-19 is the start of a new era in handwashing: one where more people actually do it.

* Emily Sohn is a freelance journalist. She tweets at @tidepoolsinc. Her website is tidepoolsinc.com.

This article first appeared at www.popularmechanics.com.

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