H04: Washing the great unwashed: a history of British public hand hygiene

Sarah Dyson, Chandni Ondhia and Nick Levell

Norfolk and Norwich University Hospital, Norwich, UK

British and European public attitudes towards hand hygiene have evolved over time. Early examples of soap-like products date from Babylon around 5000 years ago, later probably passing along the silk route to Europe. A mixture of fats boiled with ashes were found in clay cylinders. In the fourth century bc, Hippocrates propagated ancient Chinese and Greek theories that epidemics spread via noxious ‘miasma’ particles. In the Roman Empire, Galen advocated health by balancing four humours (blood, yellow bile, black bile and phlegm). The Romans brought public bathhouses to Britain after invading in 55 bc adding a social aspect to cleanliness, also bringing fresh water in aqueducts. Emily Cockayne’s book Hubbub: Filth, Noise & Stench in England documents daily life in England from 1600 to 1770. Diarist Samuel Pepys reportedly rubbed himself ‘clean’ using a cloth. King Louis XIV of France reportedly took two baths during his reign, the first during his recovery from a convulsive episode. In the Middle Ages, ‘cleanliness’ focused on keeping up appearances. It was believed that white linen garments absorbed the body’s impurities and cleaned the skin. People wore visible starched white collars and cuffs, to signal cleanliness and social superiority. British public attitudes changed during the nineteenth century, driven by discoveries showing a relationship between hygiene and health. Bulwer-Lytton disparagingly referred to the ‘great unwashed’ lower classes in his 1830 novel Paul Clifford. However, in 1837, Buckingham Palace did not have a bathroom. Bathing was mostly inaccessible, labourers would usually bath in sweat and were cleaned only on admission to hospitals or poor houses. In 1845, English dermatologist Sir Erasmus Wilson published a lay handbook called Healthy Skin. This was wildly popular and disseminated the health benefits of sanitation and clean skin. Public washhouses proliferated. By the 1920s handwashing was common practice in Western countries. Soap manufactures Lever Brothers launched a ‘clean hands’ campaign advising children to wash their hands ‘before breakfast, before dinner and after school’. After the Second World War, bathrooms became widespread and home plumbing made village washhouses redundant and unappealing. Handwashing practices among healthcare workers have remained low, averaging 39%. Hand hygiene was at the forefront in tackling the COVID-19 pandemic. The public were advised to wash their hands frequently, for at least 20 s each time. Will this be a landmark in handwashing history?