Artwork showing physicians and medical students washing their hands before examining obstetric patients.

How to Wash Your Hands, Historically

By Sarah Eilers ~

A simple act of personal hygiene that practically every human carries out daily is key to preventing the spread of viral infections. That act? Washing one’s hands. The Centers for Disease Control and Prevention (CDC) explains why, when, and how—and the science that underlies the recommendations—on its Handwashing – Clean Hands Save Lives website.

Here at the National Institutes of Health (NIH), the historical collections of the National Library of Medicine (NLM) are awash in fascinating materials that chronicle the history of hand-cleaning as a disease-prevention technique.

Historical formal portrait of a white man in a dress suit.
Ignaz P. Semmelweis, (1818– 1865)
National Library of Medicine #101428742

In 1850, Ignaz P. Semmelweis, a doctor practicing in the obstetrics ward at Austria’s Vienna General Hospital (Allgemeines Krankenhaus), began urging practitioners who delivered babies to wash their hands thoroughly in a chlorinated lime solution before doing so. He had noticed that the wards staffed by midwives had much lower death rates than those staffed by doctors, and tested several theories as to why. Midwives and laboring women were aware of this difference as well, with the women assigned to doctors’ wards often begging to be discharged.

Eventually Semmelweis figured it out. It was common at the time for doctors to perform autopsies on women who had died of puerperal, or “childbed,” fever (later identified as Group A hemolytic streptococcus). The doctors would then go directly to their obstetrical duties, infecting mothers as they labored and delivered. For his groundbreaking work, which was not fully accepted for decades, Semmelweis is often called the “savior of mothers” or Defender of Motherhood. In the Defender image, the wash basin, pitcher, and towel are shown on the left, with one man pouring water while another scrubs his hands.

Artwork showing physicians and medical students washing their hands before examining obstetric patients.
Semmelweis: Defender of Motherhood, 1961
National Library of Medicine #101651433

The film and video collection at NLM includes many titles promoting handwashing to prevent the spread of pathogens, from the animated accessibility  of The Nurse Combats Disease to the detailed techniques demonstrated in Aseptic Technique: Handwashing. Similar techniques are shown in Handwashing in Patient Care.

In The Control of Epidemic Influenza in a Large Institution, Dr. Horatio Wood describes the treatment of patients as well as the hygiene practices of hospital personnel. Wood presented this report at a medical conference in June 1919, the summer the Spanish flu subsided, having killed 50 million people worldwide in the previous 18 months. He describes the sterilization of gowns and equipment, the isolation of patients, and other practices. Wood emphasizes in his conclusion, “That the hands are an important means of conveyance of the infection and that no efforts at protection of the individual or limiting the spread of the disease which does not take into consideration the possibility of hand-borne infection is complete.”

A chart showing admissions peaking on day five at 13 and dropping to zero by day 20.
A chart showing daily admissions to emergency hospital in The Control of Epidemic Influenza in a Large Institution, 1919
National Library of Medicine #101496415
A printed public heath poster from China showing women helping children wash their hands.
Hands Hygiene (Shou De Wei Sheng), ca. 1935
National Library of Medicine #101558003

In the 1930s, the Chinese Ministry of Education commissioned a series of posters and other materials promoting public hygiene. Among the recommended actions? Hands hygiene. You can view this poster and many more online on the NLM website Health for the People.  NLM holds a wide range of other 20th century public health posters in many languages which promote handwashing.

Even in the absence of epidemic disease, keeping the hands clean is essential to good health. It’s especially critical today.

An informal portrait of Sarah Eilers.Sarah Eilers is the Manager of Historical Audiovisuals in the History of Medicine Division at the National Library of Medicine.


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