The last word^5528 March 2020 THE WEEKAbrief history of handwashingFormillennia,itsbenefitsremainedamystery,saysAmyFleming.Butinthelate19thcentury,itslife-savingpowerswererevealedItfeltoddwhenBorisJohnson
emergedfromthefirst
Covid-19Cobrameetingon
2 Marchandtoldustowash
ourhandswhilesinging
HappyBirthday.Butasone
ofthefewthingswecando
tosignificantlyslowthe
spreadofcoronavirus,the
handwashinghabithas
quicklycaughton.TheKillers’
frontman,BrandonFlowers
tweetedavideoofhimself
latheringupwhilecrooning
hishitMrBrightside;Judi
DenchandGylesBrandreth
postedfootageofthemselves
withsudsyhandsreciting
TheOwlandthePussycat;
andwashyourlyrics.com,
awebsitethatgenerates
handwashinginfographics
tothesonglyricsof your choice,hasgoneviral.
To NancyTomes,aprofessorof historyatNewYork’sStony
BrookUniversity,seeingthisbasicadviceheadliningthepublic
healthagendahasfelteven morestrange. “Beingahistorianof
thiskind ofpandemiceventandthenexperiencingthisone,”she
says,“islikebeingapassengerontheTitanicandwatchingit all
unfold.” Italso feels like goingback totheearly20thcentury,
wheninfectiousdiseases suchas
tuberculosis and smallpox were
theNo.1killer,andthe new
scienceofgermsledto ourfirst
obsessionwithhandhygiene.
Religious handwashingrituals
havebeenaroundforthousands ofyears,butthefirst recorded
discovery ofhandwashing’slife-savingpowercamein 1848.
While workingat ahospital inVienna,theHungarian doctor
IgnazSemmelweis wasfacedwithadoctor-ledmaternity wardin
whichmaternaldeathsfromchildbedfever were significantly
higherthanin the midwife-runclinic there.Herackedhisbrain
for reasons why.Germs wereyettobediscovered,anditwasstill
believed diseasewasspreadbymiasma–badsmellsin theair.So
it didn’t seemtobe aproblemthatthe hospital’straineedoctors
would hang out in themorgue dissectingcorpses, and thenpop
up to the maternity ward todeliverababywithoutwashing their
hands.Semmelweis hypothesised that cadaverous particles from
the morgue were to blame forthediscrepancy in deathrates, and
that such particles onthehands of doctorswere making their way
intowomen’sbodiesduringchild birth.To testhis theory, he
ordered doctors to wash theirhands andinstruments
in achlorine solution. Themortality rate for new
mothersdroppedfrom18%toabout1%.Despite his
success,his idea facedgreat resistance, andhemet a
tragic end. He losthisjob,and diedin apsychiatric
institution. Partof theproblem, says Tomes, wasthat
people “didn’t have that conception of themselvesas
walking Petridishes”. Anddoctors were offended by
the suggestionthatthey couldbecausing infections.
Overthe next40 years, an understanding of germs
developed, andattitudes shifted. In 1857, Louis
Pasteur,ofpasteurisationfame,raised awareness of
pathogens, andhowto killthem with heat. In 1876,
GermanscientistRobertKoch discoveredtheanthrax
bacillus,kickingoffthenew
fieldofmedicalbacteriology.
TheBritishsurgeonJoseph
Listerpioneeredantiseptic
surgery.AndFlorence
Nightingalesetabout
revolutionisingnursing.“By
theearly 1900 s,”saysTomes,
“handwashingmovedfrom
beingsomethingdoctorsdid
tosomethingeverybody
hadbeentoldtodo.”Theturnofthecenturysaw
popularpublichealth
campaignslaunchedaround
tuberculosis.“Peoplegot
totallyphobicaboutshaking
handsorkissingwhenthey
understoodtheirmouth,skin
andhairhadallthesegerms
on them,”saysTomes.It’s
onereasonyoungmenstartedeschewingbeards. Andwhyfoods
started beingindividuallywrapped.Butthiserawasshort-lived.
Public healthmessagingandthe developmentof antibioticsin
theearly 20thcenturysawdeathrates frombacterialdiseases
plummet–before, asTomespointsout,“alaxitycreptin, in
healthcare andineveryday life,aftertheSecond WorldWar”.Sincethen,saysTomes, hygienestandardshave gone upand
down.Inthe 1960sand70s,
hippies“thoughtallthis
[hygiene]stuffwasbourgeois
nonsense”,andsexually
transmitted diseasesincreased
again.“Itwasreallywith HIVin
the 198 0s thatevery onestarted
to gethyp eragainaboutpersonal cleanliness,”shesays(though
hand hygieneisn’tasignificantfactorinitsprevention). And we
have beenmoreawareingeneralsincethen.Hospitalsuperbugs
becameaproblem, “and now wehave these novelviruses coming
prettyregularly,butwe’realsogettingthe re-emergence
of bacterialdiseases becauseofantibioticresistance”.Actual
handwashingcompliance,pre-coronavirus,wasstillworryingly
low,however, inthe public realm and inmedicalcare.Research
in 2009 found that 69%ofwomen washedtheirhandsafter
urinating, but only43%ofmen.In2007,astudyconductedina
US teachinghospital foundstaff handwashing between attending
patientsin intensive care unitshad acompliance rateof just54%.How effective is handwashingin combatting the spreadof aflu
pandemic?One review, published in 2017, found that if you wash
your hands fivetoten timesmorethanusual, the risk
could be reduced byaquarter.Atthe start of a
pandemic,before effective treatmentsbecome
available,that maybepretty muchallyou’vegot.
To Miryam Wahrman,abiolo gy professor and the
author ofTheHand Book: Surviving inaGerm-Filled
World,thisknowledge feels empowering. “Youcan
say topeople:‘Here’s onething youcan do tolower
your risk.’ It’s simple. It’sright there anddoesn’t cost
anything. Wash yourhands withsoapbeforeyou
touchyour mouth,your nose or your eyes.It’s
empowering because itreally does makeadifference.”Alonger version of thisarticleappeared in
TheGuardian.©Guardian News&Media 2020.“Over the years, standards have gone up
and down. In the 1960s, hippies thought all
this hygiene stuff was bourgeois nonsense”Dr Ignaz Semmelweis practising hand and instrument hygiene