Today is a perfect time to honor our healthcare professionals, celebrate international women’s month, and remind you to lather up. Consider it a threefer. All hail to midwives, nurses, and mom.
Aqueducts and Aquamaniles APlenty
Contrary to some beliefs, bathing and hand-washing is not a historically recent phenomenon, but was a practice widely dispersed across many cultures for centuries. The Romans, Greeks, Mesoamericans, and Japanese all incorporated bathing into their daily routines. Even into the Dark Ages, where food was eaten mainly with the hands, it was customary to rinse off before dining. Special ewers were provided for noble feasters, but even commoners might prepare a hand-washing solution with herbs, like making tea.
Pour faire eaue a laver mains sur table mectez boulir de la sauge, puis coulez l’eaue et faictes reffroidier jusques a plus que tiedes. Ou vous mectez comme dessus camomille et marjolaine, ou vous mectez du rommarin, et cuire avec l’escorche d’orenge. Et aussi feuilles de lorier y sont bonnes.From Coquinaria, A Recipe for Washing Hands
To make water for washing hands at the table. Boil sage, strain the water and let cool to a little more than tepid. Or take camomille and marjoram in stead [of sage], or rosemary, and boil with orange peel. Bay leaves are also good.
It wasn’t until the post-Renaissance, the “Age of Enlightenment,” when bathing fell out favor. This was partly due to a rise in puritanical thoughts; public bathing was linked to houses of ill repute. Women were required to cover up most of their body in public, and washing was recommended only for whatever was left uncovered. Linen had overtaken wool as the fabric in use, which kept people cleaner, but also led to changing clothing less frequently and bathing less frequently. Finally, physicians of the 16th and 17th century believed that disease came from miasma–bad air–and that washing would let the disease in by exposing the body to the miasmas.
The Baby’s Coming–Start Boiling Water!
Think of any movie where a mother is about to give birth at home–especially westerns. Someone invariably shouts for boiling water. There are many theories about why that came into cultural lore, whether it was to keep the nervous husband busy or as a medical practice to aid with afterbirth and healing. But we have long associated washing up with the midwives. They knew, even if the doctors didn’t.
There were two popular early treatises on midwifery from the 17th century, when printing started to put books into the hands of more people. The one often mentioned first is Nicholas Culpepper’s Directory for Midwives (1662), one of many medical books he authored. Curiously, Culpepper himself never actually witnessed a birth. He provided some useful ideas around herbal remedies and had an in-depth diagnosis of puerperal fever, a leading cause of death for women following childbirth. But he didn’t cover much about the “how to” deliver a child portion given that he hadn’t actually seen it.
Meanwhile, Jane Sharp published a lesser known work in 1671 that was a bit more on point. The Midwives Book: or the Whole Art of Midwifery Discovered covered historical medical practices from ancient physicians like Aristotle and Galen as well as the 30 years of practical experience that Sharp herself could impart. It was the first book on midwivery written by a woman, as up until then, all the others had been written by men who were not midwives. ( Until about 150 years ago, aiding in childbirth wasn’t considered a medical practice unless it required surgery. ) Sharp’s book provided not only detailed advice about the technical process of delivery, but also described the growth of the fetus and recommended breastfeeding and nutritional practices. It was the What to Expect When You’re Expecting of its time.
Semmelweis: The Father of Hand-Washing
If you look up who “invented” or standardized the use of hand-washing in modern medicine… well, you know where I’m going with this. A guy invented hand-washing. To his credit, Viennese Dr. Ignaz Semmelweis was the first doctor to observe a clear link between hand-washing and improved survival rates. Most of his fellow physicians still believed that “miasmas” caused disease and the standard cure for that was bloodletting.
Moreover, in 1847, most doctors considered dirty hands and operating clothing to be a badge of honor. The dirtier the clothing, the more experienced the doctor. Physicians who performed autopsies were even more revered because they were considered the most knowledgeable about causes of illness. This was where Semmelweis came in. He observed two different maternity clinics.
The First Clinic had a mortality rate of over 10% from puerperal fever and other causes. The Second Clinic’s mortality rate was under 4%, a fact well known to prospective mothers,who begged to be sent to the Second Clinic or were willing to give birth in the street rather than be sent to the First Clinic. Semmelweis approached the problem scientifically, keeping meticulous track of data to eliminate causes such as overcrowding, difference in practices, and climate. Finally, he noticed that many of the doctors going over to the First Clinic to assist with surgery for difficult births were coming from the morgue and did not wash their hands after performing autopsies. Those in the Second Clinic were just plain old midwives.
I know. Ew.
But let’s give him credit. Ignaz Semmelweis standardized hand-washing, particularly with a chlorine solution, even before the germ theory of disease and infection was known and put in place.
The Lady with the Lamp
The other well-known name associated with handwashing is Florence Nightingale, whose pioneering nursing work in the Crimean war set a standard for hospital sanitation still in use. In 1854, when she arrived at Scutari (near Istanbul), soldiers were dying ten times more from dysentery, typhus, and cholera than from war wounds. In 1859, even though it was counter to common medical practice, she made it clear to those in her charge:
Every nurse ought to be careful to wash her hands very frequently during the dayFlorence Nightingale, Notes on Nursing
Nightingale was credited with reducing deaths in the Crimean war medical hospital from 42% to 2%. She brought sanitation improvements into hospitals in Britain afterwards, working closely to segregate sewers and implement hand-washing standards based on her experience from the Crimea. She also created training for nurses, especially focusing on those who cared for the poor.
Of particular fascination to me, she apparently invented a special way of displaying mortality statistics called the Nightingale Rose. Now also called a circular histogram, data projects outward from a central point rather than in linear fashion. Interestingly, the purveyor of this COVID Rose Chart–just from last week but with outdated data already–cited Nightingale by indicating “he” created it during the Crimean War. I’m not sure why this author doesn’t know the correct gender of Florence Nightingale, but given who often gets credit for improvements, it doesn’t surprise me.
Still, I know who first told me to wash my hands before dinner. And it wasn’t my dad.