A History of Soap and Hand Washing
Who invented soap? Frankly, we will never know because soap has been around for a very long time. As in a 'before recorded history' long time! The first time soap does show up in the historical record is 5,000 years ago in ancient Mesopotamia [1].
Historically, soap was first used to clean textiles and dishes rather than people. Some cultures thought it might have medical properties for the skin but at this point we're a long way from any understanding of germ theory. Even the idea of being "clean" was motivated more by religion than health [2].
The idea of hand washing for cleanliness is surprisingly new, making it's first appearances in medical writings in the late 1700s, though some had been theorizing that disease could be caused by invisible contagions since the mid-1500s [2]. This was far from commonplace thinking though.
Zsoldos and Semmelweiss
Hand hygiene trailblazers had a difficult task in store, trying to convince people that invisible "animalcules" were responsible for diseases like sepsis, when it was "common knowledge" that miasmas and bad air were the cause.
Janos Zsoldos was a Hungarian surgeon working on the battlefield during the Napoleonic War who was one of the first to stress the importance of disinfecting both hands and medical equipment, especially when working with open wounds. He also applied this thinking in the women's hospital that he founded in 1816.[2]
Despite good outcomes, Zsoldos' techniques never took off. He even published a widely read work at the time, "Rules of Procedures (Diaetetika)", which detailed his disinfecting procedures, including regular hand washing by both doctors and nurses. Today, his works are only even readily available in Hungarian.
In 1846, another Hungarian doctor, Ignaz Semmelweiss, had to make these discoveries again (it is unknown if he read Zsoldos' work on the subject). Semmelweis was an obstetrician working in a maternity hospital which had two wards, one staffed by doctors and one staffed my midwives. After some statistical investigation, he found that the ward where doctors were delivering babies had a higher maternal death rate than the one with only midwives. [3]
Semmelweiss persistently investigated and tested all the differences in methods that he saw in the two wards, everything from birthing positions to bell ringing by priests. Then, a doctor in the ward died of the same infection that some of the birthing women died of, after he had been performing an autopsy on one of these women with a cut on his hand. This was what Semmelweiss needed to figure it out.
Through this, he made the connection that since doctors were often conducting autopsies and then delivering babies there was some sort of invisible "cadaverous particle" on their hands that was causing the infections that killed these women. He instituted the washing and sanitizing of both hands and medical instruments, which caused the mortality rate to drop.
This seems painfully obvious to us in the time of microscopes. But at that time, the idea of invisible particles causing disease probably sounded just as ridiculous to most people as the idea of evil spirits causing disease sounds to us today! Without the ability to see bacteria and viruses, doctors and scientists of the day really were working blind.
So, the idea of disinfecting and hand washing stuck this time, right? Well, unfortunately, doctors at the time resented the idea that their hands were "dirty and diseased". A physicians hands were thought to be almost holy in their ability to bring healing. Also, Semmelweiss had no patience for the doctors that were causing deaths by their refusal to implement his ideas and started berating them publicly. So ultimately, Semmelweiss was fired and his hand washing practices abandoned. [4]
Florence Nightingale
Enter Florence Nightingale. Nightingale was famously a British nurse who cared for soldiers on the front lines of the Crimean War in the 1850s, though she was also highly educated in mathematics and statistics [5]. At the front line hospitals, she quickly realized that far more soldiers died of disease and infection than of actual battle wounds and became a leader in improved hygiene practices in field hospitals. This was no easy task however.
While her public criticism of the hospital conditions had effected some immediate sanitation improvements, permanent reform was not forthcoming. Upon her return from the front, she began the task of distilling the data from the front line hospitals in easily understandable and suitably convincing statistics, so that the government would be pressured to make lasting changes [6].
Her real success came when she collaborated with writer Harriet Martineau. Martineau was well-connected and was the lead writer of a newspaper that published extensively about social issues of the time, advocating for women's rights and the abolition of slavery among other topics.
Martineau was able to take Nightingale's rather dry statistical data and turn it into the book, England and Her Soldiers (1859) [7]. The literary tone of the book was far more understandable and interesting to the lay person than charts of statistical information.
The changes brought by England and Her Soldiers were not instantaneous but significant changes were made in the years after its publication. The decision makers in government and the military, as well as the general public were shocked at the impact of fatal but avoidable disease and infection on soldiers.
Nightingale's reputation as a consummate nurse also made her a trusted source of health and hygiene advice for the general public. Her book, Notes on Nursing [8] (1860), encouraged cleanliness and hand washing (and good ventilation!) as vitally important for those nursing sick family members. This was the first real attempt to spread the idea of hand washing for hygiene to the general public, not just other medical professionals.
Modern Hand Washing
In the modern day, hand washing is far from obsolete. It is still one of the best ways to prevent all kinds of illness and infection, including intestinal and respiratory diseases. But it is a bit of a drudgery, which means even the most well meaning people skip it sometimes.
I find a great way to keep at it is to have a nice soap by the sink that I enjoy using and that doesn't dry my hands out (I make quite a few nice options ;) Most of you reading this are probably not worried about sepsis or dysentery like Florence Nightingale but hand washing can help you avoid Covid-19, seasonal flu and your run of the mill stomach bugs.
So for the sake of these long ago hand washing visionaries, many of whom were ignored in their time, give those hands a scrub! [9]
References:
1. BBC Science Focus: Who invented soap? https://www.sciencefocus.com/science/who-invented-soap
2. The little-known history of cleanliness and the forgotten pioneers of handwashing:
https://pmc.ncbi.nlm.nih.gov/articles/PMC9632745/#s2
https://pmc.ncbi.nlm.nih.gov/articles/PMC9632745/#T1
3. Ignac Semmelweis—Father of Hand Hygiene: https://pmc.ncbi.nlm.nih.gov/articles/PMC7240806/
4. The Doctor Who Championed Hand-Washing And Briefly Saved Lives: https://www.npr.org/sections/health-shots/2015/01/12/375663920/the-doctor-who-championed-hand-washing-and-saved-women-s-lives
5. Florence Nightingale: Pioneer Statistician: https://www.sciencemuseum.org.uk/objects-and-stories/florence-nightingale-pioneer-statistician
6. A statistical campaign: Florence Nightingale and Harriet Martineau’s England and her Soldiers: https://journal.sciencemuseum.ac.uk/article/nightingale-and-martineau/#abstract
7. England and her Soldiers: https://books.google.com/books/about/England_and_Her_Soldiers.html?id=sD34ITqWuToC
8. Notes on Nursing: https://archive.org/details/notesnursingwhat00nigh/mode/2up
9. CDC - clean hands: https://www.cdc.gov/clean-hands/about/index.html
10. Janos Zsoldos from Hungarian Wikipedia (I used google translate to read it): https://hu.wikipedia.org/wiki/Zsoldos_J%C3%A1nos