Contrary to the popular belief that people in the Middle Ages were disgustingly smelly and dirty, medieval people frequently washed their hands, usually on rising and before and after meals. This was not just a case of good manners; they were well aware of the link between dirt and illness. Consequently, the 14th-century surgeon John of Arderne required prospective apprentices to have “clene handes and wele shapen nailes…clensed fro all blaknes and filthe”. Hand-washing mattered because it was seen to remove both external dirt and harmful bodily excretions.
This dual concern with dirt and bodily excrement continued into the Renaissance. Italian physician Tommaso Rangone (1493–1577) advised that hands must regularly “be cleaned of superfluities, sweat and grime that nature often deposits in those places”. Other medical writers also recognised that hands could transmit disease, although their concerns focused on skin diseases such as scabies, rather than the more well-known plague. Therefore, hand-washing was thought to be necessary for good health.
Early modern concerns about hand hygiene often focused on meals, so most people washed before and after eating. Some advice books insisted that even clean hands must be rewashed at the table, using a basin and ewer, so that everyone else would feel reassured about sharing food. As such, poor hygiene could provoke real repugnance: after dining with his Uncle Wight in 1663, Samuel Pepys recorded that “the very sight of my aunt’s hands…did almost turn my stomach”.
Georgian polite society fretted a great deal about servants’ hands, particularly in relation to food preparation and table service. The 18th-century author Eliza Haywood required her maids to wash their hands regularly, and other employers made serving staff keep their hands “in open view, neat and clean”, according to a conduct book of the day. Jonathan Swift’s Directions to Servants (1745) specifically criticised domestic helpers who prepared salads with unwashed hands after handling meat or visiting the lavatory.
In the 19th century, scientists such as Louis Pasteur and Joseph Lister made significant advances in germ theory and its practical applications, which explained why hand-washing works in curbing the spread of disease. Though perhaps lesser known, another important pioneer was the Vienna-based Hungarian obstetrician Ignaz Semmelweis (1818–65), who realised that labouring women caught puerperal fever from doctors who went straight from the morgue to the delivery room. He proved that maternal mortality could be drastically cut by routine hand-washing with a chlorine solution.
This revolutionary new knowledge had surprisingly little immediate impact, partly due to resistance from physicians who resented being blamed for their patients’ deaths. Nevertheless, the following decades saw frequent attempts to persuade the wider public of the value of hand hygiene, the motivations for which were sometimes concerned as much with reaping profits as promoting public health. In the 1920s, the soap manufacturing company Lever Brothers ran a Clean Hands Campaign that urged children to wash their hands “before breakfast, before dinner and after school”. Their Lifebuoy soap was marketed as the best way to tackle germs, as in a 1927 advert in which a father advises his son that “Dirty hands are dangerous”. This wise parent practises what he preaches, using the product several times each day.
Adverts such as this had considerable impact, but their message still bears repeating. Despite centuries of advice, many of us are no better than the “plaine people in the countrie” who riled the Tudor physician William Bullein – because they would not clean their filthy hands.
Katherine Harvey is a historian of medieval Europe based at Birkbeck, University of London