Hygiene is defined in current English dictionaries as "the science of health." This definition, though formally correct, hides a long history of change in the word's use, from its holistic classical meaning of "individual regimens to preserve health" to its nineteenth-century connotations of "social medicine" (including lethal eugenics programs), to its current limited construal as "personal cleanliness" or "germ removal." For more than 2,500 years of use in many different lands, concepts of hygiene have been integral to personal identity, shaping sense of self through boundary maintenance and spirituality.
The Ancient World, c. 500 b.c.e. –200 c.e.
In Greek mythology Hygeia was one of the daughters of Aesculapius, a renowned healer and demigod; she was considered the goddess of health. The Greek word hygiene hygieinē meant "sound, healthy, or strong," and was possibly related to the Sanskrit ugias, or "strength." In the works of Greek physicians, from Hippocrates (460–c. 377 b.c.e.) onward, hygiene was that branch of medicine dedicated to the "art of health," distinguished by Galen (129–c. 199 c.e.) from its other arm, therapeutics, or the treatment of disease. The Greeks understood the world to be composed of four elements—earth, air, fire, and water—and, analogously, understood life to be controlled by the four principles of hot and cold, wet and dry, which corresponded to the four "humors" that composed the body: yellow and black bile, blood, and phlegm. The body was understood holistically as a dynamic state of interaction between these four principles, whose imbalance could cause disease. The goal of hygienic practice was to achieve qualitative and humoral balance within the body, and thus for each person to live out their allotted lifespan.
Hygienic instruction was tailored to each individual's constitution, itself the result of humoral activity, and to their environmental and personal circumstances, such as age, sex, status, and relations with others. Proper hygiene included regulations concerning sexual activity, sleeping and waking, bathing, exercise (a central activity for freeborn Greeks), and above all, diet. Dietary regimens were extremely detailed as to when it was or was not appropriate to eat particular kinds of animals or grains and considered food very carefully in all its cooked and raw states, discussing strategies such as boiling, grilling, roasting, and breading that would moisten, dry, heat, and bind. Because food was considered to have such powers in altering a person's internal humoral balance, the distinction between hygiene and therapeutics was blurred, as the same foods could be prescribed to cure disease as well as maintain health. Although the Greek physicians regarded their work as purely empirical, in contrast to superstitious medical practices such as appeasing angry gods, their texts clearly equated healthy practices with the moral order of their culture: a hygienic person went with his fellows to the gymnasium, was abstemious with alcohol, and had only acceptable sexual relations.
The Greeks' conception of the body as an organic whole integrated into its environment, and their regimen-based methods of preserving health by achieving harmony within the body, were remarkably similar to health systems that apparently coincidentally evolved in India and China. Though their explanatory frameworks differ from the Greeks and from each other, both Indian Ayurvedic medicine and traditional Chinese medicine have longevity and prolonged states of health as their goal, and both discuss which substances, qualities, and actions are life-enhancing and which are not. Because of these similarities, the word hygiene is sometimes inaccurately used to refer to these traditions in English-language medical histories of these peoples.
The Middle Ages and Renaissance, 200–1700 c.e.
European medical writing all but ceased as academic study dis-integrated with the Roman Empire. Academic medicine owed its revival in the ninth century c.e. to the enthusiasm of Muslim scholars, who, having established an empire from Persia to Spain, translated and extended the classical medical corpus, particularly the works of Galen. The concept of hygiene was revitalized, particularly as it could readily absorb the Islamic belief that the spiritual unity of the cosmos was the basis for all medical practice and the cleansing and purification rituals that surrounded prayer. New texts of regimens for health were produced by such renowned physicians as Abu Bakr Muhammad ibn Zakariya ar-Razi (Rhazes; c. 865–between 923 and 935 c.e.) and Avicenna (Ibn Sina; 980–1037 c.e.).
These Islamic physicians followed Galen's successors in considering the six "nonnaturals" (that is, factors external to the body) as the canonical categories that composed hygiene: air (or "environment"), food and drink, sleeping and waking, movement and rest, retention and evacuation (including ejaculation), and mental-emotions ("passions of the soul"). Regimens and advice books were structured around these categories. While regimens were widely respected, in practice, as in the classical period, many people blended them with the incantations, rituals, and charms of popular medicine, just as the notion of spiritual harmony integral to Islamic hygiene coexisted with religious notions of disease as a test or punishment.
European enthusiasm for hygiene returned with the upsurge in medical writing that marked the Renaissance, and handbooks were produced for a much wider audience. For example, in England between 1456 and 1604, 115 out of 392 editions of books on medicine and regimen were issued in the vernacular. However, these works contained an increasing diversity of thought that left the content of hygienic practice unfixed, further blurred the distinction between hygiene and therapeutics, and, under the influence of nascent sciences and the growing authority of mathematics, assigned and calculated degrees to humoral balance. Emphases and goals were shifting. For example, although exercise had largely dropped out of hygienic manuals in the medieval period, there was a renewed emphasis on regimens of movement in the Renaissance; and practitioners now aimed higher than the Galenic allotment of years, wishing instead to preserve their youth and achieve an unlimited longevity.
Personal hygiene also became more clearly equated with the health of the soul as it was reinterpreted through Christian belief and practice. Thus classical hygienic prescriptions on diet became condemnations of the "sins" of gluttony and drunkenness. Self-help and an increasing asceticism (all-cold regimens were popular) were the twin characteristics of hygiene at this time. The works of social theorists John Locke (1632–1704) and John Wesley (1703–1791, founder of Methodism) emphasized "hardening" regimens and sobriety. These clearly moralistic ideas about hygiene fueled criticisms of "civilization" by Jean-Jacques Rousseau (1712–1778) and others, who suggested that compared with the "noble savages" of the "new" world, Europeans were being devitalized by nervous diseases brought on by overeating and drinking, failure to exercise, late rising, and tight lacing. Hygienic regimens were to aid in maintaining European identity in the face of dissolution.
Hygiene and Public Health, 1700–1945
The concept of hygiene underwent immense changes during and after the eighteenth century. As the use of dissection and the microscope became increasingly common for the new medical sciences of anatomy, physiology, and pathology, Galenic theories were quickly discarded. Many physicians began to treat traditional hygiene as at best a branch of education rather than an area of medicine, at worst a form of folklore. However the status of hygienic study was defended by Paris professor of medicine Jean Noel Hallé (1754–1822), who argued that the subject of hygiene had two facets: the individual, in which the physician would consider such factors as age, sex, temperament, habits, profession, poverty, and travel; and the social, in which the physician would consider climate, location, occupations, customs, laws, and governments, as they affected health. This transference of many of the ideas incorporated in traditional hygiene to the level of the public and the population was reflective of a general growing interest in "state science," literally "statistiks." This referred to the collection of numerical data about the composition, strengths, and weakness of a population on the grounds that the economic and political strength of a nation were directly proportional to the health of its citizens. (Indeed, the concept population may be said to have been produced by these new measurement techniques.) As Hallé wrote, the hygienist must become counsel and spiritual guide to the legislator, intervening in those areas where an individual had little control.
The concept of "public hygiene" increased in importance as European societies experienced the devastating epidemics of cholera, typhoid, smallpox, and plague that struck as a result of war, colonization, and industrialization. Acting on the statistical relationship between mortality rates and living conditions, the primary government response was in terms of "sanitation," the removal of environmental pollution by garbage and nightsoil collection services, building ventilation devices in houses, and limiting industrial refuse. This environmental focus in public-health strategies reflected the popularity of the miasmatic theory of disease transmission, which conceived disease as the airy product of refuse, decay, and smell. It also shaped, and was shaped by, an increasing social preoccupation with cleanliness, possibly attributable to the transmission of the eighteenth-century French aristocracy's mannerly culture, a new kind of hygienic regimen that was distinguished from its predecessors by its cleansing rituals, from nose-blowing to bathing. Hygiene was partially distinguished from sanitation (though the two terms were interchangeable) by its focus on the social and moral health of society, the ultimate aim of sanitation. As Benjamin Ward Richardson (1828–1896) captured in his utopian tale Hygeia: A City of Health, it was felt that the mere fact of living in uncrowded conditions and enjoying regular bathing would result in the moral and spiritual uplift and pursuit of self-improvement among the great unwashed who were filling the fever-decimated hospitals, prisons, shipping vessels, and factories of the day.
Thus hygiene became a central technique of social government in the nineteenth and early twentieth centuries; indeed this could well be termed the Hygienic Era in honor of the proliferation of societies and subjects devoted to hygiene, each of which connected individuals to projects in governing society. In domestic hygiene, maternal hygiene, tropical hygiene, international hygiene, industrial hygiene, sex hygiene, moral hygiene, and many other arenas of hygiene, governments sought to regulate their citizens' movements, interactions, choices, habits, and thoughts. As public-health measures proliferated, from establishing house, city, or national-border based quarantines to building "lock hospitals" for prostitutes with venereal disease, "lines of hygiene" became literally lines of rule, and conversely, lines of rule were manifest through hygienic regulations. This was most obvious in the colonial world, where the containment, education, and/or exclusion of nonwhites (predominantly ethnic populations and immigrant laborers) were often managed medically by quarantines or isolation measures directed at their supposedly diseased bodies and unhygienic habits.
Population hygiene or health was now clearly predicated on notions of purity and pollution as Western cultures struggled to imaginatively maintain the boundaries of their bodies and identities against the incursions of various "others," from viruses to Chinese gold-seekers. Domestic hygiene aimed at excluding dirt, and equivalently moral hygiene aimed at excluding evil. Indeed, practices and instruments of hygiene, such as the minutely detailed bodily training given to those with tuberculosis or inactive typhoid bacteria about how to prevent their illness from spreading to others, produced identities. Hygienic practice marked who was white or nonwhite, citizen or alien, clean or contaminated, a good wife and mother or an impure one. By World War I, proper hygiene was regarded as a duty that all citizens owed their society. The widespread acceptance of the germ theory of disease in the 1890s encouraged this trend by focusing public-health measures away from the general environment and much more on personal practices, as the ordinary actions of apparently healthy people were now revealed to be the mechanisms that transmitted illness. With the sudden explosion of antibacterial soaps, powders for clothing, tissues, and face masks—beards were shaved and skirts lifted as Americans worried they harbored germs—came a renewed obsession with domestic and bodily cleanliness as the markers of healthiness and moral and civic responsibility.
In the hygienic era, national populations were conceptualized as biological entities, that is, as races. Encompassing much more than skin color, the notion of race reflected social characteristics (such as courage or honesty) as well as physical ones (such as longevity and intelligence) that were considered to be hereditary. Races were thought about in Darwinian terms as organisms that could evolve or degenerate, win or become extinct, according to changes in their membership and in competition with others. Accordingly, at the beginning of the twentieth century many Western physicians and social reformers were concerned that their race would "degenerate" and become devitalized by the reproduction of "unfit" specimens, that is, those with undesirable physical and social characteristics thought to be heritable, including insanity, alcoholism, Down's syndrome, epilepsy, criminality, and poor eyesight. As new tests for fitness, such as the Binet IQ test, were developed and distributed across populations, ever increasing numbers of such "unfit" were discovered and anxieties worsened. Racial hygienists sought to improve their racial stock by encouraging the propagation of the fit, sterilizing the unfit, and forbidding racial "dilution" by intermarriage. These policies were written into law in most Western countries in one form or another, such as in the antimiscegenation and sterilization laws passed in a majority of the United States, which by 1941 had caused 36,000 individuals to have been compulsorily sterilized. The ultimate expression of these ideas was of course found in Nazi Germany, where euthanasia of "unfit" children and of the inmates of psychiatric institutions was carried out in the 1930s, a precursor to the horrors of the mass genocide of Jews, Gypsies, and others designated unfit during World War II.
In the aftermath of war, many racial hygiene associations, where couples had been encouraged to seek medical testing and confirmation of fitness before marrying, gradually became planned parenthood organizations with different social goals in mind.
In the late twentieth century, the concept of hygiene lost its prewar obsessions with purity and its heavy moral agenda. Hygiene in the twenty-first century refers virtually solely to personal cleanliness, and more particularly to personal habits that minimize exposure to germs. For the past century this has been its global definition also, as since the nineteenth century the practices of personal hygiene have been relentlessly proselytized in developing nations, not only by anxious colonizing Europeans, but also by indigenous cultures as they replaced traditional knowledges with Western medicine. (For example, the Japanese Private Association of Hygiene was founded in 1883, a decade after the new Medical Constitution of Japan, which formally declared that Western medicine would be the only legal practice in the nation, was passed.) Many physician-historians regard the spread of such personal hygiene practices as having been, and continuing to be, directly responsible for saving millions of lives, and point to the sharp downward slide in incidence of once-devastating epidemic diseases as evidence for this contention. They are not wrong—but ideas about hygiene have produced and continue to produce identities and politics that colonize other social worlds, as well as healthy bodies.
See also Biology ; Eugenics ; Health and Disease ; Medicine .
Galen. A Translation of Galen's Hygiene (De sanitate tuenda). Translated by Robert Montraville Greene. Springfield, Ill.: Thomas, 1951.
Richardson, Benjamin Ward. Hygeia: A City of Health. London: Macmillan, 1876.
Armstrong, David. "Public Health Spaces and the Fabrication of Identity." Sociology 27 (1993): 393–403.
Bashford, Alison. Imperial Hygiene: A Critical History of Colonialism, Nationalism, and Public Health. New York: Palgrave Macmillan, 2003.
Mikkeli, Heikki. Hygiene in the Early Modern Medical Tradition. Helsinki: Finnish Academy of Science and Letters, 1999.
Wear, Andrew. "History of Personal Hygiene." In The Companion Encyclopedia of the History of Medicine, edited by William F. Bynum and Roy Porter. Vol. 2. London and New York: Routledge, 1993.
Yamamoto Shun Ichi. "Introduction of the Western Concept and Practice of Hygiene to Japan during the Nineteenth Century." In The History of Hygiene: Proceedings of the Twelfth International Symposium on the Comparative History of Medicine, East and West, edited by Yosio Kawakita, Shizu Sakai, and Yasuo Otsuka. Susono-shi, Shizuoka, Japan: Ishiyabe EuroAmerica Inc., 1987.
By the close of the twentieth century, good hygiene had come to signify adherence to high standards of grooming, particularly personal cleanliness. This conception is a relatively
recent historical phenomenon, although hygiene as a health practice has its roots in antiquity. In classical Greece Hygeia was worshiped as the giver of health to all who followed a balanced physical regimen and lived in accord with her precepts. In this conception health came from maintaining both the internal harmony of the body and the equilibrium between the body and the environment in which it lived. One's well-being came from a holistic understanding of person and place. Through the European Renaissance the classical idea of hygiene as a set of routines aimed at keeping the individual in balance with the internal and external environment persisted. Prior to the modern period, however, almost all hygienic advice assumed that only the wealthiest members of society had either the leisure or the economic resources to follow hygienic rules. Nor was there much notion that children required any special hygienic attention. In the late classical period, the Greek physician Galen had given distinct advice about the hygiene of infants; otherwise most writing on hygiene and disease prevention remained primarily concerned with adults.
Evolving Ideas of Hygiene
Though many classical civilizations created strict regulations concerning domestic and personal cleanliness, the disposal of the dead, the elimination of human and animal waste, and other forms of public sanitation, these were not distinctly health routines. They were frequently rituals with deep religious meaning, like the Hebrew traditions of ritual baths, meant to purify the soul and not the body. Arabic writing incorporated the pursuit of health with religious purity. In his eleventh century Almanac of Health, Ibn Butlan, an Arab Christian, urged his audience to maintain good health through a personal regimen that included adherence to a diet that was determined by the individual's work and climate, regular exercise, sufficient sleep, daily washing, daily bowel evacuation, and weekly bathing. Central to his writing was the idea that balance in diet, exercise, and cleanliness was pleasing to God.
Christianity added an ascetic note to the hygienic. Medieval Christian writers introduced the persistent idea that good health required strict regulation of the appetites and disciplining of the body by diet and exercise. Hygiene routines became means of self-denial, aimed at living a temperate life. This conception paralleled the European medieval prejudice against public baths, which associated both classical and Muslim bathing practices with licentious sexuality and enfeebling luxury. Self-denial through strict hygiene (though not necessarily cleanliness) persisted as a theme in European and American writing well into the modern period. In early modern Europe this embedded Christian notion encouraged a cold bathing regimen for adults and children. John Locke in Some Thoughts Concerning Education (1693) proposed a hardening hygiene for children of cold water, cold air, and light clothing to toughen the body and spirit. The promotion of cold water as healthful was central to the nineteenth-century hydropathic movement.
Beginning in the eighteenth century Western European society saw a transformation in manners that increasingly emphasized physical appearance, restraint, and personal delicacy related to bodily functions. French aristocrats developed rules of etiquette that required restriction of public spitting, use of handkerchiefs, and strict toilet practices. By the end of the eighteenth century, the middle classes were imitating elite standards of cleanliness because such standards were thought "mannerly" and their use distinguished one from the common and vulgar. Such manners were a social obligation and were not necessarily associated with health. In this era Enlightenment Christians attempted to uproot the medieval Christian sense that frequent bathing was self-indulgent by asserting that cleanliness followed the laws of nature and of nature's god. The most often quoted assertion of this thinking was in John Wesley's December 1786 Sermon 88 On Dress in which he resurrected the ancient Hebrew doctrine of carefulness to support improved attention to appearance. He asserted, "Let it be observed, that slovenliness is no part of religion; that neither this nor any text of Scripture, condemns neatness of apparel. Certainly, this is a duty not a sin. 'Cleanliness is, indeed, next to godliness.'"
Theories of Contagion
Even before any notion of germs became commonplace medical innovation created significant change in the understanding of hygiene. In the late eighteenth century theories of contagion began to emphasize the role of dirt in the spread of disease. These filth theories of contagion contributed significantly to linking visible dirt to infection. The development of the germ theory by Louis Pasteur, Joseph Lister, Robert Koch and others moved attention from visible to invisible dirt. Nonetheless, as Nancy Tomes in The Gospel of Germs has noted, general understanding of germs was often a superstitious caricature of the scientific theories concerning microorganisms and disease. People continued to associate visible filth with contagion well into the twentieth century, though they increasingly became concerned with eliminating unseen contamination as well.
One thing contagion and germ theory did was emphasize the degree to which individual health was dependent on the healthfulness of a person's surroundings. The health of individuals in society seemed to depend on a public commitment to cleaning, and middle-class people began by rigorously cleaning themselves and their homes. Acceptance of the germ theory, however, meant that cleaning oneself wasn't enough; fully preventing disease transmission required clean water, careful waste disposal, and improving the health of the poor. Public health measures related to improved hygiene became common in Western Europe and North America. These reforms included improvements in sanitation, provision of clean water, and the creation of a public bath movement that provided the poor with facilities for cleaning and attempted to convince them of the necessity of being clean. Such reforms often carried with them negative judgments and stereotyping of the working classes, the people Henry Peter, Lord Brougham, is reported to have first called "The Great Unwashed."
In the early to mid-twentieth century the general public seemed to become obsessed with hygiene. Hygiene continued to include a wide variety of practices such as diet, exercise, sexual abstention, and regular evacuation of the bowels (known as internal hygiene). The concept of hygiene was extended to even more aspects of personal and public life. This included the creation of new types of hygiene, such as mental hygiene, sexual hygiene, and the racial hygiene of the international eugenics movement. In an era of imperialism other nations came to be judged as civilized on the basis of their adherence to European and American standards of cleanliness. The irony of this is that Europeans and their American cousins, who were often filthy prior to the modern era, judged unworthy those Africans and Asians who had long practiced frequent bathing.
A number of factors contributed to the zealous adherence to hygiene practice in Western European and American society in the late nineteenth and early twentieth centuries. In public hygiene movements throughout Western Europe and North America the power of the state was used to enforce adherence to hygienic behavior, including rules prohibiting public spitting as well as building extensive sanitation and water infrastructures. One primary impetus in this process was the effort to educate the public through clinics, medical publications, and social-work associations, including settlement houses. New organizations of the industrial bureaucracy contributed as well. Insurance companies in the United States contracted with public-health nurses at the Henry Street Settlement in New York to oversee and reform the hygienic habits of their subscribers. Manufacturers of soap and other hygiene supplies used the modern media to sell products first by enlisting medical claims about the need to eliminate germs, and then by creating new disease concepts (such as the Listerine company's "halitosis"). Hygiene advertisers goaded people to bathe for health and to avoid the judgments of others about cleanliness and odor. In one example, a 1928 advertisement from the Cleanliness Institute, the educational branch of the Association of Soap and Glycerin Producers, asked, "What do the neighbors think of her children?"
Nurses played an important role in the spread and enforcement of hygiene rules in late-nineteenth- and early-twentieth-century Europe and the United States. Florence Nightingale supported theories of contagion, but not germ theory. Still, she and later nursing advocates made it clear that nurses, because of their medical expertise and womanly nature, were central to spreading proper methods of personal and domestic hygiene. Other British medical reformers Charles West and Ellen and Mary Phillips saw the establishment of hospitals for poor children, in which nurses provided most of the care, as an important means of improving environmental conditions for children.
A Focus on Children
Children were at the heart of a growing public obsession with hygiene. Major health and hygiene campaigns in the United Kingdom in the late nineteenth and early twentieth centuries had as their central focus the reductibn of infant mortality, first through the Poor Laws and then through the National Health Insurance Act of 1911. Children also increasingly became the focus of much of the hygiene literature. Hygiene proponents used schools to spread the word about regulation of the body. The 1882 French primary school curriculum included instruction on proper toilet routine and washing. In the United States the Cleanliness Institute published and distributed materials for schoolteachers and schoolchildren on maintaining health through personal cleanliness. Instruction for teachers and mothers focused on the necessity of getting children to adhere to strict disciplining of the body so they might live healthy lives and fulfill their obligation to avoid offending others. This instruction was couched in medical, social, and political terms: children were taught to exercise, bathe, and eat in particular ways because it was good for their bodies, created social order, and because medical, educational, and social authority said so. This association between schooling and cleaning was so well established that the Kohler Corporation, one of the largest manufacturers of plumbing equipment in the United States, declared in a 1927 advertisement that the bathroom itself was the schoolroom of health.
Hygiene education carried with it the moralistic tone of the public health movement as a whole. In France children were taught that moral character was inextricably linked to hygiene habits. In the United States the Americanization Movement supported hygiene instruction as a means of converting European working-class immigrants into good Americans. Maintenance of social order seemed dependent on maintenance of high standards of hygiene, based on the manners of the white middle class. The hygiene lobby proposed a single standard of cleanliness that often failed to take into account individual differences in skin type or living conditions. In the United States this was particularly problematic for African Americans, both because of their physiological differences and because they often lacked the means for following the prescriptions of the hygienists. African-American leaders were well aware of this problem and offered instructions specifically geared toward the African-American community. The most famous of these was Booker T. Washington's "gospel of the toothbrush." Unfortunately, in the racial climate of the United States, even strict adherence to the rules of hygiene did not free African Americans from the stigma of being by nature dirty, because of the cultural association between whiteness and purity.
The Social Hygiene Movement
The association of cleanliness and hygiene with children and social fitness was certainly central to the international social (racial) hygiene movement. In her 1910 Hygiene and Morality, American nursing reformer and suffragist Lavinia Dock drew a connection between venereal disease incidence and the mistreatment and corruption of women and children. Not only did corrupted men infect their wives, but they also polluted what Dock called the germs of reproduction (that is, their sperm), thus creating deformed children. Finally, syphilis carriers created unhygienic conditions within the family that harmed their innocent offspring both physically and morally. Such attitudes encouraged increased intervention by the state into the personal practices of the populace.
The most radical of these efforts was the international social hygiene movement, arising from the pseudoscience of eugenics. Forced sterilization of the unfit was couched in hygienic terms that focused on preventing unclean and corrupt persons from continuing to pollute the species through re-production. The concept of racial hygiene saw its greatest expression in Nazi Germany, but it did not originate there. It was in the United States that laws related to reproductive hygiene were first initiated. By the 1930s two to three thousand forced sterilizations of the mentally ill, retarded people, criminals, and racial minorities were performed in the United States each year. During the Holocaust the Nazis used hygiene language as a code for what would later come to be called ethnic cleansing of the Jewish, Gypsy, homosexual, and other "undesirable" populations. Nazi propaganda was particularly focused on the control of women and childbearing as the means of eliminating racial corruption and creating the master race. The link between this and notions of hygiene are best seen in the euphemism of the shower/gas chambers and the experimentation with turning human fat into soap.
After 1945 the social hygiene movement was largely discredited, but the impulse toward greater and greater levels of cleanliness, particularly cleanliness in children, persisted. Schools remained the focus of much childhood education, but hygiene came to be narrowly defined as proper grooming to maintain personal cleanliness. Here, standards continued to escalate. In the United States, hygiene films for grade school and high school students became a staple of 1950s classrooms. These continued to promote cleanliness by combining scientific arguments about germs and skin and hair care with an emphasis on maintaining proper social standards. They also incorporated negative judgments about those who failed to adhere. Adolescents were particularly singled out for attention. High school students were warned that failure to follow strict grooming codes would lead to their becoming dateless social outcasts.
In the late twentieth century these messages increasingly came to be seen as ridiculous and outdated. In 1956 Horace Miner, distinguished professor of social anthropology at the University of Michigan, published an article called "Body Ritual among the Nacirema " in the American Anthropologist. In this he lampooned both jargon-ladened anthropological research and the American (Nacirema was "American" spelled backward) hygiene obsession. In this satire Miner targeted both the medical establishment for creating neuroses about health and cleanliness and parents for inculcating these neurosis in their children. In the radical sixties youthful rejection of these hygiene practices was a common feature of rebellion against parents and social authority. Around the same time purveyors of soap and children's books shifted tactics. They began emphasizing bathing as a means of relieving social tensions (a minor theme in the early-twentieth-century literature) and promoted bathing as a sensual and self-indulgent activity. Advice to parents proposed tricking reluctant tots into good habits by adding bubbles and toys. Children's literature depicted bath time as playtime.
Though hygiene came to be equated with good grooming in the late twentieth century, aspects of the health regimen of the ancients are reappearing in new forms. Proponents of aromatherapy and other New Age remedies are reemphasizing a holistic approach to hygiene. Still, this holistic attitude strikes a minor chord in the overall tone of preventive health care in Western society. Most of the activities associated with hygiene until the recent past are now specialized, distinct commodities. Postmodern society has divided care of the human body into separate components served by particular industries: the diet, exercise, soap, and cosmetic industries, as well as modern specialized medicine. Some critics call this process the commodification of the body. Yet, despite the intense selling of high levels of cleanliness and bodily discipline, public adherence to the standards authorities set shows marked unevenness. Even in the United States, where grooming practices encourage daily changing of clothes and bathing twice or more each day, hygiene routines that are less visible are often neglected. For example, studies in the 1990s indicated that cleanliness-obsessed Americans frequently failed to wash their hands after using public rest rooms.
Hygiene and Health
The impact of improved hygiene on health and comfort is difficult to deny. Several epidemiological studies have suggested that the decreased incidence of infectious disease and the dramatic decline in infant and child mortality that began in Western society in the late nineteenth century can largely be attributed to improvements in sanitation, water supply, and domestic and personal cleanliness. In the late twentieth century those nations that enjoyed the lowest levels of infectious disease were those that used the highest amounts of soap. This improvement has not been without cost, however. Increased attention to hygiene has also meant increased pressure on the natural environment. Even the most vocal proponents of maintaining high levels of cleanliness acknowledge that the degree of cleanliness in Western European and American society far exceeds what is necessary for health. This overcleaning has resulted in undue pressure on water supplies, chemical pollution of water and soil due to the use of soaps and other cleaning agents, and increased energy demands to heat water and wash clothing. Paradoxically, one cost of the advent of antibacterial soap and other products, such as Hygeia underwear, which manufacturers claim prevents the growth of bacteria, fungi, and yeast, may be the increased appearance of antibiotic resistant microorganisms.
Another possible irony in the success of hygiene campaigns is that improved domestic and personal cleanliness may also be associated with increased incidence of the socalled diseases of industrial society, particularly polio, allergies, and asthma. Under the regimen of the hygiene proponents, the best method for protecting children's health is to provide them with a clean, virtually germ-free environment. The standard care for allergy-triggered asthma, for example, is removal of asthma triggers from the sufferer's environment. In the last decades of the twentieth century researchers in Italy, the United Kingdom, Switzerland, and the United States began to suggest that lack of exposure to microorganisms and dirt at an early age may result in the body's failing to produce natural resistance to foreign substances. This failure may be associated with the mid-twentieth-century polio epidemics and with the increased incidence of asthma. Epidemiologists meeting in 2001 at the Pasteur Institute cited these studies and those related to environmental pressures as signals that we need not reject hygiene altogether, but instead should seek more carefully targeted cleanliness standards. They proposed homing in on key behaviors such as frequent hand washing and strict cleanliness of food preparation areas. The presenters noted that we need germ-free environments only in hospitals and the residences of the seriously ill. Soap manufacturers and the general public do not seem as ready to make such a nuanced distinction, however, if the promotion and sale of anti-bacterial items is any indicator.
See also: Children's Hospitals; Contagious Diseases; Epidemics; Mental Hygiene; Pediatrics; Vaccination.
Tomes, Nancy. 1998. The Gospel of Germs: Men, Women, and the Microbe in American Life. Cambridge, MA: Harvard University Press.
Vinikas, Vincent. 1992. Soft Soap, Hard Sell: American Hygiene in an Age of Advertisement. Ames: Iowa State University Press.
Whorton, James C. 2000. Inner Hygiene: Constipation and the Pursuit of Health in Modern Society. New York: Oxford University Press.
Jacqueline S. Wilkie
Historical backgroundHygiene in the earliest sense was not connected to cleanliness or personal grooming. Indeed popular attitudes in Western Europe and the US held that frequent bathing was dangerous to individual health. It upset the physical system, robbed the body of precious natural oils, and led to debilitating illness. Though individuals such as Benjamin Franklin urged cleanliness as a necessary component of healthful living, the plumbing technology required to make this easy was underdeveloped and expensive. Travellers in Europe and the US during the early nineteenth century frequently commented on the filthy conditions both of persons and households. One historian has suggested that, in a largely agricultural community, the dirt of honest labour was associated with both economic and physical well-being, an outlook that applied to both peasant cultures in Europe and yeoman farm life in the US.
Beginning in the early nineteenth century, the repeated onslaught of diseases such as cholera began to alter people's understanding of personal hygiene. Since orthodox medicine seemed powerless in response to these pandemics, a variety of alternative medicines gained popularity. Many of these alternatives emphasized disease prevention through healthful living, which included diet and clothing reform, daily cold water bathing, exercise, regulation of bowel movements, and abstinence from coffee, tea, alcohol, and sex. In their attack on heroic medicine, reformers emphasized personal and domestic responses to health crises.
For these reformers, living hygienically was essential both because it led to physical well-being, and because it revealed proper moral character. Catherine Beecher, the most prominent domestic advice author of the mid-nineteenth-century US, propounded this view of hygiene. In Letters to the People on Health and Happiness she called her hygiene precepts, ‘… laws of health and happiness, because our Creator has connected the reward of enjoyment with obedience to these rules, and the penalty of suffering with disobedience to them’.
Florence Nightingale, in her efforts to reform English hospital care, provided the most cogent arguments linking personal and public hygiene with good health and morals. Like many of her contemporaries, Nightingale believed that unhealthy living made individuals susceptible to contagion. She rejected germs as a specific causal agent, however, asserting that dirt, sewer gases, and other environmental contagion produced illness. Nightingale's system for training nurses reflects this belief, and Nightingale nurses cleaned the patient and created order in the hospital. Nightingale is, therefore, a transitional figure linking the idea that the individual has a moral responsibility to live healthfully with a desire to control external threats to individual health.
As Western society became more urban and industrial, the disorderliness of city life seemed to threaten the health of even the most dedicated follower of Beecher's ‘laws of health and happiness’. Gradual acceptance of the germ theory compounded the fear that right living alone could not prevent illness. The eleventh edition of the Encyclopedia Britannica reflects this attitude by asserting that hygiene embraces ‘all the agencies which affect the physical and mental well-being of man.’ Hygiene as a system included not only personal hygiene related to food, clothing, exercise, cleanliness, and sexual control, but also sciences such as engineering, meteorology, bacteriology, and public sanitation and waterworks.
Since social health required both environmental cleanliness and hygienic behaviour on the part of the masses, reformers sought to extend private middle-class standards of hygiene into the public arena by reforming garbage collection, water delivery, and sewage disposal. They also sought to change the behaviours of the lower classes. In the US the effort to transmit hygienic practices to the masses was inextricably linked to Americanization. The goal was to lift so-called ‘dirty foreigners’ to middle-class American standards. The lessons of hygienic living were first taught to women through ‘settlement houses’ and visiting nurses, but the most effective pedagogy of hygiene targeted children in schools. Hygiene instruction prodded children to swat flies, refrain from spitting, brush their teeth and hair, clean their clothing, wash all of their body and not just the parts that showed, eat balanced meals, and abstain from alcohol, tobacco, and sex. Humiliation of children who did not meet the teacher's standards was frequently used to reinforce these lessons, and students were expected to carry the lessons home. African– Americans and immigrants readily embraced hygienic living as a means of uplift. Booker T. Washington, prominent leader of the African– American community and founder of the Tuskegee Institute, emphasized the ‘gospel of the toothbrush’. Ironically, African–Americans, many of whom worked as janitors, maids, and laundresses, were viewed as indelibly dirty and diseased regardless of their adherence to the hygienic standards of the white middle classes.
Racial hygieneThe racism inherent in this evaluation of blacks and immigrants was at the root of the international eugenics movement, also known as the racial hygiene movement. Proponents of eugenics in the US, Great Britain, Australia, France, Germany, and Scandinavia maintained that social health and progress would arise from increased childbearing among presumably superior people and limitation of reproduction for genetically inferior people. The US led the way in passing legislation which allowed forced sterilization of ‘undesirables’ in custodial care, such as the mentally ill, criminals, and racial minorities. By the 1930s, 2000–4000 operations per year were performed in 23 states, with nearly half of all sterilizations occurring in California.
In 1933 Germany followed the American lead with the passage of two sterilization laws patterned primarily on California's model. The chief difference was that the law in Germany standardized procedures for determining eligibility for sterilization and applied these rules to the entire nation, an ‘advantage’ much admired by many American genetic scientists and eugenicists. The Nazi use of showers as a façade for the gassing of millions of Jews, homosexuals, gypsies, and communists ironically underscores this perversion of hygienic practices.
Advertising cleanlinessThe 1920s saw the introduction of a new corporate understanding of hygiene that wedded the educational approach of the social reformers to the methods of mass communication. Good hygiene became associated with good business. Metropolitan Insurance of New York and the Henry Street Visiting Nurses Association reached an agreement whereby the nurses taught Metropolitan clients to live hygienically. The Cleanliness Institute, founded by the Association of American Soap and Glycerine Producers, created lessons for teachers on personal hygiene. They also hired a popular children's author to create a series of five books with churlish characters called goops, including the unhygienic characters of Hatesope and Rodirtygus who refused to bathe. The lesson of each of the tales was that no good child would behave like a goop. Since corporate promoters of hygiene had two aims, to draw new users into the market for their products and to encourage greater consumption of their products by current users, they added new diseases, such as halitosis (bad breath) and body odour, to the list that good hygiene supposedly prevented. The introduction of these ‘disease states’ indicated a shift in the understanding of hygiene, which now emphasized a well-groomed personal image and social acceptability as important outcomes of what was once extolled as the harbinger of health. In the US this meant that hygiene now included removal of ‘unsightly hair’ from women's underarms (beginning in the nineteen-teens) and legs (after the 1940s).
Sexual hygieneAttitudes on hygienic sexual practice paralleled the evolution of general understanding of hygiene. When healthful living and moral character were equated, good sexual hygiene meant abstaining from all sexual activities. William Andross Alcott, a prominent health reformer in the nineteenth century, warned that sexual activity, including frequent heterosexual intercourse and ‘self abuse’ or masturbation, led to poor mental and physical health, because it exhausted the body's vital energies. When proper hygiene was seen as a bulwark of social order and civilization, the American Society for Sanitary and Moral Prophylaxis and the American Social Hygiene Association promoted control of erotic impulses through publication of ‘scientific’ information on sex, and sex education in schools, which emphasized negative consequences of intercourse and was intended to prevent sexual experimentation among teenagers. In addition to supporting forced sterilization of ‘undesirable elements’, the early-twentieth-century sexual hygiene movement also aimed at eliminating prostitution and inculcating a single sexual standard for both males and females. The corporate approach to hygiene created an interesting paradox concerning sex. Consumers, particularly girls, were urged to engage in hygienic practices that would make them sexually desirable, while health educators warned that nice boys and girls did not engage in sexual activities outside of marriage. None the less, heterosexual relations within the bonds of marriage were seen as natural and healthy. In the youth rebellion of the 1960s hygienic teachings about grooming and abstinence became associated with the corrupt ways of bourgeois society. Ironically, the counterculture embraced both dirt and unrestrained sexual relations as a means of breaking from this corruption and creating a ‘purer’, more ‘natural’, and ‘healthier’ way of life.
Contemporary understanding of hygiene reflects the tensions inherent in its history. Hygiene has partially become a byword for the quaint sexual mores promoted in high school classrooms of the 1950s. Yet in a era of teenage pregnancy and epidemics of sexually transmitted diseases, schools and public health agencies are returning to the message that abstinence and sexual self-control are essential to continued good health. We also face the paradox that advertising and mass communication, which successfully used sex and social acceptability to sell hygienic practices to our grandparents and great grandparents, are now promoting images of health and beauty linked to epidemic levels of eating disorders.
Jacqueline S. Wilkie
Hoy, S. (1995). Chasing dirt: the American pursuit of cleanliness. Oxford University Press, New York.
Kühl, S. (1994) The Nazi connection: eugenics, American racism and German National Socialism. Oxford University Press, New York.
See also eugenics.
HYGIENE. Before the eighteenth century, physicians and priests were the principal students of health science in Europe and the New World. For centuries, the study of medicine had been divided into theory and practice. Theory included physiology, etiology, and semiotics, whereas practice included hygiene and therapeutics. Traditionally educated physicians understood and employed hygienic practices as well as therapeutic ones.
Priests, often viewing disease as punishment for sin, assumed major roles as health educators during the early Middle Ages, and they dispensed moral advice hand in hand with medical advice. Accordingly it was a clergyman, Thomas Thatcher, a pastor at Weymouth, Massachusetts, who prepared the first medical tract in the North American colonies during the third quarter of the seventeenth century.
In the eighteenth century, as superstition declined and social roles were secularized, teachers and government authorities assumed responsibilities as health educators. Simon-André Tissot, a Swiss physician, wrote his Advice to the People in General with Their Health (1761), declaring that owners of estates and schoolteachers should be instructed in matters of health and disease and should be expected to teach the uneducated. Sustaining this emphasis, Bernard Faust, a German physician, issued his Catechism of Health in 1794. Four years later, with the enthusiastic recommendation of Benjamin Rush in Philadelphia, an English edition of Faust's book was published in New York.
Faust had lived in a political system that championed effective health care. Officials in the absolutist states of western Europe believed that an enlightened government should protect the health of its people. Several of these governments established systems of medical police that regulated the personal lives of their citizens from the cradle to the grave with a plethora of laws and administrative agencies. Most nineteenth-century political leaders in the United States rejected the rigid paternalism of these systems. Nevertheless, with the lobbying of interested physicians, health legislation did appear in numerous states before the Civil War.
Thomas Cooper (1759–1839), trained as a lawyer and physician, saw a need for regulation of such nuisances as gambling, swearing, public drunkenness, filth and sewerage, vagrants and beggars, "careless and desperate drivers" of stagecoaches, and the firing of guns in the streets. Two outstanding New York City physicians, David Hosack and John Griscom, encouraged politicians to adopt legislation relating to epidemic diseases, constructing houses, locating cemeteries, and protecting sources of water. By 1832, most of the larger American cities had created boards of health that enacted various kinds of regulations, and twenty states had adopted licensure regulations for practitioners.
However, in caring for patients, American practitioners as a profession did not honor traditional attention to hygienic practices. Only a few individual physicians, beginning with Benjamin Rush, evinced a special interest in hygiene. These physicians acknowledged new British works on health and translated some key European treatises. Elisha Bartlett (1804–1855), John Bell (1796–1872), and Robley Dunglison (1798–1869) prepared original monographs on personal hygiene. An underlying theme, expressed succinctly by Bell, was the belief that "rules for the preservation of beauty" were the "same rules to be followed for the support of health," both physical and mental; these rules were also "in entire harmony" with those by which each individual was "required to maintain his ethical and religious relations with his fellow men." Like other physician-authors of the period, Bell discussed skin care, dress, exercise, diet, longevity, and certain aspects of public hygiene. Encouraged by such physicians, a democratization of health education occurred and some citizens, at Boston in 1837, founded the American Physiological Society in order to learn "that part of Human Physiology which teaches the influence of air, cleanliness, exercise, sleep, food, drink, medicine, etc., on human health and longevity." Although short-lived, this group reflected the growing concern among American citizens for an understanding of human physiology and appropriate hygienic practices.
By 1876, there was still no comprehensive American treatise on hygiene. The situation changed abruptly with the emergence of a preventive medicine based on the bacteriological discoveries begun by Louis Pasteur and continued by many others during the last quarter of the century. These discoveries offered a rational basis for many of the sanitary reforms that legislatures began to enact and provided justification for new kinds of specific hygienic practices, both personal and public. Although public health workers were primarily concerned with the control of contagious and epidemic diseases well into the first decades of the twentieth century, the National Committee for Mental Hygiene was organized in 1908. Eight years later (June 1916), the Johns Hopkins School of Hygiene and Public Health incorporated mental hygiene into its original prospectus. An emerging interest in occupational hygiene reinforced attention to mental hygiene.
Although a few doctors studied health problems associated with the work of miners, metalworkers, shoemakers, bakers, and numerous other craftsmen during the eighteenth and nineteenth centuries, it was not until the turn of the twentieth century that American physicians and other health professionals began to give significant attention to occupational hygiene and the prevention of diseases associated with particular occupations.
Between 1870 and 1930 bacteriological discoveries, statistical surveys of disease, health regulations of industrial workers, and other forms of health legislation led to a conceptualization of hygiene as a public concern rather than a strictly private matter. The first texts on hygiene and public health were written, and the Massachusetts Institute of Technology established the first school of public health in 1912. In medical schools, hygiene became part of the curriculum in public health or preventive medicine courses. Most authorities considered personal hygiene primarily a matter of infectious disease control.
A redefinition of health began to emerge in the mid-nineteenth century, reflected in the World Health Organization's view of health as a complete state of physical, mental, and social well-being. With the mushrooming demand for medical care among citizens who saw health care as a right rather than a privilege, the emergence of multiple new groups of professionals providing health care, and the surge of scientific knowledge about ways to prevent disease and maintain health, hygiene resumed its original position as an integral component of medical and liberal education.
Bennett, James T. From Pathology to Politics: Public Health in America. New Brunswick, N.J.: Transaction Publishers, 2000.
Bullough, Bonnie. Preventive Medicine in the United States, 1900–1990: Trends and Interpretations. Canton, Mass.: Science History Publications, 1992.
Duffy, John. The Sanitarians: A History of American Public Health. Urbana: University of Illinois Press, 1990.
Chester R.Burns/c. w.
This entry focuses on the variety of experiences of enslaved African American men and women and examines how they managed to maintain a semblance of cleanliness and order in their lives. While many parts of a slave's life were beyond his or her control, the very personal element of hygiene and cleanliness could be controlled; in fact, personal hygiene was often essential to a slave's sense of dignity and self-respect. By examining slave narratives and other historical documents, one can get a very clear picture of just how important hygiene was to the slave community.
In the March 2000 issue of Journal of Economic History, economists Philip R. P. Coelho and Robert A. McGuire wrote, "[t]he antebellum plantation system consisted of relatively dense rural populations." That population density, combined with the lack of privies (outdoor toilets), made the quarters of the enslaved breeding grounds for disease. "[S]anitary privies were rare in the antebellum rural South; facilities in the rural South typically consisted of bushes or open holes or ditches" (2000, p. 235).
However, as the work done by archaeologists at slavery sites has shown, sanitary privies did exist and were used by the enslaved. Discovered by men and women trained to know where and how to look, these privies were treasure troves of artifacts and information. As Theresa Singleton wrote, these discoveries, including privies used by the enslaved population at Ferry Plantation in Beaufort, South Carolina, and the Hermitage Home of Andrew Jackson, in Hermitage, Tennessee, indicate that enslaved people in rural areas were using privies, and men, women, and children were in the habit of throwing unwanted and unusable goods into the privies as well. As is shown in archaeological research, privies were the receptacles for all sorts of waste materials, including human waste.
Controversial Views of Slave Life on the Plantation
Coelho and McGuire noted enslaved people lived in close proximity to the "free roaming coprophagous animals" (cophragous animals feed on dung). In this environment, "[s]lave infants and children, [crawled or walked] diaperless and barefoot, wearing only shirts [and] defecated randomly." Larry McKee, responsible for the archaeological dig at the Hermitage (home of former president Andrew Jackson), suggests that "enslaved people kept their houselots purposefully dirty to resist planters' desire for cleanliness, orderliness and control of their quarters."
In reality, Coelho and McGuire's description of enslaved people falls dangerously close to old stereotypes about black women and children. As a response to abolitionism, Southerners developed a defense mechanism that was called the minstrelsy, which was the first original form of American performance art. White performers would dress up and rub cork on their faces to give the appearance of dark skin, then behave the way they imagined enslaved black men, women, and children did. In these minstrel shows, there were three common characters: The first was Jim Crow, a character that represented young black men who sang and danced about with uncombed hair, ragged patched clothes, and worn out shoes. The second was the pickaninny, a character that represented black children with uncombed hair, knotty hair, dirty clothes, a generally unkempt appearance, and consistently absent mothers and fathers. The third common minstrel character was the Mammy, who was presented as an enslaved woman who neglected her own children—the aforementioned feral, unwashed, and uncombed pickaninnies.
However, regardless of the law of the time that reduced them to chattel—and regardless of Coelho and McGuire's assertion—slaves were not animals or otherwise less than human. Enslaved men and women were armed with a skill set that made them capable of running a plantation, inside and out. Those enslaved in the plantation household were responsible for the domestic sphere and those enslaved in the agricultural sector were enslaved men and women responsible for planting, weeding, picking, and processing the various crops that enriched plantation owners and yeomen farmers. That they would be unwilling to practice the most basic hygiene habits for themselves or their loved ones to get back at their masters, who, in the case of Jackson, lived a country mile away from the Hermitage field quarters, is questionable.
Artifacts and features like ash pits at the Hermitage among other places indicate that adults (most probably mothers) found time to make soap—a long and tedious process that required them to leach lye from ashes that were collected from fires, collect animal fat, and boil the two until soap was produced. This soap would then be used to wash clothes, wash floors, and clean behind the ears of their children.
On many plantations it was the custom to release adult women from fieldwork early on Saturday so that they could do their week's washing. Laundry was done manually with washboards, with sticks, in wash pots, and using the hands. It was a time-consuming and difficult chore. In fact, on one Louisiana plantation, slave men were forced to wash clothes as punishment, which clearly indicates that washing clothes was hard work, a tedious task that was equated with punishment and that was to be avoided whenever possible. Of course, the enslaved women who worked in fields from sunup to sunset during the week did not have the luxury of avoiding the laundry—it was a necessity for themselves and their families.
Other Proof of the Importance of Cleanliness
The simple act of sweeping has led to another discovery that shows how slave women likely placed a high value on cleanliness and hygiene. While examining archaeological excavations of old plantations, historians have uncovered what appear to be marks in the dirt caused by broom bristles. What this suggests is that even though most slave quarters featured nothing but dirt yards, the female head of the house would sweep the area so often that the bristle marks became part of the historical record more than 100 years after the yards were last swept.
In his 1845 narrative, the ex-slave turned abolitionist Frederick Douglass described his experience as a young boy getting ready to leave for Baltimore. "I spent the most part of all these three days in the creek, washing off the plantation scurf. I spent the time in washing … get[ting] all the dead skin off my feet and knees before I could go to Baltimore." Douglass was to be given a pair of trousers, but before he could receive them, he was told to remove "what would be called by pig drovers, the mange." Any young boy willing to take a bath on his own shows a concern for personal hygiene. Douglass remarked, "… the pride of appearance which this would indicate is not my own." Instead he was convinced to wash to avoid being laughed at when he reached his new master's home in Baltimore. Douglass, like other enslaved people, had an interest in keeping himself presentable and clean.
Coelho, Philip R. P., and Robert A. McGuire. "Diet Versus Diseases: The Anthropometrics of Slave Children." Journal of Economic History, March 2000, vol. 60: 650, pp. 232-246.
Douglass, Frederick. Narrative of the Life of Frederick Douglass, an American Slave, Written by Himself: With Related Documents, ed. David W. Blight. Boston: Bedford/St. Martin's Press, 2003 .
Gutman, Herbert George. The Black Family in Slavery and Freedom, 1750–1925. New York: Vintage, 1977.
Joyner, Charles W. Down by the Riverside: A South Carolina Slave Community. Urbana: University of Illinois Press, 1984.
Morgan, Philip D. Slave Counterpoint: Black Culture in the Eighteenth-Century Chesapeake and Lowcountry. Chapel Hill: University of North Carolina Press, 1998.
Tanya M. Mears
The definition of hygiene, or personal cleanliness, has varied from culture to culture throughout history. However, one thing is clear: contrary to popular belief, people have not become cleaner over time. Many factors, including local customs, the outbreak of disease, scientific knowledge, and religious beliefs, have affected the ways people clean their bodies and clothes and dispose of their wastes.
The idea of regular bathing as an important part of personal hygiene is not a modern one. Ancient Romans bathed themselves regularly in large public baths before the first century c.e. In Europe during the Middle Ages (c. 500–c. 1500) there were also many public bath-houses, called "stews" by the common people who used them. In the early 1300s some European monks, men who dedicated their lives to the Catholic Church by joining religious orders, had plumbing that brought water for bathing inside the monasteries where they lived. However, the bubonic plague, a very contagious, often fatal bacterial disease which swept much of the world during the fourteenth century and was also known as the Black Death, caused the closure of many public gathering places, including the public baths. People believed that public baths may have caused the disease, inspiring in many Europeans a fear of using water to clean the body. Some Christians had long believed that submerging the body in water could wash away the holy water of the baptism ritual. After the arrival of the plague, this mistrust of water increased. Many people believed that placing water on the skin would open the pores, allowing disease to enter the body. Alongside these superstitions there was good reason to doubt the safety of water. During the 1400s and 1500s plumbing was fairly primitive and, in large cities, sewage flowed down streets and gutters in open streams that smelled bad and carried disease. Even the water from wells could be contaminated, and no way to purify such water had yet been discovered.
Rather than washing in water, the preferred way of cleansing the body during the sixteenth century was to wipe it with white linen cloths, which were thought to have healing properties. The poor had little linen and no servants to keep it clean and white. They also had little leisure time for bathing or washing clothes. It became common among the poor to bathe only twice a year, once in the spring and once in the fall, though the face, hands, and teeth were usually cleaned daily. The teeth were usually brushed with a chewed twig, then wiped with cloth. The wealthy bathed more frequently, sometimes weekly or monthly. In addition, their servants kept them supplied with clean white linen, both to wipe their bodies and to wear. While most nobles wore clean linen every day, other clothes were seldom washed. The very wealthy simply gave away their clothes when they were too dirty to wear.
Soap had been invented in the Orient and brought back to Europe during the eleventh century by soldiers returning from the religious Crusades to extract control of the Holy Land from the Muslims who lived there. The new soaps were expensive, however, and even the king seldom used them. Instead, most of the royalty and nobility concealed the smell of imperfectly cleaned bodies with a variety of strong perfumes. Most wealthy people carried bottles of perfume, pomanders (scented jeweled balls), or scented handkerchiefs with them at all times. The poor simply smelled.
The idea that germs cause disease and infection, and that cleanliness can prevent the spread of germs, was not widely understood until the 1800s, but a sixteenth-century French doctor named Ambroise Paré (1510–1590) did discover the value of cleanliness in treating wounds. On the battlefield Paré ran out of boiling oil, the usual treatment for soldiers' wounds, and treated his remaining patients by simply washing their wounds with water. When he discovered that the washed wounds healed, while those treated with oil got worse, he spread the word. Doctors throughout Europe soon stopped using the boiling oil treatment in favor of water.
Hygiene refers to the health practices that minimize the spread of infectious microorganisms between people or between other living things and people. Inanimate objects and surfaces, such as contaminated cutlery or a cutting board, may be a secondary part of this process.
One of the bedrock fundamentals of hygiene is handwashing. The recognition of the link between handwashing and reduction in microbial illness dates back to the mid-nineteenth century. Then, Florence Nightingale, based on her nursing experiences during the Crimean War, wrote about her perceived relationship between unsanitary conditions and disease. At about the same time, the Viennese physician Ignaz Philipp Semmelweis noted the connection between mortalities in hospital patients and the movement of physicians from patient to patient without an intervening washing of their hands. After Semmelweis introduced hand washing with a solution containing chloride, the incidence of mortality due to puerperal fever (infection after childbirth) diminished from 18% to less than 3%. Now, hand washing with similar antiseptic agents and even with plain soap and water is known to reduce illness and death from hospital acquired infections.
Proper hygienic practices in the hospital setting not only save lives, but save a great deal of money also. According to the Centers for Disease Control , the cost of dealing with the 2.4 million hospital acquired urinary tract infections, blood stream infections, respiratory infections and infections of incisions, which are caused each year by microbes transferred from hospital staff to the patient, and which could be prevented by proper hand washing, is over 4 billion dollars in the United States alone.
Similarly, in the home and other social settings, hand washing can prevent the spread of infectious microorganisms. A common route of infection is from the bathroom to the kitchen. Improper hand washing fails to remove microorganisms, such as Escherichia coli and Salmonella acquired from fecal excretion. Handling of food transfers the organisms to the food.
Hygiene is not so concerned with the bacterial flora that normally resides on the skin. These bacteria include Corynebacterium, Proprionibacterium, and Acinetobacter. These organisms are tenaciously associated with the skin and so are not as easily removed by the mechanical scrubbing action of hand washing. Rather, hygienic efforts such as hand washing attempt to remove organisms, such as Escherichia coli that become transiently associated with the skin. The transient organisms tend be removed more easily and are more apt to be infectious.
In medical environments, hygiene is not only mandatory, but must be done according to established procedures. For example, both before and after seeing a patient, a physician must wash his/her hands with an alcohol-based preparation if hands are not visibly dirty, and with soap and water if dirt is apparent. This practice is also done if any contact with microorganisms has occurred or is even suspected of occurring (for example, handling a surgical instrument that is not wrapped in a sterile package) and after removing surgical gloves. The latter is important since the interior of a surgical glove can be an ideal breeding ground for bacteria. Furthermore, the act of handwashing is to be done for a specified period of time and with vigorous rubbing together of the hands and fingers. This is because the removal of microorganisms is accomplished not only by the presence of the soap but also by the friction of the opposing skin surfaces rubbing together.
Other hygienic practices in a laboratory include wiping the lab bench with a disinfectant compound before and after use and keeping the work area orderly and free of debris. Protective clothing can also be worn to minimize the spread of microorganisms. Such clothing includes hair nets, disposal boots and gloves, and lab coats. These items are worn in the vicinity of the work bench or other areas where microorganisms are expected, but are removed when exiting such locations.
Mechanical aids to hygiene exist. For example, many labs contain a fume hood , in which airflow is directed inward. Such laminar flow hoods do not allow the contaminated air inside the hood to move outward into the laboratory. Another standard feature of a microbiological laboratory is a small flame source. The flame is used to sterilize the lip of test tubes and vials before and after opening the containers, and to heatsterilize the metal inoculating loops used to transfer microorganisms from one place to another.
While necessary for the protection of patients and to prevent contamination in the laboratory, the use of hygienic substances can have adverse effects. In the late 1980s the socalled "hygiene hypothesis" proposed that the increased use of disinfectants, particularly in the home, had decrease the exposure of people to substances that stimulated their immune system , and so had rendered the immune system less capable of dealing with environmental antigens. The result was proposed to be an increase in allergies . Time has strengthened this hypothesis to the point where the overuse of disinfectants has become a legitimate concern.
In addition to the development of allergic reactions, the inadequate or improper use of a hygienic compound can select for organisms that are more capable of causing disease. For example, certain disinfectants containing the compound triclosan have been shown to not only fail to kill the entire target Escherichia coli population, but to actually stimulate the development of resistance in those microbes that survive. In a setting such as a kitchen, the results could be problematic.
See also Acne, microbial basis of; Antiseptics; Disinfection and disinfectants; Transmission of pathogens
The conception of personal cleanliness as both a prerequisite of holiness and an aid to physical fitness is central to Jewish tradition. Many of the biblical commandments promote hygiene, though their stated intention was ritual purity rather than physical cleanliness. The military camp had to be kept clean by establishing the latrine outside its bounds; every soldier had to be equipped with a spade with which he had to dig a hole to cover his excrement (Deut. 23:13–15). War booty had to be cleansed and purified (Num. 31:21–24), and the blood of slaughtered animals had to be covered by dust (Lev. 17:13–14). Lepers, anyone who had an "issue," and all who were polluted by contact with a corpse, were excluded from the limits of the camp for specific periods of quarantine (Lev. 15:1–15; Num. 5:1–4). Persons who touched a carcass, a creeping animal, or a reptile were similarly "defiled," as were the vessels into which these objects might have fallen (Lev. 11:27–40). The Bible also stresses the cleanliness of garments (Eccles. 9:8).
Rabbinic literature is even more specific in its stress on hygiene. The rabbis considered the human body as a sanctuary (Ta'an. 11a–b). They stressed the importance of good and regular meals (Shab. 140b), and gave much advice on the types of food conducive to good health (Ḥul. 84a; Ber. 40a; Av. Zar. 11a), and on the care of teeth (Ber. 4b; Shab. 111a; tj, Av. Zar. 3:6). Exercising their halakhic authority, the rabbis' elaboration on some rituals and the introduction of others had an expressly hygienic intent. This was certainly the case with regard to personal cleanliness. The rabbis ordained that one must wash one's face, hands, and feet daily in honor of one's Maker (Shab. 50b). The hands must also be washed on certain occasions: after rising from bed in the morning, after urination and/or defecation, bathing, clipping of the fingernails, removal of shoes, touching the naked foot, washing the hair, visiting a cemetery, touching a corpse, undressing, sexual intercourse, touching a louse, or touching any part of the body generally clothed (Sh. Ar., OḤ 4:18). It is a particularly important religious duty to wash hands before eating a meal (Ḥul. 105a–b; Sh. Ar., OḤ 158–165). Similarly, hands should be washed after the meal and before grace (mayim aḥaronim), because, inadvertently, a person may touch his eyes with salty hands (Hul. ibid.). A person who neglects the washing of hands before or after a meal "will be uprooted from the world" (Sot. 4b; see *Salt; *Ablution). The rabbinic stress on the connection between cleanliness and holiness is emphasized by the injunction forbidding those whose dress is unclean, or torn, to act as *sheli'aḥ ẓibbur (Meg. 4:6). Similarly a kohen may not pronounce the priestly benediction if his hands are soiled (Meg. 24b). No prayer may be recited by one who is in a state of physical uncleanliness, or about to relieve himself, or has touched parts of his body generally covered by clothing, without either washing his hands, or rubbing them in sand (Sh. Ar., OḤ 92:1, 4, 6).
The proper protection of foodstuffs was also noted by the rabbis. Thus, to the biblical laws of *sheḥitah (Deut. 12:23–35) were added the extensive rules of bedikah, an examination of the slaughtered animal for various signs of diseased condition. Originally eight (Ḥul. 43a), these disqualifying symptoms were increased in the Mishnah to 18 (Ḥul. 3:1), and subdivided by Maimonides into 70 (Yad, Shehitah 10:9). Indeed, according to the latter authority, the reason for the prohibition to eat pig lies in the fact that it is a "filthy animal" (Guide, 3:48). In mishnaic times, it was forbidden to drink any liquid (water, wine, milk) which was left uncovered overnight, lest it had been defiled by a venomous snake (Ter. 8:4; Sh. Ar., yd 116:1), and the Gemara advised that all foodstuffs be protected from flies because they may have been in contact with persons suffering from skin diseases (Ket. 77b). R. *Akiva praised the care which the Medians took to chop meat on the table (Ber. 8b). Later authorities advised that the hands be washed between eating a dish of meat and one of fish (Sh. Ar., yd 116:3) and that adequate precautions be taken to ensure that bread should not come into contact with human perspiration (ibid., 116:4–5). The rabbis also stressed the importance of public health. The Talmud rules that no carcass, grave, or tannery be placed within 50 ells of a human dwelling (bb 2:9), and insisted that streets and market places be kept clean (Yal. 184). In Jerusalem, they were swept daily (bm 26a). Scholars were forbidden to live in a city in which there was no doctor or where there was no bathhouse (Sanh. 17b). *Hillel the Elder considered that the act of bathing is an act of caring for the vessel containing the divine spirit (Lev. R. 34:3).
During the Middle Ages, the Jewish communities were surprisingly free of disease and plague in comparison to their non-Jewish neighbors, notwithstanding the very limited living space they had. This fact often led to pogroms, as the Jews were suspected of magical practices. There can be no doubt that the strict observance of the halakhah contributed, in no small measure, to their immunity.
J. Preuss, Biblisch-talmudische Medizin (19233); M. Perlmann, Midrash ha-Refu'ah, 3 vols. (1926–34).
hy·giene / ˈhīˌjēn/ • n. conditions or practices conducive to maintaining health and preventing disease, esp. through cleanliness: poor standards of food hygiene personal hygiene.