University of Virginia Historical Collections at the Claude Moore Health Sciences Library

Cleanliness As a Public Health Measure

“Wash germs away,” Virginia Tuberculosis Society, Christmas Seals Campaign, 1965. Historical Collections & Services, Claude Moore Health Sciences Library, University of Virginia.

Wash Your Hands |  No Spitting |  Keep Flies Off Food

These rules are accepted without question today, but only 100 years ago they marked a public health revolution. They promoted cleanliness as a public health measure and were the first health messages to be promoted through the new enterprise of mass advertising.

Bathing was uncommon in Western Europe from the end of the Roman Empire (5th to 6th centuries) until the 1800s. Christian religious authorities disapproved of the moral laxity often associated with bathing, but it was medicine not morals that virtually ended bathing in western culture. Physicians considered bathing harmful, even dangerous, for hundreds of years.

Prevalent ideas of cleanliness and health. During the centuries when physicians believed that many diseases were caused by bad air (the miasma theory), they counseled that washing the body opened the pores and let in the bad air. Therefore most people—and many physicians —thought that a layer of dirt protected a person from disease. Genteel and fastidious people washed their hands before eating but did not wash the rest of their bodies. By any measure, the stench was horrible.

Clean and respectable. Cleanliness became a mark of superiority and respectability before it became a requirement for good health. Beginning in the early 1800s, the elite in Europe and North America adopted cleanliness as a badge of their superior status, clearly separating themselves from the dirty masses of laborers, peasants, and the wretchedly poor. Their wealth allowed them to have the water, expensive soaps, and servants to scrub their houses and clothes often— and occasionally their bodies. By the late 1800s, the weekly bath (usually on Saturday night) was a staple of respectable family life in the United States, although in ordinary families the members took turns, sharing the same tub of water.

Germs and dirt. In the 1870s and 1880s, physicians increasingly accepted the germ theory but most Americans paid little attention. As evidence accumulated, however, showing that many deadly diseases are transmitted by vectors common to everyday life (such as spitting, dirty hands, and flies), informed citizens became increasingly alarmed. They looked with dawning horror at their streets and neighborhoods—and at the teeming neighborhoods of the poor—and saw disaster lurking everywhere.

It was no longer acceptable for the working class and poor to be dirty when that dirt could breed diseases that spread to everyone. The middle class set out to clean up the country and its citizens’ filthy habits. They made cleanliness part of children’s education and created organizations to teach the poor and immigrants how to be clean.

Tuberculosis campaigns are good examples of the change in ideas of cleanliness. Once it was established that tuberculosis was contagious rather than caused by weak lungs and degeneracy, people realized they could halt or limit the contagion. The tubercle bacillus, which was killing perhaps one in four people infected with it, spread from person to person through coughing and spitting, which no one had previously considered dangerous. Local and national organizations sprang up to warn Americans of the dangers and to teach them how to “break the chain of infection.”

Mass advertising. By the early 1900s, these organizations were using the same advertising techniques used to sell everything from soap to the new-fangled motor car. Leaflets and posters reinforced the messages delivered in doctors’ offices, classrooms, and public lectures. Soap manufacturers became early—and very successful—adopters of mass advertising, often using science and medicine in their cause.

We still hear a great deal from health authorities and advertisers about cleanliness. The lessons that began in the public health campaigns 120 years ago are the same lessons we live by today. We hear them echoed in mothers’ cries to children to “Wash your hands!” and in advertisers’ claims that “Four out of five doctors recommend….”

—Addeane S. Caelleigh

Addeane Caelleigh is director of special projects in the Office of the Dean, UVA School of Medicine, and curator of the Reflections exhibits. This essay is adapted from her essay “Germs and Hygiene Campaigns,” Academic Medicine, vol. 74, no. 2 (February 1999), p. 92. Normajean N. Hultman, Historical Collections Assistant, created the rest of the content for this exhibit. For permission to reproduce any of the text or those images owned by Historical Collections and Services or to make comments or suggestions, please contact a member of Historical Collections.

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