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Hygiene in the Industrial World:
An Unhealthy Obsession with Cleanliness?

(Released June 2011)

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  by Kathryn Mori & Carolyn Scearce  

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Hygiene History in the Industrialized World

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Through much of history Europe was a largely agricultural region with a relativity dispersed population, in the late 1700s and early 1800s various inventions entirely altered the continent's production of goods. The industrial revolution triggered a mass migration of people into the cities for employment and permanently transformed the urban landscape. While the industrial revolution profoundly impacted Europe as a whole, the most accessible English language documentation on conditions in Europe during the industrial revolution focuses on the UK. As a result, much of the information in this section will focus on the UK and the United States.

Dore's Over London-by Rail
Over London–by Rail from London: A Pilgrimage, by Gustave Doré (1872)

In the UK, many of the factory workers lived in slums. Contemporary writers described these slums as all being virtually alike. One or two story cottages crowded together on streets often so narrow that people could only pass one another with difficulty. Though the cottages had several rooms, often an entire family would live in a single room. In the most crowded neighborhoods scenes have been described where, indiscriminate of age or gender, 15 to 20 partially or completely unclothed people slept on the floor of a single room. One preacher talking about his parish says, “It contains 1,400 houses, inhabited by 2,795 families, or about 12,000 persons. The space upon which this large population dwells, is less than 400 yards (1,200 feet) square” (Engels).

The streets were generally unpaved, rough, dirty and filled with trash. People would toss out food, animal refuse, and even human excrement. There were often no sewers and “foul stagnant pools” collected to run off into the drinking water. There was very poor ventilation and the smell was overpowering. In some cities, the streets would fill up with mud to the ankles for months on end. Pure rivers running into the city ran out as black stinking sludge, collected from the runoff of factories and dwellings alike. Coal dust often darkened the air (Engels).

With these conditions, it is hardly surprising that disease was rampant. Cholera, typhus, typhoid, and influenza were all prevalent. There were also outbreaks of smallpox and whooping cough. The first outbreak of cholera, which is often spread by water contaminated with fecal matter, was in Sunderland, England, in the fall of 1831. In the course of the outbreak, 52,000 died. From 1837-1838, the leading cause of death by fever became typhus which is passed by lice. In the following four years there were approximately 16,000 new cases per year. Around the same time, an outbreak of smallpox killed tens of thousands, usually infants and children. Together measles and whooping cough lead to 50,000 deaths in England and Wales between 1838 and 1840. It is likely that the number of deaths from food poisoning was extremely high. There was often mineral poisoning in food from bottle stoppers, water pipes and well paint. Various dangerous chemicals were intentionally put in food such as adding alum to bread to whiten it. Also, more than one fifth of the meat sold came from diseased cattle (Douglas).

Public officials of the time were aware that improved sanitation would reduce the spread of diseases and at the prompting of reformers the Public Heath Bill was passed in 1848. This act set up local boards whose duty it was to insure that new homes had proper drainage and that the water supply was clean and dependable. With the Public Health Bill, they also tried to provide better guidelines for the disposal of the dead (Douglas).

DESCRIPTION
A ward of the hospital at Scutari where Florence Nightingale worked, from an 1856 lithograph

In 1860, the first pure food act was passed. Enforcement was difficult, but it was the first of many steps (Douglas). Around the same time there were major improvements in the medical field. Until the 1860's, doctors were not even in the practice of washing their hands before or after surgeries or when moving from patient to patient. Dr. Joseph Lister introduced the practice of doctors washing their hands between patients using calcium chloride. This practice reduced the percentage of deaths on his ward from 12% to 1%. Soon after, he introduced the technique of using carbolic acid as an antiseptic during operations. The death rates of his surgical patients dropped from 45% to 15% (History Learning Site).

Soon such practices became wide spread. The introduction of hand washing for obstetrics and midwives was also introduced, virtually eliminating puerperal fever, one major contributor to infant mortality. Meanwhile, Florence Nightingale also did much to improve the sanitation of hospitals. While serving as a nurse during the Crimean war, she was appalled at the conditions in hospitals. The hospital where Nightingale worked in Scutari is described as having “were plenty of rats, lice and fleas, but there were very few knives, forks, or spoons. Miss Nightingale and her nurses, who were allowed just one pint of water per person per day for washing and drinking and for making tea, [yet]...the ladies' own personal circumstances were hardly hygienic.” With hard work she was very successful in turning the situation around, and when she returned to England she became one of the major influences in hospital reform (Faria).

In 1877, another pure food act was passed, this time with inspections and real penalties (Douglas). Around 1900 there was a marked drop in infant mortality rates. At first, there was a marked difference in the decline depending on social class. While the mortality rates more than halved for professionals, in a 15 year period they only dropped some 20 to 30% among less skilled workers (Corsini and Viazzo). At that time in the United States, the leading causes of death were pneumonia, tuberculosis, and diarrhea and enteritis. If diphtheria is also included, these diseases caused one third of all deaths, 40% of which were among children under five. Public health action to improve hygiene and control these diseases contributed greatly to cutting down these deaths among young children (CDC).

 By the 1920s there was apparently a much better grasp of the importance of clean water and hygiene in general. A 1917 manual for military training for the US Army, covers everything from personal hygiene to the importance of fresh air for health, emphasizing the importance of both sterilizing any drinking water either by boiling or through other chemical means, and the proper neutralization of human waste (U.S. Army).

 Life expectancies rose sharply in the 1930's and 1940's thanks in large part to the improvement of cleanliness, sanitation and hygiene, and the widespread use of antibiotics. In the US, life expectancy rose from around 60 years of age in 1930 to 74 in 1987 (Noymer). In 2011, the infant mortality rate in the US is 6.06 per 1,000 children. Many countries have even lower rates then the US (CIA). In 2011, the average life expectancy in the US was about 78, in the UK it was about 80. Japan boasts one of the highest life expectancies in the world at an average of 82 (CIA). In a little more than a hundred years, infant mortality in industrialized nations has dropped from around one third to now less than one percent. Though there are many factors contributing to both of those improvements, medical sanitation and public hygiene have both played a big role, not to mention improving the general comfort of urban settings in developed countries.

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