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.
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.'"
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.
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 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.
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.
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JACQUELINE S. WILKIE