How has hygiene changed in 120 years?

This year, 2023, marks the 120th anniversary of the founding of Initial and we are celebrating its journey from supplying towels with customers’ initials embroidered on them to becoming the world's largest hygiene services company.

We all take soap, sanitisers, flushing toilets, clean water and many aspects of hygiene for granted. We have a myriad of solutions, devices and products to keep everything in our lives as clean and hygienic as possible. Yet today we still need campaigns to promote clean hands, surfaces and air to help prevent infectious diseases from spreading — even Florence Nightingale campaigned for clean air!   

So what was it like in the 1900s? Here is a brief look at what some selected areas of hygiene were like in those times and how they have changed. 

What was the understanding of microorganisms?

In the 1900s, little was known about microorganisms that caused diseases. Bacteria had been known since Antoni van Leeuwenhoek discovered them using his single-lens microscope in 1677. However, it was only after numerous discoveries in the 1800s on the causes of diseases, including by Ignaz Semmelweis, Louis Pasteur, John Snow, Robert Koch and Joseph Lister, that the idea of bacteria causing diseases was accepted. But even in the 1900s, there were many diseases for which the causes were not known. 

Robert Koch, a Prussian doctor, discovered TB was caused by a bacterium in 1882, but the only treatment was bed rest and time outdoors. It was one of the leading causes of death, killing around a third of people aged 15–34 in the UK. It is symptomatic of poor and crowded living and working conditions, malnutrition and poor ventilation. It only dropped out of the top ten causes of death in the 1950s after antibiotics had become available in the 1940s. 

Although Italian doctor Filippo Pacini discovered that cholera was caused by a microorganism in 1854, it was discovered separately by Robert Koch in India in 1883 and still took years to be accepted by the medical community. French scientist Louis-Daniel Beauperthuy proposed in 1854 that mosquitoes spread “animalcules” that caused yellow fever (a virus), but the idea was dismissed by the French Academy of Sciences. Ronald Ross (1902) and Charles Louis Alphonse Laveran (1907) were awarded Nobel Prizes for their work on malaria and diseases caused by protozoan parasites.

The first virus, the tobacco mosaic virus, was discovered in the 1890s, but the tools available could not characterise it. In the 1900s they were called “invisible microbes” and it took till the 1930s to isolate a virus. The 1918 flu pandemic, which started in the US as troops were being shipped to Europe, was initially thought to be caused by bacteria. At the time, the only known viruses were yellow fever, rabies and polio.

What was toilet hygiene like in the 1900s?

Few people had indoor toilets and piped water in the early 1900s in Europe and the US. They were slowly becoming more common in towns and cities, but most people had outhouses and used chamber pots. The modern flush toilet was being adopted by the middle classes, especially in the UK, but this also caused problems, by leading to raw sewage being flushed straight into nearby streams and rivers.

Sewerage systems were beginning to be installed in major cities in Europe. The most famous of these was the London system installed after the Great Stink caused by the sewage-filled Thames drying up in the heat wave of 1858. Politicians acted for fear of diseases entering the Houses of Parliament, which at the time were believed to be caused by bad smells — the miasma theory. Dr John Snow had shown the link between sewage-contaminated water and the cholera outbreaks in London in the 1850s, but it was not accepted for more than a decade and people still obtained untreated water from wells and the river Thames. Other cities in Europe continued to have cholera outbreaks also.

How hand washing became widespread

The widespread adoption of hand washing for hygiene was closely tied to the growth in the understanding of diseases and disinfection. Surprisingly, although the importance of hand hygiene was well known, the first national hand hygiene guidelines for healthcare were only published in the 1980s and WHO guidelines on hand hygiene in healthcare were first issued in 2006, including the use of alcohol hand sanitisers, which had been available since the 1960s.

Handwashing for personal cleanliness has been embedded in many cultures and religious practices for centuries. Soap production dates back to Babylonian times for cleaning the body and clothing but was largely reserved for the rich. It was made cheap enough for the masses in the late 18th and 19th century and industrial soap makers were among the first to use large-scale advertising to promote their products. Liquid soap was another product of the Victorians, first appearing in 1865 and expanding into uses for clothes, floors and bathrooms in the 1900s. 

How did people dry their hands?

Many ancient cultures used cloths for hand drying, including the Greeks, Romans, Egyptians and Chinese, but the towel as we know it today, with woven loops, is thought to have been developed in the Ottoman Empire in the 18th century. Towels became a mass-market product with the growth in the cotton trade and industrialisation in the 19th century. 

Modern tissue paper was first commercially produced for toilet paper in 1857 as packets of flat sheets and as rolls in 1890. In 1907 it was introduced by one company into toilets to stop people from using towels for cleaning their noses and prevent the spread of colds. It wasn’t until the 1920s that a tissue product was developed specifically for hand drying. 

One of the earliest roller towels was patented in the US in 1938 by Joseph Darman, calling it a towel dispensing cabinet. The electric hand dryer, which blows heated air over hands was first patented in 1922. The design has been tweaked by many manufacturers since then, but the main development was probably the use of a jet of air in 1993, reducing the need for heat. 

One of the biggest changes in 120 years is the consideration of the environmental impact of each hand-drying method when choosing which to use and in product development, balancing energy, natural resources, waste and recycling.

Air hygiene

Florence Nightingale in her Notes on Hospitals in 1863 wrote “One of the most common causes of unhealthiness in hospitals is defective construction … as to lead to difficulty of ventilation or want of light”. In 1884, Dr Javal compiled a report on hygiene in primary schools and nursery schools for the French government. He wrote that indoor air is stale when the concentration of CO2 exceeds 600ppm. During the 1918 flu pandemic, people were told to wear cloth masks to help prevent infection. But during the recent Covid pandemic, 140 years later, there was still a widespread lack of understanding about the risks of airborne infections and the importance of ventilation for air hygiene.

Developments in air purification also started in the 19th century, with the development of the charcoal-filter-based Stenhouse gas mask in 1854 to protect from toxic gases. Later the first “apparatus for treating air” was patented in 1906 — including a filter and temperature control. The HEPA filter arose out of the Manhattan Project in WWII, to remove radioactive particles from the air and it was adopted by air purifier manufacturers. It has been refined since but is still the standard to judge the effectiveness of air filtering devices.

What’s next for hygiene?

Many of our current understandings of the necessity of hygiene and solutions for maintaining hygiene were already established by the early 1900s. We still use many of the products that were available then, or improved versions — of soaps, disinfectants, hand drying products and air purifiers. However, our understanding of diseases and chemicals and the tools for analysing them have changed beyond the imagination of the people at the time, as has the infrastructure for ensuring hygiene in homes and cities. 

But that’s just the developed parts of the world. A large proportion of the global population is living in no better conditions than the Victorian city dwellers, lacking toilets, clean piped water, healthcare and nutrition. Only an estimated 33% of Sub-Saharan Africa has access to basic sanitation and many diseases are still widespread. Around 11 million people fell ill with TB in 2021 and a quarter of the world’s population is infected with it. Improving the state of hygiene in developing countries today is crucial in achieving the UN Sustainable Development Goals. It influences all 17 goals, including health, well-being, climate, and economics. With only eight years to go, it should be a high priority for everyone.

Initial will continue to pursue its aim to “protect people, enhance lives, preserve our planet” by innovating to improve hygiene and making the Sustainable Development Goals a priority. Let's see where the next 120 years lead us.