Did Victorian doctors wash their hands?

A care-adjacent history rabbit hole

Apr 14, 2025

There aren't many books on the history of care work, so I end up reading a lot of related histories in order to piece it together. This means certain stories about medical history pop up repeatedly and I accidentally get hooked on some little mystery or another.

One of these is a story you're probably familiar with:

In 1846, Ignaz Semmelweis noticed that the rate of deaths after childbirth were much lower in a ward run by midwives than one run by doctors. After some experiments, he discovered the doctors regularly went from the morgue to the delivery room without washing their hands. Semmelweis got them to disinfect their hands and tools after autopsies. The death rate plummeted. Semmelweis tried to get other hospitals to do the same. No one listened to him. He gets fired. He died in an insane asylum. Decades later, germ theory came out and Semmelweis was vindicated.

The other day it struck me just how bizarre this story about doctors not washing their hands is.1 Until then, I’d never stopped to consider if statements like this were believable:

“In the 1800s, handwashing was not medical common sense; it was outrageous. In fact, advocating for it often cost a doctor his career at that time.”2

A National Geographic headline proclaims: 'Wash your hands' was once controversial medical advice

There are lots of popular ideas about how people were super dirty until recently. Supposedly they rarely bathed, wore the same clothes all week, and happily dumped sewage in the streets and/or their drinking water. The impulse I felt to wash my hands after accidentally squishing a slug with my bare hands3 is, we’re told, a very recent one in the history of humanity.

Some of these things were true in the past, just as they are today, due to poverty. The industrial age was a horrible time to be poor and there were many people living in conditions far worse than their rural forefathers. If you have one outfit, it’s tricky to do laundry. Regulations for waste disposal are not new and improper waste disposal remains a modern problem. Water is difficult to transport and many people today live without access to safe drinking water.

Other examples of historic dirtiness are technically true but not quite accurate. Living in different conditions requires different ways of going about things. People wore linen undergarments and aprons, which were changed frequently, while the layers in-between were rarely washed. People did not fill up a big bathtub with water, instead using wash basins and a cloth morning and night. When I lack a hot water tap, I also opt to wash myself in parts with a cloth, rather than subjecting myself to an ice bucket challenge like shower. It works just fine.

Jewish, Christian, and Islamic religious practices have an emphasis on both physical and spiritual hygiene. When founding monasteries, locations with running water were prioritized for their ability to provide good sanitation. Nuns cared for their patients by providing them with herbal remedies, nutritious food, spiritual guidance, and hygiene. During the Black Death and other pandemics, church officials called for the bedding and clothing of victims to be burnt to prevent the spread of disease.

There’s also the practical world of lived experience. People who brew beer, make wine and vinegar, and make cheese know how to manage sanitation, even if they can’t explain the science behind it. It’s easy to find sources explaining how in an era before modern soaps, kitchen items were scoured with wood ash and sand and then rinsed with boiling water. Surfaces and wooden items were wiped down with vinegar.4 Fruit and vegetables were washed before they were eaten. Foods were carefully prepared and stored for preservation. People ate with their hands, so they washed them before and after meals. The farther the water source, the less frequently the water in wash basins was changed.5

The ambivalence about using water to wash bodies in historic documents suggests a wariness of the ways water can be a vector for disease, along with the standard justification for oppressing peasants because they’re backwards. Accounts of peasants confined to prisons and workhouses resisting being forcibly bathed make me think of recent news reports expressing outrage over detainees being subjected to cold showers. I don’t think being unhappy about being taken into state custody, having strangers strip you naked, and being doused with cold water is proof that you are against bathing in general.

If you look at old paintings, even peasants don’t appear begrimed or spattered in blood. Early photographs of butchers and fishmongers show tidy workers with clean hands, wearing crisp aprons.

Medical historians argue that religiously inspired handwashing and bathing was symbolic.6 Does it matter if the stated goal of something is disinfection if it disinfects? Wood ash, vinegar, lye, and various herbs and oils are all reasonably effective disinfectants. If things only count when we can explain their causal mechanism, we need to note that Semmelweis’s explanation for why doctors need to disinfect their hands and tools was incorrect.

The idea that no one thought it was important to be clean before the late 1800s is absurd. The Victorians designed their kitchens to be easily cleaned and confined messy tasks to the scullery, both hidden out of sight from polite society,7 yet I’m supposed to believe they were totally cool with being covered in another patient’s blood, pus, and perhaps the contents of their intestines? That Victorian ladies who couldn’t stand the sight of a pot in need of polishing were cool with corpse juices? Were Victorian patients really eager to pay more for doctors who looked like someone from a Halloween haunted house?

“Surgeons in the 19th century wielded tools caked in bodily fluids, the built-up filth serving as a measure of experience.”8
“Surgeons wore dark, unwashed frock coats, stained with blood and pus from previous operations. Some would also keep their sewing needles stuck into the lapel of their coat. In fact, a coat stiff with dried blood could be seen as a display of their experience and they worked bare handed with non-sterile instruments. In some London hospitals, the death rate after operations was over 80%.”9

We’re also told that surgeons would hold their instruments in their mouth to keep their hands free during procedures. It’s not a shock that the death rate of doctors and medical students was also high.

This leads me to suspect that early doctors were, ahem, not aligned to the standards of their time. Another tale I’m sure you’ve heard is that many of them were stealing corpses from graveyards to use in medical research, which led to a riot in NYC. Let’s just skip discussing vivisection.

I wondered if it was because Victorian doctors wanted to show their confidence in the miasma theory. Perhaps they were so confident that there were not magic invisible animalcules spreading disease that they were flaunting their filth. Or maybe it was to set themselves apart from the nuns and their superstitions, who they were working so hard to push out of hospitals or at least turn into servants.

This hunch doesn’t check out. Any bad odors are harmful under miasma and environmentalism. Hospital fever at Belleview Hospital in New York were believed to be caused by its location along the stinky waterfront. The hospital also used prisoners10 as nurses and was infested by rats.11

It’s hard to say if doctors really went around covered in layers of dried bodily fluids. One historian suggests this was an exaggeration, although they did wear old clothes for procedures. They suggest that maybe Victorians were generally living in filth:

“it is astonishing to twenty-first century sensibilities how many nineteenth century police reports note that violent male offenders left the scene of their crime completely unchallenged, apparently because nobody saw anything particularly unusual in their wearing stained and evidently bloody clothing. On being apprehended, even quite some days later, the accused was often found to be wearing the same stained clothing which had still not attracted much comment, no doubt partly due to the “legitimately” begrimed and bloody clothing of, for example, butchers, abattoir workers or gamekeepers—these implicit expectations of “ordinary” disorder in dress telling a different tale from that depicted in the posed photographs of the period.”12

The fact that people presented themselves scrubbed clean for photos still suggests, to me, that the lack of clean clothes in everyday life was due to the realities of poverty and practicality, rather than an indifference to filth.

Peter Ward’s The Clean Body tells us that in the 17th century, people showed their respectability and cleanliness by wearing clean linen, accomplished by having your undergarments peeking out from your clothes if you’re upperclass, or by wearing a clean apron if you’re a worker.13

Barber surgeons wore aprons, so gentleman doctors distinguished themselves as by dressing like gentlemen. It is much more difficult to wash a formal jacket than an apron.14 Aprons were washed regularly and with soaps containing lye, a disinfectant, and dried in the sunlight, which also disinfects. Later, doctors took to wearing the white coats of scientists, which were laundered like aprons.

While I couldn’t find information to specifically say if midwives washed their hands or boiled their instruments, it seems likely that their hands were washed. Documents decrying the habits of filthy peasants universally agree that they washed their faces and hands regularly. They had ritual baths to mark life occasions, like birth, and draped linen soaked in herbal potions over wounds.15 Many ingredients in traditional medicinal recipes do have antibiotic properties.

Thus, the horrific hygiene of doctors was likely a blip in the early days of modern medicine and something that did not effect lower class barber surgeons, midwives, and other healers. Doctors would soon succeed in passing laws to prevent their more sanitary competition from practicing medicine.

A nonchalant doctor dancing a jig amidst unhappy patients in a decrepit hospital ward. Coloured etching by C. Williams, 1813. Source: Wellcome Collection.

It’s difficult for me to understand how this blip could have happened. Let’s remember that variolation came to Europe in the 1720s. Doctors took fluids or dried material from smallpox scabs and inserted it into a scratch on a healthy person’s skin to induce a usually mild but occasionally fatal case of smallpox. It became popular at the turn of the 19th century, after doctors discovered cowpox was effective and much safer.

It wasn’t just about smallpox. From at least the 1600s scientists were performing experiments to determine how contaminating factors spread, work Louis Pasteur later built upon. Scientists in the 1700s tested the idea of spontaneous generation by boiling different liquids under various conditions and seeing if they spoiled, believing that boiling something for an hour killed all living contents.16

Given that knowledge, why would doctors in hospitals, many of which had medical schools, go from patient to patient covered in materials they knew could spread disease? Why would they not disinfect their tools when they knew how to do so? This was the era of Florence Nightingale, so clearly there was a widespread issue of poor hygiene in hospitals. It seems that perhaps the doctors kicked out the orderly nuns and turned the place into a frat house.

Despite these stories about crusty jackets, doctors in the Victorian era did believe it was important to be clean. Hospital medical charts noted the nationality, ethnicity, and moral habits of their patients. This included their drinking habits, personal hygiene, and evaluation of their housekeeping.17

It’s difficult to believe that doctors would then go from patient to patient slathered in bodily fluids, particularly those from corpses. Was this accepted practice or a few bad doctors? It seems disingenuous for historians writing in one medical journal to assume that patients found to have maggots on their blankets in a London hospital in 1825 are proof that doctors thought it was fine for patients to be covered in maggots,18 rather than a simple example of neglect.

Perhaps it’s relevant that the patients at Belleview were from the lower classes, while the doctors were not. There’s the famous Dr. Charles Meigs quote dismissing the possibility of hospital acquired infections:

"Doctors are gentlemen, and a gentleman's hands are clean."19

The Middlesex Hospital: the interior of one of the female wards. coloured aquatint by J. C. Stadler, 1808, after A. C. Pugin and T. Rowlandson. Wellcome Collection. Source: Wellcome Collection.

It was a relief to discover that it’s not entirely true that doctors didn’t wash their hands. The WHO explains:

“doctors and medical students often went directly to the delivery suite after performing autopsies and had a disagreeable odour on their hands despite handwashing with soap and water before entering the clinic.”20

It really was because they were conducting autopsies and not just because they were generally filthy. Searches about the history of doctor’s attire explains that they wore dark suits to mark their solemn work. There’s no mention of getting props for layers of bodily fluids from previous procedures. Scrolling through 2,092 images of Victorian doctors and 209 of surgeons in the Wellcome Collection didn’t bring up any spattered in gore.21

As someone who washes my hands after doing the dishes because I hate having my hands smell like dish soap, I still find it a little odd that doctors in the 1800s were cool with performing medical procedures with hands that smelled like cadavers.

Regardless, it’s understandable that the doctors didn’t piece it together, since in this case the infectious material wasn’t causing an infection of the same kind, like in variolation. They were giving their patients blood poisoning, also known as sepsis. Semmelweis’s breakthrough was realizing that childbed fever, hospital fever, and blood poisoning were the same thing and using that to reveal the cause.

Perhaps one day people will read about how modern doctors didn’t believe in washing their hands, since disinfecting hands between patients only became an official requirement in my lifetime and then only when dealing with patients infected with MRSA. According to the WHO:

“The first national hand hygiene guidelines were published in the 1980s, followed by several others in more recent years in different countries. In 1995 and 1996, the CDC/Healthcare Infection Control Practices Advisory Committee (HICPAC) in the USA recommended that either antimicrobial soap or a waterless antiseptic agent be used for cleansing hands upon leaving the rooms of patients with multidrug-resistant pathogens.”22

Thankfully, everyone agrees that doctors were disinfecting their hands and tools by the time the 20th century rolled around, regardless of the guidelines.23 At least they were disinfecting their hands some of the time…and they’re still half as likely to wash their hands between patients as nurses.24

No saints, no charity

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