59. I'm forever blowing bubbles at Joyce Green Hospital.

Key words/phrases : handwashing in the management of cross-infection, Dr. John Emsley of Cambridge University, glycerine in the manufacture of weapons, British Government supply strategies during World War I.

No.59

Not only is hot water and soap the bane of every little boy’s life -if you believe the popular myth - but according to public health experts many nurses and doctors also seem very reluctant to use these simple ingredients as often as they should.

If it is really is true that insufficient or poor hand-washing is contributing to current levels of cross-infection within hospitals perhaps mandatory basic hygiene updates are going to have to be introduced and compliance monitored.

However to avoid going down the road of criticising colleagues here you might instead be interested in going back to “basics” and reviewing what soap actually is and how it works, as a prelude to considering a situation during which soap was in short supply ?

It seems that our forebears used to take dollops of greasy animal fat from the bottom of their cooking pans, add some wood ash from the fire, mix them together and then use the resulting “goo” to clean themselves.

This is the essence of soap. Obviously although today’s soaps are slightly more sophisticated this seems to be how our ancestors made it. In due course someone also cottoned on to the fact that if you boil and cool the mixture several times it will eventually go hard, thus becoming even more practical to use.

Dr. John Emsley, previously of Cambridge University, says that it is worth remembering that "soap molecules have a head and a tail." "The head likes to attach itself to water; the tail likes to attach itself to grease and so when soap is put into water, it will find the grease, attach itself to it and will pull it into the water whereupon the grease can be washed away."

Emsley reminded interested parties that "all kinds of oils and fats can be used to make soap including mutton fat, tallow from cattle, palm kernel oil, coconut oil, olive oil, palm oil and fish oil.” “However”, he says, “if you want the soap to last a long time it is better to use a saturated fat because using unsaturated fats in the manufacturing process will - in time - cause the soap to go rancid whereas soaps that are made from saturated fats will last for years."

Another of the natural ingredients found in soap was (and still is) glycerine which is also used in the manufacture of explosives. So I wonder if you realise that during WWI the government regulated and subsidised the supply of oil and fat in order to ensure that commercial soap makers had enough material with which to carry on making their soap, from which the glycerine was extracted to be sent to munitions factories ?

Does this mean then that hospitals, including Joyce Green, never experienced shortages of hand soap, floor soap and laundry soap during the First World War because of positive government strategies aimed at maintaining the supply of these products as well as the supply of glycerine for weapons manufacture and does this also mean that adequate supplies of soap in hospitals and an old-fashioned commitment to hand washing meant that less cross-infection occurred ?

I don’t have any data to hand to support the notion that there was less cross-infection in UK hospitals during the First World War but with fewer anti-microbials (and/or supplies of them) in existence it would certainly be interesting to read anything relevant that has been written by staff who worked at Joyce Green Hospital during that era, don’t you think ?