Speaker 1: Happy Saturday, everybody. We have had several requests recently to
Speaker 1: re release our previous podcast on ignance Semialviss and his
Speaker 1: hand washing advocacy. In case you missed it, several vice
Speaker 1: was the subject of a Google Doodle on March with
Speaker 1: an accompanying animation on how to properly wash your hands.
Speaker 1: This episode that we're playing today originally came out on
Speaker 1: March twenty one. Yeah, we usually reserve Saturday classics for
Speaker 1: things that are a little older, but since so many
Speaker 1: people asked, here, we go enjoy. Welcome to Stuff you
Speaker 1: missed in History class a production of I Heart Radio. Hello,
Speaker 1: and welcome to the podcast. I'm Tracy V. Wilson, and
Speaker 1: I'm Holly fry So Holly, I think a lot of
Speaker 1: people take for granted the idea that you need to
Speaker 1: wash your hay hands to prevent disease. Yes, but also
Speaker 1: some people discounted well, and there's also a lot of
Speaker 1: research that even though this is a pretty ubiquitous and
Speaker 1: standard idea, a lot of people don't actually wash their
Speaker 1: hands nearly as much as they should. But regardless of
Speaker 1: all of that, it was not taken for granted in
Speaker 1: nineteenth century Europe, including among doctors, that you needed to
Speaker 1: wash your hands to prevent disease. And today we are
Speaker 1: going to talk about Ignaz Semmel Vice. He was one
Speaker 1: of the people who made this connection between hand washing
Speaker 1: and disease prevention. The disease that he was preventing was
Speaker 1: childbed fever, and even though it was not taken seriously
Speaker 1: at the time, like people wrote him off entirely, today
Speaker 1: he's known as everything from the father of infection control
Speaker 1: and the savior of mothers and the conqueror of childbed fever,
Speaker 1: which is a lot of, I mean, very lofty pronouncements.
Speaker 1: And he did do amazing work, but it did not
Speaker 1: last past his lifetime. Uh. This episode Also, to be clear,
Speaker 1: it's about medicine in nineteenth century Europe and to a
Speaker 1: lesser extent in North America. And we're definitely aware that
Speaker 1: religions and cultures all over the world have their own
Speaker 1: practices about everything from handwashing to delivering babies. It is
Speaker 1: not about that at all. This is not a global
Speaker 1: overview of hand hygiene and how it relates to medicine.
Speaker 1: We're really looking at how the practice of obstetrics and
Speaker 1: formal medical training collided in the eighteenth and nineteenth centuries,
Speaker 1: and this is also a listener request we've gotten from
Speaker 1: several people, including Margaret tom and Ashley. Child bed fever,
Speaker 1: also known as pure pearl fever, is a postpartum infection
Speaker 1: of the uterus or the vaginal canal, and it's often
Speaker 1: caused by a streptococcal infection, but it can come from
Speaker 1: other pathogens as well. Today, these infections are largely preventable
Speaker 1: through hygiene and infection control procedures during labor and delivery,
Speaker 1: and when they do happen, they're usually treatable with antibiotics.
Speaker 1: So in places where competent care, clean water, and antibiotics
Speaker 1: are readily available, pure pearl fever isn't very common. This
Speaker 1: was not the case before the germ theory of disease
Speaker 1: or the discovery of antibiotics. Until the late nineteenth century,
Speaker 1: childbed fever was one of the most common complications of childbirth.
Speaker 1: Within about three days of giving birth, patients developed abdominal pain, fevers, abscesses,
Speaker 1: and other signs of infection, and this would often progress
Speaker 1: to blood poisoning and death. Sometimes, incidents of child bed
Speaker 1: fever were sporadic and between twenty and thirty percent of
Speaker 1: those sporadic infections were fatal, but when an epidemic of
Speaker 1: child bed fever swept through a community or a hospital,
Speaker 1: it tended to be a lot deadlier, with seventy with
Speaker 1: a seventy to eighty percent mortality rate, and a lot
Speaker 1: of prominent women died of childbed fever throughout history, including
Speaker 1: Mary Wolston Craft, Henry the Eighth Wife, Jane Seymour, and
Speaker 1: possibly recent podcast subject Phyllis Wheatley. Obviously, a lot of
Speaker 1: ordinary women did too that aren't in the history books.
Speaker 1: It was something both expecting parents and their doctors and
Speaker 1: midwives dreaded and feared. Childbed fever was described in medical
Speaker 1: literature all the way back to Hippocrates in the fourth
Speaker 1: century BC, and in the years before evidence based medicine.
Speaker 1: People blamed it on a range of causes based on
Speaker 1: whatever medical theories were in use at the time, so
Speaker 1: everything from a balance an imbalance in the four Humors
Speaker 1: to myasthmas or bad air. By the eighteenth century, doctors
Speaker 1: were devoting a lot of writing to arguing about whether
Speaker 1: it was an inflammatory or a putrefying disease. In the
Speaker 1: eighteenth and nineteen centuries, a few things happened in tandem
Speaker 1: that led to a big increase in childbed fever epidemics.
Speaker 1: One was that more babies were being delivered in hospitals
Speaker 1: rather than at home. In some cases, these hospitals were
Speaker 1: part of social programs. The idea was to provide free
Speaker 1: care before and after delivery to try to stop infanticide
Speaker 1: among families that were living in poverty. Some of these
Speaker 1: hospitals employed midwives, and others of them employed doctors, and
Speaker 1: this was also a change. Before this point, doctors and surgeons,
Speaker 1: who were almost exclusively male, had really only been involved
Speaker 1: in delivering babies when there were really serious complications. It
Speaker 1: was so unusual for a man to be involved in
Speaker 1: delivery that in some places these doctors were called man midwives.
Speaker 1: So the idea that a doctor would be involved in
Speaker 1: the routine delivery of a baby was fairly new in
Speaker 1: the seventeen hundreds. Also fairly new was the widespread use
Speaker 1: of autopsies as part of medical education. Although autopsies existed
Speaker 1: well before this point, it was only in the mid's
Speaker 1: seventeen hundreds that the field of medicine really started using
Speaker 1: them to try to improve on medical knowledge and teach
Speaker 1: medical students, and in the late eighteenth and early nineteenth centuries,
Speaker 1: doctors started using autopsies childbed fever victims, specifically to try
Speaker 1: to learn more about the disease. All of this together
Speaker 1: meant that at about the same time, more people were
Speaker 1: giving birth in hospitals assisted by doctors, and more doctors
Speaker 1: and medical students were handling and dissecting cadavers as part
Speaker 1: of medical study, including the bodies of people who had
Speaker 1: died of childbed fever. Because illnesses were blamed on things
Speaker 1: like myasthmas and imbalanced humors rather than on pathogens, these
Speaker 1: post mortem examinations were being conducted with bare hands, and
Speaker 1: those bare hands were not usually washed before working with
Speaker 1: living patients. Surgical gloves weren't even invented yet. That wouldn't
Speaker 1: happen until the late eighteen hundreds, and when those gloves
Speaker 1: were invented, they were really about protecting the hands from chemicals,
Speaker 1: not protecting the patients from the spread of disease or
Speaker 1: the doctors from contracting diseases from the patients. The result
Speaker 1: of all of this was a dramatic increase acent epidemics
Speaker 1: of child bed fever particularly in hospitals. One swept through
Speaker 1: the Paris Hotel Dieu in seventeen in seventeen forty six,
Speaker 1: another struck the British Lying In Hospital in seventeen sixty.
Speaker 1: These were frequent and widespread enough that hospitals weren't usually
Speaker 1: thought of as safe places to give birth. There were
Speaker 1: definitely doctors who spotted the connection between autopsies and child
Speaker 1: bed fever, or who suspected that the disease could be
Speaker 1: spread from patient to patient by the doctors who were
Speaker 1: treating them. These doctors published treatises and journal articles about
Speaker 1: what they thought was causing child bed fever and how
Speaker 1: to stop it. In seventeen Alexander Gordon of Aberdeen, Scotland
Speaker 1: wrote his treatise on the Epidemic of Pure Pearl Fever,
Speaker 1: and in it he theorized that doctors who had treated
Speaker 1: a patient with child bed fever could pass it on
Speaker 1: to other patients. He recommended burning the patient's bedclothes, along
Speaker 1: with thorough hand washing and fumigating all of the clothing
Speaker 1: of the doctors and nurses who were involved in the
Speaker 1: infected patient's care. In eighteen twenty nine, when an epidemic
Speaker 1: of childbed fever struck the Rotunda Hospital in Dublin, Ireland.
Speaker 1: Hospital chief Robert Collins tried to stop it with a
Speaker 1: forty eight hour chlorine fumigation. He also ordered that all
Speaker 1: the floors and walls be scrubbed down with chlorinated lime
Speaker 1: and all the linen's be heat treated. The number of
Speaker 1: childbed fever cases at the hospital dropped almost to zero
Speaker 1: after he did all this. In eighteen forty three, Oliver
Speaker 1: Wendellholm Sr. Delivered a paper called the Contagiousness of Pure
Speaker 1: Pearl Fever to the Boston Society of Medical Improvement. In it,
Speaker 1: he said, quote, the disease known as pure pearl fever
Speaker 1: is so far contagious as to be frequently carried from
Speaker 1: patient to patient by physicians and nurses. He then went
Speaker 1: on to describe a number of steps to try to
Speaker 1: prevent the spread of the disease. These included that obstetricians
Speaker 1: should ever conduct autopsies on patients who died of childbed fever,
Speaker 1: and if for some reason an obstetrician had to, he
Speaker 1: should very thoroughly clean himself, change all of his clothes,
Speaker 1: and abstain from patient treatment for at least twenty four hours.
Speaker 1: Holmes went on to recommend that if a doctor treated
Speaker 1: a patient who then contracted childbed fever, he should consider
Speaker 1: all of the patients that he went on to treat
Speaker 1: to also be at risk until significant time had passed
Speaker 1: without anybody else being infected, and if two of his
Speaker 1: patients developed childbed fever in close proximity to one another,
Speaker 1: he should remove himself from medical practice and bring in
Speaker 1: a substitute for at least a month. Holmes's paper made
Speaker 1: recommendations that would have been both useful and effective for
Speaker 1: preventing the spread of childbed fever, but it didn't get
Speaker 1: a lot of attention until it was reprinted as a
Speaker 1: pamphlet and more widely distributed, and then the response among
Speaker 1: the medical community was total dismissal and outright mockery. Charles D. Meigs,
Speaker 1: an obstitution from Philadelphia, described holmes As theories and recommendations
Speaker 1: as quote je June and Fizzinless Dreamings, and claimed that
Speaker 1: any doctor who saw an increase in child bed fever
Speaker 1: was just unlucky. When Agna's semil Weiss came to the
Speaker 1: same conclusion that Oliver Wendell Holmes Senior, had, the response
Speaker 1: from the rest of the medical community was very much
Speaker 1: the same, and we'll talk about it after a sponsor
Speaker 1: break becas semil Weiss was born on July one, eighteen eighteen,
Speaker 1: and the Taban area of Buddha Hungary. Buddha would combine
Speaker 1: with Pest in eighteen seventy three, so it was a
Speaker 1: little bit later to become Buddha Pest. At the time,
Speaker 1: Hungary was part of the Austrian Empire, and he was
Speaker 1: the fifth of ten children born to Grosser Joseph Semilweiss
Speaker 1: and Terisia Mueller. There's a bit of disagreement about the
Speaker 1: family's heritage. Some accounts claim that they were Jewish and
Speaker 1: that anti Semitism was a factor in later parts of
Speaker 1: Semilvis's story, but Sherwin B. Newland, author of The Doctor's Plague, Germs,
Speaker 1: child bed Fever, and The Strange Story of Ignaz Semilviis,
Speaker 1: writes that parish registers document that the semil Weiss family
Speaker 1: was Roman Catholic going back to the sixteen seventies. The
Speaker 1: counter argument is that semil Weiss and his ancestors may
Speaker 1: have been baptized for the sake of assimilation while the
Speaker 1: family was still culturally Jewish, but this is largely conjecture
Speaker 1: and it seems mostly just to be based on their surname.
Speaker 1: In eighteen thirty seven, at the age of nineteen, semuil
Speaker 1: Wess went to the University of Vienna to study law.
Speaker 1: A year later he changed his course of study to
Speaker 1: medicine and he graduated with his m d. In eighteen
Speaker 1: forty four. He looked for a position practicing internal medicine,
Speaker 1: but he couldn't find one, so he changed his focus
Speaker 1: once again and looked for a position in obstetrics. On
Speaker 1: life First, eighteen forty six, he was granted a two
Speaker 1: year appointment as an assistant to Professor Johann Klein, who
Speaker 1: was the director of the Vienna Algamini corunkin House or
Speaker 1: the General Hospital. Vienna General Hospital was a teaching hospital,
Speaker 1: so in this role Semmelweis was both a doctor and
Speaker 1: a teacher. He supervised and educated medical students, and he
Speaker 1: assisted with difficult deliveries. He was also the clerk of records,
Speaker 1: which put him in a good position to spot patterns
Speaker 1: among the patients and their outcomes. The maternity clinic at
Speaker 1: the Vienna General Hospital was one of the ones that
Speaker 1: had been established to provide free medical care to impoverished patients,
Speaker 1: so patients essentially got free care and exchanged for helping
Speaker 1: with the medical students educations. Originally, the hospital had one
Speaker 1: maternity clinic, which was staffed by midwives, doctors, and their students,
Speaker 1: and after a while that one clinic became so overcrowded
Speaker 1: that the hospital opened a second one, which was still
Speaker 1: staffed by a mix of doctors, midwives, and their students.
Speaker 1: But around eighteen forty the two clinics were separated into
Speaker 1: the first and second clinic. The first clinic was staffed
Speaker 1: by doctors and medical students, and the second clinic was
Speaker 1: staffed by midwives and midwiffery students. The two clinics alternated
Speaker 1: admission days, so if the first clinic accepted patients on Monday,
Speaker 1: the second clinic would accept patients on Tuesday, and so on.
Speaker 1: When the maternity clinic first opened in seventeen eighty four,
Speaker 1: the hospital director Lucas Boer, had not included post mortem
Speaker 1: work as part of the obstetric student's course of study
Speaker 1: because he thought it carried a risk of contagion, But
Speaker 1: in eighteen twenty three Johann Klein took over as director
Speaker 1: and started using autopsies as a teaching tool for the
Speaker 1: obstetric students. By the time Semmelweis joined the hospital staff,
Speaker 1: the rates of child bed fever at Vienna General Hospital
Speaker 1: very dramatically between the two clinics. At the midwives clinic,
Speaker 1: between one and two percent of patients died of child
Speaker 1: bed fever, and at the doctor's clinic the rate varied
Speaker 1: from five to with an average of about ten percent.
Speaker 1: This difference between the two clinics was so huge and
Speaker 1: so well known that laboring patients who were told that
Speaker 1: they were being admitted to the doctor's clinic would beg
Speaker 1: to be sent to the midwives clinic instead. Some even
Speaker 1: gave birth in the street outside the clinic after hearing
Speaker 1: that it was the doctor's day for admission, and then
Speaker 1: they would say they had been on the way to
Speaker 1: the hospital and the baby just came before they could
Speaker 1: get there. That way, they would still have access to
Speaker 1: the free care at the clinic, but without the risk
Speaker 1: of death that was associated with it. That's gotta be
Speaker 1: a terrifying choice when you're like, no, I'm I'm just
Speaker 1: gonna do this in the street and then I'll let
Speaker 1: them take care of me after that. Well, and I
Speaker 1: imagine a thing I didn't find. Um, I didn't find
Speaker 1: sources that said this, but considering that my own mother
Speaker 1: did this when I was born, I imagine the people
Speaker 1: that were like, I'm in labor, but I'm not far
Speaker 1: into labor, and it's the doctor's day. I'm gonna wait
Speaker 1: a few hours so i can go to the midwives clinic.
Speaker 1: I imagine that was a thing too. My my parents
Speaker 1: did that because if they waited till after midnight, they
Speaker 1: wouldn't be billed for the extra day. Did not have
Speaker 1: a ton of money. Simil Vis noticed that even these
Speaker 1: births out in the street were safer than giving birth
Speaker 1: in the doctor's clinic at the hospital. He wrote, quote
Speaker 1: to me, it appeared logical that patients who experienced street
Speaker 1: births would become ill at least as frequently as those
Speaker 1: who delivered in the clinic. What protected those who delivered
Speaker 1: outside the clinic from these destructive, unknown endemic influences. He
Speaker 1: became completely fixated on this question. It was appalling and
Speaker 1: deeply offensive to him that there was such a huge
Speaker 1: difference between the doctors and the midwives clinics. So you
Speaker 1: started trying to figure out what was different between the
Speaker 1: two clinics, and then making adjustments to what the doctors
Speaker 1: were doing. At the midwives clinic, patients lay on their
Speaker 1: sides to deliver, but at the doctor's clinic they lay
Speaker 1: on their backs. Similar Wizz changed the procedure at the
Speaker 1: doctor's clinic to use sidelining, but that didn't make a difference.
Speaker 1: They also noticed that anytime a patient was dying in
Speaker 1: the doctor's clinic, the priest who was arriving to get
Speaker 1: to give last rites basically had to walk through the
Speaker 1: whole ward, and he rang a bell while he was
Speaker 1: doing this. Some of us thought maybe this bell and
Speaker 1: what it signified was so terrifying that it was making
Speaker 1: people sick, so he got the priest to stop it
Speaker 1: with the bell. That did not fix the problem. He
Speaker 1: looked at how crowded the two clinics were, and it
Speaker 1: turned out that the midwives clinic was understandably far more crowded.
Speaker 1: He looked at the religious practices of the people working
Speaker 1: in each clinic. He looked at the patient's diets, and
Speaker 1: none of these things seemed to make a difference. Then
Speaker 1: his friend and colleague, Jacob Colleca died of what appeared
Speaker 1: to each childbed fever after accidentally being nicked with a
Speaker 1: scalpel while performing an autopsy on someone who had died
Speaker 1: of it, and Collectica's own autopsy results were very similar
Speaker 1: to those of childbed fever victims. That's when Semilvieis realized
Speaker 1: that midwiffery students weren't performing autopsies as part of their training,
Speaker 1: only the medical students were. Another difference was that the
Speaker 1: medical students were performing vaginal examinations on their patients as
Speaker 1: a routine part of their care, while midwiffery students only
Speaker 1: did so when there seemed to be a need for one.
Speaker 1: Semilvis's conclusion was that some kind of cadaverous particles were
Speaker 1: being transmitted from the autopsies to the patients in the
Speaker 1: doctor's clinic. In mid May of eighteen forty seven, Semulvis
Speaker 1: started instructing doctors and medical students to wash their hands
Speaker 1: after conducting autopsies. They were to use chlorinated lime until
Speaker 1: their hands had no trace of the putrid smell that
Speaker 1: was left hind by a decaying body. He chose chlorinated
Speaker 1: lime because it seemed to do the best job of
Speaker 1: getting rid of the odor. But chlorinated lime is calcium hypochlorite,
Speaker 1: which today is sold as powdered chlorine bleach. Chlorine bleach is,
Speaker 1: of course a disinfectant. With Salis's handwashing protocol in place,
Speaker 1: the rate of child bed fever mortality in the doctor's
Speaker 1: clinics started to drop. It had been eighteen point three
Speaker 1: percent in April, and by June it had dropped to
Speaker 1: two point two. In August of eighty seven, for the
Speaker 1: first time since the medical students started performing autopsies, no
Speaker 1: one died of child bed fever in the doctor's clinic.
Speaker 1: Some of us couldn't exactly explain why this had worked.
Speaker 1: At one point, another outbreak of child bed fever spread
Speaker 1: through the clinic, even though there had been no autopsy
Speaker 1: to trigger it. So some of VISs began to suggest
Speaker 1: that some patients might make their own so called cadaverous
Speaker 1: particles their own bodies, rather than the autopsies being their
Speaker 1: only source. Later on, he revised his hypothesis a third time,
Speaker 1: saying that the cadaverous particles could come from any decaying
Speaker 1: animal flesh, not just from a human body. The fact
Speaker 1: that he couldn't adequately explain why his protocol worked became
Speaker 1: one of the arguments against his findings. While some of
Speaker 1: his medical students agreed with and supported his work, most
Speaker 1: of the established doctors at the hospital dismissed him completely.
Speaker 1: Director Johann Klein insisted that it was the clinic's new
Speaker 1: ventilation system which was getting rid of dangerous miasmas and
Speaker 1: that should get the credit. Other doctors also vehemently disagreed
Speaker 1: with the idea that their own hands could have been
Speaker 1: what was spreading such a devastating, painful, and emotionally wrenching disease.
Speaker 1: It was unfathomable to them that a doctor could have
Speaker 1: dirty hands in the first place. In their minds, doctors
Speaker 1: were gentlemen, and a gentle men's hands were always clean,
Speaker 1: and his word of several vices protocol spread beyond a hospital.
Speaker 1: Doctors were also resistant to the idea of washing their
Speaker 1: hands because they didn't necessarily have access to clean water
Speaker 1: where they worked, and also because it was time consuming.
Speaker 1: I like this weird chicken in the egg thing, where
Speaker 1: like a gentleman's hands aren't clean because he takes such
Speaker 1: fastidious care of himself, but just because he's a gentle yes. Uh.
Speaker 1: Later on several vice would describe it this way quote.
Speaker 1: Most medical lecture halls continued to resound with lectures on
Speaker 1: epidemic child bed fever and with discourse against my theories.
Speaker 1: The medical literature for the last twelve years continues to
Speaker 1: swell with reports of pure Borough epidemics, and in eighteen
Speaker 1: fifty four, in Vienna, the birthplace of my theory, four
Speaker 1: hundred maternity patients died from child bed fever. In published
Speaker 1: medical works, my teachings are either ignored or attacked. The
Speaker 1: medical faculty at Wurtzburg awarded a prize to a monograph
Speaker 1: written in eighteen fifty nine in which my teachings were rejected.
Speaker 1: So he wrote that a little bit later, and to
Speaker 1: return to this current part of the story, simil Weis
Speaker 1: did not back down in the face of all this opposition.
Speaker 1: In eighteen forty eight, he started requiring that medical students
Speaker 1: clean all the instruments that were used during labor and
Speaker 1: delivery with chlorinated lime as well. The clinic had already
Speaker 1: had a month where there had been no deaths, and
Speaker 1: at this point the ongoing mortality rate from child bed
Speaker 1: fever at the hospital dropped almost to zero. As doctors
Speaker 1: continued to dismiss his findings, Similviis became increasingly hostile and combative,
Speaker 1: and simultaneously, uprisings were sweeping through the area as people
Speaker 1: protested against the Habsburg dynasty in the Austrian Empire. Students
Speaker 1: held a demonstration in Vienna on March thirteenth, eighteen four eight,
Speaker 1: and the Hungarian Revolution of eighteen forty eight began two
Speaker 1: days later. Although there's no evidence that Cemilviis was part
Speaker 1: of these demonstrations, many of his student supporters were, which
Speaker 1: probably inflamed tensions between him and the rest of the faculty.
Speaker 1: As I said earlier, that position he had at the
Speaker 1: maternity clinic and at the hospital had been a two
Speaker 1: year appointment, and in eighteen forty nine the hospital elected
Speaker 1: not to renew it. He was instead offered a position
Speaker 1: that had no contact with cadavers. In eighteen fifty he
Speaker 1: left Vienna to return home without announcing his departure or
Speaker 1: saying goodbye to anyone. He knew we're going to talk
Speaker 1: about semil Vice's life back in Hungary. After we first
Speaker 1: pause for another sponsor break in eighteen fifty one, Ignaz
Speaker 1: Semilviis was named head of obstetrics at St. Rocas Hospital.
Speaker 1: Although this was really an honorary and un haide position,
Speaker 1: he did hold it for the next few years, though,
Speaker 1: during which time the rate of child bed fever at
Speaker 1: the hospital dropped significantly. In the mid eighteen fifties, some
Speaker 1: of Vis left St Roucas and became a professor at
Speaker 1: Peste University. In eighteen fifty seven, he married Maria Widenhoffer,
Speaker 1: and they went on to have five children together. During
Speaker 1: these years, some of Vice continued to advocate for handwashing
Speaker 1: after autopsies, and he also wrote a series of extremely
Speaker 1: hostile open letters to the doctors who dismissed his ideas,
Speaker 1: calling them murderers who were responsible for the deaths of
Speaker 1: women through their negligence. This seems to me like a
Speaker 1: very fair assessment, but but people began to increasingly think
Speaker 1: he is just uh an angry man that no one
Speaker 1: should listen to. He wrote things like, you, hair, professor,
Speaker 1: have been a partner in this massacre, and should you
Speaker 1: hair halfroth? Without having disproved my doctrine, continued to train
Speaker 1: your pupils against it. I declare before God and the
Speaker 1: world that you are a murderer, and the history of
Speaker 1: childbed fever would not be unjust to you if it
Speaker 1: memorialized you as a medical nero. In eighteen fifty eight,
Speaker 1: after years of his supporters telling him he should publish
Speaker 1: his work, he published The Ideology of child bed Fever.
Speaker 1: Another work, The Difference in Opinion between Myself and the
Speaker 1: English Physicians regarding child bed Fever, followed in eighteen sixty,
Speaker 1: and in eighteen sixty one he published a book called
Speaker 1: The Etiology, the Concept and the Prophylaxis of child bed Fever.
Speaker 1: In places, this was a clear and well written treatise
Speaker 1: on childbed fever, but large portions were actually diatribes against
Speaker 1: his critics, some of them rambling, repetitive, and almost nonsensical.
Speaker 1: Ignaz Semmelweiss had been described as abrasive, dogmatic, and even
Speaker 1: route for most of his career, but by the time
Speaker 1: this book came out, he was also starting to behave erratically.
Speaker 1: This got worse in the early eighteen sixties, and on
Speaker 1: July thirteenth, eighteen sixty five, he returned home from a
Speaker 1: family outing and was behaving so bizarrely that his wife
Speaker 1: became convinced that something was seriously wrong with him, and
Speaker 1: then on July twenty one, he went to a meeting
Speaker 1: at his job, where, among other things, he was supposed
Speaker 1: to talk about candidates for a vacant lecturers post, and
Speaker 1: according to his former assistant, instead he read a piece
Speaker 1: of paper containing the midwives Oath of Practice. Clearly unaware
Speaker 1: that he was doing anything amiss, Symbolsize planned to go
Speaker 1: to a spa and take water treatments there, and he
Speaker 1: departed with his wife and some attendants on July twenty nine,
Speaker 1: but the next day, for reasons that aren't entirely clear,
Speaker 1: he was instead committed to a public institution, where he
Speaker 1: died on August thirteenth, eighteen sixty five, at the age
Speaker 1: of forty seven. He was buried in Vienna to days later.
Speaker 1: There are some conflicting reports about what happened at the institution.
Speaker 1: In some accounts, he became so violent that he had
Speaker 1: to be restrained, and during that encounter he was injured,
Speaker 1: but in others, he was severely beaten by guards and
Speaker 1: then left without any kind of medical treatment. Regardless of
Speaker 1: exactly what happened, an injury to his finger that he
Speaker 1: either had when he got to the hospital or sustained
Speaker 1: in the incident became infected. An autopsy that was performed
Speaker 1: at Vienna Algaminy crunkin House diagnosed quote paralysis of the
Speaker 1: brain as his cause of death. Today, it seems likely
Speaker 1: to have been sept to semia, but the autopsy also
Speaker 1: revealed that he had severe injuries that do suggest that
Speaker 1: he had been beaten. It's also not clear what caused
Speaker 1: his behavior to become so erratic in the last years
Speaker 1: of his life. Theories range from the continual stress of
Speaker 1: being such a pariah in the medical community to early
Speaker 1: onset Alzheimer's late stage syphilis, which was an occupational hazard
Speaker 1: of being an obstetrician at a busy hospital at this
Speaker 1: point in history. In the later years the cimil Vices life,
Speaker 1: other doctors were also working on ideas that were related
Speaker 1: to contagion and the germ theory of disease. In eighteen fifty,
Speaker 1: two years after cemil Vice instituted handwashing at the Vanna
Speaker 1: General Hospital, James Young Simpson of Scotland published a detailed
Speaker 1: description of how materials more by could be introduced into
Speaker 1: the body during labor and delivery, and how the postpartum
Speaker 1: body was primed for infection and because of the dilation
Speaker 1: and abrasion sustained during birth. He even made the comparison
Speaker 1: between the attendants fingers and the ivory points that were
Speaker 1: that had been used to administer smallpox vaccinations by transferring
Speaker 1: material from a cowpox lesion to a person's skin. In
Speaker 1: the eighteen fifties and sixties, Louis Pasteur was studying how
Speaker 1: mycro organisms caused beer and wine to spoil. In eighteen
Speaker 1: sixty seven, Joseph Lister began publishing work on preventing infection
Speaker 1: during surgery, which included hygiene and handwashing with carbolic Ten
Speaker 1: years prior to that, in eighteen fifty seven, Robert Coke
Speaker 1: made the connection between the anthrax disease and the anthrax bacterium,
Speaker 1: and later he helped articulate for criteria to prove that
Speaker 1: a disease is caused by a specific micro organism, which
Speaker 1: are called Coke's postulates today. These criteria are that the
Speaker 1: micro organism is always associated with the disease, that it
Speaker 1: can be taken from a diseased animal and grown in
Speaker 1: a culture, that the cultured organism can cause the disease
Speaker 1: in a healthy animal, and that the same micro organism
Speaker 1: can be collected from the newly diseased animal. So, based
Speaker 1: on the work of Louis Pasteur, Joseph Lister, Robert Coke,
Speaker 1: and others, infection control finally became a routine part of
Speaker 1: obstetrics in the eighties. But these researchers don't appear to
Speaker 1: have been influenced by seul vices work at all. In
Speaker 1: a lot of cases, they hadn't even heard of him
Speaker 1: until long after they did their first groundbreaking work. He
Speaker 1: faded into obscurity after his death until a Hungarian doctor
Speaker 1: published a paper about him in eighteen eighty seven. Today
Speaker 1: there are lots of hospitals and clinics named after Igno's
Speaker 1: semil Vice, along with the semil Vice Medical Historical Museum
Speaker 1: in Budapest, and at some point some unknown person coined
Speaker 1: the simil Viz reflex to describe a rejection of new
Speaker 1: information because it contradicts established norms. Even though pure pearl
Speaker 1: fever is much less of an issue for a lot
Speaker 1: of the world today than it was in nineteenth century Europe,
Speaker 1: hospital acquired infections are still an issue even in the
Speaker 1: most affluent parts of the world, known as nasocomial infections,
Speaker 1: they're the most common complication in hospitalized people. They happened
Speaker 1: in between five and ten percent of acute our patients,
Speaker 1: and handwashing is a huge part of preventing them. YEA
Speaker 1: for hand washing, Yes, please wash your hands. This This
Speaker 1: story reminds me a little bit of Fritz Wiki, where
Speaker 1: somebody is really clearly onto something and their contemporaries are
Speaker 1: like Nope, nope, nope, and it makes them frustrated and
Speaker 1: it's a little bit mad having to fight against that
Speaker 1: all the time. Yes, some of the some of the
Speaker 1: things that I read about him that have been written
Speaker 1: more recently almost have a victim blamey aspect to them.
Speaker 1: They they're sort of like, if he hadn't been such
Speaker 1: a jerk about it, people might have listened to him.
Speaker 1: And I'm like, women were literally dying, and he was like,
Speaker 1: who cares how it works, washing your hands keeps the
Speaker 1: women from dying. Why won't you just do it? And like,
Speaker 1: I'm like that understandably made him really angry. Well, and
Speaker 1: it is kind of hard to understand how people were
Speaker 1: not getting the pattern recognition of everywhere he went and
Speaker 1: instituted his practices, mortality went down, and so clearly something
Speaker 1: was correct. Uh so it seems weird that they would
Speaker 1: continue to be like, nope, nope, nope, no my hands,
Speaker 1: I'm a gentleman. Thank you so much for joining us
Speaker 1: today for this Saturday classic. If you have heard any
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