June 23, 2020 • 9 mins
Dr. Ignaz Semmelweis asked fellow 19th-century doctors to wash their hands between conducting autopsies and delivering babies -- and was ridiculed for it. Learn how he and other sanitation pioneers helped save lives anyway in this episode of BrainStuff.
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Episode Transcript
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Speaker 1 (00:01):
Welcome to Brainstuff, a production of I Heart Radio, Hey,
brain Stuff, Lauren Volga bam here. Even when there isn't
a pandemic on we all know we're supposed to wash
our hands, especially before we eat or after we've touched
something gross. But that wasn't always the case. As recently
as the eighteen hundreds, a doctor was mocked for even
(00:23):
suggesting that physicians wash their hands before working with patients.
And that, dear listener, is how we begin the strange
and sad story of Ignatz Smilvis, a nineteenth century doctor
sometimes called the father of infection control some of weis
was born in Hungary in eighteen eighteen, and after graduating
from medical school, he started a job at Vienna General
(00:46):
Hospital in Austria in eighteen forty six. There he became
a ghast at the mortality rate of new mothers in
one of the hospital's wards. In this ward, up to
eighteen percent of new mothers were dying from what was
then called child bed fever or pure pearl fever. We
know today that this is a fever caused by infection
of the reproductive or urinary tract in new mothers. Yet
(01:08):
in another of the hospital's wards, where midwives instead of doctors,
delivered all of the babies. Only about two percent of
mothers died of this then mysterious fever. Zemolweiss began reasoning
his way to the root of the problem. He considered
climate and crowding, but eventually ruled those factors out. In
the end, the midwives themselves seemed to be the only
(01:29):
real difference between the two wards. Then Zemovieis had an epiphany.
One of the hospital's doctors, a pathologist, accidentally nicked himself
with a scalpel that he had used during an autopsy
of one of these unfortunate mothers. The doctor was sickened
with childbed fever, and he died. Zemoweis made the connection
that doctors were performing autopsies on patients who had died
(01:51):
of childbed fever and then immediately afterward going to deliver
babies without stopping to wash their hands. He suspected that
this was the sore of the deadly problem. But we
spoke via email with Dana Tolozievski, a philosophy professor at
Purdue University whose name I hope I am pronouncing correctly.
She explained basically his hypothesis here was that it was
(02:13):
cadaveric matter from the scalpel that entered the pathologist's blood
and caused the infection, and that same material could be
transferred to the women on the hands of the doctors,
because the doctors would do autopsies and then go straight
to examine the women who had given birth without washing
their hands, changing their clothes, or basically taking any hygienic
measures at all. He then tested this hypothesis by requiring
(02:35):
people who had performed autopsies to wash their hands with
chloride of lime, a disinfectant, before attending the women, and
after this the mortality rate in the first clinic fell
to that of the second. You'd think that Simulweis's fellow
doctors would have lauded him for this discovery, but you'd
be wrong. You see, in the eighteen forties, germ theory
(02:56):
hadn't been conceived yet. That's the theory that diseases are
caused by organisms not visible to the naked eye. People
still suspected that diseases transferred from one person to another
via toxic odors, not bacteria or viruses. This was called
miasthma theory. In washing their hands They probably wanted to
be rid of whatever was causing a bad odor, not
(03:18):
to kill germs that might wreak havoc on them or
someone else. We also spoke ya email with Michael Millinson,
an adjunct professor of medicine at Northwestern University. He said
physicians of Zimbovice's time simply did not understand or believe
that something microscopic could be wreaking such havoc on their patients.
(03:38):
They literally believed their own eyes. Lest we feel too smug,
consider how many people currently embrace a lack of COVID
nineteen deaths among people like me geographically, racially, economically, or
otherwise as evidence that scientists are overestimating the pandemics risk.
Better handwashing regiments dramatically improved death rates at the maternity ward,
(03:59):
but some of vices colleagues were at best miffed at
the implication that their ignorance was killing their own patients,
and perhaps the implication that midwives were better at delivering
babies than they were. It didn't help that Zemmolwei's essentially
laid the deaths of the ward's mothers at the feet
of his superiors. His own supervisor countered that the hospital's
(04:19):
new ventilation system must be the reason for the decline
in maternity deaths. Also, Zemmoweiss was a Hungarian in Austria,
a foreigner working in a country in the throes of xenophobia.
So those doctors rejected his theories and Smovie's himself as
being inferior. They opted to stick with their miasma theory,
(04:40):
and for good measure, in eighteen forty nine did not
renew Zemmelweis's appointment. Zemoviis eventually got a medical position in Budapest,
where he, according to the British Medical Journal Quote, publicly
harangued doctors and nurses about handwashing and reduced paternal mortality.
He eventually published a book on this object some fourteen
(05:00):
years later, but it was poorly written and poorly received.
Possibly experiencing a mental disorder or extreme stress from his
rejection by the medical establishment, Zemmoweis ended up a patient
in an asylum in eighteen sixty five. Weeks later, he
was dead of an infection from a wound that he
received in the facility. He was just forty seven years old.
(05:23):
Zemoweiss left behind a monumental legacy, but the tragedy of
his story has made it garner a few myths, one
of those being that Zemmoweiss was the first to suggest
a theory about doctors transmitting germs. Galiziaski said he wasn't
really a pioneer. Other people before Zemalweiss had hit upon
the idea that child bed fever could be transmitted from
(05:45):
doctor or midwife to patient. For example, Alexander Gordon of
Aberdeen showed in sevent that childhood fever was almost always
transmitted by doctors or midwives, and also that it was
connected to a kind of strupp, a cockle skin rash.
He so thought that the best treatment was copious bleeding.
In the States, famously, there was Oliver Wendell Holmes, who
(06:06):
was a physician but is now much better known as
a poet, who wrote a very elegant essay called the
Contagiousness a Pureborough Fever in eighteen forty three, a year
before Zemowis even completed his m d. Another misunderstanding is
that doctors of his time outright rejected Zemoviss's ideas about handwashing.
They didn't entirely, They just attributed coming down childbed fever
(06:28):
to a range of variables such as predisposition, environment, and
many other factors. To Liziski said, because people already had
such a long list, adding cadaverick or decomposing animal matter
really wasn't a big deal to them, and lots of people,
some of them pretty big shots, did add this to
their list and started disinfecting their hands, so it's just
(06:51):
not true that that part was universally rejected. Later in
the eighteen sixties, Louis Pasteur started working on what would
eventually become the theoretical explanation behind Zimbilvice's observations, and in
the eighties, thanks to the pioneering work of Joseph Lister
and others, people started using antiseptic techniques in surgical and
(07:12):
maternity wards, which is when mortality rates from child bed
fever really began to fall, along with many other inhospital
mortality rates. But even after scientists realized that Zimilvis had
been right all along about hand washing, this simple act
still remains a challenge throughout society. That's partially because even
though we now know that germs are there, we human
(07:34):
beings still sometimes trust what we see and discount what
we can't. A January poll found fort of Americans don't
always wash their hands after going to the bathroom, Even
doctors and nurses may rationalize their own behavior has nothing
to do with spreading disease. Millinson said, patients get infections
for many reasons. They come into contact with many people
(07:56):
and many objects, and have compromised immune systems, and by definition,
those who forget to wash or don't do it properly
don't know that they forgot or were ineffective. Millinsen points
out that there is still no requirement that hospitals reach
a certain threshold on hand hygiene, only that they have
a program in place to improve it. He said, almost
(08:18):
as bad, the US Centers for Disease Control doesn't monitor
a national hand hygiene rate in hospitals, which often hovers
in the ten to forty percent range. On average, US
healthcare providers clean their hands less than half the times
that they should, according to the most recent CDC study,
which was eighteen years ago. It's too soon to have
(08:38):
numbers on how the COVID nineteen pandemic has affected hand
hygiene in hospitals, though anecdotal evidence suggests it's put healthcare
providers on high alert during this time, semovices even seeing
a resurgence in pop culture. He was honored with a
Google doodle in March, and an opera about him, which
premiered Ineen, was live streamed in May. Finally, there's this
(09:02):
bright spot, Millinson equipped I like to tell provider audiences
the good news is that we've made significant progress since
Samuel Vis's time. We no longer put people who insist
on doctors washing their hands into an insane asylum. Today's
episode was written by Nathan Chandler and produced by Tyler Clang.
(09:23):
For more on this and lots of other topics, visit
how stuff works dot com. Brain Stuff is production of
iHeart Radio. For more podcasts in my heart Radio, visit
the iHeart Radio app, Apple Podcasts, or wherever you listen
to your favorite shows.
Welcome to Brainstuff, a production of I Heart Radio, Hey,
brain Stuff, Lauren Volga bam here. Even when there isn't
a pandemic on we all know we're supposed to wash
our hands, especially before we eat or after we've touched
something gross. But that wasn't always the case. As recently
as the eighteen hundreds, a doctor was mocked for even
(00:23):
suggesting that physicians wash their hands before working with patients.
And that, dear listener, is how we begin the strange
and sad story of Ignatz Smilvis, a nineteenth century doctor
sometimes called the father of infection control some of weis
was born in Hungary in eighteen eighteen, and after graduating
from medical school, he started a job at Vienna General
(00:46):
Hospital in Austria in eighteen forty six. There he became
a ghast at the mortality rate of new mothers in
one of the hospital's wards. In this ward, up to
eighteen percent of new mothers were dying from what was
then called child bed fever or pure pearl fever. We
know today that this is a fever caused by infection
of the reproductive or urinary tract in new mothers. Yet
(01:08):
in another of the hospital's wards, where midwives instead of doctors,
delivered all of the babies. Only about two percent of
mothers died of this then mysterious fever. Zemolweiss began reasoning
his way to the root of the problem. He considered
climate and crowding, but eventually ruled those factors out. In
the end, the midwives themselves seemed to be the only
(01:29):
real difference between the two wards. Then Zemovieis had an epiphany.
One of the hospital's doctors, a pathologist, accidentally nicked himself
with a scalpel that he had used during an autopsy
of one of these unfortunate mothers. The doctor was sickened
with childbed fever, and he died. Zemoweis made the connection
that doctors were performing autopsies on patients who had died
(01:51):
of childbed fever and then immediately afterward going to deliver
babies without stopping to wash their hands. He suspected that
this was the sore of the deadly problem. But we
spoke via email with Dana Tolozievski, a philosophy professor at
Purdue University whose name I hope I am pronouncing correctly.
She explained basically his hypothesis here was that it was
(02:13):
cadaveric matter from the scalpel that entered the pathologist's blood
and caused the infection, and that same material could be
transferred to the women on the hands of the doctors,
because the doctors would do autopsies and then go straight
to examine the women who had given birth without washing
their hands, changing their clothes, or basically taking any hygienic
measures at all. He then tested this hypothesis by requiring
(02:35):
people who had performed autopsies to wash their hands with
chloride of lime, a disinfectant, before attending the women, and
after this the mortality rate in the first clinic fell
to that of the second. You'd think that Simulweis's fellow
doctors would have lauded him for this discovery, but you'd
be wrong. You see, in the eighteen forties, germ theory
(02:56):
hadn't been conceived yet. That's the theory that diseases are
caused by organisms not visible to the naked eye. People
still suspected that diseases transferred from one person to another
via toxic odors, not bacteria or viruses. This was called
miasthma theory. In washing their hands They probably wanted to
be rid of whatever was causing a bad odor, not
(03:18):
to kill germs that might wreak havoc on them or
someone else. We also spoke ya email with Michael Millinson,
an adjunct professor of medicine at Northwestern University. He said
physicians of Zimbovice's time simply did not understand or believe
that something microscopic could be wreaking such havoc on their patients.
(03:38):
They literally believed their own eyes. Lest we feel too smug,
consider how many people currently embrace a lack of COVID
nineteen deaths among people like me geographically, racially, economically, or
otherwise as evidence that scientists are overestimating the pandemics risk.
Better handwashing regiments dramatically improved death rates at the maternity ward,
(03:59):
but some of vices colleagues were at best miffed at
the implication that their ignorance was killing their own patients,
and perhaps the implication that midwives were better at delivering
babies than they were. It didn't help that Zemmolwei's essentially
laid the deaths of the ward's mothers at the feet
of his superiors. His own supervisor countered that the hospital's
(04:19):
new ventilation system must be the reason for the decline
in maternity deaths. Also, Zemmoweiss was a Hungarian in Austria,
a foreigner working in a country in the throes of xenophobia.
So those doctors rejected his theories and Smovie's himself as
being inferior. They opted to stick with their miasma theory,
(04:40):
and for good measure, in eighteen forty nine did not
renew Zemmelweis's appointment. Zemoviis eventually got a medical position in Budapest,
where he, according to the British Medical Journal Quote, publicly
harangued doctors and nurses about handwashing and reduced paternal mortality.
He eventually published a book on this object some fourteen
(05:00):
years later, but it was poorly written and poorly received.
Possibly experiencing a mental disorder or extreme stress from his
rejection by the medical establishment, Zemmoweis ended up a patient
in an asylum in eighteen sixty five. Weeks later, he
was dead of an infection from a wound that he
received in the facility. He was just forty seven years old.
(05:23):
Zemoweiss left behind a monumental legacy, but the tragedy of
his story has made it garner a few myths, one
of those being that Zemmoweiss was the first to suggest
a theory about doctors transmitting germs. Galiziaski said he wasn't
really a pioneer. Other people before Zemalweiss had hit upon
the idea that child bed fever could be transmitted from
(05:45):
doctor or midwife to patient. For example, Alexander Gordon of
Aberdeen showed in sevent that childhood fever was almost always
transmitted by doctors or midwives, and also that it was
connected to a kind of strupp, a cockle skin rash.
He so thought that the best treatment was copious bleeding.
In the States, famously, there was Oliver Wendell Holmes, who
(06:06):
was a physician but is now much better known as
a poet, who wrote a very elegant essay called the
Contagiousness a Pureborough Fever in eighteen forty three, a year
before Zemowis even completed his m d. Another misunderstanding is
that doctors of his time outright rejected Zemoviss's ideas about handwashing.
They didn't entirely, They just attributed coming down childbed fever
(06:28):
to a range of variables such as predisposition, environment, and
many other factors. To Liziski said, because people already had
such a long list, adding cadaverick or decomposing animal matter
really wasn't a big deal to them, and lots of people,
some of them pretty big shots, did add this to
their list and started disinfecting their hands, so it's just
(06:51):
not true that that part was universally rejected. Later in
the eighteen sixties, Louis Pasteur started working on what would
eventually become the theoretical explanation behind Zimbilvice's observations, and in
the eighties, thanks to the pioneering work of Joseph Lister
and others, people started using antiseptic techniques in surgical and
(07:12):
maternity wards, which is when mortality rates from child bed
fever really began to fall, along with many other inhospital
mortality rates. But even after scientists realized that Zimilvis had
been right all along about hand washing, this simple act
still remains a challenge throughout society. That's partially because even
though we now know that germs are there, we human
(07:34):
beings still sometimes trust what we see and discount what
we can't. A January poll found fort of Americans don't
always wash their hands after going to the bathroom, Even
doctors and nurses may rationalize their own behavior has nothing
to do with spreading disease. Millinson said, patients get infections
for many reasons. They come into contact with many people
(07:56):
and many objects, and have compromised immune systems, and by definition,
those who forget to wash or don't do it properly
don't know that they forgot or were ineffective. Millinsen points
out that there is still no requirement that hospitals reach
a certain threshold on hand hygiene, only that they have
a program in place to improve it. He said, almost
(08:18):
as bad, the US Centers for Disease Control doesn't monitor
a national hand hygiene rate in hospitals, which often hovers
in the ten to forty percent range. On average, US
healthcare providers clean their hands less than half the times
that they should, according to the most recent CDC study,
which was eighteen years ago. It's too soon to have
(08:38):
numbers on how the COVID nineteen pandemic has affected hand
hygiene in hospitals, though anecdotal evidence suggests it's put healthcare
providers on high alert during this time, semovices even seeing
a resurgence in pop culture. He was honored with a
Google doodle in March, and an opera about him, which
premiered Ineen, was live streamed in May. Finally, there's this
(09:02):
bright spot, Millinson equipped I like to tell provider audiences
the good news is that we've made significant progress since
Samuel Vis's time. We no longer put people who insist
on doctors washing their hands into an insane asylum. Today's
episode was written by Nathan Chandler and produced by Tyler Clang.
(09:23):
For more on this and lots of other topics, visit
how stuff works dot com. Brain Stuff is production of
iHeart Radio. For more podcasts in my heart Radio, visit
the iHeart Radio app, Apple Podcasts, or wherever you listen
to your favorite shows.
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