Ignaz Semmelweis, Savior of Mothers

Nicholas Hill  0:00  
Hey everyone before we start the show today, a quick trigger warning. Today's episode contains references to birth trauma and infant loss. There are also descriptions of childbirth autopsies, dissections, and infection. If any of that sounds like too much, it might be good to skip this one. All right, let's get to the show. 

In 1822, Dr. William Campbell is helping to perform an autopsy of a young woman who died of child bed fever. He removes her pelvic organs, puts them in his pocket, and carries them to a classroom for a student demonstration. Then, without changing his clothes, or washing his hands, he assists a woman with delivering her baby. The next morning, that woman is dead. Still wearing the same clothes, he helped some medical students with another baby delivery, this woman would also die. Within a few weeks, three other women in his care would die in the same way. But it would take another seven years for Dr. Campbell to finally think, Hey, maybe I shouldn't help women deliver babies after performing autopsies. But Dr. Campbell was not alone. This disregard for hygiene, the ignorance of the role of bacteria in causing diseases like child bed fever. This was common across the world, and would go on for decades, until an 1861 man would unlock the secret of child bed fever and start a campaign to change the behavior of the entire medical industry. And so doing this man would be ostracized villainized, ignored and committed to an insane asylum, where he would be beaten and ultimately die, as this preventable disease continues to kill 1000s of mothers. So you know, a real feel good story. It would take decades for the medical community to accept that this man was right. But his recommendations would ultimately save the lives of hundreds of 1000s of women. His name was Ignaz Semmelweis. And today, we tell his story. You're listening to acts of impact. I'm your host, Nicholas Hill. Let's get started.

Let's jump forward a few decades to another story in 1846. We're at Vienna General Hospital, arguably the finest hospital on the European continent. It's past midnight, and we're joining a newly appointed obstetricians assistant named Ignaz Semmelweis. Now remember, an obstetrician is a doctor that assists with childbirth. So pregnancy delivery and aftercare. And Semmelweis is just two years out of medical school. He's walking the beds of his patients, which are tightly packed in rows in a large gymnasium, because at this time, the hospital gave free care and free delivery to any woman that will submit to be a medical school subject. We'll talk about that part later. But for now, let's get to some advices patient. She is an unmarried 16 year old girl in labor, he gives her a pelvic exam. And since Vienna is a teaching hospital, his four medical students are required to give pelvic exams as well. And they did this every few hours. So basically, if you're a woman giving birth here, you're going to have about 20 pelvic exams during the course of your labor. The exams are meant to keep her and her child safe. If doctors can catch a problem early, they can fix it. If the fetus is male rotated, they can rotate it back and save the mother and the child. If things are bad, they can use forceps and if they're worse, they can do a C section. But in this patient's case, her and her son are fine. And after 18 hours of labor, he's born without incident. She takes some opium because you know 19th century and can finally relax. But 20 hours later, she starts to vomit. She can't hold fluids. Her pulse begins to elevate her temperature hits 100 she's complaining of abdominal pain. And Semmelweis notices that when she lies on her back, she keeps her hips and knees bent. He presses his fingers into her lower abdomen, and when he releases the pressure, she cries out in pain. This is called rebound pain. And Semmelweis, his heart falls, because he's seen enough cases of this symptom to know what it means to know that this young woman would very soon be dead of a disease called Child bed fever. Now, I am definitely not an expert on child bed fever. So let's talk to someone who is to teach us about child bed fever and similar vices life. I called in a few experts. To kick us off. Let's hear from Dr. Elif Vatanoğlu-Lutz, Professor of ethics and history of medicine at the Yeditepe University medical faculty in Turkey. 

Dr. Elif  5:38  
Child bed fever is also you said very good. The pure Pearl fever is the infection of some part of the female reproductive organs following your childbirth or an abortion. Normally reproductive organs of females are sterile, they don't catch any infection. But after the bird, we always carry some microorganisms in our body like staphylococcus streptococcus, and then there is a cut these bacterias are directly can easily go into the reproductive organs. And if you don't take enough measurements to prevent infection, it's very easy to start reproductive organs infection, and especially in the times that them otherwise lead. So the microbiology theory was not there yet was not known. Nobody knew about the microorganisms and how they developed and most importantly, how to stop them develop. It was a nightmare. Childbirth totally interacts with the female reproductive organs and make some damage there. And unfortunately, it ended up with a very big percentage of the debt of new the mothers and these little babies were left as orphans. So it was a very big problem actually.

Nicholas Hill  6:59  
Now you may have noticed that Dr. Elif also called Child bed fever puerperal fever, which is another name for it. For this episode, we'll just call it child bed fever. Now although we know what child bed fever is today, at the time of Semmelweis, they had no idea what it was or how to stop it. Here's a follow up from Dr. Justin Lessler, a professor in the Department of Epidemiology at the University of North Carolina Gillings School of Global Public Health.

Dr. Justin Lessler  7:27  
What the disease is, is what we'd now call sepsis right was infection with a bacteria that led people's blood to basically become poison, and then eventually died. But for them, it was really mysterious, because what they were seeing is healthy women coming in delivering the baby, everything looks fine. And then they start getting pain and discharge around their privates. And then they'd get sick in they get a fever, and then they'd eventually die within a few days and in a very painful way. So it was a little bit mysterious what was happening. Because everybody everything looked fine.

Nicholas Hill  8:08  
This is exactly what happened with our patient. At first, the delivery seemed to have gone fine. But then seemingly out of nowhere she becomes sick. And by 2am, her temperature has risen to 102 degrees Fahrenheit. Her abdominal pain is worse. She's shaking, she's chattering her teeth. This is called Blood crisis, which we would now know is blood poisoning. And they had no idea what caused this blood crisis, the concept of infection 1000s of bacteria invading the bloodstream, the germ theory of medicine, none of that would be known for decades. So Semmelweis gets a short sleep wakes up at six and goes to the morgue to complete autopsies for the maternity ward, the largest number of maternity ward deaths, child bed fever. Now in the 1840s, all autopsies are performed with bare hands. protective gloves wouldn't be invented until the 1890s. After he's finished dissecting and examining corpses, he wipes his hands with a dry cloth and is off to the maternity ward. And by the time it gets back to our young patient, her abdomen is rigid and distended. Her pulse is 150. She begins convulsing and eventually falls unconscious and dies. Her son is placed in a nearby home. But the very next day he dies to see infants were infected through their mother's circulation. So when the mother died of child bed fever, many times the child would be soon to follow. This woman was not alone. In the Vienna maternity ward, nearly 20 women died of child bed fever every week. In one hospital in one maternity ward. It was said that child bed fever is to women what war is to men, it cuts down the healthiest, bravest and most essential part of the population in the prime of their lives. But it hadn't always been this way. In fact, child bed fever hadn't been a problem for hundreds of years. Before the industrial revolution before everyone flocked to cities for jobs, maternity care was done in the home by midwives and amateur caregivers. But in 1750, the side of deliveries moved from the home to the hospital, and physicians took on the dominant role. And almost immediately when the physicians took over cases of child bed fever began to drastically rise. And physicians had no idea why. So they just started trying things to fix it. They knew that overcrowding could be a cause. So they started with cross ventilation. They put maternity beds into these huge gymnasium like rooms, and clean air would stream in through windows on one side and exit out windows on the opposite. This meant a nice breeze for these new mothers. But it also meant zero privacy, expectant and new mothers would lay on strong mattresses covered with blankets. And the newborns would stay with the Mothers Day and night in these giant rooms, which sucked. But most importantly, the cross ventilation didn't even work. Child bed fever still accounted for half of all maternal deaths at the time, for a while it was second only to tuberculosis. So this is the situation Dr. Semmelweis is thrown into when he starts his career, the problem that he dedicates his life to conquering. But let's take another step back. Let's talk about what was being taught in medical schools when it came to preventing and carrying disease in the 1840s because this will help set the scene for the outdated thinking that Semmelweis had to fight against his entire life. When Semmelweis gets to medical school, medical theory can be traced back to the teachings of Hippocrates. Now, Hippocrates is probably a name that you're familiar with. He is known as the father of medicine. His teachings are so important to this time period, that honestly we need to take a minute to dive in and understand them. So let's hear from Dr. Elf on who Hippocrates was, why he was so important, and why his teachings were still being taught. 2000 years later, when Semmelweis gets to medical school,

Dr. Elif  12:31  
Hippocrates being this very famous Greek doctor, the Greek physician did something very important for medical history and why is known as the father of medicine. We are talking about 400 BC, and then Hippocrates lived as a medical doctor. In Greece, it medicine was only father to son, it was close to women. It was totally a male and very highly prestigious profession. And somehow, medical doctors would only tell it to their sons, nobody else saw it was a very noble profession, but only it was kept in some noble families, poor creators when he started to work as a medical doctor who was also a son of a medical doctor 30s said, being a medical doctor is so important, it can't be kept only in the family, I am ready to teach everything I know, to the boys who have virtue ethics. So I already said the two big revolutions that Hippocrates did what a he's known as the father of medical education, because he started to teach everything he knows to the people from public. And second, he said this philosophy of virtue ethics, what does it mean? He said, being a medical doctor is something so special, we can't just accept anybody, I will only accept the boys who have virtue ethics. Virtue ethics means positive, good characteristic traits. People expect very good characteristic traits from medical doctors, they should be hardworking, they should be sound, they should be trustworthy, etc, right? We don't expect bad habits from medical doctors. So these rules were also set up by Hippocrates and then he did one more thing and he said, Okay, before they start their practice, as a medical doctor, they should give a pledge which is called Hippocratic Oath. He said at the end of these years before they start their clinical practice their profession, they should give a pledge to the community that they will be totally respecting some rules which was totally unknown before No doctor before you Procrit is told of these ethical rules. So Hippocrates is no no also is the father of medical ethics. And then in this Hippocratic Oath, he said this very important medical ethics rule, which is still the basic norm of medical ethics in the whole world. He said, Whatever you do, as a medical doctor first do not harm in Latin. It's called Peter mon No, no setup. It is a very basic principle, we still see and recognize the first rule of Hippocratic Oath is the main rule of medical ethics, which is first do not harm. And then he started to write everything he has seen about his patients like the diagnosis, the Treatment and prognosis, he started to write in seven books actually, he didn't really write the seven books himself, but his pupils his students continued and completed the seven books, which totally this collection is called Corporal supercritical, which is the first time in the medical history. He started medical recording, he is the father of Operational Medicine, he is the father of secure medicine, because anti Democritus and we are talking about 400 PC, let me emphasize again, there are gods and goddesses right people worship gods and goddesses. And sickness was taken as the spell or the punishment of gods and goddesses like for some diseases, they were thinking of this as the punishment of the goddess of sun, or for other sicknesses. This is the punishment of the gods of moon, etc, totally irrational, and the last kind of Call of help, or forgiveness from these gods and goddesses. They were making the patient sit down and opening a hole on the skull, with a stone implement without anesthesia. Can you believe they are they were opening a hole without anesthesia on the skull of this patient, thinking from this hole, this bad spirit, this punishment would leave the body of this patient. So what happens to these people, of course, 90% died, right. And they were thinking how this person was, it was such a big sinner, he or she made such a big thing. Of course, the gods and goddesses did not forgive. But sometimes these patients survived, of course, with a big complication, semi paralyzed tetraplegic, when your arms do not work anymore, your legs do not work anymore. And the lightest, the simplest side effect would be these people hit epilepsy. Right? Now we know about Epilepsy Center illogical disease. And these patients who could survive afterwards, they're taken as holy patients, because I see. Now these patients were forgiven by gods and goddesses. Now, they are holy patients, and they should look after them until they die. And Hippocrates, for the first time said, these epileptic patients are not holy patients. And these diseases are not due to dispels of gods and goddesses. Diseases are natural processes with natural reasons. These people are epileptic because you open a hole on their skull. So his theory was totally based on cause and result, which was very new to the medical world. So he's also known as the father of secured medicine, for all these evolutionary acts, all these contributions he made to the medical world, he became such an authority that nobody really tried to challenge his humoral theory.

Nicholas Hill  18:46  
Let's pause there for a second. So Hippocrates is the father of medicine. And he got a lot of things. Right. Right. You just heard Dr. Elf talking about, you know, the father of rational medicine, the father of secular medicine, the father of medical ethics, and all of these things made him famous as an expert. So nobody questioned this expertise, when he got a few very big things wrong. And one of the things he got wrong, what Dr. Semmelweis would have to fight against was called humoral theory, or humoral ism. To teach us more about humoral ism. And for another perspective on Dr. Assemble vices life. Let's hear from Dr. Leslie Leighton, medical historian and instructor for the Department of History at Georgia State University.

Dr. Leslie Leighton  19:41  
At that time, certainly during the Middle Ages, and this dates back to the poverties was the humoral theory of disease that there were certain humors in the body, good humors and bad humors, black bile, yellow bile, etc. That would predict a person's health so if you had a certain Out of a certain Umer, you might have good health and a certain amount of a bad human or you might have poor health. So that was the prevailing theory of medicine, right up until about the 1800s, right at the beginning of the 1800s.

Nicholas Hill  20:15  
So this is the incorrect theory that Hippocrates has come up with and Dr. Eel of gives us a little bit more background on why he was so gung ho, about this being correct.

Dr. Elif  20:28  
humoral theory was based on actually this other very famous Greek philosopher called Emperador Klis. An input Emperador clays, was the favorite philosopher of Hippocrates. And podocarpus founded his philosophy theory based on four elements, he taught everything in the universe are composed of four elements such as fire, earth, water, and air. Then Hippocrates, liking the four element theory of doctors so much, he also explained it in our body, also, for liquids exist, flagging it is this bit liquid that we see in our head, in the brain or knows everything. And then blood, black bile, yellow bile. So what he did actually, he classified these liquids for liquids. He classified these four liquids with these four elements. And also he classified all these organs, according to these four liquids and these four elements.

Nicholas Hill  21:38  
So that's humoral theory. In your body, you have four humors, or liquids blood, phlegm, black bile, yellow bile, and if any of these liquids is out of whack, you need to get it back under control. So for example, if they think that you have too much blood, then they're going to take some away.

Dr. Elif  21:56  
But isolating was one of the very important also treatments in corporate supercritical they liked. Also, to clean the bubble a lot.

Nicholas Hill  22:06  
Other treatments they would use to get your bodily fluids back and check would be to make you sweat make up make you vomit, put liquids up your butt with enemas, and put pieces of thread into your skin using a needle. The idea was to leave this thread in for a few days until pus would form which they believed was bad fluids leaving the body. The other common way they would treat disease, according to humoral theory is by trying to treat like with like, so depending on what organ was sick, that would determine your treatment.

Dr. Elif  22:41  
For brain diseases, for example, he would recommend walnuts or for example, for simply he would recommend breakbeat for the stomach diseases, for example, he uses means a lot. But the main philosophy is that you the similars, treat similars.

Nicholas Hill  23:01  
So we're treating brains with walnuts because they look like we're treating spleen with red beat for the same reason. We're taking out people's blood because we think there's too much of it. And just so you know, listeners, none of it is correct.

Dr. Elif  23:15  
They had no idea how our buddy works. He didn't have today's medical understanding or scientific understanding. He had no idea.

Nicholas Hill  23:25  
So that's a history of humoral theory, and it is still the number one method of thinking about disease and treatment. When Ignaz Semmelweis gets to medical school 2000 years later, this way of thinking would become a huge pain for Semmelweis to overcome. So let's get back to some advice. And maybe we can start by understanding who this man was. Here's Dr. Leighton 

Dr. Leslie Leighton  23:54  
Weiss was born in 1818, to a fairly prominent Jewish family. In Buddha, none of them were doctors, they were grocers. He actually started off wanting to become a lawyer, but then switched to medicine and internal medicine and surgery with a preeminent fields at the time. And for a variety of reasons. I don't know how good a medical student he was, he might have been a very good one, maybe not. He was denied an internship or what we consider today residency in Internal Medicine, and had to settle for obstetrics and gynaecology, as it was back then.

Nicholas Hill  24:34  
So Semmelweis settles for obstetrics, but he also has a sublime experience that makes him fall in love with a specialty when he works on a condition called the transverse lie. Now a transverse lie describes when the fetus is rotated 90 degrees inside the womb. If it can't be rotated back correctly, it can cause death for both the mother and the child. So the opposite attrition has to expertly rotate the fetus back, which not only takes skilled effort to do, but when it's done correctly, it saves the lives of the mother and the child. So for Semmelweis, seeing this specific medical technique directly saving lives was the experience that energized him and made him love practicing medicine. And ultimately, it's why he does end up loving obstetrics as his niche. So Semmelweis applies for a two year assistantship, under the head of the obstetrics department, Johan Klein.

Dr. Leslie Leighton  25:36  
So he applied to Vienna now he was Hungarian and Jewish, and those were two strikes against him in Vienna. At the time, there was a lot of anti semitism, but because of his credentials, he was accepted by a Klein, who was the supervising physician at the Vienna General Hospital, obstetrics clinic for a cheap residency, which he did.

Nicholas Hill  26:00  
Now, as you just heard, Semmelweis is accepted, but the assistant position is actually taken at the time. So Semmelweis has to wait two years before he can start. But instead of just waiting around for two years, he volunteers his time trying to find the answer to a disease that's been bothering him since he took up the field, child bed fever, it came up all the time, there was nothing he could do to treat it, and he just had to watch his patients die again and again, and Semmelweis is sick of it. So he gets to work. He starts performing autopsies on hundreds of child bed fever victims, he learns a ridiculous amount about how the disease manifests in different patients, and really becomes an expert in it. He also spends that time taking courses in logic and statistics, and learns valuable methods of using data to test and answer medical questions. Remember, this was all new at the time. Semmelweis uses this new knowledge of statistics to study child bed fever mortality rates, spanning the department's entire existence. And while he's doing this, he notices that Johan Klein's predecessor, now remember, this is his future bosses predecessor, a doctor burrower was massively successful at reducing mortality rates. In fact, Dr. burrowers cumulative mortality rate over 33 years was just 1%. When everywhere else in Europe, it was closer to 15%. So Semmelweis takes notice, he starts learning everything he can about how Dr. Bower treats his patients. He learns that Dr. Bowers stressed healthy diets fresh air, exercise and normal activities as the late end of the pregnancy as possible. Dr. Voer completely eliminated treatments like bloodletting of expectant women from his practice entirely. But something that really stood out was that Dr. Bowe er refused to allow his medical students to work with cadavers. Instead, they worked with mannequins to teach the mechanics of delivery. Now, what's funny is that this is actually why Dr. Bower gets fired. The Ministry of Education requires cadavers to be used in the medical curriculum. They require students to work in the morgue dissecting the dead as part of their average work day. But Dr. Blower refuses to allow his students to do this, since they're also working with expectant mothers and he's let go due to insubordination. Now, you might not be surprised to hear that after 33 years of near perfect success, the second Dr. Bauer has let go, mortality rates for mothers skyrocket by 800%. Under the same department, that Semmelweis is now applying to join under the head that he's applying to assist. So this is the first clue that something to do with cadavers is having a negative effect on mortality rates and child bed fever, but nobody has quite put it together yet. The second clue happens later in 1839. The obstetrics department of the hospital is divided into two wards, Ward one and Ward two. If you're a patient that goes to ward one, a doctor is going to assist with your delivery. If you're a patient that goes to ward to a midwife will assist with your delivery. And watch Ward you go to watch Ward you're admitted to that alternates between the two wards on a daily basis, pretty much at random just by the time of day. But something crazy starts to unfurl. women that are admitted to ward one are dying at three times the rate of women admitted to ward two. And the women knew about this so Suddenly, none of the women want to get admitted to ward one. Here's Dr. Leslie.

Dr. Justin Lessler  30:06  
It's not like no one knew about it, right, like women would come and depending on the time of day or the day you showed up, the ward you got assigned to would differ. So women would show up to try to get assigned to ward number two, and be in the halls begging to get admitted to that Ward and not go over I think the time was 4pm and get sent to the doctor's ward where survival was a lot less. And just to give a sense exactly how bad it was when similar mice compared death rates in Word number one, to death rates of women who would deliver on the street, deaths were higher and work number one,

Dr. Leslie Leighton  30:43  
these medical schools needed clinical material. And in order to get clinical material, sometimes they paid people to come into the hospital. Now back during satellites, before the discovery before handwashing, women did not want to go to the hospital to deliver it was safer to deliver in the streets than in the hospital. And they certainly didn't want to go to clinic a they begged to go to clinic B or they would stay home or they would deliver in the streets many of the prostitutes would deliver in the street to avoid the hospital.

Nicholas Hill  31:17  
This is crazy, right? The wards are right next to one another at the same hospital. But women would rather give birth in the streets, then go to ward one. And that's the one with the doctors. So why the difference? Now, if you've ever studied the scientific method, you know that this is a perfect example of a randomized experiment. And it falls right into Semmelweis his lap cymbal vise becomes obsessed with discovering why the women in his ward the doctors Ward Ward one are dying at a higher rate such a high rate compared to the women in Ward two, the midwives Ward and Semmelweis tries a lot to figure it out.

Dr. Justin Lessler  32:02  
Yeah, he tried a lot of things because we gotta remember, there's no germ theory now, right? There's no germ theory of infectious disease. And so the thoughts were like, Oh, the male doctors must be offending the sensibilities of the women. Some examples, things that were tried were one the priest, when somebody died, a priest would walk through the ward one ringing a bell on their way to do the services, and says, One thought was, oh, that was just scaring the bejesus out of the women and that was causing it so he said, Okay, Priest, don't walk through anymore didn't make a difference. On in the more than one women usually delivered on their backs and a more to women usually delivered on the side. So you had women lay on their side and more one to deliver no difference.

Nicholas Hill  32:51  
Semmelweis starts observing everything, he notices that women with shorter labor times experience less risk of child bed fever. In fact, if Labour lasts more than 24 hours, it's nearly guaranteed that they'll contract child bed fever. He notices that women who deliver at home and then come to the hospital for post care also have a much lower risk. Now that apartment head Johan Klein has plenty of perfectly reasonable explanations for the differences in deaths, including cosmic forces, guilt due to pregnancy out of wedlock, depression, wearing tight petticoats, and symbol vices rejecting his boss's ideas left and right, because if any of that were true, Ward one and Ward two wouldn't see any differences, because the patients are being assigned at random. If it was the weather, the wind, the lack of ventilation, poor nutrition, any of these reasons, it would affect both wards equally. The patients are from the same places with the same economic statuses the same traits entirely across these two wards. And Semmelweis is starting to get really frustrated.

Dr. Elif  34:03  
This really made Semmelweis mad because he was thinking, What is the reason why child bed fever was a very common disease. But here in this clinic that I am working, be medical doctors are the ones with better education. We are the ones who know medical knowledge, but in the second clinic, these midwives have better results.

Nicholas Hill  34:25  
Now some of us did notice one thing. Remember, Ward one was made up of doctors and medical students? Well, these medical students were also performing daily cadaver dissections in the morgue. But the student midwives in Ward two never worked with cadavers. Now Semmelweis did note this fact, but he didn't go so far as to pin this as the cause. It would take one more big clue to turn his attention on to this for good this clue would present itself As the result of a tragedy, when Dr. Semmelweis his friend and colleague, Dr. Jacob Colette Chica has an incident at the morgue.

Dr. Justin Lessler  35:10  
The breakthrough happened when he actually had gone on vacation and a friend of his was doing a procedure and pricked himself. I think it was a dissection of a cadaver and pricked himself.

Nicholas Hill  35:22  
Symbol vices friend, Dr. Jacob Collette Chica is in the morgue doing an autopsy with some of his students, when one of them accidentally pokes the professor with a scalpel. The cut is small, and initially there seems no cause for concern. But soon koletzko starts to feel sick. He starts noticing red streaks coursing up his arm, then comes fever, then confusion, then coma, then death. Symbol vice is completely taken by this

Dr. Justin Lessler  35:57  
symbolizes realized that the symptoms that Jacob had, were almost identical to the symptoms he was seeing in the women. And that's what led him to make the logical leap.

Nicholas Hill  36:12  
So Semmelweis realizes that whatever happened to his friend in the morgue, something about being pricked with that needle, caused his friend to get sick in the exact same progression as child bed fever victims. He knew the two were related. Similar vice later wrote about this in his journal.

Peter Szocs (Voiceover)  36:31  
Then I did this picture of college because this is pursued me and with ever increasing determination, I was obliged to acknowledge the identify of the disease from which college kid died, with the disease of which I saw so many others that have tried that fever.

Nicholas Hill  36:49  
Semmelweis performs the autopsy himself. Which, how weird is that right to do an autopsy on your friend? Is that just something doctors are cool with? Also, while I was reading this, I found out that obstetricians consider it an honor when a fellow doctor asks them to deliver their wife's baby, but I just feel like that's kind of weird to anyway, Semmelweis performs the autopsy himself. And what he finds is astounding caleche because death followed the exact same progression, and the autopsy showed the exact same findings as the hundreds of mothers who Semmelweis himself had autopsied after they died of child bed fever. This is when Semmelweis sees the answer, clearly,

Dr. Justin Lessler  37:37  
oh, what's happening here is all of the doctors in Ward one, they're going and doing dissections of cadavers as part of their training, and then coming and delivering women and they're not washing their hands. And his theory was that they were bringing what he would call cadaverous particles in two wars one, and that was infecting the women and leading to their death.

Nicholas Hill  38:07  
Both Colette Erica, and the victims of child bed fever have one thing in common. Both of them have open wounds that have come into contact with particles from dead bodies. For Colette Chica. It was the cut on his finger for the hundreds of women that Semmelweis autopsied after dying of child bed fever, it was during their pelvic exams or delivery. This explains everything. It explains why the patients in Ward two didn't suffer the same rates of infection as in Ward one.

Dr. Leslie Leighton  38:43  
It was the practitioners in the two clinics, who's working in a and who's working in B. And a, you had physicians and residents and stuff. And they were working, but they also went to the morgue, and they did autopsies. The people who worked in clinic B, they didn't go do autopsies. They were midwives had nothing to do with the morgue. And those people were not getting sick. And that's how he was able to figure out that it was actually the physicians working in clinic a that actually transmitted the disease to their patients. And then when his friend, the pathologist died of a very similar illness to purple fever, he realized that it was the doctors that were transmitting the disease were in clinic be the nurse midwives are not.

Nicholas Hill  39:32  
Semmelweis is now completely convinced, and he proclaims for the first time what would be his lifelong mantra. Child bed fever is caused by decomposed particles getting into the body. This can happen when things like a doctor's hand, dirty linens, or even the air infect a woman after or during childbirth. Once these particles are in the body, they cause inflammation in the areas where The woman has been injured. Now if the woman has a strong immune system, she can recover on her own. But if she has a severe injury from childbirth, the particles can get into her bloodstream. This spreads through her body and ultimately causes death. Symbol vice proclaims that particles from cadavers carried on the hands of doctors and medical students are responsible for the high rates of child bed fever and maternal mortality. Now think about what it means for him to say that it means coming to terms with questions like how many times have I gone from the morgue to the maternity ward? How many women have I caused the deaths of in my career,

Dr. Justin Lessler  40:47  
it was a big leap for him to realize this because he wasn't just saying, oh, other doctors were doing this thing and killing women. She was doing it and he realized that he was doing it and was very taken aback by it. And one of the things he said is in consequence of my conviction, I must affirm that only God knows the number of patients who went prematurely to their graves because of me,

Nicholas Hill  41:11  
symbol vise writes about grappling with this dilemma.

Peter Szocs (Voiceover)  41:15  
My conscience tells me that I must reprove myself, as God only knows the number of those who have died as a result of my activity. Few of the obstetricians have had more dealings with cadavers than myself, however, painful and distressing this fact is, there will be no sense in denying it. Now, there is one remedy already to publish the truth to all those who are concerned.

Nicholas Hill  41:42  
So Semmelweis becomes intent on stopping these particles from spreading in his department. He meets with his boss Johan Klein, he explains his theory and his solution. His solution is to use mandatory hand washing to drastically reduce the mortality of child bed fever. He recommends to Klein that all personnel wash with a chlorine solution before any operation and before any patient contact. Now, Klein doesn't agree with the reasoning. But to his credit, he does agree to the recommendations. Semmelweis implements a new department wide policy. Anyone who works with or around cadavers must wash their hands in a chlorine solution, using a brush underneath their fingernails until all odor is completely gone. This includes faculty, nurses, students, even custodians.

Dr. Justin Lessler  42:39  
Yeah. So he basically put a bucket of chlorine based disinfectant between the two wards and insisted that all of the doctors who came from dissections to go to the delivery ward had to wash their hands with the equivalent of a diluted bleach situation. And he was militant about it, he would sit and he would smell people's hands, to make sure that they were actually clean. And if there was any scent of what he called cadaverous material and the scent of death on the hands, he would send them back, make them close your hands again. And it worked.

Nicholas Hill  43:22  
It really worked. The program went into effect in May, in April, the mortality rate was 18%. In May, it was 12%. In June, it's 2%. And in August, it's zero, not one infection of child bed fever, his entire department mortality rate sinks to 1%. And for the first time ever, the death rates in Ward two exceeded those in Ward one. What Semmelweis had observed at the bedside, his autopsy experience his compilation of statistics caleche, because, unfortunately serendipitous death, Semmelweis had taken all of these unrelated facts and events and formed them into one cohesive theory. And even though other doctors at the time, were starting to come to similar conclusions about child bed fever. It was really only Semmelweis, who was able to gather all of the disparate parts of the puzzle into one theory. He had solved an enigma that had frustrated some of the best minds in medicine for nearly a century. But then the question became, can he convince his colleagues? Can he convince them one, that it is their fault that these women are dying all around them at insanely high rates, and to that this has nothing to do with humors or bodily fluids or bad air or delicate sensibilities or type petticoats? How can Semmelweis change existing medical thinking? And it turns out, there are a lot of problems with Semmelweis trying to convince the medical community of his theory.

Dr. Justin Lessler  45:13  
There were so many problems. Semmelweis was not the right person to be sending this message, in a lot of ways. So just to be clear, when he first made the claim, his friends and the people who he first presented it to, they thought it was brilliant. They were all behind it, and urged him to write it up, because they were all part of the new School of Medicine, and they were experimentalists and stuff. But Semmelweis refused to write it up. It wasn't until he wrote etiology of child bed fever, a decade or so later that he actually wrote this up. So he wasn't writing it up in scientific journals and didn't like presenting it.

Dr. Leslie Leighton  46:01  
He never really published what he found. It wasn't until 1861, that he wrote a book about his findings on purple fever. But much of the evidence about purple fever that he discovered came out in other people's writings and other people's lectures. And because he didn't come forward, he was somewhat disdained in terms of how people felt about him.

Dr. Justin Lessler  46:26  
And that meant one that people who were presenting it didn't fully understand his theory, because this theory of cadaverous particles was radical. It didn't fit with the theories of the time where we're like, why asthma or the air could lead to sickness, and really put people off is he was claiming a sole cause. So he was saying, not just, Oh, these cadavers, particles cause it, but they are the sole cause. And they don't just come from corpses. They come from other people who are sick with this. And that's one of the things that when people understood it, they rejected it altogether. They're like, we're willing to believe that maybe this is something that happens, but you're saying it is a sole cause. And then the other thing is that some advice is an outsider, in a lot of ways, right? He was a Hungarian nationalist, to the extent that when he started his training, he would wear Hungarian nationalist costumes to go to work. This did not rub for the right way. This is Rob looks around. And t's not a member of the medical establishment, right. He's part of this new guard of younger people who are advocating for scientific approach to medicine, and the old guard was not having it and they thought, This is ridiculous. The folks who control the abstract Cedric swore they were old god,

Dr. Elif  48:07  
these medical scholars, his colleagues resisted his suggestion very badly. He can just think that are they were very happy. No, they weren't. A leaving a very long lasting tradition was very difficult. And they say, What are you talking about? Are our hands dirty? How can you claim How can you accuse medical doctors, they speak authorities by having dirty hands. So they resisted to implement this hand washing protocol into their clinical practice. This was very difficult for them otherwise. And he very soon also developed some enemies. People were talking about him making gossip in the hospital, and he was abandoned, I must say

Dr. Leslie Leighton  48:57  
that obstetrician at the time, very famous individual named Charles Maga said that physicians are gentleman and gentleman have clean hands, so they don't need to wash their hands.

Nicholas Hill  49:11  
Semmelweis formally addresses the Society of physicians on the origin of child bed fever. He demonstrates how after 1822, which was the year that Klein his boss took over, nearly one out of every two patients died of child bed fever. Talk about throwing your boss under the bus right? He went in front of a medical group and said when my boss took over half the women started dying. But Semmelweis explains his theory, and he shows his evidence, and His address is actually well received. But as our guests have already pointed out, Semmelweis had not bothered to prepare any formal written notes or write down anything at all. And he says that every case of child bed fever without exception happens because of decomposing matter, and it's completely unheard of, for someone to say that a single cause is enough to cause a disease. That was just too revolutionary and the old guard of the medical community just couldn't accept it. How could some invisible single contaminant be the cause of it all? There was also the fact that if this were true, it would mean the doctors everywhere were responsible for spreading a horrible disease and killing 1000s of women across the world. So Semmelweis, this theory splits the medical community and parents to the new School of Medicine get on board of Semmelweis immediately. You have people like Ferdinand von Hebron, the founder of modern dermatology, he considers similar vices discovery to be so urgent that he personally gets in front of Vienna Society of physicians. He writes articles he gives addresses. He compares Semmelweis to the work of Edward Jenner, the man who created the smallpox vaccine, but the old school adherence, they remain unconvinced. And this whole thing becomes very political, to the point where faculty at similar vices hospital start taking sides on it.

Dr. Leslie Leighton  51:06  
These are things that are very hard to change. And it takes a while and it takes proof and it takes the people who are in positions of authority, not Semmelweis, who was an assistant instructor or whatever he was the you need the chiefs of like maybe Johan Klein, or Charles Maggs to come out and say, This is what's happening and and to change these existing paradigms. I think it was a little bit of his personality that probably was a little bit of his background. Here's a Jewish Hungarian, that's telling me the chairman of Obstetrics and Gynecology at Vienna General Hospital, the premier hospital in Europe, that I'm wrong, and how dare him say I'm wrong.

Nicholas Hill  51:52  
So tensions are mounting. And to make matters worse, there isn't just a medical revolution happening. There's an actual revolution happening right outside of the hospital across Vienna. The public wants greater personal freedoms, and all of the students are pretty actively involved in this revolution. Now, as Dr. Leslie mentioned earlier, Semmelweis starts actively supporting his students in their revolt. He starts lecturing to students while wearing the freedom uniform of the academic Legion, which is boss, Johan Klein, an old school adherent hates that he does, and then later, the Austrian Empire launches this counter revolution. They take the inner back, the pendulum of power swings inevitably back to the old school adherence. And now it's really bad that Semmelweis has been openly supporting this revolt that failed, and that his own boss actively supported.

Dr. Leslie Leighton  52:51  
Klein Johan Klein was conservative Austrian, believed in the absolute authority of the Austrian government. He was not a Hungarian a file, he was not enamored with the Hungarians, there was a lot of tension there. The Austrian empire eventually put down the Hungarian Revolution and Austria Hungary remained the entity at that time. So Hungarians in the Austrian Empire, Vienna being the capital, we're not regarded Well, there are some political issues that probably prevented him from being promoted, at least in Vienna.

Nicholas Hill  53:29  
Then something else happens another famous New School inherent Joseph Skoda jumps on board with Semmelweis. Now, this guy is famous for if you're ever at the doctor and they tap on your stomach, and they're listening to it with a stethoscope while they tap on it. So that's basically a form of percussion. And Yosef Skoda was the guy who really brought percussive diagnosis to the forefront. He jumps on board with Semmelweis. Almost immediately, he starts teaching similar vices discovery in his classes, accenting his use of statistics and logic to reach his conclusions. Skoda also recommends that the Vienna medical faculty appoint a formal commission to study all aspects of child bed fever, and he recommends several people to be appointed to this commission, but he does not recommend the head of the department. Semmelweis his boss, Johan Klein. So, finally, Klein has had enough, the fact that the godfathers of the new school have all started to celebrate Semmelweis and the fact that Semmelweis is actively supporting political revolution that he is against, and the fact that some of ISIS Aryan clients terrible mortality, statistics and public and now Klein has been excluded from a committee studying the cause of a disease for a department that he is the head of. He's just had enough. So Kline open Lead declares war on this committee. He appeals to the deputy director who's also an old school adherent, and the committee has shut down before it ever meets. And then when Semmelweis his two year assistantship ends, Klein refuses to offer him another term, effectively firing him. Now the medical community gets mad at Klein for firing Semmelweis. And they start some name calling right. There's a doctor who calls Klein a mediocre practitioner, raised to his position through influential friends rather than on professional merit. And another says Professor Klein has thrown back by at least 20 years, the advance of one of the greatest achievements of the century. But Klein is undeterred. And to add insult to injury, Klein offers some advice, a low ranking unpaid position that would not allow some of us to have any patient contact at all, and only work with mannequins. For Semmelweis. This is a worse insult than just being fired. So he gathers his belongings and he leaves Vienna for good. Going back to practice medicine in his hometown of Budapest.

Dr. Leslie Leighton  56:10  
He wanted to stay as a docent at the university there and he was given that position but only to work on mannequins not to work on people. So he abruptly left he went to the University of past where he became a head of obstetrics at a small hospital, he continued to do and preach what he had done in Vienna, and very much to the to the improvement of health for women in the past and that area,

Dr. Elif  56:40  
after being fired from this Vienna General Hospital by this professor Klein, then he went to past and it started in a different clinic with a more smaller clinic and as a chief doctor with a very underpaid position. But at least he felt they are more free and started to, again use chloride and in his clinic, his results were fantastic.

Nicholas Hill  57:05  
So Semmelweis is saving lives in Budapest, but the move did a lot of harm to his career and his reputation. See, Vienna was a hotspot of medical advancement, and Budapest was considered kind of the back country of medicine. And because of civil vices rash decision to leave Vienna, his adversary started calling him the full of Budapest, and his supporters were upset to some of us had run away while they were actively putting their careers on the line for him. So he was seen as ungrateful and especially because the data showed unequivocally that he was right. It was only a matter of time before he overcame his adversaries. So why run? The answer, according to a lot of biographers is that this is the beginning of similar vices battle with mental illness. And the move to Budapest trigger something that would lead Semmelweis down a very dark path. See, Semmelweis feels exiled in Budapest. He wants to go back to Vienna, but his pride won't let him. He starts helping hospitals in the area pro bono, investigating epidemics of child bed fever, inevitably finding out that somebody somewhere was working with dead tissue and implementing his chlorine washed rituals to stop the spread. While mortality rates in Vienna and Prague were running between 10 and 15%, Semmelweis over in Budapest was at less than one. But despite his success, his personal life begins to take a toll. His mental health starts to decline. His mother and father passed away, his free flow of cash dries up, and he can no longer afford to offer pro bono services. Now, it isn't all bad. Symbol vise does get married during this time to a woman named Maria, daughter of a prosperous Hungarian merchant. They have a son who passes away and a daughter who also passes away, but they have three more children who are healthy and happy and all three survive into adulthood. For Semmelweis, Family Life provides an escape of sorts from the politics of medicine. But between the additional responsibilities of a family, the exhaustion of fighting off his adversaries, his research and the literal revolutionary war going on around him, he isn't exactly in a stress free environment. And his personality begins to shift.

Dr. Justin Lessler  59:35  
I think the opposition and everything he fought because he was fighting the establishment for a long time. He lost his job multiple times. And if you look at the accounts of his life, when he's young to subscribe is really likable and stuff. But by the time he's been fighting child bed fever for decades, keys embittered, he's angry. He wants I accept any criticism at all, and just is always itching for a fight.

Nicholas Hill  1:00:07  
According to his friends and family, Semmelweis becomes more serious, he loses his sense of humor, and things begin to go downhill at work. He loses his lecture hall and is reduced to lecturing students in hallways and corridors. His new staff becomes passive aggressive with his overbearing cleaning regimens, and so he has to start micromanaging his image evolves into an impatient and demanding overseer, people start calling him an eccentric fattest. Now, I should point out that everything he's doing is still working miraculously. In fact, out of 514 births and his new post, there are only two deaths, which is basically unheard of. But even with this continuous evidence, editors and medical journals are attacking his theory left and right, telling medical practitioners to outright ignore his advice of chlorine washings. Some advice becomes more and more heated, and his confrontational methods of problem solving go from being something that happens once in a while to something that happens all the time. His reputation gets so bad that when his old boss Klein finally passes away, some advice isn't even considered as a replacement. The job goes to another old school inherent, someone Semmelweis hates named Carl Braun. Carl basically become similar vices sore nemesis, he publicly refers to Semmelweis his theory as all humbug when lecturing to students. But as he sees his own clinic mortality rates rise, called bronze jealousy and resentment of Semmelweis grows stronger, he wouldn't admit defeat for another 30 years. Meanwhile, some of the top medical communities in the world are continuing to meet to figure out what can we do about child bed fever, which is so infuriating to me. And after seven months, their solution is who knows, maybe we should build smaller hospitals. Even though Semmelweis had been proving his regiments worked for 10 years at that point, women and their newborns are still dying unnecessarily at unacceptably high rates for no reason at all. So whenever they come out with this solution of let's just tried to build smaller hospitals, Semmelweis goes on the full offensive. He delivers an address to the medical society of Budapest, and he does a great job. It's the most rational and concise exposition of his doctrine to date, and this time he brings notes, but the attendees at the session notice something else too. Semmelweis cannot tolerate criticism. In fact, any adverse comments even innocent questions about his theory are met with hostility. Faculty members begin describing him as hypercritical and intolerable he becomes more and more eccentric, too. He starts dressing in weird clothing, colors and styles, his mood starts swinging wildly and randomly from depression to mania. Similar vices data show that he is right, but nobody wants to admit it. In fact, one professor a professor Deedle noticed on his hospital tours that everyone across Europe has been secretly incorporating similar vices chlorine wash regiment, and avoiding cadavers before examinations, even while they're publicly denying that similar vices Correct. Semmelweis then writes a full book on his offensive, the ideology, the concept and the prophylaxis of child bed fever. He explains his reasoning for writing the book in the introduction, to spread his doctrine to all teachers of midwifery.

Peter Szocs (Voiceover)  1:03:53  
Until all who practice medicine down to the last village doctor and the last village midwife may act according to its principles to banish the error from the lying in hospitals to preserve the value to the husband, the mother to the child. indignation at the greenness of this candle has thrust the pen into my unveiling hand.

Nicholas Hill  1:04:15  
So feeling that he has no other recourse Semmelweis writes this theory into a book, and it's way too wordy, completely disorganized, rambling, constantly repeating itself. biographers would later describe it as a copy editors nightmare. He would often interrupt his own arguments to attack critics or discuss other topics. But he did make the arguments he intended. And he triples down on his statement that all cases of child bed fever are due to a single phenomenon, the resorption of decaying animal organic matter. Now, by the way, we would later figure out that this was because of bacteria, but as we mentioned earlier, they didn't know that yet, Semmelweis presented dataset after dataset, proving that he was correct.

Peter Szocs (Voiceover)  1:05:07  
As living proof of my doctrine, I decrease childbirth fever mortality rates in three different hospitals by utilizing my regimen. Whoever practices this prophylaxis will experience the pleasure that from time to time to lose every third of every fourth patient from childbirth fever, but perhaps to lose only one in 400.

Nicholas Hill  1:05:30  
But the last section of his book is, in my opinion, hilarious. It is called correspondence and opinions in the literature for and against my doctrine. Symbol vise calls out everyone who has ever critiqued his theory, every argument that has ever been raised against him, and soundly destroys them one by one for 200 pages, and his anger is palpable. For example, for the section on Dr. William skin Czone, the most famous obstetrician at the time, and nearly universally loved Semmelweis starts by saying, skin Czone you are a miserable failure.

Peter Szocs (Voiceover)  1:06:15  
Scans only believes in better, but others not one syllable as to how one can prevent or destroyed. This reflects his selflessness in writing about things he does not understand. Naturally, one cannot have much positive understanding of that which does not exist. No patients have died of child bed fever as a result of emotional disturbances of mistakes in diet, or have better

Nicholas Hill  1:06:43  
his attack on skin. Czone goes for 103 pages. Next he attacks a Dr. Hoff wrath

Peter Szocs (Voiceover)  1:06:51  
had her hat on you're successful observer of my doctrine in private and my adversary orally in public. You build your greatness up on the stupefaction of those unfortunate patients who will be ground bound in death by those whom you have made stupid, you will not escape God's justice.

Nicholas Hill  1:07:12  
Next comes his attack on Dr. Virtue out a highly respected international figure in medicine. Now virtual was used to polite argumentation. But Semmelweis writes

Peter Szocs (Voiceover)  1:07:24  
the medical among surgeons and 823 female students who have been trained by me as midwives would love to be a chore if he were to lecture them on child bed fever.

Nicholas Hill  1:07:35  
Finally, he attacks his nemesis, the man who took his old boss's place, the man who replaced him as assistant of obstetrics at Vienna hospital. After his unsightly departure, Carl Braun. Semmelweis devotes over 40 pages to Dr. Braun.

Peter Szocs (Voiceover)  1:07:55  
He says a slash city things and what harm we are the students so badly towed by car brown due out in practice, they will go out into the public as trained inspectors. If Brown does not believe that the cadaver is the source of infection. Why does he asked his students not to examine patients on the same day they have had contact with a cadaver. It is curious that Raul has no trouble attacking the theory, while at the same time he exercises precautions against the infection. We give therefore, our Vienna colleague why we beat him farewell the cogent advice, not to neglect the take some semesters of logic as soon as possible.

Nicholas Hill  1:08:41  
Semmelweis then presents table after table of statistics to destroy bronze arguments. At the end of the book, Semmelweis envisions a happy future in which child bed fever would finally be conquered. And as a final farewell to his haters, he says,

Peter Szocs (Voiceover)  1:09:00  
Anyone who cannot establish the truth has proven his own incompetency.

Nicholas Hill  1:09:06  
Now, as you can imagine, this is not normal behavior for a medical textbook. And despite the fact that he's included so much evidence in his favor, the book doesn't really have the effect that Semmelweis once in fact, it kind of convinces everyone that civil vices not doing very well, the writings

Dr. Justin Lessler  1:09:27  
from an evidentiary standpoint is good. It's a pretty exceptional detailed work that really goes in much more to the data and the analysis and the history of cases than we've had a chance to touch on here. So in one sense, it's a really good work, but it is very hostile to other people. It criticizes them by essentially as killers. Right and it says I am Saving lives and everybody else who doesn't subscribe to my theory and smarter not a great way to make friends.

Nicholas Hill  1:10:09  
Now after the book comes out one medical journal publishes similar vices arguments immediately saying that the discovery is one of the most significant events in modern medicine. Another doctor sin Semmelweis, a medical textbook autographed by Jenner himself, the man who created the smallpox vaccine as a mark of His unlimited respect. But all have similar vices targets, the people he attacked in the book, ignore it completely, although it's nearly guaranteed, they all read it. But ultimately, his book doesn't do much, and the inaction of the press the inaction of the obstetrics community, it kind of wounds him. I asked Dr. Leslie, what role does guilt play here? Do you think guilt had any effect on the medical community's collective decision to rebuke similar vices theory?

Dr. Justin Lessler  1:11:01  
Absolutely. I think that was a big driver, right? You're requiring people to admit that they've been wrong and then they've been causing the death of women and babies because the babies died too. For years.

Nicholas Hill  1:11:14  
Similar vices hope that people would see the truth changed to disappointment, which turned to anger. His moods became darker, minor provocations would send him into fits of rage. When he realized that his goal of spreading the word was a losing cause his mental decline quickened. He began yelling even at his supporters and friends, and were hurl extreme insults at them over the most minor things. In a later interview, his wife Maria would say that the persistent persecution had unhinged his mind. And as more of his confrontations played out in public whispers of chronic insanity began floating through the halls between his colleagues and hospital personnel, symbol vices manic writing style, his constant swings from excitement to depression. Nobody had a name for it at the time, but a few of similar vices. biographers contend that he was probably suffering from manic depressive mental illness. See, back then, the idea of mania and depression existing in the same person was unheard of. But whatever was affecting Semmelweis, it got even worse, symbol vise started writing open letters publicly to his targets.

Peter Szocs (Voiceover)  1:12:34  
There is no other course open for me except to keep watch and every man who dares spread dangerous errors regarding tribit fever be finding me an active opponent. It's murder Mercy's

Nicholas Hill  1:12:47  
his first letter was back to Dr. Hall for eth,

Peter Szocs (Voiceover)  1:12:50  
you have sent out a significant contingent of unwitting murderers into Germany. Should you continue to train your peers in the doctrine of childbirth fever? I declare before God and the world that you are a murderer and the history of childbirth fever would not be unjust if it memorializing you as a medical Nero.

Nicholas Hill  1:13:14  
His next letter was back to Dr. Scan Czone. You have

Peter Szocs (Voiceover)  1:13:18  
demonstrated that in a new hospital like yours, provided with the most modern furnishings and appliances, a good deal of our visit can be committed where the required talent exists.

Nicholas Hill  1:13:30  
And finally, in May of 1862, Semmelweis publishes what would be his last letter. This time he addresses it not to the doctors, but to the citizens of Vienna,

Peter Szocs (Voiceover)  1:13:44  
father of the family, do you know what it means to some other practitioner to your wife who needs assistance in her delivery? It is as if you are putting your life and your yet unborn child into mortal danger. And if you do not want to be a widower and if you do not want to your as yet unborn child, to be inoculated with the germ of death, and in order that your child should not lose its mother, then by with a few pellets, some chlorinated lime, put some water in it, and do not permit the practitioners to carry out any internal examination on your wife until they have washed their hands in chlorine.

Nicholas Hill  1:14:27  
The letter ends abruptly with a simple statement, continuation and conclusion to follow. But it was not to be most to read the letters were shocked. They called them hateful, disorganized, contemptible, and the work of an obsessed maniac. His critics never utter a single word and their defense. Now, we should note that while people are calling him a maniac, Semmelweis is actively contributing to about a million projects. He's teaching his act Have in University Affairs he sits on multiple committees. He directs the smallpox vaccination program. He even runs the hospital laundry service for being an unhinged maniac. He's managing kind of a lot. And by 1860, he had even started to gain the respect of his staff. His mortality rate was an unheard of 0.9%. And after viewing firsthand the direct effects of his diligence, his staff kind of grew to respect it. At the very least, they could no longer dismiss him as impractical or too cumbersome. A few times when the hospital was late in paying its employees, Semmelweis would pay them out of his own pocket to help them keep food on the table. But his decline would continue. Nearly every one of his university lectures would somehow end up being about his theories on child bed fever. His students watched with sadness as his manic periods became increasingly bizarre. At one point, he starts confronting strangers on the streets, conducting soapbox speeches in public parks, arguing passionately for his theories, he starts drinking more. And during these episodes, he would brag randomly about his wealth and possessions, a potential signal of someone in a manic phase,

Dr. Elif  1:16:18  
people were not welcoming to this new protocol. And they didn't really want to listen to him. And it really led to a very big explosion very soon. And he started to show real symptoms, real neurological symptoms. If you ask me, it was due to burn out. Major depression, he was, I think, totally depressed. But in some books, it was written that it could be due to third stage of syphilis because it's a giant ecologist, he should have met this syphilis patients a lot. He became very absent minded. By 1861. He was totally isolated. And when you talk to him about any subject, he would always turn this object to this hand washing issue and he was saying to everybody, wash your hands. Okay, wash your hands. He was showing some really insane reactions.

Dr. Justin Lessler  1:17:20  
Yeah. So it seems that some advices turn from jovial young man and to angry loner may not have just been because the world was stacked against him, that there's some thought and hypothesis that he had may have had dementia, possibly from syphilis. We don't know for sure, he's getting to the point that he is ranting and angry against everybody.

Nicholas Hill  1:17:50  
All of this ultimately comes to a head on July 13 1865, when Semmelweis and his family attend a dinner party. Now, nobody would talk about the details. But apparently Semmelweis, his behavior was extreme enough that it broke up the party prematurely and left his wife gravely concerned. One week later at a run of the mill committee meeting, Semmelweis is supposed to deliver a short address recommending the appointment of a faculty member to a new position, and an increase in salary for himself. But when it's his time to speak, he rises from his seat, walks silently up to the podium, slowly pulls out a sheet of paper, and begins to read the midwives oath, their pledge of professional conduct. After a few minutes of this, several members of the staff get up and have to help Semmelweis back to his seat. Once this event is over, a treatment team of three doctors is assigned to observe some advice and recommend next steps. The treatment team takes some advice home, they give him some sedatives and draw some blood. Through careful observation, they compile a list of his symptoms. With similar vices, confusion and passionate outbreaks worsening, the doctors become increasingly convinced that caring for him in a home setting is impossible. During a moment of clarity, Semmelweis admits to his wife Maria, that he knows something inside his head isn't right, and that he needs help. Maria's family encourages her to get him treatment. They've always referred to Semmelweis as the crazy noxee. Now, by the way, that's not C not not C, although I have no idea what it means. Ultimately, Semmelweis, his treatment team declare him to be insane. Now, I want to pause here because I should mention that this is all the official version of events, and there are some conspiracy theorists that point out some weird stuff. First, the three doctors assigned to similar vices treatment team, Professor Bilasa Janos Wagner and gatos buckeye. They are not friends of his, they did not agree with his theories. And what's weirder is that they didn't choose Dr. Marcos who was a friend of yours and worked in the same hospital to observe him. Second, some biographers point out that although Semmelweis his behavior was erratic, it definitely was not enough to be considered insane. The theory is that his colleagues considered his behavior to be intolerably embarrassing. Basically, they just wanted him gone out of the picture. And his behavior became the excuse that they needed to get rid of them, all while pretending that they were doing it for his own good. The third and final weird thing here is that they claim similar vices deteriorating mental state was an urgent matter that he needed treatment immediately. But then instead of admitting him to the closest treatment center, where the head doctor was actually familiar with some advice, they took him to one that was further away. And the conspiracy is that if they took him to the mental mental institution, his friend worked at his friend would have seen that he wasn't as unstable as they claimed, and ordered his release. But this takes us back to the official line of events. And one thing we do know is that they had to trick some of us into going to the insane asylum to begin with. They told Semmelweis that they would be traveling by train to grow Offenburg for treatment, but that they were making a brief stop and Vienna for a visit with his old friend Ferdinand Hebron at his treatment facility. Now, here's another weird thing that I noticed. One of the guys that's traveling with them to the facility is someone that Semmelweis had just fired. Why the heck was that guy there? He wasn't on the treatment team. So it's kind of odd that they would bring this stranger along, who Semmelweis had just fired to such an important family event. But anyway, they take some advice to the lower Austrian mental home, a large public insane asylum near Vienna's General Hospital. It holds 700 inmates from the mentally ill to money scammers, gamblers, bank draft forgers, basically anyone with a significant social or mental problem, who has become a burden to those around them. Semmelweis enters the facility with Hebrew, his trusted friend, he believes that he's taking a tour of the facility. As they enter an unoccupied room on this tour, a member of the staff deliberately engages Semmelweis in conversation inside the room. But the second he's distracted, they move towards the door. Semmelweis notices and he makes a quick move to join them only to be surrounded and forcibly restrained by guards. Some of I start screaming accusations and flailing wildly, which only further convinces the guards that he's insane. It takes six attendants to secure some advice in a straitjacket. Fully restrained and locked in his room. He is beaten and imprisoned in a darkened cell reserved for maniacs. Semmelweis would not be locked up for long, only 15 days after being declared insane and admitted, he would be dead. There's a lot of mystery surrounding his time in the asylum leading up to his death, but we do know a few things. We know that when the chief physician tried to visit with him the day after he was admitted, symbol vise slapped him across the face. After that there are charts for only nine of the 15 days of his stay. And it seems like they're all written at the same time by the same person, which is a little weird. But here's what we think happened a day or two after admission when they finally let him out of his straitjacket. They noticed dark spots on similar vices right forearm that appear to be gangrenous cymbal vices not given any form of treatment for this. He becomes increasingly delirious continuously lecturing on medical topics at random. And at another point he tries to jump out the window. He asks if he can take a walk in the corridors and when they tell him no, he becomes unruly until the straitjacket is put back on. He becomes short of breath, boil start to appear on his thighs and extremities. He begins to turn blue, and a large abscess appears on his chest. By that evening, just 15 days after being admitted. Dr. Semmelweis is dead.

Dr. Justin Lessler  1:24:51  
Eventually in 1865, he is committed to a mental institution and when he goes to the mental institution he is beaten by the guards as part of the intake process, and he gets sepsis and dies at the age of 47. So, probably, he's died from more or less the same thing that was killing the women. And you know, that's the sort of sad twist of fate of this whole thing.

Dr. Leslie Leighton  1:25:24  
He was beaten to death, literally developed an infection and died. And they

Dr. Elif  1:25:31  
really said point is that he was hospitalized to a mental clinic. And he died in two weeks. And according to the data we know, I always think, I hope it's not real. But there is a big kind of proof that he died due to the he was beaten in the mental clinic. So he paid a very big price. He paid it with his life actually, by saying the truth scientifically truth.

Nicholas Hill  1:26:03  
One thing that stands out to medical professionals who review some advices treatment is that when some advice was admitted on his intake physical, there is a cut on his finger. And one theory is that the cut on his finger caused a bad infection, which would mean his insanity, quote unquote, right before that could have been a mistake in case of septic psychosis, or toxic encephalopathy, and everything before that was just manic depression and a bad temper. But many of similar vices colleagues would pay their respects in writing after his death. His friend Marcos would write how unscrewed double the ways of Providence are that a man who devoted his untiring efforts to studying a disease and succeeded in saving millions of lives should have been visited by another shape of the same disease to cut short his life and extinguished his energy. It would be unfair not to speak of his upright on his stature, his feeling heart and his goodwill to men. Although his manners may not always have been smooth and balanced. Professor Semmelweis was an upright natural man, and it was impossible for him to be anything else, egotism and cringing, were equally foreign to his noble soul. He was a loyal friend. Now after similar vices death, mortality rates at his hospital, Rose 600%. A few years after his death, physicians began to admit that he was correct. His old adversary Professor space, was professional enough to finally acknowledge publicly that similar vices theory and chloride regimen were correct. In an 1864 article, he would go on to write certainly the theory would have gained more obstetricians as open friends, if in the beginning, Semmelweis had not defended his theory in a tone which no man of science had been accustomed to up to that time. But I would also venture to state unreservedly that there is no longer any obstetrician who is not deeply convinced of the correctness of simile vices views. Finally, in 1865, the famous Louis Pasteur, a chemist would discover a new world of microscopic organisms that he would find while observing the fermentation of wine. By the end of the 1880s, the theory of germs would be firmly established, and from there surgical caps masks and gloves and gowns and air purification and the isolation of infected patients would all follow. When obstetricians finally embraced the practice of antisepsis, when its benefits can no longer be denied. The group was struck with a collective guilty conscience. Semmelweis had no doubt been treated poorly. And in 1906, in a ceremony that included his wife Maria, and a host of international dignitaries. Symbol vices likeness was unveiled at the entrance to St. rochas Hospital in Budapest, where it still stands today. In a memorial speech, Otto protec, professor of pathology in Budapest said similar vices insanity was due to the strain of knowing himself in the right and not being able to convince others of it. It caused the final collapse of his moral order. Another speaker Gustaf Derner says we know today that Semmelweis belonged to us and we knew it before to but for a time, let us be quite frank about this. We had forgotten him completely. And at long last, his name is heard again. I asked our guest See what they thought of symbol vices legacy.

Dr. Justin Lessler  1:30:03  
I like to contrast some advice with Florence Nightingale. Because in many ways the things she was saying about how care was happening during the Crimean War. And what was happening in the wards there are similar to what some of us are saying about childbirth fever, and she's the radical, right. But she's an excellent writer. She comes from a well connected family and has a good media presence and she ends up changing care and founding nursing. In some of my stuff ultimately went out right like now, we recognize that this is the way things work and the actual measures he was proposing are life saving.

Dr. Leslie Leighton  1:30:52  
It's not until well after Semmelweis his death, that he's actually recognized the university in Budapest is now called the Ignaz. Semmelweis University. And so University of Health Sciences, there are statues erected to symbolize there are awards given in the name of Samurai, same thing with Jon Snow, John Snow is considered the father of epidemiology, he died relatively young, almost, I think about the same age, there's so many interesting comparisons between the two men. And in modern times, these two individuals have been recognized for the great achievements they accomplished in the areas of infectious disease and contagious diseases. But during their lifetimes, they achieved very little recognition for what they had accomplished.

Dr. Justin Lessler  1:31:40  
I think we have to acknowledge him as a revolutionary and as an exemplar of a type of thinking that we need, because I think it would be one thing if some of us was just right from the beginning. And he was he just he had this guess it was right. He got lucky. But we got to remember, that's not what happened. He was wrong, and he was wrong, and he was wrong. And then he had critical observations. And then he was right. And then he did an intervention, he did an experiment, and it showed he was right. I don't know the intricacies of the paper and citation trails of the 1800s enough to say exactly, who was building on his work and who wasn't. But etiology of child bed fever is a classic and was a classic by the start of the 1900s. In 1909, William Sinclair writes that in the whole history of medicine, we find a clear record of only two discoveries of the highest importance in producing direct and immediate blessings to the human race by the saving of life and the prevention of suffering. These were two discoveries of Edward Jenner and Ignaz Semmelweis. So that's vaccine, and hand washing. So it's recognized by the 1900s, that he was right and his contribution is recognized. And in my vision of his place in history, I think he's as important as an exemplar of a movement, that we tend to focus on heroes, right. And some of us is, for a lot of reasons, a hard person to put for a hero because it's not clear that he ultimately succeeded. Beyond the period, he changed behavior and in his hospitals, and he was an asshole, but but he's an exemplar of this transformation of how we understand medicine and health, where the data and the numbers drive your decisions. And he's an amazing, it's important in the sense that even without the statistical tools we have today, he managed to be very rigorous, and he was able to get over his own prejudices and preconceptions.

Dr. Elif  1:34:08  
He said something extremely important today, really the first very big pioneer of Preventive Medicine. He was totally right. And now of course, when you go to Hungary Semmelweis University Semmelweis Museum, the story of Semmelweis is a very heartbreaking one very touching one big scientific revolutions are always due to the sacrifices and basically they are martyr. He is the Savior of mothers, for us.

Nicholas Hill  1:34:39  
Ignaz Semmelweis, who during his life went by nicknames such as the full of Budapest, and the crazy noxee. Now goes by the nickname, the savior of mothers. It is impossible to estimate with any real conviction how many lives Semmelweis actually saved. Now directly because of his abnormally low mortality rates, the number is at minimum in the 1000s. But given that his regimens were adopted at hospitals across the world over the next 170 years, across hundreds of millions of births, it could easily be in the millions. But Semmelweis predicted that this day would come, he knew we would eventually see the truth of his theory, and that once we understood the truth, the acceptance of his treatment regimens would follow. He envisioned this world way ahead of its time, and prophesized it in the epilogue to his book.

Peter Szocs (Voiceover)  1:35:46  
If I look back into the past, with my present conviction, that I can manage the melancholia which overtakes me, looking at the same time into that happy future, in which only cases of outdoor infection will cure. But should it not be given to me which God forbid to be heard this happy time with my own eyes the conviction that this time will come without fear sooner or later after me? Your suit the hour of my bath.

Nicholas Hill  1:36:19  
I hope that you enjoyed today's episode, I'd like to give a special thanks to our guests. Dr. ayliffe vata, Nola Lutz, Dr. Leslie Leighton, Dr. Justin Leffler, for their time and their expertise. I'd also like to take this moment to recommend that you read the book genius belaboured by Theodore G open chain, from which the majority of the research for this episode comes, and which gives far more detail on this story. I'll add a link in the show notes. Today's show was directed and produced by me with music from Alex girls and voiceover acting by Peter Zox. If you liked today's episode, please follow us wherever you listen to podcasts, and consider leaving a review as it will help us to spread the word about the show. You can view more information about today's episode online at acts of impact.com. Thank you for listening

Transcribed by https://otter.ai