0:02

Happy Saturday, everybody. We have

0:04

had several requests recently

0:06

to re release our previous podcast

0:09

on ignance Semialviss and his hand

0:11

washing advocacy. In

0:13

case you missed it, several vice was the

0:15

subject of a Google Doodle on March with

0:18

an accompanying animation on how to

0:21

properly wash your hands. This

0:23

episode that we're playing today originally came out

0:25

on March twenty one.

0:27

Yeah, we usually reserve Saturday

0:30

classics for things that are a little older, but

0:32

since so many people asked, here, we go

0:34

enjoy. Welcome

0:38

to Stuff you missed in History class a

0:40

production of I Heart Radio. Hello,

0:49

and welcome to the podcast. I'm Tracy

0:52

V. Wilson, and I'm Holly fry So

0:55

Holly, I think a lot of people take

0:57

for granted the idea that you need to

0:59

wash your hay hands to prevent disease.

1:03

Yes, but also some people discounted

1:05

well, and there's also a lot

1:07

of research that even though this is a pretty

1:10

ubiquitous and standard idea, a lot of

1:12

people don't actually wash their

1:14

hands nearly as much as they should. But regardless

1:17

of all of that, it was not taken

1:19

for granted in nineteenth century Europe,

1:21

including among doctors, that you needed to

1:23

wash your hands to prevent disease. And today

1:25

we are going to talk about Ignaz Semmel

1:27

Vice. He was one of the people who made

1:30

this connection between hand washing and

1:32

disease prevention. The disease

1:34

that he was preventing was childbed fever, and

1:37

even though it was not taken seriously

1:39

at the time, like people wrote him off entirely,

1:42

today he's known as everything from the father

1:45

of infection control and the savior

1:47

of mothers and the conqueror

1:49

of childbed fever, which

1:52

is a lot of, I mean, very lofty

1:54

pronouncements. And he did do amazing work,

1:56

but it did not last past his lifetime.

2:00

Uh. This episode Also, to be clear, it's

2:02

about medicine in nineteenth century Europe

2:04

and to a lesser extent in North America. And

2:06

we're definitely aware that religions and cultures

2:09

all over the world have their own practices about

2:11

everything from handwashing to delivering

2:13

babies. It is not about that at

2:15

all. This is not a global overview of hand

2:17

hygiene and how it relates to medicine. We're really

2:20

looking at how the practice

2:22

of obstetrics and formal medical training

2:24

collided in the eighteenth and nineteenth

2:26

centuries, and this is also a

2:28

listener request we've gotten from several

2:30

people, including Margaret tom

2:33

and Ashley. Child bed

2:35

fever, also known as pure pearl fever,

2:37

is a postpartum infection of the uterus

2:40

or the vaginal canal, and it's often

2:42

caused by a streptococcal infection, but

2:44

it can come from other pathogens as well. Today,

2:47

these infections are largely preventable through

2:50

hygiene and infection control procedures

2:52

during labor and delivery, and when

2:54

they do happen, they're usually treatable with

2:56

antibiotics. So in places where

2:58

competent care, clean water, and antibiotics

3:01

are readily available, pure pearl

3:03

fever isn't very common. This

3:06

was not the case before the germ theory

3:08

of disease or the discovery of antibiotics.

3:11

Until the late nineteenth century, childbed

3:13

fever was one of the most common

3:15

complications of childbirth. Within

3:17

about three days of giving birth,

3:20

patients developed abdominal pain, fevers,

3:22

abscesses, and other signs of infection,

3:25

and this would often progress to blood poisoning

3:27

and death. Sometimes, incidents

3:29

of child bed fever were sporadic and

3:32

between twenty and thirty percent of those

3:34

sporadic infections were fatal, but

3:36

when an epidemic of child bed fever

3:38

swept through a community or a hospital,

3:40

it tended to be a lot deadlier, with seventy

3:43

with a seventy to eighty percent mortality

3:45

rate, and a lot

3:48

of prominent women died of childbed

3:50

fever throughout history, including

3:52

Mary Wolston Craft, Henry the Eighth

3:54

Wife, Jane Seymour, and possibly

3:57

recent podcast subject Phyllis Wheatley.

4:00

Obviously, a lot of ordinary women did

4:02

too that aren't in the history books. It

4:04

was something both expecting parents and

4:07

their doctors and midwives dreaded

4:09

and feared. Childbed fever was

4:11

described in medical literature all the way

4:13

back to Hippocrates in the fourth century

4:15

BC, and in the years before

4:18

evidence based medicine. People blamed

4:20

it on a range of causes based

4:22

on whatever medical theories were in use

4:24

at the time, so everything from

4:26

a balance an imbalance in the four

4:28

Humors to myasthmas

4:31

or bad air. By the eighteenth

4:33

century, doctors were devoting a lot

4:35

of writing to arguing about whether it was an

4:38

inflammatory or a putrefying disease.

4:41

In the eighteenth and nineteen centuries,

4:43

a few things happened in tandem that led

4:45

to a big increase in childbed

4:48

fever epidemics. One was

4:50

that more babies were being delivered in hospitals

4:52

rather than at home. In some

4:54

cases, these hospitals were part of social

4:56

programs. The idea was to provide

4:59

free care before and after delivery

5:01

to try to stop infanticide among

5:04

families that were living in poverty. Some

5:06

of these hospitals employed midwives,

5:08

and others of them employed doctors,

5:10

and this was also a change. Before

5:12

this point, doctors and surgeons, who

5:15

were almost exclusively male, had

5:17

really only been involved in delivering

5:19

babies when there were really serious complications.

5:22

It was so unusual for a man to

5:24

be involved in delivery that in some places

5:27

these doctors were called man midwives.

5:30

So the idea that a doctor would be involved

5:32

in the routine delivery of a baby was

5:35

fairly new in the seventeen hundreds.

5:38

Also fairly new was the widespread use

5:40

of autopsies as part of medical education.

5:43

Although autopsies existed well before

5:45

this point, it was only in the mid's seventeen

5:47

hundreds that the field of medicine really

5:49

started using them to try to improve on medical

5:52

knowledge and teach medical students,

5:55

and in the late eighteenth and early nineteenth

5:57

centuries, doctors started using autopsies

6:00

childbed fever victims, specifically

6:02

to try to learn more about the disease. All

6:05

of this together meant that at about

6:07

the same time, more people were giving

6:09

birth in hospitals assisted by doctors,

6:12

and more doctors and medical students were

6:14

handling and dissecting cadavers

6:16

as part of medical study, including

6:19

the bodies of people who had died of childbed

6:21

fever. Because illnesses

6:23

were blamed on things like myasthmas

6:25

and imbalanced humors rather than on pathogens,

6:28

these post mortem examinations were

6:30

being conducted with bare hands,

6:33

and those bare hands were not usually

6:35

washed before working with living patients.

6:38

Surgical gloves weren't even invented

6:41

yet. That wouldn't happen until the late eighteen

6:43

hundreds, and when those gloves were invented,

6:45

they were really about protecting the hands

6:48

from chemicals, not protecting

6:50

the patients from the spread of disease or

6:52

the doctors from contracting diseases

6:54

from the patients. The

6:57

result of all of this was a dramatic

6:59

increase acent epidemics of child bed

7:01

fever particularly in hospitals.

7:04

One swept through the Paris Hotel Dieu

7:06

in seventeen in seventeen

7:09

forty six, another struck

7:11

the British Lying In Hospital in seventeen

7:14

sixty. These were frequent and

7:16

widespread enough that hospitals weren't usually

7:18

thought of as safe places to give birth.

7:21

There were definitely doctors who

7:23

spotted the connection between autopsies

7:25

and child bed fever, or who suspected

7:28

that the disease could be spread from patient to patient

7:30

by the doctors who were treating them. These

7:33

doctors published treatises and journal

7:35

articles about what they thought was causing child

7:37

bed fever and how to stop it. In

7:40

seventeen Alexander

7:42

Gordon of Aberdeen, Scotland wrote his

7:45

treatise on the Epidemic of Pure

7:47

Pearl Fever, and in it he theorized

7:49

that doctors who had treated a patient with child

7:52

bed fever could pass it on to other

7:54

patients. He recommended

7:56

burning the patient's bedclothes, along

7:58

with thorough hand washing and fumigating

8:01

all of the clothing of the doctors and nurses

8:03

who were involved in the infected patient's

8:05

care. In eighteen twenty

8:07

nine, when an epidemic of childbed fever

8:09

struck the Rotunda Hospital in Dublin,

8:12

Ireland. Hospital chief Robert

8:14

Collins tried to stop it with a forty

8:16

eight hour chlorine fumigation. He

8:19

also ordered that all the floors and walls

8:21

be scrubbed down with chlorinated lime

8:23

and all the linen's be heat treated. The

8:25

number of childbed fever cases at

8:28

the hospital dropped almost to zero

8:30

after he did all this. In

8:32

eighteen forty three, Oliver Wendellholm

8:35

Sr. Delivered a paper called the

8:37

Contagiousness of Pure Pearl Fever

8:40

to the Boston Society of Medical Improvement.

8:43

In it, he said, quote, the disease

8:45

known as pure pearl fever is so far

8:47

contagious as to be frequently carried from

8:49

patient to patient by physicians

8:51

and nurses. He then went

8:54

on to describe a number of steps to try

8:56

to prevent the spread of the disease. These included

8:58

that obstetricians should ever conduct

9:00

autopsies on patients who died

9:02

of childbed fever, and if for

9:04

some reason an obstetrician had to,

9:07

he should very thoroughly clean himself,

9:09

change all of his clothes, and abstain

9:11

from patient treatment for at least twenty

9:14

four hours. Holmes went on

9:16

to recommend that if a doctor treated a

9:18

patient who then contracted childbed

9:20

fever, he should consider all of

9:22

the patients that he went on to treat

9:25

to also be at risk until significant

9:27

time had passed without anybody else being

9:29

infected, and if two of

9:31

his patients developed childbed fever in

9:33

close proximity to one another, he should remove

9:36

himself from medical practice and bring in a

9:38

substitute for at least a month. Holmes's

9:41

paper made recommendations that would have

9:43

been both useful and effective for preventing

9:45

the spread of childbed fever, but

9:48

it didn't get a lot of attention until it was reprinted

9:50

as a pamphlet and more widely distributed,

9:53

and then the response among the medical

9:55

community was total dismissal and

9:58

outright mockery. Charles

10:00

D. Meigs, an obstitution from Philadelphia,

10:03

described holmes As theories and recommendations

10:05

as quote je June and Fizzinless

10:08

Dreamings, and claimed that any doctor

10:10

who saw an increase in child bed fever was

10:13

just unlucky. When Agna's

10:15

semil Weiss came to the same conclusion

10:17

that Oliver Wendell Holmes Senior, had, the

10:19

response from the rest of the medical community was

10:21

very much the same, and we'll talk about it

10:24

after a sponsor break

10:34

becas semil Weiss was born on July

10:37

one, eighteen eighteen, and the Taban area

10:39

of Buddha Hungary. Buddha

10:41

would combine with Pest in eighteen seventy

10:43

three, so it was a little bit later to become Buddha

10:45

Pest. At the time, Hungary

10:48

was part of the Austrian Empire, and

10:50

he was the fifth of ten children born

10:52

to Grosser Joseph Semilweiss and Terisia

10:55

Mueller. There's a bit

10:57

of disagreement about the family's heritage.

11:00

Some accounts claim that they were Jewish and

11:02

that anti Semitism was a factor in

11:04

later parts of Semilvis's story,

11:07

but Sherwin B. Newland, author of

11:10

The Doctor's Plague, Germs, child

11:12

bed Fever, and The Strange Story of Ignaz

11:14

Semilviis, writes that parish

11:16

registers document that the semil Weiss family

11:18

was Roman Catholic going back to the sixteen

11:21

seventies. The counter argument

11:23

is that semil Weiss and his ancestors may

11:26

have been baptized for the sake of assimilation

11:29

while the family was still culturally Jewish,

11:32

but this is largely conjecture and it

11:34

seems mostly just to be based on their

11:36

surname. In eighteen thirty

11:38

seven, at the age of nineteen, semuil

11:40

Wess went to the University of Vienna to study

11:43

law. A year later he

11:45

changed his course of study to medicine and

11:47

he graduated with his m d. In eighteen

11:49

forty four. He looked for a position

11:51

practicing internal medicine, but he couldn't

11:53

find one, so he changed his focus

11:56

once again and looked for a position in obstetrics.

11:59

On life First, eighteen forty six, he

12:01

was granted a two year appointment as an

12:03

assistant to Professor Johann Klein,

12:06

who was the director of the Vienna

12:08

Algamini corunkin House or the General

12:10

Hospital. Vienna

12:13

General Hospital was a teaching hospital,

12:15

so in this role Semmelweis was both a

12:17

doctor and a teacher. He supervised

12:20

and educated medical students, and

12:22

he assisted with difficult deliveries.

12:25

He was also the clerk of records, which put

12:27

him in a good position to spot patterns

12:29

among the patients and their outcomes.

12:32

The maternity clinic at the Vienna

12:34

General Hospital was one of the ones that

12:36

had been established to provide free medical

12:38

care to impoverished patients, so

12:41

patients essentially got free care and exchanged

12:43

for helping with the medical students educations.

12:47

Originally, the hospital had one maternity

12:49

clinic, which was staffed by midwives, doctors,

12:51

and their students, and after a while

12:54

that one clinic became so overcrowded

12:56

that the hospital opened a second one, which was

12:58

still staffed by a mix of doctors,

13:00

midwives, and their students. But

13:03

around eighteen forty the two clinics

13:05

were separated into the first and second

13:08

clinic. The first clinic was

13:10

staffed by doctors and medical students,

13:12

and the second clinic was staffed by midwives

13:15

and midwiffery students. The

13:17

two clinics alternated admission days,

13:19

so if the first clinic accepted patients

13:21

on Monday, the second clinic would

13:23

accept patients on Tuesday, and so on.

13:26

When the maternity clinic first opened

13:28

in seventeen eighty four, the hospital

13:30

director Lucas Boer, had

13:33

not included post mortem work as

13:35

part of the obstetric student's course of study

13:37

because he thought it carried a risk of contagion,

13:40

But in eighteen twenty three Johann Klein took

13:43

over as director and started using autopsies

13:45

as a teaching tool for the obstetric

13:47

students. By the time

13:50

Semmelweis joined the hospital staff,

13:52

the rates of child bed fever at Vienna General

13:54

Hospital very dramatically between

13:57

the two clinics. At the midwives

13:59

clinic, between one and two percent

14:01

of patients died of child bed fever,

14:04

and at the doctor's clinic the rate varied

14:06

from five to with an

14:08

average of about ten percent. This

14:11

difference between the two clinics was

14:13

so huge and so well known that

14:15

laboring patients who were told

14:17

that they were being admitted to the doctor's clinic

14:20

would beg to be sent to the midwives

14:22

clinic instead. Some even

14:24

gave birth in the street outside

14:27

the clinic after hearing that it was the doctor's

14:29

day for admission, and then they would

14:31

say they had been on the way to the hospital and the

14:33

baby just came before they could get there.

14:36

That way, they would still have access to the

14:38

free care at the clinic, but without

14:40

the risk of death that was associated

14:42

with it. That's gotta be a terrifying

14:45

choice when you're like, no, I'm I'm just

14:47

gonna do this in the street and then I'll let them

14:49

take care of me after that. Well, and I imagine

14:51

a thing I didn't find. Um, I didn't

14:53

find sources that said this, but considering

14:55

that my own mother did this when I was born, I

14:58

imagine the people that were like, I'm in labor, but

15:00

I'm not far into labor, and it's the doctor's

15:02

day. I'm gonna wait a few hours so

15:05

i can go to the midwives clinic. I imagine

15:08

that was a thing too. My my parents did

15:10

that because if they waited till after midnight, they wouldn't

15:12

be billed for the extra day. Did

15:15

not have a ton of money. Simil

15:17

Vis noticed that even these births

15:20

out in the street were safer

15:22

than giving birth in the doctor's clinic at

15:24

the hospital. He wrote, quote

15:26

to me, it appeared logical that patients

15:28

who experienced street births would

15:31

become ill at least as frequently as

15:33

those who delivered in the clinic. What

15:35

protected those who delivered outside the clinic

15:37

from these destructive, unknown endemic

15:40

influences. He became

15:42

completely fixated on this question.

15:44

It was appalling and deeply offensive

15:47

to him that there was such a huge difference between

15:49

the doctors and the midwives clinics.

15:51

So you started trying to figure out what was

15:54

different between the two clinics, and then making

15:56

adjustments to what the doctors were

15:58

doing. At the midwives

16:00

clinic, patients lay on their sides

16:02

to deliver, but at the doctor's clinic

16:05

they lay on their backs. Similar

16:07

Wizz changed the procedure at the doctor's clinic

16:09

to use sidelining, but that didn't

16:11

make a difference. They also

16:14

noticed that anytime a patient was dying

16:16

in the doctor's clinic, the priest who was

16:18

arriving to get to give last rites

16:21

basically had to walk through the whole ward,

16:23

and he rang a bell while he was doing this.

16:26

Some of us thought maybe this bell and

16:28

what it signified was so terrifying

16:31

that it was making people sick, so he got

16:33

the priest to stop it with the bell. That

16:36

did not fix the problem.

16:38

He looked at how crowded the two clinics

16:40

were, and it turned out that the midwives

16:42

clinic was understandably far

16:44

more crowded. He looked at the religious

16:47

practices of the people working in each clinic.

16:49

He looked at the patient's diets, and none

16:51

of these things seemed to make a difference. Then

16:56

his friend and colleague, Jacob Colleca

16:58

died of what appeared to each childbed fever

17:01

after accidentally being nicked with a

17:03

scalpel while performing an autopsy

17:05

on someone who had died of it, and

17:07

Collectica's own autopsy results

17:10

were very similar to those of childbed

17:12

fever victims. That's

17:15

when Semilvieis realized that midwiffery

17:17

students weren't performing autopsies

17:19

as part of their training, only the

17:21

medical students were. Another

17:23

difference was that the medical students were performing

17:26

vaginal examinations on their patients

17:28

as a routine part of their care, while

17:30

midwiffery students only did so when

17:32

there seemed to be a need for one.

17:35

Semilvis's conclusion was that some

17:37

kind of cadaverous particles were

17:40

being transmitted from the autopsies

17:42

to the patients in the doctor's clinic.

17:45

In mid May of eighteen forty seven,

17:47

Semulvis started instructing doctors

17:49

and medical students to wash their hands

17:52

after conducting autopsies. They

17:54

were to use chlorinated lime until

17:56

their hands had no trace of the putrid

17:58

smell that was left hind by a decaying

18:01

body. He chose chlorinated

18:03

lime because it seemed to do the best job of

18:05

getting rid of the odor. But chlorinated

18:08

lime is calcium hypochlorite,

18:10

which today is sold as powdered chlorine

18:12

bleach. Chlorine bleach is,

18:15

of course a disinfectant. With

18:17

Salis's handwashing protocol

18:19

in place, the rate of child bed

18:22

fever mortality in the doctor's clinics

18:24

started to drop. It had been eighteen

18:26

point three percent in April, and by

18:28

June it had dropped to two point two.

18:32

In August of eighty seven, for the

18:34

first time since the medical students started

18:36

performing autopsies, no

18:38

one died of child bed fever in the doctor's

18:41

clinic. Some of us couldn't

18:43

exactly explain why this

18:45

had worked. At one point, another

18:48

outbreak of child bed fever spread through

18:50

the clinic, even though there had been no autopsy

18:52

to trigger it. So some of VISs began

18:54

to suggest that some patients might make

18:57

their own so called cadaverous particles

19:00

their own bodies, rather than the autopsies

19:02

being their only source. Later

19:05

on, he revised his hypothesis

19:07

a third time, saying that the cadaverous particles

19:09

could come from any decaying animal

19:12

flesh, not just from a human body.

19:15

The fact that he couldn't adequately explain

19:17

why his protocol worked became

19:19

one of the arguments against his findings.

19:22

While some of his medical students agreed with

19:24

and supported his work, most of the

19:27

established doctors at the hospital dismissed

19:29

him completely. Director Johann

19:31

Klein insisted that it was the clinic's

19:33

new ventilation system which was getting

19:36

rid of dangerous miasmas and

19:38

that should get the credit. Other

19:40

doctors also vehemently disagreed

19:43

with the idea that their own hands

19:45

could have been what was spreading such a devastating,

19:48

painful, and emotionally wrenching disease.

19:51

It was unfathomable to them that a

19:53

doctor could have dirty hands in the first

19:55

place. In their minds, doctors

19:58

were gentlemen, and a gentle men's hands

20:00

were always clean, and his word

20:03

of several vices protocol spread

20:05

beyond a hospital. Doctors were also

20:07

resistant to the idea of washing their hands because

20:09

they didn't necessarily have access to

20:12

clean water where they worked, and

20:14

also because it was time consuming. I

20:17

like this weird chicken in the egg thing, where

20:19

like a gentleman's hands

20:21

aren't clean because he takes such fastidious

20:23

care of himself, but just because he's a

20:26

gentle yes. Uh.

20:29

Later on several vice would describe

20:31

it this way quote. Most

20:34

medical lecture halls continued to resound

20:36

with lectures on epidemic child bed

20:38

fever and with discourse against

20:40

my theories. The medical literature

20:43

for the last twelve years continues to swell

20:45

with reports of pure Borough epidemics,

20:48

and in eighteen fifty four, in Vienna, the

20:50

birthplace of my theory, four

20:52

hundred maternity patients died from

20:54

child bed fever. In published

20:57

medical works, my teachings are either

20:59

ignored or attacked. The medical

21:02

faculty at Wurtzburg awarded

21:04

a prize to a monograph written in eighteen

21:06

fifty nine in which my teachings

21:09

were rejected. So he wrote

21:11

that a little bit later, and to return to

21:13

this current part of the story, simil

21:15

Weis did not back down in the face of all

21:17

this opposition. In eighteen

21:19

forty eight, he started requiring that medical

21:22

students clean all the instruments

21:24

that were used during labor and delivery

21:26

with chlorinated lime as well. The

21:28

clinic had already had a month where

21:31

there had been no deaths, and at this point the

21:33

ongoing mortality rate from child

21:35

bed fever at the hospital dropped almost

21:38

to zero. As

21:40

doctors continued to dismiss his findings,

21:43

Similviis became increasingly hostile

21:45

and combative, and simultaneously,

21:48

uprisings were sweeping through the area as

21:51

people protested against the Habsburg

21:53

dynasty in the Austrian Empire. Students

21:56

held a demonstration in Vienna on March

21:58

thirteenth, eighteen four eight, and the

22:01

Hungarian Revolution of eighteen forty

22:03

eight began two days later. Although

22:05

there's no evidence that Cemilviis was

22:08

part of these demonstrations, many

22:10

of his student supporters were, which probably

22:12

inflamed tensions between him

22:14

and the rest of the faculty. As

22:16

I said earlier, that position he had at the

22:18

maternity clinic and at the hospital had been a

22:21

two year appointment, and in eighteen

22:23

forty nine the hospital elected not to

22:25

renew it. He was instead offered

22:27

a position that had no contact with cadavers.

22:30

In eighteen fifty he left Vienna

22:32

to return home without announcing his departure

22:35

or saying goodbye to anyone. He knew we're

22:38

going to talk about semil Vice's life back

22:40

in Hungary. After we first pause for another

22:42

sponsor break

22:51

in eighteen fifty one, Ignaz

22:53

Semilviis was named head of obstetrics

22:55

at St. Rocas Hospital. Although this

22:58

was really an honorary and un haide

23:00

position, he did hold it for

23:02

the next few years, though, during which

23:04

time the rate of child bed fever at the hospital

23:07

dropped significantly. In

23:09

the mid eighteen fifties, some of Vis

23:11

left St Roucas and became a professor

23:14

at Peste University. In

23:16

eighteen fifty seven, he married Maria Widenhoffer,

23:19

and they went on to have five children together.

23:21

During these years, some of Vice continued

23:24

to advocate for handwashing after autopsies,

23:27

and he also wrote a series of extremely

23:29

hostile open letters to the doctors who

23:31

dismissed his ideas, calling them

23:34

murderers who were responsible for the deaths

23:36

of women through their negligence. This

23:39

seems to me like a very fair assessment,

23:42

but but people began

23:45

to increasingly think he is just uh

23:47

an angry man that no one should listen to. He

23:50

wrote things like, you, hair, professor,

23:52

have been a partner in this massacre,

23:55

and should you hair

23:57

halfroth? Without having disproved

23:59

my doctrine, continued to train your pupils

24:01

against it. I declare before God

24:04

and the world that you are a murderer,

24:06

and the history of childbed fever would not

24:09

be unjust to you if it memorialized

24:11

you as a medical nero. In

24:14

eighteen fifty eight, after years

24:16

of his supporters telling him he should publish

24:18

his work, he published The Ideology

24:21

of child bed Fever. Another

24:24

work, The Difference in Opinion between

24:26

Myself and the English Physicians regarding

24:28

child bed Fever, followed in eighteen

24:30

sixty, and in eighteen sixty

24:32

one he published a book called The Etiology,

24:35

the Concept and the Prophylaxis of child

24:37

bed Fever. In places,

24:40

this was a clear and well written treatise

24:42

on childbed fever, but large

24:44

portions were actually diatribes against

24:46

his critics, some of them rambling, repetitive,

24:49

and almost nonsensical. Ignaz

24:52

Semmelweiss had been described as abrasive,

24:55

dogmatic, and even route for most

24:57

of his career, but by the time this book

24:59

came out, he was also starting to behave

25:02

erratically. This got worse

25:04

in the early eighteen sixties, and on July

25:06

thirteenth, eighteen sixty five, he

25:08

returned home from a family outing

25:10

and was behaving so bizarrely that his

25:13

wife became convinced that something was seriously

25:15

wrong with him, and then on July

25:18

twenty one, he went to a meeting at his

25:20

job, where, among other things, he

25:22

was supposed to talk about candidates for

25:24

a vacant lecturers post, and

25:27

according to his former assistant, instead

25:29

he read a piece of paper containing the

25:32

midwives Oath of Practice. Clearly

25:34

unaware that he was doing anything amiss,

25:38

Symbolsize planned to go to a spa

25:40

and take water treatments there, and he departed

25:43

with his wife and some attendants on

25:45

July twenty nine, but the next

25:47

day, for reasons that aren't entirely clear,

25:50

he was instead committed to a public institution,

25:53

where he died on August thirteenth, eighteen

25:55

sixty five, at the age of forty seven.

25:58

He was buried in Vienna to days later.

26:01

There are some conflicting reports about

26:03

what happened at the institution. In

26:06

some accounts, he became so violent that

26:08

he had to be restrained, and during

26:10

that encounter he was injured, but in

26:12

others, he was severely beaten

26:14

by guards and then left without any kind of

26:16

medical treatment. Regardless

26:18

of exactly what happened, an injury

26:21

to his finger that he either had when he

26:23

got to the hospital or sustained in the

26:25

incident became infected. An

26:27

autopsy that was performed at Vienna Algaminy

26:30

crunkin House diagnosed quote

26:32

paralysis of the brain as his

26:34

cause of death. Today, it

26:36

seems likely to have been sept to semia,

26:39

but the autopsy also revealed that he

26:41

had severe injuries that do suggest

26:44

that he had been beaten. It's

26:46

also not clear what caused his behavior

26:48

to become so erratic in the last years

26:51

of his life. Theories range

26:53

from the continual stress of being such

26:55

a pariah in the medical community to

26:58

early onset Alzheimer's late

27:00

stage syphilis, which was an occupational

27:02

hazard of being an obstetrician at

27:04

a busy hospital at this point in history.

27:07

In the later years the cimil Vices

27:09

life, other doctors were also

27:11

working on ideas that were related to contagion

27:14

and the germ theory of disease. In

27:17

eighteen fifty, two years after cemil

27:19

Vice instituted handwashing at

27:21

the Vanna General Hospital, James

27:23

Young Simpson of Scotland published

27:25

a detailed description of how materials

27:28

more by could be introduced into

27:30

the body during labor and delivery, and

27:32

how the postpartum body was primed

27:34

for infection and because of the

27:36

dilation and abrasion sustained during

27:39

birth. He even made the comparison

27:41

between the attendants fingers

27:44

and the ivory points that were that had

27:46

been used to administer smallpox

27:48

vaccinations by transferring

27:50

material from a cowpox lesion to

27:52

a person's skin. In

27:55

the eighteen fifties and sixties,

27:57

Louis Pasteur was studying how mycro

28:00

organisms caused beer and wine to

28:02

spoil. In eighteen sixty

28:04

seven, Joseph Lister began publishing

28:06

work on preventing infection during surgery,

28:09

which included hygiene and handwashing

28:11

with carbolic Ten years prior

28:13

to that, in eighteen fifty seven, Robert

28:16

Coke made the connection between the anthrax

28:18

disease and the anthrax bacterium,

28:21

and later he helped articulate for criteria

28:24

to prove that a disease is caused by a

28:26

specific micro organism, which

28:28

are called Coke's postulates today.

28:31

These criteria are that the micro organism

28:33

is always associated with the disease, that

28:36

it can be taken from a diseased animal and grown

28:38

in a culture, that the cultured organism

28:41

can cause the disease in a healthy animal,

28:43

and that the same micro organism can be

28:45

collected from the newly diseased animal.

28:48

So, based on the work of Louis Pasteur, Joseph

28:51

Lister, Robert Coke, and others,

28:53

infection control finally became a routine

28:56

part of obstetrics in the eighties.

28:58

But these researchers don't appear to

29:00

have been influenced by seul vices work

29:02

at all. In a lot of cases, they hadn't

29:05

even heard of him until long after

29:07

they did their first groundbreaking work.

29:10

He faded into obscurity after

29:12

his death until a Hungarian doctor published

29:14

a paper about him in eighteen eighty seven.

29:18

Today there are lots of hospitals

29:20

and clinics named after Igno's semil Vice,

29:23

along with the semil Vice Medical Historical

29:25

Museum in Budapest, and

29:27

at some point some unknown person coined

29:30

the simil Viz reflex to describe

29:32

a rejection of new information because

29:34

it contradicts established norms.

29:37

Even though pure pearl fever is much

29:39

less of an issue for a lot of the world today

29:41

than it was in nineteenth century Europe,

29:44

hospital acquired infections are

29:46

still an issue even in the most affluent

29:49

parts of the world, known

29:51

as nasocomial infections, they're

29:53

the most common complication in

29:55

hospitalized people. They happened in

29:57

between five and ten percent of

29:59

acute our patients, and handwashing

30:02

is a huge part of preventing them.

30:04

YEA for hand washing, Yes,

30:07

please wash your hands. This This

30:09

story reminds me a little bit of Fritz Wiki, where

30:11

somebody is really clearly onto something and

30:14

their contemporaries are like Nope, nope, nope,

30:16

and it makes them frustrated and it's a

30:19

little bit mad having

30:22

to fight against that all the time. Yes, some

30:24

of the some of the things

30:26

that I read about him that have been written more recently

30:30

almost have a victim blamey aspect

30:33

to them. They they're sort of like, if he hadn't

30:35

been such a jerk about it, people might have listened

30:37

to him. And I'm like, women were literally

30:40

dying, and he was like, who

30:42

cares how it works, washing your hands

30:44

keeps the women from dying.

30:48

Why won't you just do it? And

30:50

like, I'm like that understandably

30:53

made him really angry.

30:55

Well, and it is kind of hard to

30:58

understand how people were not

31:01

getting the pattern recognition of everywhere

31:03

he went and instituted his practices,

31:07

mortality went down, and so clearly

31:09

something was correct. Uh

31:11

so it seems weird that they would continue to be like, nope,

31:13

nope, nope, no my hands, I'm a gentleman. Thank

31:22

you so much for joining us today for this Saturday

31:24

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