Dispatch 2: Every Day is Ignaz Semmelweis Day
You're listening to radio at WNYC okay. Hey I'm Jaboomer Rod. This is radio lab dispatch number two. This is a story that we're all living out twenty thirty fifty times a day in twenty second bursts store at anyone really know about but when this whole corona crisis was new just seems like it's been years but just two weeks ago when I first people I called was Murad Mr Zimmer. It's good to hear your voice. Who's Carl Zimmer? He's a science writer regular guests on the show. How are you doing everyone? Okay we sort of like you know fluctuate there. Yeah Call Them Up. I just wanted to a basic read on what science we should be paying attention to and covering so is asking him questions about vaccines and treatments. There were many parenting interruptions. I assume you wash your hands Roll Your eyes on your is what I'm talking about. Yeah there you go and you know we were talking about the science and in the flow of things he throws out this name. Ignace EMMA wife I found I found a profile ignites similize and I just sort of put it on a tweet and I said you know. Every day is ignored similize day. Like who's this ignace similize you know? Just how epic story? No what is this? What is this epic story? I mean and then he told me this crazy story for two thousand year old medical mystery that involves life and death and dogma disease and sacrifice and the price of knowledge and I was like Whoa. Whoa WHOA WHOA. Whoa get a USB. Mike I'M GONNA call you back. Okay just from start. Yes so so who it. Who is ignace? Some away so similar was born in eighteen. Eighteen to a family ran grocery stores in Budapest. Hungary he was the fifth of nine kids and he was. You know they. You hear these words described about him you know. Lighthearted guy popular jocular seemed like a very pleasant man at least at the beginning when you look at his station from the earliest photographs. We have he. He looks very into. This is Nancy. Thome historian medicine at Stony Brook University. Dark hair dark moustache he to my mind must have cut a fine figure. S doctor with that impressive face and those haunting is it is true as very smiley mouth in those early pictures but his eyes are like searchlights but in any case Similize it. I thought he'd become a lawyer but then he switched to medicine. He just had a really good medical class. I guess in that university and decided. That's what I WANNA do. And so he Then travelled to Vienna because he wanted to go to the best medical school he could And he started work there. Okay so Vienna Hospital. This is where the mystery unfolds. Can you set the tasty? I'm on an Oh that's beautiful. I'm in an interview right now. it's sorry as monotype. That's just parenting the pandemic okay. So Vienna Hospital said we should be picturing the Vienna General Hospital around eighteen. Forty six is a magnificent hospital. Vienna's is one of the intellectual centers of the world. This may be one of the greatest hospitals on earth. It's professors are revered as holding all the wisdom of of Medical Lore and by the way this is a moment when science itself lease we understand. It now was just getting going. Yes data empiricism statistics when the changes in the history of science coming about moving from the the old to the new was simply using your eyes and paying attention. So you had all these. Young doctors like similize. Come into this hospital with the idea that we're going to embrace this new era. The body contains all of these secrets and in order to learn those secrets. We've got a look inside. We've got to do dissections. See what it can teach us so that we can understand. How disease affects organs so that we can then learn how to treat them in living people. Okay so and so wise arrived in Vienna eighteen. Forty four you know. He's kicked around a bit at the medical school. Trying to figure out who what his specialty would be did. A lot of autopsies to learn about medicine and then he was assigned to obstetrics the delivering of babies and so it gives routine became that He in the morning he would dissect bodies as part of his training and then in the afternoon and evening he would deliver babies so he got to Got To become an expert on on childbirth. One thing to keep in mind at at this point women did not go to hospitals to give birth routinely in this time period. The women who went there was so poor that they needed the assistance. Nancy says if you were a woman during this time and you had any means at all gave birth at home and in fact many of the women giving birth in these maternity clinics not just in Vienna but in other big cities might be single women who have become pregnant they might be prostitutes and they would exchange that care during Labor for the right of the medical personnel to use them as teaching material so teaching hospital but not all of the hospital was for teaching their this becomes important later. There were to deliver awards. This hospital. One was run by female midwives. The other was run by male doctors so the division with the doctors the first division was you know the very high status one where they were advancing. The science combining what they were learning with autopsies with doing childbirth. This is where a guy ignace similize trained and imagine in those first few years he delivered thousands of babies and very early on. He was struck by a horrible fact. Many of the young women who gave birth in his delivery ward died right after they delivered a really haunted by all these women who were dying in front of him. I mean it really got to him. It hit him very hard and and it was just relentless just just a large number of these healthy young women would come to the hospital to give birth and then suddenly die In one of the most horrific ways you can imagine they'd give birth then develop a fever that would keep climbing until they were hallucinating. Convulsing filling with bile losing blood and then ultimately passing away. He writes about how much this haunted him. Because you know every time that there was another patient who was dying they would call the priest and every time a priest will come into the hospital bring about it had a strange effect upon my nerves. When I heard the bell hurried past my door Asai would escape my heart for the victim that once more was claimed by an unknown power. He has every time you heard that bell it just. It just made him shudder. Bell was a painful exhortation me to search with this unknown cause with all of my mind to the because he knew that they were losing another young woman that unknown power that was claiming all these lives was a disease with a strange name. Purple Fever per parole fever. It's not purple as in the color. It's Pearl fever which comes from the Latin emperor which means woman who gives birth. At that point it was sometimes called child bed fever. But it went back a long way. It had been described for thousands of years have hockey's actually describes it if however the predation of the appropriate does not take place even in the Fifth Century. Bc HIPPOCRATES Father Medicine described the fevers described the symptoms. He thought something had putrefied in the mother yes other physicians hold air inadvertently received into the uterus which closes the orifices of the vessel thought. Maybe it was the air in the delivery room India period. It is widely accepted that the quality of the air play a role in determining disease. This is Daniel Margot see historian of Science Cambridge University. Paypal argue that there is seasonal variation in a number of women being afflicted in other words. Maybe it was the weather. Some people argued. It was the moral standing of the women. Because if you are immoral a youth than to be the day if you are not both morally and physically than you'll live in squalid conditions all kinds of crazy theories. Some people even thought that The problem was that the milk that expectant mothers were producing to nurse. Their Children was somehow getting routed into their abdomen or their uterus. And in a weird way you can kind of see how they could think of something as crazy as that. And that's because when doctors would examine these dead mother's open up their abdomens. They saw this huge amount of Pale liquid. That look to them with a little like milk but it was bus. That is legitimately disgusting. But the point is this. Mystery had been plaguing doctors and scientists for thousands of years and it just so happened that when Ignatius similize was in delivery ward number one. It was a really big problem sometimes. Thirty percent of the of the women giving birth at the hospital in a month die of this fever. That is a huge number. I mean it would fluctuate in some months. It would be seven percent but still you know so everybody knew that this was a problem And so the question was what what's causing this. And how can we address it? I imagine that every time I heard that bell ignored him always thought. I've got to get to the bottom of this. And so in between his morning dissections and his afternoon delivery shifts he would visit the hospital archives. The Vienna General Hospital might not have understood what pro fever was. But they're really good at keeping records so he looked at their records and some things really popped out for him first of all. Despite a general impression to the contrary neither the incidents nor the mortality Purple Fever was related to whether there was no connection with weather. Cross that off the list. You know could rule things out. But here's the really big thing. He noticed observation number one. If you remember there were two different delivery awards the same number of deliveries took place in each of the hospitals to obstetrical divisions usually between three thousand and three thousand five hundred division number one. We're doctors number two were midwives in the first division an average of six hundred to eight hundred mothers died each year from Purple Fever in the second division the figure was usually about sixty deaths. Similize like runs the numbers and he's like my God like twenty percent of these women are dying where the doctors are in charge in about two percent time when the mid wiser and charge really. Yeah so the death rate is eighteen percent higher when the doctors are delivering babies. Ten Times higher think of it that way about ten times bigger wrestle dying when you know some of the best doctors in the world are delivering your baby. Naturally ignace was like. Why would that be? Why would it be so different? He was just looking and looking and looking like what could explain this. What could explain this shortly after he has this big? Aha moment and solves the two thousand year old mystery. That's after the break. Hi My name is Ray in and I'm calling from Cape Town Pennsylvania. Radio APP is supported in part by the Alfred P Sloan Foundation enhancing public understanding of science and technology in the modern world. More information about Sloan at www dot org jaboomer on this is radio lab so it is eight hundred. Forty-seven Iggy semi wise is flummoxed. He's noticed a very distressing pattern that You know there are two delivery wards in the Hospital Division One. You have the best in the brightest male doctors in the world delivering babies too. You have female midwives. He runs the numbers and finds that women giving birth in his delivery room division. One die at ten times higher the rate then division to he has no idea why this would be these are supposed to be the best doctors in the world but then he has a homo. What seems to really have made it. All Click in place was not The death of one of these patients but the death of one of his professors a man named Jacob Coletta. He had this mentor who had taught him about Medicine and how to do an autopsy how to do forensic pathology all that stuff and During one autopsy This professor was with a student. He and the student were bent over. A cadaver in the student was cutting open cadaver under his guidance. Making some incisions an accidentally nickname with the knife. Nick the professor yet. Apparently the students hand slipped or something and he caught his professor on the Finger. So the student Knicks the professor with the knife just a tiny little scrape and then suddenly within a few days his mentor. He died a terrible death but a terrible death. That seemed familiar. Totally shattered brooded over the case with intense emotion until suddenly a thought crossed my mind at once it became clear to me that child bid fever the fatal thickness of newborn and the disease of Professor. Collect one in the you realize. Oh my God. This disease is the same one. I've been seeing in the delivery room with the mothers. We didn't know why it was happening. But here we know the cause. It was the student students knife a knife that I had been in a dead body and then hit cut professors finger. The fact of the matter is that they're transmitting source of those could ever particles was to be found in the hands of the students and intending physicians. When professor died it all clicked into place. Because what do these doctors do? These doctors in the morning might have their hands deepen cadaver and then the afternoon it would walk over to a pregnant woman and start delivering a baby with the same hands. That's haunting so they're literally carrying death into the place where life begins. Yes they were they absolutely were and so I mean the way that similize described. Do Quizzes that When a doctor was finished with an autopsy he had cadaver particles on his hands. Oh to similize call these cadaver particles that gives me chills just thinking about that. He didn't call them. Bacteria viruses anything. He didn't know what those things were and when he put all this stuff together and came up with this idea of cadaver particles he thought. Oh my God because of my convictions I must confess that God only knows the number of patients who have gone to their graves prematurely by my fault I have been sending women to their graves. He immediately recognized brutal paradox of his situation. He'd been trying to do the right thing. Advanced the science save lives but it had done the opposite. In fact the doctor who worked at the delivery ward ripe for got there who is widely recognized as a lazy scientist didn't do dissections and as a consequence more women survived. Some always shows up starts doing dissections as he believed was his duty and the death spike. I remember this very much aware of that paradox. That it's with the rise of scientific medicine. That try fever is really coming into place. And he basically says that you know me being conscientious scientist is the reason by many mothers died before. I realized that I was the cause of their deceased. But in addition it is his scientific method in his scientific way of thinking that allows them to recognize that. So there's some it's very it's very I don't know it. Yeah it it it is interesting. I mean it's it's it's the whole nine centuries a little bit like try to you know with the rise of global circulations to spread off. You know steamships you get at the same time cholera so the spread of knowledge and the spread of diseases. Is You know they are often connected? Yeah okay so what happens next is it starts telling his colleagues we've been killing women and you know actually like a number of you know the younger set said you know. I think he's right and and it was. It was very hard for some of them and in fact You know there was. There was one doctor name Michaela's who he had delivered the baby of his own niece and she had developed propel fever and the realization that he was probably responsible for the death of his niece just became too much and he committed suicide. Wow that's for similize. Any he immediately said like okay. Well what could I knowing this? Is there something that I could do at the hospital to stop it? He actually started to do these experiments. He was very familiar with the smell of death. Obviously because he was working with cadavers all the time cutting them open and they didn't have particularly good ways of preserving them so it was a pretty nasty business and he was you know. His sense of smell is very tuned to the smell of a corpse so we figured well you know if if I can get these cadaver particles off my hands then maybe then I will be safe as a doctor to go delivered babies and so he tried things out. You tried out different ways of disinfecting his hands and he would just sort of basically smell his hands and then if the odor of death after an autopsy went away he'd be like okay. This this is good. He settled on basically bleach. You would take some bleach put in some water and create a solution. It wasn't a whole lot of bleach not enough to burn your skin but it was enough to burn off that stench and to take care of those cadaver particles and so similar wise was by now was in charge of a lot of the birth that were happening at Vienna General Hospital and he just said Okay neutral folks after you do your on autopsy and before you deliver a baby. I've got this bowl here. Wash your hands disinfect. Your hands and And what happened? He kept track and He basically like brought the death rate is pretty much zero. I mean he couldn't completely eliminate it but he got pretty close. There were some months. We're like no women died at all none and it is here that ignace similize reaches his disinfected hands into the president. Because all those PSA's hearing these days but washing your hands. They really begin in this moment with a Hungarian guy realizing that handwashing the simple act of rubbing your hands together with some soap or bleach would be the key to the two thousand euro mystery of Pearl Fever. If only could have lived to see Carl. Zimmer's tweet or see steph curry or Lebron. James urge their millions of followers to wash their hands but alas he could not he was stuck in his own time and beyond his own clinic. His idea didn't really catch on poor. Ignace CIMA Vice. What a sad story. There's a final tragic chapter to this tale and this one can be many different ways. Yep Very complicated and A lot of pretty intense controversy see Nancy says summarizes end is something historians still argue about sometimes quite fiercely and one version of events. Is that classic very familiar science? History story where you've got a guy who saw something at insight but then the dogma push back absolutely it's that Galileo narrative. Yes along those lines. We know that after his big breakthrough and he collected all kinds of data. He was very scientific in many respects. We know that ignites similize began to write letters to everyone in Europe. He says I figure this out. You need to institute a handwashing and you need to accept my theory. As I mentioned there were doctors to believed him doctors however they weren't running the hospitals. They weren't running the medical schools. And so you know. The the older generation pushback really hard push. How like? Don't tell me what to do. Young person kind of thing. Imagine imagine imagine that you are one of the most respected doctors in obstetrics in the world and you've delivered thousands and thousands of babies. You know what you're doing and then a twenty eight year old. Who has barely gotten started in? The field of medicine says you are responsible for the deaths of countless women because of these mysterious things called cadaver particles And then to imply that an educated upper class DNA physician could have been had so dirty that they were transmitting. This this terrible infection. I think that that is definitely an element at a at a more subterranean personal level. Don't tell me dirty Nancy. Thanks part of it was just that the older doctors were offended. Or you call me. Filthy and similize was you know was not very not terribly diplomatic He would reply to these doctors. No I'm not calling you filthy. I'm calling you. A murderer is being really blunt about it. He you know he he would write letters to doctors and say just say like you Sir. Been a partner. In a massacre his thoughts writing more and more Batali letters and things that everyone disagrees with him must be an evil person. You get the idea that this this may have turned him from that. You know jovial popular guy to kind of amount of maniac and this gets us to the second version of events that the reason big breakthrough didn't break through at least not in his lifetime is that it's as much his own fault as anyone else's sometimes historians tell his story as an example of what not to do in terms of communicating science. He railed against his colleagues. Call THEM NAMES REALLY. Not a great way to Win A lot of friends to say especially some of them. According to Daniel Margot see had legitimate scientific questions like okay. Let's wash hands fine but can you explain to us why washing hands works and why every so often it persephone berries they shoot that Certain mother still die. After as citizens of Hand Wash Inc not all cases of tied fever disappear as a result which physicians wanted to know. Could he explain that? Isn't it possible that there's more than one 'cause here? What are these cadaver particles? Has He ever seen them with a microscope? if they really are these contaminating agents shouldn't the babies get sick as much if not more than the mothers? And that's not happening. Do we know why semi wise just didn't have the patience to deal with these questions. And the problem was that In in the eighteen sixties he seems to go into a rapid decline. I mean you can see like pictures of him In this man is early forties and pictures just show. This man starts to look like he's in his sixties or seventies. He something terrible was happening and he his personality change all sorts of ways. I mean he was already could be a pretty irascible person but He just started acting very strangely and a meeting where he was supposed to give a report he would just start reading from a random piece of paper completely confused you know he was married and had a family but he started like living openly with a prostitute. Something had gone terribly wrong. And so eventually his his family decided they had to bring him to an an asylum in Vienna use. Forty-seven that's pretty startling mental crime because of that decline again is something historians debate. People have speculated on it There had been some theories that it was syphilis. Certainly syphilis just basically eventually turns your brain and much more recently. Someone thought it was Alzheimer's disease Very early onset. Good look very much like Alzheimer's case. He was institutionalized but he didn't last more than two weeks he died he died in that institution. Yeah so it seem. It seems that what happened was that you know he was getting uncontrollable and kind of violence. By the time he was institutionalized. And you know this was a pretty dark time for people with mental illness Says the guards of the asylum basically just beat him to death I mean they beat him badly and then he probably developed an infection in some of those wounds And that determine how it's kind of sad irony it is. It is ironic. Yeah that he probably died A of an infectious disease himself very rapid devastating infection. Let me tell you what I take away from the story. This is maybe a third way to see it that. Here's the moment where we were not. Just summarize all of us were trapped in a middle space kind of tragic gap. We learned a thing but it wasn't enough similize knew that something was making these women sick. He called that something. Cadaveric particles didn't use the word bacteria because he didn't know about bacteria and only a couple years later Louis. Pastor would come along and say bacteria. That's what those could ever particles really were and he would offer the world a comprehensive new idea called Germ Theory. That would change everything. Similize was unfortunately the moment right before that in many ways. We're in that moment to now. We know the enemy. We know what shape we can draw pictures of it. We can track mutation rate. But we can't tell you why it attacks some people so harshly and others barely. We certainly don't know how to cure it. We just don't know enough yet but we do know one thing. And it's the same thing that Agnes. Some always taught us back in eighteen forty seven. Your hands are limousines for pathogens. You deliver them to their next comb. The virus that causes cove nineteen this corona virus. It's got a a membrane around it. It's kind of oily and it breaks up in soap. So all you need to do is soap. Your hands for twenty seconds. Sing happy birthday twice soaps up so rinse it off. Well and dry it off. Well and you haven't just like rubbed off viruses have actually like Split Open Kerr viruses. They can't harm you. It can't harm anybody very satisfying the way you just described that washing hands then becomes a kind of an act of war. Yeah next time you wash your hands. Think about that did this. Mundane Act was fought for and died for that. There are hundreds of years of life and death in ignorance. Knowledge all right. They're co mingling with the soap and water has a special way of cutting into the oil. It breaks the oil up into tiny drops leather from its water to penetrate the skin board and walked away dirt and other Madij glavas. Pumice could come clean with one more. Did you ever think how much fun it is just to be alive when you feel healthy and well just wash the hands clean the first? Why wait a minute that worship times in my depends in this? Wash your hands. I heard it from my parents. Jimmy did you wash your hands all well. Someday you'll find out why people want with so big. Thanks to Carl Zimmer for spending so much time on the phone with me in the past few days and a hat tip to the late Sherman newland. Who wrote a biography of IGNACE similize scrape? Biography called a doctor's played a lot of the information. The Senate was taken from that book. This story was produced with Bethel hop day. And let if Nassir I am Jabba. Rod Thank you for Washington. This is learner. Toll Washing her hands and overland park. Kansas radio APP is created by Jad Able bratwurst Robert Krulwich and produced by Soren Wheeler Dylan Keith. Our director of sound design. Suzy Lechtenberg is our executive producer. Our staff includes Simon Adler Becca. Pressler Rachel Kucic David Gavel Buffalo had T- Tracy Hunt Mac healty any Mikaelin Latif Nassar. Sir Quarry are now on Wack Pat Walters and Molly Webster of help from Shima Oli a with Harry Fortuna Sarah Sandbox Melissa. Donald Tag Davis Andrew Wrestle. 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