MrBallen’s Medical Mysteries - Ep. 24 | Blood on Their Hands

Episode Date: March 19, 2024

In the summer of 1846, a young doctor is thrilled to join Austria’s prestigious Vienna General Hospital. But he soon discovers that new mothers in one of the hospital’s maternity wards are dying at a disturbing rate. He desperately seeks an answer for why it’s happening… and what he finds changes the field of medicine forever.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Hey Prime members, you can binge episodes 49 to 56 right now and ad-free on Amazon Music. Download the app today. In the summer of 1846, a young woman screamed in pain and fear as a pair of orderlies carried her through the doors of Vienna General Hospital. The woman was about to give birth, and even though she'd been taken to one of the best hospitals in all of Austria, she was still afraid of what would happen next. The orderlies carried her stretcher down a hallway, and the woman craned her neck to see where they were taking her.

But a moment later, she was struck by a painful contraction and had to close her eyes. The woman heard the orderlies burst through another set of doors, and then she heard the cries of other women growing louder and louder. The woman opened her eyes and tried to get her bearings, but everything was a blur. Then the orderlies picked her up and settled her into a bed in a big room full of women delivering babies. The second the orderlies left, the woman shouted out for a doctor. A young man ran over, and when he asked how he could help, the woman grabbed his white coat,

and she asked him, which ward is this? And when he told her, she burst into tears. Because she knew there was a very good chance she'd never leave this room alive. Have you ever wondered who created that bottle of sriracha that's living in your fridge? Or why nearly every house in America has at least one game of Monopoly? Introducing The Best Idea Yet, a brand new podcast about the surprising origin stories of the products you're obsessed with. Listen to The Best Idea Yet on the Wondery app or wherever you get your podcasts. I'm Marsha Clark, host of Informance Lawyer X. Join me as we tell the shocking true story of a lawyer who wasn't just representing

some of Australia's most dangerous gangland criminals. She was informing on them to the police. Informance Lawyer X is available exclusively on Wondery+. Join Wondery for access to this and more Exhibit C true crime podcasts. From Ballin Studios and Wondery, I'm Mr. Ballin, and this is Mr. Ballin's Medical Mysteries, where every week we will explore a new baffling mystery originating from the one place we all can't escape, Our own bodies.

If you liked today's story, please go for a jog with the follow button. And when they ask for a drink, hand them a water bottle that's been filled with vodka. This episode is called Blood on Their Hands. In July of 1846, 28-year-old Dr. Ignaz Semmelweis reported to the Vienna General Hospital in Austria for his first day of work. Vienna General had been established over 60 years earlier, in the 1700s. Dr. Semmelweis was proud to work there, and even more proud to be working in obstetrics, where he'd get the help expecting mothers. As part of his job, Dr. Semmelweis would work in one of the hospital's two maternity wards. Dr. Semmelweis felt optimistic, but also nervous.

He'd only recently graduated from medical school and was relatively young for such an important position. But his strong work ethic had helped him rise through the ranks quickly, and he was determined to prove himself to his new co-workers. That day, Dr. Semmelweis walked up the cobblestone street to the hospital's double doors. He pulled them open and went inside, walking through the echoey hallways until he reached the first maternity ward, which was called the First Division. He wanted to make a good first impression on his new co-workers, so he smoothed out his mustache and straightened his jacket. Then he opened up the door, and what he saw next completely changed how he felt about his new job. A pregnant woman was kneeling on the floor, crying and screaming. But she wasn't giving birth. She was begging a doctor to let her leave and go to the other maternity ward, which was called the second division. The woman on the ground said she would do anything to be

transferred there. If she stayed where she was, she was sure she would die. Dr. Semmelweis had heard rumors about the first division maternity ward. In fact, most people in Vienna had heard these rumors. There were whispers that the First Division was far more dangerous than the Second, that women who gave birth there were far more likely to become sick and die. Looking on from the doorway, Dr. Semmelweis wanted to rush forward and comfort the crying patient. But the other doctors had already lifted her off the floor and put her onto one of the many beds in the room, assuring her everything would be just fine, but she was going to stay here. Even though Dr. Semmelweis was technically in charge, he didn't want to interrupt what was happening. He still felt like he didn't really

understand the dynamic of this place, and he needed to learn his way around the wards and win his colleagues' trust first. A few hours later, the same woman who'd been crying on the floor asking to leave the First Division went into labor, and Dr. Semmelweis supervised the delivery. And after seeing how scared this woman was, Dr. Semmelweis let the woman squeeze his hands during the delivery so tightly that his fingers turned blue. Thankfully though, her delivery went smoothly and she gave birth to a healthy baby. But even though she and her child were okay, Dr. Semmelweis couldn't get the image of her crying and begging to leave the first division out of his mind. The situation still made him very uneasy. He wanted to make sure women did not feel

afraid under his care. And so Dr. Semmelweis made up his mind to learn as much as he possibly could about this First Division and see what was going on here. As afternoon turned to evening, Dr. Semmelweis pulled another doctor aside to talk about what he'd seen that morning. They stood in the hallway outside the First Division, their jackets stained with blood and sweat from a long day's work. Dr. Semmelweis told his colleague that they were both men of science. As such, he asked if there was any scientific proof that the First Division was in fact deadlier for the women inside of it than the Second Division. The other doctor said yes, there was scientific evidence that demonstrated that. He dropped his voice low, just in case any patients were in the halls,

and he told Dr. Semmelweis the mortality rate for mothers in the first division could be as high as 18%, but in the second division, it was much lower, only about 2%. Dr. Semmelweis was shocked. Those numbers meant that nearly one in five women died in the first ward, but only about one in 50 died in the second. Suddenly, that woman's fear from earlier in the day seemed totally justified. The other doctor explained to Dr. Semmelweis that the patients in the first ward seemed to be dying of something called childbed fever. This was a poorly understood illness that affected women who'd recently given birth.

One to three days after delivering their baby, these women would develop severe abdominal pain and high fevers, and would sometimes become delirious. And then they would die. Dr. Semmelweis' colleagues stopped speaking for a second as another doctor rolled a woman by on a gurney. When she was back in the maternity ward safely out of earshot, the doctor continued. He said there had been plenty of meetings at the hospital to discuss the differences between the two wards,

but even one of the hospital's leading disease experts, a forensic pathologist named Dr. Jacob Kolechka, couldn't find anything to explain the vast difference in mortality rates. Dr. Semmelweis scratched his chin and glanced down at his blood-stained jacket. It really needed to be washed, and he really needed to get home and get some rest. He thanked his colleague for the information, and as he walked down the hospital's hallways, he thought over everything he'd just learned. Dr. Semmelweis believed it was his responsibility to figure out exactly why so many women were dying at this hospital in this first ward. He decided that the very next day, he would visit the second division

and try to learn what made it so much safer than the first. The following morning, Dr. Semmelweis grabbed a new crisp white coat from his office and put it on. He walked down the echoey hallways toward the maternity wards, then opened the door to the second division. It looked nearly identical to the first division. Dr. Semmelweis took note of the same pale walls, the same beds lined up in rows, the same ventilation systems bringing fresh air into the room. However, the patients in the second division seemed much happier and more at ease. Dr. Semmelweis walked past their beds to the back of the room,

where all of the equipment used during deliveries was stored, and he began pulling open a few drawers. Inside of them, he saw stacks of metal forceps and scalpels. They were the exact same tools used in the First Division. Dr. Semmelweis turned away from the storage area and back to the main section of the room, where he watched staff members bustle from one patient to the next. And that's when he noticed something interesting.

There was one major difference that Dr. Semmelweis could see between the staff of the two maternity wards, and he thought it might be the key to solving this mystery. Several months later, the doctors and medical students who worked in the first division gathered in one of the hospital classrooms where medical lectures were normally held. It was a small space with wooden tables lined up in front of a chalkboard. Dr. Semmelweis stood at the front of the room, deep in thought, one hand nervously twirling the end of his mustache. Over the past few months, he'd gone back and forth between each ward, taking note of how the different staff members worked. Eventually,

he believed that he'd gathered enough evidence to prove his theory, and so he'd called this meeting with everyone who worked in the First Division to let them know what he'd discovered. Once everyone was in their seats, Dr. Semmelweis announced that he'd been keeping a careful eye on the First and Second Divisions, looking for something that could explain the huge difference in mortality rates. He said the two wards were similar in almost every way except for one. The first division, so the more deadly division, was staffed entirely by male doctors and medical students. The second division, the safer one, was staffed by female midwives. In the mid-1800s, when this story took place,

midwives would have gone through an apprenticeship program, not a formal medical education. Because of this, they were considered less educated than doctors and wouldn't have been allowed to teach medical students. But since Vienna General was both a hospital and a medical school, it needed two maternity wards, one for doctors who could train students to handle pregnancy and childbirth, and another one for midwives who mostly managed the place themselves.

For Dr. Semmelweis, the fact that the two wards had such different personnel seemed very important. Then Dr. Semmelweis said something that shocked this room full of doctors and medical students. He wondered aloud if maybe the midwives actually knew how to deliver babies better than the doctors. The doctors scoffed and the medical students shifted in their seats, uncomfortable with the idea that midwives might be more knowledgeable than they were. Dr. Semmelweis was uncomfortable too. It wasn't easy for him to consider that after years of medical training, he might not be as much of an expert as he thought. But Dr. Semmelweis didn't want to let his ego get in his way, so he pressed on. He told the men he'd noticed that women gave birth on their backs in the first division. That was a standard procedure for doctors,

supposedly because it gave them a better view and more control over the birthing process. But in the second division, the safer one, where the midwives worked, women typically gave birth on their sides. This tended to be more comfortable for the patients and reduced the risk of injury. Dr. Semmelweis theorized that this difference might be the reason why so many women were dying in the first division. He told the doctors and medical students that moving forward, every woman giving birth in the First Division should lie on her side

instead of her back. Dr. Semmelweis watched the men murmur and roll their eyes, but he didn't react. He just thanked them for listening as the meeting ended. Then they filed out, leaving Dr. Semmelweis alone in the classroom. He exhaled, glad that the meeting was over. He still felt relatively new at Vienna General, and taking on this responsibility made him nervous. But he'd stepped up and done what he could to fix the problem in the two maternity wards. He left the classroom hopeful that this new change he had just implemented would actually work. Over the next few months, Dr. Semmelweis spent more time in the First Division, making sure everyone was

following this new protocol by having the patients give birth on their sides. Now, there was not an immediate change in the mortality rates, but Dr. Semmelweis held on to hope that his idea would work eventually. Only it didn't. Almost every day, Dr. Semmelweis heard about or witnessed multiple women dying in the First Division. He had to admit that his theory must have been wrong. Even with this new policy, the mortality rate in the First Division was as high as ever. If you like my shows American Scandal or American History Tellers, then you're going to love my new podcast, American Criminal, hosted by my friend Jeremy Schwartz.

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Follow The Best Idea Yet on the Wondery app or wherever you get your podcasts. You can listen to The Best Idea Yet early and ad-free right now by joining Wondery Plus. In February of 1847, less than a year after Dr. Semmelweis started his job at Vienna General, an average of two women died every single day in the First Division. Desperate to figure out what was really going on, Dr. Semmelweis spent his mornings in the hospital morgue doing autopsies on women who had died of this childbed fever. He, along with many other doctors and medical students, searched the women's remains for some clue as to what was really killing them. One morning, Dr. Semmelweis stood in the cold morgue, taking shallow breaths and trying to ignore the smell of death. He'd asked the hospital's disease

expert, Dr. Jacob Kolechka, to sit in on the autopsy. Dr. Kolechka was tall, broad-shouldered, and clean-shaven, with dark hair that he kept combed to one side. Dr. Semmelweis saw him as a mentor and was glad to have him looking on. Dr. Semmelweis pushed his scalpel into a woman's chest and began dragging it down her body. He peeled back layers of skin, fat, and muscle, and he found the same thing he did in other women who had died of childbed fever, an inflamed abdomen full of swollen sores and pus. Dr. Semmelweis and Dr. Kolechka both agreed that these were clear signs of some kind of infection, and yet neither of them could determine what exactly the infection

was or how it was spreading in the first division. Dr. Semmelweis set his scalpel down and rested on a metal stool. He looked around. He was surrounded by dozens of dead bodies of women he was supposed to care for. He had blood on his hands, literally from the autopsy, and also figuratively, because he clearly had not been able

to prevent all these women from dying, and so he felt like he had totally failed them. Dr. Semmelweis stood and wiped his hands on his jacket. He then told Dr. Kolechka that he needed a break from this place, the morgue, the maternity wards, the entire hospital. Maybe a vacation would help him clear his mind, and he could come back and look at the problem with fresh eyes.

Dr. Semmelweis took off his bloodied jacket, hung it on a hook on the wall, and then went to tell his supervisors that he was taking a trip to Venice. A few weeks later, in March of 1847, Dr. Semmelweis returned from his vacation. The time away had done him good. He'd been able to rest, to enjoy the museums and food that Italy had to offer. Now that he was back in Austria, Dr. Semmelweis felt reinvigorated. He showed up at the Vienna General Hospital for his first day back at work, and as soon as he walked inside, one of his colleagues rushed up to him in the hallway. The doctor looked pale and sad.

He told Dr. Semmelweis that there had been a terrible accident while he was gone. His mentor, Dr. Jakub Kolecka, had died. Dr. Semmelweis was shocked. Dr. Kolechka had been young. He asked his colleague what happened. The other doctor sounded unsure as he explained it. Dr. Kolechka had been doing an autopsy on one of the women who died in the first division. It was all routine. Some medical students were even in the room helping with the examination. Then one of the students accidentally cut Dr. Kolechka's finger with their scalpel and the wound became infected and a few days later, Dr. Kolechka was dead. Dr. Semmelweis swallowed the knot that was growing in his throat

and he shook his head in disbelief. The story was as heartbreaking as it was frightening. Dr. Semmelweis did autopsies all the time. He never imagined that getting a tiny cut during one of those autopsies could kill him. But while Dr. Semmelweis was obviously reeling from this terrible news, his mentor's death also made him curious. He asked his colleague if an autopsy had been done on Dr. Kolechka's remains. His colleague said yes and said that he would go down to the lead pathologist's office and grab the records if Dr. Semmelweis wanted him to. Dr. Semmelweis just shook his head and said he would head there himself right now.

Just a few minutes later, Dr. Semmelweis sat in his dimly lit office, poring over his mentor's autopsy report. What he found in those pages astonished him. The physician who had performed Dr. Kolechka's autopsy wrote a detailed account of what he had found inside the dead man's body. Dr. Kolechka's abdomen was inflamed and filled with swollen sores and pus. It sounded exactly like what happened to the women in the first division who died of childbed fever. This was odd because the medical consensus at the time was that only women who had recently given birth could contract childbed fever. But Dr. Kolechka's autopsy report seemed to prove that

idea wrong. Dr. Semmelweis thought it all over. His mentor had been doing an autopsy on a woman who died of, apparently, childbed fever. And Dr. Kolechka got a cut on his finger, which then became infected and led to his death. To Dr. Semmelweis, only one possibility made sense. Dr. Kolechka must have caught childbed fever from the corpse. That somehow it got into that cut. Suddenly, everything clicked for Dr. Semmelweis. The answer to the mystery of the First Division was right there in front of him. It all led back to the morgue.

Dr. Semmelweis knew that each morning, doctors and medical students completed autopsies in the morgue. He did it too. And like doctors everywhere in those days, they did their grisly work bare-handed. That's why it was so easy for Dr. Kolechka to get cut. Then after being elbow-deep in dead bodies that were often filled with infectious diseases, they would head up to the maternity ward to deliver babies, often without washing their

hands first. Looking over his mentor's autopsy report, Dr. Semmelweis theorized that Dr. Kaletschka contracted childbed fever from what he called cadaverous particles inside the corpse he was examining. They were probably all over the unwashed hands of doctors and medical students who did autopsies each morning. Then they spread those particles to women in the first division, directly causing the spread of childbed fever. And Dr. Semmelweis had a clear explanation for why the same thing did not happen in the second division

that was run by midwives. Midwives do not do autopsies. So there was no way they would ever come in contact with any of these so-called cadaverous particles that could spread this illness. Dr. Semmelweis pushed the autopsy report aside. He jumped up from his desk and sprinted down the hallway to the First Division. His findings could save countless lives.

As soon as he got to the First Maternity Ward, Dr. Semmelweis made an announcement. After completing their autopsies, all doctors and medical students would be required to wash their hands in a chlorine solution before they entered the first division. Chlorine was one of the only known chemicals that could completely remove the smell of dead bodies from clothing, medical tools, and people's skin.

Because it got rid of the scent, Dr. Semmelweis figured it would also remove the cadaverous particles that were spreading this deadly illness. And the results of this new hand-washing policy were remarkable. In April of 1847, the 1st Division had a fatality rate of 18.7%. By June, the fatality rate had dropped to only 2.2%, about the same as the second division. Dr. Semmelweis had just inadvertently discovered how to use handwashing to stop the spread of infectious disease. These days, we know the cadaverous particles he talked about were actually just germs. But this was years before the scientific community began to accept the idea that disease can be caused and spread by microorganisms like bacteria and viruses.

At the time, the idea of handwashing with anything more than just water was totally radical, and Dr. Semmelweis actually faced a serious backlash for his suggested policy. Many doctors at the Vienna hospital undermined him and refused to follow his protocols because according to them, doctors were gentlemen and gentlemen's hands were always clean. Dr Semmelweis fought back and actually ended up losing his job. And unfortunately, after he was fired, the hospital returned to its totally unhygienic way of not requiring doctors and medical students and everybody who's on staff to wash their hands.

It would take another 20 years for germ theory to catch on elsewhere and for handwashing with antibacterial chemicals to become common in medical facilities. By that time, Dr. Semmelweis was dead. He passed away in 1865 after contracting a bacterial blood infection called sepsis, which, ironically, he got after a cut on his hand became infected. To be continued... because we don't know the names of the real people in the story. And also, in most cases, we can't know exactly what was said, but everything is based on a lot of research. And a reminder, the content in this episode is not intended to be a substitute for professional medical advice,

diagnosis, or treatment. This episode was written by Karis Allen Pash Cooper. Our editor is Heather Dundas. Sound design is by Matthew Cilelli. Coordinating producer is Sophia Martins. Thank you. is Zach Levitt. Script editing is by Scott Allen and Evan Allen. Our coordinating producer is Matub Zare. Executive producers are myself, Mr. Ballin, and Nick Witters.

For Wondery, our head of sound is Marcelino Villapondo. Senior producers are Laura Donna Pallavoda and Dave Schilling. Senior managing producer is Ryan Lohr.

Our executive producers are Aaron O'Flaherty and Marshall Louis for Wondery. I'm Tristan Redman, and as a journalist, I've never believed in ghosts. But when I discovered that my wife's great-grandmother was murdered in the house next door to where I grew up, I started wondering about the inexplicable things that happened in my childhood bedroom. When I tried to find out more, I discovered that someone who slept in my room after me,

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