Radiolab - Dispatch 2: Every Day is Ignaz Semmelweis Day

Episode Date: April 1, 2020

It began with a tweet: “EVERY DAY IS IGNAZ SEMMELWEIS DAY.” Carl Zimmer — tweet author, acclaimed science writer and friend of the show — tells the story of a mysterious, deadly illness that struck 19th century Vienna, and the ill-fated hero who uncovered its cure … and gave us our best weapon (so far) against the current global pandemic. This episode was reported and produced with help from Bethel Habte and Latif Nasser. Support Radiolab today at Radiolab.org/donate. 

Wait, you're listening. Okay. All right. You're listening to Radio Lab. Radio Lab. From W. N. Y. C. See?

Yeah. Okay. Hey, I'm Chad. I'm Brad. This is Radio Lab. Dispatch number two. This is a story that we're all living out 20, 30, 50 times a day in 20-second bursts. It's a story I didn't even really know about, but.

When this whole corona crisis was new, just, I mean, seems like it's been years, but just two weeks ago. One of the first people I called was... Mr. Evermored. Mr. Zimmer. Oh, it's good to hear your voice. Was Carl Zimmer. He's a science writer, regular guest on the show. How are you doing?

Everyone okay? You know, we sort of, like, you know, fluctuate, you know. Yeah. Call them up because I just wanted to get a basic read on what science we should be paying attention to and covering. So I was asking them questions about vaccines and treatments. Hold on a second. There were many parenting interruptions. I assume you washed your hands?

Yeah. All right. I know. Roll your eyes. Roll your eyes. This is what I'm talking about. Yeah, there you go. Anyhow, we were talking about the science, and in the flow of things, he throws out this name. Ignace Semmelweis. I found a profile of Ignat Semmelweis, and I just sort of put it on a tweet, and I said, you know,

every day is Ignat Semelweiss Day. You know, like... Who's this? Ignat Semelweiss, you know, just a whole, the whole epic story. No, what is this? What is this epic story?

I mean... And then he told me this crazy story of a 2,000-year-old medical mystery that involves life and death and dogma and disease and sacrifice and the price of knowledge, and I was like, whoa, whoa, whoa, whoa, whoa.

Get a USB mic. I'm going to call you back. Okay, just from the start. Yeah, so who is Ignis Semmelweis? So Semmelweis was born in 1818 to a family ran grocery stores in Budapest and Hungary. He was the fifth of nine kids. And he was, you know, you hear these words described him about him, you know, a lighthearted guy, popular, jocular. It seemed like a very pleasant man.

at least at the beginning. When you look at his face from the earliest photographs we have, he looks very intense. This is Nancy Tomes, historian of medicine at Stony Brook University. Dark hair, dark mustache. He, to my mind, must have cut a fine figure as a doctor with that impressive face and those haunting eyes. It is true he has a very smiley mouth in those early pictures, but his eyes are like searchlights. But in any case, Semmelweis, at first he thought he'd become a lawyer, but then he switched to medicine. He just had a really good medical class, I guess, at university and decided that's what I want to do.

And so he then traveled 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 just sort of set the seat? Tachie, I'm on an, oh, that's beautiful. I'm in an interview right now, babe. Can you, can you, uh... What is your password?

Uh, it's, it's, uh, sorry, Carl. It's, uh, ask mom to type it, right? That's just parenting in the pandemic. Okay, so Vienna Hospital, set the scene. Um, we should be picturing the Vienna General Hospital around 1846. Okay. This is a magnificent hospital. Vienna is one of the intellectual centers of the world.

This may be one of the greatest hospitals on Earth. Its professors are revered as holding all the wisdom of medical lore. And by the way, this is a moment when science itself, at least as we understand it now, was just getting going. Yes. Data, empiricism. Observation. Statistics. the big changes in the history of science coming about, moving from the old to the new,

was simply using your eyes and paying attention. So you had all these young doctors like Semmelweis 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 to 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 Semmelweis arrives in Vienna, 1844. You know, he's kicked around a bit at the medical school, trying to figure out 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 Iggy's 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 become an expert on childbirth. One thing to keep in mind. At this point, women did not go to hospitals to get 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. You 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 had 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 it was a teaching hospital. But not all of the hospital was for teaching. This becomes important later. There were two delivery awards in 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. You know, where they were advancing the science. Combining what they were learning with autopsies with, you know, doing childbirth. This is where our guy, Ignis Semmelweis, trained. And we can 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. He was 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 it was just relentless. You know, 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 fever 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 every time that there was another patient who was dying, they would call the priest. And every time a priest, would come into the hospital, they'd ring a bell. It had a strange effect upon my nerves when I heard the bell hurried past my door. A sigh would escape my heart for the victim that once more was claimed by an unknown power.

Yeah, so every time he heard that bell, it just made him shudder. The bell was a painful exhortation to me to search for this unknown cause with all of my might. 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. Purpural fever. Purporeal fever. It's not purple, as in the color, it's purperal fever,

which comes from the Latin purpura, which means woman who gives birth. At that point, it was sometimes called childbed fever, but it went back a long way. It had been described for thousands of years. I mean, Hippocrates actually describes it. If, however, the purgation of the proproprium does not take Even in the 5th century BC, Hippocrates, father of medicine, described the fevers, described the symptoms. He thought something had putrified in the mother. Yes. Other physicians? Cold air inadvertently received into the uterus, which closes the orifices of the vessel.

Thought maybe it was the air in the delivery room. In the period, it is widely accepted that the qualities of the air play your role in determining disease. This is Daniel Margot C. historian of science, Cambridge University. Some people 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, you tend to be dirty. If you are dirty, both morally and physically, then you 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. Oh, wow. 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 mothers, open up their abdomens, they saw this huge amount of pale liquid that looked to their...

them a little like milk, but it was pus. 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 Ignace Semmelweis was in delivery war number one, it was a really big problem. You know, sometimes 30% of the women giving birth at the hospital in a month die of this fever. That is a huge number. Huge. I mean, it would fluctuate. You know, in some months it would be 7%.

But still, you know, so everybody knew that this was a problem. And so the question was, well, what's causing this? And how can we address it? I imagine that every time he heard that bell, Ignat Simmelweis thought, I have 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 peripheral fever was,

but they were 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 of purple fever was related to weather. You know, there was no connection with weather. Cross that off the list. You know, it could rule things out. But here was 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 hospital's two obstetrical divisions, usually between 3,000 and 3,500. Division number one were doctors, number two were midwives. In the first division, an average of 600 to 800 mothers died each year from purple fever. In the second division, the figure was usually about 60 deaths. Semmelweis, like, runs the numbers, and he's like, my God. Like, 20% of these women are dying where the doctors are in charge,

and about 2% are dying when the midwives are in charge. Really? Yeah. So the death rate is 18% higher when the doctors are delivering the babies? 10 times higher. Think of it that way. About 10 times bigger risk of dying when, you know, some of the best doctors in the world are delivering your baby.

Naturally, Ignaz 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 2000-year-old mystery. That's after the break. Hi, my name is Rayenne, and I'm calling from Couchtown, Pennsylvania.

Radio Lab 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.s. I'm Chad Abumrah. This is Radio Lab. So it is 1847. Iggy Semmelweis is flummoxed. He's noticed a very distressing pattern that, you know, there are two delivery wards in the hospital, Division I.

You have the best and the brightest male doctors in the world, delivering babies. Division two, you have female midwives. He runs the numbers and finds that women giving birth in his delivery room, Division I, die at 10 times. higher the rate than division two. And he has no idea why this would be. These are supposed to be the best doctors in the world. But then he has an aha moment.

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 Kalechka. 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.

And the student was, you know, cutting open a cadaver under his guidance. Making some incisions. And then just accidentally nicked him with the knife. Nick the professor? Yes. Apparently the student's hand slipped or something, and he caught his professor on the finger. So the student nicks the professor with the knife, just a tiny little scrape. And then suddenly...

Within a few days, his mentor... He dies. A terrible death. But a terrible death that seemed familiar... Totally shattered. I brooded over the case with intense emotion until suddenly a thought crossed my mind. And once it became clear to me that child... bed fever, the fatal sickness of newborn and the disease of Professor Kalechka were one and the same. He realized, 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, the student's knife, a knife that first had been in a dead body and then had cut the professor's finger. The fact of the matter is that the transmitting source of those could ever be. particles was to be found in the hands of the students and intending physicians. When that professor died, it all clicked into place because what do these doctors do? These doctors in the morning might have their hands deep in a cadaver. And in the afternoon, they would walk over to a pregnant woman and start delivering a baby

with the same hands. Oh, 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 Semmelweis described it was that when a doctor was finished with an autopsy, he had cadaver particles on his hands. Oh.

So Semmelweis called these cadaver particles. Oh, that gives me chills, just thinking about that. He didn't call them bacteria or viruses or 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 here 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 the brutal paradox of his situation. he'd been trying to do the right thing. Advance the science, save lives. But it had done the opposite. In fact, the doctor who worked at the delivery ward

right before he got there, who was widely recognized as a lazy scientist, didn't do dissections. And as a consequence, more women survived. Semmelweis shows up, starts doing dissections as he believed was his duty, and the death spike. Family voice is very much aware of that paradox, that it's with the rise of scientific medicine, that childbirth fever is really coming into place.

And he basically says that, you know, me being a conscientious scientist is the reason why many mothers died before I realized that I was the cause of their disease. But in addition, it is his scientific method and his scientific way of thinking that allows him to recognize that. So there's some, it's very, it's very, I don't know. Yeah, it's, it is interesting, right? I mean, it's, it's the whole 19th century is a little bit like that, right? You know, with the rise of global circulations, the spread of, you know, steam ships, 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 Ignus Semmelweis 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 it was very hard for some of them and in fact

you know there was there was one doctor named Michaelis who he had delivered the baby of his own niece and she had developed purple fever and the realization that he was probably responsible for the death of his niece

just became too much and he committed suicide. Oh, wow. That's for Semmelweis. 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, he 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, you know, they didn't have particular. 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 he figured, well, you know, if I can get these cadaver particles off my hands, then maybe then I will be safe as a doctor to go deliver babies. And so he tried things out. You know, he 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 is good. He settled on basically bleach.

He would take some bleach, put it 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 Semmelweis by now was in charge of a lot of the births that were happening at Vienna General Hospital. And he just said, okay, new rule, folks, after you do your autopsy and before you deliver a baby, I've got this bowl here, wash your hands. Disinfect your hands. And what happened? He kept track. And he basically, like, brought the death rate to pretty much to zero.

I mean, he couldn't completely eliminate it, but he got pretty close. There were some months where, like, no women died at all, none. And it is here that Ignace Semmelweis reaches his disinfected hands into the present. Because all those PSAs that we're hearing these days about 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 2,000-year-old mystery of perperal fever. if only he could have lived to see Carl Zimmer's tweet

or see Steph Curry or LeBron James urged 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 Ignat Simmelweis. What a sad story. There's a final tragic chapter to this tale,

and this one can be told many different ways. Yep, very complicated and a lot of pretty intense controversy. Nancy says Semmelweis' 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 had an insight. But then the dogma pushes back. Absolutely. It's the 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 Ignat Semmelweis began to write letters. He starts writing to everyone in Europe.

He says, I figure this out, you need to institute handwashing and you need to accept my theory. As I mentioned, there were doctors that believed him, the younger doctors mostly. However, they weren't running the hospitals. They weren't running the medical schools. And so, you know, the older generation pushed back really hard. Push back how? Like, don't tell me what to do a young person kind of thing? Well, imagine that you are one of the most respected doctors in obstetrics, like in the world, and you've delivered thousands and thousands of babies.

You know what you're doing. And then a 28-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. It was ridiculous. And then to imply that an educated upper-class, the Chinese physician could have been so dirty that they were transmitting this terrible infection,

I think that is definitely an element at a more subterranean personal level. Don't tell me I'm dirty. Nancy thinks part of it was just that the older doctors were offended. Are you calling me filthy? You know, and Semmelweis 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. Just being really blunt about it.

You know, he would write letters to doctors, you know, and say, just say like you, sir, been a partner in a massacre. He starts writing more and more bitter letters and thinks that everyone who disagrees with him must be an evil person. You get the idea that this may have turned him from that jovial, popular guy to kind of a monomaniac.

And this gets us to the second version of events that the reason Ignace Semmelweis' big breakthrough didn't breakthrough, 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, called them names.

Certainly not a great way to win a lot of friends. Especially because some of them, according to Daniel Margo C, 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 doesn't? First of all, there is the issue that certain mothers still die after the institution of handwashing. Not all cases of childbirth fever disappear as a result. 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? Semmelweis just didn't have the patients to deal with these questions. And the problem was that in the early 1860s, he seems to go into a rapid decline. I mean, you can see, like, pictures of him, you know, this is a man in his early 40s,

and the pictures just show this man who starts to look like he's in his 60s or 70s. He was something terrible was happening. And his personality changed in all sorts of ways. I mean, he was already, could be a pretty irascible person, but he just started acting very strangely. At a meeting where he was supposed to give a report, he would just start reading from a random piece of paper, completely confused. He was married and had a family, but he just started like,

living openly with a prostitute. Something had gone terribly wrong. And so eventually, his family decided they had to bring him to an asylum in Vienna. He was 47. That's a pretty startling mental decline. The cause 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 turned your brain into mush. More recently, someone thought it was Alzheimer's disease, you know, very early onset. Could look very much like Alzheimer's.

In any case, he was institutionalized, but he didn't last more than two weeks. Oh, well, he died. He died in that institution. Yeah, so it seems that what happened was that, you know, he was getting, you know, just uncontrollable. and kind of violent by the time he was institutionalized. And, you know, this was a pretty dark time for people with mental illness. So the guards at 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 did him in. That's kind of a sad irony. It is ironic, yeah, that he probably, probably died of an infectious disease himself, a very rapid, devastating infection. Let me tell you what I'd take away from the story. This is maybe a third way to see it. That here was a moment where we, not just Semmelweis, all of us, were trapped in a middle space. A kind of tragic gap. We'd learned a thing, but it wasn't enough.

Semmelweis knew that something was making these women sick. He called that something, cadaver particles. Didn't use the word bacteria because he didn't know about bacteria. And only a couple years later, Louis Pasteur would come along and say, bacteria, that's what those cadaver particles really were. And he would offer the world a comprehensive new idea called germ theory that would change everything. Semmelweis was unfortunately the moment right before that. In many ways, we're in that moment too now. We know the enemy. We know its shape. We can draw pictures of it. We can track its 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 Ignace Semmelweis taught us back in 1847. Your hands are limousines for pathogens. You deliver them to their next home. the virus that causes COVID-19, this coronavirus, it's got 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 a good 20 seconds, saying happy birthday twice, soap, soap, soap, soap, soap, rinse it off well and dry it off well. And you haven't just, like, rubbed off viruses. You have actually, like, split open coronaviruses. they can't harm you. They can't harm anybody. It's 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. That this mundane act was fought for and died for, that there are hundreds of years of life and death and ignorance and knowledge all right there combingling with the soap and water. Soap has a special way of cutting into the oil. It breaks the oil up into time.

Tiny drops and surroundings. Wash your hands. Soap leather permits water to penetrate the skin pores. And wash away dirt and other foreign matters. Lavas pumice gets them clean with one more. Did you ever think how much fun it is just to be alive when you feel healthy and well? So if I just wash my hands, I can protect myself? Hands clean the first time.

Wash your hands. Wash. Wait a minute. I think you should wash your hands. That's it. That's it. Wash your hands, like your life, depends on it. Lava las manos. This just is.

Wash your hands. I heard it from my parents. Jimmy, did you wash your hands? Oh, well, someday, Billy. You'll find out why people watch with soap. Big thanks to Carl Zimmerm for spending so much time on the phone with me the past few days. And a hat tip to the late Sherman Newland, who wrote a biography of Ignace,

great biography called A Doctor's Plague. A lot of the information in this segment was taken from that book. This story was produced with Bethel Hoppe and Latif Nasser. I am Chad Abumrad. Thank you for washing. This is Luna Toll, washing her hands in Oval and Park, Kansas. Radio Lab is created by Jad Abumrad with Robert Krollwitch. And produced by Soren Wheeler.

Dylan Keith is our director of sound design. Susie Lechtenberg is our executive producer. Our staff includes Simon Adler, Becca Bressler, Rachel Cusick, David Gable, Bethel Hapty, Tracy Hunt, Matt Kielty, Annie McEwen, Latif Nasser, Sarah Quarry, Ariane Wack, Pat Walters, and Molly Webster. With help from Shima O'Lei with Harry Fortuna, Sarah Sandbach, Melissa O'Donnell, Tad, Davis, and Russell Gragg. Our fact checker is Michelle Harris.