Listener supported WNYC Studios. Wait, you're OK? You're listening to Radiolab Radio from WNYC. OK, hey, I'm Jad Abumrad. This is Radiolab Dispatch number two. This is a story that we're all living out 20, 30, 50 times a day in 20 second bursts, a story I didn't even really know about. But when this whole Korona crisis was new, just I mean, it seems like it's been years.

But just two weeks ago, one of the first people I called was Mr. and Mr. Zimmer.

Oh, it's good to hear your voice with Carl Zimmer. He's a science writer, regular guest on the show. How are you doing, everyone OK?

You know, we sort of like, you know, fluctuate. 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 is asking them questions about vaccines and treatments.

Think there were many parenting interruptions? I assume you asked your hands. Yeah, I know.

Roll your eyes. Roll your eyes to 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 Ignaz Semmelweis.

I found I found a profile of Ignaz Semmelweis and I just sort of put it on a tweet.

And I said, you know, every day is Ignaz Semmelweis Day, you know, whose's Ignaz Semmelweis, you know, just 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 12 year old medical mystery that involves life and death in dogma and disease and sacrifice and the price of knowledge, and I was like, whoa, whoa, whoa, whoa, whoa.

Get a USP, Mike. I'm going to call you back, OK?

Just from the start. Yeah. So so who who is Ignace Semmelweis? So Semmelweis was born in 1818 to a family, ran grocery stores in Budapest, in Hungary.

He was the fifth of nine kids.

And he was you know, they you hear these words described him by him, you know, a lighthearted guy, popular, jocular, seemed like a very pleasant man, at least at the beginning.

When you look at his face from the earliest photographs we have here, he looks very intense.

This is Nancy Tome's, 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 Searchlight's. 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, in that 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.

OK, so Vienna Hospital, this is where the mystery unfolds. Can you just sort of set a seat?

I want to. Oh, that's beautiful. I'm going to interview right now. You can you, uh, what is your password? Uh, it's, uh, it's, uh, sorry.

It's a small take. That's just parenting in the pandemic.

OK, so Vienna Hospital set the scene. We should be picturing the Vienna General Hospital around 1846.

This is a magnificent hospital. Vienna is 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 of medical law.

And by the way, this is a moment when science itself, at least as we understand it now, was just getting going.

Yes. Data, empiricists, observation statistics, one of 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.

OK, so and so. Semmelweis arrived 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 got to become an expert on childbirth.

One thing to keep in mind at this point, women did not go to hospitals to give birth routinely in this time period. The women who went there were 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 DNA, 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 hospitals for teaching there. This becomes important. Later, there were two delivery wards 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 and it was just relentless, you know, 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 people 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 would come into the hospital, they 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.

Yes, every time you heard that bell, it just it just made him shudder.

That 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 the disease with a strange name, purple fever, purple role, purple fever, it's not purple as in the color, it's purple 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, hypocritic actually describes it. If, however, the progression of the program does not take place, even in the 5th century B.C., Epocrates, father of medicine, described the fevers, described the symptoms.

He thought something had putrefied 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 a role in determining disease.

This is Daniel Margaux's sea historian of science, Cambridge University.

Some people argue that there is seasonal variation in a number of women being affected. 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 nurture their children was somehow getting rooted 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 mothers, open up their abdomens, they saw this huge amount of. Pale liquid that looked to 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 Ignaz Semmelweis was in delivery, ward number one, it was a really big problem.

You know, sometimes 30 percent of the 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 seven percent. 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 you heard that bell, Ignaz Semmelweis 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 a fever was, but they were really good at keeping records. So they 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 a purple fever was related to whether, you know, there was no connection with whether cross that off the list could rule things out.

But here was the really big thing he noticed. Observation number one, if you remember, there were two different delivery wards. The same number of deliveries took place in each of the hospitals, two obstetrical divisions, usually between three thousand and three thousand five hundred.

Division number one were doctors. Number two were midwives. In the first division, an average of six hundred to eight hundred mothers died each year from a fever in the second division. The figure was usually about 60 deaths.

Semmelweis, like, runs the numbers and he was like, my God. Like 20 percent of these women are dying where the doctors are in charge and about two percent are dying when the midwives are in charge. Really? Yeah. So the death rate is 18 percent higher when the doctors are delivering the babies ten times higher.

Think of it that way, about ten times bigger risk of dying when you know some of the best doctors in the world are delivering your baby. Naturally, Ignacio's 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 20 year old mystery. That's after the break. Hi, my name is Ryan and I'm calling from Kutztown, Pennsylvania.

Radiolab 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 w w w that Slumdog.

I'm Jad Abumrad. This is Radiolab, so it is 1847, EGI Semmelweis is flummoxed.

He's noticed a very distressing pattern that there are two delivery wards in the hospital division one, 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 one, die at ten 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 Kalinka, 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. Yeah, 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.

At once, it became clear to me that childbed fever, the fatal sickness of newborn and the disease of Professor Calexico 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 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 cadaver particles was to be found in the hands of the students.

And in telling 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 the idea of cadaver particles, he thought, oh my God, because of my convictions, I must hear 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 deaths spike, life is very much aware of that paradox, that it's with the rise of scientific medicine, that childhood 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 in 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.

It's yeah, it is interesting, right? I mean, it's 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, steamships, you get at the same time the cholera. So the spread of knowledge and the spread of diseases is, you know, they are often connected to. OK, so what happens next is it Ignace 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 it was very hard for some of them. And in fact, you know, there was there was one doctor named Mickolus who, you know, he had delivered the baby of his own niece and she had developed a 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, OK, well. What could I knowingness? 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 particularly good ways of preserving them. So it was a pretty nasty business.

And he was you know, his sense of smell is very attuned to the smell of a corpse.

So he 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 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, OK, this 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 was by now was in charge of a lot of the births that were happening at Vienna General Hospital. And he just said, OK, NeuroFocus. After you do your own autopsy and before you deliver a baby, I've got this here. Wash your hands. Disinfect your hands and and what happened? He kept track and he basically like brought the death rate 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 Ignaz Semmelweis reaches his disinfected hands into the present because all those pieces that we're hearing these days about washing your hands, they really begin in this moment with a Hungarian guy realizing that hand washing, the simple act of rubbing your hands together with some soap.

Or bleach would be the key to the 2000 year old mystery of girl 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 Ignaz Semmelweis. Well, what a sad story.

There's a final tragic chapter to this tale, and this one can be told many different ways. Yes, very complicated and a lot of pretty intense controversy.

Nancy says some places and it's 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 Ignaz 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 most.

However, they weren't running the hospitals. They weren't running the medical schools. And so, you know, the the older generation. Pushed back really hard, pushed back, tell it 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, like in the world, and you've delivered thousands and thousands of babies and 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 daily's physician could have been 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 I'm dirty.

Nancy thinks part of it was just that the older doctors were offended. You call 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 Yuzu been a partner in a massacre.

He starts writing more and more bitter letters and things that everyone who 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 a monomaniac.

And this gets us to the second version of events that the reason Ignaz Semmelweis is big breakthrough didn't break through, at least not in his lifetime, is that it's as much his own fault as anyone else.

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 Marcosi, had legitimate scientific questions like, OK, 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 patience to deal with these questions?

And the problem was that in the early 1960s, 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 he 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. You know, 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 his family decided they had to bring him to an asylum in Vienna.

He was 47. That 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 turns your brain into much 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 it 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 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 did him in. It's kind of a sad irony, it is it is ironic, yeah, that he probably died of of an infectious disease himself, a 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 was the moment where we not just Semmelweis, all of us were trapped in a middle space, a kind of tragic gap. We 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 what 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 Ignaz Semmelweis taught us back in eighteen forty seven, your hands are limousine's for pathogen's. You deliver them to their next home, the virus that causes covid-19, this coronavirus, it's got a membrane around it that'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. Sing Happy Birthday twice. Stop, stop, stop, stop, stop.

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, it can't harm anybody.

It's very satisfying the way you just describe that washing hands then becomes a kind of an act of war.

Yeah. Next time you wash your hands, think about that at 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, commingling with the soap and water.

They can do did. Yes, so has a special way of cutting into the oil. It breaks the oil up into tiny drops and the rope from its water to penetrate the skin board and walk away Derg, another foreign mammographies promise to come clean with one more. Did you ever think how much fun it is just to be alive when you feel healthy and well? So I just wash my hands. I have my hands clean the first time. Why?

Wait a minute. You should wash your hands. That's. Wash your hands like your life depends on your love, I love the last man. This just can't wash your hands. I heard it from my parents. Jimmy, did you wash your hands?

Oh, well, someday, Billy, you will find out why people want with soap. Big thanks to Carl Zimmer for spending so much time on the phone with me the past few days and a hat tip to the late Sherman Nuland, who wrote a biography of Ignaz Semmelweis, 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 Hot and lots of Nassr. I am Jad Abumrad.

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