WEBVTT - Why Was a Doctor Once Ridiculed for Recommending Hand Washing? 0:00:01.920 --> 0:00:06.560 Welcome to Brainstuff, a production of I Heart Radio, Hey, 0:00:06.600 --> 0:00:10.680 brain Stuff, Lauren Volga bam here. Even when there isn't 0:00:10.680 --> 0:00:13.319 a pandemic on we all know we're supposed to wash 0:00:13.360 --> 0:00:16.560 our hands, especially before we eat or after we've touched 0:00:16.680 --> 0:00:20.800 something gross. But that wasn't always the case. As recently 0:00:20.880 --> 0:00:23.639 as the eighteen hundreds, a doctor was mocked for even 0:00:23.720 --> 0:00:27.000 suggesting that physicians wash their hands before working with patients. 0:00:27.560 --> 0:00:31.000 And that, dear listener, is how we begin the strange 0:00:31.040 --> 0:00:34.960 and sad story of Ignatz Smilvis, a nineteenth century doctor 0:00:35.120 --> 0:00:39.720 sometimes called the father of infection control some of weis 0:00:39.840 --> 0:00:43.400 was born in Hungary in eighteen eighteen, and after graduating 0:00:43.400 --> 0:00:46.160 from medical school, he started a job at Vienna General 0:00:46.200 --> 0:00:49.880 Hospital in Austria in eighteen forty six. There he became 0:00:49.920 --> 0:00:52.279 a ghast at the mortality rate of new mothers in 0:00:52.280 --> 0:00:55.440 one of the hospital's wards. In this ward, up to 0:00:55.560 --> 0:00:58.280 eighteen percent of new mothers were dying from what was 0:00:58.360 --> 0:01:02.240 then called child bed fever or pure pearl fever. We 0:01:02.360 --> 0:01:04.680 know today that this is a fever caused by infection 0:01:04.720 --> 0:01:08.600 of the reproductive or urinary tract in new mothers. Yet 0:01:08.720 --> 0:01:12.000 in another of the hospital's wards, where midwives instead of doctors, 0:01:12.040 --> 0:01:14.760 delivered all of the babies. Only about two percent of 0:01:14.800 --> 0:01:20.080 mothers died of this then mysterious fever. Zemolweiss began reasoning 0:01:20.120 --> 0:01:22.600 his way to the root of the problem. He considered 0:01:22.640 --> 0:01:26.880 climate and crowding, but eventually ruled those factors out. In 0:01:26.920 --> 0:01:29.839 the end, the midwives themselves seemed to be the only 0:01:29.920 --> 0:01:34.880 real difference between the two wards. Then Zemovieis had an epiphany. 0:01:35.120 --> 0:01:38.520 One of the hospital's doctors, a pathologist, accidentally nicked himself 0:01:38.520 --> 0:01:40.959 with a scalpel that he had used during an autopsy 0:01:41.080 --> 0:01:44.399 of one of these unfortunate mothers. The doctor was sickened 0:01:44.400 --> 0:01:48.640 with childbed fever, and he died. Zemoweis made the connection 0:01:48.720 --> 0:01:51.760 that doctors were performing autopsies on patients who had died 0:01:51.760 --> 0:01:55.480 of childbed fever and then immediately afterward going to deliver 0:01:55.560 --> 0:01:59.240 babies without stopping to wash their hands. He suspected that 0:01:59.280 --> 0:02:02.400 this was the sore of the deadly problem. But we 0:02:02.480 --> 0:02:06.040 spoke via email with Dana Tolozievski, a philosophy professor at 0:02:06.080 --> 0:02:09.160 Purdue University whose name I hope I am pronouncing correctly. 0:02:09.919 --> 0:02:13.359 She explained basically his hypothesis here was that it was 0:02:13.440 --> 0:02:17.000 cadaveric matter from the scalpel that entered the pathologist's blood 0:02:17.040 --> 0:02:20.160 and caused the infection, and that same material could be 0:02:20.200 --> 0:02:22.519 transferred to the women on the hands of the doctors, 0:02:22.919 --> 0:02:25.680 because the doctors would do autopsies and then go straight 0:02:25.720 --> 0:02:27.959 to examine the women who had given birth without washing 0:02:28.000 --> 0:02:31.480 their hands, changing their clothes, or basically taking any hygienic 0:02:31.520 --> 0:02:35.280 measures at all. He then tested this hypothesis by requiring 0:02:35.320 --> 0:02:38.120 people who had performed autopsies to wash their hands with 0:02:38.240 --> 0:02:41.920 chloride of lime, a disinfectant, before attending the women, and 0:02:42.200 --> 0:02:45.360 after this the mortality rate in the first clinic fell 0:02:45.440 --> 0:02:49.440 to that of the second. You'd think that Simulweis's fellow 0:02:49.480 --> 0:02:52.840 doctors would have lauded him for this discovery, but you'd 0:02:52.840 --> 0:02:56.600 be wrong. You see, in the eighteen forties, germ theory 0:02:56.680 --> 0:02:59.880 hadn't been conceived yet. That's the theory that diseases are 0:03:00.000 --> 0:03:03.560 caused by organisms not visible to the naked eye. People 0:03:03.639 --> 0:03:06.840 still suspected that diseases transferred from one person to another 0:03:07.040 --> 0:03:11.560 via toxic odors, not bacteria or viruses. This was called 0:03:11.680 --> 0:03:15.480 miasthma theory. In washing their hands They probably wanted to 0:03:15.560 --> 0:03:18.200 be rid of whatever was causing a bad odor, not 0:03:18.280 --> 0:03:20.960 to kill germs that might wreak havoc on them or 0:03:21.120 --> 0:03:25.840 someone else. We also spoke ya email with Michael Millinson, 0:03:26.160 --> 0:03:30.080 an adjunct professor of medicine at Northwestern University. He said 0:03:30.440 --> 0:03:34.320 physicians of Zimbovice's time simply did not understand or believe 0:03:34.440 --> 0:03:37.920 that something microscopic could be wreaking such havoc on their patients. 0:03:38.400 --> 0:03:42.040 They literally believed their own eyes. Lest we feel too smug, 0:03:42.320 --> 0:03:44.960 consider how many people currently embrace a lack of COVID 0:03:45.080 --> 0:03:49.200 nineteen deaths among people like me geographically, racially, economically, or 0:03:49.280 --> 0:03:53.400 otherwise as evidence that scientists are overestimating the pandemics risk. 0:03:54.240 --> 0:03:58.520 Better handwashing regiments dramatically improved death rates at the maternity ward, 0:03:59.040 --> 0:04:02.440 but some of vices colleagues were at best miffed at 0:04:02.440 --> 0:04:05.880 the implication that their ignorance was killing their own patients, 0:04:05.920 --> 0:04:08.960 and perhaps the implication that midwives were better at delivering 0:04:08.960 --> 0:04:12.880 babies than they were. It didn't help that Zemmolwei's essentially 0:04:13.000 --> 0:04:15.160 laid the deaths of the ward's mothers at the feet 0:04:15.160 --> 0:04:18.960 of his superiors. His own supervisor countered that the hospital's 0:04:19.040 --> 0:04:21.720 new ventilation system must be the reason for the decline 0:04:21.760 --> 0:04:26.920 in maternity deaths. Also, Zemmoweiss was a Hungarian in Austria, 0:04:27.279 --> 0:04:30.360 a foreigner working in a country in the throes of xenophobia. 0:04:32.040 --> 0:04:36.200 So those doctors rejected his theories and Smovie's himself as 0:04:36.320 --> 0:04:40.080 being inferior. They opted to stick with their miasma theory, 0:04:40.279 --> 0:04:42.839 and for good measure, in eighteen forty nine did not 0:04:43.080 --> 0:04:48.640 renew Zemmelweis's appointment. Zemoviis eventually got a medical position in Budapest, 0:04:48.720 --> 0:04:52.280 where he, according to the British Medical Journal Quote, publicly 0:04:52.360 --> 0:04:56.479 harangued doctors and nurses about handwashing and reduced paternal mortality. 0:04:58.400 --> 0:05:00.920 He eventually published a book on this object some fourteen 0:05:00.960 --> 0:05:04.400 years later, but it was poorly written and poorly received. 0:05:05.560 --> 0:05:09.200 Possibly experiencing a mental disorder or extreme stress from his 0:05:09.240 --> 0:05:12.800 rejection by the medical establishment, Zemmoweis ended up a patient 0:05:12.880 --> 0:05:16.440 in an asylum in eighteen sixty five. Weeks later, he 0:05:16.560 --> 0:05:18.400 was dead of an infection from a wound that he 0:05:18.440 --> 0:05:21.559 received in the facility. He was just forty seven years old. 0:05:23.160 --> 0:05:26.840 Zemoweiss left behind a monumental legacy, but the tragedy of 0:05:26.839 --> 0:05:30.160 his story has made it garner a few myths, one 0:05:30.200 --> 0:05:33.000 of those being that Zemmoweiss was the first to suggest 0:05:33.000 --> 0:05:38.359 a theory about doctors transmitting germs. Galiziaski said he wasn't 0:05:38.440 --> 0:05:42.200 really a pioneer. Other people before Zemalweiss had hit upon 0:05:42.240 --> 0:05:45.000 the idea that child bed fever could be transmitted from 0:05:45.080 --> 0:05:49.200 doctor or midwife to patient. For example, Alexander Gordon of 0:05:49.240 --> 0:05:53.600 Aberdeen showed in sevent that childhood fever was almost always 0:05:53.600 --> 0:05:56.480 transmitted by doctors or midwives, and also that it was 0:05:56.520 --> 0:05:58.880 connected to a kind of strupp, a cockle skin rash. 0:05:59.520 --> 0:06:02.200 He so thought that the best treatment was copious bleeding. 0:06:03.040 --> 0:06:06.240 In the States, famously, there was Oliver Wendell Holmes, who 0:06:06.279 --> 0:06:08.320 was a physician but is now much better known as 0:06:08.360 --> 0:06:11.039 a poet, who wrote a very elegant essay called the 0:06:11.040 --> 0:06:14.880 Contagiousness a Pureborough Fever in eighteen forty three, a year 0:06:14.920 --> 0:06:19.800 before Zemowis even completed his m d. Another misunderstanding is 0:06:19.839 --> 0:06:24.160 that doctors of his time outright rejected Zemoviss's ideas about handwashing. 0:06:24.560 --> 0:06:28.839 They didn't entirely, They just attributed coming down childbed fever 0:06:28.960 --> 0:06:32.600 to a range of variables such as predisposition, environment, and 0:06:32.720 --> 0:06:38.200 many other factors. To Liziski said, because people already had 0:06:38.240 --> 0:06:41.960 such a long list, adding cadaverick or decomposing animal matter 0:06:42.240 --> 0:06:45.520 really wasn't a big deal to them, and lots of people, 0:06:45.680 --> 0:06:48.320 some of them pretty big shots, did add this to 0:06:48.360 --> 0:06:51.880 their list and started disinfecting their hands, so it's just 0:06:51.960 --> 0:06:56.440 not true that that part was universally rejected. Later in 0:06:56.480 --> 0:06:59.440 the eighteen sixties, Louis Pasteur started working on what would 0:06:59.440 --> 0:07:04.680 eventually become the theoretical explanation behind Zimbilvice's observations, and in 0:07:04.720 --> 0:07:08.000 the eighties, thanks to the pioneering work of Joseph Lister 0:07:08.080 --> 0:07:11.920 and others, people started using antiseptic techniques in surgical and 0:07:12.040 --> 0:07:15.400 maternity wards, which is when mortality rates from child bed 0:07:15.440 --> 0:07:18.720 fever really began to fall, along with many other inhospital 0:07:18.800 --> 0:07:23.680 mortality rates. But even after scientists realized that Zimilvis had 0:07:23.680 --> 0:07:27.040 been right all along about hand washing, this simple act 0:07:27.160 --> 0:07:31.560 still remains a challenge throughout society. That's partially because even 0:07:31.600 --> 0:07:34.520 though we now know that germs are there, we human 0:07:34.560 --> 0:07:37.840 beings still sometimes trust what we see and discount what 0:07:37.880 --> 0:07:42.680 we can't. A January poll found fort of Americans don't 0:07:42.720 --> 0:07:45.600 always wash their hands after going to the bathroom, Even 0:07:45.640 --> 0:07:48.960 doctors and nurses may rationalize their own behavior has nothing 0:07:49.000 --> 0:07:53.680 to do with spreading disease. Millinson said, patients get infections 0:07:53.720 --> 0:07:56.360 for many reasons. They come into contact with many people 0:07:56.400 --> 0:08:00.480 and many objects, and have compromised immune systems, and by definition, 0:08:00.640 --> 0:08:03.080 those who forget to wash or don't do it properly 0:08:03.320 --> 0:08:08.160 don't know that they forgot or were ineffective. Millinsen points 0:08:08.160 --> 0:08:11.120 out that there is still no requirement that hospitals reach 0:08:11.160 --> 0:08:14.400 a certain threshold on hand hygiene, only that they have 0:08:14.440 --> 0:08:18.320 a program in place to improve it. He said, almost 0:08:18.360 --> 0:08:21.720 as bad, the US Centers for Disease Control doesn't monitor 0:08:21.800 --> 0:08:25.080 a national hand hygiene rate in hospitals, which often hovers 0:08:25.120 --> 0:08:28.560 in the ten to forty percent range. On average, US 0:08:28.600 --> 0:08:31.559 healthcare providers clean their hands less than half the times 0:08:31.560 --> 0:08:34.120 that they should, according to the most recent CDC study, 0:08:34.200 --> 0:08:38.400 which was eighteen years ago. It's too soon to have 0:08:38.520 --> 0:08:41.679 numbers on how the COVID nineteen pandemic has affected hand 0:08:41.760 --> 0:08:45.720 hygiene in hospitals, though anecdotal evidence suggests it's put healthcare 0:08:45.720 --> 0:08:49.880 providers on high alert during this time, semovices even seeing 0:08:49.880 --> 0:08:52.480 a resurgence in pop culture. He was honored with a 0:08:52.520 --> 0:08:55.840 Google doodle in March, and an opera about him, which 0:08:55.840 --> 0:09:01.840 premiered Ineen, was live streamed in May. Finally, there's this 0:09:02.000 --> 0:09:06.040 bright spot, Millinson equipped I like to tell provider audiences 0:09:06.160 --> 0:09:08.760 the good news is that we've made significant progress since 0:09:08.800 --> 0:09:11.880 Samuel Vis's time. We no longer put people who insist 0:09:11.920 --> 0:09:20.160 on doctors washing their hands into an insane asylum. Today's 0:09:20.160 --> 0:09:22.840 episode was written by Nathan Chandler and produced by Tyler Clang. 0:09:23.040 --> 0:09:24.719 For more on this and lots of other topics, visit 0:09:24.720 --> 0:09:27.200 how stuff works dot com. Brain Stuff is production of 0:09:27.240 --> 0:09:29.760 iHeart Radio. For more podcasts in my heart Radio, visit 0:09:29.800 --> 0:09:32.520 the iHeart Radio app, Apple Podcasts, or wherever you listen 0:09:32.559 --> 0:09:33.480 to your favorite shows.