Speaker 1: Welcome to Brainstuff, a production of I Heart Radio, Hey,
Speaker 1: brain Stuff, Lauren Volga bam here. Even when there isn't
Speaker 1: a pandemic on we all know we're supposed to wash
Speaker 1: our hands, especially before we eat or after we've touched
Speaker 1: something gross. But that wasn't always the case. As recently
Speaker 1: as the eighteen hundreds, a doctor was mocked for even
Speaker 1: suggesting that physicians wash their hands before working with patients.
Speaker 1: And that, dear listener, is how we begin the strange
Speaker 1: and sad story of Ignatz Smilvis, a nineteenth century doctor
Speaker 1: sometimes called the father of infection control some of weis
Speaker 1: was born in Hungary in eighteen eighteen, and after graduating
Speaker 1: from medical school, he started a job at Vienna General
Speaker 1: Hospital in Austria in eighteen forty six. There he became
Speaker 1: a ghast at the mortality rate of new mothers in
Speaker 1: one of the hospital's wards. In this ward, up to
Speaker 1: eighteen percent of new mothers were dying from what was
Speaker 1: then called child bed fever or pure pearl fever. We
Speaker 1: know today that this is a fever caused by infection
Speaker 1: of the reproductive or urinary tract in new mothers. Yet
Speaker 1: in another of the hospital's wards, where midwives instead of doctors,
Speaker 1: delivered all of the babies. Only about two percent of
Speaker 1: mothers died of this then mysterious fever. Zemolweiss began reasoning
Speaker 1: his way to the root of the problem. He considered
Speaker 1: climate and crowding, but eventually ruled those factors out. In
Speaker 1: the end, the midwives themselves seemed to be the only
Speaker 1: real difference between the two wards. Then Zemovieis had an epiphany.
Speaker 1: One of the hospital's doctors, a pathologist, accidentally nicked himself
Speaker 1: with a scalpel that he had used during an autopsy
Speaker 1: of one of these unfortunate mothers. The doctor was sickened
Speaker 1: with childbed fever, and he died. Zemoweis made the connection
Speaker 1: that doctors were performing autopsies on patients who had died
Speaker 1: of childbed fever and then immediately afterward going to deliver
Speaker 1: babies without stopping to wash their hands. He suspected that
Speaker 1: this was the sore of the deadly problem. But we
Speaker 1: spoke via email with Dana Tolozievski, a philosophy professor at
Speaker 1: Purdue University whose name I hope I am pronouncing correctly.
Speaker 1: She explained basically his hypothesis here was that it was
Speaker 1: cadaveric matter from the scalpel that entered the pathologist's blood
Speaker 1: and caused the infection, and that same material could be
Speaker 1: transferred to the women on the hands of the doctors,
Speaker 1: because the doctors would do autopsies and then go straight
Speaker 1: to examine the women who had given birth without washing
Speaker 1: their hands, changing their clothes, or basically taking any hygienic
Speaker 1: measures at all. He then tested this hypothesis by requiring
Speaker 1: people who had performed autopsies to wash their hands with
Speaker 1: chloride of lime, a disinfectant, before attending the women, and
Speaker 1: after this the mortality rate in the first clinic fell
Speaker 1: to that of the second. You'd think that Simulweis's fellow
Speaker 1: doctors would have lauded him for this discovery, but you'd
Speaker 1: be wrong. You see, in the eighteen forties, germ theory
Speaker 1: hadn't been conceived yet. That's the theory that diseases are
Speaker 1: caused by organisms not visible to the naked eye. People
Speaker 1: still suspected that diseases transferred from one person to another
Speaker 1: via toxic odors, not bacteria or viruses. This was called
Speaker 1: miasthma theory. In washing their hands They probably wanted to
Speaker 1: be rid of whatever was causing a bad odor, not
Speaker 1: to kill germs that might wreak havoc on them or
Speaker 1: someone else. We also spoke ya email with Michael Millinson,
Speaker 1: an adjunct professor of medicine at Northwestern University. He said
Speaker 1: physicians of Zimbovice's time simply did not understand or believe
Speaker 1: that something microscopic could be wreaking such havoc on their patients.
Speaker 1: They literally believed their own eyes. Lest we feel too smug,
Speaker 1: consider how many people currently embrace a lack of COVID
Speaker 1: nineteen deaths among people like me geographically, racially, economically, or
Speaker 1: otherwise as evidence that scientists are overestimating the pandemics risk.
Speaker 1: Better handwashing regiments dramatically improved death rates at the maternity ward,
Speaker 1: but some of vices colleagues were at best miffed at
Speaker 1: the implication that their ignorance was killing their own patients,
Speaker 1: and perhaps the implication that midwives were better at delivering
Speaker 1: babies than they were. It didn't help that Zemmolwei's essentially
Speaker 1: laid the deaths of the ward's mothers at the feet
Speaker 1: of his superiors. His own supervisor countered that the hospital's
Speaker 1: new ventilation system must be the reason for the decline
Speaker 1: in maternity deaths. Also, Zemmoweiss was a Hungarian in Austria,
Speaker 1: a foreigner working in a country in the throes of xenophobia.
Speaker 1: So those doctors rejected his theories and Smovie's himself as
Speaker 1: being inferior. They opted to stick with their miasma theory,
Speaker 1: and for good measure, in eighteen forty nine did not
Speaker 1: renew Zemmelweis's appointment. Zemoviis eventually got a medical position in Budapest,
Speaker 1: where he, according to the British Medical Journal Quote, publicly
Speaker 1: harangued doctors and nurses about handwashing and reduced paternal mortality.
Speaker 1: He eventually published a book on this object some fourteen
Speaker 1: years later, but it was poorly written and poorly received.
Speaker 1: Possibly experiencing a mental disorder or extreme stress from his
Speaker 1: rejection by the medical establishment, Zemmoweis ended up a patient
Speaker 1: in an asylum in eighteen sixty five. Weeks later, he
Speaker 1: was dead of an infection from a wound that he
Speaker 1: received in the facility. He was just forty seven years old.
Speaker 1: Zemoweiss left behind a monumental legacy, but the tragedy of
Speaker 1: his story has made it garner a few myths, one
Speaker 1: of those being that Zemmoweiss was the first to suggest
Speaker 1: a theory about doctors transmitting germs. Galiziaski said he wasn't
Speaker 1: really a pioneer. Other people before Zemalweiss had hit upon
Speaker 1: the idea that child bed fever could be transmitted from
Speaker 1: doctor or midwife to patient. For example, Alexander Gordon of
Speaker 1: Aberdeen showed in sevent that childhood fever was almost always
Speaker 1: transmitted by doctors or midwives, and also that it was
Speaker 1: connected to a kind of strupp, a cockle skin rash.
Speaker 1: He so thought that the best treatment was copious bleeding.
Speaker 1: In the States, famously, there was Oliver Wendell Holmes, who
Speaker 1: was a physician but is now much better known as
Speaker 1: a poet, who wrote a very elegant essay called the
Speaker 1: Contagiousness a Pureborough Fever in eighteen forty three, a year
Speaker 1: before Zemowis even completed his m d. Another misunderstanding is
Speaker 1: that doctors of his time outright rejected Zemoviss's ideas about handwashing.
Speaker 1: They didn't entirely, They just attributed coming down childbed fever
Speaker 1: to a range of variables such as predisposition, environment, and
Speaker 1: many other factors. To Liziski said, because people already had
Speaker 1: such a long list, adding cadaverick or decomposing animal matter
Speaker 1: really wasn't a big deal to them, and lots of people,
Speaker 1: some of them pretty big shots, did add this to
Speaker 1: their list and started disinfecting their hands, so it's just
Speaker 1: not true that that part was universally rejected. Later in
Speaker 1: the eighteen sixties, Louis Pasteur started working on what would
Speaker 1: eventually become the theoretical explanation behind Zimbilvice's observations, and in
Speaker 1: the eighties, thanks to the pioneering work of Joseph Lister
Speaker 1: and others, people started using antiseptic techniques in surgical and
Speaker 1: maternity wards, which is when mortality rates from child bed
Speaker 1: fever really began to fall, along with many other inhospital
Speaker 1: mortality rates. But even after scientists realized that Zimilvis had
Speaker 1: been right all along about hand washing, this simple act
Speaker 1: still remains a challenge throughout society. That's partially because even
Speaker 1: though we now know that germs are there, we human
Speaker 1: beings still sometimes trust what we see and discount what
Speaker 1: we can't. A January poll found fort of Americans don't
Speaker 1: always wash their hands after going to the bathroom, Even
Speaker 1: doctors and nurses may rationalize their own behavior has nothing
Speaker 1: to do with spreading disease. Millinson said, patients get infections
Speaker 1: for many reasons. They come into contact with many people
Speaker 1: and many objects, and have compromised immune systems, and by definition,
Speaker 1: those who forget to wash or don't do it properly
Speaker 1: don't know that they forgot or were ineffective. Millinsen points
Speaker 1: out that there is still no requirement that hospitals reach
Speaker 1: a certain threshold on hand hygiene, only that they have
Speaker 1: a program in place to improve it. He said, almost
Speaker 1: as bad, the US Centers for Disease Control doesn't monitor
Speaker 1: a national hand hygiene rate in hospitals, which often hovers
Speaker 1: in the ten to forty percent range. On average, US
Speaker 1: healthcare providers clean their hands less than half the times
Speaker 1: that they should, according to the most recent CDC study,
Speaker 1: which was eighteen years ago. It's too soon to have
Speaker 1: numbers on how the COVID nineteen pandemic has affected hand
Speaker 1: hygiene in hospitals, though anecdotal evidence suggests it's put healthcare
Speaker 1: providers on high alert during this time, semovices even seeing
Speaker 1: a resurgence in pop culture. He was honored with a
Speaker 1: Google doodle in March, and an opera about him, which
Speaker 1: premiered Ineen, was live streamed in May. Finally, there's this
Speaker 1: bright spot, Millinson equipped I like to tell provider audiences
Speaker 1: the good news is that we've made significant progress since
Speaker 1: Samuel Vis's time. We no longer put people who insist
Speaker 1: on doctors washing their hands into an insane asylum. Today's
Speaker 1: episode was written by Nathan Chandler and produced by Tyler Clang.
Speaker 1: For more on this and lots of other topics, visit
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