Hey, 42 here. In the spring of 1845, a

young woman was admitted to the

maternity clinic at Vienna General

Hospital. Her labor progressed quickly

and she soon gave birth to a healthy

baby boy. It was the happiest day of her

life.

And then, the fever started. 24 hours

later, her pulse was racing and her

abdomen was swollen and hot to the

touch. By the third day, she was

delirious.

By the fifth day,

she was dead.

An autopsy revealed she'd suffered from

a catastrophic infection that had spread

from her uterus

into her bloodstream. The official cause

of death was recorded as childbed fever,

a mysterious and devastating illness

that strikes women soon after giving

birth. Nobody knew exactly what caused

it, only that once it took hold, it was

frighteningly lethal. The death of a new

mother is a terrible tragedy, but at

Vienna General Hospital, it was an

all-too-familiar one. In a bad month on

this particular ward, up to a third of

patients would die from childbed fever.

Even by the 19th century standards, that

was staggeringly high. But it wasn't

just a sheer number of deaths that was

concerning, it was the distribution.

At the time, the maternity department at

Vienna General Hospital was one of the

largest in the world with patients split

across two separate clinics. And here's

where things start to get weird because

mothers who gave birth in the first

clinic were three to four times more

likely to die from childbed fever than

those who gave birth in the second. And

that simply didn't make any sense.

Admission to the clinics alternated on a

daily basis and there was no sorting of

patients by class, condition, or

anything else. It was completely random

which mothers ended up where. The only

formal difference between the clinics

was that one was used to train doctors

and the other midwives. Apart from that,

they were identical. And yet, month

after month, year after year, far more

women died in the first clinic than in

the second. Doctors were utterly

baffled. But, in 1846, a brilliant young

physician arrived at the hospital and

made it his mission to finally solve the

mystery. In doing so, he would make one

of the most important discoveries in the

history of medical science. A discovery

that would save tens of millions of

lives. His name was Ignaz Semmelweis.

And I'm going to go out on a limb here

and guess you've probably never heard of

him. And there's a very good, if tragic,

reason for that. Because, despite his

groundbreaking discovery, Ignaz

Semmelweis

wasn't even famous in his own time, let

alone ours. His findings should have

transformed medical care overnight.

Instead,

they destroyed him. So, what exactly was

killing all those mothers in Vienna

General Hospital? How did Ignaz

Semmelweis solve the mystery? And why

did nobody give a [ __ ] Let's find out.

Because, this is the story of one of the

most important medical discoveries in

history and how it quite literally

killed the man who made it.

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Ignaz Semmelweis was born in 1818 in the

city of Buda, then part of the Austrian

Empire, and today one half of the

Hungarian capital, Budapest. His father

was a prosperous merchant, and like many

young men of his background, Semmelweis

was expected to pursue a respectable

professional career. In 1837, he

enrolled at the University of Vienna,

originally planning to study law, but

soon switching to medicine after a

medical lecture captured his

imagination. He earned his degree in

1844 before opting to specialize in

obstetrics,

>> [music]

>> the branch of medicine dealing with

pregnancy and childbirth. In 1846, at

just 28 years old, Semmelweis was

appointed assistant to the first

obstetrical clinic [music] at Vienna

General Hospital, one of the largest and

most advanced teaching hospitals in the

world. And it was there that he learned

of this strange mystery of the

hospital's two maternity clinics. In the

first clinic, mortality from childbed

fever routinely pushed towards 20%,

sometimes spiking even higher. In the

second clinic, the death rate typically

sat well below 5%. Semmelweis wasn't the

first person to notice this startling

discrepancy. In fact, the difference in

death rates was so huge and so

consistent, rumors had even begun to

circulate amongst the general public.

Amazingly, some women chose to give

birth in the street outside the hospital

rather than risk being admitted to the

death clinic. Even more amazingly, those

who did so contracted childbed fever at

a significantly lower rate [music]

than those in the first clinic. That

fact in particular intrigued Ignaz

Semmelweis. How could it possibly be the

case that it was safer to give birth

alone in the street rather than in one

of the most advanced hospitals in the

world? It just didn't make any sense.

Semmelweis made a few inquiries and it

quickly became clear that nobody could

explain this strange phenomenon. Most

doctors seemed to believe it was some

kind of statistical fluke. But after

pouring over hospital records,

Semmelweis was convinced that simply

wasn't possible. The difference in death

rates was too large and too consistent

to be dismissed as

>> [music]

>> random noise. Semmelweis had no idea

what made the first clinic so much

deadlier than the second,

but he knew it must be something.

Some hidden difference between the two

clinics that everyone else had missed.

All he had to do was figure out what it

was. And so he did something extremely

unusual for the mid-19th century. He

came up with various hypotheses for what

might be causing the death rate.

Then he tested them one by one. Or to

put that another way, he did science.

In Semmelweis's time, the main theory of

disease transmission was miasma, the

idea that illness was caused by

poisonous vapors in the air. That seemed

like a good place to start, but it

quickly became clear that bad air

couldn't be the problem. The two

maternity clinics weren't just in the

same hospital, they were literally right

next to each other, separated by a

single wall. They also shared a common

entrance hall and were ventilated by

windows spaced just meters apart. In

other words, regardless of whether it

was good or bad, the patients in both

clinics were breathing the same air. So,

Semmelweis crossed miasma off his list.

As I've already mentioned, there was one

formal difference between the two

clinics.

>> [music]

>> The first trained doctors and the second

midwives. And it turned out each of

these two groups took a slightly

different approach [music] to childbirth

itself. The midwives typically preferred

women to give birth in traditional

positions, [music]

usually lying on their side or sometimes

squatting down. The doctors, on the

other hand, took the modern approach

with the patients lying on their backs

so that examinations and interventions

[music]

would be easier. The differing approach

between the clinics had never been

questioned because birth position wasn't

thought to have an impact on childbed

fever rates. But to Semmelweis, it was

an obvious and important difference in

procedure. He convinced doctors in the

first clinic to adopt the same birth

positions as the midwives. And when he

reviewed the mortality rate several

weeks later, he was amazed to find

absolutely [music] nothing. Women

continued to die at much higher rates in

the first clinic. Semmelweis crossed

birth position off his list. At this

point, even Semmelweis was starting to

run out of ideas.

>> [music]

>> There simply didn't seem to be any other

differences between the wards, but he

wasn't a man to give up so easily. And

so he started to study the two clinics

more closely. [music]

And it wasn't long before he noticed

something interesting. The Austrian

Empire was overwhelmingly Catholic, and

it was standard practice for Catholic

priests to deliver last rites to the

dying. That was true for women in both

clinics, but there was a small

difference in exactly how it worked.

Dying women would be moved off the wards

and into a private room for the visit of

the priest. In the second clinic, that

room was tucked out of the way, but in

the first, it could only be reached by

way of the wards themselves. That meant

the priest had to pass by all the other

expectant mothers on his way to deliver

last rites to the dying women. Was it

possible that the sight of the grim

reaper-like priest was literally scaring

the women to death and creating a kind

of deadly feedback loop? The more

deaths, the more visits from the priest,

the more visits from the priest, the

more deaths? Semmelweis decided to find

out. He switched things up so that the

priest didn't have to pass through

either ward to visit the dead. Then,

he monitored the results.

Again,

nothing changed. He crossed death by

priest off his list. Yeah, that one was

always a bit of a long shot, wasn't it?

Over the course of the next few months,

Semmelweis systematically examined and

eliminated every difference between the

clinics he could come up with. He

considered whether the the clinic might

be more crowded. [music] It wasn't. He

checked whether the patients were being

given different food. They weren't. And

he searched for differences in bedding,

room layout, temperature, and lighting.

There weren't any. By this time, he was

getting desperate. He was convinced he'd

considered everything, and yet, month

after month, the death rate in the first

clinic continued to soar high above that

of the second clinic. But, in March

1847,

a tragic accident provided a vital clue

that would ultimately unlock the entire

mystery. One of Semmelweis's colleagues

and close friends, called Jakob

Kolletschka, was giving an autopsy

demonstration to some students when one

of them accidentally jabbed his finger

with a scalpel. It was just a flesh

wound, and Jakob Kolletschka had

undoubtedly had worse.

But then, the fever started. His pulse

began to race, the tissue around his

wound grew swollen and hot [music] to

the touch.

And within days,

he was dead.

The autopsy would reveal a widespread

infection that had spread from his wound

into his bloodstream. When he saw the

report, Ignaz Semmelweis had made

exactly the same connection you just

did. [music] Jakob Kolletschka appeared

to have died from a disease with

extremely similar symptoms to those of

childbed fever.

But how could that be possible? Clearly,

Kolletschka hadn't recently given birth,

and the disease hadn't been known to

affect any other doctors before. Try as

he might, Semmelweis could only come up

with a single common factor between

Kolletschka's death and the deaths of

all those women in the first clinic.

Corpses.

Kolletschka had died after being pricked

with a scalpel used to cut up a cadaver.

The same obviously couldn't be said for

the women in clinic one, but they were

cared for by doctors and medical

students who routinely worked with dead

bodies. In fact, a typical day for a

doctor in the first clinic began in the

autopsy room dissecting the bodies of

patients who died the day before. Later

on, they'd head to the maternity ward to

do their rounds. What if something about

the dead

was making the living sick? Semmelweis

reasons that dead bodies might harbor

what he dubbed cadaverous particles,

tiny invisible infection vectors [music]

capable of spreading disease if they got

into the bloodstream. In Kolletschka's

case, that had happened by way of the

scalpel. But what about the women?

Semmelweis figured it out immediately.

Forcing an entire human out of your

reproductive organs inevitably involves

a certain amounts of

tearing. And such tears and abrasions

would be exposed to cadaverous particles

on the hands of the examining doctors.

For the mid-19th century, the idea that

invisible particles could make you ill

was pretty outlandish to say the least,

but it fit the evidence so perfectly

Semmelweis was convinced he was onto

something. The midwives in the second

clinic never carried out autopsies. The

doctors in the first clinic did. It was

a difference nobody had ever considered

before. Semmelweis set up an experiment

to test his new hypothesis. He asked

doctors and medical students in the

first clinic to wash their hands

thoroughly with a chlorinated lime

solution whenever they worked with

cadavers. In April 1847,

of 306 births in the first clinic, a

total 57 women died, a mortality rate of

18.7%

Semmelweis began his hand washing

experiment midway through the following

month and the results were absolutely

astonishing. In June, the first full

month under the new protocol,

the death rate collapsed to 2.2%

The following month, it fell even

further to just 1.2%

It wasn't always plain sailing. There

were occasional spikes when new sources

of infection appeared or when doctors

and medical students cut corners with

their hygiene protocols, but Semmelweis

continued to perfect his methods and in

March 1848, the most feared maternity

clinic in the entire Austrian Empire

recorded its first ever month

when not a single woman died. It was one

of the clearest demonstrations in the

history of medicine that a simple change

in hygiene could save lives on a massive

scale. Semmelweis was keen to spread the

word about his discovery. Second hand

accounts of his work appeared in several

medical journals and one of his

colleagues gave a lecture in front of

the Royal Medicine and Surgical Society

in London. Semmelweis expected his hand

washing and hygiene protocols to be

rolled out in hospitals all over the

world almost immediately. But it turned

out there was one small problem.

Everyone thought he was full of

At first, that might sound insane. The

evidence couldn't have been any clearer,

but there were a few key issues with

Semmelweis's work. Crucially, whilst

graphs like this one clearly show his

hand washing intervention was

spectacularly effective, Semmelweis

couldn't really explain exactly why.

What exactly were these cadaverous

particles? How did they cause disease in

the body? And why did chlorinated lime

neutralize them? Semmelweis had no idea.

He had a cause and an effect, but he

lacked the mechanism to link the two.

Broken down to its simplest form, he was

essentially claiming that by touching a

dead body, you somehow carried death on

your hands. That didn't sound like

medicine. It sounded like magic. And it

wasn't the only problem with his

discovery. Semmelweis wasn't just giving

his colleagues history's most effective

one simple trick to prevent childbed

fever. He was also informing them that

their own dirty hands were directly

responsible for the deaths of hundreds,

perhaps thousands of patients. That was

both utterly horrifying and also deeply

insulting. And since Semmelweis couldn't

entirely explain how it all worked, it

was far easier to simply dismiss the

whole thing. Which is why one of the

most important discoveries in the

history of medicine was largely ignored.

Semmelweis struggled to find supporters

even in his own hospital where the

success [music] of his methods had been

so spectacularly demonstrated. When his

contract expired in 1849, just two years

after his revolutionary handwashing

intervention was first introduced, his

superiors chose not to renew it. He

tried to get another job in Vienna, but

he was eventually forced to travel back

to Pest where he took up a relatively

lowly position on the obstetrics ward at

St. Rochus Hospital. Childbed fever was

rampant when he arrived in 1851, but

[snorts] thanks to his hygiene

protocols, over the following four years

only eight mothers died out of 933

births, a mortality rate comfortably

under 1%. In 1855, Semmelweis was

appointed professor of obstetrics at the

University of Pest. Once again, within

months of his arrival, the deaths from

childbed fever had been all but

eliminated. By this point, [music]

he had replicated his initial results in

Vienna in two additional hospitals, but

despite the mounting evidence, most of

the medical world remained either

skeptical or simply unaware of

Semmelweis' work. Part of the problem

was that Semmelweis himself had

published very little on his discovery.

Instead, he tried to spread the word

through lectures, teaching, and

discussions with colleagues. It wasn't

until 1861 that he finally published a

full and comprehensive overview of his

work in a book called The Etiology,

Concept, and Prophylaxis of Childbed

Fever. It was long, it was dense, it was

hard to understand, and it did the

square root of bugger all to convince

the medical community to adopt his

ideas. [music]

For Semmelweis, the failure of his book

was the last straw, and it marked the

beginning of a frighteningly swift

downward spiral. In the years after its

publication, he penned a series of open

letters directly attacking well-known

obstetricians [music] across Europe,

publicly denouncing them for their

ignorance and accusing them of being

complicit in mass murder. Friends and

colleagues began to notice changes in

his behavior as he grew increasingly

volatile. His lectures became more

erratic, and he would sometimes

interrupt discussions at random with

angry outbursts. In 1865,

uh this behavior became so extreme his

family secretly arranged for him to be

incarcerated in a lunatic asylum. When

he realized what was going on, he tried

to fight his way out, earning him a

severe beating before he was finally

locked inside his cell. Two weeks later,

on the 13th of August, 1865,

at the age of just 47, he died of

sepsis, a severe infection,

likely brought on by the wounds

sustained at the hands of the guards. In

a final and deeply cruel irony, the man

who'd spent his life trying to prevent

fatal infections

had died from one himself. To this day,

historians aren't entirely sure what

brought about Semmelweis's dramatic

decline. It isn't hard to imagine that

his rejection by the medical community

played a part, and it must have been

incredibly hard knowing that thousands

[music] of women continued to die

needlessly

from a disease that could be so easily

prevented. But, in recent years, some

scholars have suggested it might not

have been so simple as that, and that

Semmelweis may have been suffering from

some form of neurological disease, like

early-onset dementia.

>> [music]

>> Whatever the cause,

there's no avoiding the uncomfortable

truth that a doctor who should have been

celebrated as a pioneer and a savior to

millions died alone and disgraced in a

mental asylum. Within a few years of his

death, the scientific world would

finally catch up with Semmelweis's

ideas. In the 1860s, [music]

Louis Pasteur demonstrated that

microscopic organisms were responsible

for processes [music] like fermentation

and decay, and in the decades that

followed, scientists like Robert Koch

proved for the first time that specific

microbes caused certain diseases.

This brand new science, known today as

germ theory,

was the final piece of the puzzle

Semmelweis had been missing all along.

And by the end of the 19th century,

handwashing and sterilization had become

fundamental principles of modern

medicine. It is a colossal tragedy that

Ignaz Semmelweis

wasn't alive to see it.

Thanks for watching.