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The Man Who Knew Why Everyone Was Dying

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The Man Who Knew Why Everyone Was Dying

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0:00

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

0:04

young woman was admitted to the

0:06

maternity clinic at Vienna General

0:08

Hospital. Her labor progressed quickly

0:11

and she soon gave birth to a healthy

0:13

baby boy. It was the happiest day of her

0:16

life.

0:18

And then, the fever started. 24 hours

0:21

later, her pulse was racing and her

0:24

abdomen was swollen and hot to the

0:26

touch. By the third day, she was

0:28

delirious.

0:30

By the fifth day,

0:31

she was dead.

0:33

An autopsy revealed she'd suffered from

0:35

a catastrophic infection that had spread

0:37

from her uterus

0:39

into her bloodstream. The official cause

0:41

of death was recorded as childbed fever,

0:44

a mysterious and devastating illness

0:47

that strikes women soon after giving

0:49

birth. Nobody knew exactly what caused

0:52

it, only that once it took hold, it was

0:56

frighteningly lethal. The death of a new

0:58

mother is a terrible tragedy, but at

1:00

Vienna General Hospital, it was an

1:02

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

1:05

this particular ward, up to a third of

1:08

patients would die from childbed fever.

1:11

Even by the 19th century standards, that

1:14

was staggeringly high. But it wasn't

1:16

just a sheer number of deaths that was

1:19

concerning, it was the distribution.

1:22

At the time, the maternity department at

1:24

Vienna General Hospital was one of the

1:26

largest in the world with patients split

1:28

across two separate clinics. And here's

1:31

where things start to get weird because

1:33

mothers who gave birth in the first

1:35

clinic were three to four times more

1:38

likely to die from childbed fever than

1:41

those who gave birth in the second. And

1:44

that simply didn't make any sense.

1:46

Admission to the clinics alternated on a

1:48

daily basis and there was no sorting of

1:51

patients by class, condition, or

1:54

anything else. It was completely random

1:57

which mothers ended up where. The only

1:59

formal difference between the clinics

2:01

was that one was used to train doctors

2:03

and the other midwives. Apart from that,

2:07

they were identical. And yet, month

2:10

after month, year after year, far more

2:12

women died in the first clinic than in

2:15

the second. Doctors were utterly

2:17

baffled. But, in 1846, a brilliant young

2:21

physician arrived at the hospital and

2:23

made it his mission to finally solve the

2:26

mystery. In doing so, he would make one

2:28

of the most important discoveries in the

2:31

history of medical science. A discovery

2:33

that would save tens of millions of

2:36

lives. His name was Ignaz Semmelweis.

2:40

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

2:42

and guess you've probably never heard of

2:45

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

2:48

reason for that. Because, despite his

2:50

groundbreaking discovery, Ignaz

2:52

Semmelweis

2:54

wasn't even famous in his own time, let

2:57

alone ours. His findings should have

2:59

transformed medical care overnight.

3:02

Instead,

3:03

they destroyed him. So, what exactly was

3:07

killing all those mothers in Vienna

3:09

General Hospital? How did Ignaz

3:11

Semmelweis solve the mystery? And why

3:14

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

3:18

Because, this is the story of one of the

3:20

most important medical discoveries in

3:22

history and how it quite literally

3:25

killed the man who made it.

3:28

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today.

5:09

Ignaz Semmelweis was born in 1818 in the

5:12

city of Buda, then part of the Austrian

5:15

Empire, and today one half of the

5:17

Hungarian capital, Budapest. His father

5:20

was a prosperous merchant, and like many

5:22

young men of his background, Semmelweis

5:24

was expected to pursue a respectable

5:26

professional career. In 1837, he

5:29

enrolled at the University of Vienna,

5:31

originally planning to study law, but

5:33

soon switching to medicine after a

5:35

medical lecture captured his

5:37

imagination. He earned his degree in

5:39

1844 before opting to specialize in

5:42

obstetrics,

5:43

>> [music]

5:43

>> the branch of medicine dealing with

5:44

pregnancy and childbirth. In 1846, at

5:48

just 28 years old, Semmelweis was

5:50

appointed assistant to the first

5:52

obstetrical clinic [music] at Vienna

5:54

General Hospital, one of the largest and

5:56

most advanced teaching hospitals in the

5:59

world. And it was there that he learned

6:01

of this strange mystery of the

6:03

hospital's two maternity clinics. In the

6:06

first clinic, mortality from childbed

6:08

fever routinely pushed towards 20%,

6:11

sometimes spiking even higher. In the

6:13

second clinic, the death rate typically

6:16

sat well below 5%. Semmelweis wasn't the

6:19

first person to notice this startling

6:21

discrepancy. In fact, the difference in

6:23

death rates was so huge and so

6:25

consistent, rumors had even begun to

6:28

circulate amongst the general public.

6:30

Amazingly, some women chose to give

6:33

birth in the street outside the hospital

6:36

rather than risk being admitted to the

6:38

death clinic. Even more amazingly, those

6:40

who did so contracted childbed fever at

6:44

a significantly lower rate [music]

6:46

than those in the first clinic. That

6:48

fact in particular intrigued Ignaz

6:50

Semmelweis. How could it possibly be the

6:53

case that it was safer to give birth

6:55

alone in the street rather than in one

6:58

of the most advanced hospitals in the

7:00

world? It just didn't make any sense.

7:03

Semmelweis made a few inquiries and it

7:06

quickly became clear that nobody could

7:08

explain this strange phenomenon. Most

7:10

doctors seemed to believe it was some

7:12

kind of statistical fluke. But after

7:15

pouring over hospital records,

7:17

Semmelweis was convinced that simply

7:20

wasn't possible. The difference in death

7:22

rates was too large and too consistent

7:24

to be dismissed as

7:26

>> [music]

7:26

>> random noise. Semmelweis had no idea

7:29

what made the first clinic so much

7:31

deadlier than the second,

7:33

but he knew it must be something.

7:36

Some hidden difference between the two

7:38

clinics that everyone else had missed.

7:41

All he had to do was figure out what it

7:44

was. And so he did something extremely

7:47

unusual for the mid-19th century. He

7:49

came up with various hypotheses for what

7:52

might be causing the death rate.

7:54

Then he tested them one by one. Or to

7:58

put that another way, he did science.

8:02

In Semmelweis's time, the main theory of

8:05

disease transmission was miasma, the

8:08

idea that illness was caused by

8:10

poisonous vapors in the air. That seemed

8:12

like a good place to start, but it

8:14

quickly became clear that bad air

8:17

couldn't be the problem. The two

8:18

maternity clinics weren't just in the

8:20

same hospital, they were literally right

8:22

next to each other, separated by a

8:25

single wall. They also shared a common

8:27

entrance hall and were ventilated by

8:29

windows spaced just meters apart. In

8:33

other words, regardless of whether it

8:35

was good or bad, the patients in both

8:37

clinics were breathing the same air. So,

8:41

Semmelweis crossed miasma off his list.

8:44

As I've already mentioned, there was one

8:46

formal difference between the two

8:48

clinics.

8:48

>> [music]

8:48

>> The first trained doctors and the second

8:52

midwives. And it turned out each of

8:54

these two groups took a slightly

8:56

different approach [music] to childbirth

8:58

itself. The midwives typically preferred

9:01

women to give birth in traditional

9:02

positions, [music]

9:03

usually lying on their side or sometimes

9:06

squatting down. The doctors, on the

9:08

other hand, took the modern approach

9:10

with the patients lying on their backs

9:12

so that examinations and interventions

9:14

[music]

9:15

would be easier. The differing approach

9:17

between the clinics had never been

9:19

questioned because birth position wasn't

9:22

thought to have an impact on childbed

9:24

fever rates. But to Semmelweis, it was

9:27

an obvious and important difference in

9:29

procedure. He convinced doctors in the

9:32

first clinic to adopt the same birth

9:34

positions as the midwives. And when he

9:36

reviewed the mortality rate several

9:38

weeks later, he was amazed to find

9:41

absolutely [music] nothing. Women

9:43

continued to die at much higher rates in

9:45

the first clinic. Semmelweis crossed

9:48

birth position off his list. At this

9:51

point, even Semmelweis was starting to

9:52

run out of ideas.

9:54

>> [music]

9:54

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

9:55

differences between the wards, but he

9:57

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

10:00

so he started to study the two clinics

10:02

more closely. [music]

10:03

And it wasn't long before he noticed

10:05

something interesting. The Austrian

10:07

Empire was overwhelmingly Catholic, and

10:10

it was standard practice for Catholic

10:12

priests to deliver last rites to the

10:14

dying. That was true for women in both

10:16

clinics, but there was a small

10:18

difference in exactly how it worked.

10:20

Dying women would be moved off the wards

10:23

and into a private room for the visit of

10:25

the priest. In the second clinic, that

10:28

room was tucked out of the way, but in

10:30

the first, it could only be reached by

10:31

way of the wards themselves. That meant

10:35

the priest had to pass by all the other

10:37

expectant mothers on his way to deliver

10:39

last rites to the dying women. Was it

10:41

possible that the sight of the grim

10:44

reaper-like priest was literally scaring

10:47

the women to death and creating a kind

10:50

of deadly feedback loop? The more

10:52

deaths, the more visits from the priest,

10:55

the more visits from the priest, the

10:57

more deaths? Semmelweis decided to find

11:00

out. He switched things up so that the

11:02

priest didn't have to pass through

11:04

either ward to visit the dead. Then,

11:07

he monitored the results.

11:09

Again,

11:10

nothing changed. He crossed death by

11:13

priest off his list. Yeah, that one was

11:16

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

11:19

Over the course of the next few months,

11:21

Semmelweis systematically examined and

11:23

eliminated every difference between the

11:26

clinics he could come up with. He

11:29

considered whether the the clinic might

11:31

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

11:33

checked whether the patients were being

11:35

given different food. They weren't. And

11:38

he searched for differences in bedding,

11:40

room layout, temperature, and lighting.

11:44

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

11:46

getting desperate. He was convinced he'd

11:49

considered everything, and yet, month

11:52

after month, the death rate in the first

11:54

clinic continued to soar high above that

11:57

of the second clinic. But, in March

12:00

1847,

12:02

a tragic accident provided a vital clue

12:05

that would ultimately unlock the entire

12:08

mystery. One of Semmelweis's colleagues

12:11

and close friends, called Jakob

12:13

Kolletschka, was giving an autopsy

12:15

demonstration to some students when one

12:17

of them accidentally jabbed his finger

12:20

with a scalpel. It was just a flesh

12:21

wound, and Jakob Kolletschka had

12:23

undoubtedly had worse.

12:26

But then, the fever started. His pulse

12:28

began to race, the tissue around his

12:31

wound grew swollen and hot [music] to

12:33

the touch.

12:34

And within days,

12:36

he was dead.

12:37

The autopsy would reveal a widespread

12:40

infection that had spread from his wound

12:43

into his bloodstream. When he saw the

12:45

report, Ignaz Semmelweis had made

12:48

exactly the same connection you just

12:50

did. [music] Jakob Kolletschka appeared

12:52

to have died from a disease with

12:54

extremely similar symptoms to those of

12:57

childbed fever.

12:59

But how could that be possible? Clearly,

13:01

Kolletschka hadn't recently given birth,

13:04

and the disease hadn't been known to

13:06

affect any other doctors before. Try as

13:09

he might, Semmelweis could only come up

13:12

with a single common factor between

13:14

Kolletschka's death and the deaths of

13:16

all those women in the first clinic.

13:19

Corpses.

13:20

Kolletschka had died after being pricked

13:22

with a scalpel used to cut up a cadaver.

13:25

The same obviously couldn't be said for

13:26

the women in clinic one, but they were

13:29

cared for by doctors and medical

13:31

students who routinely worked with dead

13:33

bodies. In fact, a typical day for a

13:36

doctor in the first clinic began in the

13:38

autopsy room dissecting the bodies of

13:41

patients who died the day before. Later

13:43

on, they'd head to the maternity ward to

13:46

do their rounds. What if something about

13:49

the dead

13:50

was making the living sick? Semmelweis

13:54

reasons that dead bodies might harbor

13:56

what he dubbed cadaverous particles,

13:59

tiny invisible infection vectors [music]

14:02

capable of spreading disease if they got

14:05

into the bloodstream. In Kolletschka's

14:07

case, that had happened by way of the

14:09

scalpel. But what about the women?

14:11

Semmelweis figured it out immediately.

14:13

Forcing an entire human out of your

14:15

reproductive organs inevitably involves

14:18

a certain amounts of

14:20

tearing. And such tears and abrasions

14:24

would be exposed to cadaverous particles

14:27

on the hands of the examining doctors.

14:30

For the mid-19th century, the idea that

14:33

invisible particles could make you ill

14:35

was pretty outlandish to say the least,

14:38

but it fit the evidence so perfectly

14:41

Semmelweis was convinced he was onto

14:44

something. The midwives in the second

14:46

clinic never carried out autopsies. The

14:50

doctors in the first clinic did. It was

14:53

a difference nobody had ever considered

14:55

before. Semmelweis set up an experiment

14:58

to test his new hypothesis. He asked

15:00

doctors and medical students in the

15:02

first clinic to wash their hands

15:05

thoroughly with a chlorinated lime

15:07

solution whenever they worked with

15:10

cadavers. In April 1847,

15:13

of 306 births in the first clinic, a

15:17

total 57 women died, a mortality rate of

15:21

18.7%

15:23

Semmelweis began his hand washing

15:25

experiment midway through the following

15:27

month and the results were absolutely

15:30

astonishing. In June, the first full

15:33

month under the new protocol,

15:35

the death rate collapsed to 2.2%

15:40

The following month, it fell even

15:42

further to just 1.2%

15:46

It wasn't always plain sailing. There

15:48

were occasional spikes when new sources

15:50

of infection appeared or when doctors

15:52

and medical students cut corners with

15:54

their hygiene protocols, but Semmelweis

15:57

continued to perfect his methods and in

16:00

March 1848, the most feared maternity

16:03

clinic in the entire Austrian Empire

16:06

recorded its first ever month

16:09

when not a single woman died. It was one

16:12

of the clearest demonstrations in the

16:14

history of medicine that a simple change

16:17

in hygiene could save lives on a massive

16:21

scale. Semmelweis was keen to spread the

16:23

word about his discovery. Second hand

16:25

accounts of his work appeared in several

16:27

medical journals and one of his

16:30

colleagues gave a lecture in front of

16:32

the Royal Medicine and Surgical Society

16:34

in London. Semmelweis expected his hand

16:37

washing and hygiene protocols to be

16:39

rolled out in hospitals all over the

16:41

world almost immediately. But it turned

16:44

out there was one small problem.

16:46

Everyone thought he was full of

16:49

At first, that might sound insane. The

16:51

evidence couldn't have been any clearer,

16:53

but there were a few key issues with

16:55

Semmelweis's work. Crucially, whilst

16:58

graphs like this one clearly show his

17:01

hand washing intervention was

17:02

spectacularly effective, Semmelweis

17:06

couldn't really explain exactly why.

17:10

What exactly were these cadaverous

17:11

particles? How did they cause disease in

17:14

the body? And why did chlorinated lime

17:18

neutralize them? Semmelweis had no idea.

17:22

He had a cause and an effect, but he

17:25

lacked the mechanism to link the two.

17:28

Broken down to its simplest form, he was

17:30

essentially claiming that by touching a

17:32

dead body, you somehow carried death on

17:36

your hands. That didn't sound like

17:38

medicine. It sounded like magic. And it

17:41

wasn't the only problem with his

17:43

discovery. Semmelweis wasn't just giving

17:45

his colleagues history's most effective

17:48

one simple trick to prevent childbed

17:51

fever. He was also informing them that

17:53

their own dirty hands were directly

17:56

responsible for the deaths of hundreds,

17:59

perhaps thousands of patients. That was

18:02

both utterly horrifying and also deeply

18:05

insulting. And since Semmelweis couldn't

18:08

entirely explain how it all worked, it

18:11

was far easier to simply dismiss the

18:13

whole thing. Which is why one of the

18:16

most important discoveries in the

18:18

history of medicine was largely ignored.

18:22

Semmelweis struggled to find supporters

18:25

even in his own hospital where the

18:27

success [music] of his methods had been

18:29

so spectacularly demonstrated. When his

18:32

contract expired in 1849, just two years

18:36

after his revolutionary handwashing

18:38

intervention was first introduced, his

18:40

superiors chose not to renew it. He

18:43

tried to get another job in Vienna, but

18:46

he was eventually forced to travel back

18:48

to Pest where he took up a relatively

18:50

lowly position on the obstetrics ward at

18:53

St. Rochus Hospital. Childbed fever was

18:55

rampant when he arrived in 1851, but

18:59

[snorts] thanks to his hygiene

19:00

protocols, over the following four years

19:04

only eight mothers died out of 933

19:08

births, a mortality rate comfortably

19:11

under 1%. In 1855, Semmelweis was

19:14

appointed professor of obstetrics at the

19:17

University of Pest. Once again, within

19:20

months of his arrival, the deaths from

19:22

childbed fever had been all but

19:24

eliminated. By this point, [music]

19:27

he had replicated his initial results in

19:29

Vienna in two additional hospitals, but

19:32

despite the mounting evidence, most of

19:35

the medical world remained either

19:36

skeptical or simply unaware of

19:39

Semmelweis' work. Part of the problem

19:41

was that Semmelweis himself had

19:43

published very little on his discovery.

19:45

Instead, he tried to spread the word

19:47

through lectures, teaching, and

19:48

discussions with colleagues. It wasn't

19:50

until 1861 that he finally published a

19:53

full and comprehensive overview of his

19:56

work in a book called The Etiology,

19:59

Concept, and Prophylaxis of Childbed

20:02

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

20:05

hard to understand, and it did the

20:07

square root of bugger all to convince

20:10

the medical community to adopt his

20:12

ideas. [music]

20:13

For Semmelweis, the failure of his book

20:15

was the last straw, and it marked the

20:18

beginning of a frighteningly swift

20:20

downward spiral. In the years after its

20:22

publication, he penned a series of open

20:24

letters directly attacking well-known

20:27

obstetricians [music] across Europe,

20:29

publicly denouncing them for their

20:31

ignorance and accusing them of being

20:33

complicit in mass murder. Friends and

20:36

colleagues began to notice changes in

20:38

his behavior as he grew increasingly

20:40

volatile. His lectures became more

20:42

erratic, and he would sometimes

20:44

interrupt discussions at random with

20:47

angry outbursts. In 1865,

20:50

uh this behavior became so extreme his

20:53

family secretly arranged for him to be

20:55

incarcerated in a lunatic asylum. When

20:57

he realized what was going on, he tried

20:59

to fight his way out, earning him a

21:02

severe beating before he was finally

21:04

locked inside his cell. Two weeks later,

21:07

on the 13th of August, 1865,

21:10

at the age of just 47, he died of

21:13

sepsis, a severe infection,

21:16

likely brought on by the wounds

21:18

sustained at the hands of the guards. In

21:20

a final and deeply cruel irony, the man

21:24

who'd spent his life trying to prevent

21:26

fatal infections

21:28

had died from one himself. To this day,

21:31

historians aren't entirely sure what

21:33

brought about Semmelweis's dramatic

21:35

decline. It isn't hard to imagine that

21:37

his rejection by the medical community

21:39

played a part, and it must have been

21:41

incredibly hard knowing that thousands

21:43

[music] of women continued to die

21:44

needlessly

21:46

from a disease that could be so easily

21:47

prevented. But, in recent years, some

21:50

scholars have suggested it might not

21:52

have been so simple as that, and that

21:55

Semmelweis may have been suffering from

21:57

some form of neurological disease, like

22:00

early-onset dementia.

22:01

>> [music]

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>> Whatever the cause,

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there's no avoiding the uncomfortable

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truth that a doctor who should have been

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celebrated as a pioneer and a savior to

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millions died alone and disgraced in a

22:14

mental asylum. Within a few years of his

22:16

death, the scientific world would

22:18

finally catch up with Semmelweis's

22:20

ideas. In the 1860s, [music]

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Louis Pasteur demonstrated that

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microscopic organisms were responsible

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for processes [music] like fermentation

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and decay, and in the decades that

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followed, scientists like Robert Koch

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proved for the first time that specific

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microbes caused certain diseases.

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This brand new science, known today as

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germ theory,

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was the final piece of the puzzle

22:45

Semmelweis had been missing all along.

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And by the end of the 19th century,

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handwashing and sterilization had become

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fundamental principles of modern

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medicine. It is a colossal tragedy that

22:57

Ignaz Semmelweis

23:00

wasn't alive to see it.

23:03

Thanks for watching.

Interactive Summary

The video recounts the tragic life and groundbreaking work of Ignaz Semmelweis, a 19th-century physician who discovered the importance of hand hygiene in medical settings. While working at the Vienna General Hospital, Semmelweis observed that women giving birth in the clinic used by doctors had significantly higher mortality rates from 'childbed fever' than those in the clinic used by midwives. He eventually linked the infections to 'cadaverous particles' transferred from autopsy rooms by doctors to patients. Despite his successful implementation of a handwashing protocol that drastically reduced deaths, his peers rejected his findings because he lacked a biological mechanism to explain them, and the suggestion that doctors were responsible for the deaths was deeply insulting. Semmelweis died in disgrace before his ideas were later validated by the emergence of germ theory.

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