Maria Theresa's Medical Legacy (with Matt Kaplan)

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1:59Welcome to this very special episode of Noble Blood. I am so thrilled to be joined by Matt Kaplan, the science correspondent at The Economist. He's written about everything from paleontology and parasites to virology. He's a paleoclimatologist by training, I've just heard, written for the National Geographic, New Scientist Nature, New York Times. But more relevant to this audience, his new book, I Told You So, Scientists Who Were Ridiculed, Exiled, and Imprisoned for Being Right, is out February 24th. It has been such a roller coaster working on the book, too. I mean, I set out to look at scientists who had been screwed by the system, scientists who had had great ideas, and then their ideas didn't make it even though they were right.

2:47And what I stumbled upon as I uncovered the history of science and looked at the underbelly, a lot of these relationships, it was unbelievable to me how often monarchs in particular in Europe got involved in all of this stuff. I mean, and top, like the cream of the crop was Empress Maria Theresa of Austria. I mean, she's just such an incredible personality. Well, that's really who I'm very excited to talk to you about, because the very first chapter in your book, you start the story with Maria Theresa, who, as listeners of the show might know, was the 18th century leader of the only sole female monarch of the Habsburg monarchy in Austria.

3:31An incredibly interesting and powerful woman, the mother of Marie Antoinette, who's sort of a marquee figure. yeah she was also the mother of 16 children 16 kids i mean like i understand biologically how that works but wow really yeah i i managed one and i'm i consider that a real pet on the back doing 16 feels and also running an empire yeah and i mean the thing is and she wasn't i mean okay aside from being a baby machine, which clearly she was because, I mean, she was really popping them out. But there was also the fact that she, I mean, it wasn't just Austria she was ruling, right? She had territory all the way deep into Italy.

4:18She controlled Milan. She had sort of an arrangement where she had partial control of Florence, but she was also up in Croatia and into Transylvania and big chunks of Romania. I mean, she had so much control and her sister, was the governor of Netherlands. And really, Maria Teresa is such an interesting character because she wasn't just a ruler. Because of all her kids, she had an incredible soft spot for the overwhelmingly impoverished women of her empire. There were swarms and swarms of women in her empire who got pregnant, because, I mean, there was no birth control back then, and women had no rights.

5:03And so there was rampant rape and incest and all kinds of other horrible stuff, as well as relationships where they just had sex and didn't know what was going to happen next. Or I guess they did know what was going to happen next and just let it go. But women were having babies all the time and could not feed them. And so their only option was to go to a bridge in the dark of night and throw the baby over the bridge into the river when no one was looking and yeah i mean and i mean i'm i'm taken aback by that and i mean i worked in the emergency services in university as a emergency medic and it that kind of stuff chills my blood um and it turns out it chills noble blood too because maria teresa really cared she really wanted that to come to an end and one of her first moves as was the installation of drop boxes.

6:02Now drop boxes, you're familiar with them at libraries, right? You have them in the United States still, I hope. We had them when I was growing up in California. We have them in the UK. I'm sure you still have them. Oh man, you forgot to drop off the book. You're going to drop it off in the box and the library will deal with it when they have opening hours. They installed these at all the hospitals in Austria so that women who were going to throw their baby in the river, could put their baby in the box, turn the box around, and hope that the state could give their child better care than they could.

6:34Yeah. I mean, the state did not have a lot. So this was really not a great option. But they were, you know, she was trying. She also had a vision, as you mentioned in your book, for a hospital that would be able to take care of impoverished people and these underprivileged women, these women who are forced into situations where they have to give birth, but don't have the resources to actually do so safely. This hospital, Maria Theresa would die in 1780, but her vision would actually be fulfilled. Yeah, it was a huge deal too. So Maria Theresa met up with Gerard van Sweeten. Gerard van Sweeten was the physician who looked after her sister, who was the governor of Netherlands.

7:16she had a stillborn child stillborn children often initiated bacterial infections in the mother and Gerard van Sweeten was unable to save Maria Theresa's sister the governor of Netherlands but Maria Theresa was so taken aback by his professionalism that she brought him into her empire and started up a friendship with him now van Sweeten I mean you have to we have to backtrack here for a second because van Sweeten is a really interesting character in his own right So going way back in time for a moment, we have Hippocrates during the age of the Greeks who believed in the humors. Now, Hippocrates, he did say, you know, as a physician, you should help or at least do no harm.

7:58But he also believed that you had blood, bile, phlegm, and all of this stuff in perfect balance. And that when you became ill, it was because one of the humors was out of balance. So if you had too much fever, the solution was, well, you've got too much blood in you, drain them of blood. If you have too much phlegm in you, you know, not such a bad thing. Put them in a hot room, have them cough up the phlegm. There's actual benefits to that, right? You get a chest infection, go in the steam room or the sauna. So, I mean, like, he wasn't totally wrong, but his ideas weren't real great either for medicine.

8:31If he existed in the first place, I think as you've been clear in your book, Hippocrates is, he might have existed, but we're kind of going on Plato's word on that. Yeah, we don't really know a whole lot about Hippocrates, but what we do know for sure is that a British physician named Thomas Sydenham, who was really active, like 1650s, he rediscovered Hippocrates' ideas, whether Hippocrates existed or not, and he adopted them. And there was this huge renaissance in medicine, which was not really a renaissance because people started bleeding patients again, which wasn't good. And Sydenham taught his ideas widely.

9:07And one of the people who really picked him up was Gerard van Sweeten. And Gerard van Sweeten ended up really convincing Maria Theresa that her hospital needed to have these ideas in her hospital. and one of the possibly most disastrous things he did was he ended up hiring a guy named Anton Dehayan and I mean Dehayan was a real piece of work Dehayan believed in the devil and believed that like vampires caused certain diseases and any doctor who said I think they're ill for some reason other than God being angry at them Dehayan would not have it no no they're ill because God has made them ill. End of story.

9:47Of course. Yeah. Yeah. Right. So in the midst of all of this, you've got this hospital being built and this hospital would eventually house a man named Ignaz Semmelweis. Ignaz Semmelweis was an obstetrician who was really deeply bothered by a disease that killed one in 10 women who gave birth in the hospital. It was called per peril fever. And if you got it, you died. That was the end of story. It was only second to tuberculosis and killing people off. The reason no one really cared about it was because it only killed women off. And who cared about women back in that day? I mean, really, can you believe this?

10:27And so, but Ignaz Semmelweis saw all these women dying. There was nothing he could do. And he started running experiments to kind of explore, like, why do they get this? How does this happen. But he was operating in a hospital that had been established by DeHeyn, who believed that you only got ill if God made it so. Well, one point that you make in your book that I find very interesting is someone like DeHeyn believes, well, your illness has to do with, you know, the weather and the temperature and the position of the stars and the position of the moon. And sort of if you're thinking scientifically, it wouldn't really make sense that one woman in a ward when the weather's a certain way gets sick and the other right next to her with the weather the exact same way and the moon in the same position wouldn't get sick.

11:15Well, yeah, I mean, that's the thing. I mean, with that said, when preparal fever happened, it tended to happen in waves. So the women in the ward, many women in the ward would all die at the same time from preparal fever. So that's where they got this idea that it was the sun, the moon and the stars. But here's the catch and this is what really got Semmelweis thinking and it and it didn't work in the hospital because the hospital was founded by people like Dehaan and and von Sweden but Semmelweis said wait a minute there's this ward that is mostly managed by doctors and there's this ward mostly managed by women not women by nurses who were women and fascinating the word that gets all of the preparal fever cases, or most of them, is the ward with the doctors.

12:04The people tended to by the nurses don't get it. So like the weather's the same around the buildings, the same, what the hell's going on? One of the things I write about in the books is he noticed that the priest who was working at the hospital would come and ring his bell and smoke the incense in the room where the doctors were present far more often because we're more people dying. And he thought it's the priest. The priest is causing this. So he banned the priest from, and of course that had no effect, but Hey, you know, good on him for checking that out. And in the meantime, everyone's rolling their eyes.

12:42Like, what is this guy doing? Why is he trying this stuff? But ultimately he really had huge breakthroughs and demonstrated that it was doctors going to the morgue in the morning and examining their patients from the previous day, they were washing their hands with soap and water, but because corpse material was getting under their fingernails and because soap and water is just not up to the task of getting rid of corpse bacteria, which is rancid, they were then going, and when women were giving labor, going into labor, they would palpate to feel if they could feel the baby's head to find out if the umbilical cord was around the neck or whether or not the baby was going to be a breach.

13:21These were important things to know, and they were introducing corpse material into the babies, into the women, and the women were getting this infection and dying. I mean, it was a giant discovery and Semmelweis created this antiseptic solution that neutralized it. Unfortunately, the hospital was just not ready to accept what he discovered and his peers ended up throwing him into an insane asylum for all of his hard work. Because imagine, I mean, for these doctors, I'm sure it seems like a personal insult saying like your hands aren't clean enough to be treating these women. Yeah. I mean, in fact, actually, his ideas got out to some sections of Germany, the city of Kiel.

14:05There was a doctor surnamed Michalis. I can't remember his first name, but Michalis initially accepted Semmelweis' ideas and said, we've had tremendous success with this chlorine wash. And then it dawned on Michalis, oh, the thousands of women who have died in this hospital are because of me. And so he threw himself onto the railroad tracks and committed suicide outside of the city because he couldn't take the belief, the understanding. He understood what he had done in his life. And obviously that's not good. But actually the vitriol that Semmelweis received, you look at what these people were writing to them and what they were saying to him.

14:50Sure, part of it was they believed that God drove disease and that was the sun, the moon, and the stars. But I think deep in their heart of hearts, many of these doctors who engaged in character assassination, it was really all about the knowing deep inside that they actually were responsible and couldn't cope with that. For decades, people traveled across the world to see John of God, desperate for cures no doctor could offer. And when they arrived, they saw things they couldn't explain. This is real. This guy's actually doing surgery and it's a miracle. I never believed that miracles were real until that point.

15:30But behind those adoring crowds was something much darker. One of the reasons why I never went to the police is because I saw at least five or six men with guns everywhere he went. That was clear to me, like, close your mouth, don't open your mouth, don't say anything. I'm your host, Martina Castro. And in the podcast Two-Faced, John of God, we'll look back on a man who claimed he could perform miracles and got people from all around the world to believe him. From Exactly Right and Adonde Miria, this is Two-Faced, John of God. Listen on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts.

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18:02Out of curiosity, what was in the antiseptic hand wash that Tim O 'Lyce came up with? Yeah, that's a great question. So at the time people were having, you know, cities were getting bigger and bigger. The sewers were getting stinkier and stinkier. and the folks of Europe worked out, hey, if we take this chloride of lime, which is basically chlorine, which you throw in swimming pools, and we throw it in vast quantities into the sewer, it makes the sewer a lot less stinky. And Semmelweis, when he was running his experiments to try to assess like what the heck is responsible for perperal fever, he noticed that even after washing with soap and water, he could still smell morgue odor on his hands.

18:47And he thought he had no understanding of microbes. Bacteria would not be identified for another 40 years by Louis Pasteur. He was another really interesting character who rubbed elbows with royalty and engaged in all kinds of interesting behavior. But he worked out it's got to be the scent. The smell is the reason for the infection. So I want to eradicate the odor. So he got one of his friends who worked at the local sewage facility to give him a whole bunch of chlorine. And he created a mild chlorine solution and went, you know what? I dip my hands in this and the smell goes away. I wonder if this will work.

19:28And it was incredible. The effect of using the chlorine solution within three months, he had an 18 % death rate from preparal fever in the doctor's ward before running the experiment. at the end of three months, it dropped to zero. I mean, wow. Unbelievable. Yeah. Yeah. I mean, it was a coup. And the fact that the other doctors went, sir, how dare you tell us our hands are dirty? We are gentlemen. And in many cases, they were noblemen. He was, I mean, and this is where the noble blood side of this really comes into it because Samuel Weiss was Hungarian. Hungary was a vassal state of Austria. So he was, even though he was a very successful obstetrician, he was a second-class citizen in Vienna.

20:16And these nobles who had become doctors in the Vienna hospital, they had all this clout over him just because of their blood. And there was, of course, on top of all of this, Hungary rose up against Austria after Empress Maria died. Her son, what was his name? Joseph? Yeah, Joseph II. Joseph II. He was not the sharpest tool in the box. His favorite activities involved rolling around in the waste paper bin and trying to swat flies with his hands. Yeah. Inbreeding. It didn't do him a lot of good. And I mean, he I mean, he had very serious mental deficits and he should not have been ruler of the Habsburg Empire.

21:07I mean, really. You're sort of coming down to the thesis of this podcast, really, is when you just decide who's in charge of these wildly powerful empires based on who's born first. It doesn't always work out. No, no, definitely not. And so when the people of Hungary rose up and said, we don't like being vassals to the Habsburg Empire, we would like to determine our own destiny. He went, okay. And of course, all of the nobles who were of Austrian blood ruling Hungary went, hang on, can we have a say in this somewhere along the way? And Semmelweis actually made a huge mistake because Hungary rose up against Austria.

21:51and there was a fierce war between them. And in the midst of this, I mean, he's working as a Hungarian in the Vienna hospital. He started donning the uniform of the Hungarian soldiers while working in the operating theater. I mean, like, come on, dude. He's turning people against him. Yeah. Oh, it was, I understood that he cared, but he was reporting to a guy named Johan Klein who was not a good doctor. He wasn't a bad doctor, but he wasn't a very good one. And he was, he was a shining example of what privilege and power will get you if, if you're raised in, you know, upper-class Vienna society.

22:32And he, to his credit, when Semmelweis brought out the chlorine wash, he did try it. I mean, he did give it a shot. He did not like Semmelweis. They did not get along well. And ultimately the uniform thing and supporting the Hungarian rebels really created a clash. And this is, I think, a huge part of why Semmelweis lost the battle with the aristocracy and the doctors in the Vienna hospital. It was a mess. It's not always the message. It sometimes is the messenger. Oh, yeah. I mean, and I compare him in the book to Joseph Lister and Louis Pasteur because Joseph Lister also got just trashed by the aristocracy in London as he was coming up with his theories demonstrating that when you're conducting surgery, you need to use antiseptic on your knives, right?

23:24Like, I mean, before Joseph Lister came along, you, if you were a surgeon, the more encrusted your blade was with gore and guts, the better a surgeon you worked that showed how many bodies you had cut open. Oh God. Yeah. Yeah. Um, and I mean, it was, it was bad and people wouldn't die during the surgery. They died of post-operative infection all the time. And Lister was the one who said, you know, I think we've got a problem here. And similar to Semmelweis, they were throwing carbonic acid in the sewers in Britain. And he got some of that stuff and started using the acid on patients to treat them after cutting them open.

24:06And he received tons of pushback and aggressive attacks. He didn't get thrown in an insane asylum like Semmelweis, but he was forced into academic retreat for decades. And during that time, he just quietly taught what he knew. And eventually his students got everywhere. They were known as Listerians and they spread the word and demonstrated through deed that Joseph Lister was right. And thank goodness for that, because it was an alternative approach that Semmelweis never managed. and fortunately ultimately did lead to understanding of how to engage in surgery and treat people properly ironically ironically i don't know but it's just astoundingly the day that lister had his big breakthrough by treating a patient on the surgery table and not having them die of a post-operative infection that would have been certain it was a kid who had got run over by a wagon in scotland the bones were sticking out of the wound it was really bad he would have died was the same day that Ignaz Semmelweis died in the insane asylum in Hungary.

25:06Oh, my God. So Ignaz Semmelweis, who had this really amazing breakthrough, which is that doctors should be washing their hands with the strong stuff before treating women, giving birth, had this tragic end of dying in an insane asylum, which I think just sums up some of the interesting stories and sort of fascinating ideas that you present in your book, which are a number of these stories, which is sometimes people, science purports to be this field that is completely rational, right? Where it's like evidence-based and if people show up with the right information, the right idea will win out. But that is absolutely not always the case as you make very clear.

25:48Oh yeah. I mean, I just look at Galileo. I mean, Galileo had his ideas about the earth, not, you know, about the sun, not rotating around the earth and had all these observations of comets to demonstrate as such. But the people in power, I mean, the Pope said, well, you know, if you speak that, that's heresy, and we'll send you before the Inquisition. Galileo had to engage in such careful PR. I mean, he used pseudonyms to hide his identity and to protect himself from being eviscerated by the Inquisition. And it was all political. I mean, And going back to Tuscany and the city of Florence, which would be ruled many years later by Maria Teresa through her relationships with the Grand Duke there.

26:37I mean, when Galileo was being challenged by the Inquisition, it was his relationship with Archduke Ferdinando, the leader of Florence and Tuscany. It was his relationship with that man that protected Galileo from ultimately being killed off or imprisoned in cells. And Ferdinando, it wasn't revealed at the time, but hundreds of years later, letters emerged revealing that Ferdinando had directed his ambassador to Rome to intervene on Galileo's behalf, which reveals that all of this mythology of Galileo being tortured at the hands of the Inquisition was actually a lie. It's incredible what Galileo had to go to, to be able to endure the political society of the age.

27:25Absolutely. Although sometimes things do ebb and flow and come around. I know that now, without getting too political, there are challenges to things that I had considered done science. But I do want to celebrate Maria Teresa for openly celebrating and realizing that smallpox inoculation really does help people. And she publicly inoculated her own children in 1768. Yeah, yeah. She herself was inoculated. I mean, and she was right up there with like Louis XVI and Catherine II of Russia and Frederick II of Prussia. I mean, but you want to talk about, I suppose it's not so much noble blood as it is just American politics, but George Washington.

28:12And so during the American War of Independence, George Washington was losing more men to smallpox than he was to the swords of the British. And I have to say this under hushed tones living in Hertfordshire, the UK. You know, I guess I'm surrounded by British people around here, but he wrote to the Continental Congress saying, would you please remove your stupid rule that says I can't inoculate the troops? Because Congress had said you are not allowed to inoculate people because people can die from being inoculated. And you don't want, to be fair, you don't want, if you give everyone an inoculation at the same time, you don't want everyone knocked out by the side effects or the dangers of that immediately.