Os Micróbios e o Homem - Episódio 1 - O Inimigo Invisível (legendas em português) - Imagem 4:3

[Music] [Applause] [Music] describe the patient's symptoms mark Assad's game he has a high fever he would not be in the fever what otherwise stomach pains yes no rash on the chest you expected well well in a typhoid case you have told us nothing to suggest it is typhoid yet continue the patient has a stone it is better to remove it is one of the few internal operations we can perform with some hope of success the evening the Fatimid must be done DIF T and swiftly as possible in 1846 if one had to find one hospital that represented all that was known about medicine at this time it would be the great General Hospital at Vienna [Music] built in the 1780s by the Emperor Franz Josef it was largely a charity institution with 4,000 beds and departments for all known complaints there are a few private patients particularly maternity cases who came in to avoid a scandal the maternity or lying in hospital as it was called was the largest in Europe but most patients in these wards were poor and in return for free treatment were used as teaching material for here was the greatest medical school in the world a school which pioneered the idea of teaching both at the bedside and in the dissecting room students came from all over the world to study under doctors who rightly believed that where they led the rest of the world followed by cooling the patient we hope to counteract the progress of the fever so ice is put to melt in the mouth in order to lower the temperature of the internal organs at the same time by wrapping the limbs in wet blankets the exterior of the body can be similarly cooled the treatment of disease as a collection of symptoms as expounded by Professor font Hilton Brandt was based on principles that hadn't changed much since the ancient Greeks not surprisingly half the patients died in the operating theaters as many as nine out of ten would die sometimes from shock since there were no anesthetics more often from septicemia since no one knew anything about infections but changes were coming although to most surgeons of blood-stained coat was no more significant than a grease-stained overall is to a mechanic and although they saw no connection at all between the blood poisoning that killed their patients and the fact that instruments were only cursorily washed if at all some radical new thinking was taking place since 1840 the professor of pathology had been carved on Rockatansky in the course of his career he dissected over 30,000 corpses examining and reporting on every disease Dorgan he found it was he who paved the way for the notable advance that was about to be made at this hospital further observations lower third of the small intestine the elliptical perforated bowel and does peritonitis always follow from typhoid hi professor his dissections took him beyond the external symptoms to investigate what actually happened in the body during disease it was a basic but fundamentally new approach and its implications were carried into the wards by one of his disciples professors Clara medicine is immaterial they can surely do some good sir only if applied to halting the anatomical changes the disease is bringing about in the body I see sir you are from England yes Herr professor ruff ah mr. Skoda was head of the department for chest diseases by using such techniques as a stethoscope an invention of 20 years earlier he taught you mr. concentrate on what was happening in the lung rather than concern themselves with how the patient felt this patient has plus shortness of breath dry cough pains in the chest leather dear professor from Hildebrand has not 'lest told you how to try to treat these symptoms but a collection of symptoms does not constitute a disease they are merely the effects of it we have got to get to the disease itself by such precise techniques as tapping on a patient's chest to register the whole range of different sounds heard from the lung he may not have done much for his patient but to Schroeder and Rockatansky treatment was irrelevant first define the Sun full to hollow dull to clear heavy to light full and heavy and here what mattered to them was understanding the process of disease only then could medicine advance it was a view shared by Skoda's protege Ferran and von hybri head of the skin disease clinic who set his patients on a plinth to be examined in public however private their complaint well general man so the students can have a good look at you they've got to learn somehow do you think you have already get well now that's saw on his up-and-up it's not eczema is it yes sir good woman yes sir it must be you me sir pick him up at the back of the yosef starts deal it's more exciting than anything you get from your wife right know me sir oh come on if you're not been sleeping with the [ __ ] at the back of the years have startled have you been sleeping were they you've got syphilis man if you didn't get it from your wife who did you get it from well I don't never mind in the primary stage at the moment brats let's get your britches down and see if you've got it on the other region - oh never mind about them they'd like a good look which serve as a timely lesson to them - but Hitler Skoda and Rockatansky lacked the opportunity in their departments to show where their new approach to medicine could lead this opportunity presented itself in the maternity or lying in wards among the women here the dread was not of birth itself but of child bed fever of pure Perl fever that followed it it's progress was always the same a woman would have successfully given birth would even be nursing her child when inflammation would spread over the whole abdomen to reduce this leeches would be applied a little later a high fever would develop and with the mother often still protesting her good health the bowls and red towels would be brought out for bloodletting finally there was the last resort to the leather belts for restraining the delirious but one young doctor ignites similar ice a Hungarian was appalled by what he saw Vienna had the worst rate of this child bed fever in Europe in some outbreaks one mother in three died their newborn babies often dying with them [Music] [Music] [Music] it was in rocket on skis analytical approach that some of I saw some hope of understanding the disease and so at five o'clock every morning he'd come to the morgue to dissect the bodies of his former patients at this time Semmelweis the son of a beautiful shop keeper was 28 years old in spite of the suspicions with which Hungarians were regarded in Vienna he had obtained the post of first assistant in the lying in hospital so far his dissections had revealed a great deal about the processes of pure April fever but had brought him no nearer to discovering its cause there were two divisions to the lying in hospital the first run by similar virus and his chief professor trine the second by midwives only yes in the midwives division there was nothing like so much pure Pro fever as was found in professor Klein's in one year five times as many women died from it in Klein's division as in the other several vice knew this well so did the women who came here to have their babies okay she doesn't want to be admitted to our division since she's not here to be in the hospital at all but now doctor simulation EU fever cases this morning three years two in the next ward and one in each of the others we ask most peculiar reactive at the moment your poor child bed fever as depends on two factors externally in the be as much hangs in the air over lying in hospitals like ours or internally the failure of the uterus stick of a proper local or milky discharge always very low in pure pearl fever cases or more likely and relational milk in the body instead of being discharged from the breasts of the uterus thus leading to milk peritonitis any questions yes however doesn't explain this patient sir hey big heart this woman said she was not pregnant and she has the fever started last night he's not this the patient with the tumor which I removed from the neck of the womb yesterday without difficulty she approved fever we had a similar case when I was a student she died in a few days she was not pregnant either why so much stronger in my division that in the other 15 percent last month against only 4% in the midwives clinic and there's no difference in the television yeah well except that we have students perhaps the women are more gentle more gentler than the students when they examine perhaps the mid-block oh no fat in end if the passage of a baby causes no injury it's hardly likely than inserting a finger is of a giant attract however clumsy of course death the students do examine more often this well no more than the stupid midwives see the Midwife in shame that is plated shame women in childbirth being examined by men however much modesty is outraged by that I cannot believe that you believe is such a breakdown in health and disease getting flattened it's clearly something to do with the first division the death rate has been four times higher with us for the last six years I do know that what's clangor to say the vinyasa in the air is particularly active the way it should be four times more active in one part of the hospital than the other I can't imagine sad sounds like a woman in labor now they're strippers take this woman to the hospital a drive around the square tool is as good as born the hospital less than 50 yards away arrive in time for the child to be admitted to the foundling hospital but not in time for anyone to examine you in later even if you can't hang on till after midnight the longer she delays the less time she'll spend with my doctors and students that's what she's thinking well I must go home promise Johanna I'd be early she pregnant it the one she is counting on you to deliver the child will of course but at my home from the start Semmelweis began to compare the differences between the two divisions [Music] even on me the priest Bell had a strange effect when it passed by a door that I could not see how fear a state of mind could bring about such anatomical changes as there is to be seen in pure pearl fever but I did know that in the midwives division the priests did not have to pass through their wards to reach the dying the fever so much I very much does it but from now on I want everything conducted in our division exactly as it is with the midwives the priest is greeted in a roundabout route to reach the furthest of our wards around there unattended so there will be no bail and henceforth I want all of our women delivered in the latter all not the dorsal position on this side it's why because that is invariably how it is done in the midwives division I had thought our greater mortality it was due to something endemic to the first division itself but if so women who started their babies in the streets but were later delivered in our wards whether they liked it or not would also get topper or fever they hardly did don't you touch me and I didn't I scratched up in a cab last night have a lot of doctors going over me now I shouldn't be in this ward anyway it was gone midnight when I got here why aren't I am with the midwives Mundy isn't it they were thought up it's only in here their empty beds and I've carried the corpses away you don't need to worry about it you won't become one so if the cause is something to do with the first division must be something that happens before delivery must be having the windows kept clear for the next few weeks why the midwives division the windows is known for passage it's only an art division they have directly on the outside air so if there is anything in this peculiarly active miasma that client believes in it's a crisis of the blood Azusa many diseases top her fever is unique is it it's always assumed to be well how can it be unique come from the pathological findings that first mortals are so similar to those we find in other forms of register no I meant the course the blood disturb is not very sensitive yes but if the results are so similar to those we find in other diseases perhaps it's even those other diseases that you should be looking for the course Oh soup again I can't go another day with only soup that's all they get on the second day in the other division and dr.

Semmelweis insisted arts to be the same what do I have tomorrow soup with bread and jam cheer up on the seventh day it's roast veal she was delivered on her back against my firm instruction and they say so doctor so advise none of your instructions have made any difference the fever cases yet that's because they're not being obeyed is there anything else doctor yes on every woman's bed I want to see not only a ward number but also the number of the bed she occupied in the delivery room and if fever develops I what the time it started as well yes doctor you see and beginning to noticed of the fevers develop in exactly the same order as the women are examined in leg never doubted it's the students fault myself some of these foreign once we have well if it is then we must prove it we can only do that by eliminating all the other factors first puerperal fever has been with us for as long as I can remember yes Herr director but with respect it was never like this and professor pores time Dean I have the figures here when Bohr was professor of obstetrics it was only one percent of our women who ever died of geography are you suggesting that this disease in some way emanates from me I'm gonna trying to connect the facts Hamas's extraordinaire jessally the priest has something to do with it the priest has nothing to do with it since I've stopped him going through our ward with his Bell there has been no reduction in the fever rate at all and since the midwives have been told to have the patients deliver on their signs no reduction either you would make it so we are gradually eliminating the factors that could be responsible until in the end I have no doubt we should isolate the one that is and how much of your time will you state doctor I don't know what you do now doctor same ovation to the post of assistant is hell purgatory earth the occupant has the right to appoint an extension for another to nurse I have only held the post for four months life-extension I am talking about your predecessor dr. brat he has submitted an application to continue until July 1848 but I was appointed I was told quite definitely that the person was my personal yours again there there's nothing in brights contract to integrity to continue for another two years and nothing in this content either I just say that this application should accept it I actually expect you to give him all possible cooperation and loyalty doctor say all that a summary dismissal the confirmation for similar vice have just how precarious his position as a Hungarian was but bright soon left and Simmel vice was reinstated meanwhile news of the puerile fever mortalities had reached the Emperor and a government Commission was appointed to investigate Klein determined to maintain his entrenched position in the medical politics of Vienna did not let them meet the one man who could have thrown some light on their inquiries instead he hinted it was probably the foreign students who were responsible fine never trusted foreigners so the foreign students were banned from the wards and oddly enough the fever rate did go down as soon as I was reinstated as a system I took a short holiday in Venice with a couple of families before taking up my duties again on my return I was shocked to hear that Professor Kalitta had died the man I held in the highest esteem ha scalpel wound world a sexy mask Rockatansky he did the autopsy little more than a pinprick didn't even notice it I'm surprised collector could be so clumsy it wasn't a scalpel to the students was working in the same corpse be careful could happen to you to any others to the tiniest poacher for some coin yuge particular putrid organic method from the cadaver to enter the bloodstream and swollen finger pain in the fever yeah leave my protocol pioneer to righteous abscess in the left guy coming three batches meningitis drastic case of cadaver to conviction then exactly the same pathological findings as in pure fever yes because that said to table the blood this way but no one uses a scalpel in the lying in hospital they're not surgical cases that's a superficial point the nature of the wound doesn't matter but why cadaveric material should upset the balance of the bath now Rick [Music] cut to expose the infected area but how could Catan requite air into the bloodstream of a pretty it rushed into my mind with irresistible clarity that if the disease from which college could ID was the same as that which proved fatal to so many women after childbirth then the course could be identical did the women I see dying of cadaver dick material carried into their circulation to spare a futures that's not unusual to that question I could only answer yes every morning ironically in the best tradition of the Vienna school the students attended professor Klein in the labor ward examining women in childbirth and they come there direct from the dissecting room but they wash their hands obviously not well enough if a particle of cadaver ik matter since law it could enter a pinprick in poor college can kill him we'll think what could happen in the wound left by the separation of the placenta alone and wonder they have less pure pure fever in the midwives division they don't dissent in the dead past and it explains why women with prolonged labor may be examined by students two or three times invariably get the disease well there was was shortly but generally don't and also why they go down in rows in the same order they were examine to the labor board but it doesn't explain while why women who are not even pregnant and get it students don't examine their labor but they're still examine them and even if they don't I don't which is probably why the fever rate decreased and dr. bright temporally deprive me of my post I understood it also decreased when foreign students were barred from the ward well of course because they attended with all country interest than the others and examined more often dr.

bright examined women too dr. bright was not so anxious to discover the cause of this disease that he got up early every morning to descend his patients live because he never went near the dead house I had occupied myself with a cadaver to an extent reached by a few obstetricians God alone knows the number of women I assigned prematurely to their graves [Music] Semmelweis had now to find a washing agent that would rid the hands of any particles of putrid matter from the corpses sifting through the scant knowledge then available he found an answer all students and doctors at least includes himself all students and doctors who enter the wards to make an examination must wash their hands thoroughly and the solution of chloride of lime which is placed in convenient basins near the entrance until there is no smell of the dissecting room under hands at all have a pretty foul smell from this not one that kills do we carry the boat with us from one patient to the next as long as all traces of the dead house have been removed first certain water will be insufficient between examinations within a month the mortality rate fell from 12% to 3% by July and August it was down to under 2% figures that hadn't been bettered for 25 years when Hall was director you are implying surgeons even why should that particular professor of aesthetics be so unlikely he didn't have the advantage of doctor several vices advice no but boy used to teach on the phantom and tell you infant what did any student learn from a wooden model of a pregnant female with a cupboard for a room on a doll in sight for a fetus until you insisted that students should learn instead on the cadavers of women who died in childbirth was official policy and imperial decree nevertheless the pure pure fever I shall have to send the sent to the first yellow sugar you are professor of chess diseases Here I am professor of obstetrics good morning so head director is not impressed all the symptoms of small-minded bureaucracy some of us must publish I shall be Emperor of knickknacks will never overcome his childhood phobia I cannot write how often aware that and worse he suffers from the naive belief that the truth will be self-evident then as editor of the journal you must publish for him students if we each write to a professor obstetrician in our own countries between us we can cover the whole of Europe I shall write to London yes yes what do we have your approval sir of course if you think is this city thank you sir not a single case at the whole ward come we'll go straight to the delivery room but it wasn't long before the fever returned so this evil-smelling chloride that permeates the entire hospital is not the magic cure the figures are up again today here director five percent have fever when how does my assistant explain that one of you at least has been willfully defying my instructions show me hands I can smell it from here stench of the dead house when her man arrives you well tell him she died because you would rather have the smell of death on your fingers and the order of glory you're doing bleed her then send for the priest tell her man why she died 5% again this month brainless callous irresponsible stupid things he knows better than I do a ware of the importance of Cemil vices discovery pepper I wrote about it for a leading medical journal Semmelweis himself said nothing the facts he thought spoke for themselves yes would three doctor will examine the morning neighbor yesterday in turn beginning with this one and we all washed thoroughly as units but this woman is unaffected and we examined her more closely than any of them she has that medullary cancer you remember nine women in labor the first has a foul-smelling cancer of the uterus so I get the students to examine her most carefully we move on to the others one by one examine them all intern tonight every one of them has child bed fever except the first remember the cancer sure it's not just cadaver dick particles it's any putrescent matter we inflicted the others with what we took from the first are you sure about that no not yet but I'm going to insist that the washings take place between every examination Wow ah what is going on in this hospital my authority is being openly defied I'm sorry hey director but dr. Simmons who is that woman she has a badly discharged and carries knee joint tops my serving a transfer to the General Hospital right patient next has developed on bed fever sir your innumerable and time-consuming hand washings are a failure no Herr director this is something new that woman's knee was not touched by any of us it can only mean that putrid material can also be carried through the air on wheels in 1848 the austro-hungarian Empire was tottering under a revolution that was spreading across Europe stand up freedom no no I don't mean from nice not yet I mean here for a humble thanks to the simplest of precautions there has not been a single case of corporal fever in this division the first time for a quarter of a century yes their director in this hospital go unchanged that uniform rights with respect had director the academic Legion is still illegal organization in Vienna and since I'm not on duty I have every right to and not in my ward doctor you have five minutes mister change or even a message from Professor he bruh he want Judy's house Frau Harris pains have started and get a bag of chlorinated lime its doctor [Music] [Music] well boy perfectly delivered oh wow oh do your elbows for a while it seemed that Semmelweis is discovery would be acclaimed the letters his students at sent off began to bear fruit from London dr.

Rous wrote in the Assembly of English physicians which took place last week I delivered a lecture in which I announced your discovery my address was well received and many of the most learned members declare the arguments convincing excellent chilliness of Amsterdam the Highness of Kiel everywhere your doctrine is being recognized except in Vienna final net his head from Simpson of Edinburgh Simpson believes is nothing more than the English theory of contention then he's wrong and in too many places they keep on saying they have torpor a fever despite the fact that their students don't learn a dissecting at all well and how do you answer that because it isn't only particles from the dead house that caused it it's only putrescent organic matter surely you don't misunderstand me as well no no of course not everywhere I misinterpreted my dear certifies the Board of Studies is meeting tomorrow and I intend to ask them for a commission to construct a statistical table correlating pure proof Eva mortality with the extent to which students and assistants occupy themselves with this section you'll get nowhere as long as Klein is professor of obstetrics time a majority of vote from the Board of Studies can overall Klein and the motion was carried everyone who voted in favor with the exception of Rose s Raymond and myself so the very Commission then not this resolution is tantamount to saying I don't know how to run my own department it's a slaughter service Ryan said to the BT it's up to me to decide who supervises theory deserves further investigation I shall protest to the Ministry of Education the faculty resolution will be cost I believe Heather is quite impressed with young similar vices that discovered him and had as either a fool or he's so scared that revolution will succeed he wants to keep in with the insurgents but that's what several ICS make no mistake on that a Hungarian rebel there is scooter on his side another foreigner everything that matters is under fire society the Empire even medicine we have to stand far it's our patriotic duty the Revolution had failed the old guard were more firmly entrenched than ever Klein refused to renew Semmelweis his contract and appointed a dr. Braun in his place Semmelweis applied for a teaching post and waited in vain for a reply and still he refused to speak about his work himself they're already prepared to provide you with fountains I don't need funds I only need access to hospital records the client has now barred me from there it can't all be proved by statistics experiments on animals that's what's needed now what to learn from animals we don't know already except the Academy offer you need money to live on anyway experiment on animals so similar ice half-heartedly did a series of experiments on animals and Skoda addressed the Academy of Sciences but not only did code have failed to mention that it wasn't just particles from dead bodies that caused the disease he also launched a bitter attack on his old colleagues at the University of Prague who tell me they have undertaken these preventative measures with no appreciable result all I can say to that is that they must have conducted these chlorine washings with reprehensible carelessness Prague was outraged unwittingly Skoda had made enemies for similar vice in another European capital elsewhere his theory had now also been dismissed largely because they had nothing else to go on but showed us narrow interpretation of it Semmelweis had pointed the way at last to a true understanding of disease but so many things had conspired to obscure the real value of his results above all his own obstinate adherence to the idea that the truth will out [Applause] in October 1850 this hotend bitter short of money Semmelweis without even saying goodbye to his friends left vienna he returned to Budapest his native city where he ran into Marcus Otsuki again former student at Vienna now a prosperous GP some of I soon realized that even in his own City his doctrine was misunderstood is that our students of the university clinic they dissect but don't have women in childbirth of the hospital and yet there's plenty of puerperal fever then it's not just dead bodies Ludwig who I was led to believe show me this hospital and I will explain it it didn't take him long the chief obstetrician was also the hospital surgeon thanks to Marcus all his influence Semmelweis was now made professor of obstetrics at the university yet once introduced into the clinic all his disinfectant techniques and soon reduced the incidence of pure Pro fever then suddenly there was another outbreak and the administrators who to start with had opposed him as much as Klein ever did were triumphant of course he's cheap most of it comes back in the same foul condition it went out him smell it your clean linen that's the cause of our latest outbreak it wasn't long before his disinfectant techniques which he now applied to all instruments used made his clinic perhaps the healthiest and safest in all Europe but still no one knew about it and while in other countries other men were beginning to get to grips with the nature of infection Semmelweis put all this aside content with what he'd achieved in his native city at 38 relaxing a little at last he took up swimming and horse riding he met a girl of 18 called Mary Weiden Hoffa [Applause] gentleman chair and understanding she married him and within a year she was pregnant when the baby was born Ignatz took every care to avoid the risk of peripheral fever but within 48 hours the baby died from hydrocephalus water on the brain depressed by the child's death and aware that it was now 12 years since he'd made his discovery in Vienna he decided at last to publish the etiology concept and prophylaxis of pure Perl fever but he was 12 years too late a rambling repetitive account of his achievements in Vienna followed by an attack on all who disagreed with his views the book met with almost no response so Semmelweis took up his cause once more this time by writing open letters to his opponents I carry with me the conviction that since that year thousands of women and babies have died who need not have died in this massacre uhare professor have participated no teaching is based on the dead bodies of lying england slaughtered through ignorance and i have formed the unshakable resolution to put an end to this murderous work so far as lies within my power to do so this close I must cease I shall keep watch on every man who dare spread dangerous era if you continue to teach your students that you Pro fever is every dammit I do not sue before God and the world as a murderer if only some of us have been in London with me France he'd have realized then his fanatical raving against his enemies just makes him a laughingstock I saw a gynecological operations for form there Ignatz good lad to do here with far less danger but even now with his prophylactic method he's a far better record than they have yes but you told us that in London that I just love a third of him at all I think is a lunatic I sometimes wonder whether he may not be okay dr. Hirsch Allah tells me that the other day he suddenly left to his feet at a faculty meeting and recited the oath made by midwives on qualifying he'd have no bearing on anything they were discussing I'll get you back to work that's the best therapy for him gynecological surgery he could solve the whole problem of wound infection of his head his mind to it but while in London I a professor in Glasgow who is already teaching his students that the amount of separation from a wound follows directly the amount of decomposing matter that gets into it now what this does exactly add oh I'm sorry Laurie it's just a TED medicine is moving ahead of Ignatz and I so want him to catch up it's already been demonstrated that disease can be caused by invisible organisms carried in the air how Ignatz would say he proved that himself eighteen years ago that woman in Vienna with a Carius knee joint but the question now is what are these these organisms these germs how do they work how can they be identified [Music] Ignatz how are you Ignis yes not Vic I wanted to see your well I should hope so too after a year away in London this article you wrote in all watsi had a lot but that was years ago after your book was published something yet to be discovered here to you to find my doctrine not yet fully established it nots be reasonable that's you're not yourself and I thought my friend that was a clearer explanation of your doctrine and anything you ever wrote just because I said the next stage must be to identify next stage the facts the figures the statistics prove everything that matter cleanse the hands cleanse the instruments by a single crota's worth of chlorinated life yes but what are we fighting that's what we must ask now what is it in decomposing animal matter that causes the physiological changes seen in disease I just come back from London Ignatz and I was telling Murray about this surgeon in Scotland who's thinking on just the same lines as you have been leave my house hip nuts I said leave my house traitors murderers in July 1865 Semmelweis returned to Vienna his old friend von hipper met him at the railway station they had told Semmelweis they were to stay as guests of the Hebrews but this was not the true purpose of the journey from the first of January 18-49 to the last day of December 1858 precisely 1924 women died in you're lying in hospital who would have lived if anybody had listened to me didn't know that in the last few months Semmelweis had employed his antiseptic methods in plenty of gynecological operations but Marcus off skis hopes that he would make a new name for himself in obstetric or surgery had faded Cemil vices behavior had become so outrageous it was obvious to everyone his mind was unhinged there was only one course of action he must be committed for treatment if professors of obstetrics do not soon comply with my doctrine I will address myself to the helpless public you father of the family do you know what it is to summon a doctor to your wife it is to expose her and your unborn child to the danger of death when I with my prison convictions look back upon the past I can only dispel the sadness which falls on me by gazing into that happy future when within the lying in hospitals and also outside them only cases of self infection will occur the conviction of such a time must inevitably arise will cheer my diet I [Music] was Evan is this where you live now them in the country no no it's just another hospital I think it'd be interested to see it would you like to do we have time forces plenty of time dr.

Riedel old friend of mine be most interested to meet you go around I'd like to but there's Mari and the toll Mari won't mind waiting you'll wait won't you Mari how long [Music] ten days later in the Royal Infirmary Glasgow dr.