Noble Blood: "Maria Theresa's Medical Legacy"

With guest Matt Kaplan
Date: February 3, 2026
Host: Dana Schwartz
Guest: Matt Kaplan, Science Correspondent at The Economist
Episode Focus: How Empress Maria Theresa’s compassion, politics, and legacy shaped the history of medicine—particularly obstetrics—and the tragic tale of Dr. Ignaz Semmelweis and the long fight for antiseptic practice.

Overview

This episode delves into the intersection between European royal history and the evolution of modern medicine, centered around Empress Maria Theresa of Austria (1717–1780). Host Dana Schwartz and guest Matt Kaplan trace Maria Theresa’s compassion for her subjects—especially impoverished women—through pioneering social and medical reforms, the disastrous weight of tradition and class, and the tragic fate of medical innovator Ignaz Semmelweis. Along the way, Kaplan draws compelling parallels between historic and modern struggles for scientific acceptance and spotlights the personal and political costs paid by those who challenge orthodoxy.

Key Discussion Points & Insights

Maria Theresa: Ruler, Mother, and Social Reformer

• Maria Theresa’s Profile

  • Sole female Habsburg monarch and mother to 16 children, including Marie Antoinette.
    • “She was also the mother of 16 children.” —Matt Kaplan [02:25]
    • “I managed one and...doing 16 feels and also running an empire.” —Dana Schwartz [02:36]
  • Oversaw a massive, fragmented empire: Austria, Milan, Florence, Croatia, Transylvania, Romania. [02:45]
  • Deep empathy for poor and mistreated women in her empire, many of whom were driven to desperate acts (e.g., infanticide due to poverty and lack of options).
    • “Their only option was to go to a bridge in the dark of night and throw the baby over the bridge into the river.” —Matt Kaplan [04:01]

• Early Reforms: Baby Dropboxes & Social Hospitals

  • Maria Theresa instituted baby “dropboxes” in hospitals to offer desperate mothers an alternative to infanticide.
    • “They installed these at all the hospitals in Austria so that women...could put their baby in the box...and hope that the state could give their child better care, better life.” —Matt Kaplan [04:35]
  • Supported a vision for hospitals capable of caring for destitute and vulnerable women, laying the groundwork for innovative medical practice. [05:27]

Gerard van Swieten, Thomas Sydenham, and Medical Theory

• Gerard van Swieten’s Influence
  • Maria Theresa recruited the renowned physician Gerard van Swieten to reform Austrian medicine after he failed to save her sister.
  • Van Swieten was steeped in the ideas of Thomas Sydenham and Hippocratic humoral theory—emphasizing balance of 'humors,' leading often to harmful practices (e.g., bloodletting).
  • “He ended up really convincing Maria Theresa...her hospital needed to have these ideas in her hospital.” —Matt Kaplan [07:04]
• Dangerous Orthodoxy
  • Van Swieten and later Anton Dehaon, Maria Theresa’s medical appointees, stubbornly clung to supernatural or humoral explanations for disease.
    • "Dehaon believed in the devil and believed that, like, vampires caused certain diseases." —Matt Kaplan [07:59]

The Tragedy of Ignaz Semmelweis

• Semmelweis’s Breakthrough

  • The hospital founded under Maria Theresa’s reforms became the workplace of Dr. Ignaz Semmelweis, an obstetrician alarmed by the high maternal mortality (puerperal fever).
  • Semmelweis noted that wards run by doctors had dramatically higher rates of puerperal fever than those by midwife-nurses—a pattern suggesting direct, preventable transmission.
  • He hypothesized doctors were carrying “corpse material” from autopsies to laboring women even after washing with soap and water, and instituted a chlorine hand-wash that virtually eliminated deaths.
    • “At the end of three months, [death rate] dropped to zero. I mean, wow.” —Matt Kaplan [16:01]
  • Semmelweis had made the clinical discovery that rigorous antiseptic measures could save lives—decades before Pasteur’s germ theory.

• Resistance and Downfall

  • Semmelweis’s findings were met with outrage and denial from the Viennese medical elite, in part due to class prejudice (he was Hungarian, not Austrian), professional pride, and cognitive dissonance.
    • “Sir, how dare you tell us our hands are dirty. We are gentlemen. And in many cases, they were noblemen.” —Matt Kaplan [16:10]
  • The psychological impact on doctors accepting their complicity in maternal deaths was severe; some, like Dr. Michalis, could not bear it.
    • “Michalis...said...we’ve had tremendous success with this chlorine wash. And then it dawned on Michalis, oh, the thousands of women who have died...are because of me. And so he threw himself onto the railroad tracks.” —Matt Kaplan [12:47]
  • Ultimately, Semmelweis was shunned, confined to an asylum, and died tragically on the same day Joseph Lister’s antiseptic methods found their first success [21:17].

The Interplay of Medicine, Power, and Politics

• Class, Nationalism, and Hospital Politics

  • Semmelweis, as a Hungarian in Austrian-ruled Vienna, faced xenophobic and class-based barriers; his political sympathies for Hungarian independence further alienated him from the hospital’s leadership [17:30–18:31].
  • “Semmelweis actually made a huge mistake because Hungary rose up against Austria...He started dawning the uniform of the Hungarian soldiers while working in the operating theater.” —Matt Kaplan [18:11]
  • The succession after Maria Theresa’s death (Joseph II) saw further instability, as power transitioned to rulers ill-equipped for complex reform.
    • “Joseph the Second...was not the sharpest tool in the box.” —Matt Kaplan [17:06]

• “It’s not always the message; it sometimes is the messenger.” —Dana Schwartz [19:23]

  • The show explores how social status, peer pressure, and entrenched authority quashed progress despite overwhelming evidence.

• Comparisons to Other Scientists Persecuted by Power

  • Galileo’s battle with the Inquisition, and its political navigation via grand ducal patronage, is compared to Semmelweis’s struggles. [22:11–23:48]
    • “It was his relationship with Archduke Ferdinando...that protected Galileo from ultimately being killed off or imprisoned.” —Matt Kaplan [23:20]

Noble Leadership and Smallpox Inoculation

• Maria Theresa as an Advocate for Inoculation
  • Despite resistance, Maria Theresa and her children were publicly inoculated against smallpox, encouraging acceptance among elites.
    • “Now...I do want to celebrate Maria Teresa for openly celebrating and realizing that smallpox inoculation really does help people.” —Dana Schwartz [23:48]
• Global Context: Royals, Revolutionaries, and Science
  • Other figures (Louis XVI, Catherine the Great, Frederick the Great, George Washington) also advocated for inoculation in pivotal moments.
    • “George Washington was losing more men to smallpox than...British swords.” —Matt Kaplan [24:25]
  • Washington’s rebels only prevailed at the Revolutionary War after mass inoculation, in defiance of Congressional orders—a striking example of scientific innovation swaying history [25:18–27:56].

Notable Quotes & Memorable Moments

• On Maria Theresa’s scale as a ruler and mother:

  • “I mean, like, I understand biologically how that works, but wow. Really?” —Matt Kaplan [02:30]

• On desperation in the empire:

  • “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.” —Matt Kaplan [04:01]
  • “I’m taken aback by that...that kind of stuff chills my blood. And it turns out it chilled noble blood, too.” —Matt Kaplan [04:22]

• On the fatal arrogance of the profession:

  • “Sir, how dare you tell us our hands are dirty. We are gentlemen. And in many cases, they were noblemen.” —Matt Kaplan [16:10]

• On tragedy of recognition:

  • “[Semmelweis’s colleague] threw himself onto the railroad tracks and committed suicide...because he couldn’t take the belief, the understanding. He understood what he had done in his life.” —Matt Kaplan [12:47]

• On scientific resistance:

  • “Science purports to be this field that is completely rational...But that is absolutely not always the case, as you make very clear.” —Dana Schwartz [22:06]

• On political machinations and survival of ideas:

  • “Archduke Ferdinando...directed his ambassador to Rome to intervene on Galileo’s behalf, which reveals all of this mythology of Galileo being tortured...was actually a lie.” —Matt Kaplan [23:20]

Timestamps for Key Segments

• Maria Theresa's reign, family, and compassion: [01:57-04:45]
• The hospital reforms and "dropboxes": [04:22-05:27]
• Gerard van Swieten, medical theory, and dangerous superstition: [05:50-09:24]
• Ignaz Semmelweis, handwashing discovery, and tragic resistance: [09:24-16:10]
• Ethnic/political tensions at Vienna hospital: [16:10-19:23]
• Comparison to Lister and Galileo: [19:26-23:48]
• Royal leadership in smallpox inoculation (Maria Theresa and George Washington): [23:48-27:56]
• Closing thoughts and promoting Kaplan’s book: [27:56-28:40]

Tone & Language

Dana Schwartz guides the discussion with a clear-eyed, empathetic curiosity, blending historical detail with modern resonance. Matt Kaplan’s delivery is energetic, peppered with fascinating asides and sharp, often wry, commentary on the foibles of power and the cost of stubbornness in medicine. Together, they make history immediate, tragic, and deeply relevant—never shying away from the discomfort embedded in both royal bloodlines and the annals of science.

Summary for New Listeners

If you’re fascinated by the way power, privilege, and compassion intersect to shape the lives—and deaths—of millions, this episode offers both a gripping narrative and a sobering reminder that progress rarely comes without a hard, human cost. From the desperate women of Habsburg Austria to the doctors who refused to wash their hands, from Maria Theresa’s proto-welfare state to the chilling rise and fall of Ignaz Semmelweis, “Maria Theresa’s Medical Legacy” explores how individuals and institutions can both crush and accelerate the advance of science, for better or for worse.