Editing Ignaz Semmelweis (section)

===Response by the medical community===
{{Main|Contemporary reaction to Ignaz Semmelweis|}}
[[File:Ignaz Semmelweis 1861 Etiology front page.jpg|thumb|right|Semmelweis's main work: ''Die Ätiologie, der Begriff und die Prophylaxis des Kindbettfiebers'', 1861 (front page)]]
[[File:Yearly mortality rates 1784-1849.png|thumb|500px|In his 1861 book, Semmelweis presented evidence to demonstrate that the advent of [[pathological anatomy]] in Wien (Vienna) in 1823 (vertical line) was accompanied by the increased incidence of fatal childbed fever. The second vertical line marks introduction of chlorine [[hand washing]] in 1847. Rates for the Dublin [[Rotunda Hospital|Rotunda maternity hospital]], which had no pathological anatomy, are shown for comparison ([[Historical mortality rates of puerperal fever#Yearly mortality rates for birthgiving women 1784–1849|view rates]]).]]
Semmelweis's views were much more favorably received in the [[United Kingdom]] than on the continent, but he was more often cited than understood. The British consistently regarded Semmelweis as having supported their theory of contagion. A typical example was W. Tyler Smith, who claimed that Semmelweis "made out very conclusively" that "[[Homeopathy|miasms]] derived from the dissecting room will excite puerperal disease."{{sfnm|1a1=Semmelweis|1y=1983|1p=176|2a1=Tyler Smith|2y=1856|2p=504}} One of the first to respond to Semmelweis's 1848 communications was [[James Young Simpson]], who wrote a stinging letter. Simpson surmised that the British obstetrical literature must be totally unknown in Vienna, or Semmelweis would have known that the British had long regarded childbed fever as contagious and would have employed chlorine washing to protect against it.{{sfn|Semmelweis|1983|p=174}}

In 1856, Semmelweis's assistant Josef Fleischer reported the successful results of hand washing activities at St. Rochus and Pest maternity institutions in the'' Viennese Medical Weekly ''(''[[Wiener Medizinische Wochenschrift]]'').{{sfn|Carter|Carter|2005|p=69}} The editor remarked sarcastically that it was time people stopped being misled about the theory of chlorine washings.{{sfnm|1a1=Semmelweis|1y=1983|1p=24|2a1=Fleischer|2y=1856|2p=536}} Two years later, Semmelweis published his own account of his work in an essay entitled "The Etiology of Childbed Fever".{{efn-ua|The report was "''A gyermekágyi láz kóroktana''" ("The Etiology of Childbed Fever") published in ''Orvosi hetilap'' '''2''' (1858); a translation into German is included in Tiberius von Györy's, ''Semmelweis's gesammelte Werke'' (Jena: Gustav Fischer, 1905), 61–83. This was Semmelweis's first publication on the subject of puerperal fever. According to Győry, the substance of the report was contained in lectures delivered before the ''Budapester Königliche Ârzteverein'' in the spring of 1858.{{sfn|Semmelweis|1983|p=112}}}} Two years after that, he published a second essay, "The Difference in Opinion between Myself and the English Physicians regarding Childbed Fever".{{efn-ua|The article was originally published as: Ignaz Philipp Semmelweis, "A gyermekágyi láz fölötti véleménykülönbség köztem s az angol orvosok közt" Orvosi hetilap '''4''' (1860), 849–851, 873–876, 889–893, 913–915.{{sfn|Semmelweis|1983|p=24}}}} In 1861, Semmelweis published his main work ''Die Ätiologie, der Begriff und die Prophylaxis des Kindbettfiebers'' (German for "The Etiology, Concept and Prophylaxis of Childbed Fever").{{efn-ua|[http://real-eod.mtak.hu/2450/ Digital copy of Semmelweis' book]}} In his 1861 book, Semmelweis lamented the slow adoption of his ideas: "Most medical lecture halls continue to resound with lectures on epidemic childbed fever and with discourses against my theories. [...] In published medical works my teachings are either ignored or attacked. The medical faculty at Würzburg awarded a prize to a monograph written in 1859 in which my teachings were rejected".{{sfn|Semmelweis|1983|p=169}}{{efn-ua|The monograph to which Semmelweis refers was a work by Heinrich Silberschmidt, "Historisch-kritische Darstellung der Pathologie des Kindbettfiebers von den ältesten Zeiten bis auf die unserige", published 1859 in [[Erlangen]], which mentions Semmelweis only incidentally and without dealing at all with the transfer of toxic materials by the hands of physicians and midwives. The book was awarded a prize by the medical faculty of Würzburg at the instigation of [[Friedrich Wilhelm Scanzoni von Lichtenfels]]{{sfnm|1a1=Hauzman|1y=2006|2a1=Semmelweis|2y=1983|2p=212}}}}

In a textbook, Carl Braun, Semmelweis's successor as assistant in the first clinic, identified 30 causes of childbed fever; only the 28th of these was cadaverous infection. Other supposed causes included conception and pregnancy, uremia, pressure exerted on adjacent organs by the shrinking uterus, emotional traumata, mistakes in diet, chilling, and atmospheric epidemic influences.{{sfn|Braun|1857}}{{efn-ua|Carl Braun's thirty causes appear in his ''Lehrbuch der Geburtshülfe''. In the first of these, published in 1855, he mentions Semmelweis in connection with his discussion of cause number 28, cadaverous poisoning. In the later version, however, although he discusses the same cause in the same terms, all references to Semmelweis have been dropped.{{sfn|Semmelweis|1983|p=34}}}}

Despite this opposition, Braun, who was Assistant in the First Division in the period April 1849 to summer 1853, maintained a relatively low mortality rate in the First Division, roughly consistent with the rate Semmelweis himself achieved, as [[Historical mortality rates of puerperal fever#Mortality rates at the Vienna General Hospital|mortality rates]] in the period April 1849 to end 1853 show. These results suggest that Braun continued, assiduously, to require the chlorine washings.{{sfn|Jadraque|Carter|2017}}

At a conference of German physicians and [[natural scientist]]s, most of the speakers rejected his doctrine, including the celebrated [[Rudolf Virchow]], who was a scientist of the highest authority of his time. Virchow's great authority in medical circles contributed potently to Semmelweis' lack of recognition.{{sfn|Hauzman|2006}} [[Ede Flórián Birly]], Semmelweis's predecessor as Professor of Obstetrics at the University of Pest, never accepted Semmelweis's teachings; he continued to believe that puerperal fever was due to uncleanliness of the bowel.{{sfn|Semmelweis|1983|p=4}} [[August Breisky]], an obstetrician in Prague, rejected Semmelweis's book as "naïve" and he referred to it as "the Koran of puerperal theology". Breisky objected that Semmelweis had not proved that puerperal fever and [[pyemia]] are identical, and he insisted that other factors beyond decaying organic matter certainly had to be included in the [[etiology]] of the disease.{{sfnm|1a1=Semmelweis|1y=1983|1p=41|2a1=Breisky|2y=1861|2p=1}} [[Carl Edvard Marius Levy]], head of the Copenhagen maternity hospital and an outspoken critic of Semmelweis's ideas, had reservations concerning the unspecific nature of cadaverous particles and that the supposed quantities were unreasonably small.{{sfnm|Semmelweis|1983|pp=180–181|Levy|1848}} In fact, [[Robert Koch]] later used precisely this fact to prove that various infecting materials contained living organisms which could reproduce in the human body; that is, since the poison could be neither chemical nor physical in operation, it must be biological.{{sfn|Semmelweis|1983|p=183}}

It has been contended that Semmelweis could have had an even greater impact if he had managed to communicate his findings more effectively and avoid antagonising the medical establishment, even given the opposition from entrenched viewpoints.{{sfn|Nuland|2003}}