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Ignaz Semmelweis

 
Ignaz Semmelweis

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Ignaz Semmelweis



 
 
The Hungarian form of this personal name
Personal name

A personal name is the proper name identifying an individual person, and usually comprises a given name bestowed at Childbirth or at a young age....
 is Semmelweis, Ignác Fülöp. This article uses the Western name order
Personal name

A personal name is the proper name identifying an individual person, and usually comprises a given name bestowed at Childbirth or at a young age....
.


Ignaz Philipp Semmelweis (1818 – 1865) was a Hungarian
Hungary

Hungary , officially in English the Republic of Hungary , is a landlocked country in the Carpathian Basin of Central Europe, bordered by Austria, Slovakia, Ukraine, Romania, Serbia, Croatia, and Slovenia....
 physician who discovered in 1847 that cases of puerperal fever
Puerperal fever

Puerperal fever , also called childbed fever, can develop into puerperal sepsis, which is a serious form of septicaemia contracted by a woman during or shortly after childbirth, miscarriage or abortion....
, also known as childbed fever could be drastically cut if doctors washed hands
Hand washing

Hand washing is the act of cleaning the hands with water or another liquid, with or without the use of soap or other detergents, for the Sanitation purpose of removing soil and/or microorganisms....
 in a chlorine solution before gynaecological examinations. His ideas were rejected and only won recognition decades later.

e employed as assistant to the professor of the maternity clinic at the Vienna General Hospital
Vienna General Hospital

The Vienna General Hospital is the University clinic of the city of Vienna, Austria. The AKH is the largest hospital of Austria, and at 85-m high is one of the tallest hospital buildings in the world....
 in Austria
Austria

Austria , officially the Republic of Austria , is a landlocked country in Central Europe. It borders both Germany and the Czech Republic to the north, Slovakia and Hungary to the east, Slovenia and Italy to the south, and Switzerland and Liechtenstein to the west....
 in 1847, Semmelweis introduced hand washing with chlorinated lime solutions
Calcium hypochlorite

Calcium hypochlorite is a chemical compound with chemical formula 2. It is widely used for water treatment and as a bleaching agent ....
 for interns who had performed autopsies.






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Encyclopedia


The Hungarian form of this personal name
Personal name

A personal name is the proper name identifying an individual person, and usually comprises a given name bestowed at Childbirth or at a young age....
 is Semmelweis, Ignác Fülöp. This article uses the Western name order
Personal name

A personal name is the proper name identifying an individual person, and usually comprises a given name bestowed at Childbirth or at a young age....
.


Ignaz Philipp Semmelweis (1818 – 1865) was a Hungarian
Hungary

Hungary , officially in English the Republic of Hungary , is a landlocked country in the Carpathian Basin of Central Europe, bordered by Austria, Slovakia, Ukraine, Romania, Serbia, Croatia, and Slovenia....
 physician who discovered in 1847 that cases of puerperal fever
Puerperal fever

Puerperal fever , also called childbed fever, can develop into puerperal sepsis, which is a serious form of septicaemia contracted by a woman during or shortly after childbirth, miscarriage or abortion....
, also known as childbed fever could be drastically cut if doctors washed hands
Hand washing

Hand washing is the act of cleaning the hands with water or another liquid, with or without the use of soap or other detergents, for the Sanitation purpose of removing soil and/or microorganisms....
 in a chlorine solution before gynaecological examinations. His ideas were rejected and only won recognition decades later.

Introduction

While employed as assistant to the professor of the maternity clinic at the Vienna General Hospital
Vienna General Hospital

The Vienna General Hospital is the University clinic of the city of Vienna, Austria. The AKH is the largest hospital of Austria, and at 85-m high is one of the tallest hospital buildings in the world....
 in Austria
Austria

Austria , officially the Republic of Austria , is a landlocked country in Central Europe. It borders both Germany and the Czech Republic to the north, Slovakia and Hungary to the east, Slovenia and Italy to the south, and Switzerland and Liechtenstein to the west....
 in 1847, Semmelweis introduced hand washing with chlorinated lime solutions
Calcium hypochlorite

Calcium hypochlorite is a chemical compound with chemical formula 2. It is widely used for water treatment and as a bleaching agent ....
 for interns who had performed autopsies. This immediately reduced the incidence
Incidence (epidemiology)

Incidence is a measure of the risk of developing some new condition within a specified period of time. Although sometimes loosely expressed simply as the number of new cases during some time period, it is better expressed as a proportion or a rate with a denominator....
 of fatal puerperal fever from about 10 percent (range 5–30 percent) to about 1–2 percent. At the time, diseases were attributed to many different and unrelated causes. Each case was considered unique, just like a human person is unique. Semmelweis' hypothesis, that there was only one cause, that all that mattered was cleanliness, was extreme at the time, and was largely ignored, rejected or ridiculed. He was dismissed from the hospital and harassed by the medical community in Vienna, which eventually forced him to move to Budapest.

Semmelweis was outraged by the indifference of the medical profession and began writing open and increasingly angry letters to prominent European obstetricians, at times denouncing them as irresponsible murderers. His contemporaries, including his wife, believed he was losing his mind and he was in 1865 committed to an asylum
Psychiatric hospital

A psychiatric hospital is a hospital specializing in the treatment of serious mental illness, usually for relatively long-term inpatients.Two rules usually govern whether someone should be placed in a psychiatric hospital: if someone is an immediate threat to harm themselves, or to harm other people....
 (mental institution). Semmelweis died there only 14 days later, possibly after being severely beaten by guards.

Semmelweis' practice only earned widespread acceptance years after his death, when Louis Pasteur
Louis Pasteur

Louis Pasteur was a France chemist and microbiologist best known for his remarkable breakthroughs in the causes and prevention of disease. His experiments supported the germ theory of disease, also reducing mortality from puerperal fever , and he created the first vaccine for rabies....
 developed the germ theory of disease
Germ theory of disease

The germ theory, also called the pathogenic theory of medicine, is a theory that proposes that microorganisms are the cause of many diseases....
 which offered a theoretical explanation for Semmelweis' findings. Semmelweis is considered a pioneer of antiseptic procedures.

Parents and early life

Ignaz Semmelweis was born on July 1, 1818 in Tabán
Tabán

Tab?n is a district of Budapest, Hungary, to the south of Gy?rgy D?zsa Square, on the northern Buda side of Erzs?bet h?d to the east of Naphegy....
, the oldest sector of what is now Budapest
Budapest

Budapest is the Capitals of Hungary of Hungary. As the largest city of Hungary, it serves as the country's principal political, cultural, commerce, Industry, and transportation center and is considered an important hub in Central Europe....
. It was then part of the Austro-Hungarian empire, now Hungary
Hungary

Hungary , officially in English the Republic of Hungary , is a landlocked country in the Carpathian Basin of Central Europe, bordered by Austria, Slovakia, Ukraine, Romania, Serbia, Croatia, and Slovenia....
. He was the fifth child out of ten of a prosperous grocer
Grocer

Beginning as early as the 14th century, a grocer was a dealer in comestible dry goods such as spices, pepper, sugar, and cocoa, tea and coffee....
 family of József and Terézia Müller Semmelweis. The family was German-speaking and perhaps Jewish.According to Nuland, the name Semmelweis is of Swabia
Swabia

Swabia, Suabia, or Svebia is both a historic and linguistics region in Germany. Swabia consists of much of the present-day state of Baden-W?rttemberg , as well as the Bavarian Swabia ....
n origin, and Semmelweis' ancestors were baptized as Roman Catholics as far back as 1670. However, Horton states that "the question of whether Semmelweis's family were Jewish or retained a strong Jewish cultural identity remains contested" and argues that the issue of Semmelweis' ethnicity is "open to debate".

His father, József Semmelweis (1778–1846), was born in Kismarton, Kingdom of Hungary
Kingdom of Hungary

The Kingdom of Hungary , which existed from 1000 to 1918, and then from 1920 to 1946, was a considerable state in Central Europe....
, Austrian Empire
Austrian Empire

The Austrian Empire was a periodization successor state empire founded on a remnant of the Holy Roman Empire centered on what is today's Austria that officially lasted from 1804 to 1867....
 (today Eisenstadt, Austria
Austria

Austria , officially the Republic of Austria , is a landlocked country in Central Europe. It borders both Germany and the Czech Republic to the north, Slovakia and Hungary to the east, Slovenia and Italy to the south, and Switzerland and Liechtenstein to the west....
). József achieved permission to set up shop in Buda in 1806 and, in the same year, opened a wholesale business with spices and general consumer goods named zum Weißen Elephanten (the White Elephant) in Heindl-Haus in Tabán
Tabán

Tab?n is a district of Budapest, Hungary, to the south of Gy?rgy D?zsa Square, on the northern Buda side of Erzs?bet h?d to the east of Naphegy....
 (today a museum). By 1810, he was a wealthy man when he married Terézia Müller, daughter of the famous vehicle builder Fülöp Müller.

Semmelweis began studying law at the University of Vienna
University of Vienna

The University of Vienna is a public university located in Vienna, Austria. Having opened in 1365, it is one of the oldest universities in Europe....
 in the autumn of 1837, but by the following year, for reasons that are no longer known, he had changed to medicine. He was awarded his doctorate degree in medicine in 1844. After failing to obtain an appointment in a clinic for internal medicine, Semmelweis decided to specialize in obstetrics. Some of his teachers included Carl von Rokitansky
Carl Freiherr von Rokitansky

Baron Carl von Rokitansky , was a Bohemian physician, pathologist, humanist philosopher and liberal politician....
, Josef Skoda and Ferdinand von Hebra
Ferdinand Ritter von Hebra

Ferdinand Ritter von Hebra was an Austrian Empire physician and dermatologist, . He is known as the founder of the New Vienna School of Dermatology, an important group of physicians who set the basis for modern dermatology....
.

Discovery of cadaverous poisoning

Semmelweis was appointed assistant to Professor Klein
Johann Klein

Johann Klein was Professor of Obstetrics at the University of Salzburg and at the University of Vienna. Johann Baptist Chiari was his son-in-law....
 in the First Obstetrical Clinic of the Vienna General Hospital
Vienna General Hospital

The Vienna General Hospital is the University clinic of the city of Vienna, Austria. The AKH is the largest hospital of Austria, and at 85-m high is one of the tallest hospital buildings in the world....
 on the 1st July 1846. A comparable position today would be
"head resident". His duties were, amongst others, to examine patients each morning in preparation for the professor's rounds, supervise difficult deliveries and teach obstetrical students. He was also responsible for the clerical records.

Maternity institutions were set up all over Europe to address problems of infanticide
Infanticide

Infanticide is the practice of someone intentionally causing the death of an infant. Often it is the mother who commits the act, but criminology recognizes various forms of non-maternal child murder....
 of "illegitimate" children. They were set up as gratis institutions and offered to care for the infants, which made them attractive to underprivileged women, including prostitutes. In return for the free services, the women would subject themselves to the training of doctors and midwives. There were two maternity clinics at the Viennese hospital. The
First Clinic had an average maternal mortality rate
Mortality rate

Mortality rate is a measure of the number of deaths in some population, scaled to the size of that population, per unit time. Mortality rate is typically expressed in units of deaths per 1000 individuals per year; thus, a mortality rate of 9.5 in a population of 100,000 would mean 950 deaths per year in that entire population....
 due to puerperal fever of about 10% (actual rates
Historical mortality rates of puerperal fever

Dr. Ignaz Semmelweis worked at the Vienna General Hospital's maternity clinic on a 3-year contract from 1846-1849. There, as elsewhere in European and North American hospitals, puerperal fever, or childbed fever, was rampant, sometimes climbing to 40 percent of admitted patients....
 fluctuated wildly). The
Second Clinic's rate was considerably lower, averaging less than 4%. This fact was known outside the hospital. The two clinics admitted on alternate days but women begged to be admitted to the Second Clinic due to the bad reputation of the First Clinic. Semmelweis described desperate women begging on their knees not to be admitted to the First Clinic. Some women even preferred to give birth in the streets, pretending to have given sudden birth en route to the hospital (a practice known as street births), which meant they would still qualify for the child care benefits without having been admitted to the clinic. Semmelweis was puzzled that puerperal fever was rare amongst women giving street births. "To me, it appeared logical that patients who experienced street births would become ill at least as frequently as those who delivered in the clinic. [...] What protected those who delivered outside the clinic from these destructive unknown endemic influences?"

Semmelweis was severely troubled and literally sickened that his First Clinic had a much higher mortality rate due to puerperal fever than the Second Clinic. It "made me so miserable that life seemed worthless". The two clinics used almost the same techniques, and Semmelweis started a meticulous work eliminating all possible differences, even including religious practices. The only major difference was the individuals who worked there. The First Clinic was the teaching service for medical students, while the Second Clinic had been selected in 1841 for the instruction of midwives only.

generated with :de:Wikipedia:Helferlein/VBA-Macro for EXCEL tableconversion V1.7<\hiddentext>>
Puerperal fever
Puerperal fever

Puerperal fever , also called childbed fever, can develop into puerperal sepsis, which is a serious form of septicaemia contracted by a woman during or shortly after childbirth, miscarriage or abortion....
 mortality rates for the First and Second Clinic at the Vienna General Hospital 1841–1846. The First Clinic evidently has the larger mortality rate. Longer data series
Historical mortality rates of puerperal fever

Dr. Ignaz Semmelweis worked at the Vienna General Hospital's maternity clinic on a 3-year contract from 1846-1849. There, as elsewhere in European and North American hospitals, puerperal fever, or childbed fever, was rampant, sometimes climbing to 40 percent of admitted patients....
  First clinic   Second clinic
Year | Births | Deaths | Rate (%) |   | Births | Deaths | Rate (%)
1841 | 3,036 | 237 | 7.8 |   | 2,442 | 86 | 3.5
1842 | 3,287 | 518 | 15.8 |   | 2,659 | 202 | 7.6
1843 | 3,060 | 274 | 9.0 |   | 2,739 | 164 | 6.0
1844 | 3,157 | 260 | 8.2 |   | 2,956 | 68 | 2.3
1845 | 3,492 | 241 | 6.9 |   | 3,241 | 66 | 2.0
1846 | 4,010 | 459 | 11.4 |   | 3,754 | 105 | 2.8


He excluded "overcrowding" as a cause because the Second Clinic was always more crowded as stated above but the mortality was lower. He eliminated climate as a cause because the climate was not different, and so on. The breakthrough for Ignaz Semmelweis occurred in 1847 following the death of his good friend Jakob Kolletschka
Jakob Kolletschka

Jakob Kolletschka was Professor of Forensic Medicine at Vienna General Hospital in Austria.Jakob Kolletschka is mostly known for his tragic death which eventually lead Semmelweis to his discovery of the etiology of childbed fever....
 who had been accidentally poked with a students scalpel while performing a postmortem examination. Kolletschka's own autopsy
Autopsy

An autopsy, also known as a post-mortem examination, necropsy , autopsia cadaverum, or obduction, is a medical procedure that consists of a thorough examination of a Dead body to determine the cause and manner of death and to evaluate any disease or injury that may be present....
 showed a pathological situation similar to that of the women who were dying from puerperal fever. Semmelweis immediately proposed a connection between cadaver
Cadaver

A cadaver is a dead human body.Cadaver may also refer to:* Cadaver tomb, tomb featuring an effigy in the form of a decomposing body* Cadaver , a video game...
ic contamination and puerperal fever.

He concluded that he and the medical students carried "cadaverous particles" on their hands from the autopsy room to the patients they examined in the First Obstetrical Clinic. This explained why the student midwives in the Second Clinic who were not engaged in autopsies and had no contact with corpses experienced a much lower mortality rate. There were still opportunities for midwives to contaminate their hands, however. In a lecture in 1846 Jakob Kolletschka
Jakob Kolletschka

Jakob Kolletschka was Professor of Forensic Medicine at Vienna General Hospital in Austria.Jakob Kolletschka is mostly known for his tragic death which eventually lead Semmelweis to his discovery of the etiology of childbed fever....
 is reputed to have said, "It is here no uncommon thing for midwives, especially in the commencement of their practice, to pull off legs and arms of infants, and even to pull away the entire body and leave the head in the uterus. Such occurrences are not altogether uncommon; they often happen."

The germ theory of disease
Germ theory of disease

The germ theory, also called the pathogenic theory of medicine, is a theory that proposes that microorganisms are the cause of many diseases....
 had not yet been developed at the time. Thus, Semmelweis concluded that some unknown "cadaverous material" caused childbed fever. He instituted a policy of using a solution of chlorinated lime
Calcium hypochlorite

Calcium hypochlorite is a chemical compound with chemical formula 2. It is widely used for water treatment and as a bleaching agent ....
 for washing hands between autopsy work and the examination of patients and the mortality rate dropped a ten-fold order of magnitude
Order of magnitude

An order of magnitude is the class of scale or magnitude of any amount, where each class contains values of a fixed Geometric progression to the class preceding it....
, comparable to the Second Clinic's. The mortality rate in April 1847 was 18.3 percent, handwashing was instituted mid-May, the rates in June were 2.2 percent, July 1.2 percent, August 1.9 percent and, for the first time since the introduction of anatomical orientation, the death rate was zero in two months in the year following this discovery.

Ideas ran contrary to established medical opinion

Semmelweis' observations went against all established scientific medical opinion of the time. The theory of disease
Disease

A disease or medical condition is an abnormal condition of an organism that impairs bodily functions, associated with specific symptoms and Medical signs....
s were highly influenced by ideas of an imbalance of the basic "four humours
Four humours

Erich Adickes, Eduard Spranger, Ernst Kretschmer, and Erich Fromm all theorized on the four temperaments and greatly shaped our modern theories of temperament....
" in the body, a theory known as dyscrasia
Dyscrasia

Dyscrasia, is a concept from ancient Greek medicine with the word "dyskrasia", meaning bad mixture....
 for which the main treatment was bloodletting
Bloodletting

Bloodletting is the withdrawal of often considerable quantities of blood from a patient in the belief that this would cure or prevent a great many illnesses and diseases....
s. Medical texts at the time emphasized that each case of disease was unique, the result of a personal imbalance, and the main difficulty of the medical profession was to establish precisely each patient's unique situation, case by case.

The findings from autopsies of deceased women also showed a confusing multitude of various physical signs, which emphasised the belief that puerperal fever was not one, but many different, yet unidentified, diseases. Semmmelweis' main finding — that all instances of puerperal fever could be traced back to only one single cause: lack of cleanliness — was simply unacceptable. His findings also ran against the conventional wisdom that diseases spread in the form of "bad air", also known as miasmas
Miasma theory of disease

The miasmatic theory of disease held that diseases such as cholera or the Black Death were caused by a miasma , a noxious form of "bad air"....
 or vaguely as "unfavourable atmospheric-cosmic-terrestrial influences". Semmelweis' groundbreaking idea — that harmful infectious particles could sit in minuscule amounts on fingers — was contrary to all established medical understanding.

As a result, his ideas were rejected by the medical community. Other more subtle factors may also have played a role. Some doctors, for instance, were offended at the suggestion that they should wash their hands; they felt that their social status as gentlemen was inconsistent with the idea that their hands could be unclean.

Specifically, Semmelweis' claims were thought to lack scientific basis, since he could offer no acceptable explanation for his findings. Such a scientific explanation was only made possible some decades later when the germ theory of disease was developed by Louis Pasteur
Louis Pasteur

Louis Pasteur was a France chemist and microbiologist best known for his remarkable breakthroughs in the causes and prevention of disease. His experiments supported the germ theory of disease, also reducing mortality from puerperal fever , and he created the first vaccine for rabies....
, Joseph Lister, and others.

During 1848 Ignaz Semmelweis widened the scope of his washing protocol to include all instruments coming in contact with patients in labor, and used mortality-rate time series
Time series

In statistics, signal processing, and many other fields, a time series is a sequence of data points, measured typically at successive times, spaced at time intervals....
 to document his success in virtually eliminating puerperal fever from the hospital ward.

Hesitant publication of results and first signs of trouble

Toward the end of 1847, accounts of Semmelweis's work began to spread around Europe. Semmelweis and his students wrote letters to the directors of several prominent maternity clinics describing their recent observations. Ferdinand von Hebra
Ferdinand Ritter von Hebra

Ferdinand Ritter von Hebra was an Austrian Empire physician and dermatologist, . He is known as the founder of the New Vienna School of Dermatology, an important group of physicians who set the basis for modern dermatology....
, the editor of a leading Austrian medical journal, announced Semmelweis's discovery in the December 1847 and April 1848 issues of the medical journal. Hebra claimed that Semmelweis's work had a practical significance comparable to that of Edward Jenner
Edward Jenner

Edward Jenner, Fellow of the Royal Society, was an English scientist who studied his natural surroundings in Berkeley, Gloucestershire, Gloucestershire, England....
's introduction of cowpox inoculations to prevent smallpox.

In late 1848, one of Semmelweis' former students wrote a lecture explaining Semmelweis' work. The lecture was presented before the Royal Medical and Surgical Society in London and a review published in the Lancet, a prominent medical journal. A few months later, another of Semmelweis's former students published a similar essay in a French periodical.

As accounts of the dramatic reduction in mortality rates in Vienna were being circulated throughout Europe, Semmelweis had reason to expect that the chlorine washings would be widely adopted, saving tens of thousands of lives. Early responses to his work also gave clear signs of coming trouble, however. Some physicians had clearly misinterpreted his claims. James Young Simpson
James Young Simpson

Sir James Young Simpson was a Scotland doctor and an important figure in the history of medicine. Simpson discovered the anaesthetic properties of chloroform and successfully introduced it for general medical use....
, for instance, saw no difference between Semmelweis' groundbreaking findings and the British idea suggested by Oliver Wendell Holmes
Oliver Wendell Holmes, Sr.

Oliver Wendell Holmes Sr., was an American physician and professor who also achieved fame as a writer. During his lifetime, he was one of the best regarded poets of the 19th century and is considered a member of the Fireside Poets....
 in 1843 that childbed fever was contagious (i.e. that infected persons could pass the infection to others). Indeed, initial responses to Semmelweis' findings were that
he had said nothing new.

In fact, Semmelweis was warning against all decaying organic matter — not just against a specific contagion that originated from victims of childbed fever themselves. This misunderstanding, and others like it, occurred partly because Semmelweis's work was known only through secondhand reports written by his colleagues and students. At this crucial stage, Semmelweis himself published nothing. These and similar misinterpretations would continue to cloud discussions of his work throughout the century.

Some accounts emphasise that Semmelweis refused to communicate his method officially to the learned circles of Vienna, nor was he eager to explain it on paper.

Political turmoil and dismissal from the Vienna hospital

March15
In 1848 a series of tumultous revolutions
Revolutions of 1848

The European Revolutions of 1848, known in some countries as the Spring of Nations or the Year of Revolution, were a series of political upheavals throughout the European continent....
 swept across Europe. The resulting political turmoil would affect Semmelweis' career. In Vienna on 13 March 1848, students demonstrated in favor of increased civil rights, including trial by jury and freedom of expression. The demonstration was led by medical students and young faculty members and were joined by workers from the suburbs. Two days later in Hungary, demonstrations and uprisings eventually lead to the Hungarian Revolution of 1848
Hungarian Revolution of 1848

The Hungarian Revolution of 1848 was one of many Revolutions of 1848 and closely linked to other revolutions of 1848 in the Habsburg areas. The revolution in Hungary grew into a war for independence from Austrian Empire....
 and a full scale war against the ruling Habsburgs of the Austrian Empire
Austrian Empire

The Austrian Empire was a periodization successor state empire founded on a remnant of the Holy Roman Empire centered on what is today's Austria that officially lasted from 1804 to 1867....
. In Vienna, the March demonstration were followed by months of general unrest.

There is no evidence that Semmelweis was personally involved in the events of 1848. It is known that some af his brothers were punished for active participation in the Hungarian independence movement, and it seems likely that the Hungarian born Semmelweis was sympathetic to the cause. Semmelweis's superior, professor Johann Klein
Johann Klein

Johann Klein was Professor of Obstetrics at the University of Salzburg and at the University of Vienna. Johann Baptist Chiari was his son-in-law....
, is described as a conservative Austrian, likely at unease with the independence movements and at alarmed with the other revolutions of 1848 in the Habsburg areas
Revolutions of 1848 in the Habsburg areas

From March 1848 through July 1849, the Habsburg Monarchy Austrian Empire was threatened by revolutionary movements. Much of the revolutionary activity was of a nationalism character: the empire, ruled from Vienna, included Austrian ethnic German, Magyars, Slovenes, Poles, Czechs, Slovaks, Ruthenians, Romanians, Serbs, Italian people, and Croats, a...
. It seems likely that Klein mistrusted Semmelweis.

When Semmelweis' term was about to expire Carl Braun also applied for the position of
assistant in the First Clinic, possibly at Klein's own invitation. Semmelweis and Braun were the only two applicants for the post. Semmelweis's predecessor, Breit
Franz Breit (obstetrician)

Franz Breit was an obstetrician and assistant to professor Johann Klein of the maternity clinic at the Vienna General Hospital in Austria. He was appointed to professor and Chair of Obstetrics at University of T?bingen on 20 March 1847 allowing Ignaz Semmelweis to become Assistant to the professor....
, had been granted a two-year extention . Semmelweis's application for an extension was supported by Josef Škoda
Josef Škoda

Joseph ?koda was a Czechs physician, medical professor and dermatologist. Together with Carl Freiherr von Rokitansky, he was the founder of the Modern Medical School of Vienna....
 and Carl von Rokitansky
Carl Freiherr von Rokitansky

Baron Carl von Rokitansky , was a Bohemian physician, pathologist, humanist philosopher and liberal politician....
 and by most of the medical faculty. But Klein chose Braun for the position. Semmelweis's was obliged to leave the obstetrical clinic when his term expired on 20 March 1849.

The day his term expired, Semmelweis petitioned the Viennese authorities to be made docent
Privatdozent

Private docent is a title conferred in some European university systems, especially in German language-speaking countries, for someone who pursues an academic career and holds all formal qualifications to become a tenured university professor....
 of obstetrics. A docent was a private lecturer who taught students and who had access to some university facilities. At first, because of Klein's opposition, Semmelweis's petition was denied. He reapplied, but had to wait until 10 Oct 1850 (almost 1˝ year) before finally being appointed docent of
theoretical obstetrics. The terms refused him access to cadavers and limited him to teaching students by using leather fabricated mannequin
Mannequin

A mannequin is an often articulated life-sized doll used by artists, tailors, dressmakers, and others especially to display or fit clothing. During the 1950s, mannequins were also used in nuclear tests to help illustrate the effects of nuclear weapons on human beings....
s only. A few days after being notified of his appointment, Semmelweis left Vienna abruptly and returned to Budapest. It appears, that he left without so much as saying good-bye to his former friends and colleagues, a move which may have offended them. Accoring to his own account, he left Vienna because he was "unable to endure further frustrations in dealing with the Viennese medical establishment".

Life in Budapest

During 1848–1849 some 70,000 troops from the Habsburg
Habsburg

The House of Habsburg was an important royal house of Europe and is best known as supplying all of the formally elected Holy Roman Emperors between 1452 and 1740, as well as rulers of Spanish Empire and the Austrian Empire....
-ruled Austrian Empire
Austrian Empire

The Austrian Empire was a periodization successor state empire founded on a remnant of the Holy Roman Empire centered on what is today's Austria that officially lasted from 1804 to 1867....
 thwarted the Hungarian independence movement
Hungarian Revolution of 1848

The Hungarian Revolution of 1848 was one of many Revolutions of 1848 and closely linked to other revolutions of 1848 in the Habsburg areas. The revolution in Hungary grew into a war for independence from Austrian Empire....
, executed or imprisoned its leaders and in the process destroyed parts of Pest. It seems likely that Semmelweis, upon arriving from the Habsburg Vienna in 1850, was not warmly welcomed in Pest.

On 20 May 1851 Semmelweis took the relatively insignificant position of unpaid, honorary head physician of the obstetric ward of Pest's small St. Rochus Hospital. He held that position for six years, until June 1857. Childbed fever was rampant at the clinic; at a visit in 1850, just after returning to Pest, Semmelweis found one fresh corpse, another patient in severe agony, and four others seriously ill with the disease. After taking over in 1851, Semmelweis virtually eliminated the disease. During 1851–1855 only 8 patients died from childbed fever out of 933 births (0.85 percent).

Despite the impressive results, Semmelweis's ideas were not accepted by the other obstetricians in Budapest. The professor of obstetrics at the University of Pest, Ede Flórián Birly
Ede Flórián Birly

Ede Fl?ri?n Birly was Professor of Theoretical and Practical Obstetrics at the University of Pest. He was one of Semmelweis's principal opponents....
, never adopted Semmelweis' methods. He continued to believe that puerperal fever was due to uncleanliness of the bowel. Therefore, extensive purges was the preferred treatment.

After professor Birly died in 1854, Semmelweis applied for the position. So did Carl Braun — Semmelweis's nemesis and successor as Johann Klein
Johann Klein

Johann Klein was Professor of Obstetrics at the University of Salzburg and at the University of Vienna. Johann Baptist Chiari was his son-in-law....
's assistant in Vienna — and Braun received more votes from his Hungarian colleagues than Semmelweis did. Semmelweis was eventually appointed in 1855, but only because the Viennese authorities overruled the wishes of the Hungarians because Braun did not speak Hungarian. As professor of obstetrics, Semmelweis instituted chlorine washings at the University of Pest maternity clinic. Once again he attained impressive results.

Semmelweis had now achieved dramatic successes at three obstetrical facilities — even so, his ideas continued to be ridiculed and rejected both in Vienna and in Budapest.

He built a large private practice. Semmelweis turned down an offer in 1857 to become professor of obstetrics at the University of Zurich
University of Zurich

The University of Zurich , located in the city of Zurich, is the largest university in Switzerland, with over 24,000 students. It was founded in 1833 from the existing colleges of theology, law, medicine and a new Faculty of philosophy....
. The same year, Semmelweis married the nineteen years younger Mária Weidenhoffer (1837–1910). She was the daughter of a successful merchant in Pest.

Rejection by the medical community

  • One of the first to respond to Semmelweis' 1848 communications was James Young Simpson
    James Young Simpson

    Sir James Young Simpson was a Scotland doctor and an important figure in the history of medicine. Simpson discovered the anaesthetic properties of chloroform and successfully introduced it for general medical use....
     who wrote a stinging letter. Simpson surmised that the English obstetrical literature must be totally unknown in Vienna, otherwise Semmelweis would have known that the English have long regarded childbed fever as contagious and would have employed chlorine washings to protect against it.


  • Semmelweis's views were much more favorably received in England than on the continent, but he was more often cited than understood. The English 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 "miasms derived from the dissecting room will excite puerperal disease."


  • In 1856, Semmelweis' assistant József Fleischer reported the successful results of handwashings at St. Rochus and Pest maternity institutions in the Viennese Medical Weekly (Wiener Medizinische Wochenschrift
    Wiener Medizinische Wochenschrift

    A renowned medical journal. Currently part of Springer Verlag, WienThe ?sterreichische Nationalbibliothek have made old copies available over the internet ...
    ). The editor remarked sarcastically that it was time people stopped being misled about the theory of chlorine washings. A popular translation into English is "it was time to stop the nonsense of hand washing with chlorine", e.g. found Encyclopedia Britannica. There is little support for the nonsense translation however.


In 1858 Semmelweis finally published his own account of his work in an essay entitled, "The Etiology of Childbed Fever". Two years later he published a second essay, "The Difference in Opinion between Myself and the English Physicians regarding Childbed Fever". In 1861, Semmelweis finally published his main work
"Die Ätiologie, der Begriff und die Prophylaxis des Kindbettfiebers" (German for "The Etiology, Concept and Prophylaxis of Childbed Fever").

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. […] The medical literature
Medical literature

Medical literature refers to articles in journals and texts in books devoted to the field of medicine.Contemporary and historic views regarding diagnosis, prognosis and treatment of medical conditions have been documented for thousands of years....
 for the last twelve years continues to swell with reports of puerperal epidemics, and in 1854 in Vienna, the birthplace of my theory, 400 maternity patients died from childbed fever. 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".

  • In Berlin, the professor of obstetrics, Joseph Hermann Schmidt
    Joseph Hermann Schmidt

    Joseph Hermann Schmidt was professor of Obstetrics in Berlin, and official of the Prussian cultural ministry.In 1834 he became head of the Paderborn general hospital and eventually also of the Paderborn maternity clinic....
    , approved of obstetrical students having ready access to morgues in which they could spend time while waiting for the labor process.


  • 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 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. The impact of Braun's views are clearly visible in the rising mortality rates in the 1850s
    Historical mortality rates of puerperal fever

    Dr. Ignaz Semmelweis worked at the Vienna General Hospital's maternity clinic on a 3-year contract from 1846-1849. There, as elsewhere in European and North American hospitals, puerperal fever, or childbed fever, was rampant, sometimes climbing to 40 percent of admitted patients....
    .


  • Ede Flórián Birly
    Ede Flórián Birly

    Ede Fl?ri?n Birly was Professor of Theoretical and Practical Obstetrics at the University of Pest. He was one of Semmelweis's principal opponents....
    , Semmelweis' predecessor as Professor of Obstetrics at the University of Pest, never accepted Semmelweis' teachings; he continued to believe that puerperal fever was due to uncleanliness of the bowel.


  • August Breisky, an obstetrician in Prague, rejected Semmelweis's book as "naive" 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
    Etiology

    Etiology is the study of Causality. The word is derived from the Ancient Greek , aitiologia, "giving a reason for" .The word is most commonly used in medical and philosophical theories, where it is used to refer to the study of why things occur, or even the reasons behind the way that things act, and is used in philosophy, physics, psy...
     of the disease.


  • Carl Edvard Marius Levy
    Carl Edvard Marius Levy

    Professor, Dr. Med. Carl Edvard Marius Levy was professor and head of the Denmark Maternity institution in Copenhagen .Levy graduated 1831 from Copenhagen University in Medicine and surgery....
    , head of the Copenhagen maternity hospital and an outspoken critic of Semmelweis' ideas, had reservations concerning the unspecific nature of cadaverous particles and that the supposed quantities were unreasonably small. "If Dr. Semmelweis had limited his opinion regarding infections from corpses to
    puerperal corpses, I would have been less disposed to denial than I am. […] And, with due respect for the cleanliness of the Viennese students, it seems improbable that enough infective matter or vapor could be secluded around the fingernails to kill a patient." In fact, Robert Koch
    Robert Koch

    Heinrich Hermann Robert Koch was a German physician. He became famous for isolating Bacillus anthracis , the Mycobacterium tuberculosis and the Vibrio cholerae and for his development of Koch's postulates....
     later used precisely this fact to prove that various infecting materials contained living organisms which could reproduce in the human body, i.e. that since the poison could be neither chemical nor physical in operation, it must be biological.


  • At a conference of German physicians and natural scientists, most of the speakers rejected his doctrine, including the celebrated Rudolf Virchow
    Rudolf Virchow

    Rudolf Ludwig Karl Virchow was a Medicine, Anthropology, public health activist, Pathology, prehistorian, biologist and politician. He is referred to as the "Father of Pathology," and founded the field of Social Medicine....
    , who was a scientist of the highest authority of his time.


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.

Breakdown, death and oblivion

Beginning from 1861 Semmelweis suffered from various nervous complaints. He suffered from severe depression and became excessively absent minded. Paintings from 1857 to 1864 show that he aged rapidly. He turned every conversation to the topic of childbed fever.

After a number of unfavorable foreign reviews of his 1861 book, Semmelweis lashed out against his critics in series of Open Letters. They were adressed to various prominent European obstetricians, including Späth
Joseph Späth

Joseph Sp?th was Professor of Obstetrics in Vienna and from 1873 until 1886 he was director of the Second Obstetrical Clinic at the Vienna General Hospital....
, Scanzoni
Friedrich Wilhelm Scanzoni von Lichtenfels

Friedrich Wilhelm Scanzoni von Lichtenfels was a German gynecologist and obstetrician who was a native of Prague. He studied medicine in Prague, and spent most of his professional career as chair of obstetrics at the University of W?rzburg, where he succeeded Franz Kiwisch von Rotterau....
, Siebold
Eduard Caspar Jacob von Siebold

Eduard Kaspar Jakob von Siebold was a German Professor of Gynecology. He worked at the universities of Humboldt-Universit?t Berlin, Philipps-Universit?t Marburg und Georg-August-Universit?t G?ttingen....
, and to "all obstetricians". They were full of bitterness, desperation, fury, and were "highly polemical and superlatively offensive" at times denouncing his critics as irresponsible murderers or ignoramuses. He also called upon Siebold to arrange a meeting of German obstetricians somewhere in Germany to provide a forum for discussions on puerperal fever where he would stay "until all have been converted to his theory." The attacks undermined his professional credibility.

In mid-1865, his public behaviour became irritating and embarrassing to his associates. He also began to drink immoderately; he spent progressively more time away from his family, sometimes in the company of a prostitute; and his wife noticed changes in his sexual behavior. On 13 July 1865 the Semmelweis family visited friends, and during the visit Semmelweis's behavior seemed particularly inappropriate.

It is impossible to appraise the nature of Semmelweis' disorder. It may have been Alzheimer's disease
Alzheimer's disease

Alzheimer's disease , also called Alzheimer disease, Senile Dementia of the Alzheimer Type or simply Alzheimer's, is the most common form of dementia....
, a form of senile dementia, which is associated with rapid aging. It may have been third stage of syphilis
Syphilis

Syphilis is a sexually transmitted disease caused by the spirochete bacterium Treponema pallidum subspecies pallidum. The route of transmission of syphilis is almost always through sexual contact, although there are examples of congenital syphilis via transmission from mother to child in utero....
, a then-common disease of obstetricians who examined thousands of women at gratis institutions. Or it may have been emotional exhaustion from overwork and stress.

In 1865 János Balassa
János Balassa

J?nos Balassa Surgeon, university professor, and one of the leading personalities of the Hungarian medical society at the time. He was also an internationally recognized authority within the field of plastic surgery....
 wrote a document referring Semmelweis to a mental institution. On 30 July Ferdinand von Hebra lured him, under the pretense of visiting one of Hebra's "new Institutes", to a Viennese insane asylum
Asylum

Asylum may refer:* Right of asylum, also known as Political asylum* Asylum seeker, also known as Refugee* Lunatic asylum, Insane asylum or Mental asylum, former terms for Psychiatric hospital, a hospital specializing in the treatment of persons with mental illness...
 located in Lazarettgasse, not far from the General Hospital — definitely not one of Vienna's best. Semmelweis surmised what was happening and tried to leave. He was severely beaten by several guards, secured in a straitjacket
Straitjacket

A straitjacket is a garment shaped like a jacket with overlong sleeves. The ends of these can be tied to the back of the wearer, so that the arms are kept close to the chest with possibility of only little movement....
 and confined to a darkened cell. Apart from the straitjacket, treatments at the mental institution included dousing with cold water and administering castor oil
Castor oil

Castor oil is a vegetable oil obtained from the castor bean . Castor oil is a colorless to very pale yellow liquid with mild or no odor or taste....
, a laxative
Laxative

Laxatives are foods, compounds, or drugs taken to induce bowel movements or to loosen the stool, most often taken to treat constipation. Certain stimulant, lubricant, and saline laxatives are used to evacuate the Colon for rectum and bowel examinations, and may be supplemented by enemas in that circumstance....
. He died after two weeks, on 13 August 1865, aged 47, from a gangrene
Gangrene

For the American football team nicknamed "Gang Green," see New York Jets.Gangrene is a complication of necrosis characterized by the decay of biological tissues, which become black and malodorous....
ous wound, possibly inflicted by the beating. The autopsy revealed extensive internal injuries, the cause of death pyemia — blood poisoning. In maternity clinics this would have been called childbed fever.

Semmelweis was buried in Vienna on 15 August 1865. Only a few persons attended the services. Not one family member, not one in-law, not one colleague from the University of Pest was in attendance. A few medical periodicals in Vienna and Budapest included brief announcements of Semmelweis's death. The rules of the Hungarian Association of Physicians and Natural Scientists specified that a commemorative address be delivered in honor of each member who had died in the preceding year. For Semmelweis there was no address; his death was never even mentioned.

János Diescher was appointed Semmelweis' successor at the Pest University maternity clinic. Immediately mortality rates jumped sixfold to six percent. But there were no inquiries and no protests; the physicians of Budapest said nothing. Almost no one — either in Vienna or in Budapest — seems to have been willing to acknowledge Semmelweis's life and work.

His remains were transferred to Budapest in 1891. On 11 October 1964 they were transferred once more to a space in the garden wall of the house in which he was born. The house, in the meantime, had been converted into an historical museum and library, a monument to Ignaz Semmelweis.

Legacy


Semmelweis' advice on chlorine washings was probably more influential than he realized himself. Many doctors, particularly in Germany, appeared quite willing to experiment with the practical handwashing measures that he proposed, but virtually everyone rejected his basic and ground-breaking theoretical innovation — that the disease had only one cause, lack of cleanliness. Professor Gustav Adolf Michaelis
Gustav Adolf Michaelis

Gustav Adolf Michaelis was a German obstetrician who was a native of Kiel. He studied medicine in G?ttingen under surgeon Konrad Johann Martin Langenbeck and obstetrician Friedrich Benjamin Osiander , and later was director of the Obstetric Hospital and the School of Midwifery at Kiel....
 from a maternity institution in Kiel
Kiel

Kiel is the Capital and most populous city of the northern Germany state Schleswig-Holstein.Kiel is approximately 90 km to the north of Hamburg....
 replied positively to Semmelweis' suggestions — eventually he committed suicide, however, because he felt responsible for the death of his own cousin, whom he had examined after she gave birth.

On a broader scale, to a contemporary reader, Semmelweis would appear to have demonstrated glaringly evident experimental evidence, that chlorine washings reduced childbed fever. Today, it may seem absurd that his claims were rejected, precisely on the grounds of purported lack of scientific reasoning, or what today would be called a
scientific proof. It is equally absurd that his unpalatable observational evidence only became palatable when seemingly-unrelated work by Louis Pasteur
Louis Pasteur

Louis Pasteur was a France chemist and microbiologist best known for his remarkable breakthroughs in the causes and prevention of disease. His experiments supported the germ theory of disease, also reducing mortality from puerperal fever , and he created the first vaccine for rabies....
 in Paris some more than twenty years later suddenly offered a
theoretical explanation for Semmelweis' observations — the germ theory of disease
Germ theory of disease

The germ theory, also called the pathogenic theory of medicine, is a theory that proposes that microorganisms are the cause of many diseases....
.

As such, the Semmelweis story is often used in university courses with epistemology
Epistemology

Epistemology or theory of knowledge is the branch of philosophy concerned with the nature and scope of knowledge. It addresses the questions:...
 content, e.g. philosophy of science courses — demonstrating the virtues of empiricism
Empiricism

In philosophy, empiricism is a theory of knowledge which asserts that knowledge arises from experience. Empiricism is one of several competing views about how we know "things," part of the branch of philosophy called epistemology, or "theory of knowledge"....
 or positivism
Positivism

Positivism is a philosophy which holds that the only authentic knowledge is that based on actual sense experience. Such knowledge can come only from affirmation of theories through strict scientific method....
 and providing a historical account of which types of knowledge count as scientific (and thus accepted) knowledge, and which do not. It is an irony that Semmelweis' critics considered themselves positivists. They could not accept his ideas of minuscule and largely invisible amounts of decaying organic matter as a cause of every case of childbed fever. To them, Semmelweis seemed to be reverting to the speculative theories of earlier decades that were so repugnant to his positivist contemporaries. (For an example of an earlier dead-end speculative theory that had halted scientific development, see phlogiston).

Other legacies of Semmelweis continues in:

  • Semmelweis is now recognized as a pioneer of antiseptic
    Antiseptic

    Antiseptics are antimicrobials that are applied to living biological tissue/skin to reduce the possibility of infection, sepsis, or putrefaction....
     policy
  • Semmelweis University
    Semmelweis University

    Founded in 1769, Semmelweis University is the oldest medical school in Hungary. The faculty became an independent medical school after the World War II and developed into a university teaching medicine, dentistry, pharmacy, health sciences, health management as well as physical education and sport sciences....
    , a university for medicine and health-related disciplines (located in Budapest, Hungary), is named after Semmelweis; and
  • The Semmelweis Orvostörténeti Múzeum (Semmelweis Medical History Museum) is located in the former home of Semmelweis.
  • The Semmelweis Klinik, a hospital for women only, located in Vienna, Austria.
  • In 2008 Semmelweis was selected as a main motif for the Austrian 50 euro Ignaz Semmelweis commorative coin
    Euro gold and silver commemorative coins (Austria)

    Euro gold and silver commemorative coins are special euro coins Mint and issued by member states of the Eurozone. They are minted mainly in gold and silver, although other precious metals are also used on rare occasions....
    . The obverse shows a portrait of the eminent doctor together with the rod of Asclepius
    Rod of Asclepius

    The rod of Asclepius is an Ancient Greece symbol associated with astrology and with healing the sick through medicine. It consists of a serpent entwined around a Staff ....
    .


Morton Thompson
Morton Thompson

Morton Thompson was an American writer of newspaper journalism, novels and film screenplays. Amongst his works were a collection of journalistic memoirs called Joe, the Wounded Tennis Player, and the novels Not as a Stranger and The Cry and the Covenant....
's 1949 novel
The Cry and the Covenant
The Cry and the Covenant

The Cry and the Covenant is a novel by Morton Thompson written in 1949 and published by Doubleday . The novel is a fictionalized story of Ignaz Semmelweis, an Austria-Hungary physician known for his research into puerperal fever and his advances in medical hygiene....
is based on the life of Semmelweiss.

Yet a legacy is the so-called
Semmelweis reflex
Semmelweis reflex

The Semmelweis reflex or "Semmelweis effect" is metaphor for the reflex-like rejection of new knowledge because it contradicts entrenched norms, beliefs or paradigms....
 or Semmelweis effect. It is a metaphor for a certain type of human behaviour characterized by reflex-like rejection of new knowledge because it contradicts entrenched norms, beliefs or paradigms — named after Semmelweis whose perfectly reasonable hand-washing suggestions were ridiculed and rejected by his contemporaries. There is some uncertainty about the origin and generally accepted use of the expression.

See also

  • Historical mortality rates of puerperal fever
    Historical mortality rates of puerperal fever

    Dr. Ignaz Semmelweis worked at the Vienna General Hospital's maternity clinic on a 3-year contract from 1846-1849. There, as elsewhere in European and North American hospitals, puerperal fever, or childbed fever, was rampant, sometimes climbing to 40 percent of admitted patients....
  • Contemporary reaction to Ignaz Semmelweis
    Contemporary reaction to Ignaz Semmelweis

    Dr. Ignaz Semmelweis discovered in 1847 that hand-washing with a chlorinated-lime water solution reduced the incidence of fatal childbed fever tenfold in maternity institutions....
  • The Cry and the Covenant
    The Cry and the Covenant

    The Cry and the Covenant is a novel by Morton Thompson written in 1949 and published by Doubleday . The novel is a fictionalized story of Ignaz Semmelweis, an Austria-Hungary physician known for his research into puerperal fever and his advances in medical hygiene....
  • Oliver Wendell Holmes
    Oliver Wendell Holmes, Sr.

    Oliver Wendell Holmes Sr., was an American physician and professor who also achieved fame as a writer. During his lifetime, he was one of the best regarded poets of the 19th century and is considered a member of the Fireside Poets....
  • Joseph Lister
  • Semmelweis Society
    Semmelweis Society

    The Semmelweis Society is a non-profit organization whistle-blower and pressure group for physicians formed in 1986 by Verner S. Waite and named after Ignaz Semmelweis....
  • Semmelweis University
    Semmelweis University

    Founded in 1769, Semmelweis University is the oldest medical school in Hungary. The faculty became an independent medical school after the World War II and developed into a university teaching medicine, dentistry, pharmacy, health sciences, health management as well as physical education and sport sciences....
     (Budapest)


External links

  • by Jim Berry 17 minutes
  • Extracts from Semmelweis' 1861 book, The Etiology, Concept, and Prophylaxis of Childbed Fever were published in the January 2008 edition of
  • an organization dedicated to protecting physicians from sham peer review, named for Ignaz Semmelweis.