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Dr. Semmelweis and the Discovery of Handwashing
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  • 1. Meet Dr. Ignaz Semmelweis

    This is Dr. Ignaz Semmelweis, a Hungarian physician born in 1818 and active at the Vienna General Hospital. If Dr. Semmelweis looks troubled it's probably because he's thinking about childbed fever: A deadly disease affecting women that just have given birth. He is thinking about it because in the early 1840s at the Vienna General Hospital as many as 10% of the women giving birth die from it. He is thinking about it because he knows the cause of childbed fever: It's the contaminated hands of the doctors delivering the babies. And they won't listen to him and wash their hands!

    In this notebook, we're going to reanalyze the data that made Semmelweis discover the importance of handwashing. Let's start by looking at the data that made Semmelweis realize that something was wrong with the procedures at Vienna General Hospital.

    # Importing modules
    import pandas as pd
    import matplotlib.pyplot as plt
    
    
    # Read datasets/yearly_deaths_by_clinic.csv into yearly
    yearly = pd.read_csv('datasets/yearly_deaths_by_clinic.csv')
    
    
    # Print out yearly
    print(yearly)

    2. The alarming number of deaths

    The table above shows the number of women giving birth at the two clinics at the Vienna General Hospital for the years 1841 to 1846. You'll notice that giving birth was very dangerous; an alarming number of women died as the result of childbirth, most of them from childbed fever.

    We see this more clearly if we look at the proportion of deaths out of the number of women giving birth. Let's zoom in on the proportion of deaths at Clinic 1.

    # Calculate proportion of deaths per no. births
    yearly['proportion_deaths'] = yearly['deaths'] / yearly['births']
    
    # Extract Clinic 1 data into clinic_1 and Clinic 2 data into clinic_2
    clinic_1 = yearly[yearly['clinic'] == 'clinic 1']
    clinic_2 = yearly[yearly['clinic'] == 'clinic 2']
    
    
    # Print out clinic_1
    print(clinic_1)

    3. Death at the clinics

    If we now plot the proportion of deaths at both Clinic 1 and Clinic 2 we'll see a curious pattern…

    # Import matplotlib
    import matplotlib.pyplot as plt
    
    
    # This makes plots appear in the notebook
    %matplotlib inline
    
    # Plot yearly proportion of deaths at the two clinics
    ax = clinic_1.plot(x="year", y="proportion_deaths", label="Clinic 1")
    clinic_2.plot(x="year", y="proportion_deaths", label="Clinic 2", ax=ax, ylabel="Proportion deaths")
    
    plt.show()

    4. The handwashing begins

    Why is the proportion of deaths consistently so much higher in Clinic 1? Semmelweis saw the same pattern and was puzzled and distressed. The only difference between the clinics was that many medical students served at Clinic 1, while mostly midwife students served at Clinic 2. While the midwives only tended to the women giving birth, the medical students also spent time in the autopsy rooms examining corpses.

    Semmelweis started to suspect that something on the corpses spread from the hands of the medical students, caused childbed fever. So in a desperate attempt to stop the high mortality rates, he decreed: Wash your hands! This was an unorthodox and controversial request, nobody in Vienna knew about bacteria at this point in time.

    Let's load in monthly data from Clinic 1 to see if the handwashing had any effect.

    # Read datasets/monthly_deaths.csv into monthly
    monthly = pd.read_csv("datasets/monthly_deaths.csv", parse_dates=["date"])
    
    # Calculate proportion of deaths per no. births
    monthly["proportion_deaths"] = monthly["deaths"] / monthly["births"]
    
    # Print out the first rows in monthly
    monthly.head()

    5. The effect of handwashing

    With the data loaded we can now look at the proportion of deaths over time. In the plot below we haven't marked where obligatory handwashing started, but it reduced the proportion of deaths to such a degree that you should be able to spot it!

    # Plot monthly proportion of deaths
    ax = monthly.plot(x="date", y="proportion_deaths", ylabel="Proportion deaths")
    

    6. The effect of handwashing highlighted

    Starting from the summer of 1847 the proportion of deaths is drastically reduced and, yes, this was when Semmelweis made handwashing obligatory.

    The effect of handwashing is made even more clear if we highlight this in the graph.

    # Date when handwashing was made mandatory
    handwashing_start = pd.to_datetime('1847-06-01')
    
    # Split monthly into before and after handwashing_start
    before_washing =  monthly[monthly["date"] < handwashing_start]
    after_washing = monthly[monthly["date"] >= handwashing_start]
    
    # Plot monthly proportion of deaths before and after handwashing
    ax = before_washing.plot(x="date", y="proportion_deaths",
    label="Before handwashing")
    after_washing.plot(x="date", y="proportion_deaths",
    label="After handwashing", ax=ax, ylabel="Proportion deaths")

    7. More handwashing, fewer deaths?

    Again, the graph shows that handwashing had a huge effect. How much did it reduce the monthly proportion of deaths on average?

    # Difference in mean monthly proportion of deaths due to handwashing
    before_proportion = before_washing['proportion_deaths']
    after_proportion = after_washing['proportion_deaths']
    mean_diff = after_proportion.mean() - before_proportion.mean()
    mean_diff

    8. A Bootstrap analysis of Semmelweis handwashing data

    It reduced the proportion of deaths by around 8 percentage points! From 10% on average to just 2% (which is still a high number by modern standards).

    To get a feeling for the uncertainty around how much handwashing reduces mortalities we could look at a confidence interval (here calculated using the bootstrap method).