Question

The case of Dr Semmelweis and Childbed fever
Dr Semmelweis was an obstetrician interested in a major clinical and public health problem of
the day: childbed fever, also known as puerperal fever (the word “puerperal” means related to
childbirth or to the period after the birth).
In those days, the hospital Semmelweis worked at had 2 childbirth clinics: The First Clinic was
staffed by physicians and medical students and the Second Clinic by midwives. Physicians and
medical students began their days performing autopsies on women who had died from childbed
fever; they then provided clinical care for women hospitalized in the First Clinic for childbirth.
The midwives staffing the Second Clinic did not perform autopsies. Mortality in the First Clinic
was more than twice as high as in the Second Clinic—16% compared with 7%.
Semmelweis suggested that the hands of physicians and medical students were transmitting
disease- causing particles, from the cadavers to the women who were about to deliver. So he
developed and implemented a policy for the physicians and medical students to wash their
hands and to brush under their fingernails after they had finished the autopsies and before they
came in contact with any of the patients. The graph below shows the result of this intervention:
Unfortunately, for many years Semmelweis refused to present his findings at major meetings or
to submit written reports of his studies to medical journals. His failure to provide supporting
scientific evidence was at least partially responsible for the failure of the medical community to
accept his hypothesis of causation of childbed fever and his further proposed intervention of
handwashing before examining each patient.
Let’s check the outbreak investigation made by Dr Semmelweis:
1. How did he define the outbreak and validate the existence of an outbreak ?
2. How did he examine the cases and the relevant variables?
3. How was his hypothesis tested? What was the result?
4. What control measures did he suggest?
5. Did he prepare a written report of the investigation and the findings or communicate
findings to other?
6. What type of prevention was suggested by hand washing strategy of Dr Semmelweis?
Please answer the above questions above and submit it.

Answer 1

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Answer 2

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1. To establish the existence of an outbreak, the observed number of cases is compared with the expected number for a certain place or time period. Even if the current number of reported cases exceeds the expected number, the excess may not necessarily indicate an outbreak.

2. Largely, there are four approaches by which the effect of the extraneous variables can be controlled.

1) Randomization: In this approach, treatments are randomly assigned to the experimental groups. ...

2)Matching: Another important technique is to match the different groups of confounding variables.

3. Hypothesis testing is used to assess the plausibility of a hypothesis by using sample data. The test provides evidence concerning the plausibility of the hypothesis, given the data. Statistical analysts test a hypothesis by measuring and examining a random sample of the population being analyzed.

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