Dr. Semmelweis and the Discovery of Handwashing (Datacamp project)
Reanalyse the data behind one of the most important discoveries of modern medicine which was handwashing.
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.
# ... YOUR CODE FOR TASK 1 ...
import pandas as pd
# Read datasets/yearly_deaths_by_clinic.csv into yearly
yearly = pd.read_csv('datasets/yearly_deaths_by_clinic.csv')
# Print out yearly
# ... YOUR CODE FOR TASK 1 ...
print(yearly)
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.
# ... YOUR CODE FOR TASK 2 ...
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
# ... YOUR CODE FOR TASK 2 ...
print(clinic_2)
%matplotlib inline
# Plot yearly proportion of deaths at the two clinics
# ... YOUR CODE FOR TASK 3 ..
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")
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.
monthly = pd.read_csv('datasets/monthly_deaths.csv', parse_dates=["date"])
# Calculate proportion of deaths per no. births
# ... YOUR CODE FOR TASK 4 ...
monthly["proportion_deaths"] = monthly['deaths'] / monthly['births']
# Print out the first rows in monthly
# ... YOUR CODE FOR TASK 4 ...
print(monthly.head(1))
# ... YOUR CODE FOR TASK 5 ...
ax = monthly.plot(x = "date", y = "proportion_deaths", ylabel = "Proportion deaths")
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
# ... YOUR CODE FOR TASK 6 ...
ax = before_washing.plot(x = "date", y = "proportion_deaths", label = "before_washing")
after_washing.plot(x = "date", y = "proportion_deaths", label = "after_washing", ax = ax, ylabel="Proportion deaths")
before_proportion = before_washing["proportion_deaths"]
after_proportion = after_washing["proportion_deaths"]
mean_diff = after_proportion.mean() - before_proportion.mean()
mean_diff
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).
boot_mean_diff = []
for i in range(3000):
boot_before = before_proportion.sample(frac=1, replace=True)
boot_after = after_proportion.sample(frac=1, replace=True)
boot_mean_diff.append( boot_after.mean() - boot_before.mean() )
# Calculating a 95% confidence interval from boot_mean_diff
confidence_interval = pd.Series(boot_mean_diff).quantile([0.025, 0.975])
confidence_interval
The fate of Dr. Semmelweis
So handwashing reduced the proportion of deaths by between 6.7 and 10 percentage points, according to a 95% confidence interval. All in all, it would seem that Semmelweis had solid evidence that handwashing was a simple but highly effective procedure that could save many lives.
The tragedy is that, despite the evidence, Semmelweis' theory — that childbed fever was caused by some "substance" (what we today know as bacteria) from autopsy room corpses — was ridiculed by contemporary scientists. The medical community largely rejected his discovery and in 1849 he was forced to leave the Vienna General Hospital for good.
One reason for this was that statistics and statistical arguments were uncommon in medical science in the 1800s. Semmelweis only published his data as long tables of raw data, but he didn't show any graphs nor confidence intervals. If he would have had access to the analysis we've just put together he might have been more successful in getting the Viennese doctors to wash their hands.
doctors_should_wash_their_hands = True