{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T13:48:45Z","timestamp":1791294525090,"version":"4.1.0"},"reference-count":29,"publisher":"Springer Science and Business Media LLC","issue":"5","license":[{"start":{"date-parts":[[2022,4,29]],"date-time":"2022-04-29T00:00:00Z","timestamp":1651190400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,4,29]],"date-time":"2022-04-29T00:00:00Z","timestamp":1651190400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100002347","name":"Bundesministerium f\u00fcr Bildung und Forschung","doi-asserted-by":"publisher","award":["01ER1305"],"award-info":[{"award-number":["01ER1305"]}],"id":[{"id":"10.13039\/501100002347","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100008349","name":"Universit\u00e4t Duisburg-Essen","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100008349","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur J Epidemiol"],"published-print":{"date-parts":[[2022,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>We aimed to review Semmelweis\u2019s complete work on puerperal sepsis mortality in maternity wards in relation to exposure to cadavers and chlorine handwashing and other factors from the perspective of modern epidemiological methods. We reviewed Semmelweis' complete work and data as published by von Gy\u00f6ry 1905 according to current standards. We paid particular attention to Semmelweis's definition of mortality in and of itself, to concepts of modern epidemiology that were already recognizable in Semmelweis's work, and to bias sources. We did several quantitative bias analyses to address selection bias and information bias from outcome measurement error. Semmelweis addressed biases that have become known to modern epidemiology, such as confounding, selection bias and bias from outcome misclassification. Our bias analysis shows that differential loss to follow-up is an unlikely explanation for his results. Bias due to outcome misclassification would only be relevant if misclassification differed between time periods. Confounding by health status was likely but could not be quantitatively addressed. Semmelweis was aware that cause-specific mortality is a function of incidence and prognosis. He reasoned in potential outcome terms to estimate the reduced number of deaths from an intervention. He advanced a hypothesis of clinic overcrowding as a risk factor for puerperal sepsis mortality that turns out to be wrong. Semmelweis\u2019 data provide a great pool for illustrating the logic of scientific discovery by use of the numerical method. The explanatory power of his work was strong and Semmelweis was able to refute several previous causal explanations.\n<\/jats:p>","DOI":"10.1007\/s10654-022-00871-8","type":"journal-article","created":{"date-parts":[[2022,4,29]],"date-time":"2022-04-29T06:04:55Z","timestamp":1651212295000},"page":"437-445","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["A twenty-first century perspective on concepts of modern epidemiology in Ignaz Philipp Semmelweis\u2019 work on puerperal sepsis"],"prefix":"10.1007","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6363-9061","authenticated-orcid":false,"given":"Andreas","family":"Stang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6699-8377","authenticated-orcid":false,"given":"Fabian","family":"Standl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles","family":"Poole","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,4,29]]},"reference":[{"key":"871_CR1","unstructured":"Gordon AA. A treatise on the epidemic puerperal fever of Aberdeen. London: GG and J Robinson (University of Aberdeen Special Libraries & Archives MS 632); 1795."},{"key":"871_CR2","first-page":"503","volume":"1","author":"OW Holmes","year":"1843","unstructured":"Holmes OW. The contagiousness of puerperal fever. N Engl J Med. 1843;1:503.","journal-title":"N Engl J Med"},{"key":"871_CR3","volume-title":"Semmelweis' gesammelte Werke","author":"T von Gy\u00f6ry","year":"2007","unstructured":"von Gy\u00f6ry T. Semmelweis\u2019 gesammelte Werke. Saarbr\u00fccken: VDM Verlag; 2007."},{"key":"871_CR4","first-page":"1037","volume":"86","author":"L Pasteur","year":"1878","unstructured":"Pasteur L. La theorie des germes et ses applications a la medecine et a la chirurgie. C R Acad Sci. 1878;86:1037\u201343.","journal-title":"C R Acad Sci"},{"issue":"9785","key":"871_CR5","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1016\/S0140-6736(11)61007-6","volume":"378","author":"A Stewardson","year":"2011","unstructured":"Stewardson A, Pittet D. Ignac Semmelweis-celebrating a flawed pioneer of patient safety 1. Lancet. 2011;378(9785):22\u20133.","journal-title":"Lancet"},{"key":"871_CR6","unstructured":"Semmelweis IP. Die Aetiologie, der Begriff und die Prophylaxis des Kindebettfiebers. Pest, Vienna, Leipzig: C.A. Hartleben; 1861."},{"issue":"1","key":"871_CR7","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1177\/096777209400200104","volume":"2","author":"HO Lancaster","year":"1994","unstructured":"Lancaster HO. Semmelweis: a rereading of die aetiologie part I: puerperal sepsis before 1845. Die aetiologie J Med Biogr. 1994;2(1):12\u201321.","journal-title":"Die aetiologie J Med Biogr"},{"issue":"2","key":"871_CR8","doi-asserted-by":"publisher","first-page":"84","DOI":"10.1177\/096777209400200205","volume":"2","author":"HO Lancaster","year":"1994","unstructured":"Lancaster HO. Semmelweis: a rereading of die aetiologie part II: medical historians and semmelweis. J Med Biogr. 1994;2(2):84\u20138.","journal-title":"J Med Biogr"},{"issue":"1","key":"871_CR9","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1017\/S0025727300034104","volume":"25","author":"KC Carter","year":"1981","unstructured":"Carter KC. Semmelweis and his predecessors. Med Hist. 1981;25(1):57\u201372.","journal-title":"Med Hist"},{"issue":"3","key":"871_CR10","doi-asserted-by":"publisher","first-page":"175","DOI":"10.1016\/0195-6701(93)90023-S","volume":"23","author":"SW Newsom","year":"1993","unstructured":"Newsom SW. Pioneers in infection control. Ignaz Philipp Semmelweis J Hosp Infect. 1993;23(3):175\u201387.","journal-title":"Ignaz Philipp Semmelweis J Hosp Infect"},{"issue":"1","key":"871_CR11","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1017\/S0950268807008746","volume":"136","author":"TD Noakes","year":"2008","unstructured":"Noakes TD, Borresen J, Hew-Butler T, Lambert MI, Jordaan E. Semmelweis and the aetiology of puerperal sepsis 160 years on: an historical review 3. Epidemiol Infect. 2008;136(1):1\u20139.","journal-title":"Epidemiol Infect"},{"issue":"11","key":"871_CR12","doi-asserted-by":"publisher","first-page":"459","DOI":"10.1177\/0141076813507843","volume":"106","author":"RP La","year":"2013","unstructured":"La RP, Julien AS. How dramatic were the effects of handwashing on maternal mortality observed by Ignaz Semmelweis? 1. J R Soc Med. 2013;106(11):459\u201360.","journal-title":"J R Soc Med"},{"key":"871_CR13","volume-title":"Die aetiologie, der Begriff und die prophylaxis des kindbettfiebers","author":"IP Semmelweis","year":"1861","unstructured":"Semmelweis IP. Die aetiologie, der Begriff und die prophylaxis des kindbettfiebers. Pest: C. A. Hartleben\u2019s Verlags-Expedition; 1861."},{"key":"871_CR14","unstructured":"Murphy FP. The etiology, the concept and the prophylaxis of childbed fever together with the \"open letter\" by Ignac Semmelweis. Birmingham: the classics of medicine library; 1981."},{"key":"871_CR15","volume-title":"Demographischer wandel und modernisierung in wien","author":"A Weigl","year":"2000","unstructured":"Weigl A. Demographischer wandel und modernisierung in wien. 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Ignaz Semmelweis, Carl Mayrhofer, and the rise of germ theory. 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