Semmelweis's methodology from the modern stand-point: intervention studies and causal ontology

Abstract Semmelweis’s work predates the discovery of the power of randomization in medicine by almost a century. Although Semmelweis would not have consciously used a randomized controlled trial (RCT), some features of his material—the allocation of patients to the first and second clinics—did involve what was in fact a randomization, though this was not realised at the time. This article begins by explaining why Semmelweis’s methodology, nevertheless, did not amount to the use of a RCT. It then shows why it is descriptively and normatively interesting to compare what he did with the modern approach using RCTs. The argumentation centres on causal inferences and the contrast between Semmelweis’s causal concept and that deployed by many advocates of RCTs. It is argued that Semmelweis’s approach has implications for matters of explanation and medical practice.
Keywords randomized controlled trial  intervention study  causal ontology  internal validity  external validity  Semmelweis
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