Professional pride and personal tragedy stymied ideas about how infections spread in the nineteenth century, suggests a show about maverick Hungarian doctor Ignaz Semmelweis

Dr Semmelweis review: Mark Rylance play shows how hand washing saved hundreds of lives

Professional pride and personal tragedy stymied ideas about how infections spread in the nineteenth century, suggests a show about maverick Hungarian doctor Ignaz Semmelweis

Dr Semmelweis Dir. Tom Morris Harold Pinter Theatre, London 29 Jun – 7 Oct 2023

How do great scientific discoveries make it into the mainstream, and who gets credit? A play now showing in London tells the story of theHungarian physician and obstetrician Ignaz Semmelweis, who in the mid-nineteenth century radically reduced rates of death in childbirth at Vienna General Hospital — the largest hospital in Europe at the time. His practice — a strict hand-washing regime for doctors and nurses — was remarkably effective. Yet his ideas were rejected. Unlike French chemist Louis Pasteur, British surgeon Joseph Lister and German physician Robert Koch, who made their discoveries between the 1860s and 1880s, he is barely given a footnote in the history of antiseptic procedures and the germ theory of disease.

Why did his ideas fail to catch on? That question is at the core of Dr Semmelweis, a fascinating play produced by the UK National Theatre, and created by the writer Stephen Brown with the actor Mark Rylance, who plays Semmelweis. They powerfully capture the personal dramas that drove him to make his discoveries, the barriers to new ideas that were erected by ingrained beliefs and professional pride, and the ultimate tragedy made inevitable by the doctor’s personal flaws.

We first encounter Semmelweis towards the end of his life, working in a small obstetric ward in his native Budapest in the 1850s. His stubborn personality is immediately on show: he refuses point-blank when his former colleagues ask him to return to Vienna, or even to converse with them in German — the language of his colonial overlords. The play then unfolds in flashbacks.

Soon after his arrival in Vienna in 1847 as assistant to obstetrics professor Johann Klein (Alan Williams), Semmelweis attends a young dancer in childbirth. She pleads to be cared for in the midwives’ ward, not the doctors’, because she’s heard that it’s safer. The woman dies of childbed fever, now known to be a type of sepsis. Semmelweis learns from hospital records that at 18%, the death rate of mothers in the doctors’ ward is three times that in the midwives’. As the doctors cross the stage through an empty door frame, we realize why: unlike the midwives, they are constantly moving between the anatomy theatre, where they plunge their hands into putrefying carcasses, and the obstetric ward where they deliver babies.

Realizing this is the only difference, Semmelweis requires that all those entering the obstetric ward wash their hands in a chlorine solution. The death rate plummets to less than 3%. He wonders why, concluding that ‘cadaveric particles’ must pass from the corpses to the women’s bodies and cause infection. When he traces a further outbreak of childbed fever to a woman in the ward with an infected knee, he changes his description of the infectious agent to ‘decaying organic matter’.

At that time, the existence of microorganisms had been known for two centuries, since Dutch microbiologist Antonie van Leeuwenhoek invented the microscope (coincidentally, Leeuwenhoek died 300 years ago this month). But no one had yet connected microbes to disease transmission. In the play, Semmelweis’s inability to describe a mechanism of infection is used against him by his own professor. Klein and other senior academics refuse to accept that they themselves were agents of death to thousands of young women and children. Instead, Klein thinks new windows in the doctors’ ward will solve the problem of ‘bad air’.

Rylance’s portrayal makes clear that Semmelweis’s gifts included neither charm nor empathy, as evidenced by the increasingly bitter and offensive letters he fired off to his detractors in later life. He upsets the initially sympathetic Baroness Maria-Teresa (Roseanna Anderson), an important source of funds for the hospital, by demanding that she wash her hands in bleach. He falls out with his devoted supporters over his own failure to effectively communicate his ideas. He fails to visit his father on his deathbed or attend his funeral. With tragic results, he severely punishes a mistake made by the senior midwife (Pauline McLynn), who had aided his endeavours throughout.

Klein fires Semmelweis, who returns to Budapest in 1849. A final effort to present his ideas at a public conference ends in disaster when he calls his critics murderers, and his life soon reaches its end. He dies — of sepsis, ironically — in a psychiatric hospital at the age of 47.

Brown and Rylance have pulled off a remarkable feat in conveying a great deal of historical and scientific information, without descending into didacticism. This is a complete piece of theatre. An all-female string quartet plays throughout (Franz Schubert’s Death and the Maiden features prominently), giving an urgent quality to key moments. Observing and responding as events unfold, conveying emotion through their bodies, are the Mothers, a group of ghostly ballet dancers. They remind us that Semmelweis’s driving motivation was to save women, for whom childbirth was the most dangerous moment in their lives. The set and lighting evoke the pitiless focus of the anatomy theatre.

Although Dr Semmelweis acknowledges that the medical establishment was at fault for its resistance to change, the play seems to place most of the blame on defects in Semmelweis’s own character. There is plenty of historical evidence that the frustrations he faced eventually drove him to outbursts that hint at madness; whether Rylance’s portrayal of a stuttering, tunnel-visioned obsessive is accurate is harder to verify. Semmelweis is just about rescued from the lone-genius caricature by his dependence on the statistical skill of his assistant Franz (Ewan Black) and the professional support of the cheery anatomy professor Rokatinsky (“Just keep looking!”; Daniel York Loh).

Originally conceived before the COVID-19 pandemic, the play addresses themes that will resonate strongly with audiences who lived through those dark times — washing your hands till they are sore, divergent views in the medical establishment, the ever-present threat of disease and death. Dr Semmelweis might also be perceived as a warning to medics, scientists and others not to pursue their professional goals at the expense of their humanity.

Nature 620, 269-270 (2023)

doi: https://doi.org/10.1038/d41586-023-02493-w

This story originally appeared on: Nature - Author:Georgina Ferry