Harold Pinter Theatre, London, UK
From 29 June
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Who was Dr Semmelweis?
In Vienna in 1846, women expecting a baby were admitted to the city鈥檚 general hospital for their labour. But the hospital had two clinics: a First Clinic, attended by doctors, and a Second Clinic, attended by midwives.
The clinics admitted on alternate days, but women entering labour fervently hoped to be attended by the midwives. Some, on arrival to the hospital, . Others preferred to take their chances with giving birth on the street en route to the hospital, rather than be seen by doctors. Everyone, including the mothers-to-be, knew pregnant women were more likely to die under the care of the doctors.
In 1846, the death rate from puerperal fever 鈥� a form of what we now call sepsis 鈥� at the First Clinic was 11 per cent. At the Second Clinic, it was 2.8 per cent. Dr Ignaz Semmelweis, a Hungarian physician newly appointed as an obstetrician at the hospital, wanted to know why so many more women were dying under the care of doctors. His controversial discovery, which led to his expulsion from the medical establishment and a mental breakdown, is the subject of a opening in London in late June, starring Mark Rylance.
What did Semmelweis uncover, that was so hard for the medical community of the time to accept?
鈥淪emmelweis worked out there was a connection between the fact that the medical students were dissecting cadavers, and then going straight into examining the women patients, without any systemic form of hygiene,鈥� says Tom Morris, the play鈥檚 director. 鈥淗e worked out that there must be something on the hands of the doctors that was being carried into the wards where the women were being treated.鈥�
What we now know is that the bacteria which cause sepsis were being carried from the autopsy rooms onto maternity wards by doctors, who were then unwittingly infecting their patients. Midwives, who didn鈥檛 attend autopsies and had no contact with corpses, were less likely to carry the infection.
But Dr Semmelweis was practising before germ theory was developed, and the obstetrician struggled to explain the science behind his suggestion that 鈥渃adaverous particles鈥� carried by doctors were killing women. All he knew was that after imposing handwashing protocols, mortality at the First Clinic fell by 90 per cent. 鈥淭o be sort of groping in the darkness towards that, that seemed to be a fascinating historical scientific moment,鈥� says the play鈥檚 co-writer Stephen Brown.
How were Semmelweis鈥檚 discoveries received?
Without a coherent explanation, doctors dismissed Semmelweis鈥檚 approach. That is in part because accepting his view would be to admit their own culpability, says Brown. 鈥淭he doctors around him were not just complete stuck-in-the-mud fools, but actually were in this battle with ignorance and their own fear of the truth,鈥� he says.
Semmelweis didn鈥檛 help his cause. Widely considered , his efforts to change hospital practice were largely ignored and he was eventually forced from his post in Vienna. He spent the next 20 years in Budapest, writing increasingly angry letters to European obstetricians accusing them of murder. He died in a public asylum in 1865.
聽Why tell the story of Dr Semmelweis?
鈥淪emmelweis himself was a contributing factor in the reason why the discovery was made, but also why the discovery was not accepted,鈥� says Rylance, who plays the doctor. He says he was drawn to his character鈥檚 maverick personality: 鈥淚 know a lot of people who are on the fringes of orthodox theory about a matter. So those people are of interest to me, how we make better use of them.鈥�
Rylance says the play has two questions at its heart: 鈥淣ot only how great discoveries are made, but how are they communicated best?鈥�
Semmelweis ultimately failed in his efforts to convince medics to change their ways. It would take another 20 years, and the work of Louis Pasteur and Joseph Lister, before handwashing and antiseptic techniques started to be widely adopted by doctors.
It is a tragic tale of missed opportunities, says Rylance. 鈥淪emmelweis gets to the place where he can write to every medical institution in Europe, and he鈥檚 proven that it works, and still they brush it aside.鈥�
