Semmelweis, the musical


Luis Dias

At a time when handwashing is trending, at least among those in this world fortunate to have access to running water and soap, on account of the coronavirus, it is perhaps not surprising that even Google Doodle chose to celebrate the pioneer of hand disinfection, Hungarian physician and scientist Ignaz Philipp Semmelweis (1818-1865).

The date chosen by Google Doodle, March 20, marked the day in 1847 that Semmelweis was appointed chief resident in the maternity clinic of the Vienna General Hospital, where he deduced and demonstrated that requiring doctors to disinfect their hands vastly reduced the transmission of disease.

This pandemic has brought him out of obscurity back into the spotlight. Semmelweis is acknowledged as a pioneer of antisepsis, a concept that seems fundamentally self-evident to us but for which he faced much hostility in his lifetime.

Today, Semmelweis is widely remembered as the ‘saviour of mothers’ and ‘the father of infection control’. Semmelweis found that the incidence of puerperal sepsis or fever (“childbed fever”, a bacterial infection of the female reproductive tract following childbirth or miscarriage) could be drastically reduced simply by hand washing and disinfection with chlorinated lime solutions in 1847 while working in the First Obstetrical Clinic of the most influential medical establishment in Europe, Vienna General Hospital. At the time, the maternal mortality in the doctors-administered wards (with doctors often turning up to deliver babies directly from dissecting cadavers without washing their hands in between) was thrice that in the midwives’ wards. Indeed, it was safer to have a ‘street birth’ than to be admitted to the maternity clinic before hand-disinfection became accepted practice.

Despite the proven efficacy of the intervention and his publication of the results, his ideas were rejected by his peers and the medical community at large, as they conflicted with the established scientific and medical opinions of the time. Semmelweis was unable to offer a scientific rationale for his findings (although he correctly attributed the cause of the disease to a “lack of cleanliness”; he called the mysterious agents “cadaveric particles” as he deduced that doctors were bringing it with them from autopsies). Many doctors were offended at the suggestion that they needed to wash their hands. In 1849, he was compelled to leave the clinic when his term expired and wasn’t renewed.

He had to petition for an inferior post of docent in the same clinic, which limited his duties mainly to teaching, with very scant clinical work. He left abruptly soon after, “unable to endure further frustrations in dealing with the Viennese medical establishment”. Some observers blame Semmelweis at least partially for the impasse, for his “brusque manner, arrogant insistence that everyone obey his rules without explanation, and failure to communicate his results”. But there seems also to have been an element of xenophobia, a Hungarian viewed with dislike by the Austrian medical fraternity.

In 1865, he was committed to a mental asylum (supposedly for a ‘nervous breakdown’) by his colleagues. He died around two weeks later, aged just 47, from a gangrenous wound on his right hand, the wound allegedly sustained after being beaten by one of the asylum guards.

His contribution was acknowledged posthumously, after Louis Pasteur’s ‘germ theory of disease’ offered the rationale for Semmelweis’ hand-disinfection suggestion, and Joseph Lister implemented the idea of operating using hygienic methods.

Today, Semmelweis has become a byword; ‘Semmelweis reflex’ is a metaphor for ‘reflex-like rejection of new knowledge because it contradicts entrenched norms, beliefs, or paradigms’.

A remarkable man with a life-saving contribution to posterity, but you’d hardly expect him to be the subject of a stage musical. But there are at least two, one of them released in his birth bicentenary year, 2018.

‘Semmelweis’ is a 75-minute opera-theatre work by Raymond J Lustig (music) and Matthew Doherty (Hungarian libretto) and endorsed by the Semmelweis Foundation. It poses hard-hitting questions: “What is it like to be the first to see into a terrible blind spot and perceive a truth too awful to believe? To be an ‘outsider’—a ‘foreign’ doctor, Hungarian, but living and working in Vienna’s top hospital in a xenophobic era—and to fear that no one heard you, that the answer may die with you? To hold an earth-shattering insight, and yet be haunted by all the mothers that would not be saved?”

The story of Semmelweis is still relevant, the Foundation page reminds us, because “our world seems still not to have absorbed its powerful lessons. There has never been a more urgent moment in history to reflect on the mystery of insight, the tension between truth and hubris, our cultural myopia, and the clear truth that we, as individuals and as a society, need our ‘outsiders,’ our fresh and brave ideas, literally to survive.”

The musical is scored for women’s vocal ensemble (eight voices minimum, three sopranos, three mezzos, two altos), one male soloist (baritone), and seven instrumentalists (piano/organ, percussion, and string quintet), as well as specially designed music boxes and tuned bells, played onstage by all soloists and chorus.

The women’s voices represent different women haunting Semmelweis’ failing mind (patients, mothers, midwives, nurses, his wife).

In a video (available on YouTube, uploaded during this pandemic, two months ago), Lustig talks about the relevance of the work in our own time, and salutes and dedicates it to front-line health workers, among them his own wife, a nurse.

‘Semmelweis –When the Truth is not Enough’ is a musical by Harvard psychiatrist Joseph Aaron Shrand, “based on a true story that pits one man’s struggle for truth and justice against the cynicism and politics of the medical system”.

In the page about the musical on his website, Shrand explains that though it concentrates on the life and work of Semmelweis in the 1840s, “it is a damning comment on our own time. Semmelweis stirs issues of women’s rights, the conflict between medical care and managed care, about the ethics of medical research and discovery, the conflict between the religious right and the scientific community, about love, loyalty, betrayal, intrigue, sanity and madness. The musical delves into our relationship to God, discovery and rejection, elation and despair, and the ultimate sacrifice of one man to save the lives of thousands.”

“His discovery, so simple and so pure, was ridiculed and abandoned in his time. Now, it is so accepted that it is inconceivable it was ever questioned.” Those interested can watch Shrand talk about his musical, also released during this pandemic, and also pointing out the relevance of the Semmelweis parable today, with the same non-belief in what science is telling us today. Then it was antisepsis, today it is global warming and humankind’s direct contribution to it through environmental destruction, and the spread of diseases like this pandemic. And similarly, people could die needlessly, just because too many of us refuse to listen and learn.