“Dr Semmelweis” at Harold Pinter Theatre

Jeremy Malies in the West End
13 July 2023

“Observe first, interpret later.” This is the advice of nineteenth-century physician Ignaz Semmelweis (1818–1865) – played by Mark Rylance – when we see him confide in his senior nursing sister at a hospital in Vienna. So, I let Stephen Brown’s play flood over me and came out impressed if a little unengaged though always mindful of how an actor I respect (perhaps above anybody currently working in the theatre) has invested in this material and indeed contributed to it as a writer.


Mark Rylance (foreground).
Photo credit: Simon Annand.


This is a memory play that unravels as we see Semmelweis’s fevered recollections of his determinative years in the 1840s. I inferred from the phantasmal tone that he has joined us as a ghost and is conjuring up the other characters. A Hungarian who spent his working career in Austria, Semmelweis ran two Viennese maternity wards in parallel, with different layouts and architecture. One was staffed by midwives, and the other by surgeons and medical students. Semmelweis became puzzled by a pattern going back over 40 years: the midwives consistently outperformed the clinicians in terms of lower mortality rates except for occasional deviations at holiday times when the students returned home. His suspicions settled on the fact that while surgeons and students participated in dissections daily, the midwives were never exposed to dead bodies.

It’s hardly Copernicus or Darwin but Semmelweis is now rightly feted by historians and observers of all stripes for a conceptual leap. While the hospital’s unimaginative and conventional obstetrics professor Johann Klein (played here by Alan Williams) was on holiday, Semmelweis boldly flipped the two sets of staff. He found that even in their new surroundings the midwives achieved better results than the surgeons in terms of survival rates for the mothers.

Unable to conceptualize microorganisms, Semmelweis could still move beyond his contemporaries to grasp the idea of what he hesitatingly described as “decaying organic matter”. He posited that this was being transferred from staff who attended the mortuaries to their patients during examinations. His introduction of mandatory chlorine solution handwashing for everybody in the hospital produced such dramatic improvements that the broad theory could not be disputed. Sadly, Semmelweis was temperamental, a poor communicator, and as a Hungarian was disparaged by his Austrian colleagues. Acceptance of his findings was grudging and tardy.


Choreography is by Antonia Franceschi.
Photo credit: Simon Annand.


Author Stephen Brown has been prolific in a former life as a searching but fair theatre critic. It’s therefore a given that the memory play structure here is robust, the pace varies but never flags, and the writing exudes craftsmanship particularly when he carries audience members along with him as sleuths. It reaches a new level when Semmelweis spurns his wife, played by Amanda Wilkin. He flees his home for Vienna’s red-light district to meet former patients who are working in taverns and brothels. For me, this is the most successful scene with Rylance at his most poignant as Semmelweis deflates the posturing of his peers while picking out a few chords on an upright piano. He is now indisputably mad, and the writing is remarkable for its intensity and figurative language.

Wilkin is a stand-out in a strong supporting cast; she is affecting when giving one-person chorus commentary and authoritative in a framing device as her character steps out of the narrative to tell us about Joseph Lister and his pioneering wound management ideas some 30 years later. More intrusions of this kind might have worked well and even if things had become Brechtian, I should have liked placards with graphs showing statistics in the two wards. Wilkin is personable as she draws biblical parallels with Pontius Pilate and Covid handwashing. But there is no simplistic overarching metaphor, and it should be remembered that Rylance initiated the project prior to the pandemic.

Brown is conscientious with the basics of dialogue but can also be innovative with form which is generally a non-naturalistic heightened realism involving mime for the surgical procedures and a great deal of dance. In programme notes, director Tom Morris stresses that all the creatives worked in a collaborative manner prior to an original run in Bristol.


Set design is by Ti Green.
Photo credit: Simon Annand.


There are half a dozen dancers representing the dead mothers who in Antonia Franceschi’s choreography inhabit every part of the theatre. Jerkily like string-operated puppets, they move in tight groups. The women pop up in the theatre’s boxes, flit through the stalls, and drape themselves across a steel balcony in a set by Ti Green. Green’s design focuses attention on a wheel-shaped structure suspended over the stage with the spokes suggesting a route by which microbes can travel and perhaps radiate further as characters spin on a revolve.

Music for six violins and a cello by Adrian Sutton (Coram Boy, War Horse, The Curious Incident of the Dog in the Night-Time) is performed on stage by instrumentalists who float around with the dancers. The score has a symphonic feel; it allows the dense sections of the narrative to breathe, and becomes more dissonant and insistent as Semmelweis’s intellect disintegrates and the path of the story is more obvious.

Lighting design by Richard Howell ranges from simple techniques such as implying that the theatre’s house lights are candles when the main characters go to the ballet to subtle use of filters that make a dissection room scene resemble Rembrandt’s famed painting of an anatomy lesson.


Photo credit: Simon Annand.


Morris’s direction is the equal of Brown’s writing for invention. He is equally adventurous with theatrical form, and in publicity material Morris quotes Hamlet’s advice that actors should “hold, as ’twere, the mirror up to nature”. Unusually, however, Morris is saying that Hamlet is not just asking for lifelike acting (often spurned in this play) but wants the actors to reflect the concerns of the period, something that this piece of writing lets them do. Of course, a bacterium is not a virus but the medical theme pushes at our collective fears of a possible future pandemic and our expectations for preparedness from the medical community.

Morris concludes that Semmelweis would have been recognized earlier if he had been more articulate. As for Rylance, communication is a long suit. His Semmelweis is empathetic, charismatic, and self-analytical. Ultimately, the character is a loner to the point of leaving his wife though by this time madness has taken hold. Rylance struggling to escape a straitjacket (we learn that Semmelweis tried to fight his way out of Vienna’s Tower of Fools asylum) is a sombre image to end on. The actor makes us see the physical and intellectual pain that is breaking over his character in waves. It’s the climax of a cumulative portrait of great subtlety in which he has been the focus without once depriving his colleagues of oxygen. “Don’t be frightened of chaos” is a Rylance aphorism. He has investigated it here in a character who could see his way clearly through a set of statistics but who finally implodes.

Even the most literal part of me realizes that a play written using a close approximation to what we know about conversation styles in mid-nineteenth century Mitteleuropa would never work but the more extreme anachronisms here still jarred. Did a character really need to be encouraged with the present-day slang “You’ve got this!” and did I really hear one of the hospital surgeons singing a snatch of Queen’s “We Will Rock You”?

What is it with plays about science? Brown has also written a play about Descartes but I can find nothing about its staging history. I wouldn’t put this in the roster headed by Michael Frayn’s Copenhagen (also populated by ghosts) and Nick Payne’s Constellations but it’s certainly more enjoyable than Tom Stoppard’s The Hard Problem. We will soon be spoilt with another production of Lucy Prebble’s wonderful The Effect (at the National Theatre) which is also set in a clinical environment.