The entire action of the work may be seen as if a reflection of Ignaz Semmelweis’s inner psyche at his life’s end, in the time that he lay unconscious following a severe beating he received in the asylum in which had been involuntarily placed.  The medical community had rejected his theory of the relationship between handwashing and deadly disease and had stripped him of his credentials. Dr. Semmelweis re-experiences events from throughout his life, perhaps out of sequence, distorted, or unreliable, as if through a lens of a mind in turmoil.

1 – Wordless opening

Wordless voices sing a capella.  Very gradually a few words find their way into the growing swirl of voices, as if an awakening, or a birth.  But it is not an arrival so much as a dislocation.  Maybe the angelic peace of a woman on the cusp of motherhood, but also maybe as if out-cold unconscious.

2 – Etiology (instrumental)

A woman, Agnes, emerges and encounters a candle.  Strange figures in medical coats enter and move slowly as they study with curiosity the place they are in.  Agnes hides her candle.  When they have retreated she takes the candle and places it somewhere safe.

3 – In the Market Squares

Paper doll chains are being folded, cut, and unfolded by women in a marketplace.  A more experienced woman sings to young Agnes about the paper dolls, about their fragility.   To prove her point she tries to cut one of the chains, but her scissors are too dull.  She leaves in anger. They are made almost by instinct, and they are fragile, in peril.  Perhaps it’s just a dream.  It’s trying to say something.

4 – Give Birth on the Earthworks

Even on the streets the word was out about the shocking rate of death at the Vienna Allgehmeine Krankenhaus.  Vienna’s top hospital, and one of the greatest teaching hospitals in the world at the time, it was a public hospital and therefore treated many of the poorest citizens.  Poor women who went there to deliver their babies were handing their bodies over to the training of young doctors, and when they died, their bodies were kept for autopsy before returning them to families.  But the hospital also had a delivery ward attended by midwives that admitted patients three days a week.  It quickly became known that women were statistically safer delivering in the midwives ward. 

A group of women, or spirits, is gathered at the city wall in candlelight.  They warn other women to stay away from the hospital, or to wait for one of the three days a week when women would be admitted to the midwives ward and thus avoid the doctors ward, which even on the streets was coming to be known for its shocking death rate. A plant is growing out from the ground, or into it.  Is it taking root or is taking over? What does this mean to him?

The city wall, a symbol of civilization within, is here a last resort for survival for women giving birth.  An in-between place, a no-man’s land, both exile and home.  They are exiled in their own city.

5 – My Best Idea

Semmelweis takes his new office in the hospital as a newcomer. (Actually, it is his cell in the asylum, as it turns out later.)  He is excited, feeling confident, almost feverishly idealistic, has grand plans to decorate the walls, and aspirations to become one of the brilliant physicians he has long idolized.

6 – My Doctor’s Hands

The first sinister signs he perceives.  He becomes very aware of his “healing” hands, and begins to doubt whether he can trust them completely.

7 – It’s never a choice

A woman, Susan, arrives in labor.  Women who arrived at the Krankenhaus were assigned, depending on the day of the week, to either to the midwives ward or the dreaded doctors’ ward, known both for being a busy training facility for resident physicians, and for its shocking death rate.  Susan is unlucky.

8 – Out in the yard

Susan’s body is placed on the autopsy table.  The ghosts are with her.

9 – Archaeology

Women with no other choice than the Krankenhaus for giving birth became research tools, even in death, for physicians trying to solve the mystery and bring the epidemic to an end. Semmelweis performs an autopsy on Susan’s body, and the bodies of countless women dying each month.  Semmelweis sees himself as an “archaeologist,” digging down clues about the women’s deaths. But he finds among the ruins some implication of his own involvement, along with some suggestion of his own mortality. We are all connected.

10 – Our skin so fair, “What’s the difference?”

Their haunting angelic tone evolves to a ferocious castigation.  Is Semmelweis failing them?  Are they trying to help him find the answer?

11 – As if your body were a cathedral, lit by candlelight

The study of a woman’s body in the teatro anatomico, and simultaneously a woman’s labor in a brothel.  Latin phrases flow not as prayers but as medical terminology that makes no sense. The “learned” language is proving farcical in both realms.

12 – You cannot stay (instrumental)

Semmelweis is surprised by a deceased patient’s family member in the morgue. (The hospital kept the bodies of its indigent patients for research purposes, as part of the contract of their unpaid care.)  He tells the mother she cannot stay there.  She tells him it is he who cannot stay.  He realizes he is not in the morgue but in the brothel where he treats the women as their doctor.  He is being asked to leave.  He is no longer welcome.  He is feared.  Is it because he is a doctor?  Is he losing his mind?

13 – My dark disgrace

Semmelweis is at a professional conference, where dead women also are present, but only Semmelweis can see them.  Overwhelmed with frustration at the unresponsive medical establishment and self-loathing for his own failure to win adherents to his ideas, he has been acting more erratically.   He is sent on a leave of absence.  He chooses to go to Venice to look at artworks and restore his troubled mind.

14 – Death of Kolletschka

While Semmelweis is away, an important prosector (autopsy physician) and good friend of his, Dr. Jakub Kolletschka, suffers a cut to his finger during autopsy of a childbed fever victim.  He dies days later.  Semmelweis returns, learns of the pattern of Kolletschka’s death, and begins to make the connection to the childbed fever epidemic that had, up to this point, been considered a “disease of women.”  Something does not make sense to him.  The midwives ward has a lower death rate.  Why?  What’s the difference?  Seeing vasculature in the Venetian canals, organs in the antiquities, reproduction in the passing of candlelight in the cathedral, he begins feverishly recreating one of the paintings that holds mysteries for him.  A tableau.  He sees it!

15 – I am the experiment

Maria Semmelweis, Ignaz’s young wife has born them five children, each birth presenting a serious risk to her own life because of the epidemic and his proximity to it. He is immersed in writing letters to physicians to disseminate his discovery.

16 – Madness (instrumental)

Semmelweis is hanging directives on the hospital’s walls, having confrontation with other doctors, as he tries to implement his new hygiene protocols, and enforce compliance.

17 – Once a candle lights another candle

A ritual.  Once something is passed, the one who has passed it is no longer needed.  But is this true?  Does Semmelweis believe he has successfully passed his idea?  Has he started the revolution needed?

18 – The only one / Our skin so fair reprise

He seems to be finding peace with the world’s inertia, but it doesn’t’ take much to put him back in his furious perseverations.  The revolution hasn’t taken off yet, but his mind is deteriorating.  His wife can no longer live with his mania. His pride turns to dejection as he realizes his crucial insight is dying with him, unrecognized.  He looks at the dead women and sees only himself.  He is beaten, and within days dies of sepsis from the wounds sustained at the hands of the asylum guards.

19 – Finale

Agnes returns.  She has survived, a woman of the new era of understanding.  Her candle can now be brought back.