Big Brum

This programme was targeted across the curriculum to groups studying Drama and English, History and Science. Our aim, however, was not to teach these subjects within the limits of the curriculum. 'Of Birth and Death' was an exploration of history and science, both philosophically and, as they are in the world, totally interconnected and at the heart of the struggle for social progress. What is history? What is science? What is the relationship between history and science? We also wanted to explore cognition and the process of learning. The programme, constructed around the play, was structured in three parts. It is a complex narrative based on the story of Ignaz Semmelweis the 19th Century Hungarian Doctor. Semmelweis devoted his life to eradicating puerperal or ‘childbed’ fever, which was responsible for the deaths of millions of women and their babies throughout Europe before the introduction of antisepsis. Section One prepares the young people to watch the play by engaging them with the concepts underpinning it. Our objective is to enable the young people we were working with to understand what drove Semmelweis, and in doing so become conscious of themselves as human beings with the potential to become active agents of change in their own lives. We begin the programme by presenting the young people with a contemporary image: a father sat by a hospital bed somewhere in the Middle East. The ward is bare of equipment and dirty, the father is wearing relatively new casual clothing and in his hand is a tarnished metal jug with water in it. On the bed lies his child, it is dying, the child has chronic diarrhoea. The mother has died. On the wall, in Arabic, is written ‘the pharmacy will be closed until further notice’. They hear the father bear witness to his child’s death, in most schools we cannot understand his language, in others the children can translate. The young people investigate the image, explore the empirical evidence. Our method is scientific. Together the young people and the actor/teachers explore the symptoms (effects) of diarrhoea and its causes. Cause and effect are concepts at the heart of the programme and we want the young people to make use of them in the work; as the narrator Dr Underwood tells us in the play, “When a child does a wrong thing, the cause is not because he’s naughty. Just another word for the symptom! The cause it what makes him naughty.” We go on to explore the conditions, the history of the hospital and the child’s struggle to live, and the state of science in this place; cause and effect – conditions – history and science – all inter-related, the building blocks of our learning for the day. Having recorded our findings the facilitator explains that there truth is objective and that these findings bring us closer to knowing the truth of the situation before us. It is then acknowledged that although the truth may be knowable, seeing it is often very difficult because we are affected by our relation to it, our feelings about it, and our vested interests. Time is moved on. The child dies and the father offers a prayer. We explore the truth of the child’s death through the perspective of the doctor who delivered it, the government minister responsible for the hospital and the head of state of a western country. Finally, we socially construct a hypothesis based upon all that we have discovered as to why we think the child died. Section Two shifts the dynamic, the facilitator becomes Dr Underwood who is a professor of midwifery with expertise in the history of her field. She speaks to the children reflecting on the image of the father and child they have been interrogating: "Perhaps you like me are sickened by what happens to children like that; sickened that mothers die unnecessarily when we have the knowledge to stop it from happening; when Doctors know what the symptoms mean, and their cause, but cannot change the conditions that disease thrives in. Throughout history hospital wards have been littered with the dead and dying, proof that science is too often under the control of the ignorant and indifferent. Let us learn from our history. I wish to share some of it with you. An awful truth I have found buried in the official records, disguised by brutal facts. Ignaz Semmelweis was a great man of science and medicine, a friend to mothers and their children. He was a friend to us all because his story is our story. For the sake of that child and its father, and all those who have struggled to live, for all our sakes, please pay attention to every detail, investigate, observe, analyse, hypothesise and let us learn." The play begins. Semmelweis is a man for whom “to see, is to feel, is to act.” As a young doctor, working under Dr Klein in the maternity clinic of Vienna General hospital, he is appalled by the suffering of the women and children who die in agony from puerperal fever. Although the clinic is quite rightly regarded throughout Europe as the most progressive of its kind, doctors cannot explain the terribly high death rate from ‘childbed fever’. There are numerous theories, Dr Klein’s own is that the disease is spontaneously generated, it just happens, the vast majority of medics are in agreement that there is no cure. Semmelweis wants to know the cause. We are witnesses to his life’s struggle to find it. He does not succeed, although he comes very close. But for the first time in medical history he establishes a theory of a single causative agent for a disease. In the process of his endless search he revolutionises his field. By implementing a regime in which doctors and students must wash their hands and instruments thoroughly in chlorine before examining patients, the death rate plummets from what is now understood to be septicaemia. Yet, throughout his life Semmelweis remains thwarted by the orthodoxy and prejudices of the medical profession he tries to transform. For although “the pride of the Austrian Empire”, the Viennese medical establishment is, like the Empire itself, conservative, resolutely patrician and resistant to change. Furthermore, Semmelweis is a Hungarian and a nationalist with a ferocious temper. Branded as a troublemaker, zealous crank, an atheist, discredited and dismissed as mad, eventually he is destroyed and indeed mentally unbalanced. He dies of septicaemia after cutting his finger with a scalpel, the disease he spent his life trying to prevent. His theory of a single a causative agent is rejected and the practice of thorough hand washing with chlorine largely ignored. As a result, both during his life and for years after, thousands of women and children died unnecessarily. The hospital authorities have the autopsy record that, “The brain itself was surrounded by an evil smelling fluid, spontaneously generated by a malfunctioning of thought. It brought on a fever which could not be reversed.” In Section Three, Dr Underwood and Dr Saber, a leading obstetrician from Jordan, Mr Holmes and Ms Stott from the Coroner’s Office put the children in role as Investigators for the Coroner Office. Mr Holmes asks Dr Underwood and Dr Saber what exactly she wants from them. "The truth." The Doctors want to know why the autopsy recorded a lie. She explains that if they can persuade the Coroner to re-open the case on Dr Semmelweis it will become a public investigation, this history will be in the public domain and the truth will become the property of every human being. Semmelweis belongs to us all, Semmelweis is not just a subject for a history lesson in the classroom, he is a subject for the living. For Dr Saber the lessons of the past are not being applied to his situation today. For the next hour to two hours, depending on the length of the school day, the investigators hypothesise as to why this lie was told. They build the body of evidence using labelled exhibits, the objects from the play, "We can't speak to any witnesses because they are all dead but these things did bear witness to this life. They can speak to us about what happened. Is there any piece of evidence here that will shed further light on your hypotheses, on why the autopsy told a lie?" They build a body of evidence for their hypothesis by placing objects in relation to Semmelweis’s corpse on the slab, speaking their reasons for placing it where they do. The image builds slowly, giving them time to think on their feet and craft it, the actor/teachers, in role, amplifying and making connections between each contribution in order to elaborate on the whole. Where can we see cause? Does this part illustrate the conditions that the autopsy was written in? From then on the session unfolds in relation to the needs of the investigation through re-creating moments from Semmelweis’ life (the play), playing and replaying them, speaking to the roles, giving voice to the objects in the action. The facilitator brings a variety of drama conventions to bear upon the investigation in order to deepen the learning. The final task is to make an initial written submission to the Coroner on the investigation’s findings. It is done in the form of a rubric, which is completed in groups. The sharing of this work is critical because it encodes the understanding of that group of young people at that time, at times a deeply moving ritual. These are the initial findings of the (Year 10) Investigators at St Paul’s School: 'Dear Sir If history is the struggle to live, then we who live now owe…our lives. If we renounce it then those who follow will be…ignorant of the past and therefore ignorant in the present and in the future. Semmelweis struggles to live in a world where…people weren’t equal, doctors weren’t trusted, but where authority was always right. He saw around him…unnecessary suffering but saw how it could be different. He came to recognise the pattern of …recurring deaths. He passed on knowledge of… how history and science come together in solving a problem. And the lie exists because there are those who…obscure the truth for their own personal gain.' 'Of Birth and Death' continued to grow and develop and challenge the Company from the tours’ beginning to its end. It unlocked a hunger for knowledge in its participants and illustrated daily that young people are seekers of truth and justice. The future of science is tied to the destiny of mankind; The future of mankind is tied to the destiny of science. Cut the bond between them and all hell is let loose. Each sustains the other; and each, without the other, Spells disaster to them both. Who controls the future of science Controls the future of humanity: Who controls the future of humanity, Controls the future of science. Semmelweis by Geoff Gillham