The Birth of Love

by Joanna Kavenna

  *

  This was a transformation I had not anticipated. Indeed I was unsure what to say for a moment, not wanting to disturb his new state. He was now almost measured; certainly there was something pensive, contemplative about him. He was splashing his hands, but there was nothing frenzied about the gestures now; he was moving his fingers quite gently in the water.

  *

  ‘I have been thinking about Aristotle’s concept of the soul,’ he was saying. ‘That its residence is in the heart, yet it is also the form of the body. It permeates the entire body, though emanating from a single point. And somehow I remembered the beat of a heart, heard through the skin. Two hearts, I recalled, the mother’s and the galloping pace of her unborn child’s. I remembered the beat of these two points, two souls, contained within a single body. I was thinking how curious it is, that a philosopher such as Aristotle had failed to consider what it is to be a pregnant woman, who contains another life point, another point emanating life to a body, within herself. Surely this must change our notion of the human form? Surely this must change our sense of bodily autonomy, when many a woman spends decades with another self – various other selves – contained within her, as she moves successively from one pregnancy to another? And I began to remember. Myself, I remembered myself, leaning over a woman who was rounded and immense with child. At first I thought it was my wife. I thought I must be remembering the birth of one of our children, yet then I saw a number of these women, and I saw myself again, passing from one to the other.’

  ‘What do you think this meant?’ I said.

  ‘I realised I had been a doctor. That was the first small revelation I was permitted. That I had been a doctor and that I tended to women in childbirth. Then suddenly I knew my name. I heard the women saying it to me, their voices full of fear and hope. At first I could not hear them clearly, but then their words – the single word – became clear to me. They said it in tones of relief, that I had come – these women trusted that I could assist them, perhaps even save them. And all the while another voice was saying to me, “Do not approach them, do not, in your arrogance, approach them!”

  ‘In my vision I ignored this voice entirely, I continued to move from one to another, and gradually as I pressed my ear against the rounded mass of their bodies, I heard the hearts stop. The tiny galloping baby hearts stopped, and then the women threw up their hands and died.’

  ‘This is a dreadful vision,’ I said.

  ‘I think I have done something very grave, which is that I – in my small person – have somehow changed the course of many women’s lives, and of the lives of their children. And it is wrong for a single human to have wielded such power. Thereby I have insulted God, the ledger is marked, and I must suffer.’

  ‘You have done a great deal of good, I suspect.’ I said. ‘I can tell you, Professor Semmelweis, that you developed a theory about the way in which puerperal sepsis is spread. You argued that it was spread by the hands of doctors. That doctors infected women with this disease during internal examinations.’

  ‘Puerperal sepsis?’

  I thought for a moment he would not be able to recall his medical expertise, and indeed for some time he stared at his hands, as he splashed them in and out of the water.

  Then he shook himself, or shook involuntarily, and turned to me. His aspect was more animated now, and he said, ‘I forget your name.’

  ‘Robert von Lucius.’

  ‘Herr von Lucius, I must thank you. I confess I have wandered greatly in my thoughts but now everything is clearer. You have supplied the crucial element I lacked.’

  ‘I am sorry but I do not understand.’

  ‘I am Professor Ignaz Semmelweis and my field was obstetrics. You are quite correct.’

  ‘And you worked …’

  ‘I worked in the First Division of the Vienna General Hospital. For several years. I am not sure when it was. I do not know the year at present.’

  ‘The year is now 1865.’

  ‘Then it was some time ago that I arrived at this hospital. Perhaps twenty years ago. I was young and I was a student doctor. I had not chosen obstetrics as my first profession. I would have preferred to study something else, but I think my family was not a wealthy one, and I had to accept whatever position I could obtain. I was an assistant to …’ Herr Semmelweis was now rubbing his forehead avidly, spreading dirty water across his face. And I hesitated, for I suspected this must be Johann Klein, and I did not want to lose him to another fit.

  ‘To the head of the lying-in ward,’ I said, hurriedly.

  ‘That is correct. His name will come to me. It is not important at the moment.’

  ‘But you worked as this man’s assistant during the 1840s?’

  ‘I believe at the time there was a terrible epidemic – when I arrived there was an epidemic. In the First Division it raged, this epidemic of puerperal sepsis. Childbed fever, that is what the midwives called it. Naturally we thought our definition more precise, yet the women died all the same, however we defined the disease. And it was clear that they died in greater numbers in the First Division, where the teaching hospital was. The doctors worked there and their students. In the Second Division, which was staffed by midwives, and only rarely by doctors, childbed fever did not kill so many women. It was a mystery which tormented us all. The women would weep when they were told they must come to the First Division. I remember that. They knew they were being sent somewhere dangerous. They begged for their lives. The allocation was random – it depended on the day you arrived. They tried to wait, I remember. Some women would try to wait until the Second Division day before they came into hospital. Often they were too late and they birthed their babies on the streets. They brought them into the world while squatting in the gutters, but even this was less likely to cause them to die than coming to the First Division.’

  ‘This cannot have been the case.’

  ‘During times of epidemic, yes. The First Division was a charnel house. It was a breeding ground for death. It was horrible to see it. And yet now I forget the word they gave it. What was the word for this thing which killed the women?’ And he turned to me with a ragged expression. I perceived that he feared this period of lucidity might be fleeting, that he must glean as much information as possible while he could phrase questions and attend calmly to the answers.

  ‘Puerperal sepsis.’

  ‘Yes, that is it. I remember – De Mulierum Morbis – what is that?’

  ‘Hippocrates.’

  ‘Yes, that is right, and it says something, I must remember it.’ The horrible gestures had resumed, intensified by his desperation. He had become more urgent about the washing of his hands and so he had set his chains jangling again. We waited, with only the noise of the chains between us. Then he said, ‘I have it … I think … “And so Thasus, the wife of Philinus, having been delivered of a daughter was seized with fever attended with shaking chills as well as pains in the abdomen and genital organs.” It is that. Something of that nature. And Thasus suffers agonies for twenty days after the birth of her daughter, and then she dies. Puerperal sepsis is an illness which takes the form of a fever, with a chill. The majority of patients manifest signs of the disease on the third day after birth. They have a headache, and cold fits followed by extreme heat, perspiration and thirst. Abdominal pain begins as a mild symptom but becomes increasingly severe. The pulse increases in pace, and the patient tends to lie on her back and appear listless. She loses her appetite. The tongue is usually white, though it can become dark and furred as death approaches. Respiration becomes laboured due to abdominal pain and distention, and the patient is nauseous and prone to attacks of vomiting. The production of milk is suppressed, though lochia continues. A few particularly unfortunate patients lapse into delirium and mania. During an epidemic, so-called, the mortality rate might be as high as eighty per cent, as opposed to a normal rate of twenty-five to thirty per cent. It is a monstrous disease. And these are women who a few days earlier were young, bea
utiful, at the height of their strength, birthing a child in all their vigour. The birth might have been entirely routine. Yet in the First Division every woman in labour was examined several times by doctors and students, for the purposes of research and teaching, even if their labour hardly required it. The students were often inexperienced, and sometimes they would push their hands clumsily into the women, hurting them even as they writhed in the usual agony. Students and doctors would delve deep inside these women, and then the women would become ill.

  ‘They would complain of feeling a little flushed and faint, and the doctors would aim to reassure them, but often we would know anyway that the worst would soon be upon them. Every woman knew precisely the symptoms of childbed fever, and the look in their eyes when they realised they had succumbed was dreadful to behold. And beside them were their babies – these desperate tiny creatures, so plaintive and powerless, who just hours earlier the mothers had held and loved and been so delighted to see – but now in their illness these women would cry out when the babies were placed upon their abdomens, and they would speak of a pain in their bellies, and then they would vomit horribly and shudder, and cry about their babies and how they must feed them, and their temperatures would fly up the scale, and higher and higher, and the babies would cry because the mothers could not suckle them or hold them, oh these poor babies, these poor mothers – it was terrible to witness the decline of these mothers, just when they had performed this most vital act, summoning life, and when these new lives were crying out for them – yet despite this they were shivering with cold, their teeth chattering, and then they were hot and flushed, and they perspired and stank. That was when you knew their agony would soon be over – when the stink emanated from them, a smell of decay, coming from this womb which had so recently sustained life. The womb was infected, with vile particles, and these women were destroyed from within. They slipped away, no longer recognising the babies they had loved so briefly and intensely. And when they died, the babies were often left orphaned, their lives ruined too by the horrible demise of their mothers. If no relative came, these helpless creatures were sent to the orphanage, and half of them died within the first year.’

  *

  I sat there in silence for a moment, wondering at the change in this man. You must perceive it, Professor Wilson, even through my flawed account. Indeed to witness it first-hand was most disturbing, so stark did it seem. I had no understanding of how it might have occurred. It was rather as if Professor Semmelweis had been replaced by another man; as if the morning had presented me with an interloper, or perhaps the interloper was before me and the real, more confused and desperate Professor Semmelweis had been vanished through the twisted ministrations of Herr Meyer. Of course his appearance was the same, but the character was so very different, it was hard to understand what had occurred. I had not believed him absolutely lost to reason before, and had rather imagined – as I mentioned – that he was poised between the world we recognise and another psychic realm we generally regard as beyond our concerns, or only of concern in so far as we seek to police and restrain those who occupy this world. Yet now, as he described these unfortunate women, Professor Semmelweis was upset – the man was trembling in his grief and self-blame – and he was not eloquent in the ordinary way, but he might have passed for little more than agitated and eccentric. He would have been heeded at a supper party, though people might have said he ran on a little, lacked a sense of when to pause. And the hand-wringing, perhaps that would have attracted notice. It is true, his gestures were overblown and distracting, but, relative to the state of nerves in which I had previously found him, he was greatly changed. And though his memory was still betraying him constantly, he was picking a way through its blanks, eking out dreams and recollections. His general demeanour made me suspect his condition was one of fits and regressions, and that he might sink into an episode and then later appear relatively recovered, before descending once more. I had not previously seen an inmate who presented so dramatic an oscillation between lucidity and stupor, between his regressions and his advances, but thus I found him.

  *

  ‘You are remembering women you treated?’ I said.

  ‘I killed many of them. Before I knew about the way the contagion spread. I was one of the arch murderers in the Vienna General Hospital, because I was young and eager to learn my profession and so I performed an unusual number of autopsies. In the mornings I would always attend the autopsies of women who had died of childbed fever, and then I would hurry to the lying-in wards, and examine the living. And they would grow feverish, and often they would die. Personally I infected innumerable women, and deprived innumerable babies of their mothers’ love.’

  ‘Is this what you have been trying to forget?’

  ‘I do not forget it,’ he said, sharply. ‘It torments me. Besides I think there are other crimes upon my head. These are the gravest, I confess. These must be the gravest, the successive murders I have committed. But you see, I have done something else, I know.’

  ‘Tell me of your theory that puerperal sepsis is conveyed by the hands of doctors,’ I said, aiming to move the discussion away from these themes which merely distressed him. But he had found his motif, and did not yet want to discard it. He said, ‘I understand now why my former colleagues have banished me.’

  ‘No one has banished …’ I began, but he said, ‘They fear me, because I remind them of their guilt. My very presence accuses them. These are feted men. They are accustomed to praise. And I offer them only condemnation. This is anomalous and they despise it. Fortunately for them, they are the majority, they are the respectable keepers of orthodoxies, applauded for their efforts to maintain everything, to conserve untruth and protect fiction, and so it is perfectly easy for them to dismiss me. They dismiss me powerfully, even with anger in their voices, and everyone follows them. In a sense, their anger is absurd, because how could I ever really damage their great reputations, the names they are so proud of, when I am a single voice and they form a chiming chorus? How?’ He stopped at this, and looked at me.

  I said, ‘Perhaps you have worried them.’

  ‘They are not worried. That is their gravest crime. They are not worried at all,’ he said bitterly.

  ‘Tell me of your theory,’ I said again.

  ‘I perceive quite clearly now that I was once a fool and because of my foolishness thousands of women died. I failed to convince my colleagues. Here in Vienna, I proved my theory, but then I was secretive and reluctant to present my findings. For years I failed to communicate what I had discovered, and during these years thousands of women died.’

  ‘But I am told you wrote a book,’ I said.

  ‘Who told you that?’ And now there was his former suspicion, his tone hoarse and abrasive. I said, ‘A friend, no one you need be concerned about,’ and he seemed to accept this response. ‘I did write a book. I worked hard on it, thinking it would finally convince my opponents. And yet they massed to condemn it. The reviews were monstrous. They vandalised my argument, just to save themselves. And I became angry and lost the argument altogether. So you might say my crime is twofold. I am a murderer because of my reluctance, my secrecy. Then I am a murderer because of my anger.’

  ‘But I do not yet understand your theory. I would be glad if you could explain it to me.’

  He said, ‘Are you a doctor?’ – by this remark he revealed that however much he had regained a sense of his own past, his awareness of his immediate environment was tenuous indeed, and I was but a shade, a presence beside him, hardly an individual at all.

  ‘I am not,’ I said, again.

  ‘Well, you may know that it is not yet accepted in Austria that puerperal sepsis is contagious, that this deadly infection can be prevented by something as simple as washing the hands. Simply washing the hands.’ And now he splashed his hands frantically in the basin of water, so that most of it spilled over the sides, and he held up his hands to me. ‘A little chlorinated lime solution. A thorough wash.
That is all that is required. In my native land, this theory of mine has been generally adopted for some years now. There at least my conscience is clear. But Austria and the world in general have defeated me. I have failed entirely to convince anyone beyond my own land.’

  ‘How do you know you failed to convince anyone?’

  At that he leaned towards me, as far as he could. There was a rancid stink coming from him. Something like decay, the decay of the faculties naturally, and also a general bodily decline. The man reeked of stale blood, from the various wounds on his head and hands. He was leaning towards me, emanating these smells of disorder, as he said, ‘We must remember, it is far too late for Frau Engel, murdered by Dr Fuchs. And it is too late for Frau Adler, murdered by my esteemed colleague Dr Kuhn. Though perhaps she was murdered by his student, Herr Hirsch. Then it is too late for Frau … oh I cannot remember her name. It is in my mind but I cannot summon it. This woman was most certainly murdered by Dr Roth. You must know him. He is one of my most vehement critics, and one of the biggest murderers of them all. He moves from ward to ward, snuffing out lives. That man is Death, death to mothers. All these women, let us remember, and hundreds like them, thousands like them, had been delivered of healthy babies. So we must consider the hundreds of motherless children. The hundreds of mothers denied their destiny, to love and nurture their young.’

  *

  He was staring at me with awful intensity again, the dead and lonely gaze, more unpleasant to behold even than his hand-wringing and sudden surges of violent energy. Yet he did not see me, I now perceived, he saw merely the past and perhaps these ranks of women, reproaching him, but nonetheless his expression discomfited me, and I turned to my notebook, and began once more to write.

  *

  ‘Surely you should consider all the women you have saved?’ I said, after a pause.