The greatest derangement of the mind is to believe things
because one wants to believe them and not because one has seen that they
are. bossuet
'A barrowful will do, to begin with.'
'A barrowful of what?'
thought Alice, lewis Carroll, Alice
in Wonderland
ONE day in
1912, young Dr James, paying a visit to St Mary's
after the completion of his studies, saw a sturdy,
bronzedsoldier, in the field uniform of the London Scottish standing at the
top of the steps. It was Fleming. He was just back from the annual camp and
James was staggered to learn that a doctor of his quality, a learned
bacteriologist, should be willing to go into training as a simple private.
"At that time', says James, T had no military experience. The idea of
sharing a tent with six or seven other men filled me with horror ... I
ventured to ask him how he managed to keep his equipment so spotless, his
rifle and boots so clean in spite of the rain and mud. He gave me an
icy-blue and rather terrifying look, and replied with his habitual brevity:
"By bloody hard work!"
'My former meetings with Fleming had left me with a lively
sense of admiration. Finding my hero transformed into a soldier gave me
something to think about. I had been taught by my Nonconformist upbringing
to think of war as a crime. I believed that no one went into the Army unless
he had something to reproach himself with, and that all officers were more
or less like the immoral Cavaliers who had taken up arms in the Civil War
against the Puritans. The realization that one of my most highly esteemed
seniors, with a remarkable record of work, was prepared to risk his life as
a soldier of the King, made me revise my views about the possibility of a
war.
Actually, war did not break out until two years later.
Fleming had left the London Scottish in April 1914, because the training
periods did not fit in with his work at the hospital.
A month or two after the beginning of the war Wright was
given the rank of colonel and sent to France to establish a laboratory and
research centre at Boulogne-sur-Mer. He took with him Douglas as a captain,
Parry Morgan, and Fleming who sported the two stars of a lieutenant in the
R.A.M.C. Colebrook joined them later. Freeman went first to Russia to
prepare vaccines against the cholera and then proceeded to the laboratory at
Boulogne. This was officially attached to the hospital established by the
English Army in the Casino. To begin with, the bacteriologists were
accommodated in an appalling basement through which a drain-pipe ran, so
that the whole place stank. Every morning at six o'clock a sapper sergeant
poured some cresol into the pipes, but the sickening stench persisted.
Sir Almroth reacted in no uncertain manner (he could be most
effectively brutal on occasion), and got the fencing-school on the top floor
allotted to the research staff. Naturally it contained none of the equipment
needed by a laboratory — no benches, no running-water and no gas. The
ingenious Fleming did yeoman service. Bunsen-burners were kept going on
methylated spirit, and the incubators were heated with paraffin stoves. For
such work as demanded the use of glass, he contrived a very effective
blow-pipe out of rubber tubes and a pair of bellows mounted on a petrol-tin.
He said, later, that he had never had a better laboratory.
In war as in peace, nothing could disturb his habitual
composure. 'My first impression of Lieutenant Fleming', says his
former orderly sergeant, 'was of a short, pale officer who never said more
than he had to, but carried on calmly and efficiently with his work. When
Captain Douglas went sick, Captain Fleming (he was promoted by that time)
took over the command. Captain Douglas had always been chaffing and swearing
when he talked to me about service matters. The first time I gave Captain
Fleming some papers requiring his signature, he was busy with his
microscope. I waited respectfully until he could give me his attention. At
last, he raised his head, took a pencil and, without asking me for a word of
explanation, signed the vouchers. On such occasions as I had to make a
report to him, I got the feeling that he wasn't interested, though he was —
much more than I thought. He took the whole thing in, solved the problem on
the spot, and ended up with: "Right, Sergeant, carry on."
Throughout the war the amount of work done by the Department
was tremendous and enormously beneficial. The question was no longer one
merely of vaccines, though Wright (like Vincent in France) had fought tooth
and nail to get anti-typhoid vaccination made compulsory in the Army. It
saved thousands of lives, but the wounded brought other problems, most of
them urgent and distressing. Wright and his assistants on their way to the
laboratory had, every morning, to go through the wards, where they could see
for themselves the terrible effects of explosives more powerful than those
used in any previous war, and the infections set up in open wounds by earth
and scraps of clothing. The surgeons despairingly drew the attention of the
bacteriologists to innumerable cases of septicaemia, tetanus and,
especially, gangrene. Every day convoys of wounded men arrived with
splintered bones, torn muscles and severed blood-vessels. Within a very
short space of time the patient's face would become ashen in colour, his
pulse would weaken and his breathing diminish almost to nothing. This was
the effect of gas-gangrene and meant certain death.
How was it to be dealt with? 'In this war,' said Sir Alfred
Keogh, Head of the Army Medical Services, 'we have found ourselves back
among the infections of the Middle Ages.' Since the time of Lister, surgeons
had got into the habit of relying on antiseptic and, especially, aseptic
treatment. Except in certain cases of road-accidents, the wounds with which
they had had to deal were reasonably clean, and they had learned how not to
infect them. Lister had introduced the system of passing smocks, gloves and
instruments through an antiseptic preparation. Later, everything which had
to come in contact with the patient was first sterilized by heat. It looked
as though 'hospital sickness' had been conquered once and for all. But in
the terrible.butchery of 1914, by the time the injured reached hospital,
their wounds were already crawling with microbes. Any poor wretch who
happened to have fallen in a field or on a road was bound to have picked up
any number of deadly germs. Fleming, examining odds and ends of uniform,
found in them microbes of every description. As to manure heaps, they were
infested with germs.
What was to be done? Fleming made a careful study of recently
infected wounds, and noticed a remarkable fact. Phagocytosis was more active
in them than in wound infections observed m ordinary civil practice. The
leucocytes had devoured, and killed, an enormous quantity of microbes. Why?
In normal times/ he said, 'infections occur more or less spontaneously in
individuals, who for some reason or other have become less resistant to the
infecting agent. In civil practice also the bacteria have frequently an
enhanced virulence, due to their passage from one individual to another. In
war, on the contrary, a strong and healthy man when wounded finds himself
suddenly and violently infected by microbes the virulence of which has been
weakened as the result of living in unfavourable conditions. It is,
therefore, only natural that phagocytosis should in these cases be greater.
But why, then, in these conditions, should the infection in war-wounds be
worse? Because the projectile has produced a very extensive destruction of
tissues. Not only do dead tissues provide a good culture medium for
microbes, they actually prevent the healthy phagocytes from reaching them. His
first piece of advice, therefore, to the surgeons was: remove all necrotic
tissues as soon as possible.
He had learned from his experience as a research-worker to
have a solid respect for the natural defence-mechanisms of the human body.
What happened in the case of a wound relieved of dead tissues and left to
the processes of nature? The healthy leucocytes, penetrating the walls of
the blood-vessels, attacked in strength, and cleansed the wound by absorbing
the microbes. What was the cause of this 'diapedesis',
or migration, of the white corpuscles? To say that a 'positive chemotaxis'
attracted the phagocytes to the toxins, was merely to stress, once again,
the soporific effect of opium. But, whatever the cause might be, the effect
was certain. What mattered, therefore, was to let the natural defences of
the body have free access to the microbes.
The army doctors were lacking in neither courage nor
devotion, but they were now finding themselves face to face with a new
problem. In the absence of adequate direction, they stuffed wounds with
antiseptics, often chosen in a rather haphazard manner. That was strictly in
accordance with the instruction which they — and Fleming, too — had received
as students. T remember', he said, 'that I used to be told to be most
careful to use antiseptics in the dressing of wounds — carbolic acid, boric
acid, peroxide of hydrogen. I could see for myself that these antiseptics
did not kill
all the microbes, but was told that they killed
some, and that the results were better than if no antiseptics had been used
at all. At that time I was in no position to argue.'
At Boulogne he could see that antiseptics were powerless,
that microbes abounded, that the wounded were dying. Being nothing if not
thorough, and suspicious of all a
priori ideas,
he devised a series of brilliant experiments for the purpose of bringing
various antiseptic dilutions into contact with different forms of microbial
infection. These showed that not only did the antiseptics do nothing to
prevent gangrene, they seemed actually to promote its development.
Of course, in certain cases of superficial infection there
was an advantage to be gained in using solutions sufficiently concentrated
to destroy the bacilli. True, they also destroyed some of the cells of the
body but, since this process took place on the surface, the surgeon could
then remove the dead tissues. But cases of superficial infection were rare.
Modern explosives produce deep wounds which are more than just simple
cavities. Scraps of underclothing and other dirty objects, driven inwards by
the explosion, penetrate deeply into the tissues. The injuries with which
Fleming had to deal presented multiple anfractuosities, corners and crannies
which might be compared to the configuration of the Norwegian fjords, and
infection broke through the walls of these. Such antiseptics as were then in
use were powerless to get at the tissues. Was it possible to sterilize these
ragged recesses? In order to find the answer to that question, he hit on the
idea of modelling an artificial wound in glass. After first making the
closed end of a test-tube red-hot, he drew out, on the inside, several
hollow excrescences to represent the anfractuosities of the wound. Next, he
filled the tube with a serum previously infected with faecal matter. The
general result gave a diagrammatic, but sufficiently exact, picture of a
war-wound.
He then put the tube into an incubator and left it there for
the night. Next morning the serum, invaded by microbes, had a muddy
appearance and stank. The tube was then emptied of the serum and refilled
with an antiseptic solution strong enough to kill the microbes. After
certain intervals, not always the same, he emptied the tube and filled it
again with non-infected serum.
After incubation, this serum, which had begun by being sterile, was as muddy
and stinking as the first. No matter how many times the operation was
repeated, the result was the same. What did that prove? Obviously that,
since the new serum had been originally free of contamination, microbes must
still be lurking in the anfractuosities of the tube. From this he concluded
that it was not possible to sterilize a war-wound with the then-known
antiseptics.
Once more the question arose, what was to be done? Wright's
answer was — leave the natural defences of the body to do their work, and help
them.
The leucocytes which flocked through the walls of the blood-vessels formed a
pus the action of which was powerfully beneficial. Wright and Fleming had
demonstrated by experiment that fresh pus destroys the colonies of microbes.
To this bactericidal power of healthy leucocytes there is no limit, provided
they are present in sufficient numbers. The best form of treatment,
therefore, would be the one which would mobilize armies of leucocytes and
cause the greatest possible quantity of fresh lymph to exude from the walls
of the wound. Wright showed by laboratory tests that this action could be
produced by using a high concentration of saline solution. Fleming confirmed
these findings by experiments made on actual wounds.
The same cause explains the jsuccesses obtained in the field
by the French physiologist, Carrel, who introduced the system of washing out
wounds with Dakin's solution (hypochlorite of soda) which, like the high
concentration of saline solution, stimulated an intense exudation of fresh
lymph. Fleming, knowing that antiseptics rapidly lose their bactericidal
properties when in contact with pus and tissues, wanted to see how long
Dakin's solution remained active in a wound. He found that ten minutes after
instillation, this antiseptic ceased to be dangerous to microbes. 'Yes/ was
his conclusion, 'Dakin's solution gives good results, but, like the highly
concentrated saline, only
because it helps the natural defences. It's
lucky', he added, with a touch of humour, 'that it loses its antiseptic
action so quickly. In ten minutes it can't do much damage, and, after that,
nature has two hours' rest in which to recuperate without being
interrupted.'
Fleming's later discoveries have thrown his work during the
war into the shade. But those qualified to judge (Dr Freeman, for instance)
are of the opinion that he never conceived anything more perfect or more
ingenious than those brilliant experiments by which he demonstrated the
danger to human tissues of antiseptics when wrongly used.
Bernard Shaw, a frequent visitor to Boulogne, was
cock-a-hoop. 'We are left in the hands of doctors who, having heard of
microbes much as St Thomas Aquinas heard of angels, suddenly concluded that
the whole art of healing could be summed up in the formula: Find the microbe
and kill it ... The simplest way to kill most microbes is to throw them into
an open street or river and let the sun shine on them ... But doctors
instinctively avoid all facts that are reassuring, and eagerly swallow those
that make it a marvel that anyone could possibly survive three days in an
atmosphere consisting mainly of countless pathogenic germs. They
conceive microbes as immortal until slain by a germicide administered by a
duly qualified medical man ... In the first frenzy of microbe-killing,
surgical instruments were dipped in carbolic oil, which was a great
improvement on not dipping them in anything at all and simply using them
dirty; but as microbes are so fond of carbolic oil that they swarm in it, it
was not a success from the anti-microbe point of view Here Shaw did not
understand, or pretended not to understand. The instruments were genuinely
sterilized because in their case the strong concentrations were inoffensive.
Lancets do not have vulnerable cells.
But though Shaw may have been amused, the pundits were
shocked. Wright who, with his customary quickness of mind and his passionate
enthusiasm, had concentrated all his attention on this problem, the solution
of which might save thousands of lives, increased the number of his lectures
to English and French doctors. In 1915, he addressed the Royal Society of
Medicine in London on two separate occasions. He did his best — and this,
for him, meant a great effort — to keep his talks at a purely practical
level, with his literary genius in abeyance. He did all he could not to be
aggressive or ironical, his object being to convince without giving offence.
In this he did not succeed. Self-satisfaction is so strong an emotion that
it will deny the most obvious facts in the interest of a pride which is
quick to take offence. The President of the Royal College of Surgeons, Sir
William Watson Cheyne, who, having been a friend of Lister and spent his
life in carbolic acid, was pleased to regard these new ideas on the surgical
treatment of war-wounds as amounting to an attack upon his own honour and
that of his master — quite wrongly, for Wright and Fleming had the greatest
respect for Lister, but conditions were different. Consequently, Sir William
thundered from the mountain-top of his authority.
This was, to say the least, unwise, for Wright, when touched
on the raw, could be a ferocious controversialist. On September 16th, 1916,
he published in the Lancet an
admirably written reply which, in fact, amounted to a pamphlet. He lacked
neither authority nor competence, since he and his assistants had had recent
and extensive experience of war-wounds. Sir William Watson Cheyne had
admitted that, when infection had been active for ten or twelve hours, the
chance of doing much good with antiseptics was very small.
'But', replied Wright, 'in war, a wounded man who
has been left for a long time on the battlefield, then slowly transported in
an ambulance, can rarely receive attention within those limits of time which
you appear to think necessary for successful treatment. And once the proper
moment for the use of antiseptics has gone by, what is your programme? So
far as I can make out, you haven't any. You say, in effect: "I have opened
the wound, I have inserted a drain, I have washed the affected parts of the
body with a weak antiseptic solutibn, and I am not prepared to give further
thought to the problem."
'For my own part,' continued
Wright (and here we are summarizing his argument), 'I take a diametrically
opposite view. So far as the sterilization of war-wounds is concerned, I
share with all those who have had the same experience in France as myself,
the feeling that serious wounds inflicted in battle are never sterilized,
and never
can be,
by the application of antiseptics. I have, therefore, strongly put forward
the view that we must help the body, by physiological means,
to combat bacterial infection. By stimulating a plentiful flow of lymph, we
can aid the fluids in the blood to act upon the infected tissues. The more
fresh serum we can produce, the more we can accelerate the migration of the
leucocytes, the more we can assist in the destruction of the infecting
microbes ... It seems to me that Sir William Watson Cheyne is blind to all
these problems. He has not even caught a distant glimpse of the towers of
that city in which we are seeking to arrive ..'
He then produced overwhelming arguments to show that his
illustrious opponent seemed to have not the remotest idea what an experiment
was. 'Let us consider what the necessary qualifications for a practical
scientist are ...' Sir William had referred to a case of a gaping fracture
sterilized by Lister. 'All that this passage in Sir William's text shows is
that a muddled mind and deficient logic can draw false conclusions from a
genuine clinical observation ...' One of the objections put forward to Sir
William's contention had been that Sir Almroth Wright's physiological
treatment must be effective since so many doctors had been using it at the
front for some considerable time. 'I have nothing to do with the actions of
men at the front' Sir William foolishly replied, 'to say nothing of the fact
that a well-known piece of mechanism, known as discipline, operates in the
field ...' In other words, since Wright was a colonel, his word must always
be law in military circles. But so far was this from being true that Wright
had asked the army surgeons, no matter what their rank, to think for
themselves, and verify from their own experience the experiments carried out
in the little laboratory at Boulogne, all of which were objective, simple
and irrefutable.
No doubt, though Wright was an individualist and boasted that
he had never taken orders from anyone, he considered that in so grave, so
tragic, a situation, it was impossible to let every regimental medical
officer go his own sweet way. In peace the practitioner works in a familiar
and well-explored field. In wartime, on the other hand, he finds himself
having to deal with unfamiliar problems, and forced to take decisions on the
spot. It is essential, therefore, that his seniors and advisers shall make
available to him the results of experiments carried out by others. Thus, for
instance, Wright was totally opposed to the immediate evacuation of the
wounded to England ... After an exhausting journey, he argued, they would be
in no fit state to undergo operations which, carried out on the spot, would
have a far better chance of being successful. 'We accumulate surgeons in
France and wounded men in England ... It looks as though the problem, as set
by the Army, is never to have the wolf, the lamb and the cabbage all
together on the same side of the river ...' It was a matter of regret to him
that the medical administration of the armies in the field, excellent though
it was in dealing with the feeding and transportation of the wounded, seemed
unable to shoulder the responsibility of solving such far more important
problems as those affecting the improved treatment of the wounds themselves.
He, for his part, went to infinite trouble to make generally
known what he thought to be the truth. At Boulogne he delivered a lecture:
'On the Proper Methods of Judging Different Types of Treatment'. 'Our task,'
he said, 'is to find the truth and to convince others that it is the truth.
The medical organization of our armies is such that it becomes necessary to
persuade all the doctors who are working in the field. It is not enough to
win over their superior officers because there can be no certainty that they
will issue orders He was urgent in putting forward a suggestion that a
'Medical Intelligence and Investigation Department5 should
be set up at the War Office. Its duty would be to study all the problems
arising out of war conditions, not only as they concerned wounds, but other
matters as well, such as epidemic jaundice, trench-fever and the causes of
nervous break-down among air-pilots. Its decisions would be accepted by all.
Since he had many friends in the world of politics, he went in person to
London to put his point of view to the Secretary of State for War, Lord
Derby, and to Arthur Balfour. But the opposition of the 'high-ups' in the
Army Medical Service was violent. Sir Arthur Sloggett, the D.G.M.S., loudly
denounced the scheme, said that Wright should stick to his laboratory work,
and went so far as to demand his recall. He failed to get it, but Wright,
too, failed to get what he wanted.
Dr James, at that time a battalion M.O., visited the Boulogne
Casino on his way back from leave. There he saw Fleming and Colebrook. His
first reaction, when he compared the almost academic calm of the laboratory
with the din of battle, the dirt, the stench and the nervous tension in the
forward aid-posts, was one of faint irritation. These back-area doctors, he
thought, have too easy a life! Wright lived in a charming house on the
Boulevard Daunou, where Lucienne, an excellent French cook, looked after his
comfort. But it was not long before he noticed how much thinner Fleming had
grown and how worn-out he looked. In conversation with him, he soon realized
that these same 'back-area' doctors were working night and day, and that
their only wish was to do everything they could to help the fighting men.
Fleming, more eloquent than usual, explained to him the experiments he was
conducting and the very precise ideas he had formed about what was necessary
if that great enemy of the wounded, infection, was to be overcome. 'What we
are looking for/ he said, cis
some chemical substance which can be injected without danger into the blood
stream for the purpose of destroying the bacilli of infection, as salvarsan
destroys the spirochaetes.' They had not yet found such a substance, but the
team had already collected a number of very important facts. These enabled
them to avoid the more fatal mistakes and to help the organism of the
wounded man in its curative work. James took back with him to his battalion
several new, precise and sound ideas on the treatment of wounds.
There was no lack of visitors to the Casino. Bernard Shaw
turned up on several occasions. Wright and he spent long nights in front of
the fire discussing the relative importance of philosophy and medicine. One
evening, when they were deep in argument, the chimney caught fire and the
room was soon full of smoke. Lucienne and Freeman took turns in going into
the street to see whether the roof was alight. Shaw and Wright, completely
undisturbed, went on with their discussion.
The famous American brain-specialist, Harvey Cushing, stayed
for a while with Wright. Though the two men were very different in
temperament, they liked each other enormously. Though Cushing, like Fleming,
had a matter-of-fact mind, he was greatly entertained by Wright's passionate
tirades on women, the Catholic Church and intellectual integrity. While the
talk was going on, on one occasion, the fire died down. Wright got it going
again with the help of a newspaper and, since he had theories about
everything under the sun, explained that, to keep the paper from catching
fire, one must always on the first sign of combustion make a hole with a
poker in such parts of the paper as had turned black. Cushing, much amused
by this fire-surgery, called the method 'Wright's Punctures'.
Cushing was Surgeon-in-Chief of the American Hospital
provided by the University of Harvard, which had recently been transferred
to Boulogne. Another Harvard professor, Roger Lee, was the Head Physician.
He knew Wright by reputation because of anti-typhoid vaccination. (During
the Spanish-American war,
for every one man who died of wounds, a thousand succumbed to
typhoid.) He had done some laboratory work on the opsonins and was delighted
to learn that the famous Wright was under the same roof with him. He lost no
time in paying him a visit and found him surrounded by Fleming, Freeman,
Keith and Colebrook. 'I was at once attracted by Fleming,' he
says, 'though he hardly spoke.' The
attraction was mutual and the two men remained lifelong friends.
Among other visitors were Robert W. Bliss, the United States
Ambassador in Paris, and several Frenchmen: Professor Pierre Duval, Jacques
Calve and Dr Tuffier. Wright got along very well with the French, who shared
his taste for general ideas. Freeman soon grew tired of Boulogne and went to
work in Paris. On leaving, he said to Fleming: 'You know, Flem, we two ought
to be playing a more active part.' A
grunt was the only answer he got. Fleming was thinking that the
research-work at Boulogne might well save the lives of innumerable wounded
men.
At the time of the First World War, the British had not, as
had the French, the feeling that war is a quasi-religious ceremony, an act
of sacrifice to be made with a becoming sense of gravity. They regarded it
as a point of honour to relax occasionally, to seem to have time on their
hands. A few miles behind the front the officers fished for trout and went
sea-bathing. An eye-witness relates how one day Captain Fleming and another
scientist — CI rather
think it was Wright himself—feeling the need for exercise, had a wresding-match.
Just as both of them were rolling on the floor, the door opened to admit a
delegation of high-ranking French army doctors. The wrestiers jumped to
their feet and at once embarked upon a learned scientific discussion. But I
shall never forget the expression on the faces of those French medical
generals.'
Nothing could well have been less in accordance with army
conventions than the life led by this little group of scientists in uniform.
So careless was Wright of his appearance that his orderly sergeant, Clayden,
insisted on putting him through a dress-parade every morning, so as to make
sure that he had got his belt on properly, etc. 'One day5, says
Clayden, 'I noticed that the seat of his trousers was torn and that a piece
of his shirt was showing. I didn't quite like to mention it, so I told
Captain Fleming and said that he really ought to draw the Colonel's
attention to it. His reply was: "Do it yourself." So I went straight up to
Sir Almroth, stood to attention, clicked my heels (which always earned me a
mocking smile from the Colonel), and said, " There's
a hole in the seat of your pants, sir" He
looked at me. "That's a nice way to talk, Sergeant, I must say! I suppose
you think the nurses will be shocked. Well, what do you suggest I should do
about it?" "I think, sir, the best thing would be for you to send your
driver back to your billet for another pair." "What a brain!" he said.
Captain Fleming and I had a good chuckle, and then everyone settled down to
work.'
On Sundays Fleming and two of his colleagues (Thomson, an
Irishman from Belfast, and Dr Keith, a Canadian) used to play golf at
Wimereux. The links were situated on the sand-dunes which lie along the
Channel coast. It meant a walk of a couple of miles or so northwards from
Boulogne, but that didn't frighten the old foot-slogger of the London
Scottish. Nevertheless, if an empty staff car happened to pass, the three
musketeers would stop it. A somewhat self-important colonel regularly put in
an appearance on the links. Fleming, a silent humorist, thought it great
fun, when he was out of sight behind a dune, to drop the colonel's ball into
the hole, and the colonel, thinking he had achieved the miraculous feat of
holing out in one, was duly elated.
Fleming was far from being a brilliant player. As always, he
wanted to improvise a secondary game within the game proper. To vary the
proceedings, he adopted a number of non-regulation methods. He would, for
instance, he on the ground and use a reversed putter as a billiard-cue, or
turn his back to the hole, and putt between his legs. Sometimes the results
were successful. The others accused him of cheating, but that didn't worry
him.
Keith, the Canadian, had become one of Fleming's great
friends. He had done his medical studies at various American universities
and, in the eyes of the English, he was a Tank.
Fleming's practical mind was much to his taste, because it was so effective.
'We found this research group more than usually interesting,' says Keith,
'because it kept in constant touch with the doctors and surgeons who looked
after the wounded. The exchange of views which went on between them turned
out to be useful and exciting. At tea-time, Boulogne being the great supply
port for the B.E.F., there was always a crowd of guests, and the talk grew
animated. Though Fleming said little, he did a great deal to keep the
conversation at a practical level with his felicitous and opportune remarks.
His views on the work done by the others, though penetrating, were always
mixed with the milk of human kindness. His breadth of outlook reminded me of
the best of our American research-workers, and it played a great part in the
birth of our friendship.'
In 1918, a special hospital (No. 8 Stationary) was
established at Wimereux to deal with fractures of the femur involving deep
laceration. It was decided that a special study should be made there of
septicaemia and gas-gangrene. Tt was a proud moment for me', says Dr
Porteous, cwhen I was
sent to this hospital as a bacteriologist working under Fleming's orders. He
was in charge of the laboratory, and we shared a hut. Our lab. was a wooden
shed. The walls were covered with "pin-ups", pictures of phagocytes with,
here and there, an illustration from La
Vie ParisienneFleming
was still busy with his study of antiseptics and the saline treatment of
wounds. He did a great deal of work on the septicaemias caused by
streptococci and, with Porteous, tried to establish the conditions which
would make this form of infection less frequent. He also practised
transfusion, brought the method to a fine point, and published his results
in the Lancet Transfusion
was not yet a familiar routine. The blood donors were volunteers, who were
encouraged by the promise of extra leave. To keep himself physically fit,
Fleming had laid out two golf-holes on a piece of grass behind the hut and
the two friends played there at night, with candles in the holes, whenever
wind and air-raids permitted.
The great 1918 epidemic of Spanish flu kept the doctors hard
at it night and day. The unexpected rate at which the sufferers were dying
was heartbreaking. The orderlies themselves went sick with it. Quite often
Fleming and Porteous themselves had to carry corpses to the improvised
cemetery. Gas-gangrene was still raging and the stench was appalling, flies
became a positive scourge, until Fleming devised a method of 'bringing them
down5 by spraying them
with xylene out of a syringe. He studied the Pfeiffer bacillus which was
said to be causing this notorious form of flu. To be sure, it was found in
ninety per cent of those suffering from it, though in general this
particular bacillus is not regarded as being very dangerous, Fleming
wondered why it should suddenly have produced this deadly epidemic. He
attempted to grapple with the problem and discovered that there were several
variants of the Pfeiffer bacillus and that it was not always the same but
one or other of those variants which was found in people suffering from
Spanish flu. He concluded, therefore, that the illness was caused by some
agent other than the Pfeiffer bacillus which, in itself, was only the germ
of a secondary infection. He was right, but that did not do much to help the
sufferers.
'The picture I have of him', says his sergeant, 'is that of a
short R.A.M.C. officer carrying a tray loaded with pipettes, Plasticine,
platinum wire and a spirit lamp, standing on a cold winter's morning, with
ice an! snow everywhere, in a tent heated by a brazier, with me carrying out
an autopsy on a table, while on another table another corpse lay awaiting
its turn! We had six autopsies to do that morning! It was Christmas Day and
from each of the bodies Captain Fleming took specimens.'
In spite of all their efforts, the hospital doctors never
succeeded in protecting the wounded from gas-gangrene. Fleming was in
despair. 'Surrounded by all those infected wounds,' he wrote, 'by men who
were suffering and dying without our being able to do anything to help them,
I was consumed by a desire to discover, after all this struggling and
waiting, something which would kill those microbes, something like salvarsan
In this way he was driven back again on to the problem with which he had
been obsessed when he wrote his thesis on 'How to Overcome Infectious
Diseases'. But by this time Foch, in a sequence of unexpected blows, had
shattered the enemy front. The war ended in November 1918. In January 1919
Fleming was demobilized. |