It is not often that one has the privilege of working
alongside a Master, but Fate arranged that for me. Fleming
T he Inoculation
Department had started life in 1902 in one small room belonging to the old
Medical School at St Mary's. When Fleming joined it in 1906, the one room
had expanded to two rooms, both tiny, which had to accommodate the
Professor, his assistants and such infectious cases as might be sent for
treatment from other parts of the hospital. There was no money to spare and
the laboratory owed its continued existence to Wright's generosity. At that
time he had a rich practice. Millionaires and members of the British
aristocracy would call in Wright for the least ailment — for anything, in
fact, from a boil to an attack of typhoid. His large waiting-room at 6 Park
Crescent was always crammed with patients, and the greater part of his fees
served to maintain the bacteriological laboratory (or, as he called it, 'the
lab.').
Almroth Wright thought it useful and, indeed, necessary for a
doctor engaged on research to remain in practice — so as to 'keep his feet
on the ground*. The observation of living bodies confirms — or rebuts — the
findings of the test-tube. The spectacle of human suffering arouses, along
with pity, the desire to find a remedy — whence his insistence that a clinic
should be attached to his department. 'It wasn't at all a bad thing', says
Dr Hughes, who later worked there. 'A man engaged on research who finds
nothing has an uneasy conscience. The doctors who worked under Wright, when
not busy in the laboratory, carried on with their normal professional
duties.'
Wright encouraged his assistants to stay in private practice.
Actually it was the only way in which they could make a living, for he paid
them little: a hundred pounds a year. He maintained that research should be
entirely disinterested. 'We don't pay people to do research: they've got to
have work outside.'
Salaries and promotion were decided by Wright, the sole
master after God. 'This Service5, he said, 'is a republic. In
point of fact, it was an enlightened despotism. The dominant personality of
the Chief won not only respect but devotion, The Old Man, as he was called
by his collaborators, ruled the family like a stern but fond father. This is
how Freeman describes him: 'Wright was, at first glance, an almost clumsy
figure with large head, hands and feet. As his great friend, Willie Bulloch,
the bacteriologist at the London Hospital, used to say of him, he had
escaped being acromegalic only by the narrowest of squeaks. His movements
were slow and purposeful. He was a big man with the rounded shoulders of a
bench-worker and anti-athlete ... He wore spectacles above which showed
strongly marked eyebrows which flickered up and down very rapidly when he
was amused or being mischievous. He could almost speak with his eyebrows.'
But, though his movements were heavy, he could accomplish the most delicate
tasks with his great fingers.
His character was a mass of complexities. All things
considered, he was a difficult man. His disciples adored him for his genius,
for the way in which he made life amazingly interesting, and because his
zest, his love of paradox and his vast culture enabled him to be an
enchanting conversationalist. But to different people he showed different
facets of his personality. With some he turned into a poet, with others into
a naughty child. You're so mischievous, Wright,' said his famous friend,
Balfour; 'that is why we all like you so much!' Gentle and patient with the
sick, he could behave to his colleagues with brutal savagery. In a
controversy with a celebrated surgeon, he behaved so ferociously that
Bernard Shaw, who knew what he was talking about, said: 'It was Lessing who,
according to Heine, not only cut off his adversary's head, but held it up to
show that there were no brains in it. Sir Almroth, knowing that this is an
anatomical impossibility, puts Sir William Watson Cheyne's brains on his
operating table and shows that Sir William has never learned how to use
them.'
All his life had been a battle- He was born in 1861 of an
Irish Presbyterian father and a Swedish mother, the daughter of Nils Almroth,
a professor of organic chemistry in Stockholm. From his earliest youth he
had shown a spirit of fierce independence. 'Almroth was one of my failures,'
said his mother. 'I could never make him do what I wanted; he always went
his own way.
Nevertheless, she was very proud of him, and her other
children asserted that, if Almroth had committed a crime, she would have
said: 'What a fine, manly thing to do!' Since the Reverend Charles Wright
exercised his ministry in Dresden, Boulogne and Belfast, Almroth was brought
up by private tutors, and acquired an excellent education. So strong was his
passion for languages that at sixty-two he learned Russian, and began at
eighty to study the Eskimo tongue.
What he loved best in the world was poetry. He knew by heart
great chunks of the Bible, Shakespeare, Milton, Dante, Goethe, Browning,
Wordsworth and Kipling. He once reckoned that he could recite two hundred
and fifty thousand lines. One might have supposed that, with such tastes, he
would have embarked on a literary career. He did, actually, think of doing
so, and went for advice to the famous Edward Dowden who occupied the Chair
of English Literature at Trinity College, Dublin. When his opinion was
asked, Dowden said: cIf
I were you, I should stick to medicine. It is the finest possible
introduction to life and, if you later show gifts as a writer, your
experience will furnish you with a precious fund of knowledge.5 This
verdict was fully justified, because Wright was to become not only a great
doctor but also an excellent writer. Bernard Shaw once said to him: 'You
handle a pen as well as I do,5 which,
coming from Shaw, was a very great compliment; in fact, the only compliment
worth anything!
Wright's restless and adventurous mind could not remain
permanently satisfied with the ordered existence of a general practitioner.
He travelled in Germany and France, visiting a succession of laboratories
and striking up friendships with German and French research-workers. For a
time he read Law and dreamed of being a barrister. He went to Australia and
taught in Sydney. But his ultimate choice was scientific research. He had a
passionate desire to see 'what lies on the other side of the mountains', to
explore new worlds. He had the good fortune to enter the medical profession
at the very time when it was undergoing a profound transformation. The two
or three previous decades had seen the beginnings of a movement away from
medicine-as-an-art and medicine-as-magic to medicine-as-science.
Already, before i860, certain men of science had been
thinking that infectious diseases might be caused by microscopic creatures,
though they had not supported this hypothesis with any experimental proof.
But between 1863 and 1873 a French doctor, Davaine, had demonstrated that
one particular ailment, anthrax, was closely connected with the presence in
the blood of certain small objects which he called bactirides. A
German, PoIIender, had reached the same conclusion. Between 1876 and 1880,
Pasteur in France and Koch in Germany had thrown open to medical research
immense and unexplored territories. Pasteur in the course of a long and
prodigiously fertile career proved that numerous infections, till then
unexplained, were due to the action of microorganisms which the microscope
made it possible to detect in the blood and tissues of the sick. Round about
1877, the word 'microbe' was invented by S6dillot. Little by little,
research-workers had succeeded in establishing a catalogue of the principal
microbes: staphylococcus, streptococcus, the typhoid bacillus, the tubercle
bacillus, etc. ... The German school had taken the lead in devising
bacteriological techniques: culture-medium, staining of microbes, methods of
examination.
Thanks to the work of the great English surgeon lister,
Pasteur's discoveries had completely revolutionized the practice of surgery.
It is difficult for us today to imagine what surgery was like when Lister
was a young man. The cases in which it could be employed were strictly
limited. A very high proportion of those operated upon died of general
infection, as did, also, a large number of women in childbed. This was known
as the 'hospital sickness', and it seemed impossible to find a way of
dealing with it successfully. A Viennese doctor, Semmelweiss, had pleaded
for the adoption of hygienic methods, but in vain. From the moment that
Pasteur showed that no infection could take place without the presence of
germs, and that those germs were carried by the air, by the instruments, and
by the hands and the clothing of the surgeon, Lister realized that by
ensuring the sterility of the wound — that is to say, the absence of all
septic germs — the 'hospital sickness' could be done away with, that, in
fact, it was no sickness at all, but simply the result of a lack of
precaution.
The causes of infection had thus been partially explored. It
remained to discover a way of fighting them. Certain facts, known since the
days of antiquity, might have been of assistance in providing the
research-workers with some sort of guidance. When the plague was raging in
Athens, says Thucydides, the sick and dying would have received no attention
at all had it not been for the devotion of those
who had already had the plague and had recovered from it, since cno
one ever caught it a second timeIt
was known, too, that smallpox, one of the worst scourges of the human race
up to the beginning of the nineteenth century, which killed or disfigured
millions of sufferers, never attacked the same person twice. For more than a
thousand years in China, Siam and Persia, various forms of deliberate and
protective infection — the pricking of certain areas of the skin with
contaminated needles, or introducing portions of smallpox scab into the nose
— had been practised. In Baluchistan it was the custom to have cows
afflicted with cowpox, which was thought to be a benign variety of smallpox,
milked by children with scratches on their hands, the idea being that those
children would, thereafter, be immune from infection.
European peasants, too, had had an empirical knowledge of
these facts. The attention of the English doctor, Jenner (late eighteenth
century), was directed to this phenomenon by a girl keeping cows, to whom,
because of certain symptoms, he had said that she might be sickening for
smallpox. She replied that she couldn't have the smallpox because she had
already had the cow-pox. This gave Jenner the idea — remarkable at that
period — of determining by methodical experimentation the value of such
popular beliefs. He took the very venturesome step of infecting perfectly
healthy subjects with the smallpox, after first inoculating (in other words,
vaccinating) them with the cowpox, and reached the conclusion that in this
way they could be given almost complete immunity.
It certainly was an extraordinary phenomenon. On the practical level it led
to the elimination (not without displays of violent and absurd resistance)
of a universal scourge — the smallpox: while, on the intellectual, it
revealed the fact that men or animals, after the injection of a minute
quantity of a dangerous virus, became different creatures, better armed
against that same virus, something like a country which, frequently
attacked, has learned to keep a suitable defence army ready. 'There is',
says Dr Dubos,
'such
a thing as biochemical memory, which is no less real than
intellectual or emotional memory, and, perhaps, essentially no different
from them/ Just as a shock experienced in infancy is enough to warp the
psyche and to sow the seeds of lasting complexes, so will the simulacrum of
a disease produce deep-seated, and sometimes beneficial, changes in the
blood. The organism which has fought against an evil is no longer a novice:
... Thou hast wrestled with me and art no longer the same man/
Pasteur had given much thought to the great mystery of
infectious diseases, and to Jenner's immunity theory. His powerful mind
refused to admit that the case of smallpox was unique. Immunization aught to
be possible in other illnesses. But how could the equivalent of vaccine be
found which might be used to combat other microbes? Chance, which so often
comes to the help of those who help themselves, provided him with a key to
this problem in 1880. While studying chicken-cholera he was led to two
conclusions: (a) that increasing age diminishes the virulence of the
pathogenic germ; (b) that
hens treated with attenuated germs are rendered immune to virulent ones.
In more general terms, he discovered that a germ becomes
suitable for purposes of Vaccination* when it has been kept for a long time
in contact with the air. (As an act of homage to Jenner, Pasteur had
extended the meaning of the word Vaccine*.) How did all these vaccines work?
By provoking a defence-reaction or, more precisely, by forming in the blood
new substances, or 4antibodies',
capable of helping the organism to fight, when the time came, against the
now-attenuated germs. The threat produced a mobilization of the defending
forces. In 1888, Chantemesse and Widal proved that even a vaccine composed
of dead germs
could develop in the blood the strength necessary to overcome the microbe of
typhoid fever. About the same time, Roux and Yersin found the poison, or
toxin, secreted by the microbe of diphtheria. Then one of Koch's pupils,
Behring, revealed the anti-toxic power of the serum of animals (guinea-pigs
and dogs) which had been treated with repeated small doses of the toxins of
diphtheria and tetanus.
A natural extension of the idea led to this armed and
mettlesome blood, this battling serum, being called to the aid of blood
lying under the threat of any contamination. Behring, pursuing this line of
thought, had tried the use of anti-sera for the prevention and treatment of
some infections. The principle involved was different from that of
vaccination. The serum had to bring to the sick or threatened organism already
formed antibodies.
Behring was only partially successful, but Roux tackled the problem again
and, this time, with successful results. At the Budapest Congress of 1894,
Roux was able to announce to a gathering of enthusiastic doctors that the
serum of an immunized horse, injected into those suffering from diphtheria,
could bring about a complete cure. The era of serotherapy had dawned. It was
no longer merely a question of preventing the onset of the disease, but of
curing those who already had it.
When Wright returned to England from Sydney in 1891, and
started to look for a suitable opening, he was delighted, after a year spent
in doing odd jobs, to be offered the position of Chief Pathologist in the
Army School of Medicine at Netley Hospital. There he found a group of young
men whom he inspired with his own passion for research and with his desire
to see a new system of medicine developed which should be founded on
scientific experimentation.
His pupils admired his devotion to science and his
aggressiveness. Never had there been a man less suited to get on with
soldier-administrators. Very soon Netley was buzzing delightedly with
stories: how one day, having hunted high and low for his laboratory
sergeant, he had found him taking part in a parade and had, there and then,
hauled him off by the collar of his tunic to get busy with what he described
to the horrified military as a 'piece of work worth doing': how he had been
told by the 'brass-hats' at the War Office, not to talk so much about blood
in his lectures, since after all it accounted for 'only one-thirteenth part
of a man's weight', and how, in spite of orders to the contrary, he gave
each year, to those passing out from Netley, a revolutionary address on
'Physiology and Belief.
At the time when he was beginning to teach bacteriology — a
science then in its infancy — Wright already foresaw a future in which the
diagnosis of infectious diseases would be carried out by precise methods and
not merely by listening to the patient's chest and saying, as a certain
distinguished doctor was in the habit of doing, '1
think I can detect the influenza bacillus ... by the sound.' Widal and
Gruber had demonstrated that the blood of a man suffering from typhoid
agglutinates the typhoid microbes and that this process, being specific
(that is to say, occurring with the microbial family which is the cause of
the disease and with no other), makes diagnosis possible. Wright proved that
the same held good of Malta fever, a serious ailment which goats (numerous
on the island of Malta) can transmit to humans, a fact which led
Metchnikoff, who at that time was teaching at the Pasteur Institute, to tell
his pupils, not without humour, showing them a map of the world on which the
regions subject to Malta fever were marked: "You will notice that these are
all situated within the British Empire. This is not due to any evil
influence of the British, but it merely means that they are the only people
who have made a study of Malta fever, and know how to diagnose it.
From 1895 Wright devoted most of his time to working out how
immunity to typhoid could be achieved. In those days it was a dreaded and
frequently a fatal disease which was particularly prevalent among soldiers
in time of war. A Russian bacteriologist, Haffkine, who was working at the
Pasteur Institute and paid a visit to Netley, suggested to him that it might
be possible to protect human beings against typhoid by preventive
vaccination, as Pasteur had succeeded in protecting sheep against anthrax.
It was a question in both cases of stimulating the formation of antibodies
in the blood. Typhoid was not, as had long been thought, a disease which
affected the intestine only. The microbe, in fact,1 spread
through the whole circulatory system and, by making the patient's blood
deadly to the microbe, this invasion would be held in check.
Chantemesse and Widal had shown that animals could be
vaccinated against typhoid by means of germs killed by heat. Wright
developed a simple technique by which the power of the blood to kill
bacteria could be measured. This enabled him to establish as a fact that the
blood, after inoculation, can kill from ten to fifty times more bacteria
than before and conserves this formidable power for several months. He
observed that after inoculation there is frequently a negative phase during
which the blood loses this power, accompanied by discomfort and fever, after
which a positive period ensues. In short, he brought to a successful
conclusion a piece of precise research and, sure of his results, was in a
position to advise the War Office to have all men
going overseas vaccinated. This was in 1898. He was the first doctor to use
anti-typhoid vaccines on human beings, though Pfeiffer and Kolle in Germany
could boast of a similar success at about the same time.
In spite of favourable results in India and elsewhere, the
old medical dug-outs of the R.A.M.C. remained sceptical. When the Transvaal
war started, Wright, who wanted to have immunization made compulsory in the
Army, was allowed to have the operation performed only on those who might
volunteer to undergo it. No more than sixteen thousand out of three hundred
and twenty thousand came forward. This was a disappointingly small number.
Furthermore, it was not easy to follow up the case histories of those who
had been inoculated. In the field-hospitals, when typhoid cases were asked
whether they had been vaccinated, they were inclined to answer "yes5 from
fear of being 'crimed' if they didn't. A story is told of one
sergeant-orderly who in his returns invariably showed as having been
vaccinated all men suffering from the disease. "The fact that they've got
it,' he said, 'proves as they've been vaccinated.' Wright was so much
enraged by the incompetence of official medical practice that he resigned
his post at Netley, greatly though he had liked it. In 1902 he was appointed
Professor of Pathology at St Mary's.
There he created the Inoculation Department over which he was
to reign supreme for forty-five years. At first, his teaching covered
pathological anatomy and histology as well as bacteriology. But by degrees
he managed to shuffle off these duties and concentrate his attention on
immunology. He was now convinced that all infectious diseases could be cured
by the action of antibodies, whether those antibodies existed naturally in
the blood, whether their production could be stimulated by a vaccine, or,
finally, whether they were introduced by a 'foreign' serum. In that
direction, he maintained, lay the future of scientific medicine. 'The doctor
of the future,' he said, 'will be an immunizer.' The knowledge that
traditional medicine had been able to do so little for the cure of patients
afflicted with the most serious diseases plunged him into despair. One
evening, when he was speaking to an audience of doctors, he wound up his
remarks by saying: 'What it comes to is this, that unless our doctors learn
to do something useful, they will find themselves relegated to the position
of medical orderlies.' Two doctors rose and left the room.
Meanwhile other scientists had been hard at work trying to
find an answer to the question; *How
does the organism, in natural
conditions, protect itself against pathogenic germs?9 Human
beings, after all, had existed long before the advent of preventive
vaccines, yet many of them must have found a way of resisting the attacks
made on them by germs, as is proved by the fact that the human race has
survived. How? A scientist of Russian birth, Metchnikoff, working at the
Pasteur Institute, had discovered the essential mechanism of this defensive
process in the phagocyte. While observing, in the course of his laboratory
work, the transparent larvae of star-fish, he had hit on the idea that
certain specialized cells, the police force of the organism, provided a
defence for living bodies against harmful intruders. He introduced a number
of thorns from a rose tree among the larvae. These thorns were soon
surrounded and dissolved. This experiment struck Metchnikoff because its
outcome so closely resembled what happens when a human finger is infected by
a splinter. Pus forms. But what exactly is pus? It is a collection of cells,
especially of the white corpuscles of the blood which, in the event of
inflammation, work their way through the blood-vessels, surround the
microbial germs and 'phagocyte' them, in other words, 'eat' and destroy
them.
But how do the phagocytes digest the microbes? Thanks to the
action, said Metchnikoff, of certain digestive enzymic ferments which,
inside the cells, play a part similar to that of the digestive ferments of
the saliva or the stomach. Against this cellular theory of immunity the
Germans argued in favour of a 'humoral* theory. They believed in the action
of the humours (that is to say, of the fluid substances of the body, and,
especially, of blood serums).
Wright, who was a friend of Metchnikoff and also of several
German scientists, tried to reconcile the two theories. What he had to say
about the matter was roughly as follows. In vaccinated or infected subjects,
certain specific chemical principles (antibodies) make their appearance in
the blood serum and the humours. The effect of these principles is to
reinforce the destructive action of the phagocytes by modifying the
superficial structure of the germs, on the surface of which they leave a
deposit — one might describe it as 'buttering' them — and so facilitate
digestion.
With the help of one of his Netley disciples, Captain
Douglas, who had joined him at St Mary's, he undertook a series of
remarkable experiments which made it possible to count with perfect clarity
the number of microbes swallowed by each phagocyte. Under the microscope the
phagocyte showed as a grey patch, and the microbes it had swallowed as black
points inside it. Wright and Douglas noticed that the number of microbes
which the defence-cells could absorb depended upon the 'preparation5 of
the microbes by the substance secreted thanks to immunization. One of
Wright's favourite amusements was the invention of words drawn from the
Greek. He therefore called this property acquired by the blood, which
enabled it to 'butter' the microbes in readiness for the phagocytes' meal,
the 'opsonic' power, from the Greek 'opsono* 'I
prepare food for ...', and the substance itself'opsonin'. In a serum free
from opsonin there is littie or no phagocytosis, whereas, when opsonin is
present in* increased strength as a result of infection or vaccine,
phagocytosis is considerable.
Wright attached capital importance to his idea. In the first
place, it produced a happy marriage between the cellular and humoral
theories. True, it is the phagocytes that destroy the bacteria, but only when
the latter have been 'buttered5 or
made appetizing by the humoral opsonin. Further, Wright believed that this
theory of his made possible the diagnosis of most cases of infection, since
infections increase the opsonic power in the blood over the microbe causing
the infection, and over that only. (As
a matter of fact, the modifications, though real, are so complex that it is
difficult to interpret them.) Finally, the measure provided by the 'opsonic
index'1 in
any given subject should, he thought, open the way to rational treatment by
vaccines or serums, since by establishing the percentage of phagocyted
microbes the laboratory worker is in a position to determine the quantity of
opsonin in the blood and to say whether it increased, or not, under
treatment.
When demonstrated with Wright's brilliant eloquence, the
theory of the opsonic index seemed to be a stroke of genius. Medicine was at
last becoming an exact science! That was the feeling of a few young and
highly intelligent doctors and research-workers who, attracted by the great
gifts of the master, were prepared to accept the by no means easy life he
offered them. The first team was composed of Stuart Douglas from Netley,
Leonard
Noon, Bernard Spilsbury and John Freeman. The latter was a
man of original intelligence and an excellent scientific writer. He entered
the lab. in 1903, became one of Wright's favourite disciples, and was
called, by him, his 'son in science'. Freeman, until he married, lived with
Wright at 7 Lower Seymour Street, At a later date, Fleming (in 1906),
Matthews, Garmalt Jones and Leonard Golebrook joined the team.
A team? It would be more accurate to describe it as a
brotherhood, something in the nature of a religious order. It was accepted
as an indisputable fact by these men that they had a mission, that they were
to devote their lives to the service of science, and that they owed
unconditional loyalty to Wright. What was it that gave him this prestige in
their eyes? His charm, his intellectual brilliance, his personal passion for
research, which kept him working in the laboratory until three or four in
the morning, and sometimes until daybreak. What was it that made him spurn
all pleasures and even a family life in order to count black points in grey
patches? Ambition? Perhaps, in part. He loved authority and longed for fame.
But, more than anything else, intellectual curiosity and a profound desire
to help human suffering, for he was by nature both sensitive and kindly.
According to Freeman, Wright was led by his passion for work
so wholly to neglect his own flesh and blood that his daughter Dolly, having
to write a school essay on the pleasures of home-life, concluded it with
this sentence: *It is awfully jolly if Daddy can manage to get down on
Sunday to see how his family is getting on One day, when Wright, on arrival
at the hospital, was hanging up his hat, Douglas saw a piece of white paper
fall out of the ribbon. He picked it up, and read: 'Daddy, three times you
have forgotten to put more gas in my balloon, as you promised you would. I
have put two empty balloons in the inside pocket of your overcoat. Don't
forget this time.' Douglas filled the balloons and tied them to the
hat-ribbon* Dolly Wright got what she wanted, at last!
It was not only affection and loyalty, however, that
accounted for the admiration felt by these young scientists for their
master. His genius justified their enthusiasm. Nor were they alone in their
feelings, which were shared by many eminent men who had no connection with
the hospital. Often, round about inidnight, tea was made in a small room
next to the lab., and there many illustrious visitors were entertained:
biologists like Ehrlich and Metchnikoff; statesmen like Arthur Balfour and
John Burns; dramatists like Bernard Shaw and Granville Barker, People came
together from every corner of London and, indeed, of the world, to listen to
Wright.
In the house of his great friend, Lady Horner, a celebrated
hostess, Wright met most of the members of the Cabinet; among them was Lord
Haldane, at that time Secretary of State for War, who was responsible for
getting him knighted. Freeman, who read the letter in which the news of this
honour was communicated to the Chief, says that it ran more or less as
follows: 'Dear Wright, we must have your Typhoid Prophylactic for the Army,
but I have failed to convince the head man in the Army Medical Service of
this. I have therefore got to build you up as a Public Figure, and the first
step is to make you a knight. You won't like it, but it has to be ...
Haldane.' Wright, at first, wanted to refuse and said in a disgusted tone:
'They'll even shove it on my gravestone!' but in his heart of hearts he was
very pleased.
One evening, when Bernard Shaw was drinking tea in the lab.,
the question arose of whether a new patient should be admitted. Freeman
said: 'We've got too many cases on our hands already,' and Shaw asked: 'What
would happen if more people applied to you for help than you could properly
look after?' Wright replied: 'We should have to consider which life was best
worth saving.' Shaw laid a finger to his nose, and said: 'Ha! I smell drama!
... I get a whiff of a play!'
Not long afterwards, a certain Dr Wheeler, who was a great
friend of both Shaw and Wright, warned the latter that Shaw was making him
the hero of a play. That was true: it was called The
Doctor's Dilemma,
and it was impossible not to recognize Sir Almroth Wright in its leading
character, Sir Colenso Ridgeon. In the first act there is a passage between
Colenso Ridgeon (Wright) and an infinitely sceptical doctor of the old
school:
sir Patrick What
did you find out from Jane's case?
ridgeon I
found out that the inoculation that ought to cure sometimes kills.
sir Patrick I
could have told you that. I've tried these modern inoculations a bit myself.
I've killed people with them; and I've cured people with them; but I gave
them up because I never could tell which I was going to do.
ridgeon (taking
a pamphlet from a drawer in the writing-table and handing it to him)
Read that the next time you have an hour to spare; and you'll find out why. sir
Patrick (grumbling
and fumbling for Ms spectacles) Oh,
bother your pamphlets. What's the practice of it? (Looking
at the pamphlet) Opsonin?
What the devil is opsonin?
ridgeon Opsonin
is what you butter the disease germs with to make your white blood
corpuscles eat them.
(He sits down again on the couch*) sir
Patrick That's
not new. IVe heard this notion that the white corpuscles — what is it that
what's his name — Metchnikoff — calls them? ridgeon Phagocytes.
sir Patrick Aye,
phagocytes: yes, yes, yes. Well, I heard this theory that the phagocytes eat
up the disease germs years ago: long before you came into fashion. Besides,
they don't always eat them. ridgeon They
do when you butter them with opsonin. sir
Patrick Gammon.
ridgeon No:
it's not gammon. What it comes to in practice is this. The phagocytes won't
eat the microbes unless the microbes are nicely buttered for them. Well, the
patient manufactures the butter for himself all right; but my discovery is
that the manufacture of that butter, which I call opsonin, goes on in the
system by ups and downs — Nature being always rhythmical, you know — and
that what the inoculation does is to stimulate the ups or downs, as the case
may be ... Inoculate when the patient is in the negative phase and you kill:
inoculate when the patient is in the positive phase and you cure.
sir Patrick And
pray how are you to know whether the patient is in the positive or the
negative phase?
ridgeon Send
a drop of the patient's blood to the laboratory at St Anne's; and in fifteen
minutes I'll give you his opsonin index in figures ...
Fifteen minutes was Bernard Shaw's own rather optimistic
reckoning. In point of fact, when patients were numerous, the opsonic index
kept these young monks of science awake until dawn. |