More often than not these meetings took the form of a long
monologue by Wright who sat leaning forward in his chair, slightly
terrifying but quite fascinating in his role of feudal lord and unquestioned
ruler. No matter what the subject, he was perfectly capable of quoting
fluently and at length from Kant, Sophocles, Dante, Rabelais, Goethe and
even Mademoiselle
de Maupin. When
important visitors, like Balfour, happened to turn up, it was Wright who
answered their questions, or sometimes Freeman. Fleming, as a rule, said
nothing. At first he had been amazed at Wright's tremendous vitality and
universal knowledge. But he had the precious, if somewhat embarrassing, gift
of seeing the weak point in any argument, and driving straight forward. He
very soon realized that the Chiefs glittering oratorical performances were
not always constructed on irrefutable premisses. When the midnight tea
became an orgy of metaphysical discussion, he would listen for a long time
in silence, and then, with a single word, cause the whole laboriously
constructed system to collapse noiselessly, 'Why?' he would say, with
assumed innocence, at which there would be a general exchange of glances.
For he was perfectly right: why?
Wright valued Fleming for the perfection of his work and his
sure judgment. But his silences were in the nature of a challenge, and he
enjoyed pulling his leg. Assuming that the young Scot, who never spoke about
religion, must be a Covenanter and a Believer, the Old Man would try to
provoke some show of emotion on that impassive countenance by indulging in
blasphemous outbursts, such, for instance, as putting together two verses
from the Gospels in such a way as to produce an absurd or scandalous
sentence. Or he would say: 'Fleming, how could the star of Bethlehem be over one house?
The apparent distance of the stars is such that the same star appears to be
over all the
houses in a village. Isn't that so?' But Fleming never rose to the bait. He
knew what his behaviour was supposed to be in the lab.: that of a taciturn
Scot, and he conscientiously played up to it.
Wright had a taste for quoting at length from the poets.
Often, after a long piece of declamation, he would turn to Fleming, who had
his beautiful blue eyes fixed on him, and say: 'What's that?' In the early
days, Fleming, as a good Scot, had replied 'Burns' — on principle. Then,
having a methodical mind, he established the fact that the Old Man chiefly
quoted from three great works, the Bible, Milton's Paradise
Lost and
the plays of Shakespeare* From that moment, whenever Wright jumped on him
with the question — 'What's that?', he regularly answered, *Paradise
Lostand
one time in three the attribution was correct*
After long days of work, Fleming enjoyed this atmosphere of
gay badinage. He did not like people to take serious matters too seriously.
He loved having a bit of a game, even where work was concerned. Himself
given to teasing, he did not in the least mind being teased in return. But m
games, as in everything else, he liked to be top-dog. Calmly, imperturbably,
he would study the rules until he had completely mastered them* The really
splendid game in the lab. was not conversation but research, and there
Fleming triumphed. Though Wright was skilful in technical performance, in
spite of his podgy fingers, Fleming, or, as he was affectionately called,
'Little Flem', was even more deft and ingenious. In his hands glass was made
to serve the need of the moment. It was pure joy to watch him construct,
with incredible rapidity and improvising as he went along, some complicated
piece of apparatus. In the truest meaning of the word he was an artist, and
his colleagues instinctively spoke of his work in terms of art. 'That
experiment of Flem's,' someone would say, 'was a perfect little work of
art.' In this way, and without any effort, he retained that contact with
nature which is so precious a possession for those who question her, and
which the abstract thinker is too apt to lose.
Wright, a scholastic, believed that pure reason or, at least,
his own, could discover the laws which govern phenomena. 'Actually, he had a
far greater intellectual affinity with St Thomas Aquinas than with Bacon',
with Descartes than with Claude Bernard. He believed, of course, in the
experimental method: he had carried out innumerable and 'beautiful*
experiments, and had owed to them everything he knew, but when Nature gave
him a negative answer, it was only after a tough struggle that he could
bring himself to accept it. 'The positive spirit', says Alain, 'is a prey to
the passions ... The reply given by things to
our demands and our hopes is not always sufficiently definite to clear our
minds of fantasies.' Though Wright, wisely and with perfect sincerity,
preached self-criticism, he was not impartial where the choice and
interpretation of his results were concerned. Words held an irresistible
attraction for him. There were days when his dialectic, thickly sown with
terms taken from the Greek, and of his own invention ('cataphylaxis', 'epiphylaxis',
'ecphylaxis'), led his audience beyond the borders of the real.
Fleming admired his master's genius, was full of praise for
his integrity, and knew that, if Wright sometimes made a mistake, it was in
perfect good faith. But ever since the days of his youth he had made it a
strict rule that he would never cling obstinately to a preconceived idea if
experience proved it to be wrong. His friend, Professor Pannett, writes: 'He
never liked talking, but when he did make up his mind to express a judgment
in words, you could be perfectly certain that it would be in the highest
degree intelligent. Fleming's edged mind and clarity of thought are beyond
dispute.' When Wright, carried away by his own eloquence, pressed a
theoretical conclusion too far, Fleming was always courageous enough to say,
quite calmly: 'That won't work, sir.' Wright would repeat his argument even
more forcibly. Fleming would listen without interrupting him and then, quite
simply, say again: 'That won't work, sir.' And it didn't.
Though often, with one sharp monosyllable, he would deflate a
too audacious pilot-balloon, he felt, nevertheless, that Wright's passionate
enthusiasm was a useful source of inspiration. The young Scot might seem
cold and collected, but the indomitable, delightful and sometimes savage
Irishman had awakened in him a spirit of unlimited loyalty. To contradict
Wright to his face was one thing, and Fleming occasionally ventured to do
it, but to argue against the Old Man's ideas outside the lab. was quite
another, and that he never did. He knew perfectly well that some of Wright's
theories were controversial, but he tried his best to find a solid
experimental basis for the Chief's more hazardous hypotheses. Wright,
because of his unbounded self-confidence and excessive outspokenness, had
made a number of enemies in the world of science. Some there were who
attacked his technical methods: Fleming, on the other hand, attempted with
infinite patience, to perfect them. If Wright believed in a theory which
others held to be debatable, he would return to it again and again, and
prove to those of little faith that the Old Man had been justified.
He learned much from Wright and it was a stroke of luck for
him to have been trained by such a master, but it was also a stroke of luck
for Wright to have at his elbow so fiercely impartial and absolutely loyal a
worker. This he knew. Though he had a tendency, like many great masters, to
think of the mental processes of his disciples as his own personal
possession, and to include the results of their work in his 'papers', he
often quoted Fleming by name, and realized, many times over, how much he
owed to him.
The essential qualities of the young research-worker were a
powerful gift of observation, thanks to which no important detail ever
escaped him; a piercing insight into the causes implied by this or that
established effect; and a high degree of skill in cutting through the
tangled minutiae of any problem and revealing the main lines along which
inquiry should move. These qualities he used generously in defence of the
opsonic index against a deal of sniping. It was said that thousands of
'counts' would be necessary before a reliable estimate could be arrived at,
and that, even if the method were correct, it would be utterly
impracticable* 'No,' replied Fleming, 'an experienced and intelligent
bacteriologist does not need to count as many cells as a beginner.* In his
hands everything became easy. Two examples, chosen from the work of the
laboratory, seemed to justify the confidence felt by the team in this famous
and much-debated method.
One of the workers in the lab., John Wells, who was on
holiday in the country, wrote to say that he was suffering from influenza.
Wright replied, telling him not to come back until he had completely
recovered. Two months later, Wells wrote again: T really must get back to
work: this influenza seems to be interminable.' He returned and crawled
about the laboratory, depressed, feverish and obviously a very sick man. One
day, Fleming, who had taken a sample of his blood, showed Freeman two glass
slides, and said: 'Would you mind counting these two films?' He had marked
them 'A' and 'B', but gave no further explanation. Freeman, after making a
careful count, said: 'Blood "B" has twice as much lesseffect
upon the microbe as blood "A" ...'
'That tallies with my own finding,' replied Fleming: ' "B" is
the control sample; "A" comes from Wells. The microbe is that of "glanders"
...John Wells is suffering from the "glanders" ... Do you remember that
young woman whose pony died? ... Wells, on that occasion, handled a culture
and probably did not take sufficient precautions ... The pony must have had
the "glanders", and John Wells caught the infection Six weeks later the
diagnosis was confirmed, and John Wells died from the 'glanders' which, at
that time, was incurable.
The other case was that of Dr May, a robust and red-faced
Irishman who rejoiced in the nickname of 'Maisie'. Like the others, he had
contributed some of his blood to build up a reserve of normal blood for
control purposes. Someone put the question: 'Does this total mixture really
and truly represent the average blood of the lab. workers?' The opsonic
index of the mixture was compared with that of the individual donors. May
noticed that his blood differed markedly from that of any of the others.
Wright said to him: 'We won't take any more of your blood. You are not
normal.' 'Maisie' continued to measure his opsonic index and established the
fact that it was diverging more and more from the norm. Wright told him:
'I'm afraid you'll have to leave the lab. You are suffering from a
suppressed form of tuberculosis.' 'Maisie' laughed, for he did not feel ill,
but, nevertheless, accepted a less exacting post in South Africa. When this
became known in the medical world, many pathologists said: 'Wright really is
completely mad! He's got in his laboratory a chap who's the very picture of
health and, just because this man's opsonic index varies from the norm, he
has calmly announced that he is tubercular. Never heard anything so
ridiculous!' ... May, however, had not been in Africa two months before the
doctors found Koch bacillus in his sputum. The diagnosis by opsonic index
had anticipated the clinical diagnosis by several weeks.
It looked, therefore, as though this immense labour had not
been in vain. But it condemned Wright's disciples to spend whole nights in
the lab. The students of St Mary's knew that if they left a party round
about two in the morning, they could always look in for a final mug of beer
on Fleming, who at that hour would invariably be found bending over his
microscope. They liked nothing better than to find him there — at once
unperturbed and welcoming — wearing his neat bow tie and ready to listen to
anything they might have to say, while the eternal cigarette dangling from
his lips, even when he was speaking, made it more than usually difficult to
hear what he was saying.
Another of Fleming's qualities was the masterly manner in
which he organized his expositions. From the very first his papers had been
noted for the clarity of his scientific style. Wright, whose taste in
literature was exacting and reliable, could not help recognizing that
Fleming in his precise and sober way wrote well. cMy
colleague, Dr Alexander Fleming, has given in the treatise which is prefaced
by these remarks of mine an admirable summing-up of the results obtained by
the Inoculation Department of St Mary's Hospital ...' Wright had moved on
from preventive to therapeutic vaccination, and it is now necessary to give
some account of the flow of ideas which had carried him forward in this
direction.
To immunize means, when there is any threat of infectious
illness, to give to the blood the means of fighting against a possible
attack. Jenner's inoculations as well as Pasteur's had been preventive. But
Pasteur had also successfully treated those already infected with rabies.
How had that been possible? Because rabies in the human being does not
develop until some time after the bite has been inflicted by the mad dog. An
injection of the virus in an attenuated dose, given during the period of
incubation, stimulates the production of antibodies and with them the human
system can fight the invasion before it is established; this is still,
therefore, a sort of preventive inoculation.
Wright took it as his starting-point. Why, he asked, should
one not go farther? Up till then the 'immunizers' had held the view that the
invaded body was one and indivisible. But was this view correct? Observation
had been recorded of numerous cases of local infections which had not become
generalized. A patient might suffer from tuberculosis of the knee without
the rest of his body being attacked. To what did this point? To this — that
the local natural defences, and they alone, had been carried by the enemy;
that the microbial forces had won a bridge-head but nothing more. The
general defence mechanism had not been put on the alert.
Could the garrison be mobilized? Yes, said Wright, by means
of auto-inoculations. It would be enough, in cases of local infection,
carefully to determine the microbes responsible, to prepare from them dead
cultures (auto-vaccines), to inject these into the patient, and then study
his opsonic index to ascertain the effect of the treatment. Beyond this
first area of research Wright could already see vast fields waiting to be
explored by vaccine therapy — e.g. blood poisonings and certain secondary
infections which often accompany cancer. An enthusiastic inquirer with a
fixed idea can find it everywhere.
There can be no doubt that Fleming, like his colleagues, had
a firm belief in vaccine therapy. Indeed, numerous cures brought about by
its use were on record at St Mary's. This new conception made a great stir.
Bacteriologists from all over the world came to study auto-vaccines and the
opsonic index under Wright's direction. It was not easy to find
accommodation for them in the two wretched rooms which were all the
Department at its disposal; far too little for half a dozen foreign
scientists in addition to Wright's six or seven assistants. Patients,
attracted by favourable rumour, arrived in a steady flow. It was necessary
to take blood-samples, to identify the microbes, to prepare the vaccines,
and to keep a watch on the blood of the sufferers by making a count of the
number of microbes absorbed by the leucocytes. It was gruelling work, and
there was a shortage of everything, of money as well as space.
In 1907 the hospital authorities, who lacked the funds
necessary to equip the upper floors of a recently constructed block (the
Clarence Wing), offered them to Wright if he would undertake to obtain a
subsidy. Wright had rich and powerful admirers. He rallied to his aid Lord
Iveagh, Arthur James Balfour, Lord Fletcher Moulton and Sir Max Bonn.
Between them they rapidly collected the sum needed. In addition, as soon as
the laboratories were equipped, arrangements were made with a large firm of
pharmaceutical chemists, Parke Davis & Co., to supply them with vaccines,
serums and antitoxins for distribution. From that moment, the Department had
permanent resources, but these were used to expand the laboratories, and the
research-workers continued to be paid about what sweepers would earn today.
In 1909, the constitution of the Inoculation Department was definitely
established at a meeting held at the House of Commons under the chairmanship
of Balfour. The Department now became entirely independent. Its
administration was vested in a committee which met only when Wright thought
it necessary to call it together. Wright and two other members constituted a
quorum. In this way was the benevolent tyranny of the Old Man legitimized.
Few women ever came to the laboratory except when Wright had
prepared what his friend Ehrlich called a Damenprogramme. On
these occasions, Lady Horner, Mrs Bernard Shaw and other privileged females
were put au
fait with
the latest discoveries by means of a number of spectacular demonstrations.
Wright affected a profound contempt for the intelligence of women, and many
of the 'midnight teas' were devoted to his diatribes against the sex. 'The
continual over-estimation of the feminine intelligence', said Wright, 'is
very largely due to conjugal infatuation. Everyone must have noticed that
wives who love their husbands adopt their ideas ... I once heard a mother
say of her daughter, "she is so devoted to her husband that if he turned
Mohammedan tomorrow, she would follow suit"...'
He maintained that the passions are almost always engendered
by bacterial toxins. His taste for Greek words led him to explain the need
felt by so many men and women to press against one another, to clasp their
arms round the beloved object, and to lean his (or her) head on her (or his)
shoulder, as a stereotropic instinct,
in other words, the desire to find something solid to lean on. He had
written a whole book against Votes for Women which, at that time, were being
violently demanded by the Suffragettes, and had collected all the most
wounding things that the most famous authors had said about the 'second
sex', from Michelet's 'A man loves God: a woman loves a man', to Meredith's
expect that Woman will be the last thing civilized by Man' and Dr Johnson's
remark that 'there is always something a woman will prefer to the truth.'
The man who would pursue a great design and work without
intermission should, according to Wright, live completely separated from
women, a rule which he applied rigorously in his own case, for he kept his
family in the country while he himself lived in London. The laboratory was
his home. 'Before making a decision on any subject, a man should always have
numerous conversations with those who are expert in it' was another of his
sayings. And so it was that he surrounded himself with disciples. Some of
them, like Freeman, stimulated him and led him on to make his most brilliant
repartees: others, like Fleming, gave him their sureness of judgment,
technical skill and sturdy good sense, though at times they might be
silently rebellious.
Fleming had quickly fitted into this new world which he had
entered quite by chance. The work demanded more of human nature than human
nature could give. Every morning the young men had to make the rounds of the
wards, for Wright still clung to the view that research-workers should also
be practising doctors. The afternoon began with a 'consultation' at which
those cases regarded by the old-fashioned doctors as hopeless were examined.
Samples of blood were taken and labelled. Fleming was always anxious to get
these preliminaries over quickly, for he was in a hurry to get back to the
laboratory and prepare his slides. After dinner these innumerable specimens
were studied. The workers used their own blood for control purposes. 'We
were', says Colebrook, 'so many human pincushions.5 All
this was not without danger.
Meanwhile, though never abandoning these exacting labours,
Fleming continued to read for his final medical examinations which he passed
in 1908, coming out, as usual, top, and being awarded the Gold Medal of the
University of London. Nor should it be forgotten that at this time, too, and
without any preparation, he sat for and got his F.R.C.S. As though this were
not enough, he wrote a thesis on 'Acute Bacterial Infections' for one of the
prizes regularly offered by his own Faculty (St Mary's), and again headed
the list, winning the Cheadle Medal. His success was announced in the St
Mary's Hospital Gazette as
follows: ' Mr Fleming, who recently was bracketed for the Gold Medal and who
seems to have taken the Fellowship in his stride, is one of Sir Almroth
Wright's most enthusiastic followers, and we see great distinction in store
for him in the future.' The far-sighted author of this article was Zachary
Cope, who later became Sir Zachary Cope and a great surgeon.
Fleming's thesis on bacterial infections and the means of
fighting them constitutes, as it were, a prefiguration of the line of
research which the author was to follow all through his life. In it he
presents an inventory of the contents of the arsenal at that time available
to the medical profession in its war against bacteria: surgery, where the
centre of infection is accessible; antiseptics; general methods of
increasing the patient's resistance; the use of products which have an
effect upon certain specific bacteria (quinine for malaria; mercury for
syphilis, etc.); ways of increasing the exudation of the blood-lymph into
the infected tissues; and, naturally, serums and vaccines.
He gave the place of honour in his essay to Wright's vaccine
therapy. The latter's enemies asked ironically: 'What is the point in adding
dead microbes to a body which is already carrying on a battle against living
ones?5 — and, with an
air of triumph, brought up against him the phenomenon known as infectious
endocarditis, where, the valves of the heart being contaminated, the
microbes are continually shed into the general circulatory system. According
to Wright's theory, this process should be a natural form of vaccination,
and there should follow an increase in the resistance of the organism. In
fact, nothing of the sort occurred. The blood did not produce antibodies.
Fleming, having come up against this obstacle, ventured to
put forward an hypothesis. The intravenous route, he suggested, was not
suited to the injection of a vaccine. But this theory still needed to be
confirmed by experiment. Being unable and unwilling to use a patient for
this purpose, he became his own guinea-pig and submitted to an intravenous
injection of a staphylococcic vaccine. This was a rather courageous thing to
do. Intravenous injections were held at that time to be dangerous, and no
one could say with any certainty what the consequences might be. One
Saturday he had a hundred and fifty million dead staphylococci injected into
a vein. On the Sunday he had a feeling of nausea, a headache and a high
temperature. Given such symptoms, it was reasonable to expect an increase of
resistance in the blood. There was, however, none, whereas the same quantity
of staphylococci administered hypodermically caused it to rise sharply. This
seemed to justify the hypothesis that inoculation into the blood-stream,
which occurs naturally in endocarditis, is a bad method, which produces the
maximum toxic effect with the minimum of immunization. The results of the
experiment had been what the young doctor had expected.
This thesis on the infections is important, providing us, as
it does, at the very dawn of a life devoted to medicine, with a picture of
the direction that life was to take. All through his working career, Fleming
was to seek one thing, and one thing only: a means of fighting infections
which at that time were looked upon as the most dangerous of all the
scourges of the human race. For this line of research he felt himself to be
well equipped. He was a born naturalist, and was fully conscious of his
abilities. It would, therefore, be a great mistake to think of him as an
embarrassed and discontented man living in a refined, literary circle much
superior to anything to which he had been accustomed. For soured and
querulous persons he felt nothing but contempt. 'Alec was always happy, and
always on top of his work', writes one of his colleagues, Dr Hollis; 'there
was never any sign in him of bitterness or fatigue ... His attitude to his
research-work seemed to be a combination of humour and seriousness.' Here,
too, is what Professor Cruickshank thinks: cHe
tolerated, and was probably amused by, sophistication in life, and by the
kind of intellectual philosophy in which Almroth Wright indulged. Although
he took little part in argument, one gets the impression that, even in his
early days, his opinion was greatly respected.' His own infrequency of
speech did not at all depress him. He liked listening. It was one of his
strong points. Wright's tremendous personality dominated the scene, but the
tranquil Fleming, for ever at his side, was loved and esteemed.