THE

PENICILLIN MAN

The Story of Alexander Fleming

by

JOHN ROWLAND

LUTTERWORTH PRESS

LONDON

By the same Author:

Biography

ONE MAN’S MIND (S.C.M. Press)

GEORGE STEPHENSON (Odhams Press)

ERNEST RUTHERFORD {Werner Laurie)

Science

UNDERSTANDING THE ATOM (Gollancz)

ATOMS, ELECTRONS AND RAYS {Elek)

THE ASTONISHING ATOM (E. J. Arnold)

THIS AGE OF SCIENCE {E. J. Arnold)

ATOMS WORK LIKE THIS {Phoenix House)

MYSTERIES OF SCIENCE {Werner Laurie)

EPICS OF INVENTION {Werner Laurie)

Grade Level and Copyright

Grade Level is 9.3 using the Flesch-Kincaid readability test with sample chapters.

First edition published by Lutterworth Press, London, 1957, and Roy Publishers, New York, 1957.

Electronic edition published by Ebooks for Students, Ltd., 2023.

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To

J. F. B. ROWLAND

and his friends at Varndean Grammar School, Brighton

Table of Contents

FOREWORD

CHAPTER ONE: BRIGHT BOY

CHAPTER TWO: IN THE OFFICE

CHAPTER THREE: MEDICAL STUDENT

CHAPTER FOUR: BACTERIOLOGIST

CHAPTER FIVE: EARLY DISCOVERIES

CHAPTER SIX: WAR

CHAPTER SEVEN: WORK AND MARRIAGE

CHAPTER EIGHT: PENICILLIN’S ANCESTOR

CHAPTER NINE: THE GREAT MAN

CHAPTER TEN: PENICILLIN

CHAPTER ELEVEN: YEARS OF WAITING

CHAPTER TWELVE: PENICILLIN COMES INTO ITS OWN

CHAPTER THIRTEEN: THE TRIUMPH CONTINUES

CHAPTER FOURTEEN: MAN OF FAME

CHAPTER FIFTEEN: BACK TO DARVEL

CHAPTER SIXTEEN: LAST YEARS

FURTHER READING

FOREWORD

BIOGRAPHIES of men of action are perhaps easy to write; they are very often easy to read. Soldiers, explorers and the like lead lives that are exciting even to the most ordinary imagination.

Men whose lives are spent in the scientific laboratories are, perhaps, not so obviously exciting for the reader. Yet the work that they do may be of far greater importance, in the end, than the work of the soldiers or the explorers. For the discoveries of the scientists have an effect on the lives of every one of us; and from those discoveries have come all kinds of things, from plastics to new drugs, from brilliantly-coloured dyes to atom bombs.

This book tells the story of a very great man. Sir Alexander Fleming did not have a life which was outwardly very exciting. It was spent almost entirely in hospitals and in laboratories. He went from his home to his laboratory each morning; he went from his laboratory to his home each night. He sat in front of the fire and talked to his wife. He taught his son to swim and to fish. It was a life that, as far as one can see, looking at it from the outside, was not very different from the life of the bank manager or the office worker.

It was, however, very different when we begin to look at it from the inside. For the great work that Sir Alexander did was done for the benefit of sick men and women. His discovery of penicillin did more to help suffering people than anything else for centuries.

In this book there is an attempt to make such a man’s work plain for all to see. There is an attempt to make understandable to the young reader the way in which doctors and scientists set to work. There is an attempt to make clear the long process of discovery which went on before penicillin became a normal article which doctors prescribe nowadays almost without giving it a second thought. Here is the story of penicillin and of the very great man who made its use possible. Here are no battles, except the battle against disease—but that is perhaps the greatest battle of all. Here is no exploration, except the exploration into the secrets of Nature—but that is perhaps the greatest exploration of all. Here are no searchings after mysterious clues in the manner of the great detectives, except the tiny clues of germs which can be seen only under a microscope—and they are perhaps the most elusive clues of all.

So if it seems that this book has not the breathless excitement of a book written about a man of action, it should not be forgotten that the men whose lives are lives of quiet thought have their excitements too. And without them human life might never be improved as it undoubtedly has been improved over past years. Without them we should not have the lively hopes which we all must have about future possibilities in the years ahead.

CHAPTER ONE

BRIGHT BOY

THE BOY LEANED over the edge of the stream. He was lying down, flat on his stomach, on a large boulder that projected out into the slow-moving water. His coat, neatly folded, lay on the bank behind him, and his shirt sleeve was rolled up above the elbow. Behind him rose the tall, bald dome of Loudon Hill—a hill which had been the background of his short life; on its slopes he loved to roam. But now it was not the beauties of his Ayrshire home which interested him. All his interest and all his attention was riveted on the stream which lay only a few inches from his eyes. He watched with complete intentness a hole in the river bank which twisted underneath the stone on which he was lying. In that hole, he was sure, there lurked a trout, and probably a big one.

Young Fleming sometimes went fishing in that stream; but more than fishing with rod and line he enjoyed the skill of what he was now trying to do—the skill of catching a trout by hand. It was early in the morning and his mother was not yet out of bed. He had got up at five o’clock, had quietly dressed and had crept out of the house to this place. He had marked down the hole a few days before; it was the sort of place where the trout might often be found. And a fresh trout, especially if it was a big one, was just the sort of thing that would make a tasty dish for breakfast.

He moved his hand into the water, slowly, patiently. It scarcely disturbed the smooth surface. He knew that if he caused the least splash the trout would be out and away, and then it would be good-bye to the tasty breakfast on which he had set his heart. If he could get his hand on the fish, though, he knew that he would be able to land it.

His hand was moving almost imperceptibly towards the lurking fish. Now he knew the crucial moment was drawing near, the moment when he would either catch the fish or lose it; he held his breath with excitement as he leaned further and further forward, reaching his arm deeper and deeper into the stream. At last he got to the mouth of the hole in which he was sure that the fish was hiding. He slipped his hand quickly into the recess under the stone. Now the fish would know what was happening and would begin to fight. He felt the slippery skin of the trout under his fingers, felt the fish begin to squirm and wriggle under his grasp. Quickly he tightened his grip, joined his left hand to the right, and with a sudden heave pulled the fish out of the water and rolled over on his back on the stone.

He had got it! It was a beauty! Two pounds if it was an ounce. This was a prize indeed, and, even though his shirtsleeve had slipped down in the struggle and was now wet to the shoulder, young Alexander Fleming did not worry. He knew that his mother would welcome this addition to their diet, as she always did when he brought a fish home.

Carefully laying the fish on the river bank—it had stopped struggling now—young Fleming rolled down his shirtsleeves. The right sleeve was certainly very wet. He grinned and shrugged his shoulders as he struggled into his coat. Then he picked up the fish and set off, whistling, for home.

Home was Lochfield Farm. His father was only a tenant farmer, renting the place. Sometimes he found the rent difficult enough to pay. Those Ayrshire hills—rising above the little town of Darvel—did not produce very good crops. The soil was shallow and stony. Lochfield Farmhouse was a low, stone building, at an altitude of eight hundred feet, and it was here that Alexander Fleming had been born in 1881.

As long as he could remember anything Alexander Fleming could recall being fascinated by all the work of the farm. The place was too high to grow wheat, so that the main crop of grain was oats. Root vegetables were grown too, to provide winter food for the fine Ayrshire cattle. Sheep-breeding, and the sale of eggs and butter made in the cool dairy behind the farm, were the main source of livelihood for the Fleming family.

At Loudon Moor, in a tiny village school, Alexander had started his education. Marion Stirling, the young Scots girl who taught there, had found him a bright beginner, when he entered the school at the age of five. There were only, as a rule, about fourteen or fifteen boys and girls in the school, and the teacher knew them all very well. Alexander was by no means the first of his family to enter the school, because he was the youngest of all Farmer Fleming’s children. His father had married twice; there were four children of the first wife, and four of the second. And Alexander, as the baby of the family, had always had older brothers and sisters to keep him in order and tell him what to do and what not to do—not always what a small boy likes, but maybe something which is good for him, for all that.

The farm was his life. Hugh Fleming struggled to keep it going. There were in those days, of course, no tractors and none of the machines which were to be so useful to farmers seventy or eighty years later. The thin soil had to be cultivated by means of horse-drawn ploughs, pulling their way with difficulty through the stones and rubble which lay not far beneath the surface. But young Alexander, when he was only four or five years old, had already learned the joy of walking behind the plough, even when his little feet stumbled over the uneven furrows as he peered into the sky to see the white gulls wheeling over the new-turned earth.

“That young Fleming,” Marion Stirling had said, when he had only been a few days at the school, “that young Fleming will get somewhere before he’s many years older.” When Marion Stirling said that she could not, of course, foresee the day, many years ahead, when “young Fleming” was to be world-famous, and when she, in her old age, would write him a letter to remind him that she had given him his first lessons. But when he was very young—at the beginning of his school life—he was already known for his bright and cheerful ways. He watched everything with a bright and observant eye that was alert to all the changes and chances of the Scots countryside. Robert, his brother, later said of him: “He learnt things easily even when he was a small boy.”

It was especially with the things of Nature that he was interested. Now, as he made his way back from the trout-stream, the big fish dangling from his hand, he stood for a moment on a high projecting rock. He looked at the blackfaced sheep as they roamed slowly in search of new pasture, he glanced rapidly at the birds which wheeled and flew from point to point, disturbed by his early presence. He remembered how, with the changing seasons, the heather was growing more and more purple. And he looked forward with eager anticipation to the time, now not so far ahead, when the snow would cover the hills and his home-made toboggan would speed down the slopes. And then, he thought with a smile, there would come another spring, when the snows would melt and the little stream in which he had caught the trout would become a muddy torrent, rushing down the valley.

His world was a free and open place. There were no motor-cars. Up on the hills everything was quiet, except for the sounds of Nature. And only on Sundays, when the pony-trap took the Fleming family to Darvel to go to church, did he leave these country scenes.

He scurried home now, only pausing for a moment to look at a snare which he had devised and set under a bank, but to see that it had not this time caught a rabbit. Then he reached the farm-house and hurried into the kitchen, to find his mother just about to start with the preparation of breakfast.

“Look, mother!” he said in his high, piping voice. “See what I’ve got!”

His mother smiled. “What a whopper!” she said. “So that’s what you’ve been doing. I wondered what had happened to you when I saw you were not in your bed.”

He had plenty to do before he set off for school. His wet shirt had to be changed, and then a dish of trout, beautifully cooked, lay on the table before him. Alexander, his appetite whetted by all the exercise of the last hour, set to with a will, and then prepared for school.

A long mile over the fields he had to tramp, with his sister Grace and his brothers John and Robert. Loudon Moor school was a little squat building. There was only a single classroom. There was no need, when the Fleming family arrived, to have a roll-call, for a glance around the children showed who was present and who absent. The class was more like a large family than a school; and yet those who, like Alexander, were keen to acquire knowledge could get on quickly, because Marion Stirling and her assistant, Martha Aird, who ran the school between them, could give each boy and girl just that individual attention that they needed.

Alexander had started at the school at the age of five. His work at once attracted the attention of his teachers, because the same lively, bright mind that enabled him to catch trout with his hands, or make snares for rabbits, helped him to pick up the simple ideas of reading, writing and arithmetic which were the basis of the school’s work. For two years he went on happily there, steadily learning and improving in his knowledge of many things.

But then there came what might have been a real calamity.

His father died, and had it not been for Alexander’s elder brothers the Flemings might have been compelled to give up the farm. But Hugh, the eldest brother, took over the tenancy and, aided by the wise counsel of Mrs. Fleming, continued to run it. Alexander missed his father—missed especially the friendly chats and the occasional games in the winter evenings when the work of the farm had to be suspended.

In spite of Mr. Fleming’s death, however, the work of the farm went on; and still Alexander, in all weathers, tramped over the fields to school.

As the children grew older, however, they soon got beyond the skill of their village teachers. There were limits to what could be done by the two young girls who taught there, and so the Fleming children, one by one, left. First John, then Robert, moved to the bigger school in Darvel, four miles away. And when he reached the age of ten—three years after his father’s death—it was Alexander’s turn to join his brothers there. There was now a four-mile walk along the road to Darvel each morning, and a four-mile climb up the hill to the farm when coming home from school in the evening. In the spring and autumn the gales howled around him, in the winter the crisp snow crunched noisily under his feet. Sometimes the hill-drizzle penetrated his thick coat and made him soaking wet. But none of these changes in the weather worried him very much. He would sit in front of a huge glowing fire, made out of the peat which was dug from the hill-side, and allow his clothes to dry.

Mr. Corrie, the headmaster of the school at Darvel, soon found that Alexander’s first teacher had not been in error in thinking him one of the bright boys of his generation. The boy found that school work continued to come easily to him and that he had not to slave in order to get on in class. He was interested in everything that went on in the place.

His activities at home became more interesting for him too. He said, many years afterwards, that those of the boys whose homes were high up on the moor thought themselves really superior to those who lived in the town, because they knew all sorts of things which remained mysteries to the townsfolk. They knew how to climb safely and surely over difficult rocks; they knew where the peewits’ eggs were hidden; they knew (as he had known for a long time past) how to “guddle” for trout in the mountain streams.

All this, of course, was very much the normal life of the country boy anywhere—but Alexander Fleming, even at ten years of age, was a good deal more than an ordinary country boy. His brother Robert once said of him in those days: “He was always thinking something up, and if it didn’t work, he lost no time in discarding it and thinking up something else.”

It may be that those who had sense and foresight might have seen, even in those early days of boyhood, that Alexander Fleming had it in him to become a great scientist. But outwardly he was just the cheery Scots lad, doing his tasks at school, but apparently much more interested in birds’-nesting and catching fish.

He was by now beginning—as every son of a farmer must—to play his part in the general work of the farm. He helped in the summer months with the cutting of the peat, which was stacked against the walls of the outhouses for use in the long dreary months of winter. He took out his collie dog for long tramps across the hills behind the farm—tramps which might have seemed to some people aimless enough, but which were often intended to help the others to keep an eye on some of the sheep which might have wandered too far away from their pasture. Always in the background of his life were the hills and the streams, the valleys and the heather-clad moors, which were to mean “home” to him all through his life, even when he was working in a great hospital in London many a long mile from a hill or a country scene.

Alexander Fleming was at Darvel School for only two years. But during those two years he began to learn all sorts of things which had not previously come to him—Latin, French, more advanced mathematics. Mr. Corrie was not the warm, friendly type of teacher; he was in many ways different from Miss Stirling; but he knew well enough how to put the rudiments of knowledge into the minds of his many pupils—and the love of knowledge for its own sake into their hearts.

Part of the task which was carried out by Mr. Corrie’s school was the preparation of the brighter boys for bigger and more advanced places of education, and in this too it was very successful. It was when he was twelve years old that it was settled that Alexander Fleming should spend a year or two at the Kilmarnock Academy, which was then a very famous school indeed. Kilmarnock, however, was sixteen miles distant from Lochfield Farm—and the school was normally a day school, not taking boarders. It was clearly impossible that a boy of twelve years of age should travel sixteen miles from home, before starting his day’s work at school, and then another sixteen miles on his homeward journey, when that day’s work was done. For one thing, the nearest railway station to the farm—a station called Newmilns—was six miles away. He had been able to walk the four miles to Darvel day by day, but the six miles to Newmilns would be much worse, as well as being longer— for when he got there he would be dependent on railway time-tables, and the trains were slow and infrequent.

So at the age of twelve Alexander left home and went to lodge in a house in the town of Kilmarnock. It was his first experience of town life, though he still came home to the farm at week-ends. During the school terms, then, he tramped from Newmilns station to Lochfield Farm every Friday evening. Every Monday morning he would get up at an unearthly hour (usually in darkness except in high summer), would climb his six miles over the hills, often through rolling mist or over frozen snow, in order to catch the train and be in his place in the classroom as soon as school started.

The railway system of Scotland was then by no means complete; there were many places without an adequate train service or without railways altogether. Many a young boy had to walk distances to and from school which would appal a boy in the twentieth century. Yet at the same time the sense of interest in all that was going on around him in the countryside kept Alexander Fleming’s senses alert, even when he was tired at the end of a week’s work. He would hear the owls hoot; he would see them sometimes descend suddenly to snatch a mouse or a young rabbit. And the change from the hilly countryside to the big school in Kilmarnock, a school where there was a system of frequent tests and examinations designed to keep all the boys well and truly “up to scratch”, made his life pleasantly varied. There is something to be said, he soon came to see, for having a life which presents contrasts and differences.

In the years ahead Alexander Fleming was to pass many an examination, and he owed much of his skill in dealing with difficult papers to the training which he had at Kilmarnock.

His time in his home country was, however, now fast coming to an end. Only for eighteen months, in all, was he to attend Kilmarnock Academy. And then the change in his life was perhaps the greatest that could possibly come to any boy, whether from remote Ayrshire or from equally remote Cornwall at the other end of Britain.

His brother Thomas had studied medicine at the University of Glasgow and after practising as a doctor for a while in Scotland, had, like so many ambitious young Scotsmen, gone to London to seek his fortune. In the end he had set up as an eye specialist in the Marylebone Road, where he had been very successful. Scots doctors are proverbially reliable, and Thomas Fleming was no exception to this rule. It is usual for Scots who think they have a good future in the profession of their choice to come to London, and often relatives follow such successful pioneers. So when once Thomas Fleming had established himself he brought his brothers, one by one, to the great city so that they too might establish themselves there and make a better living than they thought would be possible in the peat and heather of the Ayrshire moors.

There were (and still are) many people who lament this; there were (and still are) many who feel that it is a pity that so many of the brighter country lads are tempted to look for jobs in the great cities and towns. But it cannot be denied that there are hundreds who have done this, impelled by some ambition which, perhaps, they cannot even define, and as a result have been able to do much valuable work for humanity which they would not have done if they had remained in their home district.

If Alexander Fleming had remained all his life in Ayrshire he would, no doubt, have been a farmer. There is no denying that, with his bright intelligence, he would have been a very good farmer. But in that case penicillin might not have been discovered, or might have been discovered many years later. Who can say, therefore, that when Alexander came to London in 1895—he was about fourteen years old—that it was not in every way a good thing, for himself and for others, that he left Ayrshire?

CHAPTER TWO

IN THE OFFICE

THE CHANGE FROM the countryside—or even the large country town—to London is the greatest change that can ever come the way of a bright boy. Alexander now left far behind him the bare moorlands which had been the background of his life; he almost forgot the guddling for trout, the searching for birds’ nests, and his feet forgot the feel of the soft turf and became accustomed to the hard, stone pavements of the London streets. Gone now was the sound of owls and sea-birds; in its place, day and night, was the roar of the never-ceasing city traffic.

He came to London, indeed, at a very interesting time in history. Queen Victoria had been on the throne for very nearly sixty years. England was an extremely prosperous place. There were, of course, poor people to be seen in the streets, in spite of the prosperity—and to begin with the contrast between the very rich and the very poor bewildered Alexander and worried him. In his brother’s surgery in the Marylebone Road he could see all classes of people, rich and poor alike, and the changes and contrasts in the crowds which filled the streets made the boy open his eyes wider and wider as he walked about in his hours of leisure.

At first he continued in London the studies which he had started in Scotland. His time at Kilmarnock Academy, as has been seen, had given him a habit of study, a habit of looking forward to examinations ahead; and when he went to the Regent Street Polytechnic, where his brother Robert was already a student, he found that his earlier work stood him in good stead. Indeed, the tasks on which the boys were engaged were little if any more difficult than the tasks which he had himself been doing two years and more earlier. He found the work at the Polytechnic, therefore, not as interesting as he had expected, because a bright boy, if he is to get out of schooling all that he should, has to have work which is enough to extend his brain and make him use it to the fullest possible capacity.

When Alexander reached the age of sixteen he was to all outward appearances no further on in life than he had been two years before. He was then living in York Street, just off Baker Street, where Thomas had taken a fairly big house, and where one or other of the Fleming sisters was usually in charge of the domestic routine, the cooking and cleaning and washing which is necessary if a home is to run at all smoothly.

Alexander was—it almost goes without saying—fascinated in all that was going on in London. He took part in many little adventures, wandering happily around the London streets and watching the ever-changing panorama of the traffic. He had always been a very good friend of his brother Robert, and it was pleasant to have him for a regular companion in these new and startlingly different surroundings. But all the same Alexander grew more and more dissatisfied with his schooling in London; he felt that it was really getting him nowhere at all. And he felt, at the same time, that he was a bit of a drag on his family, having now reached the age of sixteen without having earned anything to help with the family’s budget. Thomas was earning enough money out of his medical practice not to worry if he had another young brother to feed; but Alexander was of an independent turn of mind and did not like to feel that he was cadging from his brother.

John and Robert, two of the brothers, were studying for the opticians’ examinations of the Worshipful Company of Spectaclers, a body which existed largely to train young men in the profession of making spectacles. In the end, indeed, these two set up one of the leading optical laboratories in Great Britain and succeeded in making a considerable name in the optical world. But in those early days of the 1890s all this was in the unknown future. All that Alexander felt in his heart was that his brothers were going ahead, that they knew just what they intended to make of their lives, whereas he was left plodding away at routine studies, not very effectively and without much idea of what sort of a career he was going to carve out for himself when he grew up. He wanted to earn a good living, so that he should no longer feel that the charity and goodness of his relatives were keeping him going. But he had—so he thought at this time—no special skill of his own which would enable him to take on some special profession or occupation.

“I’ve got to do something,” he said to Thomas one day, when these ideas had been worrying him for weeks on end. Thomas, now a highly skilled doctor with a rapidly-growing reputation, had opened a new surgery in Harley Street, the home of the most famous doctors in the world, and was actually not at all worried by the fact that his sixteen-year-old brother was not yet in a position to earn his keep. He told Alexander as much, and added, with a kindly smile, that he would be quite happy to continue to contribute towards his young brother’s education for some time to come.

Alexander, however, was already a young man of considerable spirit and with a very real will of his own.

“No,” he said firmly and emphatically. “I want to earn my own living, make my own way in the world somehow. And to do that I shall have to get some sort of employment right away—get a job that will bring in some money, even if it’s not very much at the start.”

Again Thomas smiled. “And what,” he asked, “is it that you are proposing to do?”

Alexander was forced to admit that he really knew very little as to how he was to make a living in London. All his knowledge about the methods of farming in Scotland was, of course, completely useless in a city background; but by this time he was so fascinated in London by all the colour and rapid movement of city life that he felt he could not calmly go home again to resume the quiet activities of the farm, which had been his whole life for so long in the past years.

He tried for various jobs of many different kinds; and in the end he got a post as a junior clerk s of a shipping company in Leadenhall Street. To many people it may have seemed to mean dull enough work. He sat on a high stool in a back room, he entered in huge heavy ledgers details of cargoes which were coming into the Port of London from all over the world—tea from China and Ceylon, metal ore from Scandinavia and Africa, cocoa from the Gold Coast, tobacco from America, even diamonds from the South African mines. But Alexander did not find it dull; he had a lively imagination, and he was able to see in his mind’s eye these ships, coming into London from so many far-distant lands, and often carrying cargoes which were colourful and exciting and romantic.

His wage-packet was small—a good deal smaller than he would have wished—but most things were not very expensive in those days. It was possible for him to contribute a little towards the cost of running the big house at Ealing, on the outskirts of London, which the family had now rented. His mother, too, was now living there, and so the Scots family were happy to be reunited in a pleasant house in a prosperous London suburb.

Another new interest soon came his way, too. He joined a regiment of part-time soldiers which was called the London Scottish Volunteers. This gave him a happy leisure-time occupation. He did not get any sudden promotions, remaining in the ranks as an inconspicuous “Pioneer” (as the privates were called), though he soon became a first-rate shot and more than once represented the London Scottish at the great shooting meeting at Bisley, where in a few years he won several prizes.

Alexander Fleming had always been keen on an open-air life. While he had been attending the school at Kilmarnock, it had not been too difficult to get out to the country whenever his studies allowed him a few hours free. But when he had come to London this had seemed to be more and more difficult, and Alexander had often chafed under the restrictions which seemed to crowd in upon him more and more as the days passed by.

His part-time soldiering, however, gave him many new interests, and he was soon taking part in many sports and games, quite apart from his shooting at Bisley and elsewhere.

He represented the regiment, for instance, in water-polo matches (he had always been a good swimmer), and one day he was in the team which was opposing a team of students from St. Mary’s Hospital at Paddington. This was something that was soon to have a very great influence on his future, although at the time it did not seem to be anything more than just one water-polo match among many others in which he took part.

Sometimes, when he was sitting on his office stool, totting up long rows of figures, or when he was taking messages from his shipping company to the so-called Baltic Exchange, which dealt with the details of all the trade with the Scandinavian countries, young Alexander thought that he was (in spite of its background) in a dull and dismal job which meant that never again would life bring him anything worthwhile.

Yet somehow he stuck it out. His superiors never had the slightest complaint about the quality of his work. They always considered him to be a conscientious worker, taking trouble over even the dullest routine task, being careful not to make mistakes in his entries in the great ledgers, and never shirking the slightest detail of any job which might be given to him.

This was, in fact, an example of something which is often seen—a man who is in the end to be a very great man indeed in his own special line, showing himself to be really painstaking and careful in something which is quite definitely not his own special line.

If he had stayed with the shipping company in the City of London, indeed, it is probable that he would in the end have risen to a high position in the business world, because it is not easy to think of Alexander Fleming ever being content to settle down for life in a routine clerkship. He was gradually mastering his job, learning more and more about shipping and cargoes and loading and unloading. He was given more responsible tasks to do and was getting the respect of his chiefs.

But he was not to remain in that office for very long. He had started of the shipping company in the year 1897, when he was sixteen; he stayed there until early in the year 1901, when he was about twenty. Then it happened that a distant relative died and left him a legacy. The sum was not large, but it was enough for him to keep himself in moderate comfort, if not in luxury, for three or four years. He might, of course, have invested it, when it would have brought him in a small amount of money for the rest of his life. And those who thought of all Scots as being canny and cautious would have expected him to do something of the kind. But he did not do this. The reason may have lain largely in a chat which he had with his brother Thomas, not long after the legacy had been left to him.

“It’s about time you thought of leaving that shipping office of yours,” Thomas advised him one day.

“But what for? What shall I do if I leave it?” Alexander asked quietly.

“Train yourself for something better. You’ve got the money to keep yourself now, and to pay for training of any sort that you fancy,” Thomas said.

“Train for what?” Alexander objected. He was like a good many young men in that he had all kinds of ideas of what would be pleasant and attractive jobs to do, but very little decided leaning towards any particular one. This seems a very odd affair when we look back at his career and see the great work that he did over so many years. But at the age of twenty, he has admitted, it was only the pressure, the pushing, the argument of his brother Thomas that really enabled him to make up his mind as to what he was going to do with his life.

“Why not train for medicine?” Thomas asked. As one who had made a considerable success in a medical career himself, he naturally thought at once of medicine as the best career for his clever but undecided younger brother.

“Medicine?” Alexander repeated quietly and slowly, almost as if he was talking to himself. It was an idea which had not previously occurred to him, but now, as he thought it over, it was an idea that seemed to appeal to him more and more.

“Yes; you’ve got enough money to do it in comfort, and you’ll find it a very much more interesting business than that dismal office of yours in Leadenhall Street,” said Thomas with a cheerful grin of encouragement. “You think it over; I’m sure that you will find that the more you think of it, my lad, the more you’ll come to like the idea.”

For the next few days after that conversation Alexander Fleming went about his work in a rather absent-minded way. His brother had put an idea in his head and set his mind working. He felt that he had to look around this from every possible point of view, to weigh up what was to be said in favour of it and what against.

He continued to do his work at the office, not slacking off and not giving any cause for complaint. But, almost suddenly, he found that his heart was no longer in the office , his interest was no longer aroused by details of ships and their cargoes, however exciting and romantic they might seem to be.

More and more he was thinking about the work of a doctor and wondering if he might soon be training for it. In his mind’s eye he could see the long, gleaming corridors and spotless wards of some great hospital, with himself dressed in a white coat, stethoscope carelessly flung around his neck, striding rapidly and efficiently from one patient to another, saying a reassuring thing to this sick person, feeling the pulse or taking the temperature of another. It was, he realized, a life which might be a very useful life—much more useful than writing down figures in heavy books or taking messages to shipping offices. It was, too, a life which might be expected to hold a good deal of drama and excitement from time to time—and what young man of twenty years of age does not relish the idea of an exciting life in the years ahead? The more he thought about the life of a medical man, the more he was attracted to it.

So it was only a few days after his talk with Thomas that he went to his brother’s surgery again. He found Thomas studying papers—details of the patients whose eyes he had examined—and frowning portentously over details of one test which had not come out just as he had anticipated. As Alexander entered Thomas put down the papers and turned to greet him.

“Well?” he said.

“I think that your suggestion that I might train as a doctor is a good one,” Alexander answered quietly.

“I thought you’d come around to it and agree with me when you’d had time to weigh it up,” Thomas told him. “There’s no life like it, and I’m sure you won’t regret it.”

“There’s only one thing,” Alexander went on, perhaps a little nervously.

“What’s that?”

“That’s to decide what medical school to apply to.”

Thomas considered this point in silence for a few moments. “Well, there are about twelve medical schools in London to choose from,” he announced. “I don’t know that there is really very much difference between them. They’re all good in their way. Some, of course, tend to specialize more than others on some line of their own, and if you had special leanings in one direction or another, I should suggest one of them. But if you haven’t got any special leaning to any particular aspect of medicine, it’s not at all easy for me to suggest which of the schools is likely to be best for you. As I say, there’s really not much to be said for one of the main schools rather than another.”

Alexander had listened to this somewhat glumly. It was going to be difficult enough to make a choice if his brother had really painted a truthful picture of the medical schools of London as he knew them. Then Alexander suddenly remembered a water-polo match in which he had once played.

“Is St. Mary’s at Paddington one of the best schools?” he asked.

“Yes,” his brother answered. “A very good school indeed.”

It was against the students of St. Mary’s Hospital that young Alexander Fleming had played one of his best water-polo matches; so he thought that he might treat this as a kind of omen for his future. It was the only medical school in London, in fact, of which he even knew as much as the name.

“I’ll write to St. Mary’s then, and see if they will take me,” he announced.

As easily as that—and on such an unlikely pretext as that— was Alexander Fleming’s future settled.

CHAPTER THREE

MEDICAL STUDENT

ALEXANDER FLEMING HAD always been good at examinations. He delighted at pitting his wits against the examiners, and all through his career he found the passing of examinations something which he could take in his stride.

His brother Thomas had pushed him into the starting of a medical career. But this was not enough by itself. Before he could gain entry to the medical school of St. Mary’s Hospital he had, first of all, to pass London Matriculation and then to sit for a hospital examination. But his ability at once became clear. He won the Senior Entrance Scholarship in Natural Science, and so began his career as a medical man.

His ideas of the spotless, neat and tidy hospital were, however, disturbed as soon as he entered St. Mary’s. The old buildings of those days (very different from the new buildings of fifty years and more later) were squalid and shabby. The wards were not well designed; they were dark and draughty. The lighting, both of wards and of laboratories, was bad; the furniture was rough-and-ready stuff, seemingly not designed to make it possible to sit down in comfort.

One of Alexander Fleming’s contemporaries, Dr. Carmalt Jones, said long afterwards: “We must have done some dreadful things, but we did begin to handle patients.”

The medical students were soon put in charge of the casualty department; when the victims of street accidents were brought before them, they quickly learnt to bandage wounds, to open abscesses and to do all the other routine work of the department. They also learned dentistry, pulling teeth often without anaesthetics, so that the patient (again to quote Dr. Carmalt Jones) had to “sit in an ordinary wooden chair and hang on and hope.”

And when the young doctors went out to attend to people in their own homes, it was usually in the poor streets behind Edgware Road that they found themselves—in houses where whole families lived in squalor in one room. Alexander Fleming learnt much in his career as a student. What he learnt gave him a sympathy for the poor people, the underdogs, which never wholly left him in later life.

He found that most of the work of a medical student came fairly easily to him. As in his school life in the various schools which he had attended, he found himself so interested in what he was learning that he learned almost without effort. He had a very retentive memory, and when he had been to a lecture on some quite abstruse point in medical research, he found that he managed to keep most of it in his mind without too much later reading.

Meanwhile, like all students who become popular with their fellows, he managed to keep up with all sorts of outside activities. He was in the shooting team, he played water-polo (though it is not recorded if he ever played against the London Scottish!), and he took an active part in the amateur dramatic society, which was one of the most popular societies in the hospital. In later years there hung on the wall of his laboratory a photograph which showed him with Lord Moran (afterwards a very famous doctor). They were both playing women’s parts in a production put on by this dramatic society.

Soon there was no doubt at all that in deciding to take up the study of medicine Alexander Fleming had found his correct job in life. While he was in no way merely a “swot,” he won almost all the class prizes which were given in the many and various subjects of a medical student’s career. His chiefs recognized that he was one of the star men of his day, and he was soon helping with various special lines of research which were going on in the hospital—efforts to understand the working of the human body.

The person who had the greatest influence on Alexander at this stage of his life was a research professor who had taken up a post at St. Mary’s Hospital in 1902. He was already well known and was before long to become very important indeed. Almroth Wright was a pathologist and took over the Department of Pathology, which studies many difficult problems in connexion with the bodies of human beings. He found it a very much neglected department of the great hospital. It was housed in a basement, slightly below street level. The microscopes which he and his assistants had to use all day long were frequently pushed out of focus by the rattle and roar of the Underground trains, for the busy line from Paddington to Edgware Road ran just beneath the hospital buildings. The rooms were dark and dismal, and Dr. Wright felt that he was being forced to work under conditions that made any sort of care and accuracy almost impossible.

He was a very forceful man, however. Before he had come to St. Mary’s he had proved that it was possible to prevent typhoid fever by injecting germs which had been killed by heat. This discovery had made him famous and he was now able to show that any development of it was impossible in the rooms in which he was expected to work. He grumbled incessantly to the hospital authorities, taking them down to his dreary basement, keeping them there so that they could feel the whole room quiver when an Underground train rattled by, and then asking them if they would like to do very difficult and specialized scientific work in such circumstances.

In the end he was given much better quarters on the second floor of the hospital, above the busy roar of Praed Street, and well equipped for the work which he was doing.

Dr. Wright’s line of thought—which was talked about by Fleming and most of the other students at St. Mary’s—was along the road towards preventing rather than curing diseases. He thought that it should be possible to inject into the blood stream of human beings substances which would attack the germs of disease and so prevent the men and women from becoming ill when the germs started to develop in their bodies. This was described as a method of making them immune from disease, and the new science of what came to be called immunology was Dr. Wright’s great contribution to medicine.

Fleming was not, after he had been at St. Mary’s for a year or so, at all sure that he was the right person to become an ordinary doctor, attending in a surgery for some hours each day, looking after sick people of all kinds, visiting in their homes those who were unable to get to the surgery, and doing all the routine work which every general practitioner has to do. He was interested in medicine—the prizes which he won during his student days prove that—but he was more interested in it from the point of view of research and discovery than in the day-to-day routine work of prescribing medicines and bandaging wounds. He saw, of course, a good deal of this kind of thing and he was never in any way uninterested in human beings, but at the same time he became more and more fascinated by the possibilities of scientific investigation of the problems of disease and its prevention.

So Dr. Wright’s development of the ideas of immunology was something which appealed to him more and more as time went on. There were doctors who had said that the whole secret of the cure of disease was to be found in the white corpuscles of the blood—what are sometimes called the phagocytes or leucocytes—and that these attack disease germs and so bring about a cure. Others said that the actual fluid of the blood was able to kill germs. There was a long argument about this which raged for years, but Dr. Wright was not completely convinced by the other side of the argument.

To begin with, Dr. Wright’s principal assistant in this piece of work was Dr. S. R. Douglas. They studied various diseases as patients at the hospital came in; they found that the matter was not entirely a problem of the phagocytes fighting the germs. The germs had to be in some way prepared before the phagocytes would swallow them, and this, they said, was provided by something in the fluid of the blood, which they called “opsonin”, from a Greek word which meant “to prepare food”. Bernard Shaw, in a play called The Doctor's Dilemma, where one of the characters was supposed to be a caricature of Dr. Wright (whom Shaw knew personally), described this as putting butter on the microbes so that the phagocytes would eat them.

Towards the end of his career as a student Fleming had been thinking about these problems very deeply. Many of the questions were still very much in the air. Practical confirmation of them was still lacking. But Fleming had been to many of Dr. Wright’s lectures; he had been impressed by the great man’s enthusiasm, and he thought that this was the life which he would like.

In one speech Dr. Wright had said: “We are not, in fact, making any effort worthy of the name to solve the problems of disease, and we have not in England any appreciable number of workers engaged on the task of medical research.” He went on, not very encouragingly: “A young man who proposes to take up medical research as his life work finds himself immediately confronted in his own person with those very fundamental and primitive problems of obtaining subsistence and clothes and a shelter over his head.”

This was not the kind of speech which would have been thought at all likely to make a young man decide that in the work of a research worker his life should be spent. There are few doctors who have taken up their task because it brings in a lot of money—and a doctor who takes up his job for material reasons is not likely to be a very good doctor— but if there is one direction in which less than an adequate income, a comfortable living, is to be made, then few are likely to follow that direction.

Alexander Fleming, too, was making up his mind on this problem at a time which most people find difficult. He was just preparing for his final examinations, on which he knew his future would depend. He cannot, looking back at the array of prizes which he had won, have had much doubt that he would pass. But all the same this was the one time in his life when he shut out external interests, dropped many of his sporting activities and concentrated on the sheer labour of learning all the routine things which his examiners would expect him to know.

Yet, when he had put his books on one side and sat before the fire in the house at Ealing, he would think about Wright’s fascinating work. And it seemed to him, more and more, that he should somehow manage to carve himself out a career in medical research.

Years afterwards, when he was asked to explain what had led him to take up such a career, which promised small enough rewards, in preference to the more obvious jobs in Harley Street, he would shrug his shoulders and say that it was just a matter of chance and that he just drifted into it. But there was no doubt to his later friends that he could not have done anything else with his life.

Dr. Wright, in his lectures, made it clear enough that everyone who wanted to take up research must be not only prepared to sacrifice a good deal in the way of comfort and money, but must be prepared also to take immense trouble to master scientific principles. Some people have accused the average doctor of doing things by rule-of-thumb, doing something because it was usual to do it that way, but Dr. Wright would have nothing of that. Everyone who came to work for him had to know exactly what he was doing and why he was doing it. The mind of a research worker, however unimportant his first tasks might seem to be, had to be trained for its own special purpose; only then was Dr. Wright satisfied that he had recruited the men he wanted.

It was as well that Alexander Fleming had been trained in the hard school of the Scottish countryside. He had never bothered about luxuries, and now, as he studied at home, or as he walked the wards, listening to some great doctor explaining the principles of dealing with a particular disease, he grew more and more certain in his own mind that it was in research that his future would lie.

He did not say much to his friends and fellow-students about this. He did not even talk about it at great length with his brother, who was now getting more and more known as an eye specialist of great skill. This was a decision which rested with him, and with him alone.

Fleming knew, as every student knew, what posts were vacant on the staff of the hospital. There were, of course, positions as casualty officers with the out-patients, there were posts as house surgeons and house physicians which would be interesting enough in their way, but which would lead, after a few months, or a year or two, to a practice somewhere in London or in a provincial town, where a young doctor could make a name, could become respected and honoured and even loved by his patients. By the time he sat for his degree Fleming’s mind was fully and finally made up. He was not going to become a doctor of the normal, straightforward kind; he was not going to be a junior partner in a group of doctors working in a provincial town; he was not going to start practising in the country, even though there may have been moments when he felt that he would like to go back to Scotland, among the folk he loved and in the scenes of his boyhood. When he remembered his Scottish boyhood and the hills of Ayrshire, this sometimes seemed to be an inviting prospect. But then he realized that he was not, after all, thinking of this because he liked the task of general medical practice; he was thinking of it because he liked to picture himself in a Scottish background, out shooting or fishing in his leisure hours, or tramping the Ayrshire moors to visit a sick man or woman.

Resolutely he put all these ideas behind him. While he was awaiting the result of his final examination he broke the news to his brother of what had so long been in his mind. He had told Thomas of the attraction he felt for Dr. Wright, his methods and his laboratory; it may be that Thomas had a pretty good idea of what this brilliant young brother was thinking of doing.

Then one day he said, “I’m applying for a job at the hospital, Tom.”

“Yes?” Thomas said quietly. “And what sort of job is it that you are after?”

“Bacteriologist under Dr. Wright.”

Thomas considered this for a few moments. “Well paid?” he queried.

“No.”

“Worthwhile, though?”

“Yes.”

Not much more remained to be said. Alexander Fleming, though he was quiet and gentle and with a sense of modesty and good humour, was always, throughout his life, the sort of man who, when once he had made up his mind on an important subject, could not be moved. Still a student, then, he decided that he was to find his future in research.

Bacteriology, in those days at the beginning of the twentieth century, was a science that was in its infancy. It dealt, as its name suggests, with those tiny specks of life called germs, or bacteria, which are the cause of many of the most unpleasant diseases from which human beings suffer, and they are so small that they can only be studied under the microscope. Dr. Wright had written a book called Principles of Microscopy. This became almost a Bible with Fleming, even in his student days, before he had really acquired the habits of the scientific investigator. And as the days passed by and he still waited for the result of his examination and the result of his application for the position of bacteriologist in the laboratory presided over by Dr. Wright, he looked at this book again and again.

Dr. Wright had laid down in his book various scientific rules as to the way in which the microscope should be used, and those rules, too, were rules that could be applied in all kinds of ways quite apart from in the use of the microscope. They were rules of how to try to discover the secrets of Nature, the secrets of the human body, the secrets of disease and health.

Alexander Fleming waited. He was not an impatient person; he was content to let each day look after itself. In the house at Ealing his mother and his brothers and sisters were much more excited than he at the results of his examinations, which seemed to be such a long time in coming.

And then at long last the result came out. He had passed with flying colours as everyone, naturally, had expected him to do.

In his old age he was to recall this in a sentence which almost tells the story of his life. “The day after I qualified in medicine,” he said, “I joined Wright’s laboratory. I have been there ever since.”

CHAPTER FOUR

BACTERIOLOGIST

WHEN DR. WRIGHT had started at St. Mary’s Hospital he had, as has already been described, been given some ramshackle rooms in a basement, rooms violently shaken whenever a train passed on the Underground railway. He had managed to get himself something a little better in the way of working quarters, so that when Alexander Fleming joined him the department was housed on the second floor, though it was still scattered and not easily worked. There were two large laboratories and several smaller rooms.

To most people outside the immediate circle of Dr. Wright’s helpers and admirers the whole thing was a little mysterious. Many thought that all this affair of injecting men and women with protective substances was a lot of nonsense, a kind of magical affair which could not be proved as having any value at all. Others thought that it was something so remarkable that it made Dr. Wright and his assistants the high priests of a kind of medical mystery. Actually it was neither of these things. Dr. Wright had thought of a new way of studying the reaction to disease of the human body, and he realized that people working on such problems needed a special kind of mind, a special way of looking at things.

It is sometimes thought that scientists are less exciting people than explorers or soldiers or others who lead an adventurous life. Yet a Wright or a Fleming, trying to track down and fight the germs of a disease, is really doing much the same thing as an explorer finding a way through a dense jungle, or a great soldier fighting fierce enemies. The difference is that the explorer and the soldier are carrying on a struggle that we can all easily see and understand, whereas the scientist is carrying on a struggle with forces that are inside Nature. Alexander Fleming once said that the greatest need for scientists was vision: “Unless they have vision, they can do comparatively little with their formulae.” And in his first days in Dr. Wright’s laboratory at St. Mary’s he began to show that he had the right kind of vision for a research scientist.

It was, he soon found, not enough just to collect facts—to show that of half a dozen patients suffering from a disease three recovered in a week, while the other three needed a month before they got back to normal. That sort of fact might be interesting in its way, but it was necessary to know why half the patients recovered so much sooner than the other half.

Dr. Wright had shown, before he came to St. Mary’s Hospital, that typhoid fever could be prevented from attacking a patient, and that this could be done by injecting the patient with dead typhoid germs. Soon he was trying out a similar scheme with other diseases, and it was here that Fleming rapidly became his most trusted and valuable assistant.

Almroth Wright was an enthusiast. He would talk about a scheme until he managed to persuade himself of its importance. Usually he was quite right, but sometimes he would persuade himself against his own better judgement.

One of those who worked with these two great men at this time has recorded something which shows, perhaps better than most things, the way in which they helped each other. Wright was, of course, much older than Fleming, and sometimes when his chief launched out on some new scheme Fleming would say: “It won’t work, chief.” Wright, like so many enthusiasts, would not allow himself to be persuaded. He would fight against such criticism and opposition with all his strength and would start all over again, explaining in detail just what he was trying to do. Fleming would let him argue and shout, banging his fist emphatically on the table, and then he would say quietly again: “It won’t work, chief.” Often he was forced to carry out the experiment, in spite of this. But usually it did not work, for Fleming was already getting a deep insight into the way in which bacteriology could be applied.

There is, after all, nowhere as good as a great hospital for a man wanting to study microbes. People suffering from almost all the known diseases were to be found in one or other of the wards. Specimens of blood could be taken and the germs in them studied under the microscope or by growing the bacteria in test-tubes, with suitable substances added on which they could feed. Out-patients, too, attended on most afternoons; some of them were very ill indeed; some of them had been more or less given up as hopeless, but still continued to come to the hospital in the expectation that something could be done for them. From them, too, specimens could be obtained which would be used.

Patients with any queer, obscure disease were usually sent to the bacteriology department in the hope that some sort of understanding of their troubles would be possible. From every patient that came some blood was taken. It was put into a tube and labelled. The blood was then tested, put under a microscope and examined. Sometimes, if it seemed likely that an injection would help, they were given an almost immediate treatment. Sometimes they were told to come back the next day, when their case had been further considered.

Usually Fleming spent an hour or two each day preparing microscope slides of the blood specimens, and often the research assistants used their own bodies in the experiments. Fleming on a number of occasions injected himself with one or other of the vaccines which were being tried out. One Saturday he injected himself with a vaccine. He records that on the Sunday he felt very ill, with headache and sickness. “Temperature on Saturday evening,” he wrote, “reached 101 degrees.” Fortunately everything cleared up by Monday evening. Others were not so lucky. Dr. Wells, investigating some obscure disease, caught it himself and died. Dr. Noon died of tuberculosis, which he had probably caught in the course of his duties in the hospital. These men were as much heroes as those who died on battlefields; but there was not the same kind of glamour about their heroism and they did not hit the headlines of the papers.

Often in the evening, when the day’s work was being summed up, something went wrong and they had to start all over again. No one left while there was work still to be done.

It was on his birthday in 1906 that Fleming actually entered the bacteriology laboratory as an assistant for the first time. Before that the workers there had, he estimated, been working for sixteen hours a day, and he records that there was written in the log-book of the laboratory: “Enter Fleming, exit sixteen hours daily.” But they were all to work sixteen hours daily for a long time after that. It was probably his love of the open air, his swimming and all the other exercises which he somehow managed to continue, even if only at week-ends, that enabled Fleming to work such long hours without any apparent effect on his health and strength.

The work he was doing, too, seemed to him to be rewarding work. He saw that all sorts of things were being cured which were previously thought impossible to tackle. Tuberculous ulcers of the neck—open wounds which refused to heal—were sometimes cured in a short time. One man who was thus cured was a down-and-out derelict from a London slum. He had nowhere to go, and he remained for years to work as a general servant in the laboratories. It was said that he always carried about with him the original note given him in the out-patients’ department, sending him to Dr. Wright and Fleming. “That,” he used to say, showing it to anyone who seemed likely to be interested, “was my life-saver.”

Over the whole department presided the tall gaunt figure of Almroth Wright. Distinguished people visited the laboratories—Bernard Shaw, gathering material for a play; Lord Balfour, who had lately been Prime Minister. Rarely can a young man have met so many famous folk as Fleming did in his first year or two in the laboratory. And most nights, round about midnight, there would be a meeting of a group who made a kind of unofficial debating society. There were men from many countries—Americans, Canadians, Scandinavians and Germans. They were drawn there, as if by a magnet, by the fame of St. Mary’s Hospital. Even though there were many talkative men, ready to argue and dispute endlessly, Fleming was generally content to sit in the background, listening and making mental notes of the things that were said. “It’s a pity,” he said once, “that I have not the gift of tongues.”

In spite of all this, however, he became involved in many an argument on paper. His name soon featured in various medical journals—and almost always in defence of Dr. Wright’s theories. It was in May, 1908, that his first paper published under his own name appeared in print. It was in a medical journal called The Practitioner and, like so much of his writing at that time, dealt with some of the problems of the white blood corpuscles.

It should not be thought that he was so absorbed in his work that his activities in the outside world had come to a stop. He still kept up his membership of the London Scottish Volunteers, and there is a photograph of him at the head of the line. In June, 1908, the London Scottish won a cup at Bisley. The day was very hot indeed, and the men had to march from Weybridge to Bisley, a distance of twelve miles, and then to shoot almost at the moment they arrived. As they passed along the road they saw many men who had fallen out from other teams, and at one point they found that all that were left of the Life Guards’ team had been completely overcome by the heat and were lying by the side of the road.

Even on this point Fleming was lucky. He remarked that it was a good example of the value of the kilt as a marching uniform. And actually this march to Bisley took place only two days before he sat for his final examination, and one of the questions set him was dealing with “the relative humidity of the air and its effect on human exertions.” Fleming himself admitted that he knew very little about this, but added that he told the examiners of “Saturday’s march, and compared the kilt with trousers, with the result that I got honours in the subject.” When he told this story in later life he used to explain that this was doubtless because the examiner was a Scotsman!

But all the time that he was working in Wright’s laboratory he found himself less and less able to spare the time for these outside interests. Somehow he made himself do some outdoor things—shoot and swim and play water-polo; but through the early years of his life as a research student he found it increasingly difficult to find the hours needed. Sixteen hours a day, as we have seen above, was his normal ration of work; and there are only twenty-four hours in the day—which must lead to the conclusion that he had only eight hours out of each twenty-four for his own affairs, including the time that he had necessarily to spend in sleep.

His friends were mainly the medical men among whom he was working, but there were some outside friendships. Ronald Gray, a painter, came along to the laboratory one day with a painful knee. He had been told to consult Fleming as one of Almroth Wright’s most brilliant men, and eventually invited Fleming to come to lunch with some friends. Fleming had examined the knee, which had a tubercular infection, and said simply: “I think I can help you”; in the end he cured the artist by a combination of injections and exercises. They became friends for life. It was an odd kind of friendship, because Gray was an artist with all the oddities of an artist’s outlook. He had known Carlyle, had grown up with Whistler and Oscar Wilde and other artists and writers of the 1890s. Alexander Fleming was his first friend in the scientific world, and for a time he did not quite know what to make of the quiet young Scot.

He admired Fleming’s power of dealing with the job in hand, of not bothering about what might lie ahead. At the same time, Fleming broadened in his way of looking at things as a result of his close friendship with the artist. Many people get too full of their own ideas, too keen on their own job, ever to take the slightest interest in something outside that job. A tendency of that sort is bad. It is a good thing to realize that there are many tasks in the world awaiting the human being who is best qualified to do them, and that it is nearly impossible for anyone to say that his task is greater in its difficulty or its importance than anyone else’s. The friendship of Fleming and Gray, which was to last nearly fifty years, until Gray’s death in 1951, did both of the men a lot of good, for it made each of them see the value of the other’s point of view.

A story which Gray used to tell was of a lunch at which Fleming was present, when George Moore, a famous novelist, started talking about the beauties of the Bible. Moore had lately been reading the book of Ezekiel, which he insisted on mistakenly calling “Ezkiel.”

Fleming, still looking at the food on his plate, quietly corrected the distinguished guest, “Ezekiel.”

“Ezkiel,” repeated George Moore.

“Ezekiel,” Fleming said again. Moore looked very taken aback at the double correction, especially since he himself was at this time a very well-known writer and the young man who corrected him was an unknown person, at any rate in the literary circles in which Moore moved. But Fleming could not be induced to budge. He did not see why he should give way on a point on which he was quite certain, no matter how famous was the man at the other end of the table.

Soon—mainly as a result of his friendship with Gray—Fleming was elected a member of the Chelsea Arts Club. Again we should probably think at first sight that such a young man would feel very much out of his depth in such company. But, in spite of his shyness, he was able to make friends with all sorts of people.

There was one occasion when Gray, who disliked the exaggerated style of some modern painters, persuaded Fleming to try his hand at painting in the then “modern” style. Fleming produced a picture of a children’s ward in a hospital, which Gray persuaded the proprietor of one of the London art galleries to hang (with a fictitious artist’s name), alongside some of the more fashionable artists of the day. It was almost like an exaggerated cartoon, but for a time the picture gave people pleasure. Journalists who wrote about the show praised Fleming’s picture as one of the most brilliant examples of the modern style. Then Gray told the truth about it, and the fat was in the fire. There was a tremendous quarrel with some of the professional artists who were showing pictures. But in the end Gray succeeded in calming them down.

All the time the work of the laboratories went on, though there were many little holidays and enjoyable times fitted in between the long spells of difficult and trying work. There was a week-end in a Dorset cottage, for instance, with a group of friends. While walking on the sands one evening the others realized that they were in danger of being cut off by the tide and at the same time saw that Fleming appeared to have vanished. They scrambled hurriedly up the steep cliff, hoping that nothing had happened to him.

When they got to the cottage they found him sitting by the fire, a book before him and a toasting-fork in his hand. He had noticed the tide coming in, had crept up the path, and had decided to have tea ready by the time the others returned. There was only one thing that had gone wrong. He had taken so long over the book that all the toast was burnt!

Such excursions were, however, few and far between. In 1909 he took the examination of the Royal College of Surgeons and was awarded his Fellowship—again something which was not wholly unexpected, since in his final examination for his Bachelor of Medicine Examination he had been awarded the gold medal. Long afterwards he explained that he had not really been very interested in this special qualification as a surgeon. Already his interests had moved over to the field of bacteriology. “But,” he said, “I felt that, having achieved the Primary (i.e., the first part of the F.R.C.S. Examination), it would be a pity to allow so much effort and expense to be wasted.”

By this time he was twenty-eight years of age—a very different person from the clerk in the shipping company’s office some ten years before. Now he had an aim in life, now he had an interest which was overwhelming, and he was sure that he would now be able to go on, studying and expanding knowledge, for the rest of his days.

CHAPTER FIVE

EARLY DISCOVERIES

THE LIFE OF a scientist in the great laboratories of a university or a hospital is very different, as Fleming soon discovered, from that of the traditional comic-paper scientist. He does not work in sudden spurts and starts, making revolutionary discoveries at long intervals, getting immense excitement out of them, and trying experiment after experiment until he succeeds in the key one which leads to the great discovery.

Indeed, Alexander Fleming had never really anticipated that it would be just like that. In his days as a medical student, walking the wards and examining patients, he had absorbed some of the outlook of the hospital, at the same time as he had got used to its routine.

His fellow-students had recognized him as one of the most brilliant of all the students. The hospital magazine in 1909 called him “one of Sir Almroth Wright’s most enthusiastic followers” and forecast for him very great distinction in the future—though it may be doubted if even the Editor of the St. Mary's Hospital Gazette at that time had even an inkling of the fame that was to come the way of Alexander Fleming in the years ahead.

For his first few months with Sir Almroth Wright, Fleming had prepared himself for research work. He had, of course, done a good deal of the duller routine for the men who were senior to him. He got used to handling test-tubes full of deadly bacteria with almost the matter-of-fact way in which a schoolboy handles test-tubes full of the simplest substances in his early days of chemistry. The technical side of bacteriological work, which some people found pretty dull stuff, he found fascinating. Many years later, when a journalist asked him what was the secret of success, he said: “If you ask me how to be successful, I would say ‘ Work, work, and work again’ .” And in those early days he proved that to be true.

One of his first pieces of research to lead to some sort of practical results concerned the not very painful, though distressing, disease called acne. This is a disease marked by a series of pimples, especially on the face. It is something which is often troublesome, and which in bad cases may go on for years. It does not hurt the patient; it is a very local affair. But those people who suffer from it are often worried by it—and a young man with acne finds shaving a very awkward and difficult business. Whenever a sufferer from acne came his way, as often happened in the out-patients’ department, Fleming took samples of his blood and tried to see if it was possible to prove that a particular germ caused the trouble.

He proved that this was so, but that the problem was a little more difficult than seemed likely. If a disease is due to a particular germ, it is often possible to inject into the patient some substance which will kill that germ, and the main trouble of the bacteriologist is then to find a substance which will kill the germ without in any way hurting the patient.

Acne, however, cannot (this was Fleming’s first real discovery) be treated quite so simply, because there are three different forms of the disease, each one caused by a different kind of bacteria. Proper vaccines are possible for each type of disease; but in order to decide which one is to be used in any particular case it is needful to have a specimen of the patient’s blood, and to examine it very carefully under a microscope, before deciding which of the injections should be used for that particular case.

The work on this took him some months. He worked day after day, and often late into the night, testing blood specimens, adding various substances to the specimens, and then watching them under the microscope to see if the germs died and disappeared. “We may take it as definitely proved,” he wrote in the Lancet, the famous medical journal, “that in localized infection, when one inoculates the patient with appropriate doses of a carefully prepared vaccine derived from the infecting organisms, one obtains a beneficial effect.”

This shows the way in which he had set to work. He found that when the germs were allowed to grow and develop in a test-tube under laboratory conditions it was possible to kill them (usually by heat) at a certain stage, and then the substance left was usable in order to deal with a large number of germs in another patient. It was not a complete and invariable cure, but it brought about what Fleming rather cautiously called “a beneficial effect”— which meant that at all events it was a step in the right direction.

It was in some ways typical of the young man in the bacteriological department at St. Mary’s that he did not start with an attack on one of the great killing diseases—tuberculosis or cancer—but on a comparatively minor thing like acne. He knew that it was necessary for a scientific research worker to walk before he tried to run.

It is perhaps best at this stage, in order to show the sort of thing that Alexander Fleming was doing, to quote a few lines from an article describing some research work, which he wrote in 1909:

A series of small test-tubes are made from a glass tube by drawing it off in a blow-pipe at intervals of one inch. . . . These tubes are set upright in some adhesive material (plasticine is most excellent material for the purpose), in two rows, exactly like a company of soldiers, drawn up in two ranks, each rear rank tube covering one of the front ranks. Each pair of tubes (one front and one rear rank) will now correspond to the sample of serum to be tested.

Fleming, as will be seen from that, was developing a lively way of writing, very different from the dry-as-dust style of so many contributors to the learned scientific journals. The comparison of test-tubes to ranks of soldiers is the sort of thing which would have occurred, probably, to no one else, and one can imagine him chuckling to himself as he wrote those words.

But his work on acne, and soon on other diseases as well, gave Fleming a new outlook. It came gradually into his mind, though it had long been in the mind of Sir Almroth Wright. It was the idea of immunization—injecting patients who were not necessarily suffering from the disease in order that, if they were exposed to an infection later, there might already be in the blood a substance which would fight the disease and so would prevent the illness from taking place at all. The greatest triumph of this kind of approach lay years ahead, when the once dreaded children’s ailment of diphtheria was to be almost wiped out by immunization of most of the children of Great Britain. But there can be no doubt that, many years before diphtheria immunization was even possible, Fleming had a glimpse of the direction in which his researches were leading him.

His days were not, however, always days of triumph. No scientist ever finds that everything he does leads to practical results. Sometimes things went wrong. Sometimes the unexpected difficulties kept him working long hours to no avail. And there were times when he went home to his brother’s house worried and troubled, to toss sleeplessly in his bed and wonder what he had forgotten to do, as some crucial experiment had failed to reach the desired result.

But if there were disappointing days, there were also exciting days—days when the results came right, days when some new kind of apparatus was necessary, and when it would suddenly become clear to Alexander Fleming just how to design it, how to make it work, and how to see that it produced the results that had for so long been eluding him.

In those early days (as he was often to say in years ahead) it was to Sir Almroth Wright that he owed everything. Rarely can there have been a young research worker so inspired by his chief. And, for that matter, rarely in the whole history of science can a great leader have thought to have recruited an assistant so capable of carrying out his instructions and extending the work which had been well founded and brilliantly begun.

Even when results were disappointing, Wright and Fleming never gave way to despair. Always, if things went wrong, they were prepared to throw their solutions down the laboratory sink and begin again. Always, too, they were conscious that what they did with the apparently simple, superficial diseases like acne might be applied in some way to the real scourges of humanity, the diseases which claimed thousands of victims. It was this thought more than any other that kept Fleming going through all kinds of difficulties and made him tackle many a baffling problem.

His brother, still working as an eye-specialist, was by this time certain that Alexander was the genius of the family. The way in which the young man went straight to the heart of some problem, and saw exactly what was needed, was striking.

The family now lived in a flat at Clarence Gate Gardens. Old Mrs. Fleming still looked after it. During his time at St. Mary’s Alexander began to think that there was something to be said for a policy of dealing direct with some patients. So, while he continued to work in the St. Mary’s Hospital Laboratories, he embarked on specialist practice as well, attending a surgery in the West End at certain hours on certain days.

He took this surgery with some misgivings, as the rent was more than—at any rate at first—he could be expected to afford. But he shared the consulting rooms with Professor Pannett, who had been a colleague and friend since student days, in 1902. Soon Fleming began to acquire a name with the public. Patients with difficult and obscure skin troubles came to him. His fame as the man who had done the most satisfactory work on acne was now spreading far and wide.

The result of this attempt to combine two jobs—his work at the laboratory and his attendance in Devonshire Place, where his consulting rooms were situated—meant that his leisure time got less and less. This is the sort of thing that often happens to a young man who makes a great success early in life. And so it happened that in April, 1914, he left the London Scottish Volunteers. He had been a member for many years; he had enjoyed the complete change of background that it brought him. He had fired for the King’s Prize at Bisley, and he always remembered the occasion when his team won one of the most important cups there.

Fleming was always a good shot; one of his friends has said that if he had had the time to concentrate on his skill with a rifle he might have become one of the greatest, most accurate marksmen that Britain has ever known.

He always recalled those days with his fellow-soldiers with pleasure. He remembered the swing of the kilt as the men marched out into the country; the great cheers at Bisley as they scored point after point. The friendliness, the comradeship of the London Scottish was something which seemed to him a really valuable thing to have possessed.

Sometimes when he was bending over a microscope late at night in the darkened laboratory at St. Mary’s Hospital; sometimes when he examined a patient in his Devonshire Place chambers; sometimes when he lay in bed at night and wondered why that work was not going as smoothly as expected—at such times he often longed for the freedom of spirit which he had found in the ranks of the London Scottish.

There was, however, a limit to what one man could do in one lifetime, and he knew in his heart that he had been right to give up this part-time soldiering and to concentrate on the one job in life that he could do supremely well.

But it was an odd fact that when he resigned from the regiment in April, 1914, the First World War was only a few months away. Yet it was a lucky thing for the world that he did. His regiment was mobilized at the beginning of the war. Two days after war broke out in 1914 he celebrated his thirty-third birthday, and soon his friends of the London Scottish were in their headquarters in Buckingham Palace Road waiting for the order—which they knew would not be long delayed—to sail for France.

Everyone who has ever been in the Army in time of war will know the weariness and the boredom of waiting for something to happen. The hours of waiting are in many ways a worse ordeal than the actual battles which have to be fought. And one of Fleming’s most interesting experiences in that tragic autumn of 1914 was to go to the London Scottish headquarters and talk to his old comrades. A series of talks on all sorts of subjects had been organized by the authorities, partly as an attempt to fight the boredom which was worrying so many of them. The talks were in part entertainment; but Fleming’s talk was of the greatest possible practical value as well. He spoke on hygiene—the importance of cleanliness, even in the mud and slush of the trenches. He gave great attention to something which was specially important in those days when infantrymen had to march everywhere—the care of the feet.

In a short time after this his friends went to France; many of them were killed at the famous Messines Ridge. It may well be that if Fleming had not resigned from the London Scottish a few months earlier he, too, would have lost his life there—and that would have been a great loss to British medicine. But he was reserved for something finer, since it was something, probably, that no other man could have done.

The bacteriological department at St. Mary’s was under no illusions as to what was likely to happen. Some people thought that the war would be a short affair—a few great land battles, a few great naval battles, and then it would be over. And such people thought that all that would be necessary would be to teach men to obey orders, to show them how to use weapons, how to shoot, how to manoeuvre big guns, how to tackle the thousand-and-one emergencies which happen in battle.

But the medical men knew that there would be other problems too. This was the first major war to be fought with modern weapons, and they knew that there were to be many dangerous wounds which would bring about what the doctor calls sepsis and the ordinary person calls “blood poisoning”. In addition to the actual wounds inflicted by the enemy, Sir Almroth Wright pointed out right at the beginning of the war, there would be the other troubles due to ordinary work of the Army—in particular the raw and blistered feet which would come as a result of long forced marches on bad roads.

“There is, in fact,” Wright said, “one sanitary policy for peace and civilized surroundings, and another for war and uncivilized surroundings.”

The average person does not think of this. When he thinks of a war, he usually thinks of the excitement and the dangers of great battles. He does not remember all the work that has to go on behind the lines, the work of maintaining food supplies and seeing that the fighting men are kept fit and well. He does not remember that the medical work of the armed forces is vitally important, because without the work of the medical men the fighting units would not be in a fit state to continue fighting.

The great danger, as Wright and Fleming saw it, was the wounds likely to be brought about by high-explosive shells. Few people nowadays will realize that the war of 1914-18 was the first war to be fought on a large scale where high-explosive weapons were widely used. High-explosive weapons, they knew, would be likely to bring about wound infections of one sort and another far more widely than the more primitive weapons previously used in warfare.

The Army Medical Service was hastily organized at the beginning of the war. It was the first time in the history of the British Army that the need for any kind of organized medical research was admitted, and what Wright had said about infected wounds was seen by the War Office to be good sense. Wright himself was made a colonel in the Army Medical Service. It was seen that there would have to be a casualty centre in France, and that some sort of system of bringing more severely wounded men back to Britain would have to be worked out.

Naturally, Sir Almroth Wright thought of his own hospital at St Mary’s as the obvious place for the wards to be organized to deal with severe cases. This was not difficult to arrange, and it was at Boulogne that there was set up a hospital and a research centre to deal with minor wounds, as well as the very severe cases which might suffer by being moved back to British soil.

If Wright naturally thought of his own hospital as the obvious place in London to deal with wounds, he naturally thought of his own assistants, with all the experience that they had gained over the years, as the obvious men to take on the posts which would soon need filling in this research organization. Some of the men stayed at St. Mary’s, some went to Boulogne, some spent part of the time at one place and part at the other.

Fleming, as the most promising man in the bacteriological department at St. Mary’s, was one of those whom Wright thought of as a first-line choice for this new Army organization, and very soon after the outbreak of war he went over to Boulogne to take part in the valuable and important work that was going on there. Except for occasional visits back to England, to see what was happening in the wards there specially set aside for severely wounded men, Fleming spent almost the whole of the war period in Boulogne. He started there when he was just over thirty-three years of age, a young man with ideas; he came back at the end of the war, when he was nearly thirty-eight, with many of his ideas confirmed and with a flood of new ones forming which were destined, in the course of time, to produce revolutionary results in world medical practice.

CHAPTER SIX

WAR

WHEN EVEN A scientist works from scratch he has to make do with what is given him. When Fleming arrived in Boulogne he found that the laboratories and research facilities were almost non-existent. Sir Almroth Wright had succeeded in getting a biggish house in the Boulevard Daunau, near the river. There he lived, and there he provided living quarters for a number of men, including Fleming, whom he brought over from St. Mary’s. Nearby they had an emergency laboratory which had been set up in rooms on the roof of the Casino. Fleming said that before this laboratory was fitted up they worked in two underground bathrooms which were periodically flooded.

But, even though the equipment was not what the English doctors had become accustomed to at St. Mary’s, the work was necessary, and it had to be started at once, however much might be lacking. Soon the Casino began to fill up with wounded men, most of them in pain and all of them wanting careful nursing and special medical and surgical treatment.

The casualties, too, were the kind of thing scarcely ever met with in peace-time medical practice. Bones were smashed to fragments by high explosives. There were pieces of shrapnel deeply buried in the torn flesh. There were all kinds of wounds which no peace-time doctor would see in a lifetime; and here they were coming in every day.

The greatest problem, Wright and Fleming soon decided, was a disease called gangrene. This is not easy to describe, but it really amounts to some part of the body (usually a limb) going dead and decayed while the rest of the body still lives. It was caused in most of the cases that they encountered by dirty wounds which had not been cleaned in time. In the very nature of the case, it was impossible to clean the wounds quickly when a man was wounded in the front line, hours from any really well-organized casualty clearing centre.

Medical science had, of course, developed a lot over the years, but to begin with these septic wounds, caused, as Wright had anticipated, largely by high-explosive shells, seemed likely to be too much for the Army Medical Service. The Director-General of that service said, almost in despair: “We have gone back to all the septic infections of the Middle Ages.”

The danger of gangrene, which was their greatest enemy, was that it would quickly spread. If a leg had become gangrenous a quick operation, amputating the leg, might save the life of the man infected. But the operation had to be carried out very soon after the gangrene had set in; otherwise the disease would have spread too far into other parts of the body for the operation to be successful.

To begin with Wright and Fleming were at their wits’ end to know what to do. Serious cases of all kinds were being referred to them for treatment, and most of these cases seemed to be too far advanced before they ever reached Boulogne for any treatment to be of any practical use. Sepsis—blood poisoning—was the basic trouble in nearly all the cases. That was a decision that they arrived at very soon. It was easy to come to such a decision; it was much more difficult to decide what sort of treatment was likely to be effective.

Night after night Fleming lay on his hard bed in the Boulevard Daunau; night after night he listened to the gentle lapping of the river against the wharves, and night by night he heard the quiet, muffled tramp of the soldiers, as they landed from the troopships and made their way to the railway station, to be transported to the battle-front. He thought of these men, moving in their thousands to places of terrible danger; and he wondered if, in a few short weeks, they were to come back to Boulogne, to face the same kind of ineffective treatment which was the best that, up to now, the Army Medical Service had been able to offer them.

It was no one’s fault that this had happened. The emergency had come so suddenly that no country was able to prepare for it. Wright and Fleming had foreseen the kind of problem that they would have to face. But they had not had time to work out a satisfactory way of dealing with thousands of dirty wounds, hundreds of cases of gangrene which had gone too far for an operation to have very much chance of success. It was a problem that would have to be solved; the tragedy was that it could not be solved quickly. It meant research, deep thought and much experiment. But it was very different from Fleming’s earlier work on acne, in that it was urgent. Pimples on the face may be a nuisance, they may cause a person to be shy and awkward in company, but they will not kill him. Gangrene might kill men in their hundreds, and even in their thousands, unless some treatment was soon worked out.

The way in which such problems had been tackled in the past was by means of substances usually called antiseptics—that is to say, substances which were likely to kill the germs of any disease which might make their appearance. This was, in its way, satisfactory in the clean conditions of a good hospital. The great Lister had shown in England the value of cleanliness; but how was this to be applied in case of war, where none of the proper conditions was present—where, moreover, there was a probability that any wound would be a very dirty wound which no antiseptic of the ordinary type could be expected to penetrate? That was the problem that Alexander Fleming faced.

He recalled that the great French scientist Pasteur, half a century earlier, had shown that diseases like gangrene did not start of themselves, that they were only produced by some kind of germ brought in from outside. Lord Lister, accepting this, had used various chemicals to clean wounds, and in many cases this had been satisfactory. What was called antiseptic surgery was used in all operations; instruments and gloves used by the surgeon were dipped in some strong substance like carbolic acid.

When Fleming had started as a student this was not as general as it had been a few years before. Antiseptic surgery was being superseded by what had come to be called “aseptic” surgery—instruments used in an operation were heated before use, with the idea that the heat would destroy any germs that might be present. This, too, was effective, but Fleming realized that it was really nothing new; heat had merely taken the place of carbolic acid.

Fleming himself described this in these words:

I can remember in the days when I was first admitted to the surgical wards as a dresser, there were always a certain number of septic wounds which we were instructed to dress with this or that antiseptic, which stood in jars around the fire, and which we were told possessed great virtue as destroyers of microbes in the wound. . . . The wounds were religiously dressed once or twice a day with these lotions, and, although it was obvious that the antiseptic did not kill all the microbes in the wound, we were always told that it would kill many of them, and so the condition would be better than if no antiseptic was used. We applied one substance, and next day the condition wasnt much different; and we did it again until eventually the wound got well. There was a great deal of faith in that sort of treatment.

The greatest scientific research workers are always those who do not take on trust everything that is said and done by scientists of a previous generation. Fleming was typical of this. If he saw that some form of treatment, which was thought to be effective, was really not doing its job, he was always asking himself if the whole thing was wrongly thought out and wrongly applied; and in his early days in Boulogne he came to see that these systems of antiseptic or aseptic surgery might be good enough to keep healthy the wounds of an operation performed in a great hospital under perfect conditions, but that it really did nothing at all to deal with microbes which were in a wound produced before ever a surgeon came to touch it. He studied the problem in a really scientific way; he applied antiseptics to some cases and not to others, and then kept careful records of the cases, to see if those treated with carbolic acid, say, recovered more quickly than those which were not so treated. Iodine also came into use early in 1915, when Fleming had been in France for some months.

The patients came to his hospital, having been treated with these antiseptics by Army doctors working in or just behind, the front-line trenches, and Fleming, not satisfied by merely taking records, now examined the wounds as a bacteriologist, in order to see if the microbes had really been killed by the antiseptics. He found some rather surprising things to have happened—things which he had not in any way anticipated. For one thing, he found there was a higher proportion of gangrene cases among those treated with carbolic acid than among those who had not been treated at all!

Iodine had no effect either way. The germs had not, to all appearances, been affected by it. But the treatment with carbolic acid, far from saving patients, seemed to be actually making them worse.

“Just because a product is labelled an antiseptic,” Fleming said, “doesn’t mean that it doesn’t do something else.” And he soon guessed what was happening. In the blood-stream, as he had shown years ago in St. Mary’s Hospital, Paddington (taking a lead from Sir Almroth Wright), there are corpuscles which attack germs. These phagocytes or leucocytes, as Wright had called them, devoured disease germs. And the antiseptics were in part destroying the phagocytes or diminishing their power. So the application of carbolic acid to a dirty wound did not prevent gangrene from developing, as had been thought—it sometimes diminished the power of the phagocytes more quickly than it diminished the power of the microbes; and then gangrene developed in cases where, if no carbolic acid had been added, it would not have developed at all.

“Chemical antiseptics,” Fleming put it, “may affect the natural defences.”

He tried this out in his laboratory in Boulogne. In a narrow tube he put blood, with some germs and one of the chemical antiseptics. In another tube he put blood and the germs only. He found that the gradual addition of carbolic acid to the second tube caused the germs, which had been diminishing in number, to become gradually more and more in number. It was therefore clear that antiseptics did not provide anything like the complete answer.

During this time Fleming had practically no relief from the pressure of work. In days gone by he had joked about working sixteen hours a day in the laboratory, but he had had his shooting and his water-polo and his other amusements to relieve the tedium which comes from time to time even in the most absorbing work. Now there was no relief. He got up early in the morning and swallowed a hasty breakfast. Then he was in the hospital laboratory all day, with only short intervals for meals, and when he got to bed, late at night, it was often with some unsolved question to nag at his mind.

The questions, too, were very nagging ones. The workers had not just to experiment, as doctors sometimes do, to find a particular drug which will be effective in curing a particular disease. That is often hard enough—like hunting for the proverbial needle in the proverbial haystack. But that was easy compared to what Wright and Fleming set out to do.

They had not merely to find a drug that would deal with a particular diseased condition in the human body. They had to try to find something which would destroy the germs of sepsis without in any way hurting the bodies in which those germs of sepsis were living. Also, with the lesson of carbolic acid beside them, they had to try to find something which would destroy the microbes and which would still leave the blood corpuscles alive and flourishing, able to attack and devour such germs as came into the blood-stream of the patient from outside.

“We have to understand the processes going on in the wound,” Wright insisted one day when they were arguing the question. It was during one of the very few slack moments that came their way. “We don’t yet understand them even in outline,” he went on. “We have to discover what goes on in the wound.”

To many less brilliant men it seemed almost impossible that doctors who had been working for years, either in the bacteriological laboratories or in the operating theatres at Paddington, could say that they did not know what was going on. Yet they were, they thought, on the verge of great discoveries.

In the Lancet in September, 1915, Alexander Fleming published his first account of the work that had been going quietly on in Boulogne, almost unnoticed by many. His article was called The Bacteriology of Infected Wounds. He pointed out something that had not been previously noticed—that in all cases bullet and shell wounds meant that the projectile (the bullet or the piece of shrapnel) had passed through the soldier’s uniform, and that meant that it had picked up mud or pieces of dirty cloth and buried these things deep in the wound itself. “It is common,” Fleming explained, “to find in these wounds pieces of clothing, sometimes of considerable size.”

This, again, is where the really scientific attitude of Fleming, as opposed to the “hit-or-miss” methods of some of his fellow medical men, is seen. He had decided that it was worth examining the clothing of some of the wounded men, in order to discover if microbes of some sort or another had certainly been pushed into the wounds in this way.

He examined the actual wounds for bacteria; then he cut off pieces of cloth from the clothes worn by the wounded men, being very careful to take these pieces of cloth from some place far away from the actual wound itself, so that he would be quite sure that the cloth had not acquired microbes from the wounds, instead of it being the other way about. He got some surprising results at once. About one in three of the men were found to have the germs of tetanus (commonly called “lockjaw”) in their clothing; ten out of twelve had the germ called the bacillus of Welch (named after the American bacteriologist who had first discovered it years before), and the bacillus of Welch was thought to be in some way connected with gangrene.

The next job was to study the effects of the thick dressings and bandages which were in general use. Here he found that there were often what were called “secondary infections” of the skin. The thick dressing kept out air and light, and in such conditions many of the germs flourished exceedingly.

Then, working with two other doctors, Dr. Douglas and Dr. Colebrook, Fleming studied a subject with a very learned named—“bacterial symbiosis”. The name may be difficult, but the thing itself is not at all hard to understand. It really means that sometimes one kind of germ will help the growth of another. These three doctors showed, by studying microbes in the fairly simple surroundings of a test-tube, that there were certain combinations of germs which might not be very dangerous separately but which, when put together, would suddenly increase in strength and would grow far more rapidly when together than they had done when apart.

It was something of this kind, they decided, that had probably been happening when gangrene sprang up so suddenly in some of their worst wounded cases. They showed, for instance, that the bacillus of Welch, which would not normally grow when air was present, did in fact show signs of growth when various vegetable materials were there. That meant that this microbe might well flourish in a wound when a piece of cloth had been pushed deep into the flesh by a bullet or a piece of shrapnel.

Gangrene was still the problem that kept Fleming awake at night. He knew that this piece of work was more important, from the point of view of saving human lives, than anything that he had ever done, and yet—this was the trouble—he had hardly any time to study it. He was concerned for a good many hours every day in looking after desperately wounded men, and yet he knew in his heart that many more lives could be saved if he could work out some more satisfactory way of accounting for the gangrene.

There are two kinds of science—there is what is called pure science and what is called applied science. Medicine is for the most part applied science, in that it uses chemistry to work out ways of curing disease. For most of his life Fleming was a pure scientist, in that he was not so much fascinated by the actual use of his discoveries for practical ends as by seeing how the human body worked, how microbes lived and multiplied, and how their growth could be controlled or stopped.

What he wanted to do now was really a research in pure science, though it was something that could be much more quickly applied than had been usual.

Wright and Fleming, by experiments with the blood of many patients suffering from gangrene, decided that what was really the matter was that the blood had become acid. Acidaemia, as it came to be called, was the cause of the gangrene. So the way in which they set to work now was to find out if various germs, when added to blood, would make it acid. Then they would know, they argued, if there was some chance of controlling gangrene by destroying the acid-forming germs.

To begin with they carried out, when their ordinary day’s work in the hospital was finished, the experiment of mixing portions of blood serum with various microbes. Then they added to some of these small quantities of dilute sulphuric acid. They kept some free of acid, adding pure water to them. They then poured these various portions into identical narrow tubes, sealed the ends with layers of vaseline, which kept the air out, and watched results. It was soon proved that the gangrene germ grew more rapidly in the tubes where acid had been added. When a man had a serious wound which had been treated by a tourniquet having been applied, so as to prevent him from losing too much blood, the result was that the injured leg or arm became more acid, which meant that at once there was a danger of the gangrene germ getting control of the limb.

What, then, was the solution? To begin with it was something quite simple—something which might have occurred to any boy or girl at the beginning of his school career and just learning the most elementary chemistry out of some simple textbook. The opposite to an acid is an alkali. If there is danger of the blood turning acid, it might be prevented by an alkali being injected. One of the commonest alkaline substances is bicarbonate of soda. It is taken in many indigestion mixtures for that very reason— it neutralizes an acid condition of the stomach.

An acid condition in the stomach is very different, of course, from an acid state of the blood-stream of a patient, and to neutralize the acidity in the blood is a much more difficult proposition than to neutralize the acidity in the stomach. In one case the bicarbonate of soda can be swallowed; in the other case it will have to be injected.

What, therefore, Wright and Fleming suggested as a first measure of protection against gangrene was that some bicarbonate of soda should be injected into the blood of the patient. Then, they argued, there would be far less chance of the patient developing any sort of gangrene.

It was not used as much as might have been expected; it was never, indeed, tried out on a large enough scale to be sure if it was fully effective. But there seems no doubt that this piece of research was one of the most remarkable that Fleming ever did. Working in a laboratory which lacked many of the fittings that most research workers would have thought to be necessary to produce any results at all, he had managed to work out a theory which had good sense on its side. It had prevented him from having any leisure; he had had no opportunity even of exploring the country around Boulogne. His life had become one long routine of work, food and sleep. But in feeling that he had got somewhere near an answer to one of the worst troubles of the war he found his reward.

CHAPTER SEVEN

WORK AND MARRIAGE

THE MEDICAL WORLD was critical of the views on antiseptics put forward during the war by Fleming and Wright. Twice during the year 1915 Sir Almroth Wright crossed the English Channel in order to speak to meetings of doctors in London at the Royal Society of Medicine. Each time he attacked the idea that a wound must be covered with antiseptic (whether carbolic acid or iodine) as soon as a start was made on dealing with it. As a result of their experiments in France, Wright and Fleming were convinced that they were correct about this; but there were others just as convinced that Wright and Fleming were mistaken, and the others included some of the leading medical experts. The difference, of course, was that Wright and Fleming had dealt with these questions in France, with hundreds of wounded men passing through Boulogne every week, whereas many of those who criticized had done so largely on grounds of theory, without much detailed experience of what was going on.

The argument, in spite of all that Fleming and Wright could say, went on more or less all through the war. Probably the last contribution to the argument was a paper, signed by Wriglit, Fleming and another doctor called Colebrook, in which they again repeated their confidence that their way of dealing with these infections was correct.

The great difference of opinion was between those who said that the body of a human being had, within itself, the power to overcome the attacks of germs, and those who said that it was necessary to add these chemical antiseptics to the body before it could conquer the invaders. When we remember Fleming’s forthright way of writing, it is easy to see his hand in this contribution to the Lancet, though it was signed by the three men. It was almost certainly Fleming, for instance, who headed the closing remarks, at the end of the paper, “What we have to unlearn”.

If there was something a little bitter in Alexander Fleming’s heart in those closing days of the First World War, it is not altogether surprising. He had not been very close to the actual fighting front; but many of his critics had not been in France at all. And Fleming had seen the effects of war at very close quarters; he had dealt with men who were desperately ill and mortally wounded, and he was annoyed that some critics, arguing purely from theory, should belittle cures which he and his friends had found to work.

Fleming had, by the end of the war, become a captain in the Royal Army Medical Corps. He was thirty-seven years old. The rush of the early days had abated a little by this time and it was possible for the doctors in Boulogne to do more than merely eat and work and sleep. There was even an occasional round of golf to be played, and when there was no time for golf, there was endless argument over cups of strong tea, argument which sent Fleming back in thought to the pre-war days at St. Mary’s. The arguments raged throughout the whole science of medicine, and beyond. It was always friendly argument, and once Wright stirred all the men by pointing out what he held to be the justification of a doctor’s work: “All who follow the calling of medicine,” he said, “should remember that God has given every mind the choice between truth and repose.”

These men did wonders in a makeshift laboratory with second-rate apparatus, and all the time they were shocked by the sheer waste of war. It may have been this which put into the mind of Fleming the desire to do something to help men to fight infections. It may even have been this that in some way led to his great discovery of penicillin years later.

It is never easy to see just where comes the first germ of a discovery or an invention—just what makes one man turn his attention to working out a new type of steam engine, whereas another takes up chemistry and discovers a new element, or just what makes one man work on aeroplane engines, whereas another thinks about medicines. It seems sure, however, that Fleming was from the start largely interested in the preventive side of medicine—not so much in curing diseases as in preventing them from entering the bodies of men and women. He was interested in this to some extent before he was sent to Boulogne, but he had concentrated all the same on cures, as his work on acne shows us. When he came back after the war had ended in 1918, however, his whole mind was turned to working on prevention rather than cure.

In 1919 there came Fleming’s way the first of the many great honours which he was to accumulate in his lifetime. He was invited to give what is called the Hunterian Lecture before the Royal College of Surgeons. He had some weeks in which to decide what to speak about and to make up his mind how he was to do it.

It was a great occasion for him. For the first time he was to face an audience containing many of the greatest doctors of his day. For a young man of thirty-eight it might have been a very difficult occasion. Many people would have been horribly nervous, even though they could select what subject they would speak about. Not so with Fleming. He was so confident that he knew more about the treatment of wounds than anyone who had continued in ordinary medical practice that he decided to speak on “The Action of Chemical and Physiological Antiseptics in a Septic Wound”. In other words, he gave an outline of the argument that had now been going on for years and tried to show that the view of Sir Almroth Wright and himself was correct. He argued that in the body of a human being there were substances which would, if properly stimulated, deal with invading germs. He suggested, too, that the chemical substances which some doctors had used, while they might be good in keeping clean the instruments used in operations, were worse than useless if applied to a dirty wound, in that they attacked not only the harmful microbes which had come in from outside but also the helpful bodies in the blood.

He described in detail the experiments which they had carried out under such difficulties in France, and finally stated that, far from the application of the chemical antiseptics curing the infection, they made it worse. “It is not possible,” he said, “to sterilize a septic wound by a single application of any of the commonly used antiseptics.”

That evening in February, 1919, was one which Fleming never forgot. As he looked out at the sea of faces watching him, remembering that among his audience were some of the greatest men in the medical world, he realized that here he had found the work of his life. Some of his audience, naturally enough, were not altogether convinced with his arguments, but they were all sure of his sincerity and of the hard work which he had put in.

When he sat down and listened to the sustained clapping that followed his lecture, he must have thought of how far he had come in a few years. The boy who had caught trout in far-off Ayrshire, the shipping clerk who had totted up figures in the back office in Leadenhall Street—they were very different from the experienced doctor whose words were listened to with respect by men many years older than he.

“It is very difficult,” he had said, “for the surgeon not to be deluded into the belief that he has in the antiseptic a second string to his bow, and consequently it will tend to make him less careful in his surgical treatment of the wound. . . It seems a pity that the surgeon should wish to share his glory with a chemical antiseptic of more than doubtful utility.”

He must have been conscious, in that conclusion, that he was saying something that many of the great surgeons who were listening to him would not like. But Fleming was always a brave man, who did not mind speaking out what he felt to be the truth, even when it was not just what his listeners might have expected or might have approved. And even the argument, which went on long after he had finished speaking did not worry him. It meant that he had started some of his friends and colleagues thinking. It meant, moreover, that Alexander Fleming was now a power in the medical world. Up to this point he had been thought of as one of Sir Almroth Wright’s bright young assistants; now he was an authority in his own right, he was a man who had to be listened to with respect, even though there were many who did not agree with all that he had to say.

But soon he had to go back to the old routine of his work at St. Mary’s, where in 1919 he had been appointed Assistant Lecturer in Bacteriology. Now he faced a new problem. The war had exhausted many people; they had had poor food, or food of the wrong kind. Their bodies had been weakened and their nerves strained. Probably as a result of this, there came upon Europe the worst epidemic of severe influenza that had ever been known. People were ill in their thousands; there were many deaths, for this kind of influenza was an especially difficult one to nurse. And in any case, doctors and nurses went down with it, too, for it was terribly infectious and it seemed that no one could be sure of escaping from it.

Such an epidemic was bound to interest Fleming; he knew that there was a germ behind the disease and, naturally enough, he wondered if his method of preventing infections in wounds could be applied to preventing or curing influenza. The problem which most people studying such germs had to face was that, while they grew very rapidly inside the body of a human being, as soon as they were taken out of the body and put in a tube in the laboratory they died. It is impossible, of course, for a bacteriologist to study such things unless he can put the germs under his microscope and see what is happening to them. Only then can he find out what can be injected into his patient in order that the growth of the germs can be slowed up or even stopped.

There was another special problem, too, in that it had been shown that a pure extract of the influenza germ could be sprayed on the throat of a healthy person without infecting him. It was clear to Fleming that here again was a disease in the progress of which normal methods of medicine might be of little use. Dr. Clemenger, of the American Army Medical Corps, now came to St. Mary’s to work with him on influenza.

The last severe epidemic had taken place as long ago as 1890, and the principal work then had been done by a German, Dr. Pfeiffer, who had found a germ which he thought was the main cause of the rapidly-spreading disease; but during nearly thirty years there had not been another epidemic so bad, so that the findings of the German could not be properly tested.

Fleming and Clemenger managed to get samples of the germs taken from sick patients in London; they also secured samples from France and Italy. They thought that if they were able to show that the Pfeiffer germ was present in all these cases it might be that they could work out some way of immunizing people against it.

They soon found that there were many different germs. It seemed, in fact, as if influenza was caused by a group of bacteria of different types. One sort might stimulate another; the working out of a system of immunity was, therefore, a much more complicated affair than it might seem at first sight. And even though Fleming spent long and laborious hours in working at the problem, he did not come within sight of a solution of it.

Here, then, was an example of what might be thought a failure. But he did not allow the failure to depress him. He had many strings to his bow, and was doing many things at the same time.

His lecturing at St. Mary’s gave him great satisfaction. He remembered how, nearly twenty years earlier, he had derived much pleasure and stimulation from Sir Almroth Wright’s lectures on bacteriology, and he often thought, as he looked at the eager faces of the students attending his lectures, that there might well be among them someone who was to take his place in the years ahead and to carry on the work which he had started.

His private life during this time was quiet enough. He was still living at the family home. He was nearing forty years of age, and he was sometimes chaffed by his brothers because he was not married. It seemed that he was settling down to the life of a bachelor. It is probable that, like so many men doing an absorbing job, he had little chance of meeting the girls who might have been thought of as possible wives.

His brother John had married an Irish girl, daughter of John McElroy, of Killala in County Mayo. This girl had settled in London with her twin sister. They were typically Irish—gay and cheerful and excitable—and were very different in the way in which they looked at things from the Flemings, who were quiet and reserved and unemotional. But John and his wife seemed ideally happy and contented, and sometimes Alexander looked at them in some envy.

Occasionally, when his many duties at Paddington allowed, he would join John and his wife in a party at the theatre or at some West End restaurant, and then Mrs. John Fleming’s twin sister, Sarah, sometimes came too. Alexander, though very shy with women, thought her a jolly girl and a few times took her out on his own, finding pleasure in her company, and happiness in her infectious gaiety and laughter. It was good, he thought, to have such a contrast to the seriousness of his everyday life.

He did not for a good while, though, think of marriage. He was now concentrating on a new line of research which seemed to him to hold out all sorts of possibilities. He was always interested, as was clear enough in his work in Boulogne, in the ways in which to build up the natural resistance of the human body to disease. This seemed to him to be the best way of working. He did not believe, as his Hunterian Lecture showed, that the addition of chemicals to the body did much good—it would, indeed, often do harm. What was needful was to give the natural powers of the body new strength, so that they could fight the disease.

The word “antibiotic”—meaning a substance which would work inside the body and fight the invading microbes —was not yet invented, and yet it was towards this idea of an antibiotic that he was always working. Sometimes—as with his influenza investigation—he was going down a byroad that was not altogether satisfactory; sometimes he got back on the main road which was eventually to lead him to penicillin. But always there was the basic idea in his mind, the idea that he could not get away from—and that was the idea that the body must be stimulated to deal with infection itself.

It was in 1921 that he started on his most fruitful piece of work. But meanwhile he had come to a great decision. He decided that he would ask Sarah McElroy to marry him. He was then forty, and most bachelors of forty are pretty well set in their ways. A quiet, reserved Scot would not be thought to be the ideal husband for an effervescent Irish girl; but Sarah, though she might appear to be a flippant type of person, was serious enough underneath the surface. She knew that Alexander would be a good husband, she admired his work and she knew that he was a man who was destined to make his way in the world. She liked the idea that, as his wife, she would be helping him to do great work, and—which was most important of all perhaps—she loved him for his own sake.

So they were married in 1922. He left his mother’s home (she went back to Scotland to live) and took a little house in Chelsea. He had joined the Chelsea Arts Club; he now did a little painting—a hobby which had always attracted him— played an occasional game of golf and took up photography.

He had bought a small country house, too, at Barton Mills in Suffolk—a pleasant house with a stone-flagged path. There were stone seats on either side of the front door. He realized now that he was married that he could not expect his wife to accept his long hours of work. He would have to do something a little more entertaining in his hours of quiet leisure. He realized, too, that he had in recent years almost given up all those outdoor amusements which had been so much to him when he was young. So in Suffolk he went boating and fishing; he developed his garden; he bought a car, in which he used to delight to race the local train along a stretch where the railway line and the road ran parallel. His friends suspected, however, since the railway engine was an ancient one not capable of much speed, that Fleming took a delight in hanging back at the early part of the journey and then, pushing down the accelerator hard, in catching up with the train in an exciting finish. But all these things brought new happiness to him; his marriage, his friends said, had made a new man of him, since it seemed to have broadened his interests and given him fresh pleasures.

CHAPTER EIGHT

PENICILLIN’S ANCESTOR

MANY TIMES IN Alexander Fleming’s life things happened which he tended to attribute to luck. “Fortune had not finished with me,” he said once. “She continued to be kind.” But it is doubtful how far his great discoveries were due to pure chance and how far they came about because he was such a conscientious man, never missing an opportunity to study and investigate a problem.

The problem that brought Fleming close to his greatest work before the later discovery of penicillin came from an investigation that he made of his own body. Men of science have often used themselves, as one of them once put it, as their own guinea-pigs, studying their own bodies and the way in which they act when drugs are applied; but Fleming, as a bacteriologist, was not so much interested in drugs as in germs.

It so happened that he was suffering badly from nasal catarrh, that troublesome ailment that makes the head ache and the nose feel stuffed up. Breathing is difficult and sleep is sometimes interfered with, just because the patient finds such difficulty in breathing through the nose.

More out of curiosity than anything else, Fleming wondered what kind of germs might be causing this catarrh, so day by day, he took some of the substance which stopped up his nose, and tried to study it and see if there was any microbe in it to account for the severe catarrh from which he was suffering.

He put the nose-extract (to give it a popular name) on a glass plate with some of the substances that encouraged the growth of germs, and then he studied it under the microscope to see if anything interesting would develop. For three days nothing much was found—certainly nothing to account for the severe catarrh. But then on the fourth day he discovered something which gave him the greatest possible surprise. There had appeared a large microbe which Fleming had never seen before; it was bright yellow and was round in shape.

Naturally, as he thought that this was probably the germ that was causing the catarrh, he next tried the effect on it of various substances, to see if they would stop its appearance or its growth. Those who knew Fleming’s previous ideas, of course, could have given a pretty correct forecast of the sort of thing that he would decide to use. He would not add carbolic acid or any of the so-called chemical antiseptics. They would probably kill the germ, but they might well damage the delicate membranes of the nose and throat where the germ probably flourished in a patient suffering from catarrh.

No, the things to be tried out were natural things, things to be found in the human body; and one of the things he tried was a solution of the mucus—the fluid from the nose of a healthy person. He found, not altogether to his surprise, that this seemed to kill the large yellow germ. It disappeared from sight, when watched under the microscope, in a matter of a few minutes when only a few drops of this nasal mucus had been added.

It was called an “antibiotic”—Fleming’s use of this word came in a paper which he sent to the Royal Society in 1922. He also found that a similar substance, or even the same substance, was present in various other natural extracts. White of egg killed the germs in the same way as the nose-extract. Most potent of all in killing off the germs were human tears! “We took a thick milky suspension,” Fleming said, “of the right bacteria and added the smallest quantity of tears, and kept the mixture warm for just about thirty seconds. In that short time it became perfectly clear.”

It began to look now as if Fleming’s study of his own nose was bringing him near to a very great discovery. He decided that all these natural things, from tears to eggs, contained the same substance, which was very valuable as a natural germ-killer. He named it lysozyme.

This was the ancestor of penicillin. The results that came from its study created great excitement in the bacteriological laboratories at St. Mary’s. The discovery of what amounts to a natural antiseptic in various parts of the bodies of many living things was something so new in medicine that all kinds of people came to have a look at the work that was going on.

Fleming showed, for instance, that if two tubes of growing microbes were placed side by side, one having just salt water added to it and the other some human tears, very much diluted (that is, with a lot of water added to them), the tube which contained the tears would be almost free of germs in a few hours, whereas the tube which did not contain tears would still be full of germs.

Lysozyme was found to be present in the blood also, which was a reason why so few wounds, if kept clean, turn septic. The septic wounds, which Fleming had studied so long and so earnestly during his time in France, were those where outside dirt had been pushed deep into the flesh, and so the germs became so numerous and so powerful that even the lysozyme could not be made powerful enough to destroy them.

Most of the work of Fleming’s life was done with human beings and their bodies, because his great passion was to find out how to prevent human diseases. But now, for the first time he turned, with a colleague at St. Mary’s, Dr. V. D. Allison, to something quite different—to eggs.

Some eggs in shops are called “new-laid”, but probably few people except farmers and poultry-keepers ever eat eggs which are really fresh. In most cases (especially in the big towns and cities) eggs are sold in the shops some days after they have been laid. (Nowadays, of course, we sometimes have eggs which have travelled as far as from Australia to England, which means that they must be weeks old.) Yet both the white and the yolk of the egg are the sort of thing in which microbes would be expected to develop. In the laboratories of the bacteriologists, in fact, both white and yolk, after suitable treatment, are used as food (“cultures” is the word that the scientist uses) for microbes to feed on and in which to grow.

Why is it, then, that eggs do not all go bad, owing to the growth of microbes, if they are not put under a hen or in an incubator? Why is it that many of them, or most of them, keep quite good for fairly long periods of time?

This was an interesting question, and it was to this that Fleming and Allison turned their attention. It might be thought that the shell of the egg would protect it from infection; but this was soon shown to be a completely incorrect idea. Egg-shells are porous and various germs could, it was proved, pass through the shell without any difficulty.

Fleming and Allison soon showed that the newly-discovered substance, lysozyme, was present in the white of egg. Any germs which managed to get through the eggshell would then be rapidly killed by the large amount of lysozyme in the white of the egg. It was even suggested that some patients who might have certain germs in their systems should take egg-white. Some of those who suffered from the “run-down” feeling which so many felt in those days not long after the First World War got definite relief this way.

Next Fleming and Allison turned their attention to the eggs of other birds—moorhens, wagtails, thrushes—and found that there was a lot of lysozyme in them as well. One day, when Fleming had been out fishing, he caught a large pike. He spread its eggs out on a plate in the shape of a letter P. Germs grew all over the plate, except where the eggs of the pike had been placed.

The problem now was to discover if this substance, lysozyme, could exist inside the bodies of animals. Egg-white was therefore injected into the body of a living rabbit, and it was found that (at any rate for some hours) the blood of the rabbit had considerable germ-killing power.

When a piece of study like this is started in a laboratory there is always a sense of excitement everywhere. Day by day Fleming and Allison thought of new experiments. Since lysozyme was so generally found in animals, they asked themselves, why not in plants? They tried various vegetables and flowers. Turnips were the only common root vegetables shown to have much lysozyme in them, but flowers like tulips, sunflowers, buttercups and lupins were shown to have the power to kill germs.

There were, too, experiments with milk. Cows’ milk has a small amount of the germ-killing substance, and Fleming found, trying out various kinds of cattle, that four Jersey cows produced milk which had more lysozyme than any others whose milk was tested.

Another rather queer thing was that they found that saliva, the fluid in the mouth, had considerable amounts of lysozyme in it, and the saliva in the mouth of a dog had far more of this than that in the mouth of a human being. On one occasion Fleming found that, if a decayed tooth pulled out of a man’s jaw was put in a dog’s mouth, the germs of tooth decay disappeared in quite a short time.

The work on lysozyme went on for years. When once something of this sort is started it is clear enough that there are all kinds of ways in which it can be extended. And when Fleming went home at night to his house in Chelsea he often had exciting news for his wife. She found this as interesting as he did himself because, with all her cheerfulness and gaiety, she realized that her husband was doing a wonderful job in the world.

One of the things which Fleming now did in his lectures to medical students, in order to make them see that there was something in their bodies which, when healthy, would fight germs, was to conduct an amusing experiment. He used to give each student a tube containing a small colony of some germ—a colony which made the liquid in the tube look milky. This would be at the beginning of a lecture. He would tell each student to cut off a small piece of finger-nail and put this in the germ-culture. By the time the lecture ended, an hour later, the solution of germs would be quite clear. Even in the finger-nail of a human being there was a substance that would kill germs. “It is quite obvious,” Fleming would say, “that the superficial layers of the skin must have some mechanism for destroying bacteria. We are continually soiling our hands and fingers with many bacteria.”

What Fleming and Allison had really done in all this long and extensive work was to show that there were many human beings, as well as many animals and even plants, who had what he called a natural immunity from various diseases. Throughout his life this was the subject to which Fleming returned time after time. The life of the ordinary doctor was not for him. The doctor has necessarily to deal with people who are ill, to tackle cases where germs have somehow got control of the human body. Fleming thought that more valuable still and more important still was the work of finding out whether there were methods of stopping the germs from getting control—in other words, of keeping many people out of the surgery of the ordinary doctor at all.

His discovery of lysozyme was the first great step in this direction. Once he said: “I have never forgotten the importance of the body’s natural defences!” And that was the great point.

The fluid which is in the lining of the nose, the water of tears, these things he showed to be extremely powerful. He carried out one striking experiment to prove this. He had a plate of agar jelly (a substance in which germs grow and on which they feed), and he cut in it a series of small holes. In these holes he put small pieces of absorbent paper. Some of these had been soaked in tears and other sources of lysozyme; others had added to them iodine, carbolic acid, mercury chloride and other of the chemical antiseptics which were thought to be most powerful. The whole sheet was then covered with germ-culture. It was found that in the neighbourhood of the tears and other sources of lysozyme the germs did not grow at all; in the neighbourhood of the chemical antiseptics they grew fairly steadily. Fleming showed, in fact, that these natural antiseptics were far more powerful than the chemical antiseptics. The point, he added, was that the chemical antiseptics often interfered with the natural action of the lysozyme in the body. So instead of the chemical killing the invading germ, it often interfered with the body’s natural defences.

Scientists only on very rare occasions find that they have discovered something quite new and mysterious; and yet this was what Fleming had done. He had found that there was, in the bodies of human beings and widely spread through Nature, a substance which would destroy germs.

Lysozyme was used to some extent in St. Mary’s Hospital ; it was tried out elsewhere, both in Great Britain and in foreign countries, including Russia, but it was, while of very great interest, not of very great practical importance. The lysozyme actually in the body was so concentrated that it might succeed in killing germs, but it was not easy to use in the hospital ward or in the laboratory, except in tiny quantities.

After the long and weary hours of work, spread over months and years, Fleming therefore had to come to the conclusion that, even though his discovery was of great interest to all bacteriologists—indeed, to everyone who had anything to do with the problems of health—it was not, at any rate as yet, something which could be applied in medical practice.

When he discovered this substance in 1922 he was forty-one years old; he had been married about a year. And, even though it was not of great practical importance, it attracted enormous interest all over the world. Scientists studied it, wrote about it, talked about it. Alexander Fleming, even though he had not produced anything like a medicine which would cure all sorts of diseases, suddenly found himself a famous man.

He was famous, however, only among scientists. The ordinary newspapers, which are so often inclined to take up some scientific discovery and make it into something exciting and sensational, did not seem to notice lysozyme, and the very name of this mysterious substance remained unknown to the ordinary public.

One thing is certain, and that is that he was happy. He had been “pushed” into medicine by his brother, as he used to say; but the job he had been pushed into was the job that suited him. One of the chief reasons for discontent, he said long afterwards, “is that people do not find the right niche in the world.” There was no doubt that Alexander Fleming had found the right niche.

He was always a quiet, unassuming man; he never made much public fuss about his great discoveries. This work on lysozyme, which meant so much in the way of thought and of inventiveness (for much of the apparatus which was used in his laboratory he designed himself), was described by him in a quiet way that gave little indication of all the excitement that lay behind it.

So now that he seemed to have finished with lysozyme for the time being, he went back to his old tasks. He lectured to his students, he fished in Suffolk, he looked after his garden, and he continued to think about the way in which human bodies work and the way in which they can influence the development of germs inside them. The problem of how creatures became immune to disease still absorbed him.

CHAPTER NINE

THE GREAT MAN

PROBABLY TO MANY outsiders the work of a great scientist like Alexander Fleming will not seem very exciting. They will think that one piece of work in a laboratory is very much like another. The apparatus he is using may be different, the results he gets may be different, but there will not be very much variation in the way in which he sets about his job.

There may be something in this. The long working life of a scientific worker is bound to have in it a certain amount of slow routine work—work that appears dull to those who have not actually done work of that kind.

When the experiments on lysozyme were more or less complete, Fleming did not, as so many men might have been tempted to do, rest from his labours. Nor did he need to cast around him to find some new subject of study. Lesser scientists, without his original turn of mind, have been known to find some difficulty, when one long piece of work is over, in deciding what to take up next. But Fleming was always keen on immunity, and it was to this once more that he turned.

First of all, he tried to work out some way of showing the way in which blood itself would destroy germs of one kind and another. Again using his favourite argument, he tried to show that, while the blood could destroy the invaders, the addition of some chemical substance like carbolic acid would destroy this power of the blood and so make the body less able to resist disease.

Ever since he had studied the terrible sufferings of the wounded in France, this had been one of the main topics occupying his mind.

A chemical called formalin had often been injected into the bodies of people suffering from blood-poisoning, and even in the treatment of tuberculosis, when germs attack the very substance of the lung. Fleming now studied this and showed that, far from killing the tuberculosis germ, the formalin interfered with the work of the blood against the germs. Bernard Shaw wrote of this: “Formalin was squirted into the circulation of consumptives until it was discovered that formalin nourishes the tubercle bacillus handsomely and kills men.”

Fleming might not have altogether agreed with all that the great Irish writer had to say about this, but he read to the Royal Society of Medicine a paper entitled “The Bactericidal Power of Human Blood and Some Means of Altering It”. This really said, in more scientific words, just the same as Shaw had been saying in his speeches and his plays.

The work on lysozyme had taken up a long time. When he was forty-seven, in 1928, Fleming was appointed Professor of Bacteriology in the University of London—one of the leading positions in the medical world. He was naturally proud of his position, but he was sad in that his mother, who had looked after him so well, died that year.

It was, however, a source of happiness to him that the house in Chelsea now housed a small son as well as the new professor and his wife.

At this time things seemed to have slowed down a little at the hospital. Many scientists know that when they have made some great discoveries they may go on with their work (as, indeed, Fleming did with his work on blood), but they find that suddenly the excitement seems to have gone out of it. This was one of the periods of dull routine, rather like that of a soldier who is waiting for the next battle to begin.

Yet that penetrating curiosity which had always been one of the most marked things in Fleming’s character went on controlling him. In his youngest days in Ayrshire he had been curious about birds and flowers and all the things of Nature. But, now that he had found his life-work and had established himself as a leading expert on bacteria, it was on the tiny things that cause—and sometimes cure—disease that he concentrated his attention.

There are two types of scientist really, and there is little doubt as to which type Fleming belonged. One type is the scientist who is interested in research but who has no very active curiosity. He likes the work of the scientist and he is prepared to do anything that he is asked to do. A great chemical firm, say, decides that it would like to try to work out a new kind of plastic—like nylon. It therefore fits up a laboratory, tells the staff appointed there what is wanted, and then lets them get on with the job. That is the kind of work which is done by many good scientists, though they will rarely be the greatest of all.

On the other hand there are scientists (of whom Fleming was certainly one) who feel intense curiosity about some side of their science. They cannot work to order; they have to follow out their ideas in whatever direction seems best; and they concentrate on a problem which appeals to them. It is really a matter of the old distinction, mentioned earlier in this book, between the pure scientist and the applied scientist. Fleming was a pure scientist. What he did was done because he was interested in it and not because he was paid to do it. The fact that the things which he discovered were of the greatest value and importance was, in a way, purely accidental.

Doctors in many of the great hospitals have laboratories which are beautifully equipped and expensively decorated. In those days of the 1920s Fleming’s laboratory was nothing like that. It was a small and rather dingy room, with a small desk, a typewriter and a mass of papers, a microscope, rows of test-tubes and other simple apparatus. It was the man, the brain, behind it all that mattered.

He was once reported to have said, when he was taken over some of the neat and spotless laboratories of some American hospitals: “Wonderful; but penicillin could never have been discovered in a place like that.”

Penicillin, indeed, might never have been discovered in a place that was too neat and clean. The Professor of Bacteriology, with his belief in the power of the human body to fight germs, might not have bothered so much about absolute cleanliness in his surroundings as some of those who believed in the power of chemical antiseptics to kill every germ that ever brought harm to human beings.

His home life was happy; his working life was happy too. He could see his little son gradually growing, getting to know things, learning words and letters. Mrs. Fleming was the sort of wife all great men deserve but few of them seem to get, and the house in Chelsea and the country house in Suffolk seemed to him to be perfect.

“In all places like this,” he said of St. Mary’s Hospital, “everybody has a certain amount of routine work to do. He doesn’t sit down and play at research all day long. He has a job to do. He may find time for research and discover something new. Some will and some won’t. I think that is the only way to do research. Give a man a free hand for a portion of his time and let him do as he will.”

Certainly from that sort of research Fleming produced very remarkable results; and all the time he was walking the corridors of the hospital, giving lectures to students, quietly going home to his wife and his son. His hair was getting grey, lines and wrinkles were making his always expressive face even more so. An unassuming little man, many people thought him. But his fellow-scientists knew that he was a great man all the same.

It is odd that, during those years from 1922 to 1928, St. Mary’s Hospital seemed to be less an international centre than it had been in the past. True, it had in Alexander Fleming one of the greatest men in his own line. Sir Bernard Spilsbury, who gave evidence time after time at famous trials, was also there. But many of those who had flocked there in the days before the war appeared to come no more.

And then, in 1928, Fleming made the discovery which was to oust his previous discovery of lysozyme from his mind, the discovery which was to make him famous throughout the world and which will be associated with his name as long as science is studied.

“In 1928,” he said, “I hit on penicillin.”

It was some years before that he had discovered lysozyme by seeing that tears killed germs. There were spaces where the tears had been put on the germ-covered plate and the germs had gone. From that day onwards Fleming had always been interested in germ-free spaces. Yet he always insisted that his greatest discovery was a stroke of pure luck, good fortune, which might have come the way of anyone at all who happened to be interested in the same kind of subject.

A story which was told often about a game of snooker which he played at the Chelsea Arts Club may perhaps be told here, as it shows the power of concentration that may account for some of Fleming’s success as a scientist. He was playing snooker, and then he glanced at his watch. He suddenly realized that he was late for his evening meal and that his wife would be waiting to take the cooked meat out of the oven. Fleming was never a very successful player at snooker, but now he realized that the game must be finished off quickly. So he took up his cue, worked his way around the table, potting each ball in the correct order, and then, when he had potted them all, said quietly that he would go home. His friends were astounded; they had never seen him play so brilliantly before; they were never to see him play so brilliantly again; but the way in which he finished off that game of snooker is probably typical of Fleming’s attitude to things. There was, it seemed, nothing that he could not do, when once he set his mind to it.

When, therefore, he said that it was pure luck that he found penicillin, we may be a bit doubtful about the luck. It was much more a matter of being alert to everything that went on in his little laboratory, and that things that some scientists would have disregarded he looked at with care and studied. The great scientist is not dependent on luck; he spends all his time and all his energy on the topic of his choice, and then he neglects no chance of working along new lines.

There is a class of mould or fungus which scientists call penicillium. It grows in all sorts of ways. The blue mould which is seen on cheese, or very stale bread, is a penicillium. These things grow from tiny egg-like spores which send out sprouts which grow and form new sprouts, until quite soon there is a fairly big colony of this mould. The blue colour is due to these branches budding off more spores, which from quite a small colony of mould may exist in millions. These spores are very tiny and very light. They are blown about by every passing breeze. If the wind deposits them in a suitable spot, they too grow and form a new colony. They do not all take root, or no food would keep anywhere for any length of time at all.

Fleming had never studied these moulds particularly. He knew that they existed, and that was about all. The subject of moulds was not really his subject at all.

A damp summer encourages the growth of such moulds. Most people know that food does not keep so well in damp, warm weather. The summer of 1928 was warm and damp. Fleming was writing an article for a new book being planned by the Medical Research Council, and he was (with his usual thoroughness) repeating some experiments which had been done by another bacteriologist to make sure that they were correctly described.

There were some culture plates—plates on which germs were growing. These were kept covered, except for the moments when Fleming was to examine them under the microscope. The cover was off only for a short time, while the germs were examined. Then the cover was put on again and the dish was put on one side.

Fleming himself described what happened. “A mould spore,” he said, “coming from I don’t know where, dropped on the plate. That didn’t excite me; I had often seen such contamination before.”

But what did excite him was that suddenly he realized that all the germs around this spore seemed to be either dying or moving away. In a short time there was a wide space around the spore. It was having in some ways the same effect as lysozyme years before.

Many scientists, doing a routine job, would have thought this was merely a nuisance, would have washed that dish and thrown its contents down the sink. Not so with Alexander Fleming—which is perhaps why he was such a great man. To him the plate where a spore had started to kill the germs was a very special case, far more interesting and far more important than the other plates where everything was going quite normally. “Instead of casting out the contaminated culture with appropriate language,” he says, “I made some investigations.”

No one—not even Fleming himself—could possibly have foreseen where these investigations were going to lead. He said, when he was trying to show that it was a pure matter of luck that this happened, that there are thousands of different moulds and thousands of different kinds of microbes, and it was a pure stroke of luck that the right mould and the right microbe came together just at the moment when he was studying that plate under the microscope.

Maybe that is true enough, but only if the right man had his eye at the microscope would the matter have been studied as it was.

One of his friends at St. Mary’s said that when the microbes in the dish were seen to be dissolving Fleming said: “This is very interesting; it might be important.” His colleague just agreed, politely, that it might be interesting, but he did not really think it would lead on to anything worth while.

Fleming began a study of this mould. He took part of it, and developed it, allowing some of the spores from it to grow. He took a loop of platinum wire, heated it, touched the mould with it and then dropped some of the spores into a test-tube containing various substances on which the mould would grow.

Then some spores were planted on a plate of agar, just as a gardener would put some plants into a flower-bed. Various types of microbes were allowed to grow in the agar jelly. Some of them grew right up to the edge of the mould; others stopped short of it.

With all the experience of lysozyme behind him, Fleming knew that he had now something which was an antibiotic, something which would either kill germs or prevent them from growing. The result, too, was that some of the germs which were killed were germs of dangerous diseases. “Here,” commented Fleming, “is a mould doing something that might be useful.”

Soon a lot of the mould was available, grown in broth. It grew on the surface. The inside of the broth became bright yellow in colour and at first the mould was called something like “yellow magic”. (Actually it was proved in the end that the yellow colour had nothing to do with the extract from the penicillium; it was due to an impurity that need not have been there at all, and that in any case had nothing at all to do with the power to kill the germs.)

Soon it was clear that here was a very powerful substance indeed. Even when one part of the substance was dissolved in a thousand parts of water it could still destroy the germs. There are not many so-called germicides or antiseptics which have any power at what is called a dilution of 1,000.

When he had started this work Fleming scarcely knew what a penicillium was; he knew that it was a kind of fungus or mould, and that was about as far as his knowledge went. While he was making the cultures of the mould, too, he did not bother himself very much as to what the mould actually was. But now that he had managed to show that the mould produced a substance which would destroy germs in the most amazing way, he realized that he would have to give the substance a name.

A chemist would, perhaps, have analysed it and given it a name which had some relationship to its chemical composition and behaviour. A bacteriologist took a different view. He wanted a simple name which would give some indication of the origin of the substance—and in any event it had not yet been analysed, so that no one actually knew what it was from the point of view of chemical composition.

It came, at any rate, from the mould of a penicillium, so it was called penicillin.

CHAPTER TEN

PENICILLIN

THE EXPERIMENTS WITH penicillin quickly developed in much the same way as had the experiments with lysozyme, years earlier. It soon became clear, however, that penicillin was something altogether more powerful than lysozyme.

Fleming took a plate of agar jelly, cut out of it a series of holes, after having planted it all over with microbes; then he sealed the bottoms of the holes with jelly, making the whole thing like a series of cups. Into these cups small amounts of liquid from various mould cultures were poured, and the whole thing was then left to stand.

In a matter of a few hours it was seen that the germs had not come near the places where the mould had been placed, though they had grown fairly extensively at other places.

Fleming then put the whole plate on one side on a bench and left it for a week. The mould spores which had been left in the little cups had now produced a new lot of penicillin, which had spread out into the jelly, with the result that almost all the germs on the plate had been killed.

In scientific language, Fleming said that this experiment showed that penicillin was both bacteriostatic (that is, it had the power of stopping microbes from growing) and bactericidal (that is, it could kill microbes). Sometimes, too, it altered the way in which particular germs grew and developed, always weakening them, and so lessening the effect that they would have on the body of the patient.

It began to look, as Fleming had seen at the beginning, as if this was something really valuable and important; his friends at the hospital noticed that his usually rather serious face now often bore a cheerful grin. He had shown that penicillin was at least three times as powerful as any of the chemical antiseptics, such as carbolic acid. There was only one possible difficulty in the whole thing, and that was to be quite sure that this new substance was not harmful to animals or to human beings, and that it would not hurt the white corpuscles of the blood, which were known to be the main method by which the body itself could attack invading germs.

If penicillin could stand up to tests along these lines, then it would be a very valuable thing indeed.

It was injected into animals like rabbits and mice. Then there came an anxious period of waiting. Would the rabbits and the mice become ill? They did not. Penicillin, it appeared, had no harmful effects; and in 1929 Fleming made his work public, saying that he thought this might be an effective antiseptic for applying in the form of ointment, or for injecting into the blood of people infected with certain diseases, the microbes of which were known to be sensitive to penicillin.

Some people greeted this as an invention akin to Davy’s invention of the safety lamp, or Bell’s invention of the telephone; but Fleming would have none of that. “I have been accused of inventing penicillin,” he said. “No man could ever have done that; Nature in the form of a lowly vegetable has been making it for thousands of years. I only discovered it.”

But the first discovery was only the beginning. Much more work had to be done, day by day, week by week, month by month. Quantities of penicillin were prepared and it was tried out on all sorts of germs. It was found that this was a wonderful antibiotic—in other words, it killed many different kinds of germs without being in any way harmful to the body in which those germs were steadily growing. It began to seem as if it was indeed one of the most valuable medical discoveries of the century.

The next stage was to find out just how it could best be preserved and stored. Fleming had two young men working with him, and he fitted out a small room as a special laboratory to be used for these experiments on penicillin and for nothing else. He knew that this was something of very great value, and for the time various other tasks on which he was engaged were dropped. He continued with his lectures —they were one of the tasks which he had to carry on, no matter what other work claimed his attention—and he took an occasional day off for his fishing or his golf. But his wife found that he was absent-minded and that his thoughts were often far away. The problem of penicillin had absorbed his mind and he could rarely think for very long about anything else.

He prepared the broths in which the moulds of penicillium could develop. Then he tried the effect of changing temperatures on them. At a temperature of 20° Centigrade the results seemed best, though heating up quite a lot did not altogether destroy the efficiency of the penicillin. At each stage in these trials he took out some of the liquid and tried it out on germs. As long as the germs were killed he knew that penicillin was still present and was still effective; as soon as the germ-killing ceased he knew that he had done something which destroyed the penicillin.

Soon he found something which was very disturbing. Penicillin could, it seemed, grow only in a liquid which was slightly acid. When the penicillium was allowed to grow for some days—up to a week—the acidity of the broth slowly decreased, and the amount of penicillin decreased too. In fact, it began to look as if the mould, in its growth, was producing some substance which broke up or destroyed the penicillin itself. The only way that the penicillin could be produced continuously was to add small quantities of acid to the broth at short intervals. “Unless the reaction is adjusted,” Fleming wrote in some disappointment, “the selective antibacterial action disappears in a few days.”

Another problem was that one could not very well give a doctor a rather sticky-looking mass of broth, tell him to filter it and use the clear liquid as a medicine. Doctors can as a rule only use things which are in the form of tablets or ointments or exactly-calculated solutions.

So, while the curing possibilities of penicillin were becoming well known, there was a lot of hard work to be done before it became the sort of thing which any doctor could prescribe.

The broth had power to cure, but it was very difficult to separate out the penicillin from the broth. Fleming got a sticky brown substance which seemed to have more curative power, but it proved nearly impossible to separate the pure penicillin.

The next series of experiments (it has to be remembered that this work went on for many months) was concerned with the speed with which the mould produced the penicillin. It was on the fifth day after the first lot of mould was put into the broth that penicillin began to appear. At that time, if he took one drop of the broth and mixed it with twenty drops of water, Fleming’s test microbes, on the agar plate, were soon destroyed.

The next day it had doubled in strength, and on the seventh day it had increased ten times, so that one drop of the broth in 200 drops of water was strong enough to kill the germs. By the eighth day it had more than doubled again, and one drop of the broth in 500 drops of water would now do its job of germ destruction. But this was the strongest that it got. It got weaker and weaker from the eighth day onwards and the mould soon stopped producing it at all.

That series of experiments was satisfactory as far as it went. It meant that they would be able to make penicillin at its maximum strength after the eighth day. For a time, again, Fleming looked more cheerful, though many things still worried him a lot from day to day.

What worried him most was that penicillin rapidly dropped off in its power to kill microbes if it was left standing about in the laboratory at the ordinary room temperature. “Penicillin,” he said sadly, “is a very unstable substance.” And that at once seemed to rule it out as a possible medicine, because, once again, no ordinary doctor can be expected to use a medicine that will be effective for only a few days; nor can a chemist find any way of keeping such a substance in stock. Even though it might be made in laboratories all over the country, so that it would not have to be carried long distances, it would be very difficult to make sure that it was available to patients while it was still fresh.

On the surface of the broth there had formed some bright yellow drops. One day Fleming took off one of these drops and tried it out on his germs. He found, to his surprise, that this was far more powerful than anything which he had tried up to now. It killed the germs of pneumonia and diphtheria when it was mixed with 20,000 times its own volume of distilled water.

This was the most powerful germ-killing substance that had ever been discovered; if it could somehow be made less liable to break down in keeping, Fleming saw, it would be one of the greatest medicines ever known.

Now he went about the hospital in happier mood. He tried it out on some of the patients in the wards, but only rarely did he find a doctor who was prepared to use it. The trouble was, too, that sometimes a doctor would come along to Fleming’s laboratory and ask if he had some of the penicillin available. If he had, it might well be that it would lose its strength before the doctor had the opportunity of using it. While Fleming was sure that he had discovered a new medicine which would one day be used for all sorts of diseases, he knew that the time was not yet ripe when it could be generally used.

But he went on working with it, trying it out on the germs of many diseases, and nearly always with success. He was convinced that here he had something that was going to revolutionize the treatment of various ailments, if only a satisfactory way of preserving it could be found.

Some of his friends thought that he was claiming too much for it. They got tired of his constant talking about it. People often think, when a man has a real enthusiasm for something, that he makes it seem more important than it really is. They call it his “hobby-horse,” and say that he is riding it to death. That was the sort of thing that was often said of Fleming in those early days; but he did not let it worry him; he just went on working on it for years.

Nearly three years after his first discovery of penicillin in 1928, he made claims for it which were, in the end, to be very modest indeed, though at the time they were thought to be much too high. “Penicillin,” he said in 1931, “is valuable to us at present in the isolation of certain microbes, but it is quite likely that it, or a chemical of a similar nature, will be used in the treatment of septic wounds.”

When he said that, who can doubt that there came into his mind a memory of his days in Boulogne, when the desperately wounded men were brought to the hospital and the medical staff were at their wits’ end to deal with many of the cases?

In 1932 he repeated his claims with greater emphasis, but he added: “The practical difficulty in the use of penicillin for dressings of septic wounds is the amount of trouble necessary for its preparation and the difficulty of maintaining its potency for more than a few weeks.”

That is the great problem which so many scientists have to face from time to time. They know that what they have discovered is very valuable; they know that it can in the end be very important for some purpose. And at the same time they have to admit that it is not easy to translate what their laboratories have shown them to be true into words which the ordinary man can understand. Theory is one thing; practice is another. Many a boy or girl in the school chemistry or physics laboratory will know that it is possible to write something down in a notebook, but not always so easy to do on the bench the practical work which those notes have described.

But Fleming was confident that one day penicillin would come into its own and be recognized as a really worthwhile substance for dealing with disease.

On one occasion he discovered that he could make the mould grow on paper, if it was placed in the broth. The paper could then be taken out, mounted on a disc of glass and covered with a plain watch-glass. “This,” he added, “makes a very beautiful museum specimen.” He therefore kept the original specimen of mould, because he thought that it was likely to be of some interest in the future.

Yet the practical difficulties of the whole thing were such that it attracted very little attention outside his own circle of friends. Bacteriologists thought it was a very interesting experiment, but gave it little more attention.

But science does not go on in merely individual laboratories. When one man makes a discovery, others are stimulated by it and try to work out new methods. Professor Harold Raistrick, who was at the London School of Tropical Medicine, had read with a good deal of interest the accounts Fleming had written of what he was doing at St. Mary’s, and he decided to do some work on this mysterious substance, penicillin. He went to St. Mary’s, had a long talk with Fleming and persuaded him to provide some samples of the mould on which he could work. Raistrick had a chemist working with him, and so he was able to do some purely chemical work which Fleming, as a bacteriologist, specializing in a different branch of science, had not been able to do.

Raistrick showed that the yellow substance which had caused the various nicknames to be given to penicillin in its early days, was not possessed of any property of killing germs. The yellow substance he called chrysogenin, and dissolved it out of the mixture by adding ether. Then he blew air over the ether, so that it evaporated and left behind a yellow solid. When this yellow solid was tried out on various germs it had no effect on them at all. In the process of dissolving in ether and then blowing the ether away the penicillin, it seemed, had vanished. He tried a new experiment, with some water added to the ether. This time the penicillin remained in the water, but it had not been obtained as yet in a pure state.

Raistrick did all sorts of work on penicillin, but, like Fleming, he found it very difficult stuff to handle. “It was destroyed,” Raistrick wrote, “by both acid and alkali, and when we extracted it with ether it disappeared. Such a thing was never known to a chemist before; it was unbelievable. . . . We dropped it and went on with our other experiments.”

That, it seemed at the time, was the end of a very promising line of study. Fleming was still not disturbed. He was glad that what he was doing had been of interest to other men; but even though they gave up in despair, he was not intending to do so.

He was more pleased when an old student of his, Dr. C. G. Paine, who was in practice in Sheffield, wrote and asked him for a sample of the mould. Paine grew this himself in Sheffield, extracted the penicillin and tried it out on patients with eye troubles. There were four babies who had eye infections which were very difficult to clear up and which seemed likely to make them blind. Three out of the four were cured. Later he tried it on a manager of a coal mine who had been hurt in the eye while he was underground.

This man’s eye had been injured when a small piece of stone got lodged in it. The eyeball and eyelids were so painful and swollen that it was feared that the man might become blind in that eye. It was found that the germs called pneumococci (the germs which cause pneumonia) were present in the eye. Dr. Paine remembered that the germs of pneumonia were, according to Fleming, killed by the action of penicillin; so he washed out the eye with the extract from the broth. This was continued frequently over two days, and the swelling of the eye quickly went down. Soon the germs had disappeared; an operation was carried out to remove the piece of stone, and the man’s sight was saved.

Dr. Paine was delighted. But he knew, as did everyone who had anything to do with penicillin in those early days, that it was very difficult stuff to use. It was all very well for a doctor who had some of the penicillin-containing broth to use it in a special case, but that was very different from using it in ordinary medical practice.

He wrote and told Fleming what had been done in these cases of eye infection, and his story gave Fleming more confidence in the value of penicillin than he had had before. He knew that it was very valuable stuff. He knew that one day it would be used in medicine. But its difficulties still daunted him.

The laboratory did not forget it, even though by this time it dropped somewhat into the background. Mrs. Fleming heard less about it over the dinner-table; she wondered sometimes whether her husband had not, perhaps, allowed himself to be over-enthusiastic about it.

The real trouble of course, as Fleming saw afterwards, was that there was no real team-work by different kinds of scientists. If he had had a first-rate chemist working with him during those years from 1928 to 1931 penicillin might have been in general use years sooner than was actually the case; and Raistrick, at the London School of Tropical Medicine, while he had a chemist working with him, lost the expert bacteriologist on his staff in 1932. If the two men had been able to work together, they might have got results very much more quickly. But it was not to be, and so for the moment penicillin was put back on the shelf and Fleming turned to less important and more routine tasks.

CHAPTER ELEVEN

YEARS OF WAITING

IT WOULD HAVE seemed to many people that penicillin could now be written off as useless. Fleming did not think so. He often argued, both in the laboratory and at home, about the need for things which would enable the body itself to fight disease. Penicillin was the kind of thing that he had been imagining for years, and he thought it a real tragedy that, when he found it, it should be so difficult to use. In spite of all this, however, he was sure that it would some day be used in ordinary medical work.

Some foreign countries thought of him as a great man already. Even though penicillin was difficult to prescribe, they considered it very valuable as a medicine. On one occasion, when he went to Spain to lecture, he was greeted as a hero. His car was piled high with flowers and decorated with Union Jacks when he drove through the streets. He was given all sorts of gifts by the excitable Spanish people, and he was a little worried over all this generosity; so much so, indeed, that he asked the British Ambassador to give him a letter testifying that all these things really were gifts, because he was afraid that when he came home to Britain the Customs authorities would make him pay enormous sums in duty on all the things that had been given to him.

Later on he was told that Holland had given him a Victory Medal, and when he asked the Dutch authorities what victory it was meant to celebrate, since he had not fought in the war, they told him that it was meant to celebrate victory over disease.

In those years, then, while the triumph of penicillin was not yet visible, Fleming, as its discoverer, was acquiring wider fame. The general public in England scarcely knew his name; but abroad, and in medical circles everywhere, he was becoming better and better known. Mrs. Fleming, who had foreseen that something like this would happen, was very proud of him, and proud too of the fact that she was able to do something to help him by giving him a happy and a comfortable home. Some of his old hobbies were now in the process of being dropped. A man as busy as he was cannot always find as much time as he would like for golf and fishing, but he still tried to get a little time every few days for some outdoor pursuit, if it was only pushing a lawn-mower or transplanting some wallflowers in his Suffolk garden.

For a time, too, it seemed as if the ideas of medical men were turning away from Fleming’s ideas. New drugs had been introduced which seemed to be more effective than he had thought chemicals could be. Drugs commonly called the sulfa drugs were used. A new chemical called M. and B. was proving an almost certain cure for pneumonia.

Fleming himself saw this. He said, in describing what happened to medicine in the mid-193os: “Whereas in the late ’twenties the quest for an effective anti-microbic drug seemed almost hopeless, now, ten years later, not only was there hope, there was certainty.”

And yet there was still a kind of competition between the two ways of curing diseases. Some people thought that a drug could be given to a patient which would sooner or later kill the germs that had attacked him, and so would act as a cure. Other people thought that the best way was to stimulate the patient’s own

body to fight the disease.

Fleming had always belonged to the second of these schools of thought; but all the same he was a fair-minded person and was quite prepared to admit that the chemicals like M. and B. might be found effective in some cases.

Fleming even worked on some of the sulfa drugs. There was a drug called prontosil, which had been discovered by Dr. Domagh, a German scientist. He used this on a number of mice and saw that it cured them of disease. Dr. Domagh had not tried it out on human beings, until one day his daughter pricked herself when knitting and became desperately ill with blood-poisoning. It seems probable that she had picked up some germ in her father’s laboratory. The doctors who examined her said that there was little hope that she could survive the illness. Dr. Domagh therefore gave her a large dose of prontosil, and she completely recovered.

This story was not published, but it was told in scientific circles. Fleming took the prontosil as a worthwhile drug and carried out some experiments with it himself One of the most striking points about Fleming’s way of tackling problems was that he always wanted to find out the method by which a drug worked. So many doctors, having found that a particular drug or a particular course of treatment cures a particular disease, are happy enough to go on prescribing that drug or that course of treatment whenever that disease comes their way again. They do not worry very much about the way in which the drug or the treatment works, or as to why the patient recovers.

Fleming was never content with discovering a substance which would produce a cure. He always wanted to know why the cure was effective.

One of the problems which he solved with regard to the new sulfa drugs was directly allied to the work which he had been doing on immunization. He always thought that even the drugs which were likely to be effective were those which stimulated the body to fight the germs for itself. And now he found that there were some drugs which produced an immediate change in the condition of a patient; others took some time before any change was seen. He suggested that the first type acted at once on the germs causing disease; the others stimulated the body of the patient to produce, within his blood, some substance which would attack the germs.

May and Baker, the firm of English chemists who had a team of research workers trying to discover a drug that would have some effect on patients suffering from pneumonia, tried out no fewer than 693 different substances, of which only the last—commonly called “M. and B. 693”— was effective. The fact that so many different substances had to be tried before a good one was found shows that the effect of chemicals is not as simple as is sometimes thought.

The new drug, M. and B. 693, was shown to be deadly poison to the germs of pneumonia; this at once gave it great “news value” in the eyes of the popular press, and so it was widely noticed. The public soon came to see that here was something revolutionary in medicine, because it completely altered the way in which a killing disease was treated. Before this drug was found it was usual for patients who suffered from pneumonia to reach a point usually called the “crisis”, when either the patient died or the temperature dropped and the slow recovery began. The “crisis”, in fact, was the moment when the struggle between the invading germs and the natural defences of the body was at its height.

The great value and importance of M. and B. (the “693” was soon dropped from its name) was that it prevented this crisis from taking place at all. Under control, the germs of pneumonia never reached the position of being a terrible danger to the body, and so a far larger number of cases recovered than had ever been known before this treatment was applied.

All this interested Fleming. It seemed at first as if it was contrary to all that he had been working for. He had believed that there should be natural drugs, derived from some living thing, which could stimulate the body’s defences so that they would fight and kill the germs; yet here was a chemical substance, artificially made in the chemical laboratory, which seemed able to attack the germs itself.

Naturally, he saw that there was no real theory behind it all. It was, as was so often said, a “hit-or-miss” affair. All sorts of substances were tried out until, almost by sheer good luck, the scientists found something which would kill the germs without hurting the patient.

Fleming remained unconvinced that this was what it seemed to be, being sure that this was not really a chemical antiseptic of the type of iodine or carbolic acid. He was certain that what happened when a patient suffering from pneumonia was given M. and B. was that the white blood corpuscles, or leucocytes, of that patient were stimulated, so that they were better able to tackle the pneumonia germs which were endangering the patient’s life.

Nature, Fleming said, had provided the human body with substances which would themselves fight disease, and the job of the scientist (particularly the bacteriologist) was to discover other substances which would strengthen the power of those natural substances. If such things could be found, then it would be possible to prevent diseases from getting any sort of control. Immunization, in his view, was far better than cure. If a disease could be combated before it started, then the task of the doctor would be very much simplified, as he would be dealing with healthy bodies and not diseased ones.

Fleming therefore set out to do some experiments with M. and B., trying to find out what effect it had on germs, both inside and outside living bodies. He wanted, in this as in so many other matters, to find out just how it worked. And that was much more difficult than merely giving it and then just waiting for the patient to recover.

“In the past,” he wrote about this time, “too much attention has been given to the bactericidal action of chemical antiseptics, and better results may be hoped for if workers gave more care to the bacteriostatic action—that is, the power to inhibit the growth of bacteria. If the growth of the bacteria is prevented, the natural defences of the body can deal with the most virulent infection.”

What he felt was happening, even with a highly successful drug like M. and B., then, was that the drug prevented the germs from multiplying inside the body of the patient; when once this had been achieved, he considered that the natural defences of the body could be trusted to deal with the original batch of germs, and the recovery of the patient would follow.

It must have seemed, to many even of Fleming’s greatest admirers, that he was just being awkward, and that the striking success of M. and B. was a proof that his whole outlook on disease and the work of the chemical antiseptics was wrong. But it was soon to become clear that he was right in this as in so many other things.

Penicillin had dropped into the background of the minds of even those who had considered it a very striking substance, able to cure most diseases. But Fleming again put his finger on the real centre of the problem when he said that the definition of an antiseptic was a substance which would stop germs from growing, whereas nearly all those who had tried to discover new antiseptics tended to concentrate on substances which would kill the germs, not apparently bothering very much if they damaged the natural substances in the body of the patient which fought infection by germs.

In 1938 he wrote a long letter to the editor of the British Medical Journal in which he tried to link the two points of view together, suggesting that the chemical antiseptics which had been so strikingly successful had not been those which killed germs, but those which slowed down or stopped the growth of germs sufficiently for the natural defences of the body to have a chance to fight back against the invader.

There are some generals who, if besieged by forces from outside, would go out to attack the enemy. Others would prefer to let the enemy through their lines in small numbers, to stop others from coming in, and then to deal with the small number that had entered. Some of those who took the usual view of chemical antiseptics were like the first sort of general; Fleming was like the second type.

“Let us not discard the older methods,” Fleming wrote in his letter, “but let us supplement them with the new if we are to obtain the best results in the treatment of our patients, which, after all, is our only aim and object.”

Fleming knew—and he almost wearied his friends and relatives by repeating this, in season and out of season—that the vaccines and injections which strengthened the defences of the body had been very effective in the past; he was sure that they would be very effective in the future. He knew in his bones, as we say, that the day of such treatments would come again. He was sure that the success of M. and B. had blinded many medical men to the value of the antibiotics.

But meanwhile there was a period of waiting. The fact that penicillin had been such awkward stuff to handle, that it had proved to be unstable, breaking down so easily, was the real reason for the long delay in using it.

But all the same he showed that such types of treatment were good. An American doctor who had worked in London before and during the war suffered from severe attacks of asthma, which came on badly when he returned to London on a visit from New York.

Fleming took some substances from the man’s body, showed that certain germs were in them and made a vaccine from these germs. This was injected back into the blood of the American doctor and his asthma ceased. He remained free from it for at least seventeen years after. The cause was not in the throat or chest (where asthma shows itself in an almost unbearable feeling of choking) but in the digestive system, where the germs were found. Two other cases—an American woman doctor and a man she met in the boat coming to England—were similarly treated, and with similar results, Fleming commenting that he thought that there would probably be hundreds of such cases which could be treated in this way.

With M. and B. he was more or less satisfied. But when he put a mixture of blood and M. and B. in a tube, and added to it the fluid which he had made from a person suffering from pneumonia, he showed that the combination was far more effective than M. and B. taken alone.

This, of course, is the sort of thing which can be done in a test-tube; it cannot very well be tried out on human patients, but it can be tried out on animals. With Dr. Rogers and Dr. Maclean, Fleming tried an experiment out on mice. He inoculated a number of mice with a vaccine containing pneumonia germs. After six days these mice, together with the same number who had not been so injected, were infected with pneumonia. He found (as he had expected) that those who had been injected were cured, whereas those who had not been injected died, in spite of M. and B. treatment.

Then it was tried out on rabbits. One rabbit which was vaccinated and then treated with M. and B. was taken ill, but the illness was mild and the animal soon recovered. Another, vaccinated but not treated with M. and B., died; a third one, treated with M. and B. alone, recovered, but only after suffering a very serious illness. It began to look as if a combination of injection and drug was what would be most successful in dealing with this disease of pneumonia.

Fleming’s friends and admirers at St. Mary’s Hospital saw that he was now getting somewhere near something new, and something which would be of the greatest possible value in treatment of the various diseases.

By this time, however, war was approaching. Fleming, with his long and varied experience in the First World War, knew that if another war should break out methods of treating dirty wounds would be of tremendous importance and might, if properly applied, be a means of saving thousands of lives. There was now, too, the probability of air-raid casualties, which had not been a serious matter during the period from 1914 to 1918, but which would certainly be one of the greatest problems of a new war.

Fleming found his thoughts turning more and more to this problem of treating wounds.

Meanwhile penicillin had attracted the attention of two great men whose names will always be linked with that of Fleming. Professor H. W. Florey (later Sir Howard Florey) and Dr. E. B. Chain, at Oxford, had been working on Fleming’s old discovery of lysozyme. They had been studying this for years and had found out many interesting things about it. Now they turned to penicillin, mainly because they wanted to see what could be done with some other substance which had been proved to be a possible injection for dealing with germs.

Florey and Chain took up the work on penicillin where Raistrick had laid it down. Dr. Chain has described what they did to start with, and quite by chance he discovered that there were, in Oxford, some cultures of the very mould of penicillium which Fleming had originally been working with at St. Mary’s Hospital before he turned away to the other problems of M. and B. and the chemical antiseptics.

Florey and his friends had been working on lysozyme for ten years—from 1928 to 1938. This work had taught them much about the best way to set about such antiseptics and how to apply them to the treatment of various germs. Now, with the aid of both chemists and bacteriologists, they started to apply their experience to penicillin.

The work was still going on and had not been made known, either to the public or to their fellow-scientists, when war broke out.

Fleming and his wife were in the United States at this time. They were attending an international congress which was being held in New York, and a long programme of social events and visits to notable American hospitals and clinics had been planned for them; but when on September 3, 1939, Mr. Chamberlain, the British Prime Minister, announced that Great Britain was at war with Germany they felt that they would have to come home as soon as they possibly could.

Fleming naturally put his services at the disposal of the Government. With his long experience in the medical world it was sure that they could give him some worthwhile work to do. An Emergency Medical Scheme had been worked out by the Ministry of Health, for it was considered certain that sooner or later the great towns and cities of England would be bombed from the air, and then the doctors of the country would be given an immense job of work to do.

Alexander Fleming, it was clear, would have to be given some important post in this Emergency Medical Service; as soon as he arrived back in Britain from his American visit he was asked if he would take over a district under the scheme. This meant that he would have to supervise a large number of doctors spread over a fairly wide area of the Home Counties, centred on London. It was a part of the country which was regarded as particularly dangerous from the point of view of possible air-raids. One of his hardest duties was keeping in touch with a number of hospitals in several different counties. As he travelled about on these duties he thought about his days in Boulogne. In this war, he told himself, his job was very different; but all the same it was still concerned with the same subject—doing what he could as a medical man to save people from the worst results of war. The duty of every doctor in time of war is to help the wounded and to prevent their wounds from becoming fatal. He had done this in France during 1914-18; now he was to do it again in Britain. With that he was well content.

CHAPTER TWELVE

PENICILLIN COMES INTO ITS OWN

WHILE FLEMING WAS wandering all over the Home Counties on his task of getting his team of doctors and his group of hospitals ready to receive the casualties that he knew would soon be coming, Florey and Chain in Oxford were working feverishly on penicillin. While they had started out as pure scientists, trying to study an interesting problem as scientists do, they had soon realized that what they were doing might be of the greatest possible value in the new situation that the Second World War was bringing to Britain.

They took Raistrick’s work and tried to repeat it. He had dissolved his penicillin extract in ether. They repeated this, and then, when they had confirmed his results, they tried adding a small amount of acid to the ether. This produced a compound of the penicillin with the acid—what might be called a salt of penicillin. It was a brownish powder. They had very little of it, but it was a moment of great historic importance when that little pinch of powder was produced, for it was the first time that any compound of penicillin had ever been available.

They tested it out on various kinds of germs, and it was at once sure that they had something much purer than had been available either to Fleming, in his original experiments, or to Raistrick. The fluid which had been obtained from the penicillium culture slowed up the growth of germs when it was used in a dilution of 1 in 200—that is to say, with one drop in 199 drops of water—but this new material could be diluted hundreds of thousands of times and still have a considerable effect on the germs. It could also be injected into mice without any ill effect.

This work had occupied all the early months of the war, while Hitler’s armies were battling their way across France. It was on May 25, 1940, when the British Army was retreating towards Dunkirk in a rearguard action that thrilled the world, that Florey started his experiments with the brown powder and his specimens of mice.

He took eight mice. They had all been given a dose of germs sufficient to kill. He then gave four of them some of the penicillin and left the others without it. Within twenty-four hours the four with penicillin were shown to have very real protection; they were still alive, whereas the four that had not been given penicillin were all dead.

This was promising, but the numbers were small. It was soon decided to extend the test. This time fifty mice were taken, and again given a fatal dose of germs. Then twenty-five were given penicillin and twenty-five left without it. Florey spent two nights in his laboratory watching the results. Within sixteen hours all those which had not been treated with penicillin were dead. Out of the twenty-five which had been treated only one died. Florey was delighted; he told one of his assistants that the experiment was like a miracle.

Fleming, touring the Home Counties, did not know to begin with what was going on in Oxford; but he was soon told, and in August, 1940, only three months after the first experiments, Chain and Florey published an article in the Lancet explaining what they had done and describing the striking results that had been obtained.

Fleming observed, long after, that Chain and Florey had thought that they were working with almost pure penicillin; actually it had only about one part in a hundred of the substance. About 99 per cent, of it was impurity—and yet it had been proved to be the most effective substance for dealing with the germs of a number of diseases that had ever been found.

It was not until the next year (1941), that they had enough of the substance to try it out on human cases. And, as Fleming pointed out, if a scientist connected with a hospital goes on to the wards and says that he has something that may cure a certain disease, and that he wants to try it out on a patient, he is not likely to get a patient who is on the road to recovery. He is likely to get a patient who is very ill and likely to die no matter what treatment is used on him.

The greatest difficulty was that the Oxford men had only a very small supply of the drug. But Florey went to the Radcliffe Infirmary, the famous Oxford hospital, explained the situation, and asked if he would be allowed to try it out.

He was shown a policeman—the first man to be treated with penicillin. This man had what is called generalized septicaemia, which to the ordinary person would be general blood-poisoning. He was desperately ill and was not expected to live for more than a few hours. He was injected with penicillin, and after twenty-four hours, when the doctors expected him to be dead, his condition had very much improved. Unfortunately, the amount of penicillin available was not enough. It kept the man alive for about ten days, but then supplies ran out and he died. But what had been done was enough to show that here there was hope for seriously ill patients who might have been given up as hopeless. There was still the old difficulty of making the drug in sufficient quantities.

Fleming was delighted at the results of these experiments in Oxford. He obtained from Florey and Chain specimens of the substance that they had been using, and somehow snatched enough time, even in his busy life as a regional supervisor, to try it out. He knew that it was impure; he thought it might have as much as 30 per cent, of pure penicillin in it, though in the end it proved to have only about 1 per cent. But even so he showed that it stopped the growth of many germs.

The problem, he thought, was now a problem for the chemists. They would have to try out what chemicals came near to penicillin in composition, and finally to see if there was some way of making it in the laboratory, without the long and tedious process of using the fungus which had up to now been found necessary to manufacture it.

It had to be kept in a refrigerator. At the ordinary temperature of the room it soon lost its strength, and in those days of 1940-41 all the penicillin which existed in the whole world was in Oxford.

Moreover, no one knew if Oxford itself might not be battered by bombs from the air. In one night all the work that had been done might be destroyed. It was even said that the men who were working in Oxford had decided that, if Hitler’s men ever invaded Britain, they would smear the mould on the linings of their coats and inside their pockets so that they could work on it again in secret when the invaders had moved on.

Fortunately, no such desperate action had to be taken. But there was still the very real difficulty that anything that was done had to be done on a small scale. No factory could be induced to undertake the task of large-scale manufacture. Even if some commercial firm embarked on such a difficult task, it might well be bombed.

Florey and his friends at Oxford had started in the laboratory what was in effect a small factory. They kept Fleming informed as to what they were doing, and now and then he would dash down to Oxford to have a look at the work that was going on. But the amount that could be produced was very small indeed—nothing like enough to supply the hospitals with what they would need when once this new substance became widely known.

Soon, however, the United States of America, still a neutral country, was called in to help. The Rockefeller Foundation, a body established by a famous American millionaire to help with all sorts of research work, had helped the work of Chain and Florey with money; now they flew Florey and one of his assistants to New York, carrying with them a precious sample of the mould. Soon they were working in American laboratories, free from the danger of air-raids; not long after some of the big American chemical firms became interested and small-scale manufacture of penicillin began.

Some years afterwards (in 1945) Fleming met the first patient who had been treated with penicillin in the U.S.A. She was the wife of a lecturer in one of the universities. In 1941 she was suffering from a fever; she was dying, and none of the doctors held out the slightest hope of her recovery. When she was given penicillin she at once began to get better. Then all the penicillin had been used up, and as soon as the penicillin treatment was stopped she got worse again. It was, as Fleming said, a highly dramatic race between the manufacturer of penicillin and the disease from which the woman was suffering. “The manufacturer won,” Fleming commented, “and the woman is now a perfectly healthy individual.”

The work was largely done at Peoria, a town in the Middle West, and a town which had for some reason, as Fleming noticed, become a national joke in America, rather like Wigan in England. But here the first great centre for the making of penicillin grew up. Soon the postal, telegraph and telephone facilities of the place had to be increased, and more and more messages from doctors and hospitals, crying out for supplies of penicillin, had to be dealt with.

Fleming watched all this from a distance. He was, naturally enough, absorbed with what was going on. At long last his ideas were being proved to be correct. But meanwhile he was interested to see that a British firm had taken up the manufacture of the miracle drug too. It was from a British firm, indeed, that Florey, in Oxford, received his first bulk supplies.

Fleming visited all the places where penicillin was being studied, helping with advice. His wife saw less and less of him as he dashed over the country, keeping in touch with many people in many different hospitals and factories.

In the early days, both with Fleming at St. Mary’s Hospital and with Florey and Chain at Oxford, the mould of the penicillium had been grown in bottles, and bottles in large numbers were not easy to deal with. The pharmaceutical firms who were embarking on large-scale manufacture did not like this way of dealing with it; they much preferred dealing with tanks, but the mould did not readily grow in tanks. It grows (as Fleming had found out) on the top of the tank only, and the amount produced is not as large as if the same amount of fluid was in tubes or bottles. It also likes plenty of air in order to grow readily. That means that air has to be blown over the surface of the tank, and the air has to be kept free of germs, which again is difficult.

But the American manufacturers managed to overcome these practical difficulties, and they soon had penicillin being produced in tanks holding as much as a thousand gallons each. This too was duly reported to Fleming, who was again delighted at the progress that was being made. Now at last penicillin was coming into its own.

The makers, too, experimented with various kinds of mould. Fleming always said that the original mould with which he worked was chosen purely by chance. There might be other moulds of the fungus type which would be better, and these were tried out.

A young woman (who was nicknamed “Mouldy Mary”) was given the task of going to the market and bringing to the laboratory any food which had gone mouldy, in the hope that in that way something might be found which would provide a strain of penicillium which would be especially powerful. The name “penicillium” is not just a name of one type of fungus; it is a general name applied to a number of closely related ones, and one of the best types found was from a decaying melon which “Mouldy Mary” brought back from the market.

At Oxford, too, women were called in—the so-called “Penicillin Girls”. They helped in what was practically a miniature factory. They had to be very skilled at their job, because the penicillin was very easily destroyed by many germs which normally float about in the air. So the girls wore white overalls, caps and masks, and had to be especially careful to do nothing which would raise dust. The benches and floors were soaked with oil so that dust should not be raised, and the girls sometimes slid about the room in a dangerous way, but they were happy and cheerful in spite of many minor accidents.

Fleming kept a watchful eye on all that was going on. He could not play a very active part in the work at Oxford, but he could continue to take an interest in a product which, after all, was his child. He was sure that when it was possible to make pure penicillin the method of treatment of many diseases would be completely altered.

Samples were sent to him at frequent intervals and, in spite of all the other work that he was doing in those war years, he carried out experiments with the samples. But it was not until August, 1942, that he was given the chance of actually using penicillin himself, in a case where nothing else could have been any good.

In one of the wards at St. Mary’s Hospital there was a friend of Fleming’s. This man, aged fifty-two, was seriously ill, but for a time no one knew what was the matter with him. Eventually it was found that the illness was meningitis, caused by a germ which attacks the spinal cord, the great nervous centre of the body.

All kinds of drugs were given, to no avail. The man was sinking. “For one or two mornings,” Fleming said afterwards, “when I went up to see him I just wondered whether he was going to be there or whether he had gone to Heaven.”

The case was, in fact, as serious as it well could be. Fleming thought that it was just the kind of case where penicillin would be effective. He telephoned to Florey at Oxford.

“Have you any penicillin to spare?” he asked anxiously.

“What for?” Florey retorted.

“A dying man,” said Fleming, and rapidly described what was wrong with his friend and the reason why he thought some penicillin might save the man’s life.

“There’s a train in half an hour,” Florey said. “I’ll come on it.”

In a matter of two or three hours, then, Fleming had a fair quantity of the yellowish powder which was the purest penicillin then available. He decided to treat his friend with it, for it was certain enough that if the man were not treated he would die. Florey had brought with him the whole stock which the Oxford laboratories possessed of the concentrated penicillin (this was before large-scale production begun), and so Fleming had in his hands enough of the drug to have a reasonable trial.

At first he injected it into the muscles, but found that it did not take effect. He drew off a little of the so-called spinal fluid and tested it; there was very little penicillin to be found in it. It was not, he thought, getting to the man’s spine in sufficient quantity to have much effect on the meningitis germs that were attacking there. So he took another great chance—he injected penicillin direct into the spine. It was the first time that this was ever done.

“I didn’t know,” Fleming said later, “whether I was going to kill the man or not, but it seemed to be his only chance, and, instead of killing him, in a week this man was practically well.”

It was a triumphant justification of all that Fleming had claimed for the miracle drug. Fleming took it as being a good omen that his treatment of his friend had started on his own birthday, for on August 6, 1942, he was sixty-one years of age.

He was able to use this almost miraculous cure as a way of bringing penicillin to the attention of the Government. Sir Andrew Duncan, who as Minister of Supply was responsible for all kinds of war-time production, set up a Penicillin Committee, which included Fleming, Florey and Raistrick among its first members. This Committee was given the task of organizing production of the drug in this country, and some of the biggest chemical manufacturers were also represented on the Committee. They soon got in touch with the various American firms who were making it and there was considerable exchange of information about manufacturing methods.

By this time penicillin was news. It was being used in the military hospitals to cure the kind of wounds which Fleming had so long been unable to deal with; it was available in small quantities to many hospitals dealing with many diseases. And it was Sir Almroth Wright, now very old, who wrote to The Times a letter from the Inoculation Department of St. Mary’s Hospital pointing out that Fleming was the discoverer of penicillin, and that he was the first man to suggest that this new substance might be of some value and importance in medicine.

Penicillin, in fact, had now finally been accepted as the wonderful substance that it undoubtedly is. The long years of waiting were over. Fleming was able to sit back for a moment, in his home, reflecting on the fact that his early optimism about the value of the drug was now being confirmed time after time, that many a fighting man who would otherwise have died of his wounds was being rapidly brought back to life by its aid.

All these things he delighted in. But, perhaps more than all the actual practical results, he was pleased because his theory about the defences of the body was being shown to be correct. And to the pure scientist nothing is happier knowledge than the proof of a theory which has been neglected or ignored.

CHAPTER THIRTEEN

THE TRIUMPH CONTINUES

BY THIS TIME Fleming was being accepted as one of the greatest men in the whole history of medical science. His old chief, Sir Almroth Wright, had long been thought of as the greatest man in this realm of bacteriology; but now Fleming began to forge ahead even of him. Lord Moran, himself one of the greatest doctors of the age, referred to Fleming as a man who had become part of history in his own lifetime.

But he still thought of himself modestly, describing himself as a simple bacteriologist. He still went home at night, after a hard day’s work in the laboratory, and sat by the fire, with his wife on the other side of the room. It was with some surprise that he found himself to be famous. He never ceased to wonder at the pile of letters that awaited his answering, the endless succession of telephone calls, the requests to sit on committees and speak at meetings. He had for so long been accustomed to move among other men of science, accepting as his equals chemists and physicists and biologists, that the thought that he was now one of the greatest men in the scientific world was one to which he found great difficulty in becoming accustomed.

Florey had given some penicillin to a hospital which was treating airmen who had been burned in the terrible oil and petrol fires that sometimes followed an aeroplane crash; here too both Florey and Fleming found joy in the fact that many of these men were rapidly healed. Penicillin, in fact, was turning out to be a substance with almost endless possibilities.

This was the time when the British Army was fighting hard in the desert country of North Africa, and trials of penicillin were carried out, under conditions thought to be almost impossible, in a hospital in Algiers.

Florey went out there and stayed for three months, injecting penicillin into the veins of countless wounded men. One medical officer, seeing what Florey proposed to do, said quietly: “It’s murder!” Florey did not allow this to disturb him, and the man who was being given this treatment recovered.

Fleming at home and Florey in Algiers were showing that there were all sorts of ways in which the drug could be used. Sometimes it was injected into the blood-stream, sometimes it was applied in the form of ointment to the surface of a wound. The cures it produced seemed to be miraculous. The time that even severely wounded men had to stay in hospital was cut down by half. “The surgeons,” Fleming said, “are unanimous that there has been a very great diminution of sepsis.”

Things had changed beyond all comparison from the difficult days that he had spent in Boulogne during the war of 1914-18. Now, if a man was wounded, he could be at once treated with penicillin before ever being taken to a base hospital, and then the horrible danger of gangrene would not arise.

The war went on. The healing went on too. And when in 1944 the great operation of landing on the German-occupied coast of the English Channel was carried out, Lord Moran was able to report that 95 per cent, of the men treated by penicillin recovered from their wounds.

The cost of making the drug was still high. One Army doctor said that a seriously wounded man had £10,000 worth of penicillin injected into him. But it saved his life. In war the cost of saving life is rarely considered. One American doctor said that in the First World War about one in five of the soldiers who had caught pneumonia died; in the Second World War only one case of pneumonia out of a hundred was fatal.

Tributes to the drug, and to Fleming, came from the highest in the land. Lord Montgomery said that many men, who during 1914-18 would have been invalids for the rest of their lives, were fit again within a month of being wounded.

Fleming himself was swamped with requests for lectures and interviews. He was perpetually being asked by journalists to tell them something about the way in which the drug worked. He agreed that the term “miracle drug” was, for once, quite justified.

More than all these tributes in the popular Press, however, he valued the fact that he was elected in 1943 to the Fellowship of the Royal Society—the highest honour that can come to a scientist. He was then sixty-two years old. In the following year he was given a knighthood and, with characteristic modesty, said: “The Lord knows what my new form of address is—it will be simply Sir Alexander, I suppose.”

By this time he was being honoured everywhere. Many universities in Great Britain and overseas gave him honorary degrees, only too delighted to put the name of such a great man on the list of their members.

One newspaper report, when the British Prime Minister was seriously ill with pneumonia and penicillin was flown out to the Middle East to cure him, stated that Churchill, on holiday in Scotland as a boy, had been saved from drowning by a Scots boy called Fleming, adding that the cure of Mr. Churchill by the use of penicillin was therefore the second time that Sir Alexander Fleming had saved the life of the great statesman.

Sir Alexander and Lady Fleming had a good laugh over that. Mr. Churchill was actually seven years older than Sir Alexander, so that when he was at the age of fourteen (which was when Mr. Churchill was supposed to have been saved from drowning) Sir Alexander would actually have been seven years old!

All this publicity, however, Sir Alexander began to find very trying. He had not got used to being a public character, and he said that all the things he was asked to do got in the way of his work; all that he wanted to do was to be allowed to carry on with his experiments in the laboratory, without undue attention from outside.

The newspapers, indeed, tended to claim too much for the drug. Whenever he was interviewed or asked to make any sort of statement about it, Fleming was eager to point out not its benefits but its limitations. He did not want people to get the idea that penicillin was a “cure-all”. He was anxious to point out that there were diseases which it would not cure and to make it clear that even where it might appear to be helpful, it would be as well to have it extensively tested before using it. The bacteriology of the new drug must, he insisted, be tested before it was used.

There came into use, however, the idea of what was called a penicillin umbrella. In other words, when a surgeon had to carry out an operation, he felt happier if some penicillin was applied or injected before the operation started. Many operations which would have been thought impossible were then carried out, since the surgeon felt sure that, with penicillin present, there was far less danger of any kind of poison entering the wound.

Fleming also pointed out a new danger which was for long overlooked. That was the danger that, if penicillin was used too much or was applied too long to a particular patient, the microbes might become educated, as he put it, to penicillin and it would get steadily less effective.

“These microbes,” he explained simply, “are living organisms and they adapt themselves.”

He told some stories about the way in which some old-fashioned doctors, not knowing enough about the drug, misapplied it. There was one case of a doctor who had opened a painful boil and, when he was asked by the patient afterwards if penicillin would be given, said: “All right, you shall have some penicillin lozenges to suck.”

By this time the chemists had got working on penicillin. They had found out its chemical composition and had prepared it in the form of a white powder which was nearly 1oo per cent. pure. It was shown that it could be diluted as much as 50,000,000 times and still retain some of its strength. Fleming pointed out that one drop of water diluted 50,000,000 times would fill over 6,000 whisky bottles, which gives some idea of the strength of the drug, which will still act even at that stage of dilution.

All the time, however, Fleming, in spite of his great fame, paid continual tribute to those who had done the rest of the work. He had always said that the individual research worker in science was the man who produced results, and so in a sense he had proved by his own brilliant work. But all the same the work of Florey, Chain and others at Oxford had proved clearly enough that a team was sometimes necessary to bring a discovery into practical use.

In 1944 Sir Alexander took the chair at a meeting of the Royal Society of Arts in London, when Sir Howard Florey gave a lecture on penicillin. According to a history of the Royal Society of Arts published some years later, this lecture will always remain one of the finest descriptions of a scientific discovery and its application that has ever been given. It is interesting, too, to note that the Royal Society of Arts, which gives each year a medal, called the Albert Medal, named after Queen Victoria’s Consort, for the finest work in the realm of “Science, Manufacture and Commerce”, presented this jointly to Sir Alexander Fleming and Sir Howard Florey in 1946.

All the work that Fleming had done during the war had been carried on under conditions of very great difficulty.

He had continued to live in his modest household in Chelsea, without show or fuss, until one sad night a large bomb destroyed Chelsea Old Church, only a stone’s throw away.

He and his family had a very narrow escape that night. A falling beam narrowly missed his son’s head as it crashed to the floor. The house was not wholly destroyed, but it was now impossible to live in. Windows had been smashed, ceilings had cracked and crumbled. So Fleming took himself and his family off to a furnished house in Highgate, on the north side of London. Then there came the crowning tragedy for a man who had always loved his comfortable home.

One night the Chelsea house was set alight by an incendiary bomb which penetrated the already damaged roof. The top floor was soon ablaze and the London Fire Brigade set to work on it. Countless gallons of water had to be poured on to get the fire under control, and when, next day, the Flemings came to have a look at their old home, they were appalled to find that most of the furniture which they had left behind had been completely ruined either by the fire or by the water.

His country house in Suffolk was damaged, too, by a bomb dropped by a German raider which had come in across the East Coast. This, however, he accepted with more fortitude, because it had never been a complete home, in the sense in which his Chelsea house had been.

Yet, with all these excitements and the added excitement of his Fellowship of the Royal Society and his knighthood, he could write to a friend: “Nothing startling happening here. We all just go on.” The Scots habit of understatement was still with him, and he read with some amusement an American paper which described him as speaking with an Oxford drawl and as a typically absent-minded scientist.

The war gradually staggered towards its end. The invasion of Normandy was a success; British and American troops had a foothold on the continental coast. The Germans were beginning to see that their control of Europe was not as complete or as permanent as they had thought.

Fleming did not worry very much about these military problems. He was always the pure scientist and rarely bothered much about things outside his own field. Politicians and soldiers to him were just men, and they deserved as much attention as other men, but no more. With his own type—the scientists and the doctors—it was different. Here he knew what he was doing and what he was talking about. He understood their language and he understood what they were trying to do.

One day, at a meeting of the Royal Society of Medicine, he shared the platform with Florey, and (as with the Royal Society of Arts) he found that the ovation which they received, the cheers and the clapping, were so noisy and excited that tears came to his eyes. Not usually a man who showed people what he was thinking, he realized that his fellow-doctors had come to see the immense value of the work that he had done over the years.

As he sat on that platform, receiving the applause of the greatest doctors in the land, he remembered the way by which he reached that position. Only a few days before he had received a letter from an old lady in South Africa, and for a few moments he had wondered from whom it could have come. It was a reminder of his young days in the Loudon Moor School, the single classroom in which the children had been given their first lessons in arithmetic and English. For that letter had come from Marion Stirling, his first teacher, who had forecast a great future for her promising pupil so many years before. Now a very old lady, she had seen his name in the paper, which had printed a story about penicillin. She had recalled the bright boy and she had written to tell him so. Among all the correspondence which he received in those days, it was perhaps that letter from his first teacher which gave Sir Alexander Fleming most pleasure.

His first teacher saw his triumphs. Sir Almroth Wright, always his hero, died too soon to know all the facts of which Fleming made himself master. But he had seen the young Dr. Fleming who had started to work under him in 1906 become an F.R.S. in 1943, and receive a knighthood in 1944. There can, in the whole long history of science, be few men who have had the happiness both of seeing their discoveries appreciated, and of seeing their early teachers’ forecasts of fame and brilliance borne out to the letter.

Fleming’s greatest sorrow in those days of fame which came to him in the last years of his life was that his mother had not lived to see what he achieved. His brothers and sisters knew, of course; he was always a good family man, with strong loyalties to those who had been children when he was a child. He often thought that his mother would have been far more proud of his work than he was himself.

For, wherever he went and whatever compliments were paid to him, he always remained the sturdy Scot, without fuss and without pretence. And when Britain, with her Allies, won the war in 1945 he never thought that some of the credit was certainly his. Without penicillin many more men would have died in achieving that victory.

There are those who claim that the atom bomb was the greatest discovery of the first half of the twentieth century. Those who have known anything of Sir Alexander Fleming would say that penicillin was a far greater discovery, because it could not be used to hurt man, but only to heal him.

When the war ended Fleming was sixty-three years of age—an age at which many men think of retiring. He had no such thought. He could not expect to discover anything as important as penicillin; but his laboratory still called him, and he was still going to continue to go there day by day, as long as his strength remained.

CHAPTER FOURTEEN

MAN OF FAME

AT THE END of the Second World War Sir Alexander Fleming went to America and Canada, partly in order to see for himself what was being done in the way of commercial manufacture of penicillin in those countries. He said that he wanted to see how the baby was growing up.

Everywhere he went in America he was greeted by crowds. Reporters wanted a good news story to print; he was asked all sorts of questions about penicillin and about himself. All the questions he answered as patiently as he could, but he found it rather a trying business none the less. Frequently a complete stranger would approach him and shake his hand fervently.

“Thank you, thank you, sir,” the stranger would say. “I always wanted to shake hands with you, because you saved my life.”

Sir Alexander was a little bewildered by this approach, which he encountered again and again during his trip across America. “I don’t know why they do it,” he said once. “I didn’t do anything. Nature makes penicillin; I just found it.”

But in spite of his modesty and his desire not to be made a fuss of, the warm-hearted American public would not let him go. In Oklahoma, for instance, thirty members of the Kilties Band played Scottish music to this Scot, so far from his native country. His aeroplane was two hours late in arriving at the Oklahoma airport, but the huge crowd that had assembled to greet him did not dream of going home. They just waited patiently until the great man should arrive.

By this time he was growing old and was beginning to look his age. His hair was grey and his face was lined. But his cheerfulness and his perky Scots humour were as marked as ever. “Everyone is hunting through microbes,” he told a reporter at one place. “We shall have a lot of nice things in the future.”

He got very tired of all the fuss and bother of his American triumph. The citizens of the United States of America have got a way of making a lot of a stranger of distinction, and he now saw what this meant. He longed for a few minutes when he could be himself, just plain Alexander Fleming, scientific research worker, and cease to be Sir Alexander Fleming, F.R.S., discoverer of penicillin. Only on one or two occasions during this American tour did he succeed in reaching that anonymity. He once went to the famous Madison Square Gardens in New York and watched some boxing. No one recognized him and—much to his relief—no one asked for his autograph.

He went to Chicago to speak to a conference of doctors, and there, too, he was able to escape from the attention of the reporters and the crowd. At Harvard University he was given the honorary degree of Doctor of Science, and the students cheered themselves hoarse when he went up to receive the honour.

In Washington he was presented with a special Humanitarian Award. This presentation took place at one of the most sumptuous banquets which Sir Alexander had ever attended. Members of the American Cabinet, Senators and foreign visitors were present. Distinguished people sat down to a meal which included turtle soup, breast of chicken with mushrooms, ice-cream and all sorts of other delicacies. Lord Halifax, British Ambassador to Washington, was unfortunately absent on leave, but his second-in-command, the British Minister to Washington, attended and said that he was going to take the menu home with him to show to his wife, in the hope that she would be able to duplicate the magnificent meal.

The dinner was put on by the Variety Club of America, a stage organization which was supported by most of the leading actors in the United States. The story goes that, when the celebrations were over and the distinguished guests had gone, some of the stage celebrities who had organized the presentation to Sir Alexander Fleming of a plaque celebrating his great work in discovering penicillin, were sitting around having a drink before going to bed, and talking about all the excitements of the evening.

There came a gentle tap at the door and, when someone opened it, there was Sir Alexander, the plaque under his arm.

“I just wanted to tell you all what a wonderful time you have given me,” he said. “I felt I couldn’t go back to my hotel without saying ‘ Thank you “Come in, come in!” came a chorus of hearty American voices. But Sir Alexander hesitated on the threshold; he felt that he had taken up enough of their time.

Hands grasped his arm. Others took off his coat and laid it across a chair. Before he knew what was happening he was sitting down in that room while the leading figures in the American theatre crowded around him, asking him questions, telling him stories, roaring with laughter at his Scots jokes.

He could not get away from them until five o’clock the next morning. They had talked their way through the night.

While he was in America he heard from home news which showed that penicillin was more and more in the public eye. The London newspaper the Daily Telegraph organized a great concert at the Albert Hall (which was filled without a vacant seat). The London Symphony Orchestra was under the conductorship of a famous French musician, Paul Paray; the great violinist Yehudi Menuhin played violin concertos, and at the end of the concert the vast audience rose to its feet, clapping, cheering and shouting, and would not let the violinist go until he had played to them again. The artists gave their services at this concert free and all the proceeds went to create a fund for new research into the uses of penicillin. Over £5,000 was raised. Fleming felt deeply grateful to all who had helped in this way, and reflected how different things now were from the days when he had first begun, in a little makeshift laboratory in Paddington.

It was in August, 1945, that Fleming came back from all his American triumphs, and within a matter of weeks he knew that he, jointly with Sir Howard Florey, was to have the greatest honour that can come to a medical man.

When Alfred Nobel, the great Swedish chemist, died in 1896 he left well over a million pounds to a fund which was to be used to give, each year, prizes to the men and women who were regarded as having done the finest work in various spheres of activity. Five of these prizes were to be given—for physics, chemistry, medicine, literature and the promotion of peace. Many great men had received the various prizes in years gone by—Bernard Shaw, Lord Rutherford the great atom scientist, Madame Curie, the discoverer of radium, and similar figures of international fame. Each prize amounted to a sum of about £7,500, but the honour of being awarded a Nobel Prize was far more important in most people’s eyes than the actual cash value of the prize itself. The award of the prize for medicine in 1945 was an acknowledgment that Fleming was recognized by the world of science as one of the greatest men that the medical profession had ever known.

Just after the notification of this prize he was asked to go to Paris to tell the French Academy of Medicine about his work, and to be given the Legion of Honour, the greatest decoration in the country.

Fleming never grew (as so many men in his position would have grown) puffed up by the position which had come to him when he was over sixty years of age. His research work and his writings in the medical journals went on. While he was in America, he had written and delivered a lecture at the famous Mayo Clinic. In 1945 this was published in the official journal of the clinic. Its title—typically modest—was “Antiseptics, Old and New In the next year or two he contributed to the Lancet, the British Medical Journal and other such papers articles explaining various ways in which penicillin could be used. He knew that what he had done was only the beginning of a new era in medicine; all his life he was to continue working on it; all his life he was to try to show that there were new ways in which it could be used, new diseases which it might be used to treat.

“The Role of Penicillin in Surgical Practice”, “Influence of Penicillin on the Coagulation of Blood”, ‘ Estimation of Penicillin in Serum”, “Antibiotic Therapy , “Penicillin—Its Practical Application”, the titles of the articles he wrote in those years immediately after the end of the Second World War, show that his mind never moved very far from his greatest discoveries but that he was always anxious to extend them in new ways.

Penicillin, too, was soon shown to be only one of a whole series of worthwhile substances, and this development gave Fleming great joy. He had shown that penicillin was an antibiotic, and other men, far lesser in their way than the pioneer Fleming, now worked to see if other antibiotics existed which could be used for the treatment of diseases which penicillin did not touch, at St. Mary’s Hospital, Paddington, and elsewhere.

Fleming himself felt that he was now too old to work on such fresh problems. He was well content to leave the work to younger men; but he must have known in his heart that, without the pioneering work which he had started, these new ideas would never have come to the mind of the others.

There was a substance called streptomycin, which provided a hope that it might be the cure for the terrible disease of tuberculosis, which had claimed so many victims in the past. And before long there were a number of such antibiotics at the disposal of doctors. They were almost all derived from one or other of the fungi or moulds which grew on plants when allowed to rot. Some of them came direct from the soil. For a long time ahead medical men, under the inspiration which Fleming had first provided, were to try out such moulds, to grow them in the laboratory, and then to test the substances which they produced, in order to see if they would be of value in tackling various sorts of disease.

Fleming himself was still being acclaimed as the greatest man of all, however. In December, 1945, he travelled to Stockholm to receive the Nobel Prize which had been so rightly awarded him. It is usual for the recipient of the prize to make a speech in acknowledgment of the honour awarded him.

Fleming made a speech; it was quite typical of his modesty, again, that he made little of his own discovery. He said, mentioning his recent visit to the United States, that he had found it of the greatest possible interest to see how a simple discovery made in the laboratories of a London hospital had developed into a great industry employing thousands of workers, and how what he described as “one of my toys” had become the nearest approach yet known to the ideal substance for the cure of some of our common diseases.

But, in spite of his very real modesty, he was not allowed to keep out of the limelight as much as perhaps he would have liked. The hospital in which he had spent practically the whole of his working life organized, in 1945, a penicillin exhibition, showing the whole process by which this drug had been discovered and the way in which it was now made.

Miss Margaret Goldsmith, whose book, The Road to Penicillin, is perhaps the best account of the way in which the drug was found, has told a story of that exhibition. She went up the staircase in the hospital, and one of the officials, pointing to a closed door at the top of the stairs, said: “In that room Professor Fleming discovered penicillin.” It would be expected that this would be one of the real shrines of science, marked with a plate bearing some words about the great man and his work. There was a card pinned to the door which Miss Goldsmith expected would have some details of the work which Fleming had done. Actually the inscription on the card was: “Cat in Residence.”.

All through his career Fleming had paid tribute to his old chief, Sir Almroth Wright. It was due to Wright, he would say, that his own attention had been drawn to the subjects which eventually resulted in the discovery of penicillin; and so he derived special pleasure in the fact that his name and that of Almroth Wright were to be joined together for ever in the reorganization of some of the work of the great hospital which was now planned.

The study of germs and their action was comparatively new when Wright had started work. The premises available were small and unimpressive; but the new Institute of Microbiology which was now to be set up was very different, and it was to be called “The Wright-Fleming Institute of Microbiology”—a name which pleased Fleming more even than the award of the Nobel Prize.

Although he was now nearing seventy years of age, he was the only possible person to be chosen as the chief of that Institute. Again, with modesty, he did not ask for a huge and impressive study nor for an enormous laboratory which would make his importance obvious to every visitor. He took a room at the end of a long corridor. It was not a big room, but it was big enough to be both his study and his office. Opposite the chair in which he sat to write down the results of his work he hung a large portrait of Wright, as if admitting that to the old chief he owed all his own success.

His sense of humour was shown in that new laboratory-study too. H. M. Bateman, the famous cartoonist, had done a drawing of him, and the title of this appealed to Fleming, so he hung the drawing there. On it was written: “The only Fellow of the Royal College of Surgeons who never did a real operation.” Another drawing showed him in the uniform of a soldier, carrying a hypodermic syringe instead of a gun. He had also cut out of a magazine a drawing and had it framed. This showed a group outside a cinema, one of the women telling the others: “Oh, it was a lovely film, all about a woman living in a little town in America who discovered penicillin.”

It was not all fun, however. He was proud of his honours and he hung in the room the metal plaque which had been given him on that memorable evening in Washington by the Variety Club of America. Near by a bronze medal with his head on it showed that he had been awarded the Nobel Prize in 1945.

The laboratory itself was simple enough in its equipment. It was, of course, very much more satisfactory than the laboratory in which he had started his work forty years before. There was the bench with its rows of test-tubes; there were bottles and bottles, a Bunsen burner and all the other paraphernalia of the normal laboratory. But there was nothing to show that this was the working-place of one of the greatest geniuses in the whole long history of science. It was not unlike the simple laboratory in which many a schoolboy learns the rudiments of chemistry or physics or biology.

Simplicity—that was perhaps the most characteristic of all Sir Alexander Fleming’s qualities. It would have been easy for him to have a huge suite of rooms, so that his visitors could be kept away when he was busy—or wanted to pretend that he was. But he was content, even when the head of a great research institute, to be simple and unassuming. His discoveries were his toys. And the man who did such wonderful work remained to the end of his life a simple boy, working on the secrets of Nature just as he had worked on the birds’ nests in Ayrshire sixty years before.

CHAPTER FIFTEEN

BACK TO DARVEL

SIR ALEXANDER FLEMING had become a great public figure, admired by all the scientific world as well as by a good many people who knew very little about science.

But Alexander Fleming, the son of Hugh Fleming, the ex-pupil of Marion Stirling—he was a very different person with very different ideas.

For a few hours in 1946, however, the two Flemings became the same person again. In October, 1943, the Council of Darvel, having heard about the exploits of the village’s greatest son, had sent him a letter of congratulation and good wishes for his future scientific progress. Fleming had replied, thanking them and adding that it was gratifying to feel that what he called his small efforts had been worthy of such an honour.

He had added: “It is not often now that I get to Darvel, but my heart is still with you and with the moors beyond.”

Alexander Fleming, indeed, often thought of the happy, cheerful days of his boyhood, when he had roamed those hills and moors and had thoroughly enjoyed himself in the process.

On October 26, 1946, he stepped from a car that had brought him to Darvel from Glasgow. With him were his wife, his son Robert and other members of his family.

The main street of Darvel was gay. Flags and bunting fluttered in the breeze, and across the streets stretched messages of greeting. The burgh band played Scots music, Press men and newsreel cameramen waited, their cameras ready to take pictures which they hoped would be of historic importance.

Then a pipe band swung around the corner, kilts swirling in the breeze. Huge crowds had gathered in the square; Sir Alexander Fleming and his family had come home!

Magistrates and councillors received the great man. As Fleming looked around him his mind jumped back across the years. He recalled the days when he had wandered through those streets, a small boy full of excitement at the things which he had been enabled to see in the town. The school came back to his mind; the difficult learning of Latin, the sums and the essays, the first elementary algebra and geometry. It all seemed to him to be a long way behind— and yet at the same time it all seemed very near. The streets still looked the same, the very houses and shops had changed but little.

Sir Alexander Fleming had come back to be given the freedom of the burgh. He was, in fact, to become the first freeman. The Town Clerk read out a very formal statement recounting their pride in his work, calling him “Sir Alexander Fleming, M.B., B.S., F.R.C.S., F.R.C.P., F.R.S.”, and adding that they felt great esteem and admiration for the work which he had done and for him as a personality.

There was presented to him an illuminated scroll lettered in red, black and gold, with the burgh’s coat of arms in blue and gold at the corner. The scroll was contained in a casket which was designed and made by one of the many skilled craftsmen of Darvel. On the bottom of the casket was a metal plate, describing just why this honour was being paid to Fleming.

The Town Clerk presented this, with a speech of praise for all that Fleming had done and expressing the feeling of the people of the neighbourhood that he was a man whom they did well to honour.

In his reply Sir Alexander made a typical speech. He recalled his boyhood in the district, his wanderings over the moor in snow and rain, his hunt for the eggs of the moorland birds, his catching fish in the rushing streams, and the way in which he first learnt that the countryman knew something of the ways of Nature.

He praised the life of the countryman. He himself had spent most of his life in the towns, but he was still conscious of the fact that the life of the countryman was a fine life; “He has got variety in his life and he has Nature all around him,” said Fleming with feeling. Those who listened to him had little doubt that he would have been happy if his life, too, had been spent among them. He described his schooling in the little stone building in the country, “Where,” he said, “they really taught you something.” He paid a word of tribute to the school in Darvel and to Kilmarnock Academy.

In front of him as he spoke was a long array of faces looking at him, and as he gazed at them he said that there might be some there who went to school with him, though he might no longer be able to recognize them.

“I have not been in this countryside,” he said, “for many years. The people change but the country is the same. The same pools are in the burn, and the country is just the same; and I have no doubt the same trout we guddled as boys are under the same stones.”

His heart was still with the Darvel people; of that they could have no doubt at all. Then he turned to his own work, far away in London, of the discovery of penicillin and the value that it had been to humanity at large. Good luck, he said, had been his. He had just been the favoured one of fortune. It was the sort of thing, he suggested, that might have happened to anybody. And he went on to explain that no scientific research, however satisfying it might appear at first sight, was in any way complete in itself:

“The object of research is the advancement not of the investigator but of knowledge.”

That sentence, in fact, might have been taken as expressing in short the whole position that had been taken up by Sir Alexander Fleming throughout his career. “It is the glory,” he said, “of a good bit of work that it opens the way to better things and thus rapidly leads to its own eclipse.”

He may not have felt that penicillin was soon to be eclipsed, but when he read of streptomycin and the other drugs which were, in their way, going beyond penicillin, it was no doubt this sort of idea which was in his mind.

His visit to Darvel, at any rate, brought him back into his own country. Even though by now few if any of his family were still in that Ayrshire country, he always thought of it as being his real home. He liked his London house, as he liked his house in Suffolk, but it was not quite the same.

Yet by 1951 his house in Suffolk was put into good order again. He was able to go down there and look after it. His garden gave him joy, the fishing in the river brought him new satisfaction, and he found that he was spending more and more time there. He had a laboratory fitted up down there, so that if he did not feel like going up to London he could do a certain amount of work in the country, and add to the results which were still steadily piling up and being recorded in Paddington.

He still wrote for the medical journals; he still extended men’s knowledge of penicillin and all its applications, studying moulds and funguses of various types, in order to see if he would be able to produce more drugs which would be as good as penicillin, or which would be possible for use with germs which eluded its effect.

At the same time he found he was slowing up. His mind had always been very active; yet most people find that when they approach the age of seventy their brain is not as lively as it was twenty or thirty years earlier.

The greatest break that came in his life (except the death of his mother) came in 1947. Then Sir Almroth Wright died at the age of eighty-seven. Fleming had been the principal assistant of that great man for many a year; he felt that it was to Wright’s inspiration that he owed so much of his own success. Wright’s death meant a change in the set-up of the laboratory, because, while Wright had officially retired years before, his advice was still at the disposal of all the staff, and the ideas which he had started so long before still remained alive and important in the minds of his juniors.

Fleming was a freeman of his native Darvel; other bodies now gave him a similar honour. So much of his working life had been spent in the laboratories at St. Mary’s Hospital, Paddington, that it was appropriate that the Borough of Paddington should make him a freeman too. For years he had lived in Chelsea, so now he became a freeman of Chelsea as well. In Paddington a new block of flats was called Fleming Court in his honour. He was given the task of carrying out the opening ceremony, and wondered even yet at the way in which so many people thought him a great man.

Sir Alexander Fleming, indeed, in the late 1940s and early 1950s seemed to be settling down, as so many men settle down in their old age, to be a great man in semi-retirement, a man whose work is a very real inspiration to the youngsters, but whose own activity is gradually coming to a standstill.

To his pleasure, too, his only son had followed in his footsteps and qualified as a doctor, with all the necessary persistence and dogged perseverance which had made his father great.

His hobbies went on. He still looked after his Suffolk garden; he still did some shooting on occasion. On one famous day in 1951 he went to Bisley—the first time, he recalled, for twenty-five years—and shot for a London Scottish team. He may have been a little out of practice, because the rifle kicked back at him, hitting him on the bridge of the nose and causing a rather nasty cut.

He did not let it worry him. He wiped away the blood with his handkerchief and went on shooting without comment. His score was not anything striking. That night he sat up with the others, chain-smoking cigarettes and taking part in all the festivities of a Bisley party. He did not, in fact, go to bed until about one o’clock on the following morning.

Yet he got up at the normal time, shot brilliantly and returned the top score for his side. It was an amazing piece of work for a man in his seventieth year and he derived immense pleasure from it. The gap from forty-five to seventy is a very big gap in the life of any man, and yet somehow he had managed to bridge that gap and to shoot as well at seventy as he had done twenty-five years before.

His hair was now snow-white; above the lenses of his spectacles his eyes shone as clear blue as they had ever done in the years before, and as he peered along the sights of his rifle he held the weapon as steadily as he had ever done in the years gone by.

The honours that poured upon him now were too numerous to mention. He was, for instance, awarded the John Scott Medal at Philadelphia, a medal paid for out of a fund left to the city by an Edinburgh chemist many years before so that eminent scientists might be suitably honoured. He was not able to travel to America to receive it, so it was accepted on his behalf by Lord Halifax, the British Ambassador in the United States.

He was the great man in the eyes of all who met him, even though he was not himself conscious of greatness. “Contentment and smug satisfaction find no culture plate for themselves within the mind of the great scientist,” one journalist wrote of him.

Still he went on with his work. Still he left his Chelsea house at a regular time each morning, taking up his place in his simple room in St. Mary’s Hospital. Still he did his regular hours at the laboratory bench, noting down results in his neat handwriting. Still he wrote his contributions for the medical press, never letting down an editor who was expecting something on a particular day.

Yet he was beginning to feel his age. There were occasions, as has been said, when he stayed in Suffolk for a longer week-end than he would in the past have thought advisable. Even there, however, he did not merely concentrate, as some men would have done, on his gardening and boating and fishing. He had his laboratory there and his research work did not stop because he stayed away from Paddington for a day or two. Right up to the very end of his life he was to continue to concentrate on his work, seeing that he was perhaps better equipped than anyone else in the world to do this research on the antibiotics.

Slower perhaps in his ideas than before; slower, as he himself would say, in his reactions, but all the same with his whole mind concentrated on preventing or curing disease. His whole mind through his long career at the great hospital in Paddington, was concerned with the way in which to work out a solution to some of the problems which Nature sets man.

CHAPTER SIXTEEN

LAST YEARS

SIR ALEXANDER FLEMING had one sad blow in his last years of triumph. Lady Fleming, who had seen him rise from the position of a young and almost unknown assistant in the laboratories of St. Mary’s Hospital, died in 1949. It was a great private grief which was known, in all its intensity, only to those who were near to him.

He walked a little more slowly, the smile on his lips came a little less readily than it had done in the past, but to his acquaintances in the world of science there was little else to show how he felt this blow at his private happiness.

Yet in those last years he carried on with his work; he travelled all over the world. In 1950 he was in Rio de Janeiro, and was three hours out over the Atlantic in the aeroplane when one of the engines failed and they had to return to their base in order to get it mended.

He did not let it worry him. Within three weeks of his return to England he was off again—this time to Italy, where he was received by the Pope. “There was too much fuss,” he said afterwards, “but they were very kind.” He went to Belgium to make a speech on the eightieth birthday of a great Belgian scientist, Jules Bordet. He went to Spain, where he was received as a hero and a genius.

At a medical congress in Verona he was pleased, even at his age, to have a swim. He was shown three children, brought to him by their father. “If these children are alive,” the father said, “they owe it to you.”

On August 6, 1951, he was seventy. Interviewed by a journalist on that day, he expressed the hope that he had a few useful years before him. Asked what was the formula for a happy old age, he said: “Keep on working.”

In 1953 he married a lady who had worked with him as a biochemist, Dr. Amelia Coutsouris. And he did keep on working to the end. It came with merciful suddenness. It was on March 11, 1955, that he died, having been active almost to the end. As late as 1951 he had written for the British Medical Journal an article on “Syringe Needles and Mass Inoculation Technique”—an indication that he was still lively and alert, ready to think of new things and new ways of carrying on medical work.

It is not easy, so soon after his death, to see just what Sir Alexander Fleming meant to the world. There can be no doubt that, whether penicillin is used in the years ahead as much as it has been used in the years now past, his outlook will continue to be of the greatest importance. New antibiotics may well take the place of penicillin in the future, but the idea of the antibiotics will go on. The thought that what was wanted was not drugs to kill germs direct but drugs to stimulate the natural defences of the body—that is the thought that impelled Fleming all through his long career, and that is the thought that he has handed on to the new generation of doctors which has come after him.

From the boy in Ayrshire to the great scientist, honoured in his own country and far beyond it, may seem to be a very long journey, but it is a journey which we can follow and understand and appreciate. We can, too, pay honour to him.

One great American doctor, who had seen some of the damage done in the two Great Wars, said: “It is very fortunate that we have men like Fleming who love life.” That is perhaps the best way in which he can be remembered, as it is certainly the way in which he himself would have liked to have been remembered.

His life was not, as was said at the beginning, outwardly very exciting. It was a matter of slow and slogging routine work in the effort to penetrate the secrets of Nature. But in its effect on the world it was more important than many lives that seem full of action and excitement. The life of a general, fighting battles against terrifying odds, may seem more thrilling than the life of a scientist like Sir Alexander Fleming. But he fought a greater battle still, against still greater odds—and he won.

FURTHER READING

IF YOU HAVE been interested in this book you may want to know more about Alexander Fleming and his discoveries. There are a number of books about him and his work, all of which have been drawn upon for the facts in the present book. Some of them deal with other subjects as well. The most valuable, and those which deal almost entirely with Fleming and the antibiotics, are marked thus *:

* Margaret Goldsmith, The Road to Penicillin, Lindsay Drummond, 1947.

* George Lacken, The Story of Penicillin, Pilot Press, 1945. *

* L. J. Ludovici, Fleming, Discoverer of Penicillin, Dakers, 1952.

* David Masters, Miracle Drug, Eyre & Spottiswoode, 1947.

G. N. Ridley, Man Studies Life, Watts, 1944.

Joen Rowland, This Age of Science, E. J. Arnold, 1955.

* Boris Sokoloff, Penicillin, Allen & Unwin, 1946.

Arnold Sorsby, Medicine and Mankind, Watts, 1944.

S. G. Blaxland Stubbs, From Magic to Modern Medicine, Watts, 1952.

More Information about Sir Howard W. Florey

https://www.nlm.nih.gov/exhibition/fromdnatobeer/digitalgallery/detail-B07881.html