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The Life of Sir Alexander Fleming
Chapter II -  The twists in the path

'I should see the garden far better/ said Alice to herself, 'if I could get to the top of that hill; and here's a path ... but how curiously it twists

lewis Carroll, Alice Through the Looking Glass

Like many British institutions, the study of medicine in England was organized in a haphazard manner without any ^central plan. Each of the twelve great London hospitals had maintained a school long before the creation of the University. When this was founded, the hospital faculties of medicine formed part of it, but retained, from the days of their independence, the right to accept students who did not hold the Secondary Schools Certificate which was necessary before they could enter a university. These students could obtain a special diploma known as the 'Conjoint', which gave them permission to practise general medicine, but not to have access to the higher levels of the University hierarchy.

Fleming, who had neither the certificate of matriculation demanded by the University nor any other form of diploma, had to pass an examination before he could be allowed to enter a school of medicine. He took a few lessons and then sat for the examination of the Senior College of Preceptors. There was good reason to fear that a young clerk who had had no time for study for the last five years would be in no fit condition to face so exacting a test. But Fleming had a solid basis of education (which he owed to the little moorland school), a prodigious memory, a tempered intelligence which, like a scalpel, cut straight through to the essentials of any subject, and a natural gift of expression. When faced by any definite question, he could write with elegance and clarity. He passed top of all the United Kingdom candidates (July 1901).

With the certificate firmly in his grasp, he was in a position to make his choice among the available medical schools. Tn London', he wrote, 'there are twelve such schools, and I lived about equidistant from three of them. I had no knowledge of any of these three, but I had played water-polo against St Mary's, and so to St Mary's I went.' That he should have chosen a faculty of medicine for purely sporting reasons may seem strange. But the fact that he did so reveals a pleasing and constant aspect of his character — a need to combine the fanciful and the serious. He was the least pompous of men, and his mind could adapt itself to an infinite variety of interests.

St Mary's was not a hospital of ancient lineage. It had been founded in 1854 to serve the Paddington district where, since the building of a large railway terminus, the population had rapidly increased. The foundation-stone had been laid by Prince Albert. Fleming entered in October 1901, and while pursuing his studies in medicine was also reading for the matriculation examination of the University, which he passed with ease in 1902. He next set himself to compete against rivals of many different types and upbringing for the senior scholarship in the natural sciences. His most dangerous adversary was C. A. Pannett, a brilliant student with a far more extensive general culture than Fleming could claim. Nevertheless, the latter again came out top, as he was to do in every competitive test for which he entered, all through his life. The dangerous rival became his best friend and has given a partial explanation of these unvarying successes. 'From the earliest days of his career,' Pannett writes, cone thing was abundantly clear, that he was a first-rate judge of men, and could foresee what they would do. He never burdened himself with unnecessary work, but would pick out from his text-books just what he needed, and neglect the rest.'

Fleming followed with great attention the lectures of those who were to be his examiners, took detailed notes of what they said and, what was even more important in his eyes, made himself familiar with the character of each. Having done this, he described exactly what questions they would set ... and was rarely wrong. He studied his masters, to some extent, as natural phenomena to be carefully observed, and treated the examination papers themselves as a 'special subject'.

This, however, was no more than one aspect, and a secondary one at that, of his success. He maintained that, given sound common sense and a solid knowledge of the basic principles, a man ought to find it easy to improvise the right answer to any question.

Throughout the whole of his University career he triumphed all along the line by making use of these simple principles, though he made light of his successes. His fellow-students found his memory and his powers of observation astonishing. Very few knew him intimately. Either from temperamental shyness or deliberate reserve, he was slow to make friends. He did, however, belong to the hospital Amateur Dramatic Society, and on one occasion played the part of a woman — Fabriquette, in HneroJs Rocket — a sprightly French 'widow5, "whom he made a great deal more attractive than that unprincipled female deserved to be** The supporting feminine role was filled by G. M. Wilson who, in the far distant future, was to be Lord Moran, and Winston Churchill's doctor.

T do not remember much', says Pannett, 'about his anatomy and physiology period, except that he seemed to do very little reading. Yet he must have worked extremely hard, since he was one of the outstanding pupils of his year. I, personally, took no part in the activities of the swimming and rifle clubs, and so never saw much of him as a sportsman. I wish I had, because there seems to be general agreement that he revealed his true nature at these times. He seems to have excelled in any game or sport he took up. I don't mean that he reached the front rank, but that he always became proficient in the essentials, and so was more than an averagely good exponent.

T do know that he delighted in making difficulties for himself, just for the fun of overcoming them. For instance, he once undertook to play a round of golf using only one club. In sports he employed the same methods which he applied to his work. He would set himself to grasp the essentials of a technique, concentrate on them, and so win with ease. Because nothing ever presented any difficulty to him, one might be tempted to call him a dilettante, but that would be quite wrong. He was far too serious, too efficient and too brilliant ever to be described as an amateur. He found a sort of elegance and modesty in concealing all effort.

CI never heard him mention history, music or philosophy, and I was surprised to discover later on that he read the poets of whom, not unnaturally, the Scotsman Robert Burns ranked among his favourites. He never showed that side of himself to me. He did not seem to take even scientific treatises seriously, but appeared

As a young clerk in the City. About 1900

to run through them, and, with an economy of effort, get what he needed out of them, store it up in his memory, and with his fertile brain apply it to his own particular researches — a mark of true greatness.

'During our student years, I competed with him for a number of prizes, but since I always came out second, I soon gave up the unequal struggle.'

All those who were St Mary's students in those years have a clear memory of the two invincible champions, Fleming and Pannett, who between them shared all the prizes. The distinctions won by Fleming covered the whole field of medical studies: biology, anatomy, physiology, histology, pharmacology, pathology and medical practice. But in the evenings at home he was always ready to shut his books and play games with his brothers — draughts, bridge, table-tennis. Anyone would have thought he had nothing better to do. 'When he read a medical book,' says his brother Robert, 'he flipped through the pages very rapidly, and groaned out loud when he caught the author making a mistake. There was a great deal of groaning.'

In those early years of the twentieth century St Mary's Hospital, according to Dr Carmalt Jones, one of Fleming's contemporaries, was a pretty gloomy place. There was nothing 'aesthetically attractive' about the public wards, and the Medical School was even worse: squalid in appearance, ill-lit and poorly furnished. The teaching was a great deal better than the environment. The Professor of Anatomy, Clayton Greene, was dogmatic, lucid and frequently amusing. 'He always appeared in the theatre at nine o'clock to the minute, having changed his overcoat for a long white smock. He illustrated his lectures with beautiful drawings on the blackboard in coloured chalks. When the lecture was over, the students went into the dissecting-room.'

After an initial period of instruction in surgical theory, they were admitted to the hospital proper. In the Casualty Department they learned how to open abscesses, how to probe and dress wounds, and even how to pull out teeth, which they did without a local anaesthetic. They had to manage as best they could with the assistance of the house surgeons who knew very little more than they did. Medical treatment oscillated between science and routine. The professors had individual manias which, for the students, had the rigidity of law. The first with whom Fleming worked always treated a pneumonia case by applying an ice-bag to the affected lung. But, when he went on holiday, his substitute was found to prefer poultices. Consequently, when the second lung caught the infection, the patient had a poultice on one side and an ice-bag on the other. He recovered.

In 1905 Fleming spent a month attending outside maternity cases. The husband of the expectant mother would fetch the resident student from the hospital and lead him through a maze of side-streets to his wretched home, which often consisted of only one room. When that was the case, such other children as there might be slept during delivery under the woman's bed. 'Fortunately', says Carmalt Jones, 'in-ninety-nine per cent of maternity cases, there is nothing to do but to let nature take her course. Or so we thought.'

During the year which he spent in the study of anatomy and physiology, somebody told young Alec that it would be of great use to him to take the Primary Fellowship in surgery. The registration fee was five pounds. Needless to say, Fleming passed. But he never became a surgeon, partly because he had a dislike of operations on living bodies, but mainly because circumstances were directing his feet into a different path. 'However,' he said, 'being a Scot, I never ceased to regret the five pounds which I had spent to no purpose. I wondered whether I ought not, perhaps, to have a shot at the final. I knew my pathology, but had no experience in practical surgery, nor the chance of getting any. Still, the second fee was, like the first, only five pounds, so I decided to try my luck/

Much to his surprise he passed this far more difficult test and was entitled, as a result1 to put the august letters F.R.C.S. after his name. It began to look as though his career was to be at the mercy of a series of curious accidents. He had adopted the medical profession because his brother was a doctor; he had gone to St Mary's, where he was to spend the whole of his life, because of water-polo; he had become an F.R.C.S. because he wanted to justify the expenditure of five pounds; he was to choose bacteriology, to which he later owed his fame, for a reason no less strange and trivial,

The two Fleming brothers, Alec and Robert, were still members of'H' Company of the London Scottish, and as such took part in the annual camps, the various route-marches and the rifle competitions. Alec loved the life, because it brought him in contact with other Scots. Many years later in 1949, by which time he was a famous man, he took the chair at one of the reunion dinners of the few remaining old-timers of 'H5Company which had been dissolved by merger some thirty-five years before.

'You have had as chairmen at these reunions', he said in his speech, 'colonels, captains, sergeant-majors and such-like. But this is probably the first occasion on which a humble private has presided. As a member of the regiment I was always humble. I never disputed an order given by a sergeant or even a lance-corporal. As to officers, I was so insignificant a figure that I don't think I ever got an order direct from any of them.

'To be humble was a great advantage. There was no need for you to think: you just did as you were told. The officers, on the other hand, had to do a lot of hard thinking, since as often as not they did not know what ought to be done. But they had to do something, or pass the buck to the Colour Sergeant. Probably the Colour Sergeant did not know either, but it was more difficult for him to pass the buck (though he did sometimes manage it), with the result that he had to give some sort of order, whether it was right or wrong. The sergeants were always quite sure of themselves, especially when they knew nothing about what was going on.

'It is a wonderful thing in a Company to remain a private, and to watch others doing the climbing. They do it in such different ways, but all of them are interesting. When I joined "H" Company, it was at a low ebb. The other companies said we couldn't shoot, they said we couldn't drill. After five years, they discovered that we could drill and shoot. I remember one Whit Monday when "F" Company thought they had everything in their pocket, but the despised "H" Company suddenly woke up and walked off with all the best prizes. I am not at all sure that the Fleming family was not responsible for this. There were three of us shooting that day ...'

Ever since 1902, one of the most brilliant members of the teaching staff at St Mary's had been Almroth Wright. He was already celebrated as a bacteriologist, and had crcated an inoculation service at the hospital. Wright, who was eloquent, paradoxical and something of a genius, had a number of enthusiastic disciples, among them a young doctor called Freeman, a charming and cultivated man with a fine head of curly hair. He was a good shot and anxious to get new blood into the St Mary's rifle club which, after carrying off the Inter-Hospitals Shooting Cup for several years running, had fallen on evil days. Anxious, as he was, to build up a new team, he asked: 'Are there any territorials among the students?'

Someone answered: 'Yes, that little fellow, Alec Fleming, He's in the London Scottish.'

'What's he like?'

'Quite a decent accent, and wins all the prizes. Apart from that, inscrutable.'

'What's his line?'

'Surgery, but if he sticks to that it'll mean his leaving the hospital. There's only one surgical vacancy, and Zachary Cope's bound to get it.'

'Good shot?'


Hearing this, Freeman at once conceived the plan of keeping the first-rate shot at St Mary's T>y getting him into the Inoculation Service. With this in mind, he approached Fleming and tried to imbue him with his own admiration for Wright. After one of the latter's most brilliant lectures, he turned to Fleming and said: 'Wright's a marvel!'

Fleming, moved by a spirit of contradiction, replied coldly: 'What I want is facts. I've heard nothing from him but airy generalizations.'

All the same, as soon as Fleming had got his diploma, Freeman suggested that he should work in Wright's laboratory.

'Look here, I know you're a good shot ... why not join us in the lab.?'

'How can I do that?'

'I'll manage it.'

Fleming, still tempted by the prospect of a surgical career, hesitated. Nevertheless, like all the students, he was fascinated by Wright, and Freeman was persuasive. T plugged the fact that Almroth Wright's laboratory would make a good observation-post from which he could keep an eye open for a chance to get into surgery. I told him, too, that he would find work in the lab. interesting, and that the company there was congenial. The lab., at that time, consisted of only one room where the staff lived a sort of communal life.'

It remained to convince the cChief, in other words, Wright. Freeman was perfectly frank with him, and talked about his beloved shooting team. Wright thoroughly enjoyed Freeman's whimsical way of dealing with serious matters. Freeman went on to say that Fleming had a scientific mind, and would make an excellent recruit. To cut a long story short, Wright agreed to the suggestion, and Fleming was taken on to the laboratory staff. He never left it until the day of his death.

Such a method of deciding on a career may seem incredible, casual and irresponsible. 'But I don't think', says Freeman, 'that Fleming ever made plans far in advance. He was content to assemble his facts, and then leave Fate to do the rest.' It is not a bad method, for no one can ever be sure of foreseeing the effects of a decision. A water-polo side had led him to St Mary's, and a shooting team to choose bacteriology. Both choices were good.

Many years after these events, when speaking to an audience of students, he said: 'There are some people who think that medical students should spend all their time learning medicine and should give up games. I don't agree. If a student gave up all games and spent all his time reading text-books, he might know his books better than the next man. I say might, for it is by no means certain that he would. He would probably have a better knowledge of what was written in the books, but not of the meaning of what he read.

'You should know even at this stage of your career that there is far more in medicine than mere book-work. You have to know men and you have to know human nature. There is no better way to learn about human nature than by indulging in sports, more especially in team-sports,

'When you are one of a team, you have to play for the side and not simply for yourself, and this is marvellous training for a man who hopes to become a doctor. For even a doctor has to play the game of life, not just for his own material advantage, but for the welfare of his patients, irrespective of financial gain.

'Doctors are, in a sense, a team, and the selfish ones who play only for their own personal ends tend to ruin the team-spirit and lower the standard of their profession.

Play games, and you will be able to read your books with a greater understanding of your patients, and that will make you better doctors ... True, each one of you will, later, have to specialize in some particular part of the body, but never forget that your patients are live human beings.

Then, speaking of his own youth, he added: 'Sport has had a considerable influence on my own career. Had I not taken an interest in swimming in my young days, I should probably not have gone to St Mary's Hospital: I should not have had Almroth Wright as a teacher, and it is more than likely that I should never have become a bacteriologist.'

The twists in the path are numerous and surprising. But it is the winding road that gets to the top of the hill.

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