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The Life of Sir Alexander Fleming
Chapter XIV - Sir Alexander Fleming

In recent years life for me has become a little difficult. Fleming

The summer of 1944 in London was the time of the flying-bombs. These objects, fired from the Continent, travelled with a terrifying rumble, and slowly enough to be seen with the naked eye before they reached the end of their trajectory. At St Mary's as soon as the sirens sounded, a watcher went up on to the roof, ready to give the alarm if he saw any 'doodlebug' making towards the hospital. This he did by setting off a bell. A second and a third shrilling meant 'Danger imminent' and 'Go down to the shelter'.

Often at the first warning Fleming and his friend, Professor Pannett, would rush up to the roof to watch the 'doodle-bug' through their glasses and compare notes on where they thought it would fall. One day when Clayden was on watch-duty, he said to Fleming: 'Look sir, this is becoming a bloody farce. You send me up here to keep people away, and then you come up yourself. You and Professor Pannett are important men and can't easily be spared.'

'That's all right,' replied Fleming, 'just say we're carrying out an inspection.'

Sometimes it happened that if he was in the laboratory engaged on an interesting piece of work, he did not hear the siren. His secretary, Mrs Helen Buckley, describes how, one morning, he was dictating a difficult letter when the alert went.

'I just looked up, a bit nervously,' she says, 'hoping for the best, and then presently the second warning rang and I could hear the wretched flying-bomb grumbling away in the distance getting louder, and then the third warning rang, and there was the horrible thing coming straight at us. I could see it from my window, and the sweat began to drip off my face on to my block. I could hardly hold on to my pencil, and I looked at him out of the corner of my eye — not a move! Finally, the thing rattled overhead, the whole building shook, and the objects on the desk tinkled. When it was gone, and the fourth bell rang for "All clear", suddenly the Professor came to, out of his deep thought, looked at me, and said "Duck!" He had not heard either of the first three warning bells, nor the flying-bomb.3

The military authorities were beginning to permit the use of penicillin for civilian patients. Bernard Shaw's play, The Doctor's Dilemma thus became a reality. Each case had to be considered on its merits, for if the still far from abundant penicillin were used for a sick person who could be cured by other means, there was always the risk that there wouldn't be enough available when it was a matter of life and death.

Sometimes the identity of the patient had an influence on the decision. Philip Guedalla, the author, for instance, received privileged treatment. T am,5 he said later, 'one of the animals into which the life-saving substance has been injected. I am afraid that in my case it was applied as a corpse-reviver at a very late stage, but it revived the corpse. If it had not been for the investigation which Professor Fleming carried out so brilliantly, I should not be here this afternoon. I wish to testify with all humility and thankfulness to the treatment which in six weeks can bring a man out of the shadow into a state in which he is able to resist the efforts of three Government Departments to amend the text of his book.'

From all sides the relatives of sick persons wrote to Fleming begging him to help in the cure of all kinds of diseases. He always did his best to see whether anything could be done, and never failed to answer these hundreds of letters in his own tiny, elegant and readable hand. But the simple-mindedness of some of these requests saddened him. T have never said that penicillin can cure everything. It is the newspapers that have said that. It does have an extraordinary effect in certain cases of illness, but none in others ...' The publicity which he had not sought showed him no mercy and, say what he might, it was firmly fixed in the lay mind that penicillin was a 'miraculous panacea'. He knew that, like other remedies, it was specific, that is to say that it acted on certain microbes and had no action on others.

'That makes things much more difficult for the doctor. No doubt he would prefer to have a chemical substance which he could use for all cases of infection. But, since that is impossible, he should not waste his time, or his patient's, by using the wrong drug on the wrong microbe. This means that, from now on, every doctor will have to pay a great deal more attention to bacteriology than in the past. Penicillin was born in the laboratory, and has grown up in close association with the laboratory. Penicillin treatment can only satisfactorily be carried out in association with a bacteriological laboratory.'

He insisted on certain essential ideas. In the first place, penicillin could act on the microbes only if it were in contact with them, either locally or in the blood stream. 'Put the champion in the ring face to face with his opponent, and he will do the rest.' But it was not treating a boil with penicillin merely to give it a surface application of penicillin ointment, for that did not establish contact with the centre of infection. Next, care should be taken not to use penicillin for minor affections — a sore throat, for instance — because that only encouraged among the microbes the development of resistant strains. For the same reason Fleming advised doctors not to hesitate, when dealing with severe cases, to use very strong doses. There could be no danger, seeing that the product was non-toxic, and in this way they could avoid the risk of leaving resistant strains in the organism. It was necessary to wage a blitzkrieg against microbes.

Honours were now showering down thick and fast on this man who had neither sought nor wanted them, though he felt the same pleasure in receiving them as formerly in carrying through some experiment better than anybody else or, at shooting, handing in a better target. Fame could not spoil him. He was still the same simple, approachable individual about whom, very often, celebrated foreigners who had come to congratulate him at the Institute would say: 'What! is that the celebrated Fleming?' A young American army doctor, who sat next to him at a football match, spent the whole afternoon trying to find out the name of the friendly little man with the spotted bow-tie, who had solemnly explained the rules of Rugby to him. He felt sure he had seen him somewhere. Could it have been at the Royal Society of Medicine? Driving back to London through the ruins of the bombed city, he kept thinking of the smiling professor who in these agonizing days could get so excited over a game. To his friend, who was at the wheel, he said: 'Tell me, Dave, who was that prof. I was next to? I've forgotten his name.'

'Why, that's Fleming, the bacteriologist at St Mary's — the guy who discovered penicillin!'

For the young American scientist, who had seen penicillin make hay of virulent cases of septicaemia, it was as though a door had opened, and a legendary figure appeared suddenly on the threshold. T went on thinking about that friendly professor, but not as formerly. So that, jostled by the crowd, unrecognized and not wanting to be recognized, cordial and human, was the man I had met, whose name, for the good he had done, would rank higher at the Judgment Throne than Hitler would be low for the evils he had committed. In the most bitter hour of the war, I had watched the English at play, and had felt their greatness.'

In July 1944 the newspapers published the new Honours List. The 'bacteriologist at St Mary's' had become Sir Alexander Fleming, and his wife, Lady Fleming. She showed her pleasure more visibly than he did, not that he wasn't pleased, but he was still incapable of showing his feelings. 'I am almost sorry,' he said, 'that I'm not Irish, because then I could really have enjoyed it all.' For many years now, Sareen had shown him how completely the Irish can accept the most ordinary compliments, to say nothing of well-deserved honours ... Of course he enjoyed his honours — everyone could see that: what he meant was, give himself up entirely to enjoyment.

The day before the new Knight Bachelor was to receive the accolade from the King at Buckingham Palace, he said to Clayden: 'How about a party tomorrow evening?'

'What about the doings? It's difficult to get stuff these days.'

'Next door,' said Fleming, with a jerk of his cigarette, 'there are five bottles of gin. Lay in some beer, and all the usual what-nots, and we'll have a party when I get back.'

The investiture took place in the Palace basement, for security reasons, and Sareen was disappointed. When Fleming returned to the Institute for tea, he found only eight persons in the library. Many of the doctors were absent on duty. It happened to be one of the days when Wright came to London for a few hours, and he was presiding over the gathering as he had done for the last forty years. But he seemed to be in one of his bad moods, slumped heavily into an armchair, and did not utter a word until Fleming turned up. The total, the lowering, silence continued for a few minutes, then, deliberately turning his back on Fleming, Wright launched out into a tremendous discourse on the merits of immunization, and the demerits of chemotherapy which, he declared, was a heresy bristling with danger for all genuine medical research.

Dr Hughes, who was sitting opposite Fleming, expected to see some sign of amusement or anger on his face. But it remained completely impassive. Finally the Old Man had to stop talking from sheer lack of breath. Craxton, the secretary of the Institute, thinking to ease the tension, asked Sir Almroth to decide a few administrative questions. The answer came like a thunderclap:

'Don't bother me with such trivial things! Doctor Fleming will deal with them!'

Professor Sir Alexander Fleming held out his hand for the papers, got up and left the table without a word.

Wright returned to the country and the evening was a great success. The headquarters staff of the hospital was present in full force. Many toasts were drunk to Sir Alexander, and Sir Zachary Cope, the great surgeon, who had been a student with 'Flem', read a poem of his own composition:

To Alexander Fleming, Knight

To achieve an outstanding success In one's chosen career
To become a world-famous F.R.S. With a merit so clear;
On a pedestal high to be raised, With no fear of fall;
By the Commons and Lords to be praised, To be talked of by all;
Just to take in a leisurely stride The physician's top rank,
And to dream that Americans vied To put cash in one's bank;
To be praised by the authors who write And the poets who sing;
To be given the title of Knight By our Most Gracious King;
To know well that while still in one's prime One has not lived in vain,
And that none has done more in his time To alleviate pain;
To imagine these Castles in Spain Is a dream of one's youth,
But for you — one need hardly explain — It is less than the truth.

When all had left, Sir Alexander went up to Clayden, his companion in two wars, and the organizer of this party. Clayden shook his hand, and said: T'm damned glad about all this, sir.'

Fleming answered: 'That's the nicest thing I've heard this evening.'

There was still some beer left, and the two men spent an hour together, talking over old times at Boulogne and Wimereux. It had been a memorable occasion.

Paris was liberated in August 1944. In September it was the turn of Brussels. Fleming wrote to his friend, Bordet:

Inoculation Department, St Maiy's Hospital, London, W.2 Sept. 4, 44

My Dear Professor Bordet,

It is indeed great news we have heard today, that once more the Germans have left Brussels and that you are free of Nazi domination.

Every bacteriologist in England hopes that you — one of the fathers of this science — have come through the years of sadness with a stout heart and that you will still have years of fruitful work in front of you. We rejoice in your long deferred freedom.

With all good wishes

Yours sincerely

alexander fleming

Innumerable invitations poured in upon him, not only from his own country but from America and the continent of Europe. He was presented with the Freedom of Paddington, in which district of London he had spent all his medical life, and in 1946 of Darvel, the small Scottish town in which he had been at school. Early in 1945 he was elected President of the newly founded Society of General Microbiology. In his inaugural address, he said:

Other and more distinguished members were asked to assume this presidency, but they were sufficiently strong-minded to refuse it. But, true to Scottish tradition never to refuse anything, when it came to my turn, I accepted, and I was very pleased until the time came when I received a note from your Secretary saying that I had to deliver the inaugural address ...

He continued in the same half-serious, half-humorous tone. This Society, he said, would not, like many others, be a platform from which its members would read papers 'designed to advance their own honour and glory5, but a place of meeting where bacteriologists, doctors, industrialists, agricultural specialists, mycologists and biochemists could come together to exchange information. A discovery of capital importance might well be born of a simple conversation.

T have the impression5, writes Dr Clegg, 'that few people realize what a magnificent ambassador for Britain Fleming was when he went abroad. Modest to the point of shyness, by no means an orator on public occasions, he impressed those he met with his simplicity and essential humility. With it all, there was a naive schoolboy delight in simple pleasures.

' "I hear you are going to the U.S.A./5 I said to him when I saw him one evening at the Athenaeum.

' "Yes," he said, "isn't it great? I am going to see the Brooklyn Dodgers!"'

This baseball side interested him as much as all the marvels of that gigantic country.

Before leaving for America, he was, as befitted his new eminence, interviewed for the B.B.G. by Bebe Daniels. T had asked the B.B.C.5, she says, 'whether I could have Sir Alexander Fleming. Their answer was: "Oh, no! Sir Alexander will never consent to speak on the radio!55

"All the same, I5m going to give him a ring.55

"Sir Alexander never answers the telephone.55

I thought that rather odd, so I wrote him a letter, and had it delivered at the hospital by my secretary, Joan Murray, with strict orders to give it to Sir Alexander in person. When she came back I asked her: "Well, what happened?55

'"I was shown in to Sir Alexander, and he said: 'Why all this fuss? Who sent you? Mr Churchill?5 'No,5 I answered, 'Bebe Daniels.5 5' She left my letter with him, and half an hour later Sir Alexander himself rang me up. "Come and see me tomorrow, at one o'clock, at St Mary's."

'I was punctual to the minute. I had expected to find twenty-four secretaries, eight guards and I don't know what else. Actually, the only person I saw was a technician in a white overall in one of the corridors. I asked him: "Where shall I find Sir Alexander Fleming?"

' "At the end of the passage: he's making tea."

'I found him with his sleeves rolled up, making tea over a Bunsen burner. "Would you like a cup?55 he asked me, and, before I could say yes or no, I had a cup in my hand. Then he said: "It would interest me to talk on the radio ... Would you like to see the original culture?"

' "That5d be marvellous!"

'He vanished behind a pile of dishes, found the precious culture, and showed it me. Then he asked: "What's the programme? What d'you want me to say?55

' "You will be free to say exactly what you like, sir."

' "I thought that'd be your answer ... Here's what I've prepared." He read it to me, and it was perfect. Sir Alexander was marvellous, and had a delicious sense of humour.'

In June, July and August 1945 Fleming made a triumphal progress through the United States. Tt is clear to me', he said in his report, 'that they attach a great deal more importance to penicillin in America than in England.' John Cameron, of the British Mission, was his guide, and asked him to give press conferences, radio interviews and public lectures at the various universities, because it would be excellent propaganda for Great Britain. Fleming acquired a taste for this sort of thing and did it very well. He visited the factories which were turning out penicillin, and the laboratory at Peoria which had made success possible. He was amazed by the tremendous resources available to the Americans. At Peoria, where he stayed with Dr Robert D. Coghill, he found a veritable museum where all the varieties of penicillium were displayed. In his lectures he reminded his audiences that it was English scientists who had set this immense industry going, that Florey had brought the methods of production to Peoria, and that America had then perfected the technique of manufacture, and had provided England with penicillin. It was, he pointed out, a fine example of mutual aid.

In New York, the producers of penicillin gave a banquet at the Waldorf, 'to do honour,' said the president, 'and to express gratitude to the one chosen by Providence to discover and to reveal to the world the existence and the properties of the most potent weapon yet known to man to aid him in his war against disease ... We have the closest approximation yet attained to the fulfilment of the dream of chemotherapy, a substance incredibly powerful against a multitude of bacterial invaders, and incredibly innocuous to the tissues of the invaded host.' When he called upon Fleming to reply, he quoted from the Gospel according to Saint John:

c "Now there is at Jerusalem by the sheep market a pool which is called in the Hebrew tongue Bethesda, having five porches.

' "In these lay a great multitude of impotent folk, of blind, halt, withered, waiting for the moving of the water.

' "For an angel went down at a certain season into the pool and troubled the water: whosoever then first after the troubling of the water stepped in was made whole of whatsoever disease he had."

'Certainly/ concluded the president, 'it was an angel who first moved the spirit of Sir Alexander Fleming when he saw, for the first time, the effect produced on a bacterial culture by a wandering mould, for the pool thus troubled has cured not one sick man but myriads of sick men.'

Sometimes the questions put to him on his visit were of a direct nature. On one occasion at Brooklyn, John Smith, the head of Pfizer Inc., and at that time the biggest producer of penicillin in the world, asked: 'Why have you never touched the royalties which would have enabled you and yours to live as a man should who has rendered such services to humanity?'

Fleming's reply was: Tt never occurred to me.'

His visit to the Pfizer laboratories had been well publicized in advance and the benches had all been scrubbed and the instruments polished in readiness for his arrival. Looking round him at the vast and gleaming surfaces, on which there was not so much as a grain of dust, he said: Tf I had been working in these conditions, I should never have found penicillin.'

At one of the universities, a professor of chemistry asked him: 'Why didn't you complete your work and purify the product?'

'Why didn't you do it yourselves?' answered Fleming. 'All the necessary information was in the literature.'

At Washington, the press conference irritated this least irritable of men. 'Were you a boxer when you were a kid? ... If not why have you gotten a broken nose? ... Who found the dough for your studies in London?'

Nothing, as a rule, ever ruffled him. His gift of silence stood him in good stead at such moments. When he did not want to answer, he grunted and stared into the distance. But on this particular day, he suddenly said to Cameron: 'I've had about enough of this ... let's go.' And he got up.

One morning he found two newspaper men waiting on his landing at the Biltmore Hotel just as he was going downstairs to the coffee-room for breakfast.

'What are you thinking about at this moment? We'd like to know what a great scientist thinks about when he's going in to breakfast.'

Fleming looked at them with a somewhat solemn expression.

'It's curious you should ask me that. It so happens that I am thinking about something rather special,'

'What?' asked the two journalists in great excitement.

'Well, I was wondering whether I should have one egg or two.'

John Cameron, himself a Scot, was proud of his companion. He liked his quiet, dry humour and his kind heart (at Yale, hearing his hostess say that her maid, a Scots girl, was feeling homesick, he said to Cameron: 'Why shouldn't we go and cheer her up a bit?' and they did), and his utter lack of self-seeking.

The great American chemical firms, during his stay in the country, collected a hundred thousand dollars which they gave him as a token of their gratitude. Fleming said that he could not possibly accept it, but that it would make him very happy if that enormous sum might be presented to their laboratories at St Mary's, to be used for scientific research. This was done, and an Alexander Fleming Fund set up, capital and interest being put at the disposal of the research-workers.

The high-spot of his American trip was Commencement-Day at Harvard, on which occasion he was given the high honour of a Doctor's degree. He had a close bond with this university, which was very dear to him: the memory of Boulogne where in 1916 and 1917 he had a group of Harvard men working with him: Dr Roger Lee, Dr Harvey Cushing, and several others. Six thousand people had gathered in the court where the ceremony was held. When Dr Conant, the then President of Harvard, said: Tt is a great honour for me to present Sir Alexander Fleming, the discoverer of penicillin,' the whole audience rose as one man and die ovation lasted for three minutes during which time Fleming stood quietly before the microphone, his head slightly bent, stealthily smiling at Cameron. When at last it was possible for him to make himself heard, he said in his quiet voice:

'I had proposed to tell you a story in which Destiny plays a large part. It is perfectly wonderful what a part chance or fate or fortune or destiny — whatever you like to call it — plays in our lives. Decisions which we make for no particular reason, or for totally inadequate reasons, or decisions which others make, may have a profound influence on our own career. Perhaps we are merely pawns moved about on the board of life, thinking foolishly that we are deciding our own fate ... Let me take my own career. I was born and brought up on a Scottish farm

He went on to explain that he might well have been a farmer, had not others — his mother and his brothers — sent him to London: that he might have remained a simple clerk had not a small inheritance enabled him to study medicine: that he would never have chosen St Mary's had he not been a good swimmer: that St Mary's would have turned him out as a simple general practitioner like many others but for the fact that Almroth Wright had asked him to work in his laboratory. 'Almroth Wright,' he added, 'one of the great men of this world, whose work as a pioneer has never been sufficiently recognized Then followed the story, first of lysozyme, then of penicillin. He paid homage to Raistrick, 'a great chemist', to Florey, to Chain and to their collaborators in Oxford, who had made penicillin possible.

'I have been trying to point out that in our Lives chance or fortune may have an astonishing influence, and, if I might offer advice to the young laboratory worker, it would be this — never to neglect an extraordinary appearance or happening. It may be — usually is, in fact — a false alarm which leads to nothing, but it may on the other hand be the clue provided by fate to lead you to some important advance. But I warn you of the danger of first sitting and waiting till chance offers something. We must work, and work hard. We must know our subject. We must master all the technicalities of our craft. Pasteur's often quoted dictum that Fortune favours the prepared mind is undoubtedly true, for the unprepared mind cannot see the outstretched hand of opportunity.

'Thare is, then, nothing new in my advice to the young. Work hard, work well, do not clutter up the mind too much with precedents, and be prepared to accept such good fortune as the gods offer ...'

When he had finished, he was loudly cheered. An old Harvard man, then President of Smith College, hurried up to Roger Lee and said: 'Roger, Fleming's from Ayrshire: I'm an Ayrshire man: introduce me.'

Roger Lee did as he was asked.

Professor Neilson said: Tm from Ayrshire, you're from Ayrshire.5

'Aye,' said Fleming.

They shook hands, and that was all. The Scots are a laconic race, even when they have crossed the ocean.

What useful knowledge had he acquired in the course of this journey?

(a) That scientific research in the United States was advancing more rapidly than in Europe, because of the status it enjoyed and of the resources at its disposal. 'The cost of laboratories', he said in his report, 'is insignificant when compared with the results for both industry and medicine.'

(b) That an American, Captain Romansky, had perfected a form of delayed-action penicillin (a mixture of salt, calcium and penicillin with beeswax and peanut oil). This was of great value, since it made possible the presence of a constant quantity of penicillin in the patient's body without the necessity of injecting every three hours.

(c) That an extended series of researches was paving the way to the discovery of new antibiotics. One of these, streptomycin, would quite certainly prove effective.

John Cameron, who had not left his side during these two months, has written: T was completely under the spell of his charm, and our friendship has become for me one of the things that make life worth living ... I have learned to know Alec really well, and to respect him.'

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