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The Life of Sir Alexander Fleming
Chapter III - The nature of wright

It is not often that one has the privilege of working alongside a Master, but Fate arranged that for me. Fleming

The Inoculation Department had started life in 1902 in one small room belonging to the old Medical School at St Mary's. When Fleming joined it in 1906, the one room had expanded to two rooms, both tiny, which had to accommodate the Professor, his assistants and such infectious cases as might be sent for treatment from other parts of the hospital. There was no money to spare and the laboratory owed its continued existence to Wright's generosity. At that time he had a rich practice. Millionaires and members of the British aristocracy would call in Wright for the least ailment — for anything, in fact, from a boil to an attack of typhoid. His large waiting-room at 6 Park Crescent was always crammed with patients, and the greater part of his fees served to maintain the bacteriological laboratory (or, as he called it, 'the lab.').

Almroth Wright thought it useful and, indeed, necessary for a doctor engaged on research to remain in practice — so as to 'keep his feet on the ground*. The observation of living bodies confirms — or rebuts — the findings of the test-tube. The spectacle of human suffering arouses, along with pity, the desire to find a remedy — whence his insistence that a clinic should be attached to his department. 'It wasn't at all a bad thing', says Dr Hughes, who later worked there. 'A man engaged on research who finds nothing has an uneasy conscience. The doctors who worked under Wright, when not busy in the laboratory, carried on with their normal professional duties.'

Wright encouraged his assistants to stay in private practice. Actually it was the only way in which they could make a living, for he paid them little: a hundred pounds a year. He maintained that research should be entirely disinterested. 'We don't pay people to do research: they've got to have work outside.'

Salaries and promotion were decided by Wright, the sole master after God. 'This Service5, he said, 'is a republic. In point of fact, it was an enlightened despotism. The dominant personality of the Chief won not only respect but devotion, The Old Man, as he was called by his collaborators, ruled the family like a stern but fond father. This is how Freeman describes him: 'Wright was, at first glance, an almost clumsy figure with large head, hands and feet. As his great friend, Willie Bulloch, the bacteriologist at the London Hospital, used to say of him, he had escaped being acromegalic only by the narrowest of squeaks. His movements were slow and purposeful. He was a big man with the rounded shoulders of a bench-worker and anti-athlete ... He wore spectacles above which showed strongly marked eyebrows which flickered up and down very rapidly when he was amused or being mischievous. He could almost speak with his eyebrows.' But, though his movements were heavy, he could accomplish the most delicate tasks with his great fingers.

His character was a mass of complexities. All things considered, he was a difficult man. His disciples adored him for his genius, for the way in which he made life amazingly interesting, and because his zest, his love of paradox and his vast culture enabled him to be an enchanting conversationalist. But to different people he showed different facets of his personality. With some he turned into a poet, with others into a naughty child. You're so mischievous, Wright,' said his famous friend, Balfour; 'that is why we all like you so much!' Gentle and patient with the sick, he could behave to his colleagues with brutal savagery. In a controversy with a celebrated surgeon, he behaved so ferociously that Bernard Shaw, who knew what he was talking about, said: 'It was Lessing who, according to Heine, not only cut off his adversary's head, but held it up to show that there were no brains in it. Sir Almroth, knowing that this is an anatomical impossibility, puts Sir William Watson Cheyne's brains on his operating table and shows that Sir William has never learned how to use them.'

All his life had been a battle- He was born in 1861 of an Irish Presbyterian father and a Swedish mother, the daughter of Nils Almroth, a professor of organic chemistry in Stockholm. From his earliest youth he had shown a spirit of fierce independence. 'Almroth was one of my failures,' said his mother. 'I could never make him do what I wanted; he always went his own way.

Nevertheless, she was very proud of him, and her other children asserted that, if Almroth had committed a crime, she would have said: 'What a fine, manly thing to do!' Since the Reverend Charles Wright exercised his ministry in Dresden, Boulogne and Belfast, Almroth was brought up by private tutors, and acquired an excellent education. So strong was his passion for languages that at sixty-two he learned Russian, and began at eighty to study the Eskimo tongue.

What he loved best in the world was poetry. He knew by heart great chunks of the Bible, Shakespeare, Milton, Dante, Goethe, Browning, Wordsworth and Kipling. He once reckoned that he could recite two hundred and fifty thousand lines. One might have supposed that, with such tastes, he would have embarked on a literary career. He did, actually, think of doing so, and went for advice to the famous Edward Dowden who occupied the Chair of English Literature at Trinity College, Dublin. When his opinion was asked, Dowden said: cIf I were you, I should stick to medicine. It is the finest possible introduction to life and, if you later show gifts as a writer, your experience will furnish you with a precious fund of knowledge.5 This verdict was fully justified, because Wright was to become not only a great doctor but also an excellent writer. Bernard Shaw once said to him: 'You handle a pen as well as I do,5 which, coming from Shaw, was a very great compliment; in fact, the only compliment worth anything!

Wright's restless and adventurous mind could not remain permanently satisfied with the ordered existence of a general practitioner. He travelled in Germany and France, visiting a succession of laboratories and striking up friendships with German and French research-workers. For a time he read Law and dreamed of being a barrister. He went to Australia and taught in Sydney. But his ultimate choice was scientific research. He had a passionate desire to see 'what lies on the other side of the mountains', to explore new worlds. He had the good fortune to enter the medical profession at the very time when it was undergoing a profound transformation. The two or three previous decades had seen the beginnings of a movement away from medicine-as-an-art and medicine-as-magic to medicine-as-science.

Already, before i860, certain men of science had been thinking that infectious diseases might be caused by microscopic creatures, though they had not supported this hypothesis with any experimental proof. But between 1863 and 1873 a French doctor, Davaine, had demonstrated that one particular ailment, anthrax, was closely connected with the presence in the blood of certain small objects which he called bactirides. A German, PoIIender, had reached the same conclusion. Between 1876 and 1880, Pasteur in France and Koch in Germany had thrown open to medical research immense and unexplored territories. Pasteur in the course of a long and prodigiously fertile career proved that numerous infections, till then unexplained, were due to the action of microorganisms which the microscope made it possible to detect in the blood and tissues of the sick. Round about 1877, the word 'microbe' was invented by S6dillot. Little by little, research-workers had succeeded in establishing a catalogue of the principal microbes: staphylococcus, streptococcus, the typhoid bacillus, the tubercle bacillus, etc. ... The German school had taken the lead in devising bacteriological techniques: culture-medium, staining of microbes, methods of examination.

Thanks to the work of the great English surgeon lister, Pasteur's discoveries had completely revolutionized the practice of surgery. It is difficult for us today to imagine what surgery was like when Lister was a young man. The cases in which it could be employed were strictly limited. A very high proportion of those operated upon died of general infection, as did, also, a large number of women in childbed. This was known as the 'hospital sickness', and it seemed impossible to find a way of dealing with it successfully. A Viennese doctor, Semmelweiss, had pleaded for the adoption of hygienic methods, but in vain. From the moment that Pasteur showed that no infection could take place without the presence of germs, and that those germs were carried by the air, by the instruments, and by the hands and the clothing of the surgeon, Lister realized that by ensuring the sterility of the wound — that is to say, the absence of all septic germs — the 'hospital sickness' could be done away with, that, in fact, it was no sickness at all, but simply the result of a lack of precaution.

The causes of infection had thus been partially explored. It remained to discover a way of fighting them. Certain facts, known since the days of antiquity, might have been of assistance in providing the research-workers with some sort of guidance. When the plague was raging in Athens, says Thucydides, the sick and dying would have received no attention at all had it not been for the devotion of those who had already had the plague and had recovered from it, since cno one ever caught it a second timeIt was known, too, that smallpox, one of the worst scourges of the human race up to the beginning of the nineteenth century, which killed or disfigured millions of sufferers, never attacked the same person twice. For more than a thousand years in China, Siam and Persia, various forms of deliberate and protective infection — the pricking of certain areas of the skin with contaminated needles, or introducing portions of smallpox scab into the nose — had been practised. In Baluchistan it was the custom to have cows afflicted with cowpox, which was thought to be a benign variety of smallpox, milked by children with scratches on their hands, the idea being that those children would, thereafter, be immune from infection.

European peasants, too, had had an empirical knowledge of these facts. The attention of the English doctor, Jenner (late eighteenth century), was directed to this phenomenon by a girl keeping cows, to whom, because of certain symptoms, he had said that she might be sickening for smallpox. She replied that she couldn't have the smallpox because she had already had the cow-pox. This gave Jenner the idea — remarkable at that period — of determining by methodical experimentation the value of such popular beliefs. He took the very venturesome step of infecting perfectly healthy subjects with the smallpox, after first inoculating (in other words, vaccinating) them with the cowpox, and reached the conclusion that in this way they could be given almost complete immunity.

It certainly was an extraordinary phenomenon. On the practical level it led to the elimination (not without displays of violent and absurd resistance) of a universal scourge — the smallpox: while, on the intellectual, it revealed the fact that men or animals, after the injection of a minute quantity of a dangerous virus, became different creatures, better armed against that same virus, something like a country which, frequently attacked, has learned to keep a suitable defence army ready. 'There is', says Dr Dubos, 'such a thing as biochemical memory, which is no less real than intellectual or emotional memory, and, perhaps, essentially no different from them/ Just as a shock experienced in infancy is enough to warp the psyche and to sow the seeds of lasting complexes, so will the simulacrum of a disease produce deep-seated, and sometimes beneficial, changes in the blood. The organism which has fought against an evil is no longer a novice:  ... Thou hast wrestled with me and art no longer the same man/

Pasteur had given much thought to the great mystery of infectious diseases, and to Jenner's immunity theory. His powerful mind refused to admit that the case of smallpox was unique. Immunization aught to be possible in other illnesses. But how could the equivalent of vaccine be found which might be used to combat other microbes? Chance, which so often comes to the help of those who help themselves, provided him with a key to this problem in 1880. While studying chicken-cholera he was led to two conclusions: (a) that increasing age diminishes the virulence of the pathogenic germ; (b) that hens treated with attenuated germs are rendered immune to virulent ones.

In more general terms, he discovered that a germ becomes suitable for purposes of Vaccination* when it has been kept for a long time in contact with the air. (As an act of homage to Jenner, Pasteur had extended the meaning of the word Vaccine*.) How did all these vaccines work? By provoking a defence-reaction or, more precisely, by forming in the blood new substances, or 4antibodies', capable of helping the organism to fight, when the time came, against the now-attenuated germs. The threat produced a mobilization of the defending forces. In 1888, Chantemesse and Widal proved that even a vaccine composed of dead germs could develop in the blood the strength necessary to overcome the microbe of typhoid fever. About the same time, Roux and Yersin found the poison, or toxin, secreted by the microbe of diphtheria. Then one of Koch's pupils, Behring, revealed the anti-toxic power of the serum of animals (guinea-pigs and dogs) which had been treated with repeated small doses of the toxins of diphtheria and tetanus.

A natural extension of the idea led to this armed and mettlesome blood, this battling serum, being called to the aid of blood lying under the threat of any contamination. Behring, pursuing this line of thought, had tried the use of anti-sera for the prevention and treatment of some infections. The principle involved was different from that of vaccination. The serum had to bring to the sick or threatened organism already formed antibodies. Behring was only partially successful, but Roux tackled the problem again and, this time, with successful results. At the Budapest Congress of 1894, Roux was able to announce to a gathering of enthusiastic doctors that the serum of an immunized horse, injected into those suffering from diphtheria, could bring about a complete cure. The era of serotherapy had dawned. It was no longer merely a question of preventing the onset of the disease, but of curing those who already had it.

When Wright returned to England from Sydney in 1891, and started to look for a suitable opening, he was delighted, after a year spent in doing odd jobs, to be offered the position of Chief Pathologist in the Army School of Medicine at Netley Hospital. There he found a group of young men whom he inspired with his own passion for research and with his desire to see a new system of medicine developed which should be founded on scientific experimentation.

His pupils admired his devotion to science and his aggressiveness. Never had there been a man less suited to get on with soldier-administrators. Very soon Netley was buzzing delightedly with stories: how one day, having hunted high and low for his laboratory sergeant, he had found him taking part in a parade and had, there and then, hauled him off by the collar of his tunic to get busy with what he described to the horrified military as a 'piece of work worth doing': how he had been told by the 'brass-hats' at the War Office, not to talk so much about blood in his lectures, since after all it accounted for 'only one-thirteenth part of a man's weight', and how, in spite of orders to the contrary, he gave each year, to those passing out from Netley, a revolutionary address on 'Physiology and Belief.

At the time when he was beginning to teach bacteriology — a science then in its infancy — Wright already foresaw a future in which the diagnosis of infectious diseases would be carried out by precise methods and not merely by listening to the patient's chest and saying, as a certain distinguished doctor was in the habit of doing, '1 think I can detect the influenza bacillus ... by the sound.' Widal and Gruber had demonstrated that the blood of a man suffering from typhoid agglutinates the typhoid microbes and that this process, being specific (that is to say, occurring with the microbial family which is the cause of the disease and with no other), makes diagnosis possible. Wright proved that the same held good of Malta fever, a serious ailment which goats (numerous on the island of Malta) can transmit to humans, a fact which led Metchnikoff, who at that time was teaching at the Pasteur Institute, to tell his pupils, not without humour, showing them a map of the world on which the regions subject to Malta fever were marked: "You will notice that these are all situated within the British Empire. This is not due to any evil influence of the British, but it merely means that they are the only people who have made a study of Malta fever, and know how to diagnose it.

From 1895 Wright devoted most of his time to working out how immunity to typhoid could be achieved. In those days it was a dreaded and frequently a fatal disease which was particularly prevalent among soldiers in time of war. A Russian bacteriologist, Haffkine, who was working at the Pasteur Institute and paid a visit to Netley, suggested to him that it might be possible to protect human beings against typhoid by preventive vaccination, as Pasteur had succeeded in protecting sheep against anthrax. It was a question in both cases of stimulating the formation of antibodies in the blood. Typhoid was not, as had long been thought, a disease which affected the intestine only. The microbe, in fact,1 spread through the whole circulatory system and, by making the patient's blood deadly to the microbe, this invasion would be held in check.

Chantemesse and Widal had shown that animals could be vaccinated against typhoid by means of germs killed by heat. Wright developed a simple technique by which the power of the blood to kill bacteria could be measured. This enabled him to establish as a fact that the blood, after inoculation, can kill from ten to fifty times more bacteria than before and conserves this formidable power for several months. He observed that after inoculation there is frequently a negative phase during which the blood loses this power, accompanied by discomfort and fever, after which a positive period ensues. In short, he brought to a successful conclusion a piece of precise research and, sure of his results, was in a position to advise the War Office to have all men going overseas vaccinated. This was in 1898. He was the first doctor to use anti-typhoid vaccines on human beings, though Pfeiffer and Kolle in Germany could boast of a similar success at about the same time.

In spite of favourable results in India and elsewhere, the old medical dug-outs of the R.A.M.C. remained sceptical. When the Transvaal war started, Wright, who wanted to have immunization made compulsory in the Army, was allowed to have the operation performed only on those who might volunteer to undergo it. No more than sixteen thousand out of three hundred and twenty thousand came forward. This was a disappointingly small number. Furthermore, it was not easy to follow up the case histories of those who had been inoculated. In the field-hospitals, when typhoid cases were asked whether they had been vaccinated, they were inclined to answer "yes5 from fear of being 'crimed' if they didn't. A story is told of one sergeant-orderly who in his returns invariably showed as having been vaccinated all men suffering from the disease. "The fact that they've got it,' he said, 'proves as they've been vaccinated.' Wright was so much enraged by the incompetence of official medical practice that he resigned his post at Netley, greatly though he had liked it. In 1902 he was appointed Professor of Pathology at St Mary's.

There he created the Inoculation Department over which he was to reign supreme for forty-five years. At first, his teaching covered pathological anatomy and histology as well as bacteriology. But by degrees he managed to shuffle off these duties and concentrate his attention on immunology. He was now convinced that all infectious diseases could be cured by the action of antibodies, whether those antibodies existed naturally in the blood, whether their production could be stimulated by a vaccine, or, finally, whether they were introduced by a 'foreign' serum. In that direction, he maintained, lay the future of scientific medicine. 'The doctor of the future,' he said, 'will be an immunizer.' The knowledge that traditional medicine had been able to do so little for the cure of patients afflicted with the most serious diseases plunged him into despair. One evening, when he was speaking to an audience of doctors, he wound up his remarks by saying: 'What it comes to is this, that unless our doctors learn to do something useful, they will find themselves relegated to the position of medical orderlies.' Two doctors rose and left the room.

Meanwhile other scientists had been hard at work trying to find an answer to the question; *How does the organism, in natural conditions, protect itself against pathogenic germs?9 Human beings, after all, had existed long before the advent of preventive vaccines, yet many of them must have found a way of resisting the attacks made on them by germs, as is proved by the fact that the human race has survived. How? A scientist of Russian birth, Metchnikoff, working at the Pasteur Institute, had discovered the essential mechanism of this defensive process in the phagocyte. While observing, in the course of his laboratory work, the transparent larvae of star-fish, he had hit on the idea that certain specialized cells, the police force of the organism, provided a defence for living bodies against harmful intruders. He introduced a number of thorns from a rose tree among the larvae. These thorns were soon surrounded and dissolved. This experiment struck Metchnikoff because its outcome so closely resembled what happens when a human finger is infected by a splinter. Pus forms. But what exactly is pus? It is a collection of cells, especially of the white corpuscles of the blood which, in the event of inflammation, work their way through the blood-vessels, surround the microbial germs and 'phagocyte' them, in other words, 'eat' and destroy them.

But how do the phagocytes digest the microbes? Thanks to the action, said Metchnikoff, of certain digestive enzymic ferments which, inside the cells, play a part similar to that of the digestive ferments of the saliva or the stomach. Against this cellular theory of immunity the Germans argued in favour of a 'humoral* theory. They believed in the action of the humours (that is to say, of the fluid substances of the body, and, especially, of blood serums).

Wright, who was a friend of Metchnikoff and also of several German scientists, tried to reconcile the two theories. What he had to say about the matter was roughly as follows. In vaccinated or infected subjects, certain specific chemical principles (antibodies) make their appearance in the blood serum and the humours. The effect of these principles is to reinforce the destructive action of the phagocytes by modifying the superficial structure of the germs, on the surface of which they leave a deposit — one might describe it as 'buttering' them — and so facilitate digestion.

With the help of one of his Netley disciples, Captain Douglas, who had joined him at St Mary's, he undertook a series of remarkable experiments which made it possible to count with perfect clarity the number of microbes swallowed by each phagocyte. Under the microscope the phagocyte showed as a grey patch, and the microbes it had swallowed as black points inside it. Wright and Douglas noticed that the number of microbes which the defence-cells could absorb depended upon the 'preparation5 of the microbes by the substance secreted thanks to immunization. One of Wright's favourite amusements was the invention of words drawn from the Greek. He therefore called this property acquired by the blood, which enabled it to 'butter' the microbes in readiness for the phagocytes' meal, the 'opsonic' power, from the Greek 'opsono* 'I prepare food for ...', and the substance itself'opsonin'. In a serum free from opsonin there is littie or no phagocytosis, whereas, when opsonin is present in* increased strength as a result of infection or vaccine, phagocytosis is considerable.

Wright attached capital importance to his idea. In the first place, it produced a happy marriage between the cellular and humoral theories. True, it is the phagocytes that destroy the bacteria, but only when the latter have been 'buttered5 or made appetizing by the humoral opsonin. Further, Wright believed that this theory of his made possible the diagnosis of most cases of infection, since infections increase the opsonic power in the blood over the microbe causing the infection, and over that only. (As a matter of fact, the modifications, though real, are so complex that it is difficult to interpret them.) Finally, the measure provided by the 'opsonic index'1 in any given subject should, he thought, open the way to rational treatment by vaccines or serums, since by establishing the percentage of phagocyted microbes the laboratory worker is in a position to determine the quantity of opsonin in the blood and to say whether it increased, or not, under treatment.

When demonstrated with Wright's brilliant eloquence, the theory of the opsonic index seemed to be a stroke of genius. Medicine was at last becoming an exact science! That was the feeling of a few young and highly intelligent doctors and research-workers who, attracted by the great gifts of the master, were prepared to accept the by no means easy life he offered them. The first team was composed of Stuart Douglas from Netley, Leonard

Noon, Bernard Spilsbury and John Freeman. The latter was a man of original intelligence and an excellent scientific writer. He entered the lab. in 1903, became one of Wright's favourite disciples, and was called, by him, his 'son in science'. Freeman, until he married, lived with Wright at 7 Lower Seymour Street, At a later date, Fleming (in 1906), Matthews, Garmalt Jones and Leonard Golebrook joined the team.

A team? It would be more accurate to describe it as a brotherhood, something in the nature of a religious order. It was accepted as an indisputable fact by these men that they had a mission, that they were to devote their lives to the service of science, and that they owed unconditional loyalty to Wright. What was it that gave him this prestige in their eyes? His charm, his intellectual brilliance, his personal passion for research, which kept him working in the laboratory until three or four in the morning, and sometimes until daybreak. What was it that made him spurn all pleasures and even a family life in order to count black points in grey patches? Ambition? Perhaps, in part. He loved authority and longed for fame. But, more than anything else, intellectual curiosity and a profound desire to help human suffering, for he was by nature both sensitive and kindly.

According to Freeman, Wright was led by his passion for work so wholly to neglect his own flesh and blood that his daughter Dolly, having to write a school essay on the pleasures of home-life, concluded it with this sentence: *It is awfully jolly if Daddy can manage to get down on Sunday to see how his family is getting on One day, when Wright, on arrival at the hospital, was hanging up his hat, Douglas saw a piece of white paper fall out of the ribbon. He picked it up, and read: 'Daddy, three times you have forgotten to put more gas in my balloon, as you promised you would. I have put two empty balloons in the inside pocket of your overcoat. Don't forget this time.' Douglas filled the balloons and tied them to the hat-ribbon* Dolly Wright got what she wanted, at last!

It was not only affection and loyalty, however, that accounted for the admiration felt by these young scientists for their master. His genius justified their enthusiasm. Nor were they alone in their feelings, which were shared by many eminent men who had no connection with the hospital. Often, round about inidnight, tea was made in a small room next to the lab., and there many illustrious visitors were entertained: biologists like Ehrlich and Metchnikoff; statesmen like Arthur Balfour and John Burns; dramatists like Bernard Shaw and Granville Barker, People came together from every corner of London and, indeed, of the world, to listen to Wright.

In the house of his great friend, Lady Horner, a celebrated hostess, Wright met most of the members of the Cabinet; among them was Lord Haldane, at that time Secretary of State for War, who was responsible for getting him knighted. Freeman, who read the letter in which the news of this honour was communicated to the Chief, says that it ran more or less as follows: 'Dear Wright, we must have your Typhoid Prophylactic for the Army, but I have failed to convince the head man in the Army Medical Service of this. I have therefore got to build you up as a Public Figure, and the first step is to make you a knight. You won't like it, but it has to be ... Haldane.' Wright, at first, wanted to refuse and said in a disgusted tone: 'They'll even shove it on my gravestone!' but in his heart of hearts he was very pleased.

One evening, when Bernard Shaw was drinking tea in the lab., the question arose of whether a new patient should be admitted. Freeman said: 'We've got too many cases on our hands already,' and Shaw asked: 'What would happen if more people applied to you for help than you could properly look after?' Wright replied: 'We should have to consider which life was best worth saving.' Shaw laid a finger to his nose, and said: 'Ha! I smell drama! ... I get a whiff of a play!'

Not long afterwards, a certain Dr Wheeler, who was a great friend of both Shaw and Wright, warned the latter that Shaw was making him the hero of a play. That was true: it was called The Doctor's Dilemma, and it was impossible not to recognize Sir Almroth Wright in its leading character, Sir Colenso Ridgeon. In the first act there is a passage between Colenso Ridgeon (Wright) and an infinitely sceptical doctor of the old school:

sir Patrick What did you find out from Jane's case?

ridgeon I found out that the inoculation that ought to cure sometimes kills.

sir Patrick I could have told you that. I've tried these modern inoculations a bit myself. I've killed people with them; and I've cured people with them; but I gave them up because I never could tell which I was going to do.

ridgeon (taking a pamphlet from a drawer in the writing-table and handing it to him) Read that the next time you have an hour to spare; and you'll find out why. sir Patrick (grumbling and fumbling for Ms spectacles) Oh, bother your pamphlets. What's the practice of it? (Looking at the pamphlet) Opsonin? What the devil is opsonin?

ridgeon Opsonin is what you butter the disease germs with to make your white blood corpuscles eat them.

(He sits down again on the couch*) sir Patrick That's not new. IVe heard this notion that the white corpuscles — what is it that what's his name — Metchnikoff — calls them? ridgeon Phagocytes.

sir Patrick Aye, phagocytes: yes, yes, yes. Well, I heard this theory that the phagocytes eat up the disease germs years ago: long before you came into fashion. Besides, they don't always eat them. ridgeon They do when you butter them with opsonin. sir Patrick Gammon.

ridgeon No: it's not gammon. What it comes to in practice is this. The phagocytes won't eat the microbes unless the microbes are nicely buttered for them. Well, the patient manufactures the butter for himself all right; but my discovery is that the manufacture of that butter, which I call opsonin, goes on in the system by ups and downs — Nature being always rhythmical, you know — and that what the inoculation does is to stimulate the ups or downs, as the case may be ... Inoculate when the patient is in the negative phase and you kill: inoculate when the patient is in the positive phase and you cure.

sir Patrick And pray how are you to know whether the patient is in the positive or the negative phase?

ridgeon Send a drop of the patient's blood to the laboratory at St Anne's; and in fifteen minutes I'll give you his opsonin index in figures ...

Fifteen minutes was Bernard Shaw's own rather optimistic reckoning. In point of fact, when patients were numerous, the opsonic index kept these young monks of science awake until dawn.

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