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modelled Sir Colenso Ridgeon in The combination of vaccine and sulphonamide The shooter and Doctor's Dilemma. He had produced a treatment would be beneficial, but he vaccine that offered protection against showed no renewed interest in penicillin. the shot typhoid fever and was persuaded that The evidence is overwhelming for the con­ Edward Abraham vaccines would cope with bacterial clusion that neither he nor anyone else at infections in general by stimulating phago­ that time envisaged that penicillin would be Alexander Fleming: The Man and The cytosis. Fleming, who never liked to stray a systemic therapeutic agent. Perhaps, as Myth. far from experimental facts, was as Macfarlane suggests, Fleming's attitude By Gwyn Macfarlane. different from Wright as Florey was from was conditioned by a finding that penicillin Chatto & WinduslHaTVard University Chain, but he became Wright's disciple in a Press: 1984. Pp.304. £12.50, $20. newly created Inoculation Department which financed itself by the sale of vaccines. GWYN Macfarlane prefaced his biography In 1921, Fleming made an unexpected of Lord Florey with an aphorism attributed observation. While suffering from a cold, to Voltaire: "We owe consideration to the he isolated, apparently from his nasal living; to the dead we owe only the truth" . He mucus, a rare coccus which he then showed might have saved it for this following volume. was lysed by nasal mucus and thus dis­ But "what is truth" said Francis Bacon's covered lysozyme. Macfarlane wonders jesting Pilate. The fluent prose of Alexander why the mucus was tested against an Fleming: The Man and The Myth, a book organism that had survived in its presence which provides a definitive assessment of the and suggests that the experiment might be role of Sir Alexander Fleming in the story of placed in the random category condemned penicillin, should persuade readers to stay for by Wright as a sin against the Holy Ghost. the author's answer. However that may be, Fleming regarded In the 1940s there was world-wide his work on lysozyme as his best contri­ gratitude for penicillin. Fleming found that bution to bacteriology. fame had been thrust upon him and that he His second major discovery, in 1928, was alone had become associated in the public at least as extraordinary as the first . He was mind with the name he gave to an active not looking for an antibacterial substance "mould broth filtrate". But his discovery but for staphylococcal variants because he had been made in 1928. Andre Maurois and had been asked to write an article on others have presented their views on the Staphylococcus. A seeded plate he had put eclipse of penicillin during the intervening aside was later found to be contaminated years. Gwyn Macfarlane has now written with a Penicillium and around the fungus the most detailed of all the biographies and bacterial colonies were apparently under­ has taken pains to consult primary sources. going lysis. But since penicillin lyses only As one who has made distinguished contri­ growing staphylococci and not fully grown butions to medical research but has no colonies, how did this come about? personal place in this story, his judgement Macfarlane accepts the convincing explan­ deserves respect. ation given by Ronald Hare in The Birth oj Fleming's Scottish background and the Penicillin: cool weather allowed the fungus events which led him from an Ayrshire to grow first and produce penicillin; it then farm to St Mary's Hospital are the subjects became warmer, and the bacteria grew and of early chapters. The farm held no future underwent lysis. for him, as a younger son, and he took the Fleming deserved praise and gratitude road to London, like many Scots before for his acute observation and for the him. Living with a brother, he attended the curiosity which prevented him from dis­ Regent Street Polytechnic and then became carding an unexpected contaminant, as a junior clerk in the American Line. others might have done. He showed that It was an unexpected legacy of £250 that his culture filtrate had selective activity enabled Fleming to study medicine, and he against bacteria and that it was not toxic to apparently chose St Mary's because he leukocytes and a rabbit. He thought at first had once played water-polo against the that it might be used for the local treatment Fleming in caricature, as "Private 606". A hospital team. Later, another seeming irre­ of septic wounds, in which other anti­ cartoon by Ronald Gray, 191 I. levancy - that he was a fine shot - septics had been worse than useless because deflected his thoughts of becoming a they killed leukocytes before bacteria. But disappeared rapidly from the blood and his surgeon. To keep him in St Mary's rifle when "there was no miraculous success" belief that it was inactivated by serum. team a colleague persuaded Sir Almroth he was quickly discouraged and wrote in Penicillin was not forgotten, however, Wright to take him as a part-time research 1940 that' 'the trouble of making it seemed when Howard Florey and Ernst Chain of assistant. By this time we see him as a not worthwhile". In his paper on cultures the Sir William Dunn School of Pathology modest man who was remarkably good in of a Penicillium in 1929 he made "special decided to make an academic study of the examinations, and enjoyed games and reference to their use in the isolation of B. antimicrobial substances known to be pro­ company, but who was so lacking in inf/uenzae", which he had studied during duced by microorganisms. The decision conversation that his blue eyes were said to the influenza pandemic of 1918, and pre­ was a consequence of Florey's earlier be sometimes immobilized in a basilisk sumably had in mind the preparation of a interest in lysozyme and the urgent need to stare. vaccine. obtain money for research. Its outcome, The book contains an amusing sketch of In 1936, when Colebrook was demon­ made possible by the efforts of a small Almroth Wright, a formidable intellectual, strating at St Mary's the ability of prontosil group of people under the constraints of full of conviction that his mental powers to cure dangerous streptococcal diseases, war, was Florey's demonstration in 1940 would reveal the solutions of medical Fleming carried out experiments in mice that even very impure penicillin could problems, on whom Bernard Shaw and rabbits to determine whether a protect mice from otherwise lethal systemic © 1984 Nature Publishing Group _NA_ru_~__ V_O_L._~ __ U_~ __ RI_L_I~ ______S~NGBOOKS~ ______105 infections with streptococci and staphy­ Dr Simpson's book, like Professor lococci, and the finding in 1941 that it Arms across the Margaret Gowing's official histories ofthe could save patients from infections that very early years, affords intriguing glimp­ would previously have been regarded as waves ses of mixed and often conflicting reason­ fatal. ing that has led successive British govern­ The results obtained at Oxford trans­ Laurence Martin ments of both political parties to persist in a formed penicillin from a biological curi­ game in which the odds are uneven but in The Independent Nuclear State: The osity into a substance with great potential which not even the outsiders are negligible. United States, Britain and the Military in medicine. A letter from Almroth Wright The game is not made easier by continual Atom. changes in the rules. At the beginning the to The Times, in which he placed a laurel By John Simpson. wreath on Fleming's brow, was followed problem was to get the bomb; by the 1960s St Martin's Press, New York/Macmillan by a flood of misleading publicity. Gwyn the trick was to deliver it. At the outset hav­ Press, London: 1984. Pp.340. $30, £25. Macfarlane attempts to throw light on how ing the bomb was thought to be more im­ it happened that Fleming was credited with portant than knowing what it was for. In a vision he did not have and even with work A KINDLY angel must have supervised the 1947 the Foreign Secretary, Ernest Bevin, he had not done, while the discovery at gestation of Dr Simpson's enterprising was content merely to argue that Britain Oxford, if mentioned at all, was presented book, for he begins by explaining that he "could not afford to acquiesce in an as a minor development. It is clear that intended to write on a different subject American monopoly in this new develop­ Florey had no wish for notoriety when so altogether and that subsequent changes of ment". When, in 1948, the RAF specified a little penicillin was available and turned plan have greatly delayed its completion. force capable of attacking 59 Soviet cities journalists away. As to what occurred at St The result is that the book emerges at a - even though many members of the Mary's the author can only surmise, but he most timely moment in both the politics Labour Cabinet would not accept that the points out that the Medical School had a and the historiography of British nuclear Soviet Union was an enemy, a scruple the history of poverty, and consequently of forces: politically because of the current Berlin blockade and Czech coup were to fund-raising, and that its Dean, Lord and continuing debate over the British ac­ remove - policy was still concerned with Moran, numbered Lord Beaverbrook (no quisition of Trident II, and historiographi­ tactics rather than strategy. Only in 1952, stranger to publicity) among his influential cally because a great deal of hitherto highly when the British Chiefs of Staff devised friends. secret information is beginning to appear in and later sold to Churchill when restored to Fleming himself made no exaggerated the United States. Indeed it is one of the power a "grand strategy" based on deter­ claims, although he acquiesced in what was few and unavoidable limitations of this rence by nuclear retaliation, could.it be said happening and occasionally insinuated book that already it needs updating by that the expensive and secret weapon pro­ that the short-comings of others were reference to recent disclosures. So much gramme was harnessed to a strategic theory responsible for his failure to exploit his dis­ more closed is the British defence establish­ - albeit a debatable one. covery. Towards the end of the book we ment than the American, however, that It has long been known that the incom­ have an entertaining account of the effect this new information affects the context ing Eisenhower Administration drew some of his rise to fame on his later life. rather than the substance of the British support from the British strategic theory Innumerable invitations, often involving story, and Dr Simpson's heavily docu­ in evolving its own doctrine of Massive long travel and coupled with scientific mented account is likely to remain stand­ Retaliation. The whole British story is, of and social programmes that would have ard and invaluable for some years to come. course, intimately bound up with the daunted many a younger man, were Scientifically competent readers will United States. The relationship was and is accepted without hesitation. But he doubtless take particular interest in the a complex one, and the motives, principles received the praises of the crowds with author's effort to put precise numbers on and prejudices of so many different layers becoming modesty and certainly never suc­ the scale of British military nuclear produc­ of the pluralistic American machine - cumbed to folie de grandeur. tion, by means that he himself admits to be politicians, military and scientists - made The main reason for concern about the crude and disputable. For those with a it difficult for the United States to pursue a Fleming myth was the possibility that it more general concern for the strategic and consistent policy. would permanently falsify the history of a political implications of the British nuclear What the British needed from the United dramatic medical advance. It had little force, it is instructive to note that the cur­ States - help in reducing costs - was influence on the judgement of the scientific rent generally accepted "force loading" of rather simpler, and they were not without establishment. Although the first clinical the British submarine strategic force of levers: among them their undoubted skill trial made it likely that penicillin's contri­ about 200 warheads, is exactly the goal set and know-how, even if those of the junior bution to medicine would be immense, the in 1948 for achievement in 1960. This may partner, the goodwill of past co-operation, work that had brought this about had made say something about the stability of British and such legal holds on the United States as no comparable contribution to science. conceptions of an adequate "assured the Quebec agreement of 1942 requiring Florey wrote "The almost miraculous destruction" capability, especially if we British consent for American use of properties of penicillin should not blind us assume some rough correlation between nuclear weapons and agreed rights to a to the fact that the work carried out at St the off-station factor in the submarine share in scarce uranium supplies from the Mary's Hospital, London, and at Oxford force and the likely attrition of its airborne Congo. Less tangible but nonetheless ef­ introduced no new chemical or biological predecessor. Whereas, however, the 1948 fective was the power Britain paradoxically principles. The results, however, were new projection was conceived to be about half enjoyed by being the weaker partner in an and the effects on medicine widespread". the American capability, today's British enterprise - the containment of the Soviet No one could have foreseen, in 1941, the force is eclipsed in scale by that of the Union - of great importance to the United chemical and biological developments United States. The record of the British States. Merely by implication - often which were to give the (3 -lactam antibiotics a nuclear effort is, indeed, one of being genuinely without any intention of doing scientific interest for a further forty years steadily overtaken, though running a very so - Britain could threaten to divert its and continue to do so today. But this story game race. In 1941 Britain was probably resources from supplying the conventional lies outside the scope of Gwyn the leader; by the time its national pro­ strength NATO needed, could show signs Macfarlane's book. 0 gramme approached the point of acquisi­ of paying a political price, perhaps even a tion of weapons, a decade later, Britain was price in nuclear co-operation, to win a Sir Edward Abraham is Emeritus Professor of already trailing the Soviet Union and about French welcome to the European Com­ Chemical Pathology in the University of to become the world's first "Nth nuclear munity, or could obstruct an arms control Oxford. power". initiative dear to America. © 1984 Nature Publishing Group