The Invisible Victory

18

I had no chance to discuss the German discovery with Colebrook before we met in the hall of Queen Charlotte's in Marylebone Road on the early evening of Monday, March 6, 1935. He had just come through the door, bag in hand and mackintosh flapping. He greeted me, 'Hello, Elgar-had your baby?'

'Yes, this morning. Everything seems fine.'

'Congratulations. Boy or girl?'

'Girl. I'm on my way to see them now.'

'I say, those papers by Domagk and Co in the _Deutsche Medizinische Wochenschrift_ are causing something of a sensation in London.' Coli strode along with me. 'They've even got into the newspapers. I wrote to Domagk for more information, but I haven't heard. I expect he's snowed under with similar requests from all over the world. And of course things are getting a little sticky in Germany, they do so seem to be turning in upon themselves. It's as though they were already at war with the rest of us in Europe.'

'I wondered why they renamed it "Prontosil"?' I had once mentioned to Coli my being one of the earliest cases on 'Streptozon'. 'Or as I suppose the Germans would pronounce it, "Pronto_zeal".'_

'Oh, I G Farben register any number of trade marks-euphonious labels for drugs as yet unsynthesized.' (The name 'Prontosil' had been registered in 1928 with the intention of sticking it on some new sleeping-draught.) 'You know what someone in my lab suggested? It's an abbreviation _of pronto_ and _silentium.'_ Coli gave his laugh, which could fill a corridor. He was a cheerful man behind his solemn manner and austere tastes. 'I must say, it's strange-to say the least-that Domagk kept completely quiet about his discovery for more than two years.'

'Wouldn't he want to be absolutely certain it always worked? It would be cruel to raise the world's false hopes.'

'You're being very Christian. The reason for the delay is simple. I G Farben wanted to be certain they'd got all their patents safely tied up. And they wanted exactly the right moment to market the stuff. I know my German drug industry.'

Remembering my past discouragement, I felt entitled to complain, 'Perhaps some lives might have been saved had Sir Almroth Wright seen the possibilities.'

'You can't blame The Lion.' Expectedly, Colebrook came to his defence. 'This is chemotherapy, of course. But a different sort than we've been accustomed to since Ehrlich first coined the word. It's not like the cure of syphilis or malaria or kala azar. The drug is simple, the administration is simple, and the streptococcus is no rare parasite, but flourishing upon all of us.'

'You mean, it's one of those concepts which stand out like mountains, which nobody sees because we're too busy staring at the toes of our boots?

'You might put it like that, yes.'

We parted, as I turned towards the entrance of the ward. The baby had been born at seven o'clock that morning. Rosie had started her pains early on the Sunday, when I had found a taxi at King's Cross Station and taken her into the hospital, waiting in a room with two other husbands. A well-starched midwife had appeared after an hour or so to explain that my wife had 'gone off the boil' and the baby was not expected that day. I gathered that for the first child the labour pains provided a prolonged overture to the drama. When I returned the next morning they had been trying to find me, and I was a father.

After I left Colebrook, I found Rosie still with the radiance of new motherhood, an expression which can transform the most ordinary girl into a saint, and which I do not believe has ever been accurately caught by painters of the Madonna.

'What do you think of her?' she asked, squeezing the bundle against her breast.

'She seems perfectly all right.'

'She's lovely. Do you still want to call her Clare?'

'Why not?'

Rosie wrinkled her nose. 'I dunno…it's a sort of stuck-up name.'

'I don't think so. St Clare of Assisi founded the order of Poor Clares.'

'Are you sorry she ain't a boy?' Rosie was looking at me guiltily.

'Why should I be?'

'Most men like a boy first.'

'It's all the same to me.'

'We'll have a boy next time,' predicted Rosie, smiling and snuggling up the baby again.

When I returned on the Tuesday evening, Rosie was not in such high spirits, a little tired, but well. On the Wednesday, she was flushed, with a temperature.

'It's nothing to worry about unduly,' said the starched midwife. 'After all, it's hardly unknown for a mother to run a slight temp during the puerperium. Your wife's got a rather nasty discharge down below, which would account for it. We've already taken a swab for the lab.'

'Do they know the infecting germ yet?' Her reassurance had made me anxious.

'They'll have the culture tomorrow. With luck, she'll be on the mend by then.'

The following evening, a nurse asked me to wait outside the ward door. The midwife appeared with the news, 'I'm afraid your wife's rather poorly, Mr Elgar.' I felt a pang of alarm. 'Her temp's gone up, and she's rather miserable because she's having a rigor or two. The doctor's just been with her, and he thinks the infection is still localized to the birth canal.'

I was even more suspicious of her optimism. 'What was the organism? I've had some training in bacteriology.'

'It's a haemolytic streptococcus,' she said calmly.

'Oh,' I said. Rosie was seriously ill. Potentially, gravely so. I went into the ward to find her pale, shivering and frightened. I stayed only a few minutes, distrusting too plainly my own reassurances.

'The doctor wants to move your wife to the hospital isolation block out at Chiswick,' the midwife imparted as I left. 'She'll be better looked after there.'

'Can Dr Colebrook see her? You know that I'm acquainted with him.'

'Dr Colebrook sees all the patients in the isolation block.'

'It's puerperal fever, isn't it?'

'I don't think we need quite say that. It's a severe infection, but still not a generalized one. Let's hope for the best, shall we? Can we get hold of you if we want to?'

'I'm at Arundel College all day. At night you'll have to send a policeman, or something.'

The isolation block in Goldhawk Road at Chiswick had been opened five years. Its forty beds gathered puerperal fever cases from the whole of west London. The patients were nursed in separate cubicles off battleship-grey corridors and the place reeked of antiseptic. Colebrook had instituted nursing with rubber gloves, sterile gowns and face masks, like a surgical operation, but two or three out of every thousand women delivered at Queen Charlotte's still died from childbed fever, and twelve of the forty ill women in the cubicles would not leave them alive.

With characteristic kindness, Colebrook came from his laboratory to Rosie's cubicle as I was leaving on the Friday afternoon.

'She doesn't look too well, Coli.'

'The infection seems to have spread to the peritoneal membrane lining the abdomen,' he said in his solemn way. 'That's not a good sign, I'm afraid. And of course your poor wife is suffering, with the distention and tenderness.'

We started walking along the corridors towards the door. 'She was very distressed at leaving the baby.'

'The little girl will be looked after on the ward until she's better. Obviously, we can't allow the babies here, there's too much risk of infection.'

I frowned. 'Where could this terrible streptococcus have come from?'

'Perhaps from the midwife's hands. The labour was rather long, and she had a number of vaginal examinations. Perhaps from Mrs Elgar's own nose and throat. Perhaps from the air. We can never say. Though if our precautions of gloves and so on were more widely used, the mortality rate might start to come down at last.'

We walked a few more steps in silence. I had of course felt concern for Rosie while she was having the child, but only as if she were suffering from some straightforward illness, like influenza. Now I saw she might die, I think for the first time in my life I began to develop fondness for her.

'For centuries, of course, the disease was a complete mystery,' Colebrook continued. 'It was seen as a visitation of some particular town or parish, which lifted after a month or two and let the women bear children perfectly healthily once more. For which the local ecclesiastic doubtless took all the credit. But in reality, the streptococcus was simply being passed from case to case by the midwife or doctor. That revolutionary idea was mooted at the end of the last century by an Aberdonian obstetrician called Alexander Gordon, who was ostracized for it and had to join the Navy-a hard fate for a midwifery expert. I suppose none of us likes being accused of possessing dirty habits.

'Didn't a man called Semmelweiss come into it somewhere?'

We pushed through a pair of frosted glass doors. 'You don't want to go into all this, Elgar. You've enough to upset you, without my lecturing about your troubles.'

'I'm interested. The doctor I lodged with in Wuppertal kept a photograph of him in his surgery. I remember he had a beautiful moustache, and resembled a Viennese opera singer, or the man on the packet of Gillette razor blades.'

'Semmelweiss was at the Allgemeines Krankenhaus in Vienna ninety years ago. There were two obstetric wards there, one used for training medical students the other for training midwives. Five of the students' mothers died of puerperal fever for one of the midwives'. It was ascribed to the poor women's shame at being examined internally by young men. But the students went to the labour ward straight from an obstetrical class in the post mortem room, while the midwives were taught everything from models. Ignaz Semmelweiss put the fever down to "cadaveric particles", made everyone wash their hands in lime water, and knocked down the mortality by two thirds. Mind, it took another fifty years before Louis Pasteur discovered bacteria and showed _how _it worked. Meanwhile, Semmelweiss was sacked, went mad and died from septicaemia contracted at a post mortem.'

'Semmelweiss was another man who saw the range of mountains which everyone overlooked?'

'Most definitely,' agreed Colebrook.

We had reached the front door. 'What's my wife's outlook?'

He considered this for a moment. 'Her infection may well localize itself as a pelvic abscess, which can be drained surgically. But it will be a long and debilitating illness, there's no getting away from that. And one which may well leave her sterile for the rest of her life.'

'I wouldn't mind. I don't want any more children.'

Colebrook raised his heavy eyebrows but said only, 'I expect you've informed her relatives?'

'My wife has none. She comes from a home for destitute children. She's completely anonymous. She's a particle unconnected to anyone in the world except me. The circumstances of my marriage were singular, don't you think?'

'A little unusual, perhaps,' said Colebrook guardedly.

'She was a housemaid. Why do you imagine I married her? Because I got her with child. And on to her death bed.'

'You must not simply accept that she is going to die,' he told me severely.

'Of course she will.' I was anguished not through love but through guilt, which are intertwined often enough.

'I'm going to give her a blood transfusion in the morning. I've already got a donor. It will reinforce her own white scavenger cells, in the best Almroth Wright tradition.'

Transfusion was then a complicated operation, done directly with a syringe and yards of bright red rubber tubing, the donor lying on the bed next to the chalk-white desperately ill woman. I suggested. 'Couldn't you try Ehrlich's arsenicals? Sir Edward once said something about your using them.'

'I was chasing a hare. We thought they increased the ability of the blood to kill streptococci, when injected for the entirely different purpose of killing the germs of syphilis. But they don't. We're giving streptococcal antiserum, naturally. Otherwise, we must rely on the skills of the nurses, as in any other severe infection. But your wife has a sound constitution.'

'Then what about "Prontosil"?'

'The answer's simple. I haven't got any.'

'But I have.'

His eyebrows rose again. 'How?'

'I stole them. From Domagk. Twenty tablets.'

Colebrook shook his head. 'I'm afraid that's out of the question, Elgar. I couldn't give any maternity patient an untested new drug.'

'But it has been tested. One of those papers alongside Domagk's was specifically on its use in puerperal fever. From Professor Max Heinkel's clinic in Jena. Isn't that good enough?'

'No, it is not good enough,' objected Colebrook forthrightly. 'I have been through those papers most carefully, and a lot of the experimental and clinical work in Germany was most slipshod. As far as Domagk's lab work goes, mice are not men. Surely you remember well enough The Lion's axiom-"experimental infections in animals have no relevance to natural infections in humans".'

I thought he was procrastinating only from blind loyalty to Wright and to Wright's hate of chemical remedies and chemists. 'I can have the "Prontosil" here in half an hour,' I counter-attacked. 'Or are you going to let my wife die?'

'Please, Elgar! You should not put things like that. You are a scientist, you surely realize that emotion is a dangerous ingredient in the making of clinical decisions.'

'But why not try it, in God's name?' I pursued arguing, through rising anger against Wright and his self-satisfied bigotism. 'Surely, it can't do any harm.'

'How can you claim that?'

'There was nothing to suggest ill-effects in any single one of those German papers.'

'The cases reported were few. And the enthusiastic research worker forgets his fatalities.'

'Isn't it worth taking the risk, just for once, that the Germans should not be bigger liars than we are?'

'Do please try and contain your language, Elgar.' Colebrook was embarrassed, annoyed and impatient with me all at once. 'I don't believe any German scientist would be deliberately misleading, even in these days of Dr Goebbels. But supposing I did give "Prontosil" to your wife? And supposing she did die? You might well blame me. Or you might well blame yourself for insisting on it. Which would be the worse for you.'

'I do insist on it. I'll sign a paper, indemnifying you.'

Colebrook said nothing for some moments. 'Very well,' he announced resignedly. 'Fetch the drug. The paper won't be necessary.'

But Rosie died. At ten o'clock on the night of Monday, March 11, 1935. Colebrook gave her the 'Prontosil', a tablet every four hours. But her blood and her body were already overwhelmed by the infection before he started.

Rosie's death was a shock to the Harley Street house. I had told no one that she was so ill. I had the impression that above and below stairs I was held to blame for it. I felt penitent, but it was penitence only through my suffering no true feeling of grief. I am not heartless, and the bell which tolls for all mankind can never make pleasant music. But I did not know her very well. I had been strongly attracted to Rosie through 'the hot, spicy smell of dirty petticoats'. I had married her because my upbringing left me with a raw sensitivity to the opinions of the world, to be driven rather than pushing. In short, not through honour but through cowardice.

Only my parents and myself went with her to Kensal Green. But poor Rosie had one valuable legacy. On the Saturday before her death her temperature steadied, she sat up with her face suffused pink from the dye and said she felt much better. She lived long enough for Colebrook to set aside his doubts and even Sir Almroth Wright's principles. He searched Germany and France for sulphonamide, dosed his own mice, and issued his own paper on the sulphonamide treatment of puerperal fever in the _Lancet _in June, 1936. A year after that, the mortality at Queen Charlotte's for the disease which killed my wife had dropped from thirty-three in a hundred to under five.

There was still Clare.

I put my problem to Colebrook. The evening of the funeral I went to his home in Chiswick Mall, which was bright with daffodils from his week-end house at Farnham in Surrey-which he had characteristically bought near Sir Almroth Wright's.

'Puerperal fever is a triple tragedy,' he told me solemnly. 'Though I've no children of my own, I do my best to sort out the domestic problems of bereaved husbands. They've sometimes two or three small ones to manage somehow or other, and often enough financial troubles into the bargain. Do you want to keep the child?'

'No.'

'Adoption may not be easy.' he remarked doubtfully. 'A lot of people these days can't run to the luxury.'

'She'll have to be put in a home, like her mother.' As he said nothing, I asked, 'Am I abnormal? I don't feel particularly attached to the child.'

'I have seen too much of the relationships between husbands and wives and their newborn babies to find any variation whatever abnormal. Do you know of anyone who might take her?'

'Not a soul.'

The Lady Almoner at Charlotte's is of course an expert on this subject. Though I'm afraid she can't perform miracles any more than I can in the wards.'

Mrs Packer saved her. She called the next morning at Arundel College. 'Jim, I have something terribly important to say,' she began earnestly as I went down from my lab to the hall. 'Can we sit down?'

I took her across to the refreshment room at Euston Station, where Clare's fate was decided.

'My husband's a solicitor, you know, and doing as well as anyone can these times,' she explained. 'As I expect you noticed at your wedding, he's…well, he's older than I am. I mean, Jim, we'd love to have her, and we can afford to look after her, and we've a new house at Hendon which is really very nice, and of course whenever you want to come and see her-'

'There's one condition.'

She swallowed, her Adam's apple bouncing in her thin neck like a ping-pong ball. 'Anything you say, Jim.'

'Clare must never have the faintest idea who her father and mother were.'

She looked flustered. 'Of course, we'd try if you really want us to. But these things do tend to slip out, and everyone in Sir Edward's house knows-'

'You must give me your promise. Your solemn promise.'

'I promise. At least, I promise I'll do my best.'

She did very well. Clare today-and Mrs Packer's is the only false name I have used in this narrative-became a bright young MP in the 1960s, but left politics to become Professor of Sociology at a university situated…shall we say, between St Louis and Oklahoma City. She is married for a second time, to an American professor who smokes a pipe, wears tweeds and goes fishing. Perhaps he wanted her to complete his English milieu. She has had three children, without even running a temperature. I was once about to be introduced to her at a party in the House of Commons, but I left in tears.

That summer of 1935 was King George the Fifth's Silver Jubilee. There were flags and tea-parties in working-class streets, royal processions, military reviews, vibrantly choral services of thanksgiving. In London, St Paul's was floodlit, at Spithead the Fleet was beflagged. Clever fellows who saw it all as a carnival to boost the National Government were quickly lost in the morass of emotion. On June 7, MacDonald departed from No 10 Downing Street, Baldwin returned. On June 27, two and a half million Britons voting in Lord Cecil's Peace Ballot stood against any military measures whatever to repel foreign aggression.

The following January had Sir Edward Tiplady on the front pages again. The King was suffering a recurrence of his old chest infection. Like Leonard Colebrook with Rosie, the doctors were against ransoming a King's life with an unknown German drug. At half past nine on the night of Monday, January 20, Lord Dawson's medical bulletin said only, The King's life is moving peacefully to its close.' The BBC fell silent, but for the ticking of a clock. The nation dropped its head. At five minutes to midnight the King died. Nobody was sure if his last words were, 'How is the Empire?' or 'Bugger Bognor'.