Book Review
The Plato of Praed Street: The Life and Times of Almroth Wright
Michael Dunnill. The Plato of Praed Street: The Life and Times of Almroth Wright. London: Royal Society of Medicine Press, 2000. xiii + 269 pp. Ill. £17.50 (1-85315-477-6).
The first three decades following Louis Pasteur's establishment in 1880 of immunology as an experimental science of great practical value witnessed startling advances, violent disputes, and interesting and complex personalities. Perhaps none of the latter was more interesting and complex than Almroth Edward Wright (1861-1947), even in the company of such contemporaries as Elie Metchnikoff, Paul Ehrlich, Emil von Behring, Richard Pfeiffer, Jules Bordet, and [End Page 158] Karl Landsteiner. Certainly none was more combative in his day, nor seemingly so badly treated by his posterity. His supporters would compare him favorably with Pasteur and Claude Bernard; his detractors gave him the nickname "Sir Almost Wright."
Pathologist Michael Dunnill's biography of Wright is the third to appear. The first was by Wright's student and longtime associate Leonard Colebrook, whose Almroth Wright: Provocative Doctor and Thinker (1954) is perhaps too respectful a treatment of "the Old Man." The second, Almroth Wright: Founder of Modern Vaccine-therapy (1966) by surgeon Sir Zachary Cope, a former student of Wright's, is somewhat more extensive and objective, but still bows before Wright, the icon of vaccine therapy. Dunnill's offering is by far the best. It is well written and even-handed, and it presents much new material from the Public Record Office, the Contemporary Medical Archive Centre at the Wellcome Institute, and elsewhere. The book is to be recommended to all those interested in the byways of British medical science and medical politics, and especially to those who might try to understand the character of one of the more colorful biomedical scientists of the twentieth century.
Wright's two greatest achievements during his ten years as professor of pathology at the Army Medical Hospital at Netley were his insistence on the importance of laboratory testing in support of medical practice, and his attempt to popularize the use of preventive vaccine against typhoid fever, a more serious threat during wartime than the enemy. He would thenceforth battle against all opponents of his proposal, arguing his case vociferously against the army medical establishment and even going over their heads to the secretary of state for war and to the public press. This uncompromising attitude led eventually to his departure from Netley and his move in 1902 to found the Inoculation Department at St. Mary's Hospital in London. Here he continued the fight for typhoid inoculation. He fought the statisticians Karl Pearson and Major Greenwood, who challenged the validity of his data; he fought the entire medical community, as exemplified by "Harley Street," for its outdated approaches; he alienated the surgeons by insulting the president of the Royal Society of Surgeons, Sir William Watson Cheyne; and, when asked by the chairman of a medical committee before whom he was testifying if he had anything further to tell them, he replied, "No Sir, I have given you the facts--I can't give you the brains" (p. 68). In the end, the First World War saw the victory of the antityphoid campaign; while inoculation was not yet made mandatory in the army, Lord Kitchener decreed that no soldier would be sent abroad uninoculated!
Wright's second major scientific undertaking lay squarely in the middle of the young field of immunology. Metchnikoff had proposed that the principal actor in the defense of the body is the phagocyte; this was contested bitterly by Koch's students and especially by Paul Ehrlich, who championed the role of circulating antibodies as the most important element in immunity. The battle was waged for many years--ultimately to be mediated, in a sense, by the award of the Nobel Prize for 1908 jointly to Metchnikoff and Ehrlich. Wright, who admired both scientists, also attempted to resolve the conflict. In 1903, with S. R. Douglas, he [End Page 159] described opsonins, antibodies that mediate phagocytic action. As Bernard Shaw put it in the preface to his playful portrayal of Wright in The Doctor's Dilemma, "[the phagocytes] do their work only when we butter up the disease germs appetizingly for them."
Wright developed an elaborate theory for the treatment of infectious diseases, based upon the principle of "vaccine therapy," in which the patient would be treated with a course of vaccine inoculations made from cultures of the offending pathogen. The treatment would be controlled by periodic estimates of the "opsonic index" of the patient's blood (i.e., the amount of opsonin present to encourage phagocytic action). Wright advertised this approach widely as the ultimate solution to the problem of infectious diseases, and indeed for a brief period it was widely applied. But the technique of measuring opsonic indexes proved difficult, was not very reproducible, and soon fell out of favor. Finally, only the laboratory at St. Mary's continued to do opsonic indexes, at Wright's insistence.
The start of the war in 1914 saw Wright once again combating the medical establishment, this time on the best way to treat war wounds. The Royal Army Medical Corps was, typically, fighting the last war, and paid little attention to the new dangers of such wound infections as gas gangrene from the well-fertilized fields of Flanders. Wright called for rapid surgical debridement of wounds near the front, and challenged the overreliance on Listerian antiseptics. He argued for the special training of army surgeons, and for a more rational organization of the treatment and evacuation services. Some of his proposals were adopted, over the strenuous opposition of the army and civilian hierarchy, but it would take yet another war before the full benefits of his ideas were realized.
It is curious that Almroth Wright is remembered, if at all, only for his opsonic indexes, perhaps the least significant of his contributions, rather than for his fundamental (and life-saving) work on antityphoid inoculation and on the treatment of war wounds. He should also be better known for the quality of the students whose careers he fostered, including Leonard Colebrook, FRS, renowned for his work on puerperal fever; Sir Alexander Fleming, FRS, Nobel laureate, discoverer of penicillin; Stewart Douglas, FRS, Parry Morgan, and Carmalt Jones, noted bacteriologists; John Freeman and Leonard Noon, early workers in allergy; and Sir W. B. Leishman, FRS, leading parasitologist and later director-general of the Army Medical Services.
One must wonder, however, whether the quality of Wright's philosophical
contributions justifies Dunnill's title, The Plato of Praed Street.
After a reading, one might have thought it more appropriate to have
entitled the book The Old Curmudgeon of Praed Street.
Arthur M. Silverstein
Johns Hopkins University
