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SPECIAL ARTICLES

IN HONOUR OF ALMROTH WRIGHT

ON Tuesday of last week a graceful tribute to thework of Sir Almroth Wright was paid when he waspresented with a bust purchased with subscriptionsfrom those who over many years have admired the

untiring persistence and great results of his work.The presentation was made in the library of themedical school of St. Mary’s Hospital before a largeand representative gathering, and Sir HENRY DALEbefore unveiling the bronze, which is to stand in theinoculation department of the hospital, spoke in

eloquent and intimate manner of the debt owed bythe world to Wright.

SIR HENRY DALE’S TRIBUTE

Sir Henry Dale said that he had an easy taskbefore him, since all were present with the one

object of expressing their admiration and affec-tionate regard for Sir Almroth Wright, now ap-proaching the completion of his seventy-fifth year.They wished to tell him that they all realised whatscience and humanity had gained by his completeand tireless devotion, through so many years, to theincrease of health-giving and life-saving knowledge,by work with his own skilful hands and his owningenious mind. They wished to ask him to allowthem to leave a permanent memorial of himself andhis work in his own institute, so as to give somecontact with his inspiring personality to those whowould be working there long after all present hadpassed from the scene.Some of those present could appreciate Almroth

Wright’s achievements chiefly from their practicalresults in the prevention and cure of disease and therelief of suffering. They would have in mind thecomparison-who could miss it ?-between the

tragic toll taken of our armies in the South AfricanWar by the enteric fevers and the. experience of theGreat War, in which this one of the weapons indeath’s armoury had been effectively put out ofaction by the knowledge which Almroth Wright’sresearches had by then made ready for use. Thegreat institute in which they were meeting was itself-a monument of generous recognition of the greatpractical results for humanity, which had long been,were still being, and would continue to be obtainedby the work in progress there into a far distantfuture.There were others among those present who

from a more intimate and expert knowledge couldrecognise not only the practical results, but thedetailed interest and subtle beauty of the researcheswhich had made these results possible. They knewtheir friend Sir Almroth Wright as a scientificphilosopher, building and rebuilding, with brilliantingenuity, the theories which gave order and coherenceto the facts which he observed, and threatening totax the resources of the Greek Lexicon for nomen-clature to give precision to his ideas ; but, thoughWright was a philosopher with this scholarly instinct,it was never in the study or the library that theyexpected to find him. They knew by experiencethat, when they visited him in that institute, at

any time of the day or even far into the night, theywould find him bending over his laboratory bench,patiently at work with his own hands and eyes, andwith the simplest of mechanical aids, putting ingeniousquestions to Nature, and loyally and humbly accept-

ing her answers. In that he resembled the othergreat scientific investigators throughout the ages.When he thought of their friend at his laboratorybench he was reminded of another great medicalinvestigator-a friend of Sir Almroth Wright’s-the late Paul Ehrlich. Ehrlich used to say that hecould carry out all the experiments which he wishedto make if he were provided with a supply of dyesand chemicals, a handful of test-tubes, a water-tap,and a sheaf of blotting-paper. It might be suggestedthat Almroth Wright would require for his beautifulresearches little more than a supply of glass tubing,some rubber teats, a dab of plasticine, a gas burner,a microscope, and a tolerable incubator. With thesehe would need as material only some drops of blood,taken from himself, his colleagues, or his patients-for throughout his career, from his earliest researchesto those which were still actively in progress, he hadbeen consistently a man of blood. With these simpleappliances and materials, his inspired imaginationwould devise experiments leading always to deeperknowledge of the nature of human blood, with itssubtle mechanisms and delicate reactions to infection.He sometimes thought that they might regard SirAlmroth Wright as one of the born burglars ofNature’s mysteries, fashioning his skeleton keys withhis own ingenious fingers from the most homelymaterials, and using them with a touch of genius toforce one after another of the intricate locks withwhich Nature seems to guard her secrets.

Seventy-five years was a long innings, and, in thecase of Sir Almroth Wright, the score was 75 notout and well set. His long career included periods atBelfast, Dublin, Cambridge, Sydney, the ArmyMedical School at Netley, and, lastly, the InoculationDepartment at St. Mary’s Hospital, which he founded,and where they still found him working with a groupof enthusiastic colleagues. In every place where hehad been he had acquired devoted friends andadmirers and enthusiastic disciples, and all were

represented among the subscribers to the memorial,which they were going to ask him to accept, andmany of them were represented in person in that

gathering.The portrait bust by Donald Gilbert, which was

now unveiled, had the advantage over any paintedportrait, that the subject could be seen from everyaspect. It would preserve a memory of Sir AlmrothWright, which was the most familiar to those whovisited him in his laboratory-namely, that of theback of a massive head and shoulders, bowed withpatient diligence over his working bench. From theother aspect they would see no actual smile fixedin permanent bronze; but, he thought that theywould agree, there was the hint and promise of thesmile of friendly humour, which so characteristicallylit up Sir Almroth Wright’s features when he wastalking to his friends. They all hoped that theirfriend would be willing to leave this portrait andmemorial of himself in the niche on the landing ofthe institute, which the architect had, with properforesight, provided for such a purpose.He could not help introducing one note of sadness

into a happy occasion. There was one man whom theywere all sadly missing on that day-Almroth Wright’sdevoted friend and assistant, and his most intimatecollaborator for many years, and, in more recentyears, his own (Sir Henry Dale’s) most loyal senior

colleague and dearly loved friend, Stewart Ranken

Douglas. All who knew Douglas, who died last

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January, would know that he would have been

among the most enthusiastic members of that

gathering in honour of his great friend and teacher.Sir Henry Dale then handed to Sir Almroth Wright

an illuminated address, with the names of all thesubscribers to the memorial bound in a small volume,asking him to receive this and the portrait bust asvery sincere tokens of the admiration and affectionin which he was held by all who had participated,and of their desire to keep the memorial of his

personality and his influence alive among all whowould follow him in his work.

SIR ALMROTH WRIGHT REPLIES

Sir Almroth Wright deplored that languageprovided only descriptive words for objects andevents, and made no provision whatsoever for themore important business of expressing the emotions.Everybody was aware of that defect of language.The lover found it difficult to express his affectioneven to an ideally sympathetic audience of one. And

everybody found it difficult to express in a con-

vincing manner sympathy with the happiness or

bereavement of others. And a man who had toexpress an internal commotion of gratitude experi-enced, as he did, the same sense of incompetence.

I would have you note that it is not impossible toexpress emotion through the channel of appropriatecombinations of rhythmical words. It can be done

provided only you are an orator and a poet. Whenhowever you are neither the one thing nor the other,then you have only the poor alternative-and I

propose to avail myself of that now--of enumeratingthose to whom one feels one’s special thanks are due.

I would, first in order, desire to express mygratitude to my friend Sir Henry Dale for havingdone me the honour of functioning as your spokesmanand for having, in conveying this gift of yours to me,employed every sort of over-indulgent kindlyexpres-sion. I would further express my gratitude to thesculptor-Mr. Donald Gilbert-for the skill and painshe has lavished upon this bust. I would express mythanks also to all those numerous friends whosenames are written in this book as co-partners in thispresentation. And I am specially grateful to the

organising committee and their secretary, but I havefrom them the strictest orders that I must not evenmention them by name. I would further thank allthose who are assembled in this hall to-day for theircourtesy in coming, some of them far away from

London, to add distinction and grace to thisceremony. And lastly, I would thank those whowould have desired to be here, but have beenprevented by illness or absence abroad. And I have,among those absent for this latter reason, speciallyin mind Lord and Lady Iveagh. I would have you,when you presently make the round of the spaciousquarters of this Institute of Research and VaccineTherapy, bear in mind that this building owes itsexistence in large part to the munificence of LordIveagh.

I will now ask you to let me off saying anythingmore on the subject of my emotional reactions andmy incompetence in giving voice to them. It will bemore within my competence, and more congenial tothe vocation of a scientist, for me to think out withyou the philosophic basis of this ceremony in whichSir Henry Dale, and you, and I are playing ourseveral parts. I would in particular very brieflydiscuss with you two questions : first, that of theassociation of the word pleasure with work in generaland medical research work in particular; and,

secondly, the question of the rewards of work. Theterm " pleasure" is the most enigmatical in the

English language. It embraces three kinds of"feelings" and "inward sensations" which are asfar as far can be apart. First, pleasure includes whatI am accustomed to call " voluptuary pleasures"-or, if you prefer the term, " pleasures of sense." Allmen, however much they may disagree in other

points, are agreed that the pleasures of sense are

genuine pleasures. There are pleasant sights andpleasant sounds and joys of taste and pleasures ofsmell-" fragrant the fertile earth," for example, ’’ aftersoft showers." There is a second kind of internalsensations which count for a great deal in life, butto which the term " pleasure" is only doubtfullyapplicable. These are satisfactions of our sensory nerves—" satisfactions of our sensory requirements," wemight call them. Sleep would be such a requirement.Life without sleep would be unendurable. And

sleep has had from the poets its store of tenderestnames. But even the poets would scruple to describesleep as a pleasure. We may think further of therequirements of our nerves of temperature. We sufferfrom intense malaise when we are cold and chilly andwe revive when we get comfortably warm. But relieffrom the malaise of chill is not what we have in viewwhen we speak of pleasure. Precisely the same thingholds of freedom from hunger and thirst. There aremany other somatic and psychical urges (biologistscall these impulses tropisms) which are all of themreliefs from sensory discomforts, but would none ofthem properly be called pleasures. In particular, if £I had time I might speak to you about our stereo-tropic cravings--our cravings for intimate contactwith solid substances.

I come now to a third description of inward feelingswhich have been called pleasures. These are dis.

tinguished from the others by the fact that they comeinto consideration in connexion with work. Andthere are about these feelings all sorts of insultingmisunderstandings abroad. I call it an insultingmisunderstanding when a man who has never donea hard day’s work in his life comes to one who hasexperience of the miseries of physical fatigue andtells him that it is perfectly plain that everyone whoworks works because he finds that work is a pleasure.Now no one who has ever done any strenuous physicalor intellectual work ever thinks of work in that way.Hard work is always compelled work-there being ofcourse two different sorts of compulsion. The one sortwhich we most frequently associate with the term isexternal compulsion. But there is also internal com-

pulsion, this being an urge to get rid of the miseryof wanting to do some particular thing (I call that

misery " neuronic tension "), and to feel that the thingis done, or is at any rate so far as we are concerneddone (I call that relief neuronic relief). And theproof that all hard work is done not for the sake ofwhat is ordinarily called pleasure but from externalor internal compulsion, is to be found in the factthat the " ordinary sensual man," who is untroubledby urges, absolutely refuses to undertake any of theserious forms of work. You cannot get him to digthe ground, or to learn languages, or to follow anyhandicraft or profession, and you may tell him asmuch as you please that there is pleasure in hardwork, but he-for he is not a fool-knows perfectlywell that there is in hard work always more painthan pleasure and more " neuronic tension" than" neuronic relief."

I have been talking with you, as you will have

recognised, in quite general terms about the relation

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between work and that spurious entity which isdenoted by the term pleasure. But while most of

you have been dwelling upon the instances ofsuccessful research work emphasised by Sir HenryDale, all of us here who are engaged in medicalresearch have had in mind the enormous disproportionof failure to success. And it is that which puts medicalresearch in the same category of pleasure-givingoccupations as, let us say, painfully attempting to climbMount Everest, or passing a winter alone under thesnow for the sake of making meteorological records.

I pass now to consider what are the externalrewards of research work. For you will want toknow whether the hard work of medical researchcan be made up to the worker by external rewards ;and you will want to know something about theavailable rewards. I may remind you, to begin with,that Marcus Aurelius scoffs at the notion of rewards." Does the eye," he says, " ask a reward for seeing, ordo the legs ask a reward for walking ?

" And, youmay rejoin, Does the brain ask a reward for thinking That sort of high flown talk may seem foolishness, soI return to the discussion of rewards and of theappropriate sort of rewards for successful research.

I have it from the lips of a very famous researchworker now dead that he who did important researchwork, such as he himself had done, should receive theemoluments of an archbishop and should be presentedwith a Rolls-Royce car and a salmon river. I havealso heard from more than one research worker thatthose who are successful should be rewarded withtitles of honour and public fame and decorationsand fellowships of learned societies and gold medalsand honorary degrees, and I can take heart of graceand say that to me these things may upon occasionhave their value. For there is in my memory a

speech made by a distinguished friend here presentwhen returning thanks for a dinner given to himon his election into the Royal Society. He made thispoint, that every intellectual worker who is not

incurably vain must in due season ask himselfwhether he is really the stout fellow that he imagineshimself to be. And there followed then the pointthat a man who has been perturbed by such self-questionings is put into good heart again by hiselection into a learned society or the award of a medal,for these may be taken as sure indications that hiswork is really held in some esteem. I should like toput this to you; that the amount of pleasure thatcan be extracted from gratified intellectual vanity is- venture to think-very strictly limited. And asfor the ordinary flattering speech it is much betterimmediately forgotten. And there is with flatteringspeeches this special disadvantage-a man cannotwith any decency go about retailing them to hisfriends. But I would make here one exception.There is a kind of flattering speech which is so

tempered with reserves and criticism that it mayquite profitably be remembered ; and there is thisgood point about such a speech that it may withoutimmodesty be repeated. Let me give you an example.A professor was seeking information as to the meritsand demerits of your honourable servant now addressingyou.

" Oh ! " replied Metchnikoff (and the professorreported this sally to me with pardonable pride),"Wright is a man who has very good original ideas :but he has also ideas which are only original."

I come now to the point as to what is the reallygladdening reward of laborious research work. I findthis reward not in the pleasures of sense which arrivein the course of our work. For these are few and rare.Nor do I find that reward in the neuronic reliefwhich comes along with weariness at the end of a

long day’s work, for the work of the day often turnsout unprofitable. But I find that reward in thesatisfaction of certain important psychical require-ments. Just as a man requires sleep when he is tired,and food when he is hungry, and just as he longs forcontact with the firm land and rest after a badchannel passage, so he requires, for the peace andsatisfaction of his mind, some goodwill and affectionateesteem from those around him. Presentations, as

I understand them, have something to do with thisand this presentation which has been conveyed tome constitutes, I venture to believe, no exceptionto that rule. Finally, let me cite to you a passagethat strikes the note upon which it will be good toend. It is-you will be surprised to hear-a criticism(I think a very penetrating criticism) of Shakespeareby Bernard Shaw. This is the passage :

" You suddenly see that Shakespeare, with all hisflashes and divinations, never understood virtue and

courage-never conceived how any man who was not afool could, like Bunyan’s hero, look back from the brinkof the river of death over the strife and labor of hispilgrimage, and say, ’yet do I not repent me’; or, withthe panache of a millionaire, bequeath my sword tohim who shall succeed me in my pilgrimage, and mycourage and skill to him that can get it."’

MEDICINE AND THE LAW

Heart Disease as an Accident

Reddish v. London, Midland and Scottish Railway,decided at the Manchester county court last week,was one of those interesting cases where death fromheart disease is found to be an accident within theWorkmen’s Compensation Act. An engine-drivercollapsed and died on the express from Manchesterto London. The court had to consider whether his

employment had caused a strain which in turn hadcaused death. The widow contended that the heartattack was due to her husband’s effort in helping toturn the turn-table at Manchester station before

beginning the journey: it was aggravated, she said,by his action in closing the regulator of the enginewhen the train was running down from HaddonTunnel to Rowsley. The judge went in person to therailway station, entered the cabin of an expressengine, and tested for himself the requisite degree ofexertion. He came to the conclusion that to pullthe regulator over when the train was at rest meantno serious effort to an engine-driver in good health,but that, if the train was travelling down an inclinewith considerable oscillation, the effort would be astrain to a man in Reddish’s state of health. Thework contributed to, and materially accelerated,death ; the employers were therefore liable to paycompensation.

’

The legal position has been well established sinceClover Clayton and Co. v. Hughes in 1910, where theworkman ruptured an aneurysm of the aorta whilemerely using a spanner to tighten a nut without anyunusual effort. There was medical evidence that theaneurysm was so far advanced that death might haveoccurred during sleep. The employers contendedthat it was a case of disease and not of accident."Accident," they argued, must be some sudden orunexpected occurrence of an untoward kind; the

ordinary use of a spanner could not be an accidentwithin the statute. The Lord Chancellor, however,laid down that the accident might be "somethinggoing wrong within the human frame, such as thestraining of a muscle or the breaking of a blood-