This notebook was made by Sir Alexander Fleming (1881–1955), the bacteriologist best known for his discovery of penicillin. It details his work during World War One, where he was employed to investigate the infection of war wounds.
World War One introduced a new style of warfare, where death caused by battlefield injuries exceeded death from disease. Bullets had also changed from their traditionally rounded shape, to a pointed shell which embedded itself into the flesh and dragged in dirt, clothing and debris. This resulted in wounds rapidly becoming infected. The most prevalent consequence of these infections caused gas gangrene, a dangerous disease, where gas-releasing toxins caused swelling and severe pain to the patient.
Bacteriology and treatment
In late 1914 the British Army asked Sir Almroth Wright, a leading pathologist, to set up a research laboratory to explore how to improve the treatment of war wounds. Fleming, then a member of the RAMC (Royal Army Medical Corps), accompanied Wright to a makeshift lab, based on the top floor of a casino in Boulogne, France. The Army hoped that their discoveries would help to conserve manpower.
Their experiments looked at how to prevent and cure the most common threats to an injured soldier’s health. Pictured here is the work Fleming conducted between June 1917 and January 1918.
Antiseptics and Cressy’s hole experiment
Antiseptics had been used since the 1860s to combat the risk of infection, and were widely employed in World War One. However, in 1915 Wright and Fleming learned that antiseptics were often unsuccessful when tackling the aggressive microbes harvested on the battlefield. This contradicted the theory accepted by the medical profession, and responses to their findings were frequently hostile.
A later experiment, based on ‘Cressy’s hole’ (ff. 41v–88, ff. 140–45), not only proves the ineffectiveness of antiseptics, but also their role in suppressing the body’s natural defences and encouraging the growth of infection.
The Cressy’s hole experiment consisted of taking two patients with similar cup-shaped wounds to their tibia [shinbone] (as seen on f. 51r), and examining how they reacted to different antiseptic solutions. First, the wounds were cleaned with ‘normal salt solutions’, then different antiseptics were applied for set intervals over an hour and a half period. Fleming would then measure both the destruction of the antiseptic behaviour of the solution, and the impact the solution had on white blood cells and other defensive proteins.
The test tubes (f. 150r) illustrate an experiment on gas gangrene. To understand the behaviour of the disease, Fleming added a concentrate of the disease to blood enhanced with either glucose or sulphuric acid, and sealed the mixture into test tubes using Vaseline. After 24 to 72 hours, Fleming measured the amount of gas emitted by assessing how far the Vaseline had been pushed up the tube.
 Roger Cooter, ‘War and Modern Medicine’, as cited in Mark Harrison, The Medical War: British Military Medicine in the First World War, (London, 2010), p.10
 Almroth E Wright and Alexander Fleming, ‘Acadaemia in gas gangrene and on the condition which favour the growth of its infective agent in the blood fluids’, in The Lancet (February 9 1918), p.205
 Col. A. E. Wright & Capt. A. Fleming., ‘Acidaemia in Gas Gangrene’, The Lancet, (9 February 1918), p.208