The Fevers of Reason

by Gerald Weissmann

  After 1965, Thomas moved from the lab bench to the rougher terrain of medical administration and science policy. Thomas had a broad interest in how medical science shapes, and is shaped by, society. Wit, candor, and attention to principle rather than politics made him a valuable spokesman for medical science. While still at NYU, Thomas served as a member of the New York City Board of Health (1957–1969), was instrumental in the construction of the new Bellevue Hospital, and set up the Health Research Council, a sort of local NIH. As chairman of the Narcotics Advisory Committee of the New York City Health Research Council, he guided Vincent P. Dole into methadone research and pointed Eric Simon to endorphins (1961–1963). After a stint in New Haven as professor of pathology and dean (1969–1973) at Yale University School of Medicine, he became president and chief executive officer of the Memorial Sloan Kettering Cancer Center (1973–1980). At MSKCC, he launched a major attack on tumor immunology, recruiting Robert Good as director; Thomas became chancellor of MSKCC from 1980 to 1983. In retirement, his summer home in the Hamptons made a university professorship at SUNY–Stony Brook (1984) convenient, and his Manhattan apartment let him serve as writer in residence at Cornell University Medical School until his death in 1993. By then he had been for several decades the most widely read interlocutor between the older literary culture and the new world of medical science.

  LEWIS THOMAS WAS PRECEDED IN HIS ROLE as medical scribe to the nation by such other American physician-writers as Oliver Wendell Holmes, William James, Walter B. Cannon, and Hans Zinsser. Each contributed vastly to the biology of medicine, each wrote books that gained a broad general audience, each taught that science is a very human activity. Zinsser, who, as we’ve seen, was responsible for Thomas’s admission to Harvard Medical School, summed up the tradition by proposing that

  Aside from the habits of hard work that [medicine] demands, it embraces a broad survey of the biological field, enforces a considered correlation of the fundamental sciences, and, on the human side, brings the thoughtful student face to face with the emotional struggles, the misery, courage and cowardice of his fellow creatures.

  Like Zinsser before him, Thomas fused the two cultures of “fundamental science” and “the human side,” because for him they were one. He went on to become a persuasive spokesman for the biological revolution because he was convinced that while science is only one of the many ways we have of making sense of nature, medical science is the only way we have of making sense of disease. That conviction would have remained more or less private were it not for the public language in which it was voiced. His sound was distinct and unmistakable, the prose direct and limpid. Here, for example, is Thomas’s suggestion for signals we might send from earth to announce ourselves to whatever life there might be in outer space:

  Perhaps the safest thing to do at the outset, if technology permits, is to send music. This language may be the best we have for explaining what we are like to others in space, with least ambiguity. I would vote for Bach, all of Bach, streamed out into space, over and over again. We would be bragging, of course, but it is surely excusable for us to put the best possible face on at the beginning of such an acquaintance. We can tell the harder truths later. . . . Perhaps, if technology can be adapted to it, we should send some paintings. Nothing would better describe what this place is like, to an outsider, than the Cézanne demonstrations that an apple is really part fruit, part earth.

  That sort of writing is the product of another unique period in American culture. Thomas and his colleagues were educated in colleges at which the liberal arts were still firmly in place and John Dewey’s learning-by-doing had moved from primary schools into the universities. It was an era when those who did medical science were expected to know why it was done and for whom. They were also expected to make only modest claims for their success: “I was lucky,” Thomas quipped after he received a medal at Bologna in 1978, “chance favored the prepared grind.” One knew that he was speaking for a generation of medical scientists who believed that one could do serious work without taking oneself too seriously.

  Thomas wrote one, rather impersonal, memoir, The Youngest Science. He believed that a scientific memoir ought to remember not only how the science came about but how it felt at the time: sometimes right, sometimes wrong, always surprising. Thomas called it a story of finding a pattern in a jumble, a task even he found daunting:

  It should be easier, certainly shorter work to compose a memoir than an autobiography, and surely it is easier to sit and listen to the one than to the other. . . . In my [memoir] I find most of what I’ve got left are not memories of my own experience, but mainly the remembrance of other people’s thoughts, things I’ve read or been told, metamemories. A surprising number of them turn out to be wishes rather than recollections . . . hankerings that the one thing leading to another had a direction of some kind, and a hope for a pattern from the jumble—an epiphany out of entropy.

  That passage, precise and informal at once, illustrates the flow of Thomas’s thought and speech. Thomas was as likely on the wards as in print to pair epiphany (as in James Joyce) with entropy (as in the second law of thermodynamics). That balance of phrase could be said to be the signature of Thomas’s prose; epiphany seemed to be having it out with entropy on every page. He was also sparing of words when fewer spoke louder. Half a year before his death from Waldenström’s macroglobulinemia, a slow, wasting form of bone marrow disease, he received an award named in his honor at Rockefeller University. Confined to a wheelchair by his illness, he declined the podium and apologized to the audience for “not rising to the occasion.” About the same time, I reached him on the telephone:

  “How are you doing?” I asked. He knew what I was asking.

  “So,” he replied.

  “What do you mean by ‘so’?”

  “Well,” said Thomas, “in my family, there were only three ways of answering that question of yours. If things were going along splendidly, you’d answer ‘fine.’ If there were a bit of trouble around, you’d say ‘so-so.’ Right now, I’m ‘so.’”

  When more words were required, they flowed like wine. Thomas’s chosen means of expression was the informal essay, a literary form that accommodates many topics but always has the mind of its author as the subject. A reader of his pieces quickly becomes aware that Thomas has invited him to a tug of war between two turns of mind, a playful match between two equally attractive personae: a cheerful Thomas who urged holism and a doubting Thomas who was a card-carrying reductionist. Holism, as I learned from Thomas, was invented by General Jan Smuts (the intelligent design chap) in 1926. It implies that matter and life are one. Reductionism derives from Hippolyte Taine, who borrowed the term from the chemists who use it to denote an agent that reduces a compound to a simpler substance by removing oxygen. Matter without life, one might say.

  As a medical scientist, Thomas was persuaded that only patience, doubt, and diligence, the reductionist virtues, could pluck facts from nature. But Thomas also understood the very human need to turn the strands of fact into a fabric of belief. In that mode he had but one exemplar: William James. Especially in his later, more ruminative essays Thomas successfully blended the Jamesian “Will to Believe” with James Lovelock’s newer Gaia hypothesis, a postulate that life on our planet has been chiefly responsible for the regulation of that life’s own environment. Lovelock’s holistic notion seems to unite the best of James with the best of Thomas, and it is no mean compliment to suggest that a passage such as this from James would fit comfortably in any of Thomas’s essays:

  We find ourselves believing, we hardly know how or why. We all of us believe in molecules and the conservation of energy, in democracy and necessary progress . . . all for no reason worthy of the name. We see into these matters with not more inner clearness, and probably with much less, than any disbeliever in them might possess. . . . For us not insight, but the prestige of the opinions, is what makes the spark shoot from them, that lights up our sleeping magazines of faith. Our faith
is faith in someone else’s faith, and in the greatest matters this is most the case. Our belief in truth itself is that there is a truth and that our minds and it are made for each other.

  Like James, Thomas was celebrated as a “poetic” or “creative” writer and scientist. But modern critics use those adjectives in much the way that eighteenth-century essayists would have used “sentimental.” Thomas was by no means a sentimental essayist. I’m convinced that there was more structure than sentiment to his writing, just as there was more science to his art than art to his science. Here is a Thomas passage with a Jamesian sense of our planet:

  The overwhelming astonishment, the queerest structure we know about so far in the whole universe, the greatest of all cosmological scientific puzzles, confounding all our efforts to comprehend it is the earth. We are only now beginning to appreciate how strange and splendid it is, how it catches the breath, the loveliest object afloat around the sun, enclosed in its own blue bubble of atmosphere, manufacturing and breathing its own oxygen, fixing its own nitrogen from the air into its own soil, generating its own weather at the surface of its own rain forests, constructing its own carapace from living parts: chalk cliffs, coral reefs, old fossils from earlier forms of life now covered by layers of new life meshed together around the globe, Troy upon Troy.

  Again like James, Thomas was not simply a clever scientist with a creative turn of mind; he was a writer to the bone. Evelyn Waugh, whom Thomas had admired since his undergraduate days on the Princeton Tiger, introduced the term “architectural” to describe the difference:

  Creative is an invidious term [for a writer] . . . a better word, except that it would always involve explanation, would be “architectural.” I believe that what makes a writer, as distinct from a clever and cultured man who can write, is an added energy and breadth of vision which enables him to conceive and complete a structure.

  The architectural structure that Thomas worked out fitted readily into the conventions of the informal essay. He derived from the facts of natural science, such as the workings of inflammation, symbiosis, the planetary ecosystem, and the life of social insects, metaphors for broad aspects of human activity, such as curiosity, language, and altruism. Fact marched hand in hand with solace; he assured us that a meningococcus with the bad luck to catch a human was in more trouble than a human who catches a meningococcus. Who on earth would not welcome those tidings of comfort and joy? Every once in a while Thomas reversed the direction of his metaphors, using human behavior or language as a metaphor for the odd fact of cell biology:

  The meaning of these stories [of protozoan symbiosis] may be basically the same as the meaning of a medieval bestiary. There is a tendency for living things to join up, establish linkages, live inside each other, return to earlier arrangements, get along, wherever possible. This is the way of the world.

  But his years in the lab served him well on the page. His sense of trial and error at the bench and in the clinic, of how cells divide, microbes hurt, and creatures die, gave a tough edge to his writing:

  When injected into the bloodstream, [endotoxin] conveys propaganda, announcing that typhoid bacilli (or other related bacteria) are on the scene and a number of defense mechanisms are automatically switched on, all at once . . . including fever, malaise, hemorrhage, shock, coma and death. It is something like an explosion in a munitions factory.

  Thomas had been writing for publication since his efforts on the Princeton Tiger. His poetry became more ambitious, and in his house office days he published several remarkably polished verses in literary magazines such as the Atlantic Monthly. One of these even appeared in 1944 while he was in the Pacific with the Rockefeller Institute Medical Research Unit. But, for twenty years after he returned from the war, his writing was pretty much limited to the scientific literature. Later, after he had made his contributions to immunology, after he had secured his reputation in science, and while he was serving as chairman, dean, and chancellor at three sometimes-exasperating institutions, he turned his attention once more to the muse.

  In 1965, he had permitted himself a ruminative essay on inflammation, which was brought to the attention of Franz Ingelfinger, editor of the New England Journal of Medicine and an old colleague of Thomas’s at Harvard. At Ingelfinger’s request, Thomas began his stint as author of the bimonthly column “Notes of a Biology Watcher.” Thanks to Elisabeth Sifton, then an editor at Viking Press, those sparkling essays were soon collected into The Lives of a Cell, the volume became a best seller, won a National Book Award—and Thomas was well on his way to a place in the world of letters.

  Unlike other scientist-writers who tend to limit their subjects to their own field of research—evolution is the core of Stephen Jay Gould, for example—Thomas worked hard at the task of writing well about all manner of things. Waugh would have appreciated that effort:

  In youth high spirits can carry one over a book or two. The world is full of discoveries that demand expression. Later a writer must face the choice of becoming an artist or prophet. He can shut himself up at his desk and selfishly seek pleasure in the perfecting of his own skill or he can pace about, dictating dooms and exhortations on the topics of the day. The recluse at the desk has a bare chance of giving abiding pleasure to others; the publicist has none at all.

  Tough critics of his science claimed that much of Thomas’s immunology was small scale and anecdotal. But Thomas’s lasting contributions to our understanding of inflammation and immunity can be readily identified today; his notions are embedded in the history of immunology. On the literary side, Stephen Jay Gould accused Thomas’s essays of disguising their serious themes as “homegrown Yankee wisdom” cloaked in “charming and superficially rambling” accounts—too charming, perhaps, for words. Sidney Hook complained about his memoir that “Mr. Thomas’s ‘A Long Line of Cells’ is an instructive lesson in biology but tells us nothing about his life that distinguishes it from any other human life.” Christopher Lehmann-Haupt accused Thomas of “Optimism (relentless) on humanity.” Thomas himself confessed that he may have told us once too often that all is for the best in this best of all possible worlds: “I’m not sure Pangloss was all that wrongheaded. This is in real life the best of all possible worlds, provided you give italics to that word possible.” But his mandarin wit prevailed over the Panglossian strain; he became a fine essayist by the best means available, which was to work hard at writing well. Indeed, his very last, somewhat slight, book, Et Cetera, Et Cetera, was devoted entirely to words and the sound of words. That attention to the mot juste reminds one of Waugh’s advice that over time the writer is better off perfecting his style rather than peddling his subject:

  Literature is the right use of language irrespective of the subject or reason of utterance. A political speech may be, and often is, literature. A sonnet to the moon may be, and often is, trash. Style is what distinguishes literature from trash. . . . The necessary elements of style are lucidity, elegance, individuality; these three qualities combine to form a preservative which ensures the nearest approximation to permanence in the fugitive art of letters.

  That point taken, I’d make the partisan argument that Thomas’s careful attention to style, which so clearly meets Waugh’s criteria of lucidity, elegance, and individuality, gives Lewis Thomas a shot at permanence in the world of letters. A number of his compositions stand up to essays by such other modern masters of the genre as E. B. White, A. J. Liebling, and John Updike. In a select few of his essays, Thomas reaches back to touch the mantle of Montaigne.

  Notes

  Prefatory Note

  Mencken, H. L. A Mencken Chrestomathy: His Own Selection of His Choicest Writings. New York: Vintage, 1982. First published 1949.

  Thomas, Lewis. The Lives of a Cell: Notes of a Biology Watcher. New York: Viking, 1974.

  GOING VIRAL

  1.Arrowsmith and CRISPR at the Marine Biological Laboratory

  Baltimore, D., et al. “A prudent path forward for genomic engineering and germline gene mod
ification.” Science 348 (2015): 36–38.

  Chicago Daily Tribune. “Loeb Tells of Artificial Life.” December 28, 1900.

  Doudna, J. A. “From Bacterial Adaptive Immunity to the Future of Genome Engineering.” Glassman Lecture at the University of Chicago, July 1, 2016.

  Jinek, M., et al. “A programmable dual-RNA-guided DNA endonuclease in adaptive bacterial immunity.” Science 337 (2012): 816–821.

  Kim Kardashian’s Twitter page. https://twitter.com/kimkardashian?lang=en.

  Lander, E. S. “The Heroes of CRISPR.” Cell 164 (2016): 18–28.

  Lewis, Sinclair. Arrowsmith. London: Jonathan Cape, 1925.

  Loeb, Jacques. “On the Limits of Divisibility of Living Matter.” In Biological Lectures at MBL Wood’s Holl. Boston: Ginn & Co, 1894.

  Loeb, Jacques. “Experimental Studies on the Influence of Environment on Animals.” In Darwin and Modern Science: Essays in Commemoration of the Centenary of the Birth of Charles Darwin and of the Fiftieth Anniversary of the Publication of “The Origin of Species.” Edited by A. C. Seward. Cambridge: Cambridge University Press, 1909.

  Loeb, Jacques. The Mechanistic Conception of Life. Chicago: University of Chicago Press, 1912.

  Pourcel, C., G. Salvignol, and G. Vergnaud. “CRISPR elements in Yersinia pestis acquire new repeats by preferential uptake of bacteriophage DNA, and provide additional tools for evolutionary studies.” Microbiology 151 (2005): 653–63.

  San Francisco Call. “Believes Germ of Life Will Be Discovered.” October 1, 1907.