The Youngest Science

by Lewis Thomas

  PENGUIN BOOKS

  THE YOUNGEST SCIENCE

  Lewis Thomas was born in New York City in 1913. After earning his bachelor’s degree at Princeton, he received his doctorate in medicine at Harvard in 1937. He went on to become Professor of Pediatric Research at the University of Minnesota, Chairman of the Departments of Pathology and Medicine and also Dean at the New York University—Bellevue Medical Center, Chairman of the Department of Pathology and Dean at Yale Medical School, and President of the Memorial Sloan-Kettering Cancer Center in New York City. He is also the author of Late Night Thoughts on Listening to Mahler’s Ninth Symphony, The Lives of a Cell, and The Medusa and the Snail. Articles by him have appeared in The New Yorker, Scientific American, The Atlantic Monthly, Harper’s Magazine, and many other periodicals.

  Lewis Thomas died in 1993.

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  First published in the United States of America by The Viking Press 1983

  Published in Penguin Books 1995

  Copyright © 1983 by Lewis Thomas

  Penguin supports copyright. Copyright fuels creativity, encourages diverse voices, promotes free speech, and creates a vibrant culture. Thank you for buying an authorized edition of this book and for complying with copyright laws by not reproducing, scanning, or distributing any part of it in any form without permission. You are supporting writers and allowing Penguin to continue to publish books for every reader.

  This book is published as part of an Alfred P. Sloan Foundation Program

  “Millennium” was originally published in The Atlantic Monthly. Copyright 1941 by Lewis Thomas. Copyright renewed © 1969 by Lewis Thomas. “Allen Street” was originally published in the Aesculapiad, Harvard Medical School, 1937.

  Portions of this book were previously published in McCall’s and Self.

  Ebook ISBN 9781101667071

  THE LIBRARY OF CONGRESS HAS CATALOGED THE HARDCOVER EDITION AS FOLLOWS:

  Thomas, Lewis, 1913–1993

  The youngest science.

  1. Thomas, Lewis, 1913–1993. 2. Physicians—United States—Biography. I. Title.

  R154.T48A36 1983

  610′.92′4 [B] 82–50736

  ISBN 0-670-79533-X (hc.)

  ISBN 978-0-14-024327-7 (pbk.)

  Version_1

  To Beryl, Abigail, Judith, Eliza, best friends

  PREFACE TO THE SERIES

  The Alfred P. Sloan Foundation has for many years included in its areas of interest the encouragement of a public understanding of science. It is an area in which it is most difficult to spend money effectively. Science in this century has become a complex endeavor. Scientific statements are embedded in a context that may look back over as many as four centuries of cunning experiment and elaborate theory; they are as likely as not to be expressible only in the language of advanced mathematics. The goal of a general public understanding of science, which may have been reasonable a hundred years ago, is perhaps by now chimerical.

  Yet an understanding of the scientific enterprise, as distinct from the data and concepts and theories of science itself, is certainly within the grasp of us all. It is, after all, an enterprise conducted by men and women who might be our neighbors, going to and from their workplaces day by day, stimulated by hopes and purposes that are common to all of us, rewarded as most of us are by occasional successes and distressed by occasional setbacks. It is an enterprise with its own rules and customs, but an understanding of that enterprise is accessible to any of us, for it is quintessentially human. And an understanding of the enterprise inevitably brings with it some insight into the nature of its products.

  Accordingly, the Sloan Foundation has set out to encourage a representative selection of accomplished and articulate scientists to set down their own accounts of their lives in science. The form those accounts will take has been left in each instance to the author: one may choose an autobiographical approach, another may produce a coherent series of essays, a third may tell the tale of a scientific community of which he was a member. Each author is a man or woman of outstanding accomplishment in his or her field. The word “science” is not construed narrowly: it includes such disciplines as economics and anthropology as much as it includes physics and chemistry and biology.

  The Foundation’s role has been to organize the program and to provide the financial support necessary to bring manuscripts to completion. The Foundation wishes to express its appreciation of the great and continuing contribution made to the program by its Advisory Committee chaired by Dr. Robert Sinsheimer, Chancellor of the University of California–Santa Cruz, and comprising Dr. Howard H. Hiatt, Dean of the Harvard School of Public Health; Dr. Mark Kac, Professor of Mathematics at Rockefeller University; Daniel J. Kevles, Professor of History at the California Institute of Technology; Robert K. Merton, University Professor, Columbia University; Dr. George A. Miller, Professor of Experimental Psychology at Princeton University; for the Foundation, Arthur L. Singer, Jr., and Stephen White; for Harper & Row, Edward Burlingame.

  —ALBERT REES

  PRESIDENT, ALFRED P. SLOAN FOUNDATION

  THE ALFRED P. SLOAN FOUNDATION SERIES

  Disturbing the Universe

  by Freeman Dyson

  Advice to a Young Scientist

  by Peter Medawar

  The Youngest Science: Notes of a Medicine-Watcher

  by Lewis Thomas

  Haphazard Reality: Half a Century of Science

  by Hendrik B. G. Casimir

  In Search of Mind: Essays in Autobiography

  by Jerome S. Bruner

  CONTENTS

  ABOUT THE AUTHOR

  TITLE PAGE

  COPYRIGHT

  DEDICATION

  PREFACE

  THE ALFRED P. SLOAN FOUNDATION SERIES

  1. AMITY STREET

  2. HOUSE CALLS

  3. 1911 MEDICINE

  4. 1933 MEDICINE

  5. 1937 INTERNSHIP

  6. LEECH LEECH, ET CETERA

  7. NURSES

  8. NEUROLOGY

  9. GUAM AND OKINAWA

  10. ITINERARY

  11. NYU PATHOLOGY

  12. NYU BELLEVUE MEDICINE

  13. THE BOARD OF HEALTH

  14. ENDOTOXIN

  15. CAMBRIDGE

  16. THE GOVERNANCE OF A UNIVERSITY

  17. RHEUMATOID ARTHRITIS AND MYCOPLASMAS

  18. MSKCC: THE MEMORIAL SLOAN-KETTERING CANCER CENTER

  19. OLFACTION AND THE TRACKING MOUSE

  20. ILLNESS

  21. SCABIES, SCRAPIE

  22. ESSAYS AND GAIA

  APPENDIX

  1

  AMITY STREET

  I have always had a bad memory, as far back as I can remember. It isn’t so much that I forget things outright, I forget where I stored them. I need reminders, and when the reminders change, as most of them have changed from my childhood, there goes my memory as well.

  The town I was born and raised in disappeared. The only trace left behind to mark the location of the old clapboard house we lived in is the Long Island Rail Road, which still penetrates and crosses the town through a deep ditch, and somewhere alongside that ditch, behind a cement wall, is the back yard of my family’s house. All the rest is gone. The yard is now covered by an immense apartment house. The whole block, and the other blocks around where our neighbors’ clapboard houses and back-yard gardens were, are covered b
y apartment houses, all built fixed to each other as though they were a single syncytial structure. The trees, mostly maples and elms, are gone. The church my family went to, most Sunday mornings, is still there, looking old and beat-up, with a sign in the front indicating that it is no longer the Dutch Reformed Church and now is Korean Protestant. I drove down this block, darkened now like a tunnel by the apartment buildings set close to the curb on each side, and saw nothing to remind me of any part of my life.

  Lacking landmarks, I cannot be sure that the snatches of memory still lodged in my brain have any reliability at all; I could have made them up, or they could be the memories of dreams. I do dream about Flushing from time to time, finding myself on a bicycle on Boerum Avenue between Amity Street and Madison Street (all of these street names are gone, replaced now by numbers), and there is the town garbage wagon, horse-drawn, driven by a wild-eyed and red-haired youngish man named Crazy Willie, racing along the block on his high seat, talking to himself. I’m pretty sure of that memory; there was such a garbage wagon, driven by Crazy Willie, but why do I still have the image taped in my temporal lobe ready for replaying so many late nights, and so little else? I remember, now that I think of it, the late Sunday afternoon when the Lawnmower family arrived for a visit, friends of my family from somewhere far away, Ohio maybe, whose name turned out years later to be Lorrimer. It must have been around the same time that I discovered what the maid told me was copper beneath the sandbox, great soggy sheets of friable copper, enough to secure the family’s fortune, which I already knew needed securing, and then, a couple of years later, I lost the fortune on learning that she must have been saying carpet. There was a huge cherry tree at the back of the yard, close to the cement fence, and something went wrong with it, death I suppose, it was cut down and chopped up there in the yard, and what remains stored in my brain now, sixty years later, is the marvelous smell of that wood, the smell of the whole earth itself, all over the yard and, for a few days until it was carted away, in all the rooms of our house.

  My earliest clear memory of my mother is her tall figure standing alone in the center of the lawn behind the house, looking down at the grass, turning in a slow circle, scanning the ground. From the time of my earliest childhood I knew this to be a mild signal of trouble for my mother, trouble for the family. Sometimes she stood there for only a few moments, sometimes for as long as five minutes. Then, in the quickest of movements, she would reach down to pluck the four-leaf clover she was hunting and come back to the house. If I was there on the back porch, watching as she came, she would laugh at me and say, always the same sentence, “The Lord will provide.”

  So far as I know, this was her only superstition, or anyway, the only one she ever acted on. And it was always used for the same purpose, which was to get my father’s patients to pay their bills.

  Very few of the patients paid promptly, and a good many never paid at all. Some sent in small checks, once every few months. A few remarkable and probably well-off patients paid immediately, the whole bill at once, and when this happened my father came upstairs after office hours greatly cheered.

  There was never an end to worrying about money, although nobody talked much about it. The family took it for granted that my father had to worry about his income at the end of every month, and we knew that he was absolutely determined to pay all his bills on the first of each month, without fail. He believed that being in debt was the worst of fates, and he paid everyone—the grocer and butcher, the coal man, taxes, and the instrument and drug houses that supplied his office—as soon as he could after the bills arrived, depending on how much cash he had in the bank. But it was not the style of the time to pay the doctor quickly.

  These were the years everyone thinks of as the good times for the country, the ten years before the Great Depression. The town was prosperous, but the practice of medicine was accepted to be a chancy way to make a living, and nobody expected a doctor to get rich, least of all the doctors themselves. In the town where I grew up, there were two or three physicians whose families seemed rich, but the money was old family money, not income from practice; the rest of my father’s colleagues lived from month to month on whatever cash their patients provided and did a lot of their work free, not that they wanted to or felt any conscious sense of charity, but because that was the way it was.

  My father kept his own books, in a desk calendar that recorded in his fine Spencerian handwriting the names of the patients he had seen each day, each name followed by the amount he charged, and that number followed by the amount received. It was the last column that mattered. My mother kept a careful eye on those numbers, and it was always toward the end of the month that she went back to the lawn to find her four-leaf clovers.

  I’ll never understand how she did it. As I grew older, seven or eight years old, I liked to go along while she sought the family fortune, to help out if I could, but I never spotted a single one, even though my eyes were a lot closer to the ground. We would stand side by side, and I would try to scan the same patches of lawn, staring hard, but even as she swooped down to pick one, I was never able to see it until it was in her fingers.

  Much later, when I was a fourth-year medical student at Harvard, I learned more objectively some of the facts of medical economics. The yearbook for the class of 1937 was edited by Albert Coons, my closest friend in the class, and I was invited to be on the editorial staff because I’d written a rather long and disrespectful poem about medicine and death, called “Allen Street.” Coons prepared a questionnaire for the book and sent it out late in 1936, to the Harvard graduates from the years 1927, 1917, and 1907. The questions dealt mainly with the kinds of internship and residency training experiences most highly regarded by Harvard doctors ten, twenty, and thirty years out of school, but there were also a couple of lines asking, delicately and promising anonymity, for the respondent’s estimated income for 1937, and then a generous empty space at the bottom of the page requesting comments in general, advice to the class of 1937.

  Surprisingly, 60 percent of the questionnaires were filled in and returned, and they made interesting reading for Coons and me and all our classmates. Most of the papers neglected the business about postgraduate training and concentrated on the money questions. The average income of the ten-year graduates was around $3500; $7500 for the twenty-year people. One man, a urologist, reported an income of $50,000, but he was an anomaly; all the rest made, by the standards of 1937, respectable but very modest sums of money.

  The space at the bottom of the page had comments on this matter, mostly giving the same sort of advice: medicine is the best of professions was the general drift, but not a good way to make money. If you could manage to do so, you should marry a rich wife.

  It was very hard work, being a doctor. All the men (there were only men in those Harvard classes) had a line or two about the work: long hours, no time off, brief holidays. Prepare to work very hard was their advice to the class of 1937, and don’t expect to be prosperous.

  Watching my father’s work was the most everyday part of my childhood. He had his office at home, like all the doctors in Flushing. The house was a large Victorian structure with a waiting room and office in the ground-floor area that would have been the parlor and drawing room for other houses of the period. My family had their sitting room on the second floor, but the dining room was downstairs, a door away from the patients’ waiting room, so we grew up eating more quietly and quickly than most families.

  In the best of times, right up until the start of the Depression, we had a live-in maid who had her room on the third floor and a laundress who worked in the basement; then a part-time maid during the first years of the Depression; finally nobody. My mother always did the cooking, even when there was a maid; later, she did all the cleaning and everything else in the house, and in her free time she worked the garden around the edges of the back yard. We had had a gardener once, I remember, in the early 1920s, an Italian named Jimmy who came
up from Grove Street. Jimmy and my mother would discuss the progress of the garden every day, he in rapid torrents of passionate, arm-waving Italian, she in slow, careful, but firmly put English, and they got along fine. Later on, in the Depression years, she gardened the whole place herself, while the children mowed the lawn.

  Two streets scared the children away by their strangeness: Grove Street, just beneath the Long Island Rail Road Station, where the Italians lived, several dozen families, all poor, all speaking Italian at home and broken English elsewhere; and Lincoln Street, where the black people lived. Lincoln Street was not a ghetto, it was right in the center of Flushing, the best part of town, but two blocks of Lincoln Street were entirely black. I used to wonder how that happened, why all the Negroes lived together on those two blocks, but it was never explained; it had always been like that.

  Memorial Day and the Fourth of July were the town’s major events. Both involved parades, the first down Northern Boulevard to Town Hall and the Civil War Monument, where a Boy Scout was required to recite Lincoln’s Gettysburg Address (one year I had to do it), the second up from Main Street along Sanford Avenue. The people lined the streets waiting for the open cars containing the Civil War veterans, old, grizzled, confused-looking men in their eighties, wearing Union uniforms, then the World War I veterans (it was called the Great War then, nobody thought of giving it a number), young and fresh, in khaki uniforms and puttees. Brass bands, flags, the Masons and the Knights of Columbus, the village police and firemen, streams of children in Boy Scout, Girl Scout, Girl Pioneer, Sea Scout uniforms, and smaller children from the parochial school in everyday clothes, faces flushed pink with pleasure.

  The two most important people in town, known and respected by everyone, were Miss Guy, who taught first grade at P.S. 20, and Mr. Pierce, the principal. Miss Guy was the great eminence, having taught several generations of Flushing people. Mr. Pierce owed his social distinction to the loftiness of his position alone, having arrived from out of town only ten years earlier.