by Lewis Thomas
Also, another matter. The world has become crowded with knowledge, and there is more to come. The fair redistribution of knowledge will be a more important problem in the century ahead than at any time in the past. Women have not had much hand in this up to now. The full education of children, up through adolescence into early adult life, will soon become the great challenge for humanity, once we have become free of the threat of bombs. All the more reason, I should think, to put the women, born teachers all of them, in charge. Send the men, for the time being anyway (the time being a hundred years), off to the showers, for the long, long bath they have earned.
22
ESSAYS AND GAIA
In 1970, a symposium on “Inflammation” was held at Brook Lodge, somewhere outside Kalamazoo, sponsored by the Upjohn Company, which maintains the place as a conference center for meetings of university scientists. My assignment was to provide something called the keynote address, to precede about forty other papers by researchers, from all over, who were working on the phenomenon of inflammation. Since I had no way of knowing in advance what the papers would be about, I was free to say whatever I liked about the matter. I knew that the general drift of the papers would concern biochemical details of the defensive machinery in living tissues: the ways in which signals are exchanged between leukocytes and other cells in the presence of foreign invaders, mediators governing expansion and constriction of small blood vessels to regulate the passage of blood cells and various soluble components across the walls of capillaries and small veins, the clumping and sticking of leukocytes and platelets inside the vessels, all culminating in the Galenic signs of rubor (redness), calor (heat), tumor (swelling), and dolor (pain), the classical inflammatory reaction. This complicated chain of linked events, leading to the destruction and ejection of foreign material lodged in living tissue, was the topic at hand.
This kind of conference tends to be rather heavy going, and my talk was designed to lighten the proceedings at the outset by presenting a rather skewed view of inflammation. I thought of it, and still do, as an example of largely self-induced disease rather than pure defense, with all sorts of mutually incompatible, combative mechanisms turned loose at once, frequently resulting in more damage to the host than to the invader, a biological accident analogous to a multicar accident involving fire engines, ambulances, police cars, and tow trucks all colliding on a bridge.
The whole conference was recorded on tape by the sponsors, and several months later I received in the mail a pamphlet-sized reproduction of my talk, accompanied by a note saying that it was being sent round to the other participants. A day or so later I had a telephone call from Franz Ingelfinger, the editor of the New England Journal of Medicine.
Ingelfinger said he had read the piece and liked it, parts of it anyway, although he didn’t agree with all of it, and he wanted me to try writing some essays for the Journal in the same general style. The terms were attractive enough: I would have to write one essay each month, due on Thursday of the third week, no longer than the space of one Journal page (around a thousand words), on any topic I liked. There would be no pay, but in return he would promise that nobody would be allowed to edit an essay. They would print them or not, but not change them.
I could not say no. Not because of the Journal’s prestige or the opportunity to publish any idea I liked, but because I had been conditioned, long ago, to doing whatever Ingelfinger told me to do. Partly, this was a behaviorist reflex established by the contingencies of the Boston City Hospital internship. I had come to the service as the pup when Ingelfinger, who had graduated from Harvard a year earlier, was the Senior, nine months ahead of me and, therefore, my boss. Our relationship began, and continued, with him giving the orders and me carrying them out. But there was more to it. Going through the City Hospital internship in those days was something like combat on a disordered battlefield, and we became close friends. Ingelfinger was, among other things, a born teacher, and he set about teaching me everything he knew, from the moment I turned up on his ward in my new white suit. There were a great many small skills to be learned—how to put together a makeshift oxygen tent when the proper parts were missing, how to bring a new oxygen tank to a patient’s bedside from the outer corridor where the things were stored (they were much too heavy to carry, and what you did was to tilt them over at exactly the right angle and then run down the ward behind them, sliding them along the waxed floor), how to wash out the stomach of someone in a coma, how to get a needle into an invisible vein, and so forth. Evenings we would sit around his room or mine, waiting for calls from the emergency room, playing records. Ingelfinger knew more about Mozart than I did, and couldn’t stop teaching even then: he loved to put a record on, play it for a second or so, then lift the needle and challenge me to identify the phrase and its location. I was on duty Christmas Eve in 1937, and Ingelfinger was off, due in the next morning at seven. It was a quiet night on the wards. I tacked a note on his door to greet him, a Christmas card:
Of Christmas joy I am the bringer.
I bring good news to Ingelfinger.
Though many turned in bed and cried,
Nobody died, nobody died.
We had eighteen months together, and I came away with a deep respect for his mind and character. After the internship, he went to Philadelphia, I to New York, and in the years that followed we met each other infrequently, once or twice a year, usually at the May meetings of the Society for Clinical Investigation in Atlantic City. Whenever we did meet we settled down to continue last year’s conversation wherever we’d left off.
So, I told Ingelfinger I’d be glad to try writing the column for his Journal, and began.
I had not written anything for fun since medical school and a couple of years thereafter, except for occasional light verse and once in a while a serious but not very clear or very good poem. Good bad verse was what I was pretty good at. The only other writing I’d done was scientific papers, around two hundred of them, composed in the relentlessly flat style required for absolute unambiguity in every word, hideous language as I read it today. The chance to break free of that kind of prose, and to try the essay form, raised my spirits, but at the same time worried me. I tried outlining some ideas for essays, making lists of items I’d like to cover in each piece, organizing my thoughts in orderly sequences, and wrote several dreadful essays which I could not bring myself to reread, and decided to give up being orderly. I changed the method to no method at all, picked out some suitable times late at night, usually on the weekend two days after I’d already passed the deadline, and wrote without outline or planning in advance, as fast as I could. This worked better, or at least was more fun, and I was able to get started. I finished an essay called “The Lives of a Cell,” then one about the precautions against moon germs at the time of the first moon landing, then several about the phenomenon of symbiosis, and after six months I’d had six essays published and thought that was enough. I wrote a letter to Ingelfinger, suggesting that now it was probably time to stop—six essays seemed more of a series than I’d planned, and perhaps the Journal would do well to drop the venture and start something new with someone else doing the writing. I got a letter back saying no, I had to keep it up, they were getting letters from readers expressing interest, and in case I had any doubts myself, I should know that even Lowell had telephoned Ingelfinger and said that the Thomas essays were not bad. Lowell was Dr. Francis Cabot Lowell, an intellectually austere Boston classmate of Ingelfinger’s and a severe critic. If Lowell approved of the pieces I should surely keep them going.
After a while it became a kind of habit, and I continued writing with fair regularity for something over four years. One day I had a letter from Windsor, Canada, from Joyce Carol Oates, whom I had never met, telling me that a physician had shown her reprints of some of the essays; she advised me to think about collecting them for a book. I had received quite a lot of interesting mail about the essays, mostly from doctors and medical
students, but the Oates letter was, and remains, the nicest letter in my files. I didn’t see how the pieces could ever be made into a book, since they seemed to me quite unconnected with each other, but I was encouraged by her approval. A bit later, in 1973, I had notes from several publishing houses inquiring about the possibility of a book, but also letting me know that if I was interested in trying I would have to do a lot of rewriting and insert some new essays—“connecting pieces,” they were called—in order for the thing to make sense. I was preoccupied in the dean’s office at Yale, and wrote back that I couldn’t manage the work. Then Elisabeth Sifton, an editor at The Viking Press, telephoned one morning to say that she would like to publish the essays as they were, no patching or connecting for me to do, and I said yes over the phone. They came out in 1974, titled for the first essay, The Lives of a Cell. It was the easiest of books to write, and I was surprised that it did well in the marketplace, especially pleased that its most active market was in university and medical school bookstores, which was what I’d hoped for. Having caught the habit, I kept on writing short essays, some for the New England Journal, some unpublished, and four years later there were enough for a second book, The Medusa and the Snail.
Although the books were favorably reviewed in Nature and Science, and a good many basic scientists have written letters of general approval and support, I have gotten myself in trouble with several groups of very knowledgeable people who are closely involved in subjects that I’ve written about and who disagree with me vigorously, not so much on matters of fact as on points of view.
Some of the evolutionary biologists criticize the suggestion, running through many of the essays, that the earth’s body represents a kind of organism, displaying so many instances of interdependency and connectedness as to resemble an enormous embryo still in the process of developing. This notion has seemed reasonable enough to me, considering the plain paleontological fact that the life of the earth was, for nearly 75 percent of its existence, made up entirely of separate, prokaryotic, microbial cells, themselves the progeny of what may have been, long ago, the single first cell, and these somehow succeeded in developing into nucleated cells around a billion years ago and then into multicellular entities, culminating in today’s elaborate plants and animals, all of which live their lives in dependence, direct or indirect, on today’s microbial populations. The Gaia hypothesis, proposed by Lovelock and supported by Margulis, goes a step further to postulate that the conjoined life of the planet not only comprises a sort of organism but succeeds in regulating itself, maintaining stability in the relative composition of the constituents in its atmosphere and waters, achieving something like the homeostasis familiar to students of conventional complex organisms, man himself for example.
The concentrations of oxygen, carbon dioxide, and nitrogen in the atmosphere are optimal for life, and they are wildly different from what would be predicted for the atmosphere of a lifeless planet. There is substantial evidence that each of these, and other trace gases such as ammonia and methane, are held at optimal concentrations by the metabolic activity of various forms of life. The salinity and pH of the oceans remains constant, in spite of trends which could have been expected to turn the seas to brine long since if it were not for life. The earth’s mean temperature is fixed somewhere between 10 degrees and 20 degrees Centigrade, and has been this way for at least a billion years. The life of the planet maintains the life, in the face of forces that would, in the absence of an intricate mechanism for keeping the balance of things constant in the environment, have led inevitably to death everywhere. Moreover, and most spectacularly of all, the biosphere has managed to adjust, and to keep on adjusting, to a steady increase in the luminosity of the sun amounting to at least 30 percent since the beginning of life 3.5 or so billion years ago. The place is remarkably stable. It begins to look as though the only real threat to its abundant continuance may be us.
The arguable trouble with the Gaia idea is that it seems to violate the central doctrine of Darwinian theory, that species emerge and then survive or fail on grounds of competition for natural selection, and that the appearance of any new species in candidacy for survival is a matter of pure chance, governed by random mutations or by equally random rearrangements of existing genes. According to some of the evolutionary biologists, the suggestion that the whole apparatus, Gaia, now possesses an array of unfathomably complex mechanisms for its own internal regulation, and that these mechanisms, operating together, maintain the stability of the whole, carries the implication that the thing was somehow designed to work this way. This would be against the rules, for as one critic said of the idea, “Natural selection cannot plan ahead.” I agree with this, but I do not regard the notion as all that teleological, and certainly not, as the same critic asserted, a “deification” of the earth. It seems to me that there are solid biological advantages in behavior that results in cooperation and collaboration, and the record of the earth abounds in successful examples of partnership, starting early on in the algal mats in which much of the earth’s life was embedded, in mutually dependent layers, more than a billion years ago, perhaps culminating in the entry of microorganisms into the flesh of other microorganisms to form the chloroplasts and mitochondria. This I view as the most fundamental of all stages, making possible everything that came on the scene in the last billion years: a system of increasingly complicated metazoan life, plants and animals, equipped to utilize the sun’s energy for the making of food and oxygen, and, in turn, using the oxygen to gain the energy stored in the food. I have no doubt that it happened by chance and succeeded by natural selection, but it happened with such dazzling success that it set the stage for all sorts of later events which would not have occurred without it. These primary, primal endosymbionts have retained enough of their own DNA and RNA to inform the molecular geneticists that they are, or were, indeed, separate living things to begin with, but they have probably turned over some of the essential genes for their structure and function to the nuclei of the cells in which they now live.
I confess that I am overwhelmed by what I take to be the meaning of this piece of natural history, and perhaps because of this I tend to look for as many other examples of symbiotic living as I can find in the record. Perhaps also, with my mind set in this bias, I pay less attention than I should to the examples of aggression, grabbiness, and terrorism in nature. I cannot help this. I suppose I could change my mind and spend my time thinking about insects as mainly parasites, mainly spreaders of disease, mainly an affliction, instead of thinking of them as the major, indispensable sources of food for aerial and aquatic life, carriers of heredity for plants, and technical assistants in the recycling of forest life. It is a Panglossian bias, I acknowledge, but 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.
I am not so optimistic about us. Human beings are getting themselves, and the rest of the world, into deeper and deeper trouble, and I would not lay heavy odds on our survival unless we begin maturing soon. Up to now, we have been living through the equivalent of an early childhood for our species. We have not been here any length of time, in evolutionary terms, and no wonder we are still young, with nothing but frontal lobes, thumbs, language, and culture to rely on for our shelter and survival. We could fumble and do it wrong. Thermonuclear war is the worst case to contemplate, enough in itself to cause the crash of the species, but we have other threats to make against our lasting existence: overpopulation and crash, deforestation and crash, pollution and crash, a long list of possible bad dreams come true, the sounds, always outside the window offstage, of the destruction of the orchard. With luck we may come through. The luck will have to be incalculable, and unbelievably on our side over the next few decades. The good thought I have about this is that we are, to begin with, the most improbable of all the earth’s creatures, and maybe it is not beyond hope that we are also endowed with improbable luck.
/> APPENDIX
What follows is a series of notes and references which are in no sense comprehensive or scholarly. They do not form a real bibliography, since most of the references are to studies from my own laboratory and only a few are to the body of much more important work on the same or related matters by others. I have keyed them by page number in order to provide convenient sources for those who may be curious about some of the details. Here and there, I have also included comments that could not be fitted neatly into the chapters themselves. And I have used the whole section as an excuse to insert some items of verse that I grew fond of long ago when I wrote them. Anyone who wishes to skip the whole Appendix will be missing very little.
p. 4
Allen Street was what everyone called the morgue at the Massachusetts General Hospital: the morgue doorway opened on that street. Herewith the poem.
ALLEN STREET
Canto I: Prelude
Oh, Beacon Street is wide and neat, and open to the sky—
Commonwealth exudes good health, and never knows a sigh—
Scollay Square, that lecher’s snare, is noisy but alive—
While sin and domesticity are blended on Park Drive—
And he who toils on Boylston Street will have another day