The Youngest Science

by Lewis Thomas

  To pay his lease and live in peace, along the Riverway—

  A thoroughfare without a care is Cambridge Avenue,

  Where ladies fair let down their hair, for passers-by to view—

  Some things are done on Huntington, no sailor would deny,

  Which can’t be done on battleships, no matter how you try—

  Oh, many, many roads there are, that leap into the mind

  (Like Sumner Tunnel, that monstrous funnel, impossible to find!)

  And all are strange to ponder on, and beautiful to know,

  And all are filled with living folk, who eat and breathe and grow.

  Canto II

  But let us speak of Allen Street—that strangest, darkest turn,

  Which squats behind a hospital, mysterious and stern.

  It lies within a silent place, with open arms it waits

  For patients who aren’t leaving through the customary gates.

  It concentrates on end results, and caters to the guest

  Who’s battled long with his disease, and come out second-best.

  For in a well-run hospital, there’s no such thing as death.

  There may be stoppage of the heart, and absence of the breath—

  But no one dies! No patient tries this disrespectful feat.

  He simply sighs, rolls up his eyes, and goes to Allen Street.

  Whatever be his ailment—whate’er his sickness be,

  From “Too, too, too much insulin” to “What’s this in his pee?”

  From “Gastric growth,” “One lung (or both),” or “Question of Cirrhosis”

  To “Exitus undiagnosed,” or “Generalized Necrosis”—

  He hides his head and leaves his bed, and, covered with a sheet,

  He rolls through doors, down corridors, and goes to Allen Street.

  And there he’ll find a refuge kind, a quiet sanctuary,

  For Allen Street’s that final treat—the local mortuary.

  Canto III

  Oh, where is Mr. Murphy with his diabetic ulcer,

  His orange-red precipitate and coronary?

  Well, sir,

  He’s gone to Allen Street.

  And how is Mr. Gumbo with his touch of acid-fast,

  His positive Babinskis, and his dark luetic past?

  And what about that lady who was lying in Bed 3,

  Recently subjected to such skillful surgery?

  And where are all the patients with the paroxysmal wheezes?

  The tarry stools, ascitic pools, the livers like valises?

  The jaundiced eyes, the fevered cries, and other nice diseases:

  Go! Speak to them in soothing tones. We’ll put them on their feet!

  We’ll try some other method, some newer way to treat—

  We’ll try colloidal manganese, a diathermy seat,

  And intravenous buttermilk is very hard to beat—

  We’ll try a dye, a yellow dye, or different kinds of heat—

  But get them on their feet—

  We’ll find some way to treat—

  I’m very sorry, Doctor, but they’ve gone to

  Allen Street. . . .

  Canto IV

  Little Mr. Gricco, lying on Ward E,

  Used to have a rectum, just like you or me—

  Used to have a sphincter, ringed with little piles,

  Used to sit at morning stool, face bewreathed with smiles,

  Used to fold his Transcript, wait in happy hush

  For that minor ecstasy, the peristaltic rush. . . .

  But in the night, far out of sight, within his rectal stroma,

  There grew a little nodule, a nasty carcinoma.

  Oh, what lacks Mr. Gricco?—Why looks he incomplete?

  What is this aching, yawning void in Mr. Gricco’s seat?

  Who made this excavation? Who did this foulest deed?

  Who dug this pit in which would fit a small velocipede?

  What enterprising surgeon, with sterile spade and trowel,

  Has seen some fault and made assault on Mr. Gricco’s bowel?

  And what’s this small repulsive hole, which whistles like a flute?

  Could this thing be colostomy—this shabby substitute?

  Where is this patient’s other half! Where is this patient’s seat!

  Why, Doctor, don’t you recollect: It’s gone to Allen Street.

  Canto V: Footnote

  At certain times one sometimes finds a patient in his bed,

  Who limply lies with glassy eyes receding in his head.

  Who doesn’t seem to breathe at all, who doesn’t make a sound,

  Whose temperature is seen to fall, whose pulse cannot be found.

  And one would say, without delay, that this is a condition

  Of general inactivity—a sort of inanition—

  A quiet stage, a final page, a dream within the making,

  A silence deep, an empty sleep without the fear of waking—

  But no one states, or intimates, that maybe he’s expired,

  For anyone can plainly see that he is simply tired.

  It isn’t wise to analyze, to seek an explanation,

  For this is just a new disease, of infinite duration.

  But if you look within the book, upon his progress sheet,

  You’ll find a sign within a line—“Discharged to Allen Street.”

  p. 5

  Considering everything (inflation, taxes, etc.), you can match the incomes of 1937 to those of today, very roughly, by multiplying by five. Thus, the twenty-year graduates were making, in today’s money, approximately $37,500. It seems safe to say that the average Harvard Medical School alumnus of the class of, say, 1963, makes a lot more than that, by two or three times, considerably more if engaged in a surgical specialty.

  The cost of a medical education, however, was very much less. Tuition, room, and board, in the years between 1922 and 1937, came to around $650. Today, more than twenty times that sum would be needed for the minimum cost of a year in Harvard Medical School. Most students, or their families, must take out loans (formerly sponsored by the federal government at low interest but now costing the moon), and it is common for students to graduate under a high-interest debt of $60,000 or more.

  p. 23

  My mother and father were married on October 31, 1906. The only record I possess of this event is a page in the center of the family Bible, which still rests for most of its time on a back shelf of a closet, too big a volume for housing in an ordinary bookcase. Someday, I tell myself, I must bring that page up to date. As it stands, it ends with a note in my father’s handwriting recording my marriage to Beryl and the birth dates of our three daughters, followed by similar notes about my brother Joe’s marriage some years later. There is a lot more to be filled in, and I must do it soon.

  p. 30

  The discovery that liver extract was a cure for pernicious anemia was made in 1926. The bare outline of the story is as follows: Dr. George Whipple, at the University of Rochester, reported in 1925 that dogs that had been made anemic by repeated bleedings were helped in reconstituting their blood by being fed large quantities of fresh liver. Because of this, Dr. George Minot decided to try feeding liver to patients with pernicious anemia and, aided by his younger associate Dr. William P. Murphy at the Peter Bent Brigham Hospital, quickly observed that the disease was indeed cured. Years later, others found that the active ingredient in liver extract responsible for the cure was a complex cobalt-containing molecule now known as vitamin B12.

  That was the essence of the story, and probably all that is needed to illustrate the neatness and precision with which biomedical research can sometimes solve major disease problems. Until the Minot-Murphy-Whipple discovery, pernicious anemia had been a universa
lly fatal disease and a blank mystery.

  But the story is more complicated than this outline. A somewhat longer version was told to me by one of Minot’s colleagues, who had been around on the wards of the Peter Bent Brigham at the time. If it is true, which I cannot prove, it illustrates another important aspect of medical discovery—the role of luck.

  According to this colleague, Minot customarily recruited junior associates for his busy private practice in hematology from the ranks of residents at Peter Bent Brigham, and Murphy was next in line for such a job. Minot met with Murphy to discuss the position, and advised the younger man to take on a research project of some kind for the next few months in his spare time; Minot’s office associates were expected to have at least one publishable paper at the time of starting practice. Minot leafed through a stack of journals on his desk and came across Whipple’s paper on anemia in dogs. Why not try the same sort of liver extract in patients with anemia? What kind of anemia? Well, why not pernicious anemia? There were always some patients with this disease on the Peter Bent Brigham wards.

  So much for that part of the luck. There was more, if my story is true. The earliest versions of raw liver prepared for feeding were extremely unpalatable, and the first patient selected for trial of the therapy was an exceedingly resistant elderly woman whose personality had been so affected by her illness that she had the reputation of being obstreperous, cantankerous, and impossible to deal with. Murphy regarded her as a double challenge to his ability: to test the treatment and to persuade her to cooperate. It was a contest of wills, and Murphy, through sheer stubbornness, won. On about the seventh day of battle, her personality abruptly changed, she was transformed into an agreeable, accommodating woman, and a few days later her blood began to show the now-familiar signs of recovery from pernicious anemia.

  And now the final piece of luck. Looking back at the events, doctors are now generally agreed that Whipple’s dogs could have had nothing at all like pernicious anemia. Their anemia was actually due to iron deficiency brought about by repeated hemorrhage, and the response to liver was almost undoubtedly caused by the iron contained in the very large doses of liver used for feeding. It was the wrong model to use for studying pernicious anemia, and it led straight to a Nobel Prize.

  Minot was personally lucky in still another sense. He became ill with severe diabetes in 1921 and by 1922 was being maintained on the near-incapacitating dietary restriction that was the only treatment available at the time. His weight had dropped to 120 pounds (he was 6 feet tall). Had it not been for the Banting-Best discovery of insulin in 1922, it is unlikely that Minot would have lived to find the cure for pernicious anemia.

  I knew a New York internist, a professor of medicine at P & S, who claimed that he could have made Minot’s discovery and gotten the Nobel Prize himself if he’d had his wits about him in the early 1920s. He had a patient with all the blood manifestations of pernicious anemia, a wealthy spinster living in an apartment on Park Avenue, who baffled him and his hematologist colleagues by remaining in vigorous good health despite her disease. He should have looked into her kitchen, or inquired more closely into her diet. Years later, after the Minot discovery was announced, she told him that she had always adored pâté de foie gras, and ate jar after jar all through those years.

  p. 35

  I discovered, by accident, a new way of adding to my income during my internship and residency. I had been writing verse off and on, late nights, while on call, using the secretary’s typewriter in the Harvard office on the top floor of the Peabody. One night I forgot to bring the folder back to my room, and Dr. A. P. Meiklejohn, a Scottish physician then working in the nutrition laboratory at the Thorndike, found it the next morning. Without telling me, he sent copies to friends of his in New York who were running a literary agency, Russell (A.E.’s son) and Volkening. A few weeks later I had a letter from Russell saying they’d be glad to try selling some of the poems. The Atlantic Monthly, Harper’s Bazaar, and The Saturday Evening Post bought about a dozen items all together, at $35 each, and I had a steady income. With two transfusions and one poem sold each month, I lived quite well.

  When the first poem turned up in The Atlantic, I received a handwritten note from Dr. Minot in his official capacity as chief of the Harvard Medical Services at the Boston City.

  Dear Thomas—

  I knew you were an excellent physician and student of medicine, but not until this evening did I know you were a poet. I have just seen the December issue of The Atlantic Monthly. I consider it a splendid achievement to “make” The Atlantic Monthly. I wish I had known of this earlier today when I saw Mr. Weeks, the editor.

  This note carries my sincere congratulations to you.

  As ever yours,

  George R. Minot

  I still have these old magazines, on a back shelf in my closet, along with my old violin, which I keep telling myself I will exhume someday, restring, and play again—but haven’t, for forty years. I’ve forgotten exactly when the poems were written, but all of them came from the time between 1938 and Pearl Harbor. The atom bomb was nowhere in sight, but even so the new technologies of warfare seemed to have no limits.

  MILLENNIUM

  It will be soft, the sound that we will hear

  When we have reached the end of time and light.

  A quiet, final noise within the air

  Before we are returned into the night.

  A sound for each to recognize and fear

  In one enormous moment, as he grieves—

  A sound of rustling, dry and very near,

  A sudden fluttering of all the leaves.

  It will be heard in all the open air

  Above the fading rumble of the guns,

  And we shall stand uneasily and stare,

  The finally forsaken, lonely ones.

  From all the distant secret places then

  A little breeze will shift across the sky,

  When all the earth at last is free of men

  And settles with a vast and easy sigh.

  p. 36

  When I was five months along in my internship, the hierarchy in command of the wards consisted, in rank order, of Dr. William Peltz, House Physician; Cary Peters, Assistant House; and Franz Ingelfinger, Senior Physician. The names of all three are embedded in a poem which I have kept in a folder of unpublished verse from those years. This one concerns a patient named A. Maloof who came to my ward terribly ill with some disease that I’ve now forgotten. I can’t explain why I’ve forgotten; you might expect an intern from that time to remember anyone who came in terribly ill and then got well, but anyway I’ve forgotten. What I do remember is the gift he brought in later as a token of gratitude to all his doctors. It was a sort of antique jug, about two feet tall, solid brass, with the strangest-looking spout I’d ever seen on a pot. Since Peltz was the House Physician, he claimed rights to the object. There was no argument, but I thought the event needed memorializing.

  ODE TO MALOOF

  Oh, Gift of Brass! Oh, splendid proof

  Of gratitude from A. Maloof—

  —If thou could’st speak!

  What tales of years fourscore and ten,

  What memories of now and then

  Would pass that beak?

  What hopes had thou? Did e’er thy heart

  Aspire to be an objêt d’art?

  Despite the beak?

  Who fashioned thee? What mad designer

  Did pound out brass in Asia Minor

  And made that beak?

  What idiot child, with halt and stammer,

  Was given brass, and handed hammer,

  And forced to stay away, aloof

  From others of the clan Maloof,

  To use his tortured, fevered mind,

  To make this pot on which we find

  This Monstrous Beak?

  And did’st t
hou hope, oh, Burnished Pot,

  That such a fate would be thy lot?—

  That thou would’st be so doubly blest:

  To leave Maloof, and be the guest

  Of someone else?

  Of William Peltz?

  Oh, Happy Pot! Oh, lucky toss!

  Maloof came in while Peltz was boss!

  For if he’d chose at home to tarry,

  Thou might’st have gone to Peters, Cary!

  And if he’d longer chose to linger,

  Thou would’st have gone to Ingelfinger!

  But No! Thou goest to no one else

  But Dr. William Learned Peltz!

  p. 44

  The effects of alcohol on the human brain were a matter of lively interest in the Boston City Hospital because of the great numbers of patients with advanced alcoholism on most of the wards. Professor Leo Alexander, an Austrian neuropathologist, worked in the late 1930s on Wernicke’s disease, a strange affliction involving the brain centers for eye movement, which he believed was due to the combined effects of alcohol and nutritional deficiency. He had some experiments going on in his laboratory with pigeons, in which he claimed that brain lesions similar to those of Wernicke’s disease could be produced. He announced these results at a seminar, followed by a celebratory dinner. A friend of mine, Joseph Ross, working in the pathology department, was invited to make a few remarks at the dinner and asked if I could write a piece of light verse for him to read. I had just given a transfusion that afternoon and, with the help of my allotment of Golden Wedding, produced the following lines. I should add that Professor Alexander was an impressive figure, very dignified, portly, unmistakably Viennese; each spring he shaved his large head bald.

  LINES DEDICATED TO DR. LEO ALEXANDER

  Hail to Alexander, that giant Man of Science,

  And all the happy pigeons, his little waddling clients,

  A happy lot, I truly wot, to meditate upon—

  Each little bird, with vision blurred, may daily tie one on.

  May daily have his highball, with little ice cubes clinking,

  May walk around his cage all day while absolutely stinking,