Lewis Thomas, 1983. This is a sort of intellectual autobiography, or a biography of a science.
Thomas writes that his medical education at Harvard in the 1930s was almost “entirely descriptive”. The curriculum taught “the recognition of disease entities, their classification, their signs, symptoms, and laboratory manifestations, and how to make an accurate diagnosis. The treatment of disease was the most minor part of the curriculum, almost left out altogether. … On the wards of the great Boston teaching hospitals … it gradually dawned on us that we could do nothing to change the course of the great majority of the diseases we were so busy analyzing, that medicine, for all its façade as a learned profesion, was in real life a profoundly ignorant occupation.” As an intern he found that there were only a few illnesses which were actually treatable: lobar pneumonia (treated with serum, the type depending on the particular strain of pneumococci), diabetic coma (insulin), acute heart failure (bleeding, digitalis or oxygen) and the early stages of syphilis (treated with months or years of arsenicals, mercury and bismuth).
He describes another intern who “would arrive on his ward promptly at 6:45 each morning, stand in the doorway, flap his arms, and crow like a rooster”.
The notes section is “an excuse to insert some items of verse that I grew fond of long ago when I wrote them,” both light verse and a serious apocalyptic poem. Here’s the last verse of a poem in honour of Professor Leo Alexander, whose research involved using alcohol to produce brain lesions in pigeons:
A pigeon with religion, a pigeon with the shakes,
A little dove protesting love to twenty thousand snakes,
A pigeon having horrors of being hung on hooks,
Or being chased and then defaced by busts of Phillips Brooks.
Oh, Happy Lot! Oh, Joyous News! Oh, Science on the Brink!
The Mamillary Bodies are susceptible to drink!
The Region of the Thalamus delights in getting blotto,
And also the entire damned Medulla Oblongato!
A strange partly lost world of undergraduate light-heartedness, hospitals serving extremely poor people with “one exotic disease after another superimposed on mental illness, or … problems like thyroid disorders hidden away as the cause of the mental illness,” Board of Health officials touring tenements with “rats as big as cats, roaches as big as rats, and every kitchen jam-packed with small children trying to keep warm around a lighted stove”, and above all, an entirely male world, apart from “the solid underpinnings of culture”, passed along by women to children before the men appear with “the necessary ambiguities and abstractions”.