Novel Medicine: Arrowsmith

Sinclair Lewis' novel Arrowsmith was first published in the United States back in the 1920s. The author was already well known for Babbit and had intended for his next book to involve something ‘heroic’. At first he had planned on writing a work about a labour giant. In preparation, Lewis had even gone to visit the US union leader, Eugene Debs, one of the founders of the International Labor Union and a five-time (!) candidate for the American presidency on behalf of the Socialist Party of America. However, a mutual friend, Dr Morris Fishbein, who among other things was for many years the editor of JAMA, introduced Lewis to a young bacteriologist, Paul de Kruif. The scientist, who had just been fired from his job at the prestigious Rockefeller Institute, collaborated with him in ways that today would have given him claim to have been listed as a co-author. However, those were different days. Perhaps it is not too surprising that Lewis was attracted to medicine as the theme of this book. Fishbein and de Kruif were hardly Lewis' first brush with the profession, as his elderly father was still practicing as a physician at the time of writing. As well, one of his grandfathers and an uncle were also doctors. The novel's plot involves the life and career of Martin Arrowsmith, a typical Midwesterner hayseed who shortly after entering medical school meets up with and is heavily influenced by one of his professors, Max Gottlieb. This senior physician is a German Jew, and Lewis probably modelled him after Jacques Loeb, an eminent researcher most famous for his discovery of artificial parthenogenesis. On the impressionable young Arrowsmith, the older researcher exerts a powerful influence in his role as teacher, mentor and role model, offering his protege a glimpse into ‘scientific’ medicine. Through Arrowsmith's career and struggles, Lewis presents the thesis that there is an essential conflict between clinical medicine and scientific research; moreover, that the struggle in fact cannot be resolved. One is either a ‘scientist’ or a ‘doctor’. As quoted in a fascinating analysis of the novel,1 ‘In his memoirs, de Kruif quotes Jacques Loeb as having said that something like “medical science” did not exist, as it was a contradiction in terms.’ In a way, we are still grappling, sometimes not all that successfully, with the same conflict today. While the issue remains as fresh as ever, the book is dated. To this reader, the novel is what we would today clearly consider overwritten. Both clinical medicine and laboratory research are caricatured more than they are characterized. That being said, it is still a good read. But to fully enjoy the book and to understand the currents of medical history which explain its background and which the book itself elucidates, I strongly suggest reading the review referenced below as a companion to the novel.1 Apparently in its day and for a long time afterwards, Arrowsmith influenced many young people to choose medicine and perhaps some even to opt for a life of ‘pure’ bench research. I doubt, however, it would do the same today. Young people are more jaded than was I when I first read this novel more than four decades ago. As well, for many reasons, medical research has lost some of its innocence since then. In the two decades after Lewis published Arrowsmith, the Nazi and Japanese medical atrocities followed, as well as other abuses less egregious but still not worth copying, took some of the shine off of this career goal. For their part, the blandishments of Big Pharma and the resultant corruption which so many of our colleagues have fallen into have had their ill effects as well. That being said, for a clear look at some of the strong forces which influenced American medicine in the era just following Osler's, and which continue to roil it to this day, turn to Sinclair Lewis' fine novel.

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