The novel Arrowsmith, Paul de Kruif (1890–1971) and Jacques Loeb (1859–1924): a literary portrait of “medical science”
- Correspondence to: H M Fangerau Institute for the History of Medicine, Heinrich-Heine-University Duesseldorf, Universitaetsstrasse 1, 40225 Duesseldorf, Germany;
- Accepted 4 July 2006
Shortly after bacteriologist Paul de Kruif had been dismissed from a research position at the Rockefeller Institute for Medical Research, he started contributing to a novel in collaboration with the future Nobel laureate Sinclair Lewis. The novel, Arrowsmith, would become one of the most famous satires on medicine and science. Using de Kruif’s correspondence with his idol Jacques Loeb, this paper describes the many ways in which medical science is depicted in Arrowsmith. This article compares the novel with de Kruif’s and Loeb’s biographies, and (1) focuses on the struggles of the main character, Martin Arrowsmith, as an allegory of the institutionalisation of medical research in the US, (2) shows that (influenced by de Kruif) Sinclair’s purpose is to caricaturise scientific work in modern medical research institutions anywhere and (3) shows that the novel depicts a reductionist philosophy of research that seems to contradict the “messiness” of medical practice.
The microbiologist Paul de Kruif (1890–1971) was forced to resign from his research position at the Rockefeller Institute for Medical Research in 1922, shortly after he anonymously published a four-part polemic about medicine between science, commerce and charlatanism in the popular The Century Magazine. It was already the second anonymous article in which he drew on his experiences from the Rockefeller Institute.1,2 In both articles, he mocked the institute’s research objectives, purposes, methods and organisation. When it became obvious that de Kruif had written both articles, the director of the Institute, Simon Flexner (1863–1946), advised the promising researcher to resign. Flexner considered the promotion of team spirit as crucial, and the revelation of insider information was a violation of the rules (Corner,3 p 161).
Even de Kruif’s mentor at the institute, his friend and role model, the physiologist Jacques Loeb (1859–1924), could not or would not intervene in his favour, because “powerful influences” were “determined to get” de Kruif’s “scalp”. As he wrote to de Kruif:
I should be only too glad to take steps in your behalf with the administration if I were not absolutely convinced of the
futility of such steps. It is a case where powerful influences are determined to get your scalp and I hardly need to tell
you that my advice has not been asked for and will not be asked for, and that no steps I could take would bring any result.4
de Kruif, who had been thinking about swapping his life as a researcher for one of a writer, proudly and stubbornly signed his resignation with immediate effect, rejecting an offer of advance payment.5
Previous to these events, he had explained to Jacques Loeb that if he had to choose between writing no such articles and leaving the institute, he would not hesitate to resign. This would mean the end of his scientific career and the beginning of a literary one, of which he hoped Loeb would “not be ashamed”.6
At the beginning of this envisaged literary career stood probably one of the most famous “medical novels” of the 20th century, which de Kruif wrote between the end of 1922 and 1924, together with the already popular and future Nobel laureate in literature, Sinclair Lewis (1885–1951). For the bestseller Dr. Arrowsmith, published in 1925 under Lewis’s name, de Kruif contributed crucial elements, making the history of the life of the medical student Martin Arrowsmith an important roman à clef.7
In the following text, I examine de Kruif’s views on medical research in the US, using the novel and his real experiences.
DE KRUIF, LEWIS AND ARROWSMITH
The genesis of the bestselling novel Arrowsmith and the cooperation between de Kruif and Lewis has been intensively studied.8,9,10 Earlier analyses showed that de Kruif’s influence on the development of the book should not be underestimated. de Kruif himself stated modestly in his memoirs that, of course, Sinclair Lewis had written the book. Nevertheless, he found some evidence that Lewis considered de Kruif to have been of help.11 De Kruif’s assessment was based on Sinclair Lewis’s letters to his publisher or to the reviewer Henry L Mencken (1880–1956), while working on Arrowsmith, in which he described de Kruif’s contribution to the novel as essential for the development of probably his best book (Hutchisson,8 p 56). The novel was initially to be a genuine coproduction, published under Lewis’s and de Kruif’s names. However, commercial interests resulted in its being published only under the more famous name of Sinclair Lewis. The deep friendship between the two men was shattered by conflicts over Sinclair’s apparent lack of appreciation for de Kruif’s achievement. However, de Kruif said that Lewis’s being named as the sole author was morally right; “apprentices” ought not expect to become authors.11
Sinclair Lewis and Paul de Kruif met for the first time shortly after de Kruif’s departure from the Rockefeller Institute. For de Kruif, this meeting was a definite turning away from the laboratory to writing; as he wrote a little pathetically in his memoirs, “Lewis seemed like a delegate of divine destiny planning our life”.11 Morris Fishbein (1889–1976), editor of the Journal of the American Medical Association for many years, had brought the two men together. Lewis was looking for new material to follow his big success Main street (1920) and Babbit (1922). His new book was to be a heroic novel on the Christian labour movement. He had already conducted some research when he met de Kruif. As a result of their encounter, Sinclair abandoned this original project and established the plan to write about a scientist as hero. With de Kruif’s help, Lewis intended to portray the world of American medical science in fiction. For Lewis, de Kruif offered direct access to medical research work. de Kruif also supplied Lewis with background knowledge on various philosophies of science.12,13 For the plot and characters, de Kruif provided his own experiences in medical research. In 1931, he deposited a key for characters and prototypes at the New York Academy of Medicine, requesting them to keep it under lock and key for 30 years “to avoid those unseemly obscenities that constantly arise in literary and scientific controversies”.14
The novel tells the story of the protagonist Martin Arrowsmith and his development from a medical student to a doctor and microbiologist. Lewis transferred fundamental characteristics of his own personality to the novel’s central character, but the first stages of Arrowsmith’s life seem to correspond more to those of Paul de Kruif (Richardson,10 p 227; Hutchisson,8 p 53).
The novel opens in the practice of an old, alcoholic country doctor, Doc Vickerson. Martin Arrowsmith, 14 years old, works as his assistant and is encouraged by him to study medicine. Arrowsmith starts to study at the University of Winnemac, where he meets his mentor, the bacteriologist Max Gottlieb, of German origin. Martin admires Gottlieb for his unconditional commitment to research and science and becomes his assistant, hoping to emulate him.
Martin gets engaged to a student of English, before falling in love with the nurse Leora. Dissatisfied with studying, he leaves the university, breaks off from his association with Gottlieb and hangs around aimlessly, before deciding to marry Leora. Under the pressure of his father-in-law, Martin finishes university, and subsequently enjoys his first success as an emergency physician in the town of Zenith during his internship. After his final examinations, he establishes a practice as a country doctor in Leora’s home town Wheatsylvania, where he quickly makes enemies because of hasty sanitation measures informed by his old bacteriological research ambitions.
Arrowsmith sees a new role model in the Swedish sanitation propagandist Gustav Sondelius, whom he meets on his lecture tour through the US. Sondelius takes a fancy to Martin and supplies him with a position in the town of Nautilus, where he becomes an assistant of Almus Pickerbaugh, the popular director of the department of public health. Pickerbaugh seems to be more a propagandistic salesman than a doctor, writing popular poems on preservation of health and organising sanitation weeks. When Pickerbaugh becomes senator, Arrowsmith takes up Pickerbaugh’s job; however, he quickly makes himself unpopular with the upper class of the town. He does not spend much time promoting public health, but withdraws from public life, concentrating on laboratory work. He also manages to anger the farmers by closing contaminated dairies, and as a result has to leave Nautilus.
Martin obtains a position as a pathologist at the private Rouncefield Clinic in Chicago, through the intervention of his old medical school friend Angus Duer. This clinic sells health services and is dedicated to the greed of gain rather than providing humanitarian healthcare. While Martin is dying from the monotony of his work, his old mentor Max Gottlieb comes to his rescue.
Gottlieb brings him to the McGurk Institute, a private research institute financed by the tycoon McGurk. Here, Gottlieb heads a bacteriological research department. Martin returns to the pure science that he had once practised with Gottlieb. He feels comfortable until he is pressed by the director of the institute (DeWitt Tubbs) to publish “useful” (for medical purposes) research results. Nevertheless, Martin achieves an outstanding research success with the discovery of a bacteriophage that seems to control pneumonia and plague pathogens.
When plague breaks out on a Caribbean Island, Martin is advised by Gottlieb to test the therapeutic effectiveness of his phage in a controlled clinical trial. On his voyage, Martin is accompanied by his former benefactor Sondelius and his wife Leora, who then both die from the plague: Sondelius dies because he refuses inoculation with the phage, as long as Martin inoculates only half of the islanders in the frame of his case–control study; Leora dies because she smokes a carelessly contaminated cigarette. As a result of these events, Martin terminates the study and inoculates all inhabitants of the island.
After his return, he marries the rich Joyce Lanyon, but is unable to come to terms with her lifestyle. He abandons her and their child to establish a laboratory in the wilderness together with a former colleague from the McGurk Institute, where they are able to pursue their beloved research free from institutional and social constraints.
SCIENCE IN ARROWSMITH
The real research background of Martin Arrowsmith’s research is based on a debate between microbiologists of that time about the nature of a bacteriolytic phenomenon described by d’Herelle in 1917.15–17 In addition, medical science appears in the novel on three other levels.
The life of Martin Arrowsmith—from Doc Vickerson’s assistant to general practitioner and finally to researcher at the established McGurk Institute—is an allegory about the history of the institutionalisation of medical research in the US and about the conflicts between medical practice and medical science (Rosenberg,12 p 448).
A radically reductionist research philosophy is being portrayed, personified in the character of Max Gottlieb.
In the description of the McGurk Institute, scientific work is characterised and caricatured.
These three topoi, taken up by Lewis in a masterly satirical manner, were provided by de Kruif. When Lewis and de Kruif started work on Arrowsmith, de Kruif had already written about these topics in his controversial articles in The Century Magazine,1 in Stearn’s Civilization in the United States2 and in a portrait on Jacques Loeb published in Harper’s Magazine.18 However, as de Kruif stated, his earlier versions lacked Sinclair Lewis’ authorial skills and talent.11
Arrowsmith as a reflection of American medical history
The parallelism of Arrowsmith’s life with the history of American experimental science becomes obvious in the comparison of the rise of institutionalised laboratory science with Arrowsmith’s rise to experimenter at an outstanding research institution.
In the novel, Martin Arrowsmith is born in 1883. Around this time, a drastic change, which lasted for about 30 years, occurred in the US concerning the self-image of the discipline of university medicine. Since the 1880s, medicine in America had focused on the sciences of physics and chemistry, in an effort to discard irrational, purely empirical healing concepts—older views, represented by Doc Vickerson. An example was set by the developments in Europe, particularly in Germany and France, where, since the middle of the century, mechanistic physiology and above all experimental bacteriology showed groundbreaking success in understanding processes of life, health and disease. This development was exemplified by the establishment of research laboratories, in which descriptive, morphologically oriented research was replaced by laboratory-based experiments. Physiological experimentation was virtually non-existent in the US during the 1880s; American doctors were of the opinion that laboratory science had nothing to contribute to practical medicine.19 With the exceptions of Harvard and Johns Hopkins universities, experimental medicine was hardly ever taught. As a result, only a few of the many Americans who visited European research institutions for training purposes were able to use the methods learnt abroad. A private practice with a little laboratory attached was the only outlet possible, a perspective which Arrowsmith also depicts.
Not least thanks to the travelling researchers, who transferred European methods to America, dramatic changes occurred between 1880 and 1900 in the establishment of life sciences in the US. Universities and private research institutions saw a boom in the foundation of laboratories according to the European model. Forces that encouraged this boom were conceptual and structural: practical application of scientific bacteriology for the prevention of diseases by means of sanitation was very successful, and a new class of industrialists who had come into money provided private means for the philanthropic foundation of institutes; examples are JD Rockefeller, A Carnegie or RB Mellon. There are parallels for this in the novel as well. The sanitation officer Pickerbaugh and the hygienist Sondelius put new theories into practice; the McGurk Institute, where Arrowsmith has his greatest research success, was founded by a rich industrialist.
In Arrowsmith, the struggle takes place between the reductionist, quantifying, mechanistic philosophy of science behind this development, oriented merely on experimental work, set against a holistic medical view. This conflict is the reason for Arrowsmith to abandon this kind of science after his wife’s death and by terminating the control study in favour of treating all islanders; he returns to it at the end of the book in an even more radical manner, with the laboratory in the wilderness.
The character personifying the mechanistic philosophy of science in the novel is the scientist Max Gottlieb. One of the book’s working titles was Gottlieb’s shadow (Richardson,10 p 226). An emigrated German Jew, Gottlieb was a student of Helmholtz. He symbolises the stereotype of the incorruptible, altruistic, disinterested researcher, who lives only for science. He cares nothing for money or prestige. Only his experimental work at the laboratory is important and he pursues it with great meticulousness, always aiming to gain quantifiable results. He fights every form of vitalism (the theory that vital forces are active in living organisms) and acts as a strict mechanist. His idols are “… Father Nietzsche and Father Schopenhauer (but damn him, he was teleological-minded!) and Father Koch and Father Pasteur and Brother Jacques Loeb and Brother Arrhenius” (Lewis,7 p 42). As Arrowsmith’s mentor, Gottlieb forces his protégé to take an oath on one of these prominent scientists from the reality. Before going to the Carribean Island “Martin swore by Jacques Loeb that he would observe test conditions” (Lewis,7 p 361).
In Gottlieb, the characters of de Kruif’s first scientific tutor Frederick Novy (1864–1957) and his admired role model Jacques Loeb are merged. (Robert Coard regards Conan Doyle’s Sherlock Holmes as a further element of Gottlieb.20) Although Gottlieb is endowed with the microbiology and the exploratory spirit of Novy, he shares Jacques Loeb’s antivitalistic, mechanistic philosophy and his German-Jewish origin.
Jacques Loeb, who immigrated to America in 1891, embodied the archetype of a mechanist. He also served as a model of scientific mechanism for other authors such as Theodore Dreiser (1871–1945).21 For Loeb, every form of life, all creatures were physicochemical machines; hence, his primary research objective was to explore the physics and chemistry of all life processes. His greatest research success, granting him international fame, was the discovery that by manipulating their liquid environment, sea urchin eggs could be stimulated to divide as if they had been fertilised. He called this phenomenon “artificial parthenogenesis”. Lewis referred to Loeb’s invention in Arrowsmith when he let a country doctor (Dr Coughlin) misunderstand Loeb’s experiments: “… Arrowsmith … told some Reverend that everybody ought to read this immunologist Max Gottlieb, and this Jacques Loeb—you know—the fellow that, well, I don’t recall just exactly what it was, but he claimed he could create living fishes out of chemicals” (Lewis,7 p 184). In a similarly spectacular manner, Loeb had succeeded in stimulating tubular echinoderms to regenerate organs in unnatural parts of the body, substitute one organ for another or transform one organ into another. He also developed methods for hybridising eggs of one echinoderm family with the semen of another.22–24
Public reaction to this research was often exaggerated,25 a phenomenon which the satirist Lewis took up in Arrowsmith, with a description of the public perception of Gottlieb and his research.
Professor Gottlieb was the mystery of the University. It was known that he was a Jew, born and educated in Germany, and
that his work on immunology had given him fame in the East and in Europe. He rarely left his small brown weedy house except
to return to his laboratory … A thousand fables fluttered about him. It was believed … that he had immense wealth, that he
lived as sparsely as the other professors only because he was doing terrifying and costly experiments which probably had something
to do with human sacrifice. It was said that he could create life in the laboratory, that he could talk to the monkeys which
he inoculated, that he had been driven out of Germany as a devil-worshiper or an anarchist, and that he secretly drank real
champagne every evening at dinner (Lewis,7 p 11).
Although appreciation by his research colleagues was of great importance for Jacques Loeb, he did not like the public stir about his experiments. He commented on a manuscript for a Loeb biography written by de Kruif:
When you asked my permission to write an article about me, I took it for granted that you were going to write about my scientific
work, using it, perhaps, as an example for the illustration of the fact that the establishment of quantitative relations between
different groups of phenomena is the aim of science. […] It did not occur to me that you intended to bring in personal traits,
otherwise I should have protested at the very beginning. You may know that I am very sensitive and nervous, and that I can
only keep going if any outside friction and unpleasantness is spared me. When the newspapers exploited my work on artificial
parthenogenesis, it almost finished me.26
It was in the Rockefeller Institute for Medical Research that Loeb had pursued his research since 1910 in an undisrupted manner, free from “outside friction” because public relations were managed by an administrative apparatus. For the recently dismissed de Kruif and Sinclair Lewis, this institute was satirised as the McGurk Institute.
In Arrowsmith, the McGurk Institute is initially described as a temple of science, which seems to offer optimal conditions for research. Free from economic constraints, world-famous scientists conduct their investigations in a sophisticated ambience. Equipped with excellent infrastructure and the best and latest devices, scientists work autonomously without interference and are provided with everything necessary for their research. The laboratories are linked socially by the institute’s dining hall, where inspiring conversation promotes team spirit.
The glorious picture of the temple of science starts to show flaws with the outbreak of the First World War. The institute becomes completely devoted to patriotic service, all members wear uniforms and Gottlieb’s favourite assistant is ordered to the front. Owing to his German origin, Gottlieb is reviled, avoided and increasingly isolated by the other members until the end of the war.
Not only does Arrowsmith find pure happiness in research at the McGurk Institute but he also discovers the vanities of the institute’s workers. Either they rest on old laurels as autonomous directors of separate departments doing no research at all (Rippleton Holabird modelled after Peyton Rous (1879–1970) and Rufus Cole (1872–1966)) or they are more occupied with the organisation of research and public relations than with research itself (DeWitt Tubbs modelled after Simon Flexner).14 Having to cope with constraints that go against his scientific spirit, Arrowsmith soon learns that pure, altruistic and free research is impossible there. For instance, the premature publication of unfinished results is urged upon him, which would cultivate a positive public representation of the institute. He is also compelled to participate in the institute’s routine and the meals. Meanwhile, the dining room exchange between researchers increasingly degenerates into a stage for self-admiration.
When compared with university institutions, the satire on the Rockefeller Institute with its structural and social peculiarities is obvious. Just like the fictional McGurk Institute, the Rockefeller Institute, founded in 1901, offered its members the opportunity to do fulltime research without distractions of teaching obligations or clinical work. In contrast with its European models, it was not grouped around a single outstanding person such as Pasteur, Koch or Ehrlich, but consisted of various, completely autonomous departments that were managed by outstanding scientists. The director of the institute, Simon Flexner, was the administrative head, but the departments were scientifically self-sufficient. The heads of department were hand-picked scientists, selected with regard to only their prior achievements and interests. The central focus of this selection was the institute’s task: medical research. However, this was not defined in a limited manner by certain diseases but applied in a broader manner on all life processes. This led to a broad scientific basis of the institute, oriented on fundamental issues of physiology.3,27,28 The heads of department made the decisions about the direction and organisation of their department, leading to different assessment of hierarchies at the Rockefeller Institute. For Loeb and Flexner, who were oriented on the German system, it was crucial to have staff at their laboratories work closely on their own topics, whereas in other departments assistants were allowed more freedom. As the director, Flexner took care that reports and research results were published regularly to enhance the institute’s prestige, which sometimes led to the accusation that scientists at the Rockefeller Institute would rashly publish unready results (Corner,3 p 158).
The central point of integration of all departments and researchers was the institute’s dining hall as the place of social and scientific interaction. For Flexner, it was crucial that members of the institute met there regularly. Furthermore, the institute hosted a weekly conference with lectures by staff or guests on current topics. This atmosphere was intended to promote cooperation between departments (Hollingsworth,28 p 31). For example, de Kruif as an employee at Flexner’s laboratory published several articles on agglutination of bacteria together with John H Northrop from Jacques Loeb’s laboratory.
For insiders, the parallels between the research routine at the McGurk Institute and at the real Rockefeller Institute must have been obvious.
The picture of medical research painted in Arrowsmith is characterised by two crucial conflicts. On the one hand, practical medicine and scientific research are opposed as incommensurable. The acting protagonists can be only scientists or doctors. Martin Arrowsmith’s repeated attempts to combine the two fail because, as a scientist, he must think in a mechanistic, quantifying and reductionist manner, whereas as a doctor, he has to include holistic and vitalistic elements into his treatment concepts. For doctors, science must be related to application; whereas for the scientist, pure research is the more important objective. 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.11 Lewis and de Kruif convey this point of view into their novel via Max Gottlieb’s opinions and Arrowsmith’s actions.
On the other hand, in the research routine of the McGurk Institute, the individual scientific genius of the research organisation is contrasted with team work and division of labour. In his literary works, de Kruif displays the opinion that only individual genius will lead to success. In his view, despite its nominal success, the Rockefeller Institute as an institution did not have the same effect on medical progress as would individual geniuses working alone. The vanities of the researchers assembled at the Rockefeller Institute, caricatured in a masterly manner in Lewis’s work, would hinder the development of the respective genius. For de Kruif, Jacques Loeb was such a genius, and he became the novel’s Gottlieb. He placed Loeb on a plane with Diderot, Pasteur, Faraday and others.18 In a letter to Loeb he wrote:
Finally, my most sincere thanks and gratitude for the priceless inspiration you have been to me, and for the interest you
have taken in me. […] There is Beethoven, and Rembrandt, and Da Vinci, and you. No one can take the guiding light of these
torches from me.5
At the same time, he recognised Loeb’s tragedy “in his comparative loneliness in science”. One of the reasons for this isolation lay in Loeb’s attempt to fight the romantic folklore of the biologists with simple explanations based on physical laws.18
Loeb shared de Kruif’s views to some extent. For example, after de Kruif’s dismissal, Loeb feared to enter into the maelstrom; his colleagues who so disliked him thought him capable of a Socratic coauthorship of de Kruif’s critical thoughts. Loeb wrote to de Kruif:
As it is, they almost seem to hold me responsible for your articles, and if in addition you were to write about my work
during the next year, it would convince them that I am responsible for all that “deviltry” and it would make my position here
unpleasant if not impossible. For this reason I hope you will understand if I beg you not to write anything about my work
for at least a year.29
However, unlike de Kruif, Loeb made the compromise of integrating into the system to be able to do his research—a compromise that he also suggested de Kruif to make. Commenting on de Kruif’s criticism against the spirit of the medical system in the US, Loeb recommended:
If you could point out the good intentions in a number of these men (and, perhaps, I might say even men like Barker believe
that they are helping in the cause of medicine by working towards a more complete diagnosis); I mean, if you could give them
credit for their good intentions, your article would not hurt their feelings to the same amount. I mention this since it might
help you in straightening out the situation with the administration, because I do not want you to be lost to science.26
The stubborn de Kruif did not take Loeb’s advice. He even seemed to look forward to the argument with Flexner preceding his dismissal. He wrote to Loeb: “Flexner has refused to say whether or not I shall be fired. […] If he gives me an interview, it will be good fun. I shall at least have the satisfaction of showing him that he deals with a Dutchman, and not a worm.”30 Loeb, on the contrary, showed more willingness to cooperate. When Flexner asked him for a research report, Loeb submitted it, albeit belatedly, with the remark: “The delay was due to the fact that I had to overcome a good deal of internal resistance”. Consequently, Flexner was conciliatory. He deemed the report excellent and wrote: “I sympathize with you and do not want to ask you to do it again.”31,32
Finally, the question arises of how contemporaries reacted to the description of science in Arrowsmith and whether they shared de Kruif’s opinion of the system that he left. It can be said that Arrowsmith caused exactly the level of excitement depicted in the novel. The conflicts dealt between medicine as a science and as practice, as well as the conflicts within the scientific routine, are reflected in the reviews. For example, HL Mencken was enthusiastic about the description of medicine and research in the novel, whereas the doctor Haven Emerson accused the authors of giving an unrealistic and exaggerated picture.33,34Arrowsmith hit a nerve that de Kruif had already irritated with his series in The Century Magazine. With his cooperation on the novel, de Kruif fulfilled his dream to write, and realised his prophecy of giving “certain vested and pompous interests an occasional moment of mild discomfort” as he put it in a letter to Loeb.6 Fierce reactions and speculations about the caricatured people accompanied the novel’s reception for many years.
These reactions had several sources. The two “biopics” of Paul de Kruif and Jaques Loeb and the characterisation of institutional science described above are just a few of the many features tackled by the novel. In its day, the novel was influential and inspirational for various reasons. For example, the scientific background story was so close to the contemporary research front of immunology that the historian of medicine William Summers considered the choice of science as a topic for the novel to be
… especially advantageous. First, it was fresh material and had not been used in fiction before. Second, as in science fiction,
readers would not have other related knowledge against which to ‘check the facts’ stated in the novel, and third, the reader
could indeed believe that Martin Arrowsmith had discovered something new (Summers,16 p 331).
In addition, Lewis’s Arrowsmith—like his novels Babbit and Dodsworth—considered potent anxieties pervasive among its targeted readers, which was one of the keys to the novel’s success. Michael Augspurger could show that the emotional, romantic and unpragmatic response Lewis gives to the dangers of “commercialism, bureaucracy, and comfortable bourgeois social life” (Augspurger,35 p 75) especially appealed to the professional managerial class of the 20th century, who believed these dangers threatened their opportunity to have an important role in reforming the US.
The novel, in its concern with public health issues, medical education and the conflict between medical science and medical practice, seems remarkably prescient of some current dilemmas. Since 1945, it has been cited again and again as a classic, but still valid novel work. The Science Citation Index and the Arts and Humanities Index (http://isiknowledge.com/wos) list 145 citations of Lewis’s Arrowsmith (either as a citation or in the title or abstract of the articles). Most of the journals quoting Arrowsmith are medical journals. The years with the highest share of quotations are 1985, 1996 and 2000 (10, 9 and 8 citations, respectively). These data may underline the novel’s topicality: medical students all over the Western world complain that their education is far from their medical practice. Our public health systems seem to be corrupted by a lack of money, leading to a need for resource allocation not always agreed with by doctors. Doctors themselves feel overworked and frustrated, lacking positive feedback from their patients.36 It has become a balancing act for medical doctors to be clinicians and scientists.37,38 Finally, in the view of many doctors, “scientific idealism” seems to have been replaced by conflicts of interest. Howard Markel trenchantly put it as follows:
As the ties between medical scientists and the biotechnology industry become increasingly intertwined, the doctor in me
wishes he could prescribe a page or two of Arrowsmith each day to his more profit-driven colleagues. (Markel,39 p 375)
Markel’s wish is a reminder that many of the issues causing dissatisfaction among doctors with their present situation have already been taken up presciently in a satirical manner in Lewis’s book. Thus, current medical romans á clef, such as Samuel Shem’s House of God, Mount Misery or Karl Köhler’s Gumpelmann, are in the cynical tradition established by de Kruif and Lewis, touching traditional issues of being a doctor and being a scientist in a modernised setting.
I thank Professor Jacalyn Duffin and Andrea Bojarra, MA, for their help in preparing the manuscript. I also thank Professor Irmgard Müller and two anonymous reviewers for their helpful comments on the manuscript.