Arrowsmith: Sinclair Lewis and the Transformation of Twentieth-Century Medicine

At the turn of the last Century, medicine was undergoing a dramatic change from isolated physician practitioners to a centralized model of institutional health care delivery and research. In 1925 Sinclair Lewis published the novel Arrowsmith as a cautionary tale against this change.  Although Lewis believed in the research and the advancement of medicine, he believed that American research required more personal integrity than was possible with the corrupting powers of large institutions. This novel is a detailed commentary on the loss of individualism in medicine, and the impact of this change on individuals in medicine when their practices are replaced by the centralization and bureaucratization that led to the transformation of the functions of the hospital, medical training, and research.

Lewis was interested in recording and analyzing how American society affects the creative spirit (Griffin 34), and is as pertinent to us almost a century later as it was at the time Arrowsmith was published. The central questions of the novel are whether fame and money is enough compensation for family life, and whether the value of individualism is enough compensation for its hardships. With the changes occurring in medicine at the time the novel was published, these questions were framed by the stresses that were being placed on physicians for the first time.

In the novel, the character development of Martin Arrowsmith as a physician is used to convey Lewis' distaste for non- traditional medicine. Arrowsmith leaves his small Midwest town to practice medicine in the city, but realizing his mistake, returns to rural America, where he can conduct ethical research on his own. The novel spans Martin Arrowsmith's life, from his first marriage, his rural medical practice in Wheatsylvania, to his move to the city to become involved in the commercial and fraudulent research at McGurk Institute. Arrowsmith becomes completely absorbed in the politics of institutional research and his own success until his neglected wife accidentally dies from a cigarette he had carelessly contaminated from his laboratory. Depressed, Arrowsmith begins to understand that McGurk used his intelligence, not for the advancement of drugs, but for the company's financial benefit. Almost immediately after quitting McGurk and returning to the country, he resumes his research career, but this time however, focusing on a cure for the disease that killed his wife. Because this research had pure motives, it was research performed "by applying his intellectual powers wisely, honestly, and selflessly" (Furst 171). Arrowsmith is content with his personal research and realizes that wealth was not worth the sacrifice of his principles.

While the previous generation explored the frontier, Martin Arrowsmith is a journey of self-realization. Arrowsmith begins with his great-grandmother's exclamation, "we're going on jus' as long as we can. Going West! They's a whole lot of new things I aim to be seeing!" (Griffin 69). Arrowsmith, like his relatives before him, continues the American pioneer spirit in the discovery of unknown ground. In the novel, Lewis drew on the experiences of his physician father, older brother, grandfather, and uncle to describe Martin Arrowsmith's medical education, contrasting it with the more rigorous curriculum which was being implemented in medical schools at the time.

At the turn of the last century, medical schools became lecture-oriented, including such classes as biochemistry and physiology in the curriculum. Both research and teaching were emphasized, although full-time researchers still taught traditional medical sciences. Formal medical specialization in the United States also was developed by the American College of Surgeons in 1913. Although the College assessed each of its applicants with a comprehensive examination, there was still no obligation for hospitals or patients to employ certified surgeons. It was not until the Carnegie Foundation underwrote a hospital regulation system that specialty certification had widespread validity. Hospitals also became more numerous and bureaucratic. During the early twentieth-century, the number of hospitals across America increased, implemented standards of care, and updated technologies used for diagnosis and treatment. Arrowsmith is a historical documentation of these developments in American medicine. Lewis meticulously researched the medical profession, such as the material Martin Arrowsmith's professors presented in their lectures, and consequently the details in the novel lend accuracy to Lewis' argument (Markel 372).

In addition to the development of medical education, the change in how medical research was performed is an important theme in Arrowsmith. The McGurk Institute, where Martin Arrowsmith takes a research job, is a fictionalized version of the Rockefeller Institute, one of the most important medical research facilities in the United States at the time. However, these organizations arose so rapidly in the early 20^th Century that by 1930 there were forty medical foundations worldwide (Bynum et al. 305). Many young students were offered one-year scholarships in exchange for their research on diseases in the hospital and in the laboratory. Universities, such as Cornell, Yale, Harvard, and Johns Hopkins also established their importance as centers for medical research.

One of the former physicians at the Rockefeller Institute, George Canby Robinson, was an advocate of medical "holism," and later became the dean of Vanderbilt University. Robinson's holistic ideas were intertwined throughout Arrowsmith and early-modern medicine. Having an understanding of the whole patient was the motivating force behind "holism," which was particularly attractive to Lewis. This practice seemed to effectively combine the personal emphasis of solo physicians with the advances of modern medicine. This belief is represented by Martin Arrowsmith leaving the city to establish his own research center in the countryside of Vermont, where he could combine its efforts with the personal care of the individual physician.

Lewis' writing resonated with the public, and he received a Pullitzer Prize for Arrowsmith, which he turned down. Later, he was awarded a Nobel Prize for his work that analyzed culture in America, which he called "the most contradictory, the most depressing, the most stirring, of any land in the world today" (Nobelstiftelsen 282). The theme of individuality and success, as well as the bureaucratic and sometimes corrupt realm of medical research, still has meaning for us today.

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