Martha Keys Memorial Lecture

THE MARTHA KEYS MEMORIAL LECTURE ON SCIENCE AND THE ARTS
Albany Medical College
November 20, 1996

When Henry Keys invited me to present the Martha Keys Lecture, I immediately wanted to do it, mainly because I knew and admired Martha Keys, and also because the theme of the series, science and the arts, was challenging yet flexible.

The theme of the Martha Keys lecture series is the relation of science and the arts, a theme that embraces the artistic life and creative expression of Martha Keys as well as the scientific medicine pursued by others of her her distinguished family. I may be the first of the Keys lecturers who knew Martha, and so would like to say a word about her as we celebrate her life and art here today.

The family home of Ancel and Margaret Keys, Carrie, Henry, and Martha, on Lake Owasso in Minnesota, was the heartbeat for a pulse felt ‘round the world. From the 1940s, Ancel Keys carried out researches on the causes and prevention of heart diseases and started a new field, cardiovascular disease epidemiology. The field was developed by physiologists and physicians who became epidemiologists in order to explore heart disease outside the clinic, the metabolism and behaviors of individuals, and the mass phenomena that influence risk of heart attack and stroke in the whole population.

These ideas about population differences were developed by Keys and colleagues into a far-flung enterprise to test hypotheses about lifestyle, the Seven Countries Study, with laboratory work going on in Minnesota and field investigations in many countries, studies that are still going on today. Its findings on the importance of diet and other risk factors led, along with those of other laboratory, clinical and population studies, to a newer public health of the prevention of heart attacks. These ideas have been extrapolated to the promotion of health and the prevention of high risk in the first place.

Young Martha Keys and her brother and sister, Henry and Carrie, were at the center of all this activity, travelling abroad with their parents in the field work, living at the social kernel that nurtured the intellectual bloom of these efforts in Memorial Stadium at the University of Minnesota and beyond. Martha, when I knew her then, was a charming and colorful part of this burgeoning activity in the 50s; utterly confident, direct and comfortable, but correct, whether curtsying elegantly before the tall somber physician to the Swedish royal family, or receiving the homage of a Japanese professor doing his best to bow lower than her diminutive height. Martha, as a youth in these social-professional scenes, was always an individual to be reckoned with, a naturally curious but courteous companion, a warm and gracious host who effectively complemented her parents’ role.

I recall one characteristic gesture of Martha from many years ago in a musical disaster that I and Gunnar Blomqvist, another post-doctoral fellow, perpetrated on a holiday gathering in the Keys’s home. Following a sumptuous dinner, we attempted to perform a clarinet duet as part of the late evening entertainment. But in the afterglow of that meal and its bountiful wines, all musical precision was dissolved. We labored interminably through three movements, our parts rarely close together and often whole measures apart! The agony finally over, Martha, perhaps age twelve at the time, came up to us and said brightly, thus saving the evening for me: “That should be quite nice after you’ve practiced a bit.”

Martha integrated in her life an artistic sensitivity and a personal creative expression in a natural way that few of us achieve. Her family also live artfully, devoted to science and its fruits. When one sees such examples of art and science joined in a life, or in a family, dualisms dissolve and a creative harmony emerges.

MUSIC OF THE SPHERES

“Music steals its way into the secret places of the soul.” Plato.

Our tentative this afternoon is to look at how science and medicine, and music and the arts, developed in common and still mingle strongly in our lives, and how creativity and discipline apply to both. This will be very much a work-in-progress.

Let us start with the familiar adage: “My, so many of you doctors are musical!”

Peter Medawar, the molecular biologist and Nobelist, said the following about the many kinds of scientists: “Scientists are people of very dissimilar temperaments doing different things in very different ways. Among scientists are collectors, classifiers, and compulsive tidiers-up; many are detectives by temperament, many are explorers; some are artists and others artisans. There are poet scientists [musician scientists] and philosopher scientists, and even a few mystics. What sort of mind or temperament can all these people be supposed to have in common?”

He closes, “Obligative scientists must be very rare, and most people who are in fact scientists, could easily have been something else instead.”

So the possibilties are left open, but we don’t get very far with Sir Peter in our quest for any special relation of scientific medicine and music.

Of course, there are broad similarities between science and music: similarities of form and method, of order and repetition, of skill and training, of awful tedium and great bounds of joyous creativity. Perhaps we should talk of parallels rather than similarities. Science and medicine, music and art, proceed by parallel processes of logic and deduction, observation and induction, and certainly by peer review. And they also proceed by leaps of progress, usually in the hands of an individual genius such as a Newton and Einstein, a Medawar or Watson, or a Bach or Beethoven, a Louis Armstrong or Sidney Bechet, and yes, a Charlie Parker or Thelonious Monk.

Once upon a time, art and science were very close, as in ancient Greece and “the music of the spheres.” Apollo, of course, was the god of medicine, of music, and of poetry. But along came mind-body dualism, specialization, and the fragmentations of modern life that have separated the spheres of science and the arts.

My theme today is that after 2500 years of Western scientific thinking and the arts, we still need both. The acts of making art and doing science do not just complement each other, they intertwine. For the Greeks, as we shall see, scientific truth made itself obvious by its beauty; while artistry provided individual beautiful instances within which to recognize truths. My sources for these ideas, beyond my own experience, include especially the remarkable book Measure for Measure, by Tom Levenson.

Science behaves like other arts but is not identical to them: modern science puts its results to the test. But if we consider science as a form of art, we see that it is not so much about nature outside as it is about ourselves, and about making sense of the human condition. “Science can help us come to terms with our existence, to understand, and not just simply command [or control] our circumstances.” (Levenson)

Even the most abstract science remains a human passion. “This is where science is closest kin to the arts.”

THE PREHISTORIC ORIGINS OF MUSIC AND SCIENCE

I have been engaged for some years in a hobby about the origins of modern mass diseases. It is a hobby because it involves much teleological reasoning and relatively little opportunity for hypothesis testing, but it is an intriguing way of looking at modern behaviors and risks. The assumptions of evolutionary medicine go something like this:

All forebears of modern humans were hunter-gatherers (H-G). Thus, characteristics favoring survival in H-G subsistence cultures were central to the fundamental adaptations of human evolution. The recent epidemiological transitions leading first to agriculture, then to sedentary communities, civilization, and eventually to industrialization, occurred far more rapidly (in a mere 500 or so generations) than major physical adaptations can occur. It follows that modern humans remain hunter-gatherers metabolically. Discordance between modern lifestyle and this evolutionary legacy places serious stress on these adaptations, leading in affluent societies, to widespread maladaptations: elevation of risk characteristics, obesity, high blood cholesterol and insulin activity, high blood pressure and thrombogenesis.

A general theory based on this view states that: mass modern diseases result from interactions between the evolutionarily determined species susceptibility and powerful cultural influences on behavior. A corollary follows that unfavorable environments encourage maximal exhibition of high-risk phenotypes. Conversely, favorable population exposures assure minimal expression of the phenotype.

I would like to be able to develop an analogous theory that assumes an evolutionary legacy of survival traits among sound, speech and story-telling, rhythm, music, and the dance. How are these fundamental adaptive patterns in our heritage, if so they are, influenced by the dissonance and excess of today’s noisy bombardments, or by our greatly reduced participation in regular celebrations involving song, music, and dance? We quickly run into a paucity of data.

We learn from, “A Million Years of Man,” by Richard Carrington, New American Library, that [adapted] “the upper paleolithic period is divided into five cultural phases … distinguished by evidence found at various levels in Europe and the Middle East. The late paleolithic period beginning about 20,000 years ago is called the Magdalenian, where the explosion of mind was greatest. There is the first clear evidence of a flowering of creative energy with an aesthetic and with religious elements as they are understood today. The artistic sense of the Magdalenians is expressed in many other forms [than the famous cave paintings of southern France]. Engravings on implements of bone, ivory, and horn are of a much higher standard than those of the Gravettians, as well as work on pebbles, rock fragments, and lumps of amber and ocher which may have been used as charms. [The Magdalenians] “must also have had a musical sense, for pipes and whistles of bone have been found in the caves. We cannot, of course, deduce from such evidence any of the special character of Magdalenian music, but these primitive instruments were probably used to accompany ritual chants and also, we may hope, the joyful sing-songs which followed a successful hunt.”

“Art, like science, may have had utilitarian beginnings, but as evolution proceeded, its purely material function has been transcended and the work of art itself has become the key to a new level of awareness. Originating in the rhythmic sounds made by primitive peoples, either as signals or accompaniments, it [music] grew progressively more abstract, until it became a most subtle and flexible means of expressing the composer’s vision of the universe. Far more exactly than words, music can provide a commentary on man’s metaphysical awareness of his environment, and in its highest forms may offer an illumination of the world much more valid and direct than any offered by formalized religion. But, like visual art, it also often retains functions it possessed at an earlier stage of evolution; for instance, man [today] enjoys dancing to music as much as [did] his primitive ancestors….” (Carrington)

There is no lack of theories about the origins of music. “Charles Darwin attributed song to the imitation of animal cries in the mating season. Rousseau, Herder, and Spencer argued that speaking with a raised voice was the beginning of song. A kind of ‘speech-song,’ or chant-like recitative, is … found in many primitive cultures. It is …. possible that the whole [of] language is merely a levelled-down music; but it is more likely that sound-language is the older element from which developed both speech and song, speech driving toward the free rhythm and music towards the more regulated one.” (Carrington)

In the known primitive cultures, speaking, shouting, imitation of animals, and the rhythms of movement, all tend to musical forms. Anthroplogists suggest that, “music has a unifying effect in human society. Melody liberates and gives objective form to amorphous …. feelings. Singing enables things to be said or hinted at which would be difficult to express in formal speech. An idea set to music is more …. general, or more ambiguous than the same idea expressed in words alone, subject as it is to a regular rhythm.” (Carrington) In language, something of the same kind occurs in proverbs, which probably for the same reason are still popular with primitive peoples.

The evolutionary view of the importance of music is strengthened by observations among native American tribes where: “Song and dance accompany all the events [of the tribe] and they are an essential part of the culture of the people. Although there are expert performers, everyone is obliged to take part in the singing and the dancing so that the separation between performer and audience that we find in modern society does not occur in more primitive society…. .” (Franz Boas).

According to Schoolcroft, writing in the mid 1800s, “dancing is both an amusement and a religious observance among the American Indians and is known to constitute one of the most widespread traits in their manners and customs. It is accompanied in all cases with singing and, omitting a few cases, with the beating of time on instruments. It is believed to be the ordinary mode of expressing intense passion or feeling on any subject, and it is a custom which has been preserved with the least variation through all the phases of their history and probably exists among remote tribes precisely at this time as in the era of Columbus.” (Schoolcroft)

Finally, from Music Through the Centuries by Leslie Violette: “In the beginning was rhythm. Many common occupations, sowing, digging, or paddling can be made more effective, more agreeable with the accompaniment of song. Music and dance are rarely separated among primitive people.”

Even in the limited experience of my lifetime, growing up in the south, there was once a greater reliance than now on live music as a part of daily life. It was the essence of picnics, fish-fries, church socials, teas, dances, and balls. These were less frequent but more intensive personal experiences than the contrived mass exposures of today, Muzak, Pop, Rock, and Rap.

At any rate, I suggest that it seems likely we are as fine-tuned by evolution to shout, sing, and dance as we are to run, eat berries, and procreate. Few of us would return voluntarily to a primitive subsistence culture, but understanding our evolutionary adaptations may provide a guide to more healthy behavior and more integrated lives.

WHEN MUSIC AND SCIENCE WERE ONE

Music and science have been intertwined in western thinking from the time of their shared origins. In fact, the oldest mathematically expressed law of nature is that of the direct relationship between the pitch of a note and the length of a string or pipe that produces it. The Western musical scale is descended directly from the holy arithmetic of Pythagoras, the 6th century Greek who recognized the profound connection between numbers, mathematics, and sound. At their beginnings, then, music and science were one.

The legendary story is told by Nichomacus (NIK KOM’ IKUS): “Once upon a time, by miraculous chance, Pythagoras walked by a smithy and heard the hammers beating out iron on the anvil and giving off sounds most harmonious in combinations with one another. Delighted, therefore, since it was as if his purpose was being achieved by a god, he ran in to the smithy and found by various experiments that the difference of sound was consistent with the weight of the hammers. Such that gave the consonance of an octave were found to weigh in the ratio of 2 to 1. He took the one that was double the other and found its weight 4/3 the weight of the hammer which gave the consonance of a musical fourth.. The same hammer was 3 halves the weight of a hammer which rang a fifth.” (from Levenson) He went back home, it is said, and tied comparable weights to strings and plucked them to produce the harmonics discovered earlier.

Could this legend be true?

It was surely apochryphal. Hammers of different weight striking the same anvil give off the same tone at different loudness. The bell, not the clapper, sounds the note. Pythagoras was, nevertheless, a real person, and he used a monochord, a device like a guitar with a string strung against a body, the string divided into two lengths variable by a movable bridge, and with this scientific musical instrument he investigated the musical ratios producing the octave, and the natural harmonics of the fourth and the fifth.

The fundamental arithmetic of the musical scale was built up, therefore, of the relations between the numbers 1, 2, 3, and 4, illustrated in this Pythagorean mystical pyramid of the 6th century BC:

•
• •
• • •
• • • •

“The Pythagoreans were not scientists; they sought magic in numbers. But still, here is where science begins.” “Three thousand years separate us from the extraordinary sense of revelation Pythagoras must have felt at the moment he recognized what he was hearing. For the first time, ephemeral evidence of the senses could be accounted for by an idea that would hold true for anyone at anytime.” In their enthusiasm, they deduced a universe. They postulated that “the planets moving through the heavens gave off sounds, ‘the music of the spheres’ which exemplified the perfect organization of nature on the largest scale.” (Levenson)

Tradition has it that only the master, Pythagoras himself, could actually hear that perfect harmony. But a musical cosmology developed in which God’s hand stretched the monochord’s string as it passed through two octaves, from high G up among the angels, to the Sun at middle G, down past Venus, Mercury, and the moon, then through the elements of fire, air, and water, down to the resonant G of Earth on the bottom. God turned the tuning peg.

They believed that all the world rings to the same music. The first six in the series of natural overtones produce the octave, fifth, fourth, and third. The second series creates the five-note pentatonic scale that can be heard by playing just the black keys on the piano. “The perfect fifths divide the perfect octave and create the scale of twelve notes that still forms the scaffolding for all Western music.” (Levenson )

I once met Bongo Joe in New Orleans. A black folk musician from San Antonio, he was taught by his grandmother never to touch the white notes as he improvised on the piano. In fact, many gospels and folk ballads use this pentatonic scale. But imagine trying to jam with him in a New Orleans bistro with my playing a B flat instrument, in a scale made up of C-sharp, G-sharp, F-sharp, A-sharp, C-sharp, and D-sharp!

THE PIPE ORGAN

Science and music continued their common development, as one entity, with invention of the pipe organ in the second century BC by Ktesibios (TES SI’BIOS) of Alexandria, an engineer who studied hydraulics and pneumatics. In the course of building a cistern, he noted the sounds produced by air leaving the exit pipe as water flowed into the closed tank. As decoration, he installed a toy whistle in a figurine of a bird at the extremity of the pipe, creating a bird song. To this first feeble pipe organ (Aristotle had probably built a similar toy earlier) he subsequently added a pump to supply air, a reservoir or wind chest to distribute the air properly, and a manual to control pipes that would sound or not. Ktesibios used the double-barrelled cylinder pump he had developed to help fight fires, and with it produced a continuous source of air compressed to a relatively constant pressure. The rest was lagniappe: regulators, sliders to block sounds, a spring keyboard, and variable pitched pipes. The first organ, called a hydraulis is the core of the organ that remains unchanged over two millennia.

Thus, early science and engineering, with recognition that air was compressible and water not, was intimately tied in with music and all its aspects of inspiration and power. Ktesibios and his followers went on, in what some consider the last flowering of Greek science, to develop a theory of gases, including an experiment of burning gases similar to that Lavoisier was to use two thousand years later to demonstrate the combustion of oxygen.

The first use of the pipe organ was secular, as described by Athenaeus in the second centry BC on the occcasion of a Roman feast: “The sound of the hydraulis was….so pleasant and charming ..that we all turned toward the sound, fascinated by the harmony.” (Levenson)

In this way, the pipe organ, then a new musical technology, was inspired by the study of physical questions. It was reasoning applied to the understanding of nature. With the organ, the connection between abstract mathematics and the natural world was made. It is one of few remnants of Greek scientific thought, all of which was to disappear with the Goths taking Rome in 410 AD, until the 12th century when Western man relearned from the Arabs what the Greeks had contributed, as well as from discoveries of China, India and Persia.

There followed a long period when the pipe organ became a symbol of advanced civilization. For example, it was borrowed from Byzantium by the barbarian court of Louis, son of Charlemagne, in 800 AD, as a display of power through technological mastery. It appeared that to possess an organ was to possess civilization.

Then came another long period in which science and music were unpopular with the Church. But music and the organ became a tool of the Church, a symbol of harmony between God and Man, in the eleventh century when it was brought into celebration of the Holy Mass. The organ dates then to the era “when a very small community of men created the first glimmerings of the notion that all of nature might be encompassed by a single theory” (Levenson) — a notion still entertained by a few such people as Steven Hawkings.

CHURCH MUSIC AND THE SCIENTIFIC REVOLUTION

Pope Gregory sought to replace the cosmology of Pythagoras with that of the Church. He elevated choral music to the worship service and in the sixth century AD systematically reorganized and codified the entire schola cantorum.. His powerful, simple Gregorian chants evolved over the next centuries to a new major discipline of the church’s scientific quadrivium; arithmetic, geometry, and astronomy were now united by the science of music. Music became a principal tool of the Church, and was “seen to express essential characteristics of the human experience in truths that could be easily understood by all.” “The melodies heard at every service fixed listeners with the order of nature and of human affairs as God had designed it for the faithful.” (Levenson)

Thenceforth, the Church, specifically a priest, Guido d’Arezzo, around 1050 AD, led in the development of musical notation in a four-line staff. In the most important transition, he added notes above and below the staff, vertical arrangements of sound that gave harmonies. This Medieval Polyphony, poly-phonics, is the musical science which is still essential — to Beethoven and the blues alike. In rapid order there followed notation of the duration of notes, tempo, and rhythm. In late medieval life music became “a kind of {scientific] laboratory within which to examine and sound [out] the operation of laws that govern not just music, but all of creation.”

This explosion of musical ideas was part of a transformation of what scientists thought and did. From demonstrating eternal truths, music, the science, became a tool of discovery and innovation. The new music (read, new science) produced new sounds, new facts, and new experiences not accounted for by old ideas. Thus, music became integral to the scientific revolution and the Renaissance.

THE RENAISSANCE

Galileo was raised at the interface of music and science and may have got his passion for experiment from his father Vincenzio, a noted musician who used acoustical experiments to test music theory. Galileo, with the microscope and telescope, “severed the medieval link between the evidence of science and the testimony of faith,” (Levenson) gaining access to truth independent of revelation — forbidden fruit — for which he suffered much.

Newton pursued the science of music throughout his career, actually developing an in-tune, 53-note octave, but he used a simpler scheme to line up the seven colors of light with the 7 musical notes A,B,C,D,E,F,G, with red sounding the low note, and purple the top of the scale. He, too, pondered the universal problem of tempering the scale, but we’ll not address today the distortions in the scale necessary to tune the octave perfectly, nor will we consider the brilliant scientific achievement of Bach’s “well-tempered klavier” and other devices. Newton felt, however, that harmonic theory worked well enough to indicate that the true connection between sound and light was simply waiting to be discovered.

Newton remained the optimist, that all nature’s rules would one day be known as thoroughly as his law of gravitation. He maintained that: “Whatever reasoning holds for great motions …. should hold for lesser ones as well.” Newton played with color, music, and the arcane, serious business of alchemy. But his analysis of nature expressed in mathematical relationships, his laws of motion and gravitation, completed the scientific revolution.

Keppler compared the speed of each planet at the point nearest the sun, when planets move the fastest, with their velocity farthest away. With the ratio of the two speeds he turned, as had Pythagoras and Newton, to the science of music and constructed planetary musical intervals. Mars covered a perfect fifth with the ratio 3 to 2, while Saturn sounded out a perfect third. Each planet produced its own song. Together, the Solar System generated the “glorious, interwoven sound” that for him confirmed the truth of his system.

Keppler’s musical astronomy does, in fact, work. The set of planetary tones fits remarkably well into an octave. (Yale professors Ruff and Rodgers, some years ago recorded the planet’s songs on electronic instruments and brought them up to audible range. I’m sorry not to have here their record of “The Music of the Spheres”).

Keppler’s heavenly music provided for him the link between his mind and God’s; his science was driven by the belief that such links existed throughout nature, that the patterns he expressed as harmony, as music, did exist in the real world. Hence, Keppler’s ecstasy at the celestial music heard in his mind’s eye. It was for him a revelation. His belief in the existence of such patterns of nature created what remains today as an esthetic of science; “when he recognized a given order, it appeared to him beautiful.” The very beauty and elegance of his invention served to reinforce his commitment that nature forms orderly patterns. Keppler is said to have restored to science the reward of intuition, insight; the sudden glimpse of harmony that Newton’s apparent rigor had seemed to eliminate. But Newton emphasized the same esthetic, saying: “It is the perfection of all God’s works that they are done with the greatest simplicity.”

This is the idea that made modern science possible, that any natural phenomenon can be understood within a framework of abstract, universal, and simple laws.

In the eighteenth century, Bach achieved his astounding marriage of precision and passion. Many find that Bach’s Great Fugue matches Newton’s mathematical arguments in its logic and formal elegance. The common evolution of science and music continued with Poincaré who wrote, “It is only through science and art that civilization is of value.”

“Science is something that human beings have always done to help them make sense of the world. Art in its own way aims at the same end. Art and science don’t just track the same quarry; they form between them a common endeavor, each presenting one face of the same impulse.” (Levenson)

MODERN SCIENCE AND MUSIC

We come with some concern now to the recent vast progress of science and technology and their extensive interaction with music today. This might be said to have started with the electric theremin of the 20s, when music was composed by waving ones arms in an electric field; then the electric guitar of the 40s, the digital synthesizers of the 70s, and the current consonance of synthesizer, sampler, and MIDI, the Musical Instrument Digital Interface that allows infinite representations of sound and music. The beautiful analog wave that we hear from an acoustic instrument (trumpet demonstration) quickly decays to nothing. Nowadays it can be frozen, digitized, in a transformable and permanently resurrectible state. And Informatics allows us to compute 211,000 bits of information in Beethoven’s fourth piano concerto, compared to 70,000 in all of Hamlet’s speeches. And now, Yo Yo Ma performs the modern composition Born Again Again on his electronic hypercello fed into a vast synthesizer, shocking the devout to the core in that great cathedral of music, the Amsterdam Concertgebouw.

WHERE MEDICINE AND MUSIC MEET: IN CREATIVITY

Having done with their common origins and evolution, I am basing the rest of our short time together on the idea that science and art, medicine and music, come together most naturally at the point of manifest creativity.

A remarkable assemblage was brought together a few years ago of some of the most creative folks to talk about creativity in science and medicine: John Eccles, Manfred Eigen, Hans Krebs, Jacques Monod, Desmond Morris, Karl Popper and others. I have put together some of their thoughts and present them here without attribution:

“In their less guarded moments, many scientists will call a theory or even a …set of conclusions eloquent or beautiful. These words reflect, of course, the infinity shared between scientific and artistic activity in the wish to create order. It is also strong in those who apply science or an artistic skill to construct tangible things, utilitarian constructions such as a bridge or artistic ones such as a musical composition. And I cannot see more than a difference of degree between these highly sophisticated activities.”

Scientific creativity starts with an assumption based on a hypothesis that can be tested. The assumption preceeds the empirical observation or experiment. The scientist, like the artist, achieves a form of internal representation or simulation of the phenomenon and its sources. The next stage is to verbalize or symbolize this simulation. The last state is the mathematical or logical term for the assumption. The more critical point of all is the ability to identify and see a problem, to ask a question in the first place. Central also is the ability to discard a less desirable idea for a better one.

Along the way is the importance of not disregarding oddities that appear in observations or experiments. They prove to be the source of many important discoveries. Retention of childlike imagination, playfulness, curiosity, independence, and rebelliousness are involved. “Orthodoxy is the enemy of creativity.” (Desmond Morris).

Throughout the process, boldness and courage are needed, to go to the new idea, approach, or method from the traditional one. And not be afraid to be laughed at. Along the way to creativity is coping well with inhibition, sterility, mistakes, failure, and anxiety, and, as well, with happiness and hubris. An important aspect of creativity is over-emphasis and over-simplifying to provide the most obvious and vulnerable hypothesis. (Keys over-simplified and testable hypothesis on diet.)

Then, “A kind of liberation is required before one is able to be creative.”(Magee). Einstein told Northrup in Berlin in 1928 that he would never have dared to overthrow basic Newtonian assumptions if he had not just recently read the Scots philosopher David Hume. Even the creative genius needs to be liberated from habitual patterns of thinking.

These characteristics of risk-taking mean “that a quality not only of intellect but also of character is involved in creativity.” (Magee).

I was interested that none of these brilliant, individualistic Nobel laureates mentioned qualities of communication or teamwork. Rather they quoted Gibbon: “Conversation enriches understanding, but solitude is the school of genius.”

“Ultimately creativity in any field requires mastery of technique. There is no way of playing an instrument with freedom and creativity unless you can control each finger with a precision come from long exercise, and can then integrate freedom with discipline…. “

The interplay of good fortune and the prepared mind was introduced by their quoting Pasteur: “Chance favors only the mind prepared.”

These chaps asked if creativity can be taught and a few mentioned new communication methods. But most pooh-poohed the idea, one saying: “There’s not a single college in the US that doesn’t teach a course in creative writing. And what do they produce?” In contrast, Krebs felt that creativity can be taught: by asking the right kind of questions, by forging new tools, by being ruthless in self-criticism, by taking pains to verify facts and to express ideas and results clearly and concisely, and by learning to challenge set ways of thinking.

In the summary by these perhaps cloistered geniuses (the gregarious Peter Medawar was not among them), creativity in science and medicine is made up of the following components: 1. productive originalty; imagination controlled by knowledge, 2. an apparently unconscious ability to pick out among various possibilities the way natural processes work (intuition), 3. a conscious critical ability which permits the selection from a pool of ideas those likely to be fruitful, 4. the abililty to fashion the tools required for testing the idea, 5. persistence, 6. and the ability to stimulate new connections in the minds of others.

Interestingly, curiosity about the world, and ambition to do well and to justify one’s existence were simply assumed and not mentioned by the experts.

Finally, they felt, to be creative it helps to be optimistic, to overcome disappointments. Even the greatest may choose wrong ideas. It is said that Einstein’s last 20 years were spent in pursuit of the metaphysical idea that God does not throw dice; therefore, there had to be a deterministic explanation. Many colleagues say he wasted years of potential creativity pursuing that thesis.

In their considerations, there was no explanation for the fact that the reputation of most pioneers rests on one or a very few new ideas.
They concluded also that the creative act is not linked inevitably with excellence. Because it is a sudden and a dramatic shift in direction, the creative act is often full of errors. Original thinkers make terrible mistakes. Those who give us a new way of thinking may be wrong on this or that. The first airplane is not the best. “We must not expect the innovator to produce something of supreme excellence, but we must be thankful to him for showing us the new direction.”

The danger of relying on hunches, which the most creative scientists are prone to do, is that it leads to certainty rather than to the doubt needed for further exploration. (Example of Pauling)

The desirablity of leisure or freedom from pressure was considered. “The mind of a man about to be hanged may concentrate wonderfully, but it will not be very creative.”

THE ARTS AND MEDICINE TODAY

Closer to home for us in clinical medicine, Paul Rodenhauser, professor of psychiatry at Tulane, lectures eloquently about creativity in medicine, about the involvement of physicians in the arts, and on theories of creativity, with the probability that creativity can find a place in modern medicine. He points out how creativity fascinates the medical profession, but how medical education, medical practice, and society in general push us toward conformity and away from our creative attributes; how creativity is appreciated but not fostered.

“From selection for medical school of the most orderly, competitive, perfectionist, over-achievers, to the need to memorize massive amounts of material, the necessity to succeed on multiple choice exams and to master methods and procedures, perfectionist behavior is everywhere reinforced. Nevertheless, the average creativity score of medical students is [apparently] higher than that of architects, engineers, mathematicians, psychologists, or research scientists.” (The Pharos )

He asks whether the profession should be actively recruiting creatively gifted students and whether medical education should cultivate creativity.
In support, James Knight finds that creative students are better able to tolerate uncertainty and to question existing theories, are more likely to have the courage to be different and to be innovative through science, and possess a greater passion for learning, thus inspiring others. They may have a finer appreciation of human suffering, are more likely to be curious, sensitive, persistent, capable of intense concentration, and have a high tolerance of ambiguity as well as their faculty for divergent thought. All these qualities have implications for improved relationships with patients and colleagues. They also influence personal health habits and the promulgation of healthy lifestyles. He speculates that such artistically endowed students might also provide greater impetus for needed reform in medical education.

Rodenhauser goes on to wonder whether compulsiveness, an important ingredient in the practice of medicine, tends eventually to inflexibility and a compromised ability for healthy self-interest. Our familiar way in medicine of coping with psychic pain is to do more, thus perpetuating the problem. Student and physician indulgence in the creative arts is proposed to counteract these tendencies and to reduce stress. The direct and vicarious benefits of physicians becoming involved in the arts include: community involvement, scholarly expertise and recognition, inclusion in the creative process, collection and benefaction of the arts, and personal writing or performance in visual arts, dance, music, theater, or, thank you, Henry Keys, finding stimulus and challenge in a memorial lecture!

The far end of the spectrum of physicians in art includes those extraordinary talents who contribute to both science and the arts through rare genius. von Helmholz, inventor of the ophthalmoscope, was a skilled musician. Auenbrugger, the discoverer of percussion, wrote the libretto for Salieri’s operas. Karl Schleich, poet, musician, and painter, was persecuted for his proposals to use local over general anesthesia in many instances. (I appreciate being in a direct line of his “genius,” having been required to use “Schleich,” a mixture presumably of his concoction, of 1/3 ether, 1/3 chloroform, and 1/3 ethyl chloride, in a closed system, for obstetric anesthesia in a hospital in France after World War II. This dangerous system may explain why he later proposed sweeping increases in the application of local anesthesia, for which he was run out of the profession).

And then there are those physicians better known for their artistic brilliance than for their medical contribution. For example, Chekhov, a most successful playwrite, said in Uncle Vanya, that “…man is endowed with reason and creative power so that he can increase what has been given him, but up to the present he has been destroying not creating. There are fewer and fewer forests, the rivers are drying up, the wild creatures are almost exterminated, the climate is being ruined, and the land is getting poorer and more hideous every day.” That was written in 1900!

The profession and the world may be better off that some successful artists never practiced medicine: consider James Joyce, Gertrude Stein, Percy Bysse Shelly, John Keats, Hector Berlioz, Somerset Maugham, and Michael Crichton. One study of famous men in medicine implied that physician-writers Chekhov, Maugham, and Joyce personified mild, marked, and severe psychopathology, respectively. Physicians Havelock Ellis, Sigmund Freud, and William James were considered badly troubled. Berlioz’ severe mood swings would probably have rendered him ineffective as a practitioner. A few flourished with strong identities and success in both medicine and the arts: Borodin, Albert Schweitzer, William Carlos Williams. And then there were the ambivalent and conflicted such as the surgeon Billroth, who wanted to be a pianist.

Although the metaphor is offensive to modern sensibilities, Chekhov had an interesting way of looking at his two passions, playwriting and medicine: “I feel more contented when I realize that I have two professions and not one. Medicine is my lawful wife, literature my mistress. When I grow weary of one, I spend the night with the other. Although this may seem disorderly, it is not so dull and besides neither of them really loses anything at all from my infidelity.”

The profession seeks those easier to educate, conforming, convergent thinkers with more an exaggerated sense of responsibility than a capacity for brilliance. What then are the characteristics of creativity? Are they compatible with good medicine, good science, good practice, and with mental health? The lecturer’s view of capacities and conditions for creativity include qualities of alertness and discipline, but also of “aloneness, inactivity, day-dreaming, free-thinking, similarities-detecting, gullibility, and remembrance of and inner replaying of traumatic events.”

I am reminded of our experience as second-year medical students at Tulane in the days of Ochsner and Debakey and George Burch, who was named chief of medicine that year, at age 34. He rode us unmercifully, admonishing us that if we were quitting work and going to bed before 2 am we had no business in med. School! We were amazed when this driven, brilliant man returned from a summer leave in London. There, Burch had daily encountered clinical investigators as bright as he, and grand rounders just as erudite. What astonished and changed him was that these same people went regularly to concerts and the theater and discoursed on the arts as fluently as on medicine. On his return, and for some time thereafter, Burch admonished us students: “If you don’t have season tickets to the New Orleans Opera, you’ve no business in med. School!”

Finally, today’s Tulane professor, Rodenhauser, laments that if physicians were more artistic in professional temperament, they would not tolerate regulation of the kind imposed by managed care. In contrast, he fears, physicians experiencing the suppression of their prerogatives in managed care settings may be displacing their self-fulfillment onto the pursuit of excellence in alternative areas, to the potential detriment of medicine.

He suggests there are two extremes available to the physician so torn between medicine and the arts; on the one, emersion in creative activity after burn-out and crashing, or, on the other, practicing medicine cursorily for the income needed to pursue a career in the arts. Is there a middle ground, Rodenhauser asks, within medicine, from which imaginative brilliance in either or both professions can be cultivated, and creative activity become a more integral part of the lives of physicians? He also asks how different might their life experiences be; how different might the profession be?

MUSIC AND MEDICINE AS AMERICAN EXPORTS

Now, I want to divert briefly and tell a personal story about a favorite idea, that music and medicine are good diplomacy. I do this from direct experience of their people-to-people power, in medical missions to pre-Castro Cuba, from three years in displaced persons camps in Austria, from ten years in rural, traditional areas of seven countries in the Seven Countries Study, from serving in the U.S.-Russian and U.S.-Japan Health Treaties, and from musical events world-wide. And I do it in part from sadness that the 104th Congress closed all funding for export of American musical experience, and much of it for U.S. Health Treaties abroad.

The theme I propose is that medicine, and music, including jazz, are the real and “true coloration of our American society. They export so very well because they reflect us best, because they are non-ideological, because they are directly and immediately effective, and, because they touch people, they are important.” (from a conversation with photographer-musician Bill Carter).

UPDATE

Meanwhile, we come more and more to appreciate the uncertainty principle in science and to accept that there are limits of what science can tell us about experience. Faced with the uncertainty now discovered in science, having lost our ancient authority, there remains a test that can be given to a scientific work, just as it is applied to art: is the result beautiful?

Einstein used this test and found his own theory simply too beautiful to be false. When asked at the time of the 1919 eclipse of the sun what he would do if the measurements being made of starlight bending should contradict his theory of relativity, he replied, “Then I would feel sorry for the good Lord. The theory is correct.”

“The human ability to perceive structure, to recognize the quality of beauty, and to agree on what is elegant serves as a guide …” a fallible guide, of course, to what idea has value and what is dross.

Finally,“science and music are ultimately aesthetic endeavors. They give pleasure in the doing. The proof of having done them well lies in the coherence and beauty that the outcomes of both science and music present….” (Measure for Measure)

I close with Rodenhauser’s summary:

“Creativity [in the arts and in science] has deeply personal and spiritual implications. It provides affirmation, passion, expression, excitement, and experience of a universal nature. It provides the means to accept, transcend, or modify reality, perhaps to introduce a new version of reality, to make the ordinary extraordinary, and to advance knowledge and culture. Along with humanism in medicine, it ranks among the highest forms of giving.” ( The Pharos)

Well, I would love to have been a wizard here today and to have brought all these things closer together. Clearly, this dream was doomed. But I find in my life that medicine and music are not that disparate. There is more harmony than duality in their conjoined practice. I admit, however, to finding an even closer harmony between medicine and writing.

So, we leave unresolved the broader issues of the interaction of science and music and the arts. I believe, nevertheless, that we must keep trying to bring them together, at least in our own personal and professional lives.