Book Review
Henderson's Equation
N Engl J Med 2008; 359:1740-1741October 16, 2008
- Article
Henderson's Equation
By Jerome Lowenstein. 290 pp. Great Barrington, MA, Gadd & Company, 2008. $17.95. ISBN: 978-0-9774053-7-4Lawrence Henderson's simple equation, H+=K×HA/A−, which describes the dynamic equilibrium that occurs when weak acids are in solution, was a revolutionary breakthrough that changed forever the way clinicians evaluate and manage acid–base disorders. This book, however, is not a treatise on acid–base chemistry or on Henderson's scientific breakthrough, but rather an engaging portrait of the man and his time.
The time is the early 20th century, and the reader experiences medical education as it was then, as well as glimpsing the mindset of the medical teachers and scientific investigators of that era. We learn about Henderson's ideas and accomplishments only through his interactions with Aaron Weiss, a Zelig-like fictional character created by author Jerome Lowenstein. Aaron first encounters Henderson as a medical student, and he is immediately enthralled by Henderson's ideas and his revolutionary mode of teaching. While Aaron is still in medical school, he becomes personally acquainted with Henderson and works in his laboratory. Although their career paths diverge, the fictional Aaron and the real Henderson maintain a lifelong relationship.
The portrait of Henderson that we see through Aaron's mind is complex and not always flattering, raising issues such as his class-consciousness, his indifference to social injustice, and his attraction to social Darwinism. Lowenstein bases his portrait of Henderson on the scientist's unpublished memoirs and other writings and states that he has tried to use Henderson's own words as much as possible. We are left to guess at the accuracy of the depiction.
Aaron is alternately encouraged (in the field of science) and rebuffed (because of his social class and background) by Henderson. After his clinical training, Aaron returns to his roots in Brooklyn, New York, and establishes his own acid–base research program, getting frequent input from Henderson. Aaron's research activities are quickly swamped by his clinical responsibilities, however, and he eventually devotes his life to caring for patients and teaching students and residents. He has a successful and satisfying career.
Over the course of the book, Aaron experiences World War I, the influenza pandemic of 1918–1919, the Great Depression, and most notably the trial of Sacco and Vanzetti in the 1920s. The outcome of this trial and the outrage it engenders ultimately drive a wedge between Aaron and Henderson. Henderson's all-encompassing interest is science, and he has little interest in the fates of Sacco and Vanzetti. Our fictional hero, by contrast, is engaged and engulfed by the injustice that these men suffered. Aaron tries unsuccessfully to convince Henderson to use his influence to intervene.
The book is at its best when Aaron is communicating directly with Henderson or telling us about Henderson's influence on his life and career. Many moral and philosophical questions are raised as a result of their interactions. None can be answered, but they certainly engage the reader's mind. One of the book's few flaws is that it seems to wander into more areas than it can thoroughly address. In addition, it provides an overly detailed chronology of Aaron's life yet fails to develop his character sufficiently to hold the reader's interest. We long to return to the ongoing dialogue between our fictional hero and Henderson, and thus the sections of the book that venture into Aaron's life are something of a distraction. The main theme of the book is the connection between Aaron and Henderson and the issues raised by their interaction.
This connection is portrayed well, and it is what makes the book a great read. The book gives us a remarkably intimate portrait of Henderson and opens a frank discussion of larger moral issues. It is particularly enjoyable for those of us who have lived with Henderson's equation and all its ramifications for most of our careers, and who have personally grappled with the conflict between basic science and clinical practice. I couldn't put the book down, and I certainly recommend it for a much wider group of readers than the few of us who are acid–base mavens.
F. John Gennari, M.D.
University of Vermont College of Medicine, Burlington, VT 05401
fgennari@uvm.edu
