Showing 31 - 40 of 496 annotations tagged with the keyword "History of Medicine"

The Death of Cancer

DeVita, Vincent

Last Updated: Feb-04-2016
Annotated by:
McEntyre, Marilyn

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

The book offers a detailed account by one of the nation’s leading cancer researchers of developments in chemotherapy over the past several decades, as well as the recent history of surgical and radiation treatments in the “war on cancer”—a term he resisted at first but finally embraced with full understanding of its implications.  The narrative touches on many of the writer’s own struggles over economic, political, and moral implications of what a NYT reviewer described as a “take-no-prisoners” approach to cure.  He also includes stories about disagreements with other researchers that give some insight into the acrimony that is part of high-stakes science.  At the NIH and later as head of the National Cancer Institute, DeVita faced many decisions about distribution of resources, how much to put patients at risk, and whom to include in clinical trials.  He provides his own point of view on those controversies frankly.  Not much mention is made of the causes of cancer, of nutritional or other complementary approaches, or the environmental factors in the spread of cancer. The strong focus on the book is on the development of chemotherapeutic treatments that have succeeded in raising survival rates, though few current statistics are cited.

View full annotation

Dr. Mütter's Marvels

O'Keefe, Cristin

Last Updated: Jan-25-2016
Annotated by:
Glass, Guy

Primary Category: Literature / Nonfiction — Secondary Category: Literature / Nonfiction

Genre: Biography

Summary:

Those who are familiar with the Mütter Museum of the College of Physicians of Philadelphia, best known for its anatomical oddities, may have wondered about the institution’s namesake.  The author of this book, a poet and native of Philadelphia, endeavors to place Thomas Dent Mütter within the context of 19th-century American medicine.  

We learn here that notwithstanding being “medicated” with wine, surgical patients emitted such agonized screams that observers were known to vomit and pass out in their seats. We learn that Philadelphia was a cesspool of infectious disease for which there was no effective treatment.  We learn too of the rivalry (including behavior that would be considered unprofessional today) between the well-established school of medicine at the University of Pennsylvania (Mütter’s alma mater) and upstart Jefferson (whose faculty Mütter would join).  

In an era before the germ theory of disease became widely accepted, there was of course no concept of sterile technique.  To suggest that a surgeon should wash his hands was to imply he was not a gentleman because “all gentlemen were clean” (page 104).  Resistance to anesthesia was based not so much on concerns about potential danger but on the notion, when it came to obstetrics, that pain was a punishment for the sins of Eve.  Doctors could be downright sadistic to their patients, to the point of beating them like livestock.  That there was no concept of surgical aftercare meant that patients would be sent home immediately following an amputation. Victims of grotesque tumors and disfiguring accidents were considered “monsters” who lived lives of unimaginable misery.  

Enter Mütter, whose importation of plastic surgery from Paris to America brought hope to thousands of incurables.  He had an intuitive sense of the role of cleanliness in reducing morbidity and mortality.  He was a passionate advocate for anesthesia when it was seen as little more than a fad.  He abandoned traditional teaching methods that held a professor should be distant and unapproachable, and became beloved by generations of Jefferson students.  
 

In short, Mütter emerges as not just a likeable guy, but the forerunner of a whole new concept of what a good doctor should be, a sort of cross between P.T. Barnum and Mother Teresa.    

View full annotation

Annotated by:
Kohn, Martin

Primary Category: Literature / Nonfiction

Genre: Essay

Summary:

Brian Dolan has done a great service for the field of medical humanities through his efforts in putting together this volume. Its 19 reprinted articles cover the spectrum of disciplines/fields/methodologies that anchor our work:  history, literature, film, theater, arts, narrative, storytelling, critical (disability) studies, human values, and professionalism. His opening essay, “One Hundred Years of Medical Humanities: A Thematic Overview” very pertinently and extremely ably sets the stage for the remainder of the book. Quite helpfully, authors of “recently published articles,” in this instance from 1987 on, were asked “to reflect on their piece and add introductory comments that would help frame it, or enable them to address issues raised since its original publication” (p.167).  To the reader’s benefit, almost all of those contemporary authors did so.  As cited on the book’s  back cover, the work of some of our field’s most important educators are in this volume, including contributions from Erwin Ackernecht, Gretchen Case, Rita Charon, Jack Coulehan, Thomas Couser, Lester Friedman, Kathryn Montgomery Hunter, Paul Ulhaus Macneill, Guy Micco, Martha Montello, Edmund Pellegrino, Suzanne Poirier, Johanna Shapiro, Abraham Verghese, and Delese Wear. 

View full annotation

Call the Midwife

Worth, Jennifer

Last Updated: Dec-15-2015
Annotated by:
McEntyre, Marilyn

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

Many are familiar with these stories from the author's practice as a midwife among the urban poor in London's East End in the 1950s.  Each piece stands alone as a story about a particular case. Many of them are rich with the drama of emergency interventions, birth in complicated families (most of them poor), home births in squalid conditions, and the efforts of midwives to improve public health services, sanitation, and pre- and post-natal care with limited resources in a city decimated by wartime bombings.  As a gallery of the different types of women in the Anglican religious order that housed the midwives and administered their services, and the different types of women who lived, survived, and even thrived in the most depressing part of London, the book provides a fascinating angle on social and medical history and women's studies.

View full annotation

Blood Feud

Sharp, Kathleen

Last Updated: Dec-01-2015
Annotated by:
Duffin, Jacalyn

Primary Category: Literature / Nonfiction

Genre: History

Summary:

Beginning in 1992, Mark Duxbury and Dean McClellan are high-flying salesmen for Johnson and Johnson, Ortho branch – happily promoting the drug Procrit, (or Epogen -- erythropoietin), for anemia. The drug stimulates the bone marrow to produce more red blood cells. Developed by fledging company Amgen, it was licensed to Ortho for specific uses. Their careers take off, and they earn bonuses and stature, peaking in 1993. Soon, however, Duxbury realizes that he is being encouraged to promote the drug for off-label uses and in higher doses that will enhance sales and profits through kickbacks. He soon realizes that the drug is not safe when used in these situations. People are dying because their unnaturally thickened blood results in strokes and heart attacks.

He raises objections with his employer. For voicing concerns he is ostracized and then fired in 1998. Along with the stresses of his work, the financial difficulties and emotional turmoil, Duxbury’s home life is in tatters; his marriage falls apart and he worries about his daughter Sojourner (Sojie). He develops multiple health problems, including sleep apnea and dependency on drugs and alcohol.

Enlisting the help of the famous lawyer Jan Schlictmann (A Civil Action
), whistleblower Duxbury launches a qui tam lawsuit in 2002 against his former employer. This is a civil action under the False Claims Act, which can offer cost recovery should the charges prove warranted. The lengthy process is still going. The last ruling issued in August 2009 allowed the case to proceed. But Duxbury soon after died of a heart attack in October 2009 at age 49.

View full annotation

The Physician

Gordon, Noah

Last Updated: Nov-17-2015
Annotated by:
McEntyre, Marilyn

Primary Category: Literature / Fiction

Genre: Novel

Summary:

When nine-year-old Rob Cole, child of poor 11th-century English farmers, loses his mother, he is consigned to the care of a barber-surgeon who takes him around the countryside, teaching him to juggle, sell potions of questionable value, and assist him in basic medical care that ranges from good practical first-aid to useless ritual.  When, eight years later, his mentor dies, Rob takes the wagon, horse, and trappings and embarks on a life-changing journey across Europe to learn real medicine from Avicenna in Persia.  Through a Jewish physician practicing in England, he has learned that Avicenna’s school is the only place to learn real medicine and develop the gift he has come to recognize in himself.  In addition to skill, he discovers in encounters with patients that he has sharp and accurate intuitions about their conditions, but little learning to enable him to heal them.  The journey with a caravan of Jewish merchants involves many trials, including arduous efforts to learn Persian and pass himself off as a Jew, since Christians are treated with hostility in the Muslim lands he is about to enter.  Refused at first at Avicenna’s school, he finally receives help from the Shah and becomes a star student.  His medical education culminates in travel as far as India, and illegal ventures into the body as he dissects the dead under cover of darkness.  Ultimately he marries the daughter of a Scottish merchant he had met but parted with in his outgoing journey, and, fleeing the dangers of war, returns with her and their two sons to the British Isles, where he sets up practice in Scotland.

View full annotation

Annotated by:
Miksanek, Tony

Primary Category: Literature / Nonfiction

Genre: Essay

Summary:

This thoughtful essay from the author of The Emperor of All Maladies expounds on information, uncertainty, and imperfection in the medical setting. The author recalls witnessing a difficult operation when he was a medical student. The attending surgeon admonished the operating room team, "Medicine asks you to make perfect decisions with imperfect information" (p.5). This essay is constructed around that idea as the author shares three personal principles that have guided him throughout his medical career.
     Law One: A strong intuition is much more powerful than a weak test. (p. 22)
     Law Two: "Normals" teach us rules; "outliers" teach us laws. (p. 38)
     Law Three: For every perfect medical experiment, there is a perfect human bias. (p.54)

He views the medical world as a "lawless, uncertain" place and stresses that biomedicine is a "softer science" than chemistry or physics. Clinical wisdom, in his opinion, is imperfect, fluid, and abstract whereas the knowledge base of other basic sciences is concrete, fixed, and certain. He laments, "My medical education had taught me plenty of facts, but little about the spaces that live between facts" (p. 6).

His own "laws" of medicine are actually laws of imperfection. Clinical diagnosis can be thought of as a "probability game" where human bias creeps into the process. And ultimately common sense trumps pure statistical reasoning. Woven into the discussion are considerations on a variety of topics - children with autism, Heisenberg's uncertainty principle, genomics, radical masectomy, and randomized, double-blind studies. Nods to Lewis Thomas (The Lives of a Cell: Notes of a Biology Watcher), Thomas Bayes (Bayes' Theorem), and Johannes Kepler (Kepler's Laws of planetary motion) fit in nicely with the thrust of the treatise.


View full annotation

A Lucky Life

Goldbloom, Richard

Last Updated: Nov-11-2015
Annotated by:
Duffin, Jacalyn

Primary Category: Literature / Nonfiction

Genre: Autobiography

Summary:

Born into a Montreal Jewish family in 1924, Richard Goldbloom was always sensitive to minorities and at ease with difference. Jewish and Christian, French and English, music, theatre, and the arts in all forms were prevalent and valued in the family home. He became a skilled pianist and a gifted storyteller. Richard trained in medicine with his father and at McGill University then specialized in pediatrics at Harvard with the famous Charles A. Janeway at Boston Children’s Hospital.

He met the vivacious, intrepid Ruth Schwartz at McGill when they both auditioned for a play. Also Jewish, she hailed from Cape Breton Island, Nova Scotia. They married in 1945 before his studies were complete and had three children. Unlike many male physicians of his era, Richard was in awe of this tiny dynamo and attributes his happiness and success to her.

In 1967, the family moved to Halifax, Nova Scotia, where Richard became Professor of Pediatrics, Physician in Chief and director of research at the new children’s hospital. Ruth was instrumental in a wide array of philanthropic endeavors that inevitably involved her husband. She developed a remarkable museum at Pier 21, the point of arrival for generations of immigrants to Canada—a place to gather their stories and their achievements.

Many anecdotes about clinical practice and scientific innovations are told with accessible enthusiasm and gentle humor. He dispels myths, exposes hidden agendas and explains with clear examples the importance of listening to children and their parents. Underlying the entire narrative is a refreshing humility and gratitude for his “lucky life.” 

View full annotation

Will Starling

Weir, Ian

Last Updated: Oct-16-2015
Annotated by:
Duffin, Jacalyn

Primary Category: Literature / Fiction

Genre: Novel

Summary:

In 1816 London, Napoleon has been defeated and troops have returned, including teenaged Will Starling, who survived the wars as assistant to the decent surgeon Alec Comrie. Will now serves Comrie in the city, still in strained circumstances.

Medical science has turned to the utility of anatomy, but material for research and teaching is scarce. Body-snatchers procure subjects from robbing graves—sometimes from murder—but they are not the only bad actors. Flamboyant, privileged Doctor Dionysius Atherton is trying to raise the dead by applying newly harnessed electricity to fresh cadavers.

From this ghoulish world of science and crime, young Will Starling tells his own tale, as your “Wery Umble Narrator.” Vivid scenes of wretched urban poverty, wanton cruelty, and selfless heroism march past to a grim ending.  

View full annotation

The Normal Heart

Kramer, Larry

Last Updated: Oct-06-2015
Annotated by:
Glass, Guy

Primary Category: Literature / Plays

Genre: Play

Summary:

New York, 1981.  As the play opens, Ned Weeks sits outside a doctor’s office with a friend who has developed worrisome symptoms of a mysterious “plague” that strikes homosexuals.  The doctor, Emma Brookner, complains that she cannot make headway in getting the gay community to take the threat seriously.  This encounter inspires Ned, a writer, to dedicate himself to becoming the spokesman for the growing ranks of disenfranchised patients. He attempts to convert others to his cause, including his heterosexual brother, a closeted bank executive, and a reporter for the New York Times (whom he begins to date).  When it becomes clear that the City is not interested in assisting, he co-founds a grassroots activist organization.  As the epidemic veers out of control, the man he loves falls ill as well.  Over time, Ned’s abrasive, confrontational approach, as well as his focus on abstinence, makes him many enemies within the gay community.  Ultimately, he is forced out of his own organization.  At the same time, there are hints that, as a result of his work, the disease is beginning to be taken seriously.  At the end of the play, Ned’s lover Felix becomes the latest gay man to succumb to the epidemic. 

View full annotation