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The author, a Canadian physician-historian-educator, blows the dust off the shelves of medical history with this fascinating text designed for medical students, educators, and those with an interest in history of medicine. Duffin begins this survey of the history of Western medicine with a glimpse at a pedagogical tool designed to spark the interest of even the most tunnel visioned medical students: a game of heroes and villains. In the game, students choose a figure from a cast of characters selected from a gallery of names in the history of medicine.
Using primary and secondary sources, the students decide whether the figures were villains or heroes. The winner of the game is the student who first recognizes that whether a person is a villain or hero depends on how you look at it. This philosophy imbues the entire book, as this treatise is not a tired litany of dates, names and discoveries, but rather a cultural history of the various times in which medical events occurred.
The book is organized by topics which roughly follow a medical school curriculum: anatomy, physiology, pathology, pharmacology, health care delivery systems, epidemiology, hematology, physical diagnosis and technology, surgery, obstetrics and gynecology, psychiatry, pediatrics, and family medicine. The last chapter, entitled "Sleuthing and Science: How to Research a Question in Medical History," gives guidance to formulating a research question and searching for source material. Fifty-five black and white illustrations are sprinkled throughout the book, as well as 16 tables.
Direct quotes from historical figures, such as Galen and Laennec, as well as excerpts from writings of eyewitnesses of events, anecdotes and suggestions for discussion, appear in boxes within the chapters. Many of the chapters contain discussion about the formation of professional societies. Each chapter ends with several pages of suggested readings and the third appendix delineates educational objectives for the book and individual chapters. The other two appendices list the recipients of the Nobel Prize in Physiology or Medicine, and tools for further study, including titles of library catalogues, and resources in print and on-line.
Although the book is a survey covering multiple eras and topics, each chapter contains choice tidbits of detail. For instance, the chapter on obstetrics and gynecology includes the story and photograph of Dr. James Miranda Barry, the mid-nineteenth century physician, surgeon and British military officer, who was discovered to be a woman at the time of her death. The impact of the stethoscope on the practice of medicine is explored in depth in the chapter, "Technology and Disease: The Stethoscope and Physical Diagnosis."
A small boy overhears his parents discussing the memory loss of a ninety-six year old neighbor who lives next door in the old people's home. He tries to discover the meaning of "memory" by asking the other residents who tell him, respectively, it's something warm, something sad, something that makes you laugh, something precious as gold.
Young Wilfrid gathers his own "memories" to bring to Miss Nancy, his favorite neighbor because she, too, has four names. Each of his treasures, a freshly laid egg for warmth, a toy puppet for laughter, his grandfather's war medal for sorrow, and his precious football stimulate warm reminiscences for Miss Nancy Alison Delacourt Cooper and smiles and smiles for the two of them.
Between April 1795 and September 1801, 306 bodies were pulled from the river Seine in Paris. A register of these deaths, indicating, sex, age, hair colour, wounds (if any) and a description of clothing (if any) was kept by two mortuary clerks, Citizen Bouille and Citizen Daude. If witnesses came forward in the days that followed, the names, occupations of the "silent guests" and the witnesses would be added together with the circumstances of the deaths. In most cases the cause of violent death was unknown, or unrecorded--be it "accident, misadventure, suicide, or murder." Bouille and Daude would not speculate.
This artistic documentary uses a male narrator and an eloquent text to present 23 out of the 306 cases: traveling clerks, hearty horsemen, children, mothers, mistresses, aged widows, and a laundress with her little daughter drowned together. These people had lived through the Revolution, the Terror and the early Consultate and it seems reasonable to wonder if the political circumstances they had experienced were somehow connected to their demise. On the other hand, the occupations--tobacco-pouch maker, carter, delivery clerk--invoke the continuity of daily life in the great city despite the political turmoil.
Each case is presented with the site and details of the discovery of the body, followed by a description of the external anatomy as the camera moves slowly and clinically upward over the naked corpse from the feet to head. The shadowy antics of the crude yet sympathetic bureaucrats Bouille and Daude appear throughout, as they retrieve bodies, wash them, label them, and arrange for the witnesses to view them with enforced respect. But we know less about Bouille and Daude than we do about their "guests."
The narrator reminds us how memory rarely survives more than three generations. Who will remember us, he asks, or these actors who lay very still? And as the register ends, the Revolutionary calendar that governed it ended too. These people who no longer exist could be said to have lived in a time that also no longer exists, because it is no longer measured.
Leandra lives alone in the backwoods of North Carolina where she makes a small but sufficient living repairing antique dolls for a dealer who sells them to collectors. The broken and ragged dolls occupy an old "mourner's bench" in her one-room cabin. For ten years she has lived in relative contentment, though she carries the pain of a trip to Boston when her sister bore a defective child who died.
The sister committed suicide soon thereafter. During that visit, as Leandra's sister withdrew into late-pregnancy depression and hostility, Leandra and Wim took comfort in one another's presence and finally fell in love. But after the suicide, Leandra returns to North Carolina with no intention of ever seeing Wim again.
Now, ten years later, he shows up on her doorstep, wanting to spend the final months of his life with her; he has inoperable brain cancer. He knows what course it is likely to take. He wants only to see her, but she insists that if he is to reenter her life, she wants to see him through all of it, even the worst parts.
They weather and cherish the days with gentle humor, frankness, careful sharing of memory, and the deepest love either has ever experienced. Leandra's neighbor, a friend from childhood, helps Wim build an extension onto Leandra's little cabin, one of several ways he finds to "provide for her" as he wishes he could have earlier.
A medical instrument kit from the year 2450 is transported back in time and falls into the possession of old Dr. Full, a retired physician and drunkard who had been expelled from the medical association for milking patients. The futuristic instruments are awe-inspiring and virtually operate themselves. The discovery of the black bag restores Dr. Full's self-worth and dedication to healing.
A street-wise woman, Angie, realizes the value of the medical instruments and their origin. She forces Dr. Full to accept her as a partner. The two of them soon establish a successful medical practice. When Dr. Full decides to donate the instrument kit to the College of Surgeons, Angie murders him.
While demonstrating the safety of the medical bag to a patient, Angie plunges the futuristic surgical scalpel into her own neck, confident it will do no harm. Meanwhile, authorities in the future learn that the medical bag is missing and deactivate it just prior to Angie's demonstration. She slits her own throat. By the time the police arrive, the contents of the black bag had already rusted and are decomposing.
Nick and Fran move into an old house with their family: Miranda, thirteen, Nick's daughter from a previous marriage (her mother has been hospitalized with depression); eleven-year-old Gareth, Fran's son (who was almost aborted); and a toddler, Jasper, the child of both. Fran is pregnant again. Nick tries to hold them together as a family, but must also take care of Geordie, his grandfather, who is dying of cancer at the age of 101.
Geordie believes that what's killing him is a bayonet wound he received in World War I. As his disease progresses, the old man relives the war, especially the battle in which his brother died, with increasing vividness. After Geordie's death, Nick learns that in the battle he had killed his wounded brother who may, he thinks, otherwise have survived.
Geordie tells the story in an interview with a historian working on memory and war, and confesses that he hated his brother. She gently tells him that "a child's hatred" is different, but he--like the novel itself--refuses to see this as mitigation. Geordie's tale resonates both with what Nick learns about the house he bought--in 1904 the older children of the family living there were believed to have murdered their two-year-old sibling--and with Gareth and Miranda's resentment of Jasper, which has near-fatal consequences.
The Hours begins with a reconstruction of Virginia Woolf's 1941 suicide by drowning. What follows is an exploration of despair and tenacity, of the reasons that some people choose not to continue living, and of the things that enable others to go on. Patterned as a kind of theme and variations on Woolf's Mrs. Dalloway, this novel has three strands, each tracing a day in the life of a woman: Virginia Woolf herself, in 1925, as she begins to write Mrs. Dalloway; a middle-aged 1990s New Yorker named Clarissa Vaughan, but nicknamed "Mrs. Dalloway" by Richard, her ex-lover, an acclaimed writer who is dying of AIDS; and Laura Brown, a young mother in Los Angeles in 1949, pregnant, depressed, and reading Woolf's Mrs. Dalloway.
Laura's small son, Ritchie, we gradually realize, has grown up to become the Richard in Clarissa Vaughan's story and, as the hours pass in the day-long story of each woman, patterns intertwine. Clarissa (living as a lesbian, so following a path that Woolf's Mrs. Dalloway was offered but chose not to take) is planning a party for Richard. Laura is preparing a birthday dinner for her husband but after a visit from the woman next door, whom she kisses in a moment of profound but disruptive empathy, she checks into a hotel room to read, and to consider suicide. Woolf, recognizing the deep connection between her mental illness and her writing, tries to flee from the faintly suffocating safety of her home and husband.
Each woman survives, and all three days end with a sense of qualified and temporary happiness, drawn together, I think, by the fictional Virginia Woolf's decision about her novel: throughout the day she has thought about her main character, and has intended the book to end with her suicide. Late in the evening, having returned home, Woolf decides to let Mrs. Dalloway live: "sane Clarissa--exultant, ordinary Clarissa--will go on, . . . loving her life of ordinary pleasures, and someone else, a deranged poet, a visionary, will be the one to die."
A doctor and a magistrate are driving down a country road in a rainstorm on their way to an autopsy. The doctor says he doesn't notice the weather. "I feel a strange oppressive dread," he says. "It seems to me as if some misfortune were about to overwhelm me." The magistrate scoffs at this. They decide to stop at a country home for the night.
The doctor mentions his foreboding to the pretty widow who lives in the house. When they go to bed, the drunken magistrate, who thinks the widow was flirting with the doctor, encourages his colleague to visit the woman's room. The straightlaced doctor not only refuses, but also prevents his companion from visiting her.
The magistrate blows up in anger and the two men go home. Three days later the autopsy remains to be done. Once again, the two set off to the autopsy, but this time they are waylaid by a tavern and decide to stop and have a few drinks.
Megan was one of the best players on her school basketball team until she accepted a ride home on the back of a motorcycle that slid on gravelly surface, overturned, and left her with a spinal cord injury. Now, a few months later, in a wheelchair, with no sensation in her feet or legs, she is packed up with all her equipment to spend the summer with the family on the island where they've always vacationed.
At first she can hardly bear being confined to watching from windows or negotiating makeshift ramps where she once ran so freely in woods and rowed so happily on the lake. When a boy appears from the neighboring cabin and tries to make friends she resists at first, but is finally drawn into a friendship that gives her the courage to "pick up the pieces" of her broken life and try new ways of being active, including, at the end of the summer, a wheelchair race on the mainland.
She also finds herself befriending the boy's grandmother, an aging actress turning alcoholic because she can't come to terms with aging and the loss of romantic leads in film. As Megan learns to come to terms with her own limitations, she is able indirectly to help the older woman come to terms with her own sense of loss.
The poet contemplates (metaphorically) an abandoned, overgrown garden. "What god is proud / of this garden / of dead flowers, this underwater / grotto of humanity?" he asks. He sees limbs waving, faces drooping, and voices clawing. He recognizes great medical figures like Charcot and Alzheimer. There are no gardeners. As he turns away, he tries to take solace in the thought that somewhere "there is another / garden, all dew and fragrance." [30 lines]