Showing 71 - 80 of 493 annotations tagged with the keyword "History of Medicine"

Annotated by:
Duffin, Jacalyn

Primary Category: Performing Arts / Film, TV, Video

Genre: Film

Summary:

In 1904, the 19 year-old Russian Jewish Sabina Spielrein (Keira Knightley) is admitted to Burgholzi clinic under the care of Dr. Carl Jung (Michael Fassbender) who is beginning to adopt the talk-therapy methods of psychoanalysis promoted by Sigmund Freud (Viggo Mortensen). 

She is hysterical and difficult to control, but she is also bright and has been studying to become a doctor. Jung slowly breaks through her resistence using dream interpretation and word association; eventually she reveals that her mental distress has its origin in her relationship with her father. He would punish her physically and she found it sexually exciting. 

The married Jung is obsessed with his patient and seduces her. They conduct a heated affair that entails sessions of bondage and beating, that they pursue almost like a scientific experiment.

On this background, Jung is becoming the protégé and anticipated heir of Freud—but they disagree over whether or not psychotherapy can cure. Spielrein recovers and goes on to become a physician and psychiatrist who develops her own methods of therapy. Freud comes to admire her and Jung is torn by jealousy. 

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The Soul of the Nurse

Robinson, Elizabeth

Last Updated: May-23-2013
Annotated by:
McEntyre, Marilyn

Primary Category: Literature / Nonfiction

Genre: Treatise

Summary:

In her reflections on the vocation of nursing Robinson explores many myths and archetypes that give shape and energy to the identity of the nurse as it has evolved in Western culture, including the stories of Hygeia, Baubo, Hermes, Hecate, Cassandra, and the Dionysian Maenad.  The ancient stories of each of these figures and others articulate particular constraints, conventions, and conflicts involved in caregiving, especially in the ways women assume the role of caregiver.  She explains at the outset that she deals particularly with women in nursing, though now many men are nurses, since traditionally it has been a profession deeply shaped by cultural notions of female roles.  Another layer of this exploration is a chapter on the nurse in popular culture that considers ways in which the figure of the nurse has been both elevated and debased, made comic or tragic, sidelined or sexualized.  The multidimensionality of the nursing vocation and, consequently, the challenge it poses to women who enter it, is strongly emphasized throughout the six chapters, which together depict the work of nursing as a soul journey. This journey challenges nurses in new ways to work within institutions that suppress important aspects of their power to do healing work at a level of intimacy generally not accessed by doctors.

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Primary Category: Literature / Nonfiction

Genre: Treatise

Summary:

F. González-Crussi, professor emeritus of Pathology at the Feinberg School of Medicine at Northwestern University, has written several books on medicine and the human body. Carrying the Heart deals with five basic organ systems; he styles them as Digestive, Scatology, Respiratory, Reproductive, and Cardiovascular.

In his Foreword, he rejects a mechanical view of the body and medicine that treats patients as passive protoplasm. He seeks to engage the imagination of his readers so that they can become active participants in health care.

For each system, González-Crussi assembles an eclectic wealth of materials: views of authors from classical times onwards, scientists who changed perceptions of the body, his own hands-on view as a pathologist, parallel organs in other mammals, and, usually, an extended narrative of a person with an unusual anatomical history. These are highly personal essays, “rhapsodies,” we might say, which stitch together unusual and interesting facts, observations, and interpretations. It’s impossible to guess what will be on the next page, and the discoveries are many. A gifted stylist, González-Crussi writes with both erudition and wit. 

For “Digestive,” he cites Livy, Paracelsus, Joan Baptista van Helmont, and others before turning to Thomas Bartholin, who questioned the notion that the stomach was somehow the “king” of the body and the seat of the soul. González-Crussi writes, “the gastric cardia admits and stores impure food, without this having any discernible effect on the soul. Nor is the soul damaged by performers at circuses and country fairs who lower swords and knives into the stomach” (p.7). The text marches on through Réamur, Spallanzani and others, before turning to the well-known story of Dr. William Beaumont and his patient Alexis St. Martin, who had a hole in his side (from a gunshot). Beaumont experimented with materials placed directly into the stomach.

Next in the digestive process are the bowels, discussed on “Scatology,” literally the study of scat or excrement. González-Crussi is fascinated by cultural values of “death, putrescence, and dissolution” that attach to our scat. He draws on Rabelais, Luther, the Gnostics, Chuang-tzu, and the Aztecs for the views on the contents and process of the bowels—more than the nature of the actual bowels themselves. The next 30 pages deal with enemas, including the modern (and discredited) notion of “auto-intoxication” a justification bruited about even today for colonics.

Oddly enough, the enema theme continues in the “Respiratory” essay, because there were “smoke enemas” for some 200 years. Page 104 shows a French illustration of interlocked tubes for this purpose; indeed the same illustration graces the slipcover for the book. González-Crussi draws on Anaximenes, Pirandello, Plutarch, Hawthorne, and others. Some 15 pages describe a famous tuberculosis patient, Frederic Chopin, although perhaps he was actually a cardiac patient.

Part I of “Reproductive” is “Female.” We quickly learn that “The uterus is placed between the bladder and the rectum. As a piece of real estate, the uterus would be much devalued by the condition of the neighborhood” (p. 152). Nonetheless, the uterus is “immunologically privileged,” fending off germs that might infect a fetus (which in itself is “half foreign” because of the father’s genes). Drawing on many commentators, González-Crussi discusses menstruation, and pregnancy, although not genital pleasure or orgasm. Some insightful pages explore the normal death of cells within our body.

Part II, “Male” discusses erections, side-curving penises, and the famous penises of Napoleon, Rasputin, and Jesus.

The last essay, “Cardiology” briefly explores two types of knowing (from the heart, from the brain) before a lengthy retelling of the Lay of Ignauer; this strange story ends with women whom he has seduced eating his cooked heart. The last section discusses Harvey’s discovery of the heart as a pump. The final two pages see a new consideration of the heart as a second brain.

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Propofol

Kirchwey, Karl

Last Updated: Jan-23-2013
Annotated by:
Ratzan, Richard M.

Primary Category: Literature / Poetry

Genre: Poem

Summary:

"Propofol" is a 20 line poem of five quatrains each with an a-b-a-b rhyming scheme. Appearing in the June 30, 2008 New Yorker magazine, it is a description of the Classical allusions and hallucinatory experience surrounding the administration of the hypnosedative, propofol, to the speaker-patient for an undescribed medical procedure.

It involves a whimsical conversation, of sorts, between the patient and the physician. After the patient references many of the Greek and Roman materials (moly, mandragora), art ("Euphronios' famous calyx-krater" [http://en.wikipedia.org/wiki/Euphronios_krater]) and deities (Somnus, Hypnos, Morpheus) involved with sleep and death ("Sleep and Death were brothers"), the physician is made to ask why the patient is there - one presumes, and only hopes, he in fact knows!

The poem ends with the onset of what is known as procedural sedation ("A traveller/approached the citadel even while I was speaking,/seven seconds from my brain; then it was snuff."). The final two lines describe the image - apparently now in the hallucinating patient's head - of Félicien Rops' 1879 painting "Pornokrates", in the Musée provincial Félicien Rops, Namur, France (http://www.museerops.be/tech/drawing/pornokrates.html), the genesis of which Rops described thus in a 1879 letter to Henri Liesse:

"I did this in four days in a room of blue satin, in an overheated apartment, full of different smells, where the opopanax and cyclamen gave me a slight fever conducive towards production or even towards reproduction."[quoted at the Musée provincial Félicien Rops site.]

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Summary:

This book describes San Francisco’s Laguna Honda Hospital, where Victoria Sweet worked as a doctor for 20 years. In the tradition of the Hôtel-Dieu in Paris (literally “God’s Hotel”), Laguna Honda cares for the sickest and poorest patients, many staying there indefinitely because there is no alternative for them. Sweet learns from her long experience at Laguna Honda that “Slow Medicine” has benefits, that a holistic or unified view of patients works best, and that the reductionism and specialization of modern medicine has limitations and costs. During these years Sweet becomes fascinated by the medieval abbess Hildegard of Bingen and earns a Ph.D. focusing on medieval medicine. At the same time (and increasingly) various forces—economic, legal, political, bureaucratic—cause many changes at Laguna Honda, mostly contrary to Sweet’s vision of medicine.

            Part history, part memoir, part social criticism, the book is informative, entertaining, and important for its discussion of the care of our least-well-off citizens and for its perspectives on modern, Western medicine.         

            There are three intertwining strands to this engaging book: Sweet’s medical evolution as a physician, the changes in Laguna Honda, and her investigations of Hildegard of Bingen and other spiritual matters.

            Sweet joins up with Laguna Honda initially for only two months, but she finds the hospital and her work there so fascinating that she stays for 20 years. As an almshouse, Laguna Honda takes care of indigent patients, most with complicated medical conditions, including mental illness and dependencies on alcohol and/or drugs. Many of these cases come from the County Hospital with continuing (but not carefully reviewed) drug treatments. Every 15 or 20 pages, Sweet describes the dilemmas of a particular patient, and her medical (and personal) attention to that patient. The cases are vivid and instructive.

   Clearly Laguna Honda is a major figure on the book; we can even consider it (or “her”) a beloved character and a teacher to the young Dr. Sweet, who learns three principles from her work there: hospitality, community, and charity. 

Because Laguna Honda is old-fashioned in many ways, Sweet reads her own X-rays, goes the to lab to see results, and spends large amounts of time with each patient. Laguna Honda has an aviary, a farm with barnyard, and a solarium; such features help to heal the whole person. While respectful of modern medicine, Sweet slowly learns that a careful review of a patient through Slow Medicine is more accurate and more cost-efficient than standard, reductionist, high-tech medicine. She comes to respect approaches from “premodern” medicine, including that of Hippocrates and Hildegard.

  The second strand is the evolution of Laguna Honda itself. Sweet describes a variety of pressures: the recommendations of consulting firms, rulings from the Department of Justice, a lawsuit, financial difficulties (including fiscal mismanagement), administrators focused on a narrow concept of efficiency, a utilization review board, forms and more forms, and a pervasive sense that modern (including Evidence Based Medicine) is always good. All these and more create a “relentless pressure squeezing the hospital’s Old Medicine into the New Health Care” (p. 322). Sweet demonstrates that her Slow Medicine can actually save money in the long run. Confident that her way is better, she proposes an “ecomedicine unit” that she would match against the modern, “efficient” units in a two-year experiment. (For more information on her concept of ecomedicine proposal, see http://www.victoriasweet.com/.)

            As the hospital is “modernized,” many important features of the old place are gone and many “new and improved” aspects don’t work. Somehow there are no rooms for physicians in the new building while there is plenty of space for administrators and managers. A sophisticated computer system doesn’t work. Sweet doesn’t say “I told you so” directly, but we get the picture.

            The third strand is Sweet’s investigations of spirituality and pilgrimage. She is fascinated by Hildegard’s notions of the healing power of nature, the ability of the body to heal itself, and wholeness as an aim for a person and for a community. Sweet attends a Swiss conference on Hildegard. She hikes the pilgrimage route from France to Santiago de Compostela in four installments and considers notions of pilgrimage. She feels called to pursue her ecomedicine project and to write this book.           

            By the end of the book, both Sweet and Laguna Honda have changed and are now headed in different directions. 

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Summary:

            Hillel D. Braude, a physician and a philosopher, has written an important, albeit dense and narrowly circumscribed, study. While “Intuition in Medicine” is the main title, the subtitle, “A Philosophical Defense of Clinical Reasoning” is a more accurate description of the book, which originated as a doctoral dissertation.  While some of the prose will appeal only to specialists, there are important and thoughtful analyses of such topics as Evidence-Based Medicine, modern dehumanized medicine, the relation of beneficence and automony, and principalist ethics in general. 

            Throughout, intuition is narrowly conceived and in the service of clinical reasoning, as it applies to standard, Western physicians and not to other healers (or nurses), and the emphasis is on interventive medicine to cure illness and relieve suffering more than on health promotion. 

            Braude writes in the introduction that intuition has long been understood to be “a direct perception of things,” but he resists a more precise definition: “Rather than defining and using a single concept of intuition—philosophical, practical, or neuroscientific—this study examines intuition as it occurs at different levels and in different contexts of clinical reasoning” (xviii).

            Eight chapters explore these different levels in such topics as moral intuitionism, Aristotle’s phronesis (or practical reason), the rise of statistics (a basis for Evidence-Based Medicine), and C. S. Peirce’s notion of abduction. Braude’s careful analysis traces historical and theoretical developments in analytic philosophy and how these may be applied to clinical reasoning.  He uses an impressive range of thinkers: Achenwall, Albert, Allan, Andre, Ashcroft, Aristotle, Bacon, Barrow, Barton, Beauchamp, Bergson, Bernard, Bichat, Black, Bottero, Bourdieu, Brody, Browne—just to take names headed by A or B.  

            Throughout, Braude puts in dialectic two poles on a spectrum arguing that they both have contributions to make. He believes that between them is an “ethical space,” where discoveries and applications can be made, but he clearly favors all the concepts from the lefthand list for medicine. In tabular form, we can list aspects of the two poles:

 

            Medicine                                               Philosophy

Aristotelian practical reasoning                        Kantian abstraction

Naturalist approaches                                    Nonnaturalist approaches

Primacy of beneficence                                  Primacy of autonomy

Fact and value joined                                    Fact and value separated

Case-based                                                 Evidence-Based Medecine

Individual patients                                        Large groups of patients

Narrative experience                                     Statistical correlations

Anthropocentric focus                                    Mechanist, positivist foci

Tacit, organic knowledge (Polanyi)                   Dualism (Descartes)

 

            Braude believes intuition is a cognitive process but has other dimension, the corporeal and the social. While these provide a grounding, intuition for him is generally rational. He also argues for medical care at the personal, face-to-face level, not through applications of algorithms. 

            A brief conclusion, “Medical Ethics beyond Ontology” clarifies some of the arguments and sketches some valuable notions from Husserl and Levinas. He writes “intuition . . . does appear to be fundamental for human judgment” because “an intuition faculty” can “extract universals from the particular” (p. 170).  Drawing on Husserl, he defines phenomenological intuition as “the primary means through which objects are presented to consciousness.” This affirmation includes the basic human, which is also the focus for medicine. For Levinas (and my summary is much too brief), “interhuman solidarity” is a source for medical care, a form of responsibility that is different from Foucaultian power relationships, ethical rules and priniciples, or “an uncritical acceptance of medical authority” (p. 177). 

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The Dark Light

Newth, Mette

Last Updated: Aug-30-2012
Annotated by:
McEntyre, Marilyn

Primary Category: Literature / Fiction

Genre: Novel for Young Adults

Summary:

Tora lived happily on a mountain farm in Norway until her beloved mother's death  and her own subsequent diagnosis with leprosy, an illness common in early 19th-century Norway and one that drove her mother to suicide.  Upon diagnosis (at the age of 13) she is taken to the leprosarium in Bergen, from which very few emerge.  Most are left there by families whose fear of the disease leads them to abandon even much-loved children, parents, and spouses.  There, despite the misery of living among many who consider themselves the living dead, she finds a friend in Marthe, the chief cook and general caregiver, a woman of almost boundless kindness; and the "Benefactor," a pastor who is remarkably unafraid of the disease from which most flee, and who befriends Tora as she grows into an unpromising early adulthood.  Another unlikely friend is a noblewoman who has languished, embittered, behind a closed door with a trunk full of her old gowns and several cherished books, including the Bible, The Divine ComedyGulliver's Travels, and a popular Norwegian epic about the adventures of Niels Klim at the center of the earth.  She gradually softens toward Tora, who cares for her tenderly as the older woman teaches her to read.  Reading becomes not only Tora's consolation, but that of many of her fellow inmates.  Near the end of her own short, but surprisingly rich life, Tora's father shows up after years of neglect.  Forgiving him, almost against her will, she reaches a new level of acceptance of her own mysterious fate.  The book includes a short afterword about the actual leprosarium in which the story is situated and about Gerhard Armauer Hansen who in 1873 discovered the bacillus responsible for leprosy, the first bacterium proved to be the cause of a chronic human disease.

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The Ghost Map

Johnson, Steven

Last Updated: Aug-23-2012
Annotated by:
McEntyre, Marilyn

Primary Category: Literature / Nonfiction

Genre: History

Summary:

Parts of medical history read like detective novels.  The discovery of the source of cholera by Dr. John Snow in London in 1854 is one of those episodes.  The Ghost Map tells the story of Snow's pioneering work in what have now become standard epidemiological methods.  Tracing a cholera outbreak to a local pump in a poor section of London involved many door-to-door visits working with people who weren't always cooperative, incurring the suspicion and/or ridicule of both them and the medical professionals with whom he worked.  In the course of the story the author offers reflections on the organization of cities and on public hygiene.  Snow, an out-of-the-box thinker, also helped develop surgical anesthesia. 

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Puncture

Kassen, Adam; Evans, Chris; Kassen, Mark

Last Updated: Aug-15-2012
Annotated by:
Duffin, Jacalyn

Primary Category: Performing Arts / Film, TV, Video

Genre: Film

Summary:

Drug-addicted but high functioning lawyer Mike Weiss (Chris Evans) and his partner Paul Danziger (Mark Kassen) run a small personal injury firm in Houston.
They agree to represent an emerency room nurse who has sustained a needle-stick injury and become infected with HIV. Through this work, they discover that a new safety syringe could avoid such injuries in the future, but the innovators are unable to bring it to market because of legal opposition from giant corporations.
The young lawyers become more and more engaged with the case, but  they meet sinister opposition and the outcome is gloomy.

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Nemesis

Roth, Philip

Last Updated: Aug-15-2012
Annotated by:
Duffin, Jacalyn

Primary Category: Literature / Fiction

Genre: Novel

Summary:

Bucky Cantor is a young, athletic, Jewish javelin thrower who is acting as a coach for young boys in the sweltering New Jersey summer of 1944. He is ineligible for war service because of his weak eyes.

His coaching efforts are much appreciated by the children and their parents because a polio outbreak is on the rise, and sports help take their minds off their fears of death and permanent illness. One by one, boys fall ill and disappear. Some die. But the games continue in Bucky’s own private campaign against the epidemic.

No one really knows how polio is contracted and spread.

Bucky falls in love with Marcia Steinberg who urges him to leave the city to avoid exposure to the germs. She works at a summer camp in the Poconos far from the city and uses her influence to have him invited to fill a sudden vacancy when the sports instructor is called up to military service. After agonizing over his decision, Bucky accepts the position—admitting that he is running away from fear as much as he is going to Marcia.  He is amazed that no one seems to blame him.

The camp life is idyllic, and he is reconciled to his choice.  But soon one of the boys at camp shows signs of the dreaded illness, and Bucky believes that he must have brought it with him. Then, Bucky himself falls ill and develops a permanent disability that ends his athletic career.

Marcia rushes to his bedside more than willing to continue as his lover and wife, but he sends her away believing that she should not be saddled with a disabled lover. He thinks he did the right thing.

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