Summary:

Andrew Mangham’s The Science of Starving in Victorian Literature, Medicine, and Political Economy examines how Victorian writers drew upon the era’s medicine and physiology to represent the physical realities of starvation. Wondering readers, at first glance, might ask if starvation can be described in any terms other than a physical experience; however, Mangham argues that prevailing nineteenth-century political economy theorized population growth and food scarcity in ways that radically obscured the corporeal suffering wrought by starvation. Undergirding Victorian-era political economy was the influential work of the British cleric-economist, Thomas Malthus, and the rise of statistics. Malthus’s well-entrenched theories maintained that starvation, or large-scale famine, was a natural (and therefore inevitable) response to overpopulation. “In Malthus’s thinking,” Mangham clarifies, “hunger is the greatest tragedy in human economics: in the worst of times it rises up as a horrible check on those nations whose resources have been overrun by improvident birth rates” (1). These theories further solidified within religious contexts, which produced the peculiar notion of “salutary starvation” (26) or “the providential law of starvation” (30)—an understanding of famine and other disasters as just consequences for exceeding the material capacities of God’s “natural system” (26). Malthus’s theories, imbued with religious interpretations, were pernicious and far-reaching, seeping into how the British government and affluent classes viewed and (mis)understood poverty. Mangham also maintains that Malthus’s theories were augmented by the emergence of statistics during the first several decades of the century, which enabled the government to measure and evaluate epidemiological patterns, demographic data, and other information about human populations (53). He notes that while statistics were used to collect data about starvation, the data were frequently presented in ways that skewed the prevalence of malnutrition, food scarcity, and diseases and mortality rates related to starvation (56). Using a range of literary and primary sources, Mangham underscores that support for statistics was far from monolithic, that for all the scientific certitude that government officials invested in the discipline, there were critics who vociferated about how statistics were often reductive representations of human experience. In other words, masses of tabulated numbers created a cold, mathematical distance between government authorities and those human lives suffering starvation (56–57). Overall, Mangham outlines a bleak picture of Victorian political economy and its views of material privation.

For Mangham, then, one of the most injurious consequences of political economy was its failure to observe starvation (and its manifold health complications) as a material, indeed physiological, experience. As noted, political economists viewed starvation as anything but a form of bodily suffering, using theories instead to explain the naturalness and necessity of hunger and thus blaming the poor, not government and industry, for their problems (31). While political theorists were preoccupied with these explanations, Mangham traces the era’s concurrent developments in medicine that examined the physiology of hunger and digestion. The gastrointestinal research of Italian Lazzaro Spallanzani influenced Victorian physicians, namely John Hunter, Charles Thackrah, George Henry Lewes, Thomas Southwood Smith, and others, who sought to describe the anatomical workings of the stomach and explain the bodily sensations of hunger (36). Against this backdrop, Mangham argues that Charles Kingsley, Elizabeth Gaskell, and Charles Dickens—united in their “antipathy towards Malthusianism” (17)—recognized the power in articulating starvation using physiological terms, and turned to science to limn “. . . the material sufferings of the starving and, more importantly, on detailed analysis of what it means to go hungry and to observe and to write about it in a way that seeks to be truthful” (16). In chapters that individually examine each author’s literary works, Mangham demonstrates how “. . . physiological ideas offered both an alternative way of thinking about hunger and an exploration of the ways in which it might be interpreted” (47). This volume’s close readings of these authors’ various novels, journalism, and speeches reveal that medical science offered a language that could undermine theories that misunderstood human starvation and the sociopolitical conditions that perpetuate it. Kingsley, Gaskell, and Dickens used new science to depict not only physiologically accurate but humanized renderings of the poor.

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Mallory Smith died of complications following a double-lung transplant for cystic fibrosis (CF). She was twenty-five years old and kept an extensive journal on her computer for 10 years. Salt in My Soul: An Unfinished Life is her memoir, edited by her mother, Diane Shader Smith, from the 2,500 pages of notes, observations and reflections which Mallory Smith wrote. The title refers to the intimate relationship of salt imbalance in cystic fibrosis, and the fact that Mallory felt her most well while swimming in the sea. Diagnosed at age three, she spent much of her days and nights treating the disease with medication, nutrition, chest percussive treatments, breathing treatments, adequate sleep, and aggressive treatment of infections. Unfortunately, while still a child her lungs were colonized with B. cepacia, a resistant bacteria ‘superbug’ which makes transplantation highly risky and hence leads to most centers to not accept CF patients onto their wait lists. Ultimately, University of Pittsburgh does accept Mallory as a transplant candidate, although her health insurance puts up every road block possible to her receiving care. 

Mallory Smith was extraordinarily accomplished – she graduated from Stanford University Phi Beta Kappa, and became an editor and freelance writer. She was also deeply engaged with life and others; she was grateful for her loving, devoted family, and she developed close, fierce friendships within the CF community, among classmates, and eventually, she fell in love. 

She resists being called ‘an inspiration.’ She writes: “I’m not an inspiration. I’m just a person, grounded in compassion, striving to achieve empathy and wanting to make my way with goodness and grace.” (p. 171) She marvels at the miracle of life: “Our existence is the result of stars exploding, solar systems forming. Our Earth having an environment hospitable to life, and then, finally, millions of highly improvable events accumulating over millions of years to bring us, a capable and conscious bag of stardust, to the here and now.” (p 111) Her memoir is a story of living and dying from CF, but it is also an inside look at the brief life of young gifted writer.

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The author, Sandeep Jauhar, attributes his “obsession” with the human heart to family history, which includes fatal heart attacks that took both of his grandfathers from him, and to the beginnings of his own coronary artery disease revealed on screening tests. That he became a practicing cardiologist, though after first becoming a PhD-level theoretical physicist, is no surprise then.  

It was this obsession with the heart and his chosen profession that drove him to write this book, which he says, “is about what the heart is, how it has been handled by medicine, and how we can most wisely live with—as well as by—our hearts in the future.” (p. 10) In form, the book is a series of brief accounts of selected events in the history of medicine involving the human heart and circulatory system, interwoven with personal anecdotes and reflections.  

Some of the historical events and developments include how the heart and circulatory system work, and the methods used to assess how well they are working such as echocardiography and coronary catheterization. How heart-lung bypass, first person to person then mechanical, made cardiac surgery possible is described, as are many of the surgical procedures it enabled to treat coronary artery disease and to replace malfunctioning valves. Nonsurgical procedures Jauhar explains encompass those for intervening during acute heart attacks (e.g., angioplasty, stents, thrombolysis), managing life-threatening heart rhythm disturbances (e.g., external and implantable pacemakers and defibrillators, radio-frequency ablation), and replacing parts or all of the heart (e.g., coronary artery bypass, heart valve replacement, left ventricular assist devices, heart transplant). Little mention is made about the use of drugs despite having contributed to both important advances and surprising failures in heart disease.  

Topics related to the heart indirectly include the effects of emotions and psychological problems (e.g., stress), social determinants of disease (e.g., social economic status), and wellness concepts (e.g., diet, exercise). Some history of heart disease and the reduction of deaths from it over the past several decades are also touched upon. Parts of the book take the form of memoir, which add to his previous two books (Intern: A Doctor’s Initiation and Doctored: The Disillusionment of an American Physician).

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This entertaining and wide-ranging book discusses the importance of the human foot and many related topics. There are five alliteratively named chapters.  

1. Destiny
Drawing on anthropological research, Rinzler discusses the deep history of humans and their primate ancestors. Our bipedalism—our upright stance—preceded our large brain, making possible a larger diet and working well with our bodies as they evolved away from other primates. She discusses the idealized ratios of Leonardo’s Vitruvian man. Leonardo considered our foot as “a masterpiece of engineering and a work of art” (p. 6).  

2. Disability
Rinzler discusses historical senses of disability, notably clubfoot. She mentions various people with a clubfoot:  Joseph Goebbels, Sir Walter Scott, King Tut, Cludius I, Dudly Moore, Kristi Yamaguchi, and Mia Hamm; the last are two successful athletes. Rinzler reviews the history of surgical approaches, many of which were harmful. X-ray and sonography provided new insights, and genetics may have further promise, given that families and ethnic groups often have higher instances of clubfoot.  

3. Difference
This chapter describes the anatomy of the foot, bones, arches, tendons, and on as well as artistic representations and, of course, ballet and other forms of dance. A footprint is as individual as the much-used fingerprint. In Nazism and the American south, a flat foot was discriminated against as Jewish or Negro. Various treatments have been proposed for flat feet.  

4. Diet
Gout has been known since antiquity, but only in modern times has the underlying biochemistry and, now, genetic heritage been understood. The chapter mentions many famous names of people who suffered from gout. rheumatism, or corns. The closing pages discuss pharmaceutical approaches.  

5. Desire
The foot as sexual symbol: Rinzler discuss folklore (Cinderella’s slipper), pheromones, and Biblical topics: God’s feet, footwashing, and feet as symbols for sex and urination. Foot fetishism can be understood in terms of the lavish sensory innervation that links to our brain. Discussion mentions the bound feet of China, the folktale The Red Shoes, also Fifty Shades of Grey, Sex and the City, and Judy Garland’s red shoes in The Wizard of Oz

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Most students of biology are well aware of our humble beginnings as puny, single-celled lifeforms. The mechanism of our remarkable transformation was famously described by Charles Darwin in his groundbreaking text On the Origin of Species, published in 1859. In many respects, Darwin’s magnum opus was just the opening chapter of a much broader discussion of how we humans have taken our current form. Darwin elucidated only a general process of adaptation and evolution in the face of environmental pressures. He left his successors with the more onerous task of applying this rule to the tortuous history of human evolution.

Rising to the occasion nearly a full century later was Homer Smith, a prominent kidney physiologist who spent much of his life and career as the Director of Physiological Laboratories at the NYU School of Medicine. Dr. Smith shares his account of our evolutionary history in his 1953 book From Fish to Philosopher. In the book, he posits that organisms must have a system for maintaining a distinct “internal environment” in order to have any sense of freedom from the perennially dynamic external environment. He guides the reader through the various biological filtration devices that have come and gone over the eras, culminating with the fist-sized organs dangling next to our spines.

The book is often billed as a detailed treatise on how modern-day mammalian kidneys have arisen from their more primordial forms – a fair assessment, especially given the author’s background. But this book offers readers something much more ambitious in scope than a rehashing of his work in renal physiology. For example, the first chapter of the book, “Earth”, highlights geological milestones that molded the early environment of the first known lifeforms. In Dr. Smith’s words,

“the history of living organisms has been shaped at every turn by earth’s vicissitudes, because every geologic upheaval, by causing profound changes in the distribution of land and sea, has had profound effects on the climates of both, and hence of the patterns of life in both” (pp. 9).

By the final chapter, “Consciousness”, he has begun to ponder questions of metacognition and learning. He marvels at how our complex nervous system has allowed classical pianists to balance the rigidity required for technical prowess, and the fluidity required for creativity. This is not a textbook about our kidneys. From Fish to Philosopher is a story of mankind’s genesis, told through the existential musings of a physiologist who left no stone unturned.

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"Blood" ("La Sangre") is a poem in Spanish by Vincente Aleixandre, a member of the Spanish intellectual group called "The Generation of '27" and the 1977 Noble Laureate for Literature. It first appeared in "En Un Vasto Dominio", a collection published in Madrid in 1962, consisting, in part, of "a series of poems on parts of the body." (page 264). The present volume is a bilingual edition with the Spanish text on the left page and facing English translations by 15 different translators (including Willis Barnstone, Robert Bly and W. S. Merwin) on the right. The editor, Lewis Hyde, is a poet, translator and teacher of creative writing. He has also furnished an introduction to Aleixandre's work and the selections in this volume in particular, based in part on his personal acquaintance with the poet. Tomás O'Leary translated this poem, the only translation of his in the book.  

"Blood" has no formal elements or rhyme scheme. In a curiously casual voice, it describes the cycle (a word never used in this poem) that the blood makes in its journey from oxygenation in the lungs to the heart - nor are these organs mentioned by name in the Spanish text of the poem - and thence to all the near and remote cells of the body in order to deliver this beneficial oxygen. Once the blood has delivered its cargo, it completes the cycle by returning as de-oxygenated venous blood to the heart, the origin of the cycle, only to begin it, and the sustenance of life, anew.

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