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A young man, an intern at UCLA Medical Center, is heading out of Los Angeles on his way to his niece’s wedding in Phoenix.  He has signed out for the long weekend and he is eagerly anticipating some time with his family, which will include (though he doesn’t know this yet) his niece’s college roommate, an eligible young woman from a prominent Washington, DC, family, who will be at the wedding also.  Driving his mother’s late-model Cadillac, with his suitcase, medical bag, and his father’s golf clubs in the trunk, he is fifteen miles out of Indio and in the middle of nowhere when he spots a teenage girl by the side of the road.  She’s a bit disheveled and is carrying a small canvas travel bag and a white plastic handbag and nothing else; she looks to him like the girls his younger sisters refer to as “cheap.”  He pulls over and rolls down his window.  She is sullen and somewhat evasive in answering questions, and she happens to be going to Phoenix also.  Hugh feels that he can’t just leave her here, in the desert, where who knows who she might encounter, so he
offers a ride; he decides, however, that he will drop her off at the next town, where she can catch the bus. 

What could possibly go wrong, right?

This is the set-up of Dorothy Hughes’ The Expendable Man, and the answer is, of course, plenty.  It is not a big reveal to say that the girl’s motives seem dubious and she proves hard to be rid of, being dropped off and then showing up again, including showing up at Hugh’s Phoenix motel room, where he refuses to speak to her.  It is not even a big reveal to say that the morning after she shows up at his motel room her body is found in a canal on the outskirts of Phoenix, and the autopsy reveals her to have been pregnant—and aborted.  Nor is it a big reveal—indeed, it is only logical to assume—that the suspicion of the local police falls on Hugh, the last person—and conveniently, a physician—known to have seen her alive.   It will be up to Hugh to prove his innocence despite the damning circumstances.

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This novel recasts Charles Dickens’ David Copperfield for modern day as a literary take on the opioid addiction crisis in the U.S. during the 1990s and 2000s with apparent connections to Beth Macy’s nonfiction book, Dopesick, and the eight-part TV miniseries of the same name it spawned. The author, Barbara Kingsolver, assures potential readers that having read David Copperfield is not a prerequisite for comprehending and appreciating Demon Copperhead.   

Demon Copperfield, a name that evolved naturally enough in early childhood from his birth name, Damon Fields, was born into entrenched poverty in the heart of Appalachia, Lee County, Virginia. He tells his story starting from when he drops out of his drug-addicted mother’s womb onto the floor of a rented trailer, to when as a young adult, he makes a last-chance effort at breaking loose from the life-threatening clutches of Lee County. In between, his stepfather frequently beats him bloody, his mother dies from a drug overdose, he enters foster care, attends school off and on, and works assorted jobs, many of which involve illegal, unethical, and dangerous activities. All the while he is variously abused, starved, and exploited.  

Demon shares his plight with many others in the community, and though they help each other as best they can, nearly all of them become ensnared in the same traps—drug addiction, alcoholism, unemployment, hazardous occupations, unfinished education, familial disintegration, and societal abandonment. For Demon, these conditions and experiences obliterated any vision of a future free of entrapments, let alone one of prosperity and happiness. “Here, all we can ever be is everything we’ve been. I came from a junkie mom and foster care,” is how he assessed his prospects (p. 461).  

Amidst all this suffering and bleakness, an observant and caring teacher discovers Demon’s talent in graphic arts, and he gets a peek at a path to commercial success. He has to first fight off what he knows of “Lee County being a place where you keep on living the life you were assigned” (p. 460). His story turns to this fight and onto this path. 

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Anna Gasperini builds on existing scholarship by examining how Victorian ‘penny blood’ literature depicted working-class readers’ anxieties concerning medical dissection following the 1832 Anatomy Act. Within the historical context of Britain, a dearth of cadavers spurred the rise of various crimes, including body-snatching, graverobbing, and murder. While the families of the middle- and upper-class dead could finance a funeral and secure a place of safe rest, such as in an ancestral vault or tomb, the poor were often buried in shallow or mass graves. These burial sites were often unearthed, and the bodies were sold to (knowing and unknowing) medical men for anatomical examination. To quell these crimes, government authorities instated the 1832 Anatomy Act, which was “a law that allowed anatomists to source dissection material from the pauper” (xii). More specifically, Gasperini explains, “[w]hen it was passed, the Anatomy Act imposed that the bodies of those who were too poor, or whose families were too poor, to afford a funeral were to be handed over to the anatomy schools for dissection” (xii). The Anatomy Act, disregarding pauper consent and personal wishes, effectively targeted impoverished people who relied on workhouse support and alms, exploiting poor bodies to supply medical schools and advance research. The fear and disgust for the law were widespread: “. . . for them [working-class penny blood readers] dissection, bodysnatching, and forfeiture of one’s body to the anatomists after 48 hours under the Anatomy Act were a terrifying reality” (xiii). This fear oddly presaged Count Dracula’s remark in Tod Browning’s 1931 film: “There are far worse things awaiting man than death.” In other words, the finality of death may be incomprehensible, but posthumous desecration of the body through dissection provokes a deeper sense of horror.

Exacerbating the act’s legal conditions was the fact that “semi-literate” working-class people, although vaguely aware of the law’s significance, could not fully interpret the dense legal argot that described the new regulations—an example of cruel political skullduggery—which obscured what would happen to their bodies following death (12–13). Far from being a benevolent political gesture, the act “. . . was an exercise in rhetoric, against which the pauper—semi-literate, socially powerless, and politically underrepresented—could not possibly win” (15). Popular fears that predated and intensified following the act concretized suspicion and anger directed at physicians, the medical sciences, and mortuary practices.

These apprehensions, Gasperini argues, found vivid expression in the pages of the penny blood, a genre “churned out by underpaid hack-writers” and obsessed with storylines “involving murder, betrayal, gender-shifting, and the occasional supernatural event (not to mention scantily clad damsels in distress)” (4). While the penny blood’s serialized melodramas were derided as tawdry sensationalism by middle- and upper-class readers, the genre reflected working-class preoccupations about the Anatomy Act and how the bodies of the impoverished dead were subject to the posthumous medical gaze (4). The penny blood embraced a “generally more violent and graphic concept of entertainment that was popular among lower class individuals. . . .” (4) and constructed plots that directly tapped into long-entrenched suspicions about medical cruelty and physical dismemberment. While the era’s educated readership disdained the recognizable tropes of the penny blood—murderous graverobbers, devious surgeons, vampires, eldritch cemeteries, and cadavers—the narratives in which they figured elucidated the virulent classism and exploitation perpetuated by the Anatomy Act. 

Gasperini provides close readings of a range of penny blood texts, including Manuscripts from the Diary of a Physician (1840s), Varney the Vampyre; or: the Feast of Blood (1840s), The String of Pearls (1840s, popularly referred to as Sweeny Todd, The Demon-Barber of Fleet Street), and The Mysteries of London (1840s). Not all narratives have explicitly medical themes or characters who are physicians or anatomists, nor do the stories make overt reference to the Anatomy Act. Instead, as Gasperini’s analyses demonstrate, they all confront larger working-class anxieties concerning mortality and what might be regarded as the social afterlife of a human corpse, whether that be posthumous dissection, cannibalism, necrophagy, or some other horrific desecration of the body. Fundamentally, while the stories vary, they share a general preoccupation with the corpse’s “bodily integrity” (16), asking what forces act upon the body (or have the authority to) following death and expressing fear over the individuals and institutions that presume to disturb the repose of the dead. Indeed, for all the penny blood’s grotesquery, there is a tacit insistence on the sanctity of the corpse; however, as Gasperini illustrates, the genre does not flinch from revealing the grim consequences of disturbing this repose in the interests of greed and medical progress.

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The author’s beloved Jewish mother is a great storyteller. A favorite tale describes how her grandmother was shot dead while sitting on the family’s Winnipeg porch nursing her baby. An accomplished investigative journalist, author Hoffman assumes it is fiction but decides to investigate. He is astonished to discover that, indeed, his great-grandmother was murdered, although the details deviate slightly from the family tradition. 

Through official records, the Census, and newspaper accounts he pieces together the circumstances of her life and death and the frustrated search for her killer. In the process, he learns a great deal about his ancestors and the world of Jewish immigrants in early twentieth-century Canada. Eager to share his findings, he is confronted by his mother’s decline into dementia and the poignant difficulties of grasping and reshaping memories, both collective and individual. 

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Mindy Thompson Fullilove, MD, is a Black social psychiatrist with wide-ranging interests; her book analyzes factors that support or diminish the health of cities as places that sustain its citizens. Over many years, she has visited and studied 178 cities in 14 countries, and she draws on the work of experts from several disciplines to address the fundamental question: how may we best live together?  

Her discussion moves through five concepts for understanding the health of a city by describing a dozen cities ranging from Paris to Jersey City. Each features a “Scroll,” a two-page presentation of photos, graphics, and text. Her discussions give an inductive basis for her concepts that become criteria for assessing the health of any city.     

(1) Box (“in all sizes and shapes”): the surrounding shape of buildings, street, and sky; it gives an identity to the city’s center with its useful assets such as stores, post office, bank, food, and entertainment.
(4) Tangle: a dense network of streets and highways that connect to main streets and the Box.
(5) Time: no city is static; as years go by, there are changes for good or ill.  

Fullilove mentions politics, capitalism, poverty, disincentives, tribalism, racism, highways, malls, interstates, and “urban renewal” that destroyed neighborhoods of minorities, as well as redlining against Blacks and gerrymandering school districts to segregate Black and white students. 

In “Naming and Framing the Problem,” she turns to a larger overview of challenges for cities in many places, but especially in the US: (1) “deep structure of inequality” (p. 211), such as the legacies of slavery, lynching, the 3/5 Compromise, and the Trail of Tears, as well as white supremacy today (2) ecological damage, including industrial farming, deforestation, and global warming, and (3) the inertia of the status quo. 

Citing Dr. Martin Luther King, Jr., and Father Richard Rohr, Fullilove affirms love as the root  for social justice, political activism (p. 211) so that cities might become what Thomas Edison termed “factories of invention” that will support the mental health and well-being of all of its citizens.   

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Colective was a popular nightclub in Bucharest, Romania.  In 2015, a fire broke out during a band performance killing 27 people and injuring 180. The public protests that erupted over the lack of fire exits in the club led to the resignations of government officials, including the Minister of Health.  Within four months of the fire, 37 of the critically burned died, not as originally thought from the burns they suffered, but from hospital- acquired infections.

 

The feature documentary follows Catalin Tolontan, an investigative journalist at a sports newspaper and his team as they track down the cause of the fatal infections.  They are aided by doctors from the hospital who come forward to voice their suspicion that the infection control agents used by the hospital were diluted to the point of being ineffective.  The journalists bring samples to a lab which verifies that the agents were diluted to 10% of their effective strength.  The owner of the company supplying the agents had been engaged in the practice for years.

 

We hear tragic stories from parents whose children died, prevented by “communication errors” from having them transferred to other, better equipped burn units in other European countries.  And we meet the survivors, among them, Tedy Ursuleanu, who, despite her disfigurement, bravely poses for photographs for an exhibit about the event.  The film returns to Tedy at several moments--- she is a reminder of the human tragedy that has caused so much suffering. And we listen to the despair of a doctor who says, “We’re doctors; but we are no longer human. All that matters is money,” as she describes how politics, bribery and greed have taken over the health system and made patients’ lives expendable.

 

This is a story without a happy ending.  Vlad Voiculescu, the newly appointed health minister who previously worked in patient advocacy tries to reform the system and install safeguards against hospital procedures that fall short of accreditation requirements.  But the system proves too strong.  This time political corruption wins over people’s health.

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