Summary:

Perhaps no topic in the history of medicine has been explored as much as the lobotomy.  Psychiatrists, historians and journalists have weighed in on this controversial topic, and the procedure has been featured in a number of Hollywood films.

Yet there is nothing like a narrative of a specific lobotomy patient to draw us into the subject anew.  And that is why Kate Clifford Larson’s new book, Rosemary: The Forgotten Kennedy Daughter, is so compelling—even if we already know the sad outcome of Rosemary Kennedy’s life.

Originally devised in 1935 by the Portuguese neurologist Egas Moniz, the lobotomy involved drilling holes in the skull and using a blade to sever nerve fibers running from the frontal lobes to the rest of the brain.  Moniz believed that psychiatric symptoms were caused by longstanding faulty nerve connections.  Severing them, and allowing new connections to form, he postulated, would help treat patients with intractable mental illness, such as schizophrenia and its paranoid delusions.

America’s chief proponent of lobotomy was Washington, D.C. neurologist Walter J. Freeman who, working with neurosurgeon James W. Watts, reported in 1937 that 13 of 20 patients undergoing the operation had improved.  Freeman would later devise his own procedure, the transorbital lobotomy, in which he actually used a mallet to pound an ice pick through the patient’s eye socket into the brain, then moved the pick around blindly to cut the nerve fibers.

Among the first histories of lobotomy was psychologist Elliot S. Valenstein’s  Great and Desperate Cures (1986), which strongly criticized Freeman and his contemporaries as overzealous physicians who did far more harm than good, creating docile and apathetic individuals no longer capable of caring for themselves.  Physician-historian Joel Braslow’s Mental Ills and Bodily Cures (1997) argued convincingly that a main motivation for the popularity of lobotomies—roughly 40,000 would be performed in the United States by the 1960s—was to enable staff members to maintain order in crowded, understaffed institutions.   In Last Resort (1998), historian Jack D. Pressman made the provocative claim that lobotomy represented the best science of the day and that, at least in some cases, it allowed patients to return home with fewer psychiatric symptoms.

Rosemary Kennedy was born in 1918, the third of what would eventually be nine children of Joseph and Rose Kennedy.  Joe was a successful businessman and investor who later entered politics, first as chairman of the Securities and Exchange Commission from 1932 to 1935 and then as U.S. Ambassador to Britain from 1938 to 1940.  At an early age, it was clear that Rosemary was not as mentally sharp as her two older brothers, Joe Jr. and John.  Larson hypothesizes that Rosemary’s “intellectual disability” occurred at birth, when a nurse forcibly kept her in her mother’s womb—perhaps without adequate oxygenation—while waiting for the doctor to arrive.

It was Rosemary’s blessing and curse to be born into the high-powered and prominent Kennedy family.  Her parents left no stone unturned in trying to help their daughter, sending her to special schools and programs around the world.  But they simply could not tolerate her lack of improvement.  Rosemary was a terrible speller and writer, socially awkward and at times unruly.  Joe Sr., in particular, worried about the negative ramifications to his sons’ possible political careers if word got out about their “retarded” sister.

Reading about Rosemary’s first two decades, and knowing that her lobotomy is approaching, is truly heartbreaking.  Writing letters home from her various placements, she was so eager to please.  “I would do anything to make you happy,” she told her father in 1934 at the age of 16.  “I hate to Disppoint [sic] you in anyway.”

When the Kennedys first arrived in England in 1938, Rosemary, her mother Rose and her younger sister Kathleen were presented to the king and queen.  For once, the circumstances tilted in Rosemary’s favor.  The event was smashing.  Photographs show Rosemary, who had become a very attractive young woman, resplendent in a “picture dress of white tulle.”  She felt, she said, like Cinderella.

But when the family returned to the United States in 1940, with war approaching in Europe, the situation was no different than it had always been.  Plus, now in her early twenties, Rosemary’s moodiness and emotional outbursts were becoming more frequent.

Lobotomy had gotten a lot of press in 1941, particularly in a May article in the Saturday Evening Post that highlighted the work of Freeman and Watts.  And while this piece warned about the dangers of the procedure, it mostly praised its ability to make people with mental illness into “useful members of society.”  At some point, Joe Kennedy met with Freeman and decided that Rosemary should undergo the operation.  Larson does not unearth exactly how the decision was reached—or what Rosemary was told.  But it seems to mostly have been Joe’s doing.

The problem, of course, was that lobotomy was not meant for what Rosemary had—essentially a low IQ.  But Joseph Kennedy, in conjunction with her doctors, had convinced himself she had an “agitated depression,” and thus was a candidate.  That Freeman was a zealot for the operation, as is well documented in journalist Jack El-Hai’s The Lobotomist (2005), did not help.  Most tragically, when Rosemary underwent her lobotomy some time in November 1941, something went “horribly awry.”  Patients were kept awake during the procedure and asked to talk or sing to help guide the surgeon’s scalpel.  But in Rosemary’s case, when Watts made his final cut of brain tissue, she became incoherent.  “The operation,” Larson writes, “destroyed a crucial part of Rosemary’s brain and erased years of emotional, physical and intellectual development, leaving her completely incapable of taking care of herself.”

The rest of Rosemary discusses her life after the lobotomy until her death in 2005.  She spent most of these years at a Catholic residential institution in Wisconsin.  Most cruelly, family members rarely visited, trying to render invisible what had happened.  To the Kennedys’ credit, in later years they corrected this error and brought Rosemary for visits to Hyannis Post and other family outposts.  There are only a few photographs in the book from this later era, but they help to humanize the woman who suffered for so long.

View full annotation

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

Summary:

The great French actress Sarah Bernhardt (1844-1923) conducted an affair with her doctor, gynecologist Samuel Pozzi (1846-1918) in the decade before he married. They remained friends, and she always called him her Docteur Dieu (doctor god).

The handsome physician was a leading light in French gynecology and in the Paris arts community. Clad in his red dressing gown, Pozzi was the subject of John Singer Sargent's wonderful portrait (1881), which spawned erotic legends about him.

At first happy, Pozzi’s marriage degenerated into coldness, but his wife would not grant him a divorce. He then established a long-standing, public relationship with Emma Fischhof. During the Dreyfus affair, which unmasked the horror of entrenched anti-Semitism in France, physician and actress both fought against the ill treatment of the Jewish officer.

In 1915 and at Sarah’s insistence, Pozzi amputated her painful leg. Three years later, he was shot and killed by a disgruntled and delusional patient who blamed him for a minor illness.

 

View full annotation

Summary:

Emily Bauer, mother of two small children, psychotherapist and teacher, social, smart, athletic, and strong-willed, finds, after a curious series of falls and other accidents, that she has ALS, "Lou Gehrig's Disease," a disease that involves slow atrophy of all muscular control, leading to complete paralysis and then death.  The disease is relentless, and treatments palliative at best. 

View full annotation

Summary:

Rosalind Franklin: The Dark Lady of DNA is the biography of the scientist whose research James Watson and Francis Crick needed to elucidate the structure of the DNA molecule.  Even though the discovery has had profound implications for modern medicine, Franklin's contribution to it almost remained obscure.

In 1968 Rosalind Franklin (1920-1958) became visible to the world beyond a small circle of scientists when Watson published The Double Helix (1968), his "personal account" of puzzling out DNA.  If not for Watson's self-incriminating candor about stealing glances at Franklin's research, we might not know how crucial her lucid x-ray diffractions of hydrated DNA were to him and Francis Crick.  However, the account that indirectly acknowledged Franklin's contribution to their work represented her in a patronizing caricature.  Since ovarian cancer took her life a decade before Watson's memoir appeared, others have been left to respond to his version of the DNA story and representation of his female colleague.  Among Franklin's defenders, Brenda Maddox offers the most complete and insightful restoration of the scientist, her research, and her life. 

Maddox's biography draws from not only the many scientific archives and personal papers of scientists Franklin worked with in England, Europe, and America, but also from previously undisclosed letters written by Franklin, her friends, and her family.  Maddox also interviewed Franklin's relatives.  Doing so allowed her to position Franklin's life within the history of her close, extended Anglo-Jewish family, generations of wealthy London publishers and bankers who experienced discrimination.  This history does more than belie some of Watson's hasty assumptions about Franklin's background.  It creates a biography of a complex woman who negotiated biases as a citizen and a scientist.     

The biography is divided into three parts.  The first narrates the story of Franklin's childhood, rigorous education, and successful career before accepting the fateful research post at King's College, London.  She's known for thinking skeptically and working mathematically.  Yet early on she showed an aptitude for three-dimensional thinking and for understanding crystalline structures.   As an undergraduate at Cambridge she speculated about a "'Geometrical basis for inheritance'" (56).

The second section concentrates on the 27 months at King's when she worked uneasily with Maurice Wilkins, who showed her revelatory x-rays of DNA to Watson.   This balanced account of a controversial episode in the history of science offers evidence that Franklin was close to drawing the same conclusion about the structure of DNA that Watson and Crick rushed into print.  This section also accessibly explains the molecular biology of her day and the painstaking physical and intellectual intricacies of making and interpreting x-rays of crystalline molecules. 

The third section reminds us that Franklin had a very productive, though short career after leaving DNA to others.  She directed research programs for the study of plant viruses, and she investigated the polio virus shortly before she died.  Respected scientists, including Crick, praised her research.   Many, unlike Wilkins, liked working with her.  More than 40 years after viewing what's known as Franklin's Photograph 51, Watson publicly acknowledged that seeing it "'was the key event'" in understanding the geometry of DNA (316).  (See the note on Photo 51 below.)        

View full annotation

Summary:

Candice Millard portrays several figures in the 19th century whose lives came together to change history: newly-elected President of the U.S. James Garfield; the insane would-be assassin Charles Guiteau; Doctor Bliss, the arrogant physician who claimed control of Garfield's care; Alexander Graham Bell, who invented a device to find the bullet; and major political figures of the time. Ironically, Garfield attended the Centennial Exhibition in Philadelphia in 1876 where Joseph Lister was displaying his germ theory of infection and Alexander Graham Bell demonstrated his telephone. But when Guiteau shot Garfield in 1881, the bullets did not kill him.  What killed him after months of suffering was the massive infections caused by the doctors' probing without clean hands or clean instruments. At the autopsy, the doctors saw evidence of massive infections, but the bullet was encysted and harmless. All the probing by the doctors created a tunnel, but it was not the path of the bullet.  "Gentlemen, we have made a mistake," said the doctor.

View full annotation

Summary:

Mary Anning was born in Lyme Regis in 1799 on the southern coast of England. With her father, she learned to hunt for fossils that have become popular curiosities among tourists. But the science of paleontology was still in its infancy. Her father died in 1810 leaving his small family in precarious circumstances. The following year, at the age of twelve, Mary unearthed the full skeleton of the world’s first ichthyosaur--more than 30 years before Richard Owen would propose the term, dinosauria (terrible lizards) to describe the class of these extinct creatures.

For the rest of her life she was driven to scour the cliffs day in, day out. Wearing odd, bulky clothing to protect her from the elements, she found many important fossils, including the first Plesiosaur and the first representative of a certain kind of pterodactyl.  She sold them to scholars. Although isolated and poor, she kept up with the new discoveries through the literature, and was skilled at reading the landscape and the unique bones.

Mary never prospered from her work, but received all visitors with generosity, flattered and proud of the small attention they gave her. Lacking privilege and a husband, her discoveries were taken over by male scientists who used them to build the new science and their reputations. Religious concerns over the age of the objects is a backdrop for the discoveries; however, Mary appears to have been convinced that her fossils challenged the standard interpretations and yet unshaken in her faith. She died of breast cancer at age 48.

View full annotation

Summary:

In September 1796, 32-year-old Mary Lamb (1764-1847), stabbed her mother to death with a carving knife during an incoherent frenzy. Almost immediately, she became calm and was sent to a madhouse, remaining away from home for months until her grieving and unforgiving father had died. Mary was released into the care of her much younger brother, Charles (1775-1834), soon to be known for his poetry and essays. She never went to prison, but would return to the madhouse many times over the next fifty years. As a result, this life is an interesting exploration of chronic mental disturbance in the early nineteenth century.

Neither Charles nor Mary ever married; they always lived together and professed to be each other's dearest friend. Obliged to eke out a middle class income--she (until her crime) at dressmaking, he in an office--they turned to writing, often together. The Lambs' famous Tales from Shakespear [sic] was written mostly by Mary, but their friend William Godwin under Charles's name as sole author first published it. Mary's other books, edifying texts for young female readers, were published anonymously.

Letters to their many friends reveal Mary's vexation with Charles's drinking and smoking and his concerns over her multiple relapses, which were triggered by being obliged to move house. Charles predeceased his older sister by ten years and she spent the rest of her life in chronic care of a private couple, visiting his grave almost every day.

View full annotation

Summary:

John Romulus (also known as Richard) Brinkley was a physician (in the diploma-mill sense of the word) who, in 1917, pioneered, in the U.S. at least, the notion of goat testicle transplant. "Transplant" must be understood in the loosest sense of the word since Brinkley simply removed the testicles from young goats and sewed them into the abdominal wall and scrotal tissues - without any attempt to connect blood or nervous tissues of either goat testicles or human  - of men for the alleged purpose of relieving impotence. From 1917 until his downfall at the hands of Morris Fishbein, a medical crusader esconced in the AMA, which organization Dr. Fishbein helped establish as the premier advocate of organized medicine in the U.S., Dr. Brinkley was perhaps the most recognizable physician in the U.S.

He ran for the office of Governor of Kansas in 1930 (losing by technicalities that today would have overturned the results), and established the most powerful radio station in the land, XERA, that promulgated his glandular chicanery all across the continental U.S. As a proponent of such skullduggery, Brinkley was continually in the sights of Dr. Fishbein, whose main reputation nationally was as an exposer of medical fakery. Eventually Fishbein lured Brinkley into a libel trial that resulted, in 1939, in the catastrophic downfall of an immensely talented and wealthy man who spiraled into bankruptcy and death in 3 short years.

View full annotation

Summary:

In the prologue to "The Anatomist" author Bill Hayes explains why he undertook the task of writing a biography of the author of the famous illustrated textbook "Gray's Anatomy." The reasons stem from his childhood and are multifold: an early interest in becoming a doctor, a fascination with religious (particularly Catholic) and artistic perspectives of the body coupled with an acceptance of his own homosexuality, a growing admiration for the writing and drawing in his bargain table copy of "Gray's Anatomy," and finally an attraction to a photograph of the enigmatic author in his anatomy lab - one of the few traceable artifacts of the man himself. Hence "The Anatomist" is not only a meticulous and fascinating biography of Henry Gray, the writer, and Henry V. Carter, the illustrator of "Gray's Anatomy," but also a memoir of the education and life of Bill Hayes himself during the period of research and writing this book. The book is a masterful mix of the history of medicine, anatomy education both current and historic, methodology of historical research, and poignant, insightful commentary on the frailties of human bodies and human relationships.

Hayes took three anatomy courses at University of California, San Francisco during the preparation of the book - one with pharmacy students, one with physical therapy students, and the final one with medical students. By the third course, Hayes was a pro at dissection and had first hand knowledge and appreciation of the skills needed to be an anatomist.

Because of the paucity of information available on Henry Gray, the bulk of the research rests on the diaries and letters of the tireless, self-critical and amazingly skilled younger member of the book's creative team - the artist-physician Henry Carter. Through Carter's diaries we learn of the formidable genius of Gray, his academic accomplishments, the genesis of the idea for the book, and Gray's early death at age 34.

Interestingly, in a pattern similar to that of Andreas Vesalius's "De Humani Corporis Fabrica," whose illustrator was most likely Jan Stephen van Calcar, the artist Carter receives scant reward or acknowledgement of his vast contributions to the book. Hayes's biography rectifies this hundred-and-fifty-year-old omission by tracking not only the career of Gray, but also Carter. Indeed, peppered throughout "The Anatomist" are more illustrations than quotes from "Gray's Anatomy."

View full annotation