Summary:

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."

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This posthumously published collection of essays by Dr. Klawans, an eminent neurologist and writer, explores the interactions between patient, family and neurologist and the implications of specific neurologic diseases. Klawans's special interest in neurology is movement disorders, such as Huntington's chorea and Parkinson's disease, but his outside interests range from evolutionary biology to classical music. His essays, therefore, focus on single patients or families, but the author weaves thoughts about his other interests into each "case."

The book is divided into two sections, "The Ascent of Cognitive Function" and "The Brain's Soft Spots: Programmed Cell Death, Prions, and Pain." In a brief preface, Klawans declares that this book is "more than just a set of clinical tales about interesting and at times downright peculiar patients" from his 35 years of practice, but rather it "humbly grapples with the 'whys' of our brain, not the 'hows.'" (pp. 9-10) In the preface, as well as in one essay, Klawans acknowledges the work and impact of fellow neurologist-writer Oliver Sacks ("Oliver is truly the father of us all." p 12).

The title essay concerns a six-year-old girl who was found, locked and completely speech-deprived, in a closet. Because she is still within the window of opportunity for language acquisition, "Lacey" quickly learns to speak, unlike Victor, the Wild Boy of Aveyron, whose story was immortalized in the François Truffaut film, L'enfant Sauvage. Klawans uses these stories as a launch pad to discuss the evolution of language, including a proposal that the cavewoman, not the man, was responsible for development of the human species as she taught her offspring language.

Other chapters focus on patients with epilepsy, Parkinson's disease, localized and hemispheric stroke, "painful-foot-and-toe syndrome, " and Creutzfeldt-Jakob disease. Two particularly memorable chapters concern Huntington's chorea and Refsum's disease. The chapter, "Anticipation," explores the profound ethical concerns of genetic testing for Huntington's chorea as applied to three generations of one particular family. In the chapter, "The Hermit of Thief River Falls," Klawans recollects his first year as a neurology resident, and his care of a reclusive patient with a rare eponymous illness, Refsum's disease--just in time for a visit by Refsum himself, a famous Norwegian neurologist.

The book concludes with a speculative "afterthought" about genetics, evolution, and the importance of extended "juvenilization" --the protracted post-natal development of Homo sapiens. This essay intertwines some of the threads regarding speech development and evolutionary biology, particularly brain development, that were introduced earlier in the text.

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In this lyrical, funny, sad, heartwarming work, Joyce Dyer takes us inside an Alzheimer's unit where she visits her mother daily and watches as she experiences the many absurdities and contradictions of this disease over several years. Dyer records not only the behavior of her mother and other patients in the unit but also her own feelings of worry, anger, frustration and then acceptance. The prose-poem style of this writing makes the work especially wonderful to read, because it is a work of art as well as a very helpful document.

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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.

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The story is a letter written by a 24-year-old woman to her niece who was given up for adoption. Bitte Liten, from a close Norwegian family, remembers the summer she was 12 when she was sent away during the last months of her sister's pregnancy to stay with her uncle. Her sister, 15, unwed and pregnant, had found adoptive parents for the child, but Bitte, imagining the pleasures of being an aunt and helping care for a baby, wanted her to keep it.

While at her uncle's, she visits her aging favorite aunt in a nursing home. Her aunt, sinking into dementia, doesn't remember her. This leaves her reflecting on how much of life is memory of the past and dreams of the future. Her period comes that summer for the first time, and with it, a new understanding of adult responsibilities and her sister's predicament.

She writes her sister to tell her she understands her decision and will support her. In return, her sister invites her to be at the hospital the day the baby is born. There Bitte meets the adoptive parents as well as the baby, says hello and goodbye to her little niece, and comes to understand something new and harder about what love looks like. Twelve years later, she records all these memories for the niece who has grown up as someone else's child.

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When six fifty-year-old women gather for an annual reunion they've come laughingly to call "Camp Men-o-pause,” at an idyllic midwestern lakeside bed-and-breakfast they face a bewildering and sorrowful difficulty unprecedented in their many years of friendship since college: Micky, in many ways a leader and intellectual bright light among them, has been diagnosed with early Alzheimer's disease. She is present and functioning, but has bouts of confusion and memory loss.

She knows a great deal about her own condition and has shared it with the others. Only with one other, Jan, has she shared her desire to be helped to commit suicide when she becomes seriously incompetent, and, enjoined to secrecy, Jan has to bear the burden alone of deciding whether to make Micky that promise.

The story chronicles the week the women spend together, their various thoughts and conversations about their lives, and the ways in which Micky's disease leads them all to reframe their feelings about friendship, loyalty, aging, and medical options. Much about the week is bittersweet; the story ends inconclusively as Jan is unwilling to promise to help Micky die, but all come to some sobering understandings about what it might mean to "see their friend through” a gradual leavetaking that may erase them all from her memory.

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Narrated in the third person, the poem is a telephone conversation between an adult son and his complaining mother. This is the mother's second phone call of the day to her son, who had spent several hours shopping for groceries with her earlier that same day.

She is tired, says the mother, and there is no food in the house worth eating. Replies the son, "Did you take your iron? He wanted to know. / He sincerely wanted to know. Praying daily, / hopelessly, that iron might make a difference." Food is a touchy subject--"it never brought them anything but grief."

Later the mother frets that she is afraid, "afraid of everything. Help me, please." If her son would only help her, then he could go back to "[w]hatever / it was that was so important / I had to take the trouble / to bring you into this world."

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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]

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As Joanne Trautmann Banks indicates in the Foreword of this fine anthology, "when we are sick, very sick, it is often the nurse who is closest to our bodies, minds, and souls." This experience of closeness to suffering is well-reflected in the poetry and prose of the 49 nurses whose work is collected here. While these writings vary widely in form and style, they focus almost exclusively on the nursing interaction; they are nurses' stories of patients and nurses' reflections on nursing. Two major themes pervade the book. One is the powerlessness of nurses in the face of illness and suffering. The other is their tough, unsentimental devotion to their patients and the profession.

Of the poetry, particularly fine pieces include: "Raiment" (Carol Brendsel); "Daffodil Days" (Celia Brown); Butterfly (Jeanne Bryner; see this database); "What the Nurse Likes" and The Body Flute (Cortney Davis); "Hospital Parking Garage" (Jeanne LeVasseur); and "Euthanasia" (Belle Waring). Among the excellent prose pieces are "Nighthawks" (Carolyn Barbier), a tale in the voice of a ventilator-dependent woman who has elected to discontinue treatment and die; "While His Life Went on Around Him" (Angela Kennedy); "Wisteria" (Leslie Nyman); "Where Are You Now, Ella Wade?" (Joyce Renwick); and "Bev Brown" (Sybil Smith).

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To take care of Aunt Martha, a Mississippi family agrees to a cousin's moving in with her; cousin Howie then maneuvers the family into running a home for the elderly. Martha agrees because Lucas, a physician with whom she's had a long relationship, will come to live there. As more elders come and as they get sick, the methods (restraints, use of drugs, unclean conditions) of Howie and his hired staff become a threat to all.

Martha and Lucas are rendered powerless by their inability to make the family believe their side of the story; even Harper, the family's longtime African-American butler, cannot help. Because he fears that Howie will sedate both of them into oblivion, Lucas decides to burn the house down--after killing several of the "prisoners" first.

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