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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Terrified of dying from AIDS but even more afraid of living with it, the title character of this romantic comedy--a gay actor/waiter-- makes the ultimate safe choice: to give up sex entirely. Determined to find both a substitute for sex and the meaning of life in the cruel meaninglessness of an epidemic, Jeffrey embarks on a journey through a picaresque and postmodern landscape. What he discovers is that while his desperate renunication of human connection may remove him from the physical experience of death, it will not protect him from the emotional experience of loss.

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Jacob Hansen is sheriff, undertaker, and pastor in the little Wisconsin town of friendship. A Civil War veteran like many of the men in his town, he has seen many faces of death and knows how to balance compassion, prayer, and practicality in the presence of grief. When he recognizes a diphtheria epidemic as one after another the people of Friendship fall ill and die, he has to shoulder responsibility for protecting public health.

This means imposing and enforcing quarantine, extending even to the encampment of religious revivalists at the edge of town who mostly keep their distance and their own ways. Jacob's equanimity falters when his wife and baby daughter succumb; he keeps them alive in his mind and unburied for days, unable to acknowledge his own loss, though he helps others through theirs.

Finally he forces a passing railroad engineer to transport the survivors across the quarantine border into a neighboring town for safety, but the train is sabotaged, wrecked, and the fugitives killed. Jacob survives almost alone to return to what is now a ghost town and cope with the grim fate of survival.

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Having fled Corinth because of a fearful prophecy that he would murder his father and wed his mother, the young Oedipus angrily attacks and kills a small band of travelers who refuse to make way for him at a crossroads, a "place where three roads meet." He ultimately journeys to Thebes, a kingdom without a leader and without any hope of freeing itself from the tyranny of the Sphinx. Relying on his "wit alone," Oedipus solves the riddle of the Sphinx and ascends the throne, eventually marrying the widowed queen, Jocasta, and fathering two sons and two daughters, Antigone and Ismene.

The prosperous and just reign of Oedipus is halted by a devastating outbreak of plague--a pestilence whose only remedy, according to Apollo, is justice for the murder of the murdered Theban king, Laius. An intelligent man and responsible leader, Oedipus launches an investigation, only to discover that he is not the savior of the city but the cause of its destruction. When his true heritage and his terrible crimes of parricide and incest are revealed, Oedipus blinds himself and invites banishment, nobly accepting his fate as "the greatly miserable, the most accursed . . . above all men on earth."

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This is a study of the influence of medicine and medical practice on Chekhov's writing. While the material is presented in a roughly biographical manner, the chapters are thematically organized. In "University Years" the author discusses Chekhov's experience at Moscow University Medical School (1879-1884) and the influence of several of his professors. "Diseases of the Mind" focuses on the play "Ivanov" and several stories that demonstrate Chekhov's keen interest in and understanding of mental disorders, including endogenous depression (Ivanov), neurotic depression or dysthymia (Uncle Vanya), and reactive or exogenous depression(An Attack of Nerves (A Nervous Breakdown)).

The next chapter covers Chekhov's extended trip to Sakhalin Island in 1890. "Tolstoy Versus Science" describes Tolstoy's position that scientific and technical progress lead to moral regression. For several years Chekhov was sympathetic to Tolstoy's ethical position, although he never embraced the older man's opposition to science.

"The Country Doctor" deals with Chekhov's medical and public health work during the years he resided at Melikhovo (1892-1897). The last chapter describes Chekhov's own battle with pulmonary tuberculosis.

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This history of western medicine in the nineteenth century chronicles the lives of some men and women who were innovators in the field of medicine. Williams begins the book in the 1700s with the life of John Hunter and his influence on nineteenth century medical practice and research.

The book consists of 16 chapters, many of which, like the one on Hunter are biographic. For example, Williams writes of the contributions, education, and lives of Florence Nightingale, Hugh Owen Thomas (orthopedics), Marie Curie, Joseph Lister, Ignaz Semmelweis (maternal health), Patrick Manson (tropical medicine), Jean-Martin Charcot, and William Conrad Röntgen. Other chapters are more theme-oriented, such as body-snatchers, discovery of anesthesia, homeopathic medicine, blood transfusion, and medical use of spas.

Black and white illustrations, such as Mrs. Röntgen's hand in an X-ray photograph help the reader to appreciate the advances in medical knowledge in the nineteenth century.

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The austere and homesick Breton doctor, René T.H. Laennec (1781-1826) (Pierre Blanchar) and his religious friend, G.L. Bayle (1774-1816) are caring for the hundreds of patients dying of epidemic tuberculosis in the Necker Hospital of Paris. They conduct autopsies on the dead, but cannot predict the findings before the patients' demise, nor can they offer any treatment.

Laennec's sister, Marie-Anne, arrives from Brittany with news of their brother's death from tuberculosis. He confesses his despair over this devastating scourge to his friend, but quickly realizes that Bayle too is doomed. A distant cousin, the widow Jacquemine Guichard Argou, becomes Laennec's housekeeper and companion in philanthropic work for the sick after he is able to reassure her about her health; she engages the widow of Bayle in the same enterprise.

One day in 1816, Laennec is invited by urchins to hear to the scratching of a pin transmitted through the length of a wooden beam. He is thereby inspired to fashion a paper tube to listen to the chests of his patients. With Jacquemine at his side, he joyously announces that he can hear sounds from inside the chest. Feverish research ensues as he links the chests sounds of the dying to the findings at autopsy.

He turns his wooden, cylindrical stethoscopes on a lathe in his apartment, publishes his findings, and marries Argou. Fame and notoriety follow, as Laennec is able to distinguish fatal disease from minor illness and to predict the need for operations; however, he is ridiculed by jealous colleagues. Suffering now himself, Laennec consults his friend Pierre Louis, who tells him that he has tuberculosis. In the final scene, he returns to his native Brittany only to collapse on the stairs of his beloved home and die.

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Grégoire Ponceludon de Malavoy (Charles Berling) travels to the court of Louis XVI at Versailles seeking support for his plan to drain a marsh in order to relieve his poverty-stricken community from the scourge of malarial fever. Naive in the ways of court, he is robbed and left on the road for dead. A kindly doctor and would-be courtier (Bernard Girardeau) finds Grégoire and nurses him back to health with the help of his beautiful and highly intelligent daughter, Mathilde (Judith Godréche).

Grégoire accompanies the doctor to court where he quickly excels in the fine arts of repartee, ridicule, and sang-froid. Seeing this practice as a route to the king, Grégoire plays the game well and begins to have fun, in spite of himself. He attracts the attention of the influential Comtesse de Blayac (Fanny Ardent) with whom he sleeps, despite his love for Mathilde.

A peasant child's death at home inflames his obsession over the marsh. At the moment he is finally about to have the king's attention, he duels with an officer over a matter of honor; he wins the duel but loses his regal audience for having shot a royal soldier. The film ends in the Revolution: Grégoire and Mathilde are well launched in their drainage project and the doctor is an émigré on the English coast learning the fine arts of British humor.

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During the course of a plague, Prince Prospero calls together his friends to come to his castle for fun and frolic until the danger of pestilence has passed. A masquerade is planned, and in typical "Poesque" fashion the great halls are described in imagery that foreshadows a horror to follow. The night of the ball comes, the guests arrive in their costumes and the festivities begin.

The gaiety is interrupted by the arrival of a guest, dressed in the garments of the grave besprinkled with the scarlet blood associated with the plague of "red death." The intruder stalks the halls until confronted by the host in (of course) the black hall. Without explanation, the host falls dead at the masquer's feet and the revelers, setting upon the intruder, find that the costume is "untenanted by any tangible form." Whereupon, the guests began to die in their tracks as they acknowledge the presence of the Red Death.

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Dr. Tom More, from Love in the Ruins (see this database), now middle-aged, returns to Feliciana after spending two years in prison for selling prescriptions of Dalmane and Desoxyn at a truckstop. On his return to his psychiatric practice, More observes that two of his former patients are acting strangely. In his own words: "In each there has occurred a sloughing away of the old terrors, worries, rages, a shedding of guilt like last year's snakeskin, and in its place is a mild fond vacancy, a species of unfocused animal good spirits." (21)

More observes that his wife Ellen and his children have also undergone some mysterious personality change. More, the scientist-physician, with the help of his cousin Dr. Lucy Lipscomb, launches a search for the cause of these and other observations. More and Lucy discover that John Van Dorn, head of the computer division of the nearby Grand Mer nuclear power plant and Dr. Bob Comeaux, director of the Quality-of-Life Division of the Federal Complex overseeing euthanasia programs, are involved in social engineering, releasing Heavy Sodium into the water supply to "improve" the social welfare.

Throughout the novel, Dr. Tom More returns several times to evaluate and talk with Father Rinaldo Smith, a parish priest who has exiled himself to a firetower overlooking the vast pine forest of Feliciana. More has been asked by Comeaux, who sits on the probationary board overseeing More's return to practice, to declare Father Smith crazy, so that Comeaux can take over Father Smith's hospice and put it to better use. The conversations between More and Father Smith contain the philosophic and moral themes that support the plot and action of the novel.

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