Summary:

The 30 year old Anton Chekhov, determined to pay his "debt to medicine," sets off from civilized Russia to investigate the prison colonies on Sakhalin Island, off the east coast of Siberia. (See Chekhov's A Journey to Sakhalin, annotated in this database.) In the poem Chekhov stands at the rail of a steamer on Lake Baikal and downs a jigger of cognac, then smashes the glass on the rocks. "In the months to come / It rang on like the burden of his freedom / To try for the right tone--not tract, not thesis--"

In his attempt "to squeeze / His slave's blood out" (Chekhov was the grandson of serfs), he spent the next several months feverishly documenting the conditions on Sakhalin. Subsequently, he spent several years trying to express his experience in writing.

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This book contains the complete text of "Sakhalin Island" [300 pages], Chekhov's treatise describing his visit in 1890 to the Russian penal colonies on Sakhalin Island, and "Across Siberia" [30 pages], a description of his journey across Siberia to Sakhalin. The book also includes a collection of letters that Chekhov wrote during the seven-month trip. A series of appendices provide information on the Tsarist penal system, books consulted by Chekhov in preparation for his journey, and related matters.

Chekhov begins by describing his trip across the Tatar Strait on the steamer Baikal and his arrival at Alexandrovsk, the largest settlement and administrative center of Sakhalin Island. In the first two-thirds of the book, the author describes his systematic survey of almost every Russian community on the island. The text combines a travel narrative, which includes bits of conversations and fine descriptive writing, with demographic data.

At the time of Chekhov's visit, there were approximately 10,000 convicts and exiles living on the island, along smaller numbers of indigenous Gilyak and Ainu. Chekhov indicates the number of households and population of each settlement, and its breakdown by penal status of residents.

There were three categories of residents: (1) prisoners (some, but not all of whom were confined to the prisons that existed in the larger settlements); (2) settled-exiles, who had completed their prison terms but had to remain for life on Sakhalin; and (3) peasants-in-exile, who were permitted to leave Sakhalin, but had to remain in Siberia. Army folk and the families who accompanied some convicts to Sakhalin constituted a fourth class--they were free to return to European Russia.

Chekhov eloquently describes the poverty and terrible living conditions in this inhospitable land, as well as providing snippets of local geography and history. The final one third of the book consists of chapters on social and economic conditions, daily life, morality, and the health status of the population.

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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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In Gain, Richard Powers interweaves two narratives. One is the story of Laura Bodey, a forty-two-year-old divorced realtor with two adolescent children, who lives in the midwestern U.S. town of Lacewood. Sometime in the late 1990s, Laura is diagnosed with ovarian cancer. The account of her illness, treatment, and eventual death is set against the story of the Clare Soap and Chemical corporation, whose headquarters are in Lacewood, from its inception as a trading company at the beginning of the nineteenth century.

The Clare corporation is implicated in Laura's death: pollutants from its Lacewood plant have been associated, not quite unquestionably, with abnormally high cancer rates in the area. A class-action suit against the company succeeds, but Clare, globally powerful and massively differentiated, is ultimately immune: no matter how much we might sympathize with individual members of the Clare company (and Powers ensures that we do), the corporation has become a kind of monster beyond human control.

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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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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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The young English doctor, Mary Percy Jackson (M.D. Birmingham 1928), went to practice in northern Alberta for a year. She had been recruited by a philanthropic movement that targeted women doctors: they could be paid lower wages and would also cook and keep house. But she fell in love with the subarctic community, its native peoples, and a certain widowed farmer with two young sons, and stayed for the next seven decades.

Dr. Jackson became the only physician responsible for the well being of aboriginals and settlers in a wide radius of remote territory where winters last more than six months and the only effective mode of transportation was the horse. Married and in relative prosperity, she did not seek payment for her medical work, although she appreciated gifts in kind.

Despite the isolation, Jackson was vigilant about nutrition, vaccination, and tuberculosis control and she kept up with the latest advances in health promotion. She and her husband were active in improving opportunities for education. The film closes with a simple party for Jackson, at the local school named in her honour.

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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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This is the most detailed and comprehensive biography of Anton P. Chekhov written to date. Rayfield is a Chekhov scholar who published an earlier biography of the writer in 1975. There are numerous biographies of Chekhov available. In the Preface to this book, Rayfield explains why he wrote it. Chekhov's life is documented by a vast amount of archival material, much of which was unavailable to Western scholars in the past. Russian scholars have studied these sources extensively, but the studies they have published use only a small part of the material. Rayfield's own study convinced him that by drawing liberally from these archives he could write a new biography that would increase our understanding of Chekhov's life and character.

Rayfield's approach is strictly chronological. The book consists of 84 short chapters, each one named and subtitled with the period covered (e.g. July - August 1894). Rayfield sticks closely to the texts, developing a rather staccato style that is heavy on factual statements and light on his own interpretations. He also chooses not to discuss Chekhov's writings as such, except to present brief summaries of the plays and some of the more important stories, and to indicate relationships between Chekhov's life and his art.

The new material gives us a much better view of the day-to-day texture of Chekhov's life, his interactions with family and friends, and his interesting and enigmatic relationships with women. The book also includes a helpful diagram of the Chekhov family tree, two maps of Chekhov's country, and many photographs.

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This essay was written ten years after the author's Illness as Metaphor (see this database). Sontag begins by explaining the stimulus for her earlier essay: her own experience as a cancer patient. During that time, she discovered that cultural myths about cancer tended to isolate and estrange cancer patients. They suffered needlessly because of "meaning" attributed to their illness by society. A decade later, Sontag observes that attitudes about cancer have become more open and truthful. However, a new illness (AIDS) has arisen to carry forward the metaphorical banner.

AIDS brings together two powerful metaphors about illness. First, AIDS develops further the theme (seen earlier in cancer) of disease as invader: the enemy invades and destroys you from within. Thus, AIDS strengthens the use of military metaphors in medicine. The war against cancer is reincarnated as a war against AIDS. Secondly, because AIDS is a sexually transmitted disease, it also evokes the theme of plague-as-punishment.

Sontag's project in this essay is more focused than in the earlier book. She acknowledges that the medical and public health response to AIDS explicitly counters these myths. She concludes that "not all metaphors applied to illnesses and their treatment are equally unsavory and distorting" (p. 94). The metaphor she is most anxious to see eliminated is the military metaphor, both on an illness level (illness invades the person) and a societal level (social problems invade society).

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