Summary:

Aging, Jewish-Canadian gum-shoe, Benny Cooperman, awakes in hospital from a coma to discover that he has forgotten many things about himself and his recent past. He has also lost the ability to read, although he still can write: alexia sine agraphia. The therapists give him a memory book as an aide to functional recovery; he must record vital information for later deciphering. He learns that he was found unconscious in a dumpster with a blow to the head; beside him lay the corpse of a woman professor.

Leaving the hospital only once (without permission), Cooperman uses dogged determination and ingenuity to unravel the complex academic homicide. Adapting to his own disability proves just as demanding to Cooperman as solving the murder. Without giving away the ending, this "whodunit" involves premonitory dreams, pretty students, rogue professors, a crusty underworld, and drugs. Engel's trademark light touch and vignettes of Toronto and its University colleges and hospitals add humor and credibility to the vivid yarn.

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Subitled, Invisible Wounds of War. Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery, this monograph features 27 contributing researchers. Published by the RAND Corporation, it is funded by a grant from the Iraq Afghanistan Deployment Impact Fund. The study was conducted under the joint auspices of the Center for Military Health Policy Research, a RAND Health Center, and the Forces and Resources Policy Center of the National Security Research Division of the RAND Corporation.
 
The work deserves our full attention as it delineates and explains the economic, human, medical, political, public health, and social consequences of injuries suffered by returning veterans of US involvement in 8 years of continuous conflict in Afghanistan and Iraq. The introduction defines the three kinds of invisible wounds affecting thousands of the 1.64 million American troops deployed in Operation Enduring Freedom (Afghanistan) and Operation Iraqi Freedom (Iraq) since 2001. These combat related injuries are post traumatic stress disorder (PTSD), major depression, and traumatic brain injury (TBI). Upwards of 26% of returning troops may have mental health concerns, including drug and alcohol dependency, homelessness, and suicide.

The monograph analyses numerous studies of these issues, both governmental and non-governmental, and RAND has conducted its own study. The data collection is recent: from April 2007 to January 2008. RAND estimates that approximately 300.000 persons currently suffer from PTSD or major depression; in addition, 320,000 veterans may have experienced TBI during deployment.

The recommendations include evidence based care at the VA level, the state and community level, and on site in Afghanistan and Iraq. Adequate care would pay for itself and save money in the long run by improving productivity and reducing medical and mortality costs for members of the US armed forces.

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This study sets forth the mystery of scurvy  which devastated the British Navy during the eighteenth century. Among several diseases common on board, including yellow fever, typhus, or typhoid fever, syphilis, tuberculosis, and dysentery, scurvy was the most devastating. Caused by a lack of vitamin C, scurvy’s symptoms appear as swollen and bleeding gums, livid spots on the skin, and prostration. Untreated, the illness results in agonizing death. When Commodore George Anson’s flagship, Centurion, sailed from Plymouth in 1741, rounded Cap Horn and returned to Britain, his ship carried home only two hundred of the two thousand men he set out with. A deadly combination of voyages lasting a year or more, unhealthy conditions on board, including malnutrition, filth, crowding, ignorance about basic facts of biology, as well as inexperienced sailors pressed into crewing on ships managed by violent officers using harsh physical punishment resulted in millions of deaths at sea from the age of Columbus to the nineteenth century, when scurvy remedies were finally found.

Bown credits three men with discovering a solution to the mystery of scurvy: a surgeon, James Lind (1716-1794), sea captain James Cook (1728-1779), and a  physician, Gilbert Blane (1749-1843). Lemon juice had been known to prevent and cure scurvy since the 17^th century, but 18^th century medical men disregarded empirical knowledge in favor of the theory of humours.

James Lind entered the Royal Navy as a surgeon’s mate in 1739 under appalling conditions similar to those described by Tobias Smollett in Roderick Random (1748). He initiated a two-week controlled experiment where he separated the afflicted sailors into 6 groups who each received a different diet: cider, vitriol, vinegar, sea water, oranges and lemons, and nutmeg paste. The group receiving the oranges and lemons obtained the best results. Lind published his treatise on scurvy in 1753. However, he was unable to explain the causes of scurvy and why oranges and lemons led to its cure.

James Cook circumnavigated the world 3 times. On his lengthy voyages, he stopped for fresh fruits and antiscorbutics wherever he could, as he noticed these kept the seamen free of scurvy. Cook showed that scurvy was curable, but not why.

During the War of American Independence, Gilbert Blane served as a physician on board several warships in the British Navy. He instituted a diet of fresh fruits and better hygiene on board ship. He published Observations on the Diseases Incident to Seamen, in which he advocated using oranges and lemons to cure scurvy. He advised that lemon juice be mixed into the sailors’ grog.

The British Navy encountered an historic ordeal in 1805 with the Battle of Trafalgar. Admiral Nelson, commander of the British Navy, had nearly died from scurvy in 1780. Now he faced Napoleon Bonaparte and the French fleet. Bown argues that the near- elimination of scurvy on board their ships contributed mightily to the British victory.

A timeline, from 1492 to 1933, concludes the volume. Recommended readings, a bibliography and an index are provided.

 

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This book chronicles four meals, tracked from the production of the food through to the preparation and consumption of the meals themselves. The first is a fast food meal eaten in the car, the quintessential American meal consisting entirely of industrially farmed produce. Pollan then goes on to have an industrial-organic meal, an organic pasture-grown meal, and finally a meal containing only products that he foraged, hunted, and cultivated himself. Throughout, he looks closely at how economic and commercial values have supplanted ecological ones in the cultivation and production of the food we ingest. In addition to attending to the social and political dimensions of the American diet, Pollan also notes the effects of this diet on public health, from rising levels of obesity through to the antibiotic resistances developing in herds of cattle living in pens in their own manure.

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This is another wonderful book from Dr. Sacks. The subtitle, “Tales of Music and the Brain,” is accurate: we have a charming and informative mixture of stories of patients and the neurophysiology that interprets how music is processed and performed. The book is synthetic in combining cases from his practice, other clinical reports, letters from correspondents, references to medical literature, and even Sacks’s own personal experiences with music.

Sacks finds that humans have a “propensity to music,” something “innate” in human nature, perhaps like E. O. Wilson’s biophilia. “Our auditory systems, our nervous systems,” he writes, “are indeed exquisitely tuned for music” (xi). Although humans have been involved with music for millennia, it is only in the last few decades that medical imaging (functional MRI, PET) has shown what areas of the brain are active when music is heard.

While humans routinely enjoy music, the book emphasizes unusual events and neurological patients, in short, departures from the norm. Sacks—himself a lover of music—reports on his own experiences with hallucinatory music and anhedonia (loss of pleasure) in hearing music. He describes going to hear the great baritone Dietrich Fischer-Dieskau but finding that he could not, on that day, perceive the beauty of the music. Another condition “amusia,” or loss of musical ability, can be chronic, acquired, or temporary.

Some patients have had injuries or diseases of the brain that change how music is perceived. A man hit by lightning is suddenly obsessed with piano music. Another man (who survived a brain infection) has amnesia about many things but can still make and conduct music at a professional level. The concert pianist Leon Fleisher visits Sacks to discuss his dystonia, or loss of muscle function in one hand (with implications for the brain). Rolfing and Botox helped him heal and he returned to two-handed performances.

Sacks discusses other phenomena that involve brain structures, for example, perfect pitch; persons with this ability have “exaggerated asymmetry between the volumes of the right and left planum temporale” (128). People who experience synesthesia (perceiving notes as colors) have cross activation of neurons in different areas of the brain. Professional musicians (and patients with Tourette’s) demonstrate cortical plasticity, that is they have expanded areas of the brain for particular uses. Children with Williams syndrome have brains influenced by a microdeletion of genes on one chromosome; they have some cognitive deficits and also a great responsiveness to music. For some conditions, the brain determines all; for others, behavior components are also important.

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In 1921, the twenty-four year-old Scottish medical graduate, Andrew Manson, takes up an assistant’s position in a small Welsh mining town. He is idealistic, but he quickly learns that his training is inadequate and that his hemiplegic employer will never return to practice. Manson must do all the work for a pittance and bad food. He befriends another assistant, the surgeon Phillip Denny, whose fatal flaw is devotion to drink. Together they solve the town’s problem with typhoid by blowing up the sewer.

Manson’s escape comes in a new job in a larger town and marriage to the equally idealistic Christine. She encourages him to continue his studies and to conduct research on the relationship between dust inhalation and tuberculosis. The results include higher degrees and international recognition, but they also bring about the wrath of the town’s antivivisectionists. To add to the gloom, Christine looses a much wanted pregnancy and the ability to have children.

The Mansons leave Wales for London, where Manson hopes to extend his research within a government agency. Quickly disillusioned by bureaucracy, he is lured into society practice and slowly abandons his ideals in exchange for prestige and wealth. Christine is increasingly unhappy, but his response is annoyance with her and an affair with a married woman. When one of his new associates botches an elective operation on a trusting patient, he realizes the colleague is nothing more than a society abortionist and that he and his new friends are little better.

He decides to sell his practice and renews contact with Denny to establish a group consulting practice "on scientific principles" in a carefully chosen Midland town. He also helps the tubercular daughter of an old friend to an unorthodox (but effective) pneumothorax in a clinic run by Stillman, an American who does not have an MD. Just as he and Christine have rediscovered joy in each other and their future together, she is killed in a freak accident. Only days later in the depths of grief, he is brought before the General Medical Council on charges of unprofessional conduct laid by his former associates. He acquits himself brilliantly and leaves with his old friend Denny for work in the Midlands.

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A collection of short stories loosely connected to each other by centering on the experiences of four people from their first encounters during medical school and continuing into young middle age.

The first and third stories “Getting into Medical School, Part I” and “Part II,” are about study partners, Fitzgerald and Ming, who have trouble admitting their love for each other until she is accepted to medical school and he is not. Ming teaches Fitzgerald how to prepare successfully by passing along learning tips her physician-cousin provided her in exchange for sex. In the second story, Ming meets fellow students Sri and Chen and drifts away from Fitzgerald. In the third, he wrestles with feelings of rejection and misery as he realizes she has opted for a relationship with the more culturally “appropriate” Chen; however, her study tips pay off in more than one way when he meets Ming’s unsavory cousin at his medical school interview.

Later stories describe clinical encounters with specific cases, one of the most memorable being “Winston,” about Sri’s relationship with a paranoid person; the tale is told alternatively from the doctor’s perspective and the patient’s. in “Afterwards,” Sri must explain to a man’s wife and son, how he died suddenly at a strange hairstylist salon; the news disturbs the family who discover that the supposedly impotent diabetic had been a regular at a sex shop.

Fitzgerald and Chen become emergency physicians. Less settled, Fitzgerald tries several settings, including working for an air ambulance company. His problem with alcohol emerges from deep disaffection and brooding resentment over Ming’s callous rejection years earlier and her subsequent marriage to Chen. The problem begins to threaten his judgement and seriously compromises his health when he falls ill.

In the ironically titled “Contact Tracing” both Fitzgerald and Chen contract SARS (the latter from the former) during the (real) 2003 Toronto epidemic. They are isolated in adjoining rooms separated by glass and phone each other for support and discussion. They reminisce about Sri who has died of cancer and muse on the relevance of do-not-resuscitate orders. The outcome is both humorous and surprising.

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Idealistic, nervous, and rigid, Andrew Manson (Robert Donat) takes his first medical job as an assistant to a doctor in a Welsh mining community. The greedy wife of his invalid employer obliges Manson to hand over most of his earnings. But he finds a local kindred spirit in the outspoken Dr. Denny (Ralph Richardson). In a drunken prank, they blow up the town sewer forcing the unwilling government to repair a notorious source of typhoid.

Manson marries a beautiful school teacher (Rosalind Russell) who leaves her beloved classroom to follow him to an even larger mining town. There he is employed by a group practice run on a capitation basis by the miners. In their evenings, the Mansons investigate the problem of chronic cough in miners, linking it to tuberculosis and coal dust--a discovery that they publish. But suspicious miners destroy their laboratory and force them to London and poverty.

A chance encounter with a wealthy hysteric and an old mate (Rex Harrison) raises Manson’s social standing. He opens a Harley Street practice and makes a fortune. His wife regrets the loss of his ideals and the death of his research. She begs him to remember how happy they were in poverty when each day was a noble challenge to take "the citadel" of life. Denny returns to entice Manson into a new group practice funded by community insurance, but Manson flatly refuses. Denny’s accidental death and a blunder by an elite, unethical Harley Street surgeon bring Andrew back to his idealistic senses.

The film closes with his eloquent self defense against charges of irregular practice for having intervened (successfully) in the case of a little girl with tuberculosis. Manson assists as the child is treated gratis with the controversial new pneumothorax operation administered by an American who does not hold a medical degree. Whether or not Manson keeps his license, the audience is confident that his sense of purpose has been restored and that his wife loves him more than ever. He will return both to the comfortably compatible pursuits of research and serving the sick poor.

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Bewell examines the rise of "colonial geography," the assumption that disease naturally belongs to the colonial setting. He argues that British colonialism was "profoundly structured" by disease encounters, as diseases began to piggyback on the increased mobility of both troops and trade (2). The book traces colonial disease as both figure and reality in travel journals, diaries, medical treatises, prose, and poetry of the eighteenth century and the Romantic period. It focuses on the rising British anxiety about colonial disease from the mid-eighteenth through the mid-nineteenth century.

Romanticism and Colonial Disease examines the development of the field of medical geography, tracing the cultural meaning of various disease theories focused on climate, topography (disease landscapes), diet, habit, gender, and of course race. Bewell argues that British identity was based on a relational model, in which national health, and even "British" diseases such as tuberculosis, could be understood only in contrast to the tropical diseases that defined colonial lands.

The Asiatic cholera pandemic of 1817, as it approached ever nearer to British shores, shook the nation by explicitly showing that colonial disease had become global. Chapters focus on specific projects and problems, such as the doomed attempts to explore the Niger River and "open" West Africa to European trade, or the problem of the diseased colonial soldier, rather than tracing a general history.

Bewell includes readings of Tobias Smollett, Oliver Goldsmith, William Wordsworth, SAmuel Taylor Coleridge, George Gordon Byron, William Hogarth, Thomas De Quincey, John Keats, Charlotte Bronte, and the Shelleys, as well as little-known writers like Joseph Ritchie and Thomas Medwin.

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This is the story of a Chicano family in the little town of Tome, New Mexico: Sofi, her (sometime) husband Domingo, and their four daughters--Esperanza, Fe, Caridad, and the youngest, who is epileptic, "La Loca Santa." So Far From God includes a full cast of characters including the healer, Doña Felicia, Francisco el Penitente (El Franky), a psychic surgeon, and an assortment of others.

The novel tells the story of relatively short lives and (longer) deaths of the four daughters. Esperanza, a journalist, dies as a hostage in the Middle East; Fe dies of cancer as a result of chemical poisoning from her job in the weapons industry; Caridad is miraculously restored after a mysterious mauling, and later dies--or disappears--off a cliff with the woman of her dreams; La Loca, the remaining daughter, dies of what appears to be HIV infection. Sofi, having pronounced herself mayor of Tome, in her grief over Loca's death, goes on to found the worldwide organization, M.O.M.A.S. (Mothers of Martyrs and Saints).

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