Summary:

In this account of early practitioners and advocates of 'inoculation,' or the use of tiny amounts of smallpox contagion to induce a mild case of smallpox and immunity, author Carrell weaves prodigious historical research with fictionalized dialogue to create a tale of two prominent figures: Lady Mary Wortley Montagu of London and Dr. Zabdiel Boylston of Boston. Both Lady Mary and Boylston suffered scarring from smallpox, and, by living in the early 18th century, both witnessed the devastation of epidemics in terms of public health and private loss.

Both were also aware of the use of inoculation to prevent severe disease in Turkey (Lady Mary visited with her ambassador husband) and in Africa (on the advice of Cotton Mather, Boylston interviewed Africans, slave and freemen, living in Boston). Both faced formidable challenges and risked personal security to promote the use of this technique. Both proved their belief in the technique by the inoculation of their own children. And both, perhaps, met. At the behest of the Royal Society, Boylston traveled to London, witnessed numerous inoculations, and presented his Boston experience to the Society.

The book also chronicles the natural course of the disease, its various symptoms, forms and popular treatments, and the political impact of smallpox on the royal families of Europe and business interests in Boston. The medical research of various doctors is detailed. In particular, selected Newgate prisoners were offered pardon in return for participation in an experiment conducted by Mr. Maitland, who also inoculated Lady Mary's children. These experiments were used to test the safety and efficacy of inoculation prior to royal inoculation.

Ultimately, detractors of inoculation ceased their vitriolic attacks, as the risks of inoculation were proven to be far lower than exposure without such protection. The success of inoculation paved the way for Edward Jenner, often called 'the father of immunology,' to successfully use cowpox to induce smallpox immunity later in the 18th century.

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The Agnew Clinic by Eakins was commissioned by Dr. D. Hayes Agnew's students at the University of Pennsylvania to celebrate the seventy-year-old physician's retirement as Professor of Surgery in 1889. It was unveiled at commencement 1 May 1889. The size of the painting, the largest Eakins ever created, is 84 3/8 x 118 1/8 inches. The artist painted the work in ninety days and received a fee of $750. Its frame carries this inscription in Latin: The most experienced surgeon, the clearest writer and teacher, the most venerated and beloved man.

Dr. Agnew (1818-1892), a Pennsylvania native, was a well-respected surgeon and educator who had served in two army hospitals during the Civil War. He was best known for his competence in removing bullets, but Eakins has chosen to show him performing a lumpectomy or partial mastectomy.

The surgeon is shown standing in an enclosure, having stepped back from the operation. He is lecturing to students, faculty, and spectators seated in the operating theatre. Dr. Agnew holds a scalpel in his left hand. He is wearing a white surgical gown.

Eakins has placed the operating table with the female patient in front of Dr. Agnew. Her hair and face are visible, the ether cone just above her chin. Her right breast and arm are shown; the left breast is being operated on. A sheet covers her lower body. The sheet beneath the patient carries the inscription: University of Pennsylvania. Between Dr. Agnew and the bed we see a closed case holding the sterilized instruments. The anesthesiologist and the surgeons all wear white. Dr. Agnew's nurse, Mary Clymer, stands by the patient's waist. She is dressed in a high white cap, white apron and black dress.

Eakins illuminates Dr. Agnew, the patient and her doctors, and the nurse. The spectators sit in semi-darkness, but they are individualized by face and posture. The painting contains about thirty small portraits of doctors. Most of the doctors and spectators have been identified by name (see site at University of Pennsylvania: http://www.archives.upenn.edu/histy/features/1800s/1889med/agnewclinic.html). Eakins is standing to the extreme right, listening to a doctor who whispers to him. Because of time constraints, Eakins's mini portrait was painted by his wife, the artist Susan Macdowell Eakins.

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Dr. Pauline Chen is a transplant surgeon and hence highly trained in the surgical care of desperately ill patients. She found, however, that although she had intensive and first rate training, time and again the message she received from her mentors and peers encouraged a distance from frank discussions about dying with patients who were clearly dying. Dr. Chen successfully suppressed her urges to reflect on the meaning of illness and death. Years into her training, she finally witnessed an attending surgeon stay with a patient and the patient's wife until the patient passed away. The widow sent a thank you note to Dr. Chen for allowing a "dignified and peaceful death." (p. 101) Chen notes that observing her attending stand with the patient during death changed her profoundly: "...from that moment on, I would believe that I could do something more than cure. This narrative, then, is my acknowledgment to him." (p. 101)

Final Exam chronicles Chen's journey from medical student to attending surgeon and examines her experiences with death and serious illness - of patients, family members, friends. The memoir contains three parts: Principles, Practice, and Reappraisal - each with three chapters. The book is chronologically arranged, beginning with anatomy dissection at the start of medical school and ending with Chen as an attending arranging for hospice, thus honoring a patient's desire to die at home rather than in hospital. Chen skillfully weaves her stories around commentary on the social, cultural and philosophical issues surrounding death and the medical response to death. An introduction and epilogue bookend the text and 46 pages of extensive notes and bibliography complete the book.

Although Chen claims to have slowly and painfully awakened to the fact that patient needs extend well beyond good technical care, in fact one sees Chen emerge as a caring physician even from her initial patient contacts in medical school. Chen speaks more to her role as an Asian-American than to being a woman in a male-dominated field, but she clearly has what it takes to succeed in this extremely competitive field, including a good dose of compulsiveness and an incredible work ethic.

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This 2002 DVD, copyrighted by WHYY in Philadelphia and narrated by Blythe Danner, consists of a one-hour documentary about Philadelphia-born painter, photographer, and sculptor Thomas Eakins (1844-1916) and eight short films about different facets of his life and work. Photographs by and of Eakins, his paintings, letters, and sketches are interspersed with commentary by his biographer Elizabeth Johns, and by art historians and historians. The DVD describes Eakins’s training, art production, and aspects of his personal life.

Eakins was already an excellent draftsman, trained at Central High School in Philadelphia, but he first learned to paint during the three-plus years he spent in Paris at École des Beaux Arts. The practice there was to paint from live, nude models instead of from plaster casts, as was customary in Philadelphia. After Paris, he traveled to Spain where he visited Madrid and Seville. He developed great admiration for Goya, Ribera, and Velazquez. His letters home indicate how much he missed his family, yet also how seriously he worked on his art.

Returning to Philadelphia, Eakins set up his studio in his family's home on Mt. Vernon Street. He spent most of the rest of his life in his childhood home. Eakins painted portraits of athletes, for example, rowers and boxers. He chose sitters skilled in the arts, in medicine, business and industry, and painted family members. He always portrayed people and scenery he knew well, and athletes skilled in sports he himself loved. An excellent draftsman and highly trained painter, Eakins became a popular instructor at the Pennsylvania Academy of Fine Arts.

Pennsylvania Academy of Fine Arts had an institute policy that prohibited the use of live, nude models, especially in mixed classes, but Eakins rebelled against these rules by asking his students to model nude in the classroom and outside. Eakins also modeled in the nude himself. He photographed and painted his students in the nude. He believed that artists must study human anatomy through anatomy lectures, dissection, and observation of the body in motion. He assigned such tasks to his American students. Because of his rebellion against Academy rules, he was forced to resign.

Eakins finished his most ambitious painting, The Gross Clinic (annotated in this database) when he was 31 years old. The work, now recognized as an American masterpiece, was poorly received by his contemporaries. Much of his later production was portraits of people he asked to sit for him, including Walt Whitman. He painted a number of cowboy pictures during his stay at a North Dakota ranch where he was recuperating from depression. He also painted twenty-five portraits of Philadelphia physicians.

The last photo of Eakins in his studio, featured in the documentary, shows him seated with his back to the viewer and surrounded by the many pictures he had been unable to sell or which were rejected by his sitters. Eakins is now recognized as a major American artist, particularly in portraiture.

 

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The authors analyze developments in the scientific article in Europe from the seventeenth century to the present. They devote a chapter to "style and presentation" in each century, and a separate chapter to "argument" more specifically in each century, in French, German, and English examples. They find a remarkable similarity of style already evident in seventeenth-century examples, demonstrating that scientific authors were already addressing an international audience. Seventeenth-century articles show an "impression of objectivity" and "a movement toward a more impersonal style" (47), although the English examples were somewhat more personal, less quantitative, and less interested in explanation than were the French examples, and the prose overall is hardly what we would currently expect from a scientific article.

Although the eighteenth-century examples should, perhaps, be considered part of a larger period that included the seventeenth century, Gross et al do track a movement from impersonal to personal style, nominal to verbal style, and minimal presentation to more elaborate presentation during this period. Also, the French examples continue to approximate more closely to twentieth-century norms of scientific style, reflecting their more professionalized community. Overall, the authors characterize much of the eighteenth century as a period of "consolidation and altered emphasis," with "relative stability" of style (116), although the last quarter of the eighteenth century showed a sharp rise in standardization and standards for accuracy and precision.

Gross et al note that nineteenth-century prose still addresses amateurs as well as professionals, and they comment on its persistent difference from "the highly compressed, neutral, monotonal prose" of late-twentieth-century science(137). However, the English and German examples do become more professional in their use of impersonal style, and examples demonstrate a consolidation toward a more "homogeneous communicative style" (138). They also note that the nineteenth century exhibits a "master presentation system approaching maturity," with "title and author credits, headings, equations segregated from text, visuals provided with legends, and citations standardized as to format and position," as well as standardized introductions and conclusions (138).

They find that the combination of an increasing "passion for factual precision" and systematization produces more careful theorizing generally in science during this period, even as individual sciences specialize and diverge (158). Increased attention is given to the process by which facts are linked to theory, and to the role of evidence, governed by an "overriding need for explicitness" (160).

Twentieth-century examples include shorter sentences with more information packed into each by way of "complex noun phrases with multiple modifications in the subject position, noun strings, abbreviations, mathematical expressions, and citations" (186). The scientific article is now generally marked by high incidence of passive voice and low incidence of personal reference, along with a "master finding system" made up of "headings, graphic legends, numbered citations, numbered equations, and so on" (186). They argue that the current state of the scientific article reflects an evolutionary process whereby "current practices are a consequence of the selective survival of practices that were, persistently, better adapted to the changing environments of the various scientific disciplines over time" (212).

 

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In the not too distant future, the morose Egyptian, Antar, works in New York City, as a home-based computer employee, monitoring artifacts which he can study holographically through cyber space. He conjures up the I.D. card of one L. Murugan, who had supposedly disappeared in Calcutta back in 1995. Murugan is/was an expert on Nobel laureate Ronald Ross, discoverer of the role of the anopheles mosquito in the transmission of malaria.

Through flashbacks to the intense week of his disappearance and to episodes in the late nineteenth century, the virtual Murugan roams Calcutta trying desperately to understand and expose a subtext of counter science in Ross's laboratory. He is joined by Urmila, a journalist whose life is endangered by their collaboration.

Murugan theorizes that Ross was sloppy, intent on fame and fortune though a simplistic rendering of the parasite-host relationship; his discoveries were fed to him by others and he was blind to the spiritualistic ambitions of Mangala, his Indian laboratory technologist. Conceiving of the powerful significance of malaria prevention and control, Mangala held different views on the purpose and means of investigating the disease and, Murugan thinks, she anticipated the later discovery of another Nobel laureate, J. Wagner-Jauregg, in the use of malaria for the treatment of syphilis. The travels of Murugan and Urmila imply that these views are still there awaiting their own discovery.

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Canadian surgeon Norman Bethune, 1890-1939, (Donald Sutherland) journeys 1500 miles into China to reach Mao Zedong's eighth route army in the Wu Tai mountains where he will build hospitals, provide care, and train medics. Flashbacks narrate the earlier events of his life: a bout with tuberculosis at the Trudeau sanatorium; the self-administration of an experimental pneumothorax; the invention of operative instruments; his fascination with socialism; a journey into medical Russia; and the founding of a mobile plasma transfusion unit in war-torn Spain.

Bethune twice married and twice divorced his wife, Frances (Helen Mirren) who chooses abortion over child-rearing in her unstable marriage. By 1939, Bethune had been dismissed from his Montreal Hospital for taking unconventional risks and from his volunteer position in Spain for his chronic problems of drinking and womanizing. As his friend states: "China was all that was left." Even there, Bethune confidently ignores the advice of Chinese officials, until heavy casualties make him realize his mistake and lead him to a spectacular apology. The film ends with his much-lamented death from an infected scalpel wound.

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Winter surveys the rise and fall of mesmerism in Victorian Britain, from animal magnetism to hypnotism, including electrobiology (a form of group hysteria), table-turning, and other fads. The book offers rich detail about the different stages of the use of mesmerism in medicine: its initial appearance in staged experiments; its uncertain status and the struggle to locate the boundary demarcating alternative medicines; its performance by professional medical men as well as travelers and quacks; its importance in the development of anesthesia; and its role in prompting skeptical scientists to consider the possibility of mental reflexes as one way to explain away mesmeric phenomena.

Winter argues that mesmerism was not "illegitimate" so much as it brought "legitimacy" itself - of medical authority, of evidence, of knowledge -- into question. Thus, she argues, mesmerism crucially inspired many of the considerable changes in nineteenth-century medicine as well as the reorganization of science and the educational reforms of the later nineteenth century. The book also discusses mesmerism as a form of religion, as a conduit for spiritualism and communication with the dead, as a catalyst in orchestral conducting, and as a model for liberal political consensus.

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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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Based on historical records, family archives, and established New Jersey folklore, this story about Deborah Leeds, 18th century midwife and healer, reconstructs the events that led to her being identified as the bearer of the "Jersey devil." An English immigrant brought to Burlington County to marry, "Mother Leeds" worked as herbalist and caregiver in a largely Quaker--and therefore unusually tolerant--community while bearing her own thirteen children. Her extraordinary skill seemed to bespeak not only careful study but powers that some associated with witchcraft.

After 30 years of faithful service, during which time she shared her work with two other women and with her daughter, her position was challenged by a newly arrived Edinburgh-educated physician who undertook to discredit her work and breed distrust among her neighbors by implications of witchcraft. His efforts came to a head when, at the birth of her thirteenth child--who died shortly after birth--he claimed to have seen the child turned to a flying demon, grow scales, and escape into the night. The story is told with great sympathy for the woman's predicament and a lively imagination for the situation of powerful women healers whose mysterious gifts both blessed and threatened their communities.

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