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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The narrator, an author, is accosted by his friend, Sam Nolan, who has just had his appendix taken out and thinks his experience would provide useful information for one who writes stories: Sam says he has discovered how and why male patients fall in love with their nurses. Sam's experience of being hospitalized is at first like being caught in a machine, he says. This changes after the surgery, when the nurse becomes his caregiver and rescuer.

He feels a great tenderness for what he calls the "beauty of her efficiency." He denies being in love, blaming the morphine and fever for his attachment, but he tells how he did not want to see his wife when she visited, and when he describes giving the nurse a parting gift, a pair of gloves, the narrator sees tears in his eyes. According to the narrator, Sam's story is in fact about his "terrible wife," and she is the reason "it [falling in love] has happened."

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The wife of an anthropologist can not bring herself to confess to her husband that she had all her upper teeth removed many years before when he was away for an extended period. When she is hospitalized for a hysterectomy, she is told she must remove her dentures. She is appalled that her husband might see her without her teeth and nearly refuses the operation. She is helped by an Indian physician with a limp who understands her needs.

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Once in a while someone fights for breath. The crowd around him continues with its business, not realizing that inside the man there might be something drastic going on. There might be a sea monster growing, or a raven named Nevermore, or "a huge muteness of fairy tales," or "the wood-block baby that gobbles up everything." Medical tests show that the lung is vanishing and becoming "an abandoned room" in a queer world where "only surgeons / write poems." [34 lines]

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Editors Angela Belli, professor of English at St. John’s University in New York, and Jack Coulehan, physician-poet and director of the Institute for Medicine in Contemporary Society at the State University of New York at Stony Brook, have selected 100 poems by 32 contemporary physician-poets for this succinct yet meaty anthology. The book is subdivided into four sections, each of which is prefaced by an informative description and highlights of the poems to follow.

Section headings take their names from excerpts of the poems contained therein. There are poems that describe individuals--patients, family members ("from patient one to next"), poems that consider the interface between personal and professional life ("a different picture of me"), poems that "celebrate the learning process" ("in ways that help them see"), and poems in which the poet’s medical training is brought to bear on larger societal issues ("this was the music of our lives").

Several of the poems have been annotated in this database: Abse’s Pathology of Colours (9); Campo’s Towards Curing AIDS (13) and What the Body Told (94); Coulehan’s Anatomy Lesson (97), I’m Gonna Slap Those Doctors (21), The Dynamizer and the Oscilloclast: in memory of Albert Abrams, an American quack (129); Moolten’s Motorcycle Ward (105); Mukand’s Lullaby (33); Stone’s Talking to the Family (79) and Gaudeamus Igitur (109).

Other wonderful poems by these authors are also included in the anthology, e.g. Her Final Show by Rafael Campo, in which the physician tends to a dying drag queen, finally "pronouncing her to no applause" (11); "Lovesickness: a Medieval Text" by Jack Coulehan, wherein the ultimate prescription for this malady is to "prescribe sexual relations, / following which a cure will usually occur" (131); "Madame Butterfly" by David N. Moolten, in which the passengers in a trolley car are jolted out of their cocoons by a deranged screaming woman (142).

Space prohibits descriptions of all 100 poems, but each should be read and savored. Some others are particularly memorable. "Carmelita" by D. A. Feinfeld tells of the physician’s encounter with a feisty tattooed prisoner, who ends up with "a six-inch steel shank" through his chest as the physician labors futiley to save him (23). In "Candor" physician-poet John Graham-Pole struggles with having to tell an eight-year old that he will die from cancer (27). Audrey Shafer writes of a Monday Morning when she makes the transition from the "just-awakened warmth" of her naked little son to tend to the patient whom she will anesthetize "naked under hospital issue / ready to sleep" (72).

In "The Log of Pi" Marc J. Straus muses about being asked "the question / I never knew" that he "pretend[s] not to hear" whose "answer floats on angel’s lips / and is whispered in our ear just once" (113). Richard Donze wants to know why "Vermont Has a Suicide Rate" (132). Vernon Rowe remembers the "hulk of a man" who shriveled away from an abdominal wound and begged, " ’Let me go, Doc,’ / and I did" (44).

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A victim of a car accident suffers severe cranial fractures and facial disfigurement. Assuming a passive-aggressive stance toward the medical staff, and carrying on a sarcastic inner dialogue with her surgeon, she creates her own world, to escape and combat the pain. She becomes infatuated with the mystery and power of her own brain.

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This is a personal narrative by one of America's most accomplished authors. For the past thirty years Reynolds Price has written novels, stories, poems, essays. In this memoir Price describes his battle with a spinal tumor detected in 1984 which left him with some neurological impairment. He struggled with his own rehabilitation and eventually recovered with the aid of biofeedback and hypnosis.

The most compelling part of the book is near the end. The author muses about the meaning of his illness, "advice I'd risk conveying to a friend confronted with grave illness or other physical or psychic trauma" (p.182). He puts the travails of life into a philosophical perspective that is almost Zen-like.

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To escape accusations of plagiarism, Swedish neurosurgeon Stig Helmer (Ernst Hugo Jaregard) has come to work at The Kingdom, a large Copenhagen hospital. He is a surgical butcher with lamentable bedside manners and utter contempt for Denmark, but he resembles his colleagues in his medical positivism and abhorrence of spiritualism. His inadequacies are easily perceived by the hospital staff and resident Dr. Hook (Soren Pilmark), but his fellow consultants celebrate his arrival and make him a member of their lodge.

The malingering spiritualist Mrs. Drusse (Kirsten Rolffes), admitted for a variety of fictitious ailments, discovers The Kingdom is haunted by a little girl murdered there a century ago by her scientist stepfather. Drusse engages the help of her son, who is an orderly, to trace the child's secret.

Tangents to the main plot involve a pathologist, who is so obsessed with obtaining research tissue that he has a cancerous liver transplanted into himself, and the psychopathic medical student son of the hospital director, whose sick sense of humor leads him to mutilate corpses in the hospital morgue. The ending is pure horror.

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Ingenious Pain tells the life story of James Dyer, a surgeon in eighteenth-century England who is gifted--and cursed--with the inability to feel physical or emotional pain. Beginning with his postmortem, the novel traces the thirty-three years of his life, from his illegitimate conception on a frozen river, through the rise of his career from itinerant quack's assistant to ship's surgeon, and then to the court of Empress Catherine of Russia where he meets Mary, a mysterious woman who performs magical surgery on him with her hands, enabling him for the first time to feel and, as a result, to love.

At first this new ability drives him mad, and he is submitted to the infamous torments of Bethlehem Hospital. He gradually recovers, but his new sensitivity has disrupted his identity as a surgeon. He performs one last operation, saving the life of a Negro wrestler by opening his chest and massaging his heart. His own death, not long after, seems to signify that he has at last become a normal man, and this is a form of redemption.

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