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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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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Millie is a "baby nurse," hired as a domestic helper and live-in night nurse who cares for other women's infants up to the age of two years. She is "condemned by life to love many babies and lose them all" (1). Millie is described as old, but we are not told how old, or of what else her life has consisted; probably little, since she appears to have cared for one child after another, and has no home apart from where she is employed.

The story begins as she starts a new job, caring for Mrs. Jones's baby daughter. She adores the baby, but is tense and possessive, strongly dislikes the Jones's noisy six-year-old boy, and complains to Mrs. Jones about the other servants. Reluctant to let the baby grow up, she does not encourage her development, and she is overly defensive and protective of the child.

As the baby gets older, Millie becomes more and more anxious until, after a fight with one of the other servants, Mrs. Jones fires her. The story ends where it began, in the waiting room of the employment agency as Millie seeks a new position, a new baby to love and lose.

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Corky Nixon is a patient in a ward of amputees in a military hospital for casualties of the Korean War. He has lost both legs. The head nurse on the ward has been given the nickname "Old Ironpuss" because she is so fierce and strict and unattractive, showing, as Corky says, "no warmth, no sympathy, no concern" (131). By implication, she is unfeminine. All the patients fear and hate her.

On Christmas Eve, a severely injured patient, Hancock, is brought in. He is conscious but catatonic. Corky is outraged that "Old Ironpuss" should be taking care of Hancock (he says that so sick a patient should get "the best damn-looking nurse in Christendom"!). Corky tries to get Hancock to talk, but is interrupted when the nurse comes in and berates Hancock for being such a difficult patient. Corky is outraged and complains to the colonel, who then points out that Hancock, reacting to the nurse's diatribe, has roused himself, talked back, and begun to recover.

He tells Corky that in cases like this, kindness and sympathy don't work and that the best treatment is the provocation of anger. Corky accepts this, and decides to collaborate with the nurse by having all the men in the ward stage the loud singing of Christmas carols with bawdy new lyrics, ostensibly to irritate her. In the midst of this chaotic display of good spirits, we see "Old Ironpuss" listening to their spirited defiance, and then turn away, alone, weeping.

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Fred McCann is an energetic man in his thirties, something of a playboy, when the Second World War breaks out. He becomes a soldier, and in an Italian village one day he goes to a pump for a drink of water. The pump is booby-trapped and explodes. He is blinded and loses all four limbs. The story traces the development of a relationship between Fred and Alice, his nurse in the military hospital.

As he learns to submit to being entirely helpless, reliant on Alice for all his needs, he gradually begins to adapt to his new condition. Then Alice changes everything by having sex with him. At first their new and obsessive relationship makes him happy, restoring some of his old sense of himself as a man. When Alice is moved to another duty and replaced by a sadistic male nurse, Fred is so devastated and makes such a scene that he gets Alice back.

To celebrate her return, Alice sneaks some whiskey into his room and they get drunk. She then says something that appalls him: she calls him her "thing" and confides that she has always hated men, who look at her and touch her and have power. Fred is nauseated, seeing himself reduced to nothing more than a "a phallus on its small pedestal of flesh." He realizes now that he is no longer a man, and later that night he manages to drag himself out into the garden, where there is a small pool in which he drowns himself.

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In this extensive review of her experiences in public health and rural and urban medicine, Eva Salber, MD, explores the commonalities and the differences in medical practice among three environments: pre-World War II South Africa, urban America, and the hills of North Carolina. Trained in South Africa, where she and her husband practiced for many years, Salber came to the US during a very difficult political period for whites in Cape Town.

In Boston, she pursued her passion for the plight of the poor and their health issues by studying further public health and running a ghetto clinic. Later, as a member of the Duke University faculty, she established rural health clinics in North Carolina. She describes, in this memoir, the contrasts among the cultures as well as her own difficulty in obtaining the funding and support she needed to carry out her work in each setting.

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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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The editor of this volume has pulled together a collection of essays directed toward the history of women as healers. The essays are divided into two groups--the first dealing with women healers in the medieval and renaissance periods of Europe, and the second addressing the emergence of professionalism, beginning with an essay on women physicians in ancient Greece, Rome and the Byzantine Empire and moving quickly to nineteenth-century Russia, Germany, England, Australia and America.

The subject matter of each essay reflects the period covered. Most use definitive examples of individual women healers who were either unusually effective or who reflect the struggles women had with the existing local social or medical hierarchy in gaining the opportunity to train for or practice their chosen profession.

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At Christmas, 1913, the two Rappard boys and their grandmother (May Robson) bring a cake to the Brussels nursing home where the English matron, Edith Cavell (Anna Neagle), is caring for their dying mother and many small children. The prayer is for peace, but in a few short months war has spread over Europe and the oldest boy is sent to fight.

He is taken prisoner, but escapes to the nursing home because he hears that Germans are shooting prisoners. Cavell, with a network of friends including the boys' grandmother, the barge-owner Mme Moulin (ZaSu Pitts), and a dignified Countess (Edna May Oliver) help him and two hundred other wounded young men to escape into Holland and France.

By August 1915, Cavell and her friends are betrayed by a German spy and put on trial. Despite international pleas for her release or detention, she is shot at dawn on 12 October 1915. Linking nursing to religion, the priest who attends her final hours tells her, "it is God's will," while the hymn, "Abide With Me," sung in the final scene of her 1919 memorial service at Westminster Abbey, reminds viewers that she had been "help of the helpless."

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This etching illustrated a book criticizing (male) physician birth attendants--"man midwives"--today’s obstetricians. The etching shows a figure that is male on one side, female on the other. The male half stands on a plain wood floor next to a large mortar and pestle, holding an instrument labeled a "lever" in his hand, which is pressed against his thigh. The background seems to be a shop, with shelves lined with vials, bottles, and frightening looking instruments labeled "forceps," "boring scissors," and "blunt book."

In contrast, the female half of the figure stands in a homey room on a decoratively carpeted floor; in her outstretched hand she holds a small cup. Behind her, a fire burns in a grate.

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