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Dr Hunter’s 75th birthday in April 1948 falls forty years to the day after he started practice in the little prairie town of Upward. He is retiring, moving away to the big city of Saskatoon, and the citizens have gathered to say fare-well. They celebrate in the patient lounge of the new hospital soon to open bearing the name of this long-time servant of all Upward’s needs--physical, mental, social. The doctor has donated his late wife’s piano and the board is already planning to sell it for much-needed cash. It tinkles softly, unwelcome songs are awkwardly sung, coffee and sandwiches served, while the crowd of locals chatters away sotto (and not so sotto) voce, with each other and the doc. 

Over the course of the evening, forty years of memories unfold: births, couplings, deaths, desires, hostilities, random acts of kindness and of spite. Folks sidle up to the doc to express thanks for his support and wisdom. The pharmacist wishes he had prescribed more pills. The journalists want him to spill secrets for a feature article in the local rag. The minister engages him in a debate over the existence of God and the meaning of life—both of which the medic denies. Gossips watch, whispering to each other about the doctor’s imagined survival and his dead wife whose alleged frigidity justified his supposed numerous infidelities. 

Shopkeeper Sarah’s revisits her embarrassed memories of adolescent attraction, that ripened into adult affection and pleasure that the doctor has long treated her son Dunc with almost fatherly care, taking him and the big but isolated Ukrainian boy, Nick, on house calls. Home from overseas with an English war-bride and now running the store, Dunc presides over the evening, trying to smooth conflicting undercurrents. The gossips speak sweetly to the newcomer bride and behind her back predict the marriage will fail.

It emerges that the incoming young medic will be Nick, once mercilessly bullied as a “hunky kid” by a few shiftless bigots still languishing in Upward. They are convinced that he is returning to extract his revenge. The old doctor defends Nick in his final words and urges his patients to help the young successor. He knows that they can briefly come together in a crisis, but he scolds them for their chronic lack of charity to strangers and to each other.

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It is Dublin in late autumn 1918, the waning days of World War I, and nurse-midwife Julia Power is suddenly thrust into the task of managing a small ward of heavily pregnant women who have contracted the deadly influenza. Having survived influenza herself, she does not fear infection, but she worries about her lack of experience. She also worries about her shell-shocked brother with whom she shares a home. 

Two people appear to help: the intelligent but uneducated young volunteer Bridie Sweeney raised in an institution; and the legendary woman doctor Kathleen Lynn –who quietly reveals her competence and skill, even as authorities are lurking to arrest her.  

Over the course of just a few days, they encounter recalcitrant mothers, complicated deliveries, battered wives, stillbirths, and deaths. Influenza adds special dangers to the natural event, but some patients survive their ordeal. 

Although Bridie was to help for just one day, she learns quickly and returns. Julia is impressed by her diligence and drawn ever closer to her kindness and earthy wisdom. They pass a night together sharing confidences, and Julia begins to understand the physical and emotional mistreatment that Bridie suffered in the care of nuns. Their embrace awakens in Julia a yearning she had never imagined. But only hours later Bridie falls ill and succumbs rapidly to the deadly infection.

When an unwed mother suddenly dies after giving birth to a deformed child, Julia is horrified that the baby must be placed in an institution. Instead, she takes the baby home to an uncertain future but sparing the child the same horrors that Bridie once suffered. 

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George and Rufus (Rue) are born one year apart into grinding poverty of a Nova Scotia community, to a violently abusive father and a frightened well-intentioned mother. They have mixed heritage, part Black, part Mi’kmaq. Battered and hungry, they struggle with learning and abandon school after several attempts at grade three. 

George is stolid, strives to be good, serves briefly (and badly) in the military, and is happiest doing heavy physical work for farms, gardens, and woodlots. But he can never hold a job for long. He marries Blondola and they start a family in Fredericton, New Brunswick. 

Rue is more dashing, calculating, and slippery. He has a self-taught talent for piano and cultivates an odd form of jazz. He falls in love twice and loses both times--first to an accidental death and next to his own imprisonment. Arrested for theft, he serves two years in prison and, upon his release, barges into George’s marginal existence, contributing nothing and menacing the precarious but loving home. 

When Blondola goes into hospital for the birth of her daughter, the doctor refuses to let her leave until his bill is paid. George needs money desperately. Rue convinces him to use a hammer to stun a white man – any white man—and take his money. Together they settle on targeting a taxi driver, but the man who responds to the call is George’s friend. He cannot go through with it, but Rue clobbers the driver, cajoles George into robbing the dying man and dealing with the evidence.

The brutal murder and shockingly clumsy aftermath of their barely disguised deeds results in their arrest. During the police interrogation, George tries to explain his innocence and blames his brother. They are tried within the racially intolerant British-inherited court system that wrongly flatters itself to have avoided American excesses of racism. They are executed on the gallows, hanging side-by-side. 

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Anna Gasperini builds on existing scholarship by examining how Victorian ‘penny blood’ literature depicted working-class readers’ anxieties concerning medical dissection following the 1832 Anatomy Act. Within the historical context of Britain, a dearth of cadavers spurred the rise of various crimes, including body-snatching, graverobbing, and murder. While the families of the middle- and upper-class dead could finance a funeral and secure a place of safe rest, such as in an ancestral vault or tomb, the poor were often buried in shallow or mass graves. These burial sites were often unearthed, and the bodies were sold to (knowing and unknowing) medical men for anatomical examination. To quell these crimes, government authorities instated the 1832 Anatomy Act, which was “a law that allowed anatomists to source dissection material from the pauper” (xii). More specifically, Gasperini explains, “[w]hen it was passed, the Anatomy Act imposed that the bodies of those who were too poor, or whose families were too poor, to afford a funeral were to be handed over to the anatomy schools for dissection” (xii). The Anatomy Act, disregarding pauper consent and personal wishes, effectively targeted impoverished people who relied on workhouse support and alms, exploiting poor bodies to supply medical schools and advance research. The fear and disgust for the law were widespread: “. . . for them [working-class penny blood readers] dissection, bodysnatching, and forfeiture of one’s body to the anatomists after 48 hours under the Anatomy Act were a terrifying reality” (xiii). This fear oddly presaged Count Dracula’s remark in Tod Browning’s 1931 film: “There are far worse things awaiting man than death.” In other words, the finality of death may be incomprehensible, but posthumous desecration of the body through dissection provokes a deeper sense of horror.

Exacerbating the act’s legal conditions was the fact that “semi-literate” working-class people, although vaguely aware of the law’s significance, could not fully interpret the dense legal argot that described the new regulations—an example of cruel political skullduggery—which obscured what would happen to their bodies following death (12–13). Far from being a benevolent political gesture, the act “. . . was an exercise in rhetoric, against which the pauper—semi-literate, socially powerless, and politically underrepresented—could not possibly win” (15). Popular fears that predated and intensified following the act concretized suspicion and anger directed at physicians, the medical sciences, and mortuary practices.

These apprehensions, Gasperini argues, found vivid expression in the pages of the penny blood, a genre “churned out by underpaid hack-writers” and obsessed with storylines “involving murder, betrayal, gender-shifting, and the occasional supernatural event (not to mention scantily clad damsels in distress)” (4). While the penny blood’s serialized melodramas were derided as tawdry sensationalism by middle- and upper-class readers, the genre reflected working-class preoccupations about the Anatomy Act and how the bodies of the impoverished dead were subject to the posthumous medical gaze (4). The penny blood embraced a “generally more violent and graphic concept of entertainment that was popular among lower class individuals. . . .” (4) and constructed plots that directly tapped into long-entrenched suspicions about medical cruelty and physical dismemberment. While the era’s educated readership disdained the recognizable tropes of the penny blood—murderous graverobbers, devious surgeons, vampires, eldritch cemeteries, and cadavers—the narratives in which they figured elucidated the virulent classism and exploitation perpetuated by the Anatomy Act. 

Gasperini provides close readings of a range of penny blood texts, including Manuscripts from the Diary of a Physician (1840s), Varney the Vampyre; or: the Feast of Blood (1840s), The String of Pearls (1840s, popularly referred to as Sweeny Todd, The Demon-Barber of Fleet Street), and The Mysteries of London (1840s). Not all narratives have explicitly medical themes or characters who are physicians or anatomists, nor do the stories make overt reference to the Anatomy Act. Instead, as Gasperini’s analyses demonstrate, they all confront larger working-class anxieties concerning mortality and what might be regarded as the social afterlife of a human corpse, whether that be posthumous dissection, cannibalism, necrophagy, or some other horrific desecration of the body. Fundamentally, while the stories vary, they share a general preoccupation with the corpse’s “bodily integrity” (16), asking what forces act upon the body (or have the authority to) following death and expressing fear over the individuals and institutions that presume to disturb the repose of the dead. Indeed, for all the penny blood’s grotesquery, there is a tacit insistence on the sanctity of the corpse; however, as Gasperini illustrates, the genre does not flinch from revealing the grim consequences of disturbing this repose in the interests of greed and medical progress.

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Izzy is a teenager who has been in foster care for a decade since the age of 7 when her mother was imprisoned and judged insane for having killed her father. She struggles with a desire to cut herself. Her current foster parents, Harry and Peg, seem kindly and engage Izzy in their task to catalogue artifacts from the nearby state asylum that has recently closed. 

Izzy is given the journal of Clara, a patient who, at age 18 in 1929, was pregnant by her Italian lover, Bruno. She was committed to the asylum by her angry father.  Clara gave birth, but her baby girl was taken from her. She observed how the brutality of the hospital damaged those who did not belong there, eventually provoking the mental illness it purported to treat. With the help of a gravedigger, Bruno planned an escape, but their plan was uncovered, and Bruno died.

Izzy’s own story unfolds as she works her way through the journal, subjected to bullying and tormented by her anxieties. Peg kindly arranges to take Izzy to see her dying birth mother in prison, where she learns that the murder of her father was to prevent him from abusing young Izzy.  

Spoiler alert! Izzy learns from an elderly nurse that the asylum director took Clara’s baby for himself and that Clara is still alive. She reunites the mother and child, who is now a grown woman. Izzy joyfully learns that Peg and Harry will formally adopt her.

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Through ten short chapters, family doctor Susan Boron explains the origin of her neologism, “tokothanatology,” the study of common practices that surround both birth and death, events that “bookend” our existence. Daughter of an obstetrician who pioneered family-centered birth and spouse of a man who worked in palliative care, Boron noticed the tremendous similarities in the gestures, rituals, and obligations of dealing with both the beginning and the end of life. The obligations extend to the loved ones in the sphere of patients in care--a practice, she writes, “from pre-cradle to post-grave.” 

One chapter reviews the rituals emerging from many different cultures and religions; another examines portrayals of birthing and dying in image and word; yet another addresses the impact of sudden and unanticipated outcomes. Ethical and legal dilemmas and the contingencies imposed by time and place are discussed frankly.  

Recognizing the advantages of medical technologies, she is nevertheless skeptical of their utility in every case and includes practical advice for dealing with pain, showing that midwifery techniques could enhance palliation. Throughout, she acknowledges that things have changed, are changing, and will change again. Sources are referenced in footnotes. 

In the end, the repeated message is one we’ve heard many times before, offered in a refreshing way: the importance of empathy and of listening to the patient's wishes in birthing and in dying. 

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In Medical Bondage: Race, Gender, and the Origins of American Gynecology, Owens argues that the emergence, practice, and professionalization of American gynecology in the 19th century were inextricably enmeshed with the institution of slavery and discourses of biological racism. “Modern American gynecology,” writes Owens, “could certainly exist without slavery, but slavery’s existence allowed for the rapid development of this branch of medicine, and especially of gynecological surgery” (6). As she shows, gynecology developed as quickly as it did only because white American physicians had access to women’s bodies marked as racially inferior. That gynecology’s maturation accelerated in the American South is no indication that its practitioners had a humane interest in enslaved women’s health (66). On the contrary. Owens argues that slave owners were invested in maintaining the reproductive health of enslaved women in the interest of increasing the size of their population: “Thus the repair of any medical condition that could render an otherwise healthy slave woman incapable of bearing children further strengthened the institution of slavery” (39). Additionally, there were broader implications, as medical research using enslaved women’s bodies produced knowledge about how to treat, in turn, white women: “Black lives mattered medically because they made white lives healthier and better” (107).

This leads Owens to argue why enslaved women should be esteemed as the maternal counterparts to the oft-celebrated white ‘fathers’ of American gynecology: “. . . black women, especially those who were enslaved, can arguably be called the ‘mothers’ of this branch of medicine because of the medical roles they played as patients, plantation nurses, and midwives. Their bodies enabled the research that yielded the data for white doctors to write medical articles about gynecological illnesses, pharmacology, treatments, and cures” (25). This is especially true, as she points out, when examining the medical research of the lauded gynecologist, James Marion Sims, who opened and operated a “sick house” for enslaved women suffering from gynecological ailments (36). Sims operated this clinic to devise a surgical solution to a serious and commonplace gynecological issue among enslaved women, vesico-vaginal fistulae. As an enterprising young physician, Sims took advantage of enslaved women’s bodies to conduct his surgical trials. Eventually, he triumphed and cured an enslaved woman, and published the results in a respected medical journal, thus enshrining his reputation (39). The point, Owen emphasizes, is that “[t]hanks in large part to his experimentation on enslaved black women, Sims had established himself as one of the country’s preeminent gynecological surgeons less than a decade after he began his gynecological career” (39). Medical Bondage thus strives, in part, to restore the lives and contributions of these enslaved women to the story of American gynecology’s genesis.

Owens’ study takes a surprising turn, arguing that “. . . the later development of modern American gynecology can no more be disentangled from Irish immigration than it can be separated from its roots in slavery” (90). This shift in racial and geographic focus parallels the similar roles of enslaved black women of the South and poor, immigrant Irish women of the urban North in the development of gynecology. Owens shows how racial alterity was “mapped onto” poor Irish immigrant women living in major urban centers, such as New York City (20). As many Irish immigrant women suffered poverty, inadequate (if any) medical care, sexual assault, and were drawn into prostitution (and the attendant onslaught of venereal diseases), they became ideal medical subjects for gynecologists. Physicians eventually published their Irish patient case studies, which “. . . helped to create the foundation for the racist laws that colored the Irish as not quite white and sometimes placed them alongside black people as biological models for racial inferiority” (90). Just as Southern gynecologists had access to enslaved women’s bodies, their Northern counterparts treated and experimented on racially othered immigrant women. In this way, Owens argues, “[t]he scientific and medical beliefs that doctors held about Irish women were nearly indistinguishable to [sic] those they held about African women” (115). Overall, Medical Bondage articulates a well-researched and sobering retelling of the dominant accounts of American gynecology.

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Brother Diggery, formerly called Jack Fox, tells us that he was given to the monastic order of St Odo at the age of seven in 1341. For another seven years, he is raised in innocence within the strict rules of the community, serving the brother healer, learning herbal remedies, and playing the hurdy gurdy.  

As plague arrives in 1349, he is assigned to help care for the anticipated sick – and immediately falls ill. The brothers seal him inside his cell, where he suffers greatly, narrowly escaping death; however, when he recovers and forces himself out of confinement, he discovers that everyone else has died or fled. After filling a mass grave with the remains of his brothers, he sets out on a picaresque series of adventures, blithely unaware that he and his fleas spread illness wherever they go.  

Like a fourteenth-century Candide, Brother Diggery’s gullibility and curiosity lead him to discover the wonders of good food, sex, and marriage, the cruelty of lies, theft, and wrongful imprisonment, and the corruption of the church (p. 164). He closes his account in 1352, age 18, already twice widowed, but set for life as a lay physician and father of a young boy whom he plans to give to the monastery of St Odo when he reaches age seven.

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