Summary:

The Crimean War (1853-1856) holds a place in the history of medicine, specifically, the history of nursing. For as the British public read the 1850s Times reports about the total lack of care suffered by their wounded in this conflict, a British nurse, Florence Nightingale, volunteered to recruit a team of nurses to aid the suffering men. The Times created a relief fund for the sick and wounded, and Queen Victoria, an enthusiastic supporter of this war against Russia, sponsored an even larger fund. Female nurses had a reputation for drunkenness and promiscuity. Nightingale made it a point to recruit nuns and women from the lower classes who would be more manageable than educated, upper class women. Three black nurses applied, including Mary Seacole, but they were rejected.

The Turks, British allies, allowed Florence Nightingale the use of their army barracks at Scutari, across from Constantinople: "'I have been well acquainted with the dwellings of the worst parts of most of the great cities of Europe,' Nightingale wrote,' but have never been in any atmosphere which I could compare with that of the Barrack Hospital at night'" (111). Open sewers ran beneath these vermin-infested structures  which were crammed with sick soldiers lying on the filthy floor. There were no supplies and few doctors. Typhus, typhoid, cholera or dysentery killed many patients. Nightingale's meticulous statistics showed alarming escalation of mortality rates; she believed in cleanliness and fresh air but not in the germ theory of disease. When comparing her numbers with those of other military hospitals, Nightingale understood that soap alone would not save the men.

Rappaport describes the nursing offered by army wives, widows and other volunteers, including French nuns. The women's living conditions, especially during pregnancy and childbirth, often resulted in sickness and death. Others volunteered as cooks, including Elizabeth Davis who alleged that while "...she and the other nurses dined on the stewed-up, tough old meat used to make soup for the patients, Nightingale ‘had a French cook, and three courses of the best of every kind of food ... served up everyday at her table'" (168-169).

Nightingale became famous as the heroine of the Crimean War. She is known now as the founder of professional nursing. Recent research has questioned whether Nightingale was the real angel of the Crimea. Rappaport investigates the work of the Jamaican nurse, healer, and entrepreneur Mary Seacole, one of the 3 black nurses rejected for service in the Crimean War. She financed her journey to and stay in the Crimea herself. She built a British Hospital in the Crimea, and treated the wounded at Balaklava there and in the field. The soldiers called her Mother Seacole because she cared for their material and spiritual needs. She sold gin and raki and home-cooked meals, and went bankrupt because too generous with credit. Seacole recouped her losses and achieved bestseller status with her memoir, Mrs. Seacole's Wonderful Adventures in Many Lands (1857), the first memoir by a black woman from Britain.

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Summary:

Because this lucid, rich, and incisive book has not, as yet, been published in the United States, it has not acquired the readership it deserves. For those teaching Medical Humanities or those interested in broader or more global stories and perspectives about physician training, practice, and experiences, Helman’s most recent publication should be considered.

Part One (“Setting Out”) begins in South Africa where Helman’s family, comprised of a dozen doctors, has lived for generations and where his own medical studies occurred. As a child, he accompanied his father on rounds while other children spent holidays at the beach. Before long he discovered how hospitals, during the madness of Apartheid, were to “some extent a distorted mirror-image of the world outside” (3). Appalled by the differences in care and treatment, the keenly aware young man kept notes. His vivid observations of the harsh context of social injustices provide an unequivocal, eloquent, and disturbing critique of medicine then and there. His acute observations of physician behaviors and indigent populations in the city and in the bush contribute, as readers discover in later chapters, to the author’s expanded and compelling interests in cultural anthropology.

Part Two (“The Family Doctor”) leads to London. “After all the heat and light and space of Africa, London—with its low leaden sky and constant drizzle—was like living inside a Tupperware box, one stored deep inside a refrigerator” (47). In the 60s Helman’s migration required an adjustment to a world of technology and order, where as a family practitioner, he had become, in fact, a suburban shaman. In any society, patients wanted “relief from discomfort, relief from anxiety, a relationship of compassion and care, some explanation of what has gone wrong, and why, and a sense of order or meaning imposed on the apparent chaos of their personal suffering to help them make sense of it and to cope with it” (xvi).

Gradually Helman saw connections between the role of family physician and traditional healer: both involved an understanding of “not only a body’s internal equilibrium but also the equilibrium of the patient’s relationships with the world he or she lives in and how treatment should aim not only to treat the diseased organ but also to restore the patient’s life that equilibrium of relationships” (xvii). His encounters with patients and the stories they reveal suggest how important these often overlooked connections are and why they ought to be included in medical training and practice.

By the time readers reach Part Three ("States of the Art”), the author has moved into broader realms of thinking, in which medicine and illnesses are examined anthropologically. After 27 years of clinical practice Helman’s white coat and stethoscope are placed on a hook. Now, as a credentialed anthropologist at University College London, his larger lens allows for sustained scrutiny of the complexities, ambiguities, and nuances in such chapters as “Grand Rounds,” “Hospitals,” “Placebos,” “Third Worlds.” Helman’s range of experiences, multi-disciplinary training, intellectual conclusions, and abundant common sense argues for techno-doctors to learn from holistic practitioners. Whether devastating or humorous, the critiques reflect not just care provision but shared human capacities: the insights are thoughtful and fresh and very worthwhile.

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Summary:

Dr. Paul Brand, who grew up son of English missionaries to South India, achieved world renown for his research on leprosy and related research on the dynamics of pain. This book, one of several of his reflections on physiology, combines autobiography, stories of research, and reflections on pain and pain management. The three topics roughly correspond to three discrete sections.

It opens with a story of the early death of a child with a rare neurological dysfunction that made her insensitive to pain. Brand's long work with victims of leprosy in India and then in Carville, Louisiana, gave him wide exposure to the consequences of life without adequate pain. Having spent 27 years in India, 25 years in England, and 27 years in the U.S. before writing this retrospective, many of his reflections include observations about cultural variables in perception of pain, how pain is communicated and managed, and how people deal philosophically with the problem of pain.

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Twelve-year-old Jake moves from Boston to the rural port town of Wicasset, Maine, with his mother, father, and six-year-old brother, who has "fits" as a result of what we now know to be cerebral palsy. The family keeps Frankie hidden, because neighbors in Boston regarded his disease as evidence of some wrongdoing on the parents' part and shunned them. It is 1838, and the father has lost his job in a bank because of the "Panic of 1837," and takes a job at a lumber mill for which he is ill suited. As the job keeps him away except for weekends, Jake has to learn how to gather food, fuel, and local information to care for his mother and brother in a small, drafty house.

He gets to know neighbor children whose mother remains hidden because, as he later learns, she is a hopeless alcoholic. Eventually he gets a job with the schoolmaster/jailer, befriends a mentally handicapped young man with no home, and gets to know the local doctor who persuades him that the community will accept his brother and family, and that their secret need not remain hidden. After weeks upstate on a logging trip, the father comes home with an arm crushed in an accident. The doctor helps him find work as a clerk in the custom house.

In the father's absence, in addition to his other accomplishments, Jake helped prison inmates and the schoolmaster/jailer's family escape a burning building, winning the gratitude and respect of the townspeople. On his father's return and promise of new work, he has renewed hope of private tutoring that might prepare him for college despite the family's poverty.

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This study examines representations of feminine illness in American culture from 1840 to 1940. It argues that the figure of the invalid woman emerged in the 1840s amid significant changes in "American literature, medicine and culture," including the emergence of a specifically American literature, the professionalization and masculinization of medicine, and the "sometimes complementary, sometimes opposed" ideologies of feminism and domesticity (17).

The book discusses mid-nineteenth-century medical theories that articulated women as "biologically inferior . . . given to disease and pain" (34) before analyzing contemporary literary works by E.D.E.N. Southworth, Harriet Beecher Stowe, Nathaniel Hawthorne (see this database for annotations of The Birthmark and Rappaccini’s Daughter) Washington Irving, Edgar Allan Poe, and works by twentieth-century authors including Ellen Glasgow, Charlotte Perkins Gilman (see this database for The Yellow Wallpaper annotated by Felice Aull and also annotated by Jack Coulehan), Tillie Olsen, Edith Wharton, F. (Francis) Scott Fitzgerald (see this database for Tender Is the Night annotated by Jack Coulehan, also annotated by Pamela Moore), and Henry James. Art, advertisements, and the film, Dark Victory (see annotation) are other points of reference.

Price Herndl examines compliant and resistant uses of women as invalids; the surprisingly small changes in figures of feminine illness in response to changes in women’s rights; the links literature constructs between illness, money, work, and value; shifting theories of cure (from somatic to psychic); and the rise of germ theory in relation to fictional representations of illness. She argues that male and female fiction writers in the period she studies use feminine illness for different purposes: "What that figure signifies is kaleidoscopic, shifting to suit the political needs of its user" (218).

Invalid figures in literature and culture, Price Herndl asserts, can "divert political dis-ease into an overwhelming attention to the individual body and away from the body politic," locating people’s problems in their individual bodies and selves rather than in the oppressive aspects of their culture (220). Recurrent representations of sick women reflected the extreme unease attached to the position of women in American culture in the years 1840-1940. While her study stops at 1940, Price Herndl asserts that after World War Two and at other points when "masculine privilege seems threatened . . . illness is figured more and more often as male" (220).

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Summary:

Lucilla Finch, a young middle-class woman who has been blind since early childhood, falls in love with Oscar Dubourg. After a head injury, Oscar develops epilepsy, and then turns blue from the treatment. Lucilla harbors an irrational hatred of dark colors, including dark skin; thus Oscar has a strong desire to hide his blueness from Lucilla until after their marriage. When his twin brother comes to visit, Oscar tells Lucilla that Nugent is the blue man, a deception that backfires when Nugent--who has fallen in love with Lucilla himself--brings in Herr Grosse, an oculist who cures Lucilla's blindness.

Her first vision is of Nugent, who sabotages Oscar by assuming his identity and making it impossible for Oscar to reveal the truth. Oscar goes abroad, becoming a nurse, but returns in time to rescue Lucilla--who is blind again--from marrying Nugent. After the brothers reconcile, Lucilla and Oscar marry and have two children; Nugent freezes to death during an Arctic expedition.

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Margaret Hale is raised in fashionable Harley Street along with her cousin Edith, but when Edith marries, Margaret returns to Hampshire County in the South of England to live with her mother and her father, a country clergyman. The pastoral life she has imagined is quickly disrupted by her father's confession that he is no longer able to remain true to the Church of England and will leave his position to become a tutor of adult learners in the northern manufacturing town of Milton. The traumatic relocation is exacerbated by Mrs. Hale's diagnosis with a "deadly disease" (probably cancer) soon after the move.

Margaret takes charge of most of the practical aspects of the move and then assumes charge of her mother's illness, acting as an intermediary between the doctor and her parents. As well as learning more about her own family's servant, Dixon, who has been with her mother since her girlhood, Margaret becomes friendly with textile worker Nicholas Higgins and his daughter Bessy, who is dying of consumption (tuberculosis) from inhaling textile dust. The Milton workers' activism and independence appeal to Margaret; she rethinks both class and labor relations as a result, including charitable relationships. Her strong opinions and actions bring her into conflict with the family of John Thornton, a factory owner and self-made man who is also one of her father's students.

When Margaret shields John from a stone thrown by a striking worker, however, he avows his love for her. A series of obstacles to the relationship include Margaret's initial rebuff of John and her dishonesty about her exiled brother's secret return to his mother's deathbed. Before the ending brings John and Margaret back together--as well as calming the tension between workers and factory owners--Margaret experiences not only the deaths of almost everyone she loves, but also the suicide of one of the striking workers.

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This scholarly study examines "what it meant to ’talk of diseases’ in the second half of the nineteenth century" (2) and how discourses of health and illness were a vehicle for exploring individual and social identities, including gendered, racialized, and national identities. Narratives of physical illness are not simply artifacts of Victorian medical culture, Vrettos argues, but offer examples of the pervasive "master narratives" that shaped Victorian middle-class culture.

Individual chapters focus on the ill female body as an expressive text with variable legibility (and on nurses as privileged readers of ill bodies); "nervous illness" and the role of narrative in reconstructing the self; "neuromimesis" or neurotic imitation of disease; and the "politics of fitness and its relation to imperialist ideology." Vrettos discusses fictional works by Louisa May Alcott, (Hospital Sketches; see this database) Charlotte Bronte, George Eliot (Middlemarch; see this database), H. Rider Haggard, Henry James, Bram Stoker, and Harriet Beecher Stowe.

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Subtitled "Tuberculosis and the Social Experience of Illness in American History," the book chronicles the medical and societal treatment of tuberculosis in the United States from the perspective of individuals who suffered from the disease. The author includes illness narratives derived from letters and diaries of the afflicted; her analysis spans the period in American history from the nineteenth through the first half of the twentieth century.

The book is divided into four sections. Part I, "The Invalid Experience: New England Men, 1810-60" and Part II, "The Female Invalid: The Narrative of Deborah Vinal Fiske, 1806-44" reveal an interesting contrast in the medical/societal treatment of tubercular men and women, and the resulting differences in their lives as "consumptives." Whereas men were expected to seek a cure by embarking on sea voyages and other travel, women remained at home and sought to control the disease by adjustments in domestic life. For men this meant major disruption and even change of career along with a sometimes exhilarating change of scene; for women it meant relentless anxiety and elaborate coping strategies.

Part III, "Health Seekers in the West, 1840-90" describes the role of cure-seekers in the westward migration and demonstrates how the culture of the time, an optimistic faith in nature and in the economic promise of the newly settled western territories, was reflected in the treatment regimen for tuberculosis. Interestingly, much of the promotional effort to bring "consumptives" west was initiated by physicians who were themselves tubercular.

The final section, "Becoming a Patient, 1882-1940," moves into the modern era with the discovery of the tubercle bacillus, public health measures, and the illness narratives of people who were confined in sanatoriums. Rothman points out that this period marked a transition away from the patient’s ability to understand and determine his/her treatment to one more like the current one in which the medical establishment is the authoritarian "expert."

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In his dedication to the book, the author addresses his sons: "The secret to life? Clean your room." The meaning of this becomes clear as Vernon traces the story of his brother, Paul, with whose death the book begins. Paul was 15 years older than the author and had been only a shadowy presence in his life. When Paul died, John Vernon had to exercise his duties as executor of Paul's "estate," an estate that turned out to be a festering, stinking nightmare of a house.

The house was filled with 20 years worth of trash that represented 20 years of Paul's life as a recluse. This memoir is an attempt to imagine Paul's life and to understand the reasons for the course it took. It is also an attempt to "bear painful news" and to reflect on his own reactions to what he discovers and to Paul's death.

In order to do this, Vernon calls on history, interweaving his memories and what was revealed of Paul's life after his death with discussions of the beliefs and discoveries of past eras. Finding himself nailing a thermometer to the outside of Paul's house, the author describes the development of thermometers, and the nature of heat ("Heat"). What, he asks, is meant by "normal" atmospheric pressure? How abnormal was his brother? After all, he bought nursing-home insurance a year before he died. And how normal is he, John Vernon, affixing a thermometer to this wreckage?

As he builds a primitive set of steps to the house, the author explores the history of tool making and speculates about what distinguishes humans from animals; did Cain murder Abel with a hammer, and is he, John Vernon, his brother's keeper? ("Tools") Similar expositions and speculations interdigitate in subsequent sections entitled "Body," "Corpse," "House," "Origins." [At the end of the book, there is a bibliography of references for each section.]

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