Summary:

This lively volume of medical history chronicles the forms of suffering, illness, injury, and treatment endured by the members of the Lewis and Clark expedition of 1805. Beginning with three chapters of political and medical history to set the context, the story follows the adventures of the extraordinarily fortunate "Corps of Discovery" among whom Lewis was the most trained in the medicine of the time (having studied in preparation for the trip under Dr. Benjamin Rush of Philadelphia), and he only an amateur. Even professional medicine of the time was approximate and largely ineffectual, limited mostly to purgatives, opiates and laudanum for pain relief, bleeding, and topical applications of various compounds or herbal substances.

The story chronicles the main events of the trip based on the extensive journals of Lewis and Clark as well as other historical account, maintaining focus in each chapter on the medical incidents including gastrointestinal distress from parasites and contaminated water; effects of overexposure like hypothermia and exhaustion; infections from wounds and scratches; syphilis; dislocations; muscular spasms; mosquitoes and other insect bites; snakebites and other animal attacks.

Along the way Peck pauses to explain the rather rudimentary medical theories upon which treatments were based, the effects of particular known treatments, and what Lewis and others likely knew, guessed at, or didn’t understand about lead, mercury, opium, and certain herbal substances they used. He speculates about the contexts of their medical decisions and offers occasional contemporary analogies to help readers imagine the circumstances and tradeoffs the explorers faced.

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Middlemarch is a middle-sized country town typical of rural British life in the early nineteenth century. George Eliot (born Mary Ann Evans) was part of the realist school that dominated Victorian literature. She tried to create a true representation of the real, historical lives of ordinary people.

The novel has a vast number of characters and events but most of the plot centers on two couples: Dorothea and Casaubon (later Will Ladislaw) and Rosamond and Lydgate. Dorothea is an intelligent, vigorous woman, eager to improve the lives of her friends and the poor. She is determined not to marry any of the local, mindless squires but to devote herself to godly work.

Soon, however, she is introduced to Casaubon. Casaubon is an aging, ugly scholar, but Dorothea is attracted by his learning and agrees to marry him in hopes of helping him in his work. Their marriage is unhappy and cold. It is contrasted to Dorothea’s growing relationship with Will Ladislaw, a distant relative of Casaubon. Where Casaubon is cold, Will is passionate. Casaubon senses the kinship between his wife and Will and adds a codicil to his will insisting that if Dorothea and Will marry after his death than Dorothea must give up Casaubon’s house and money.

Shortly thereafter, Casaubon does die, and Dorothea is outraged upon hearing of the codicil. She does not recognize her feelings towards Will as feelings of love. By the end of the novel, however, the two confess their feelings and Dorothea gives up her earthly possesssions to live happily.

The plot developed around Lydgate and Rosamond is of particular medical interest. Lydgate is a new kind of medical practitioner. At the beginning of the nineteenth century, the traditional medical order, consisting of physicians (like modern consultants), surgeons, and apothecaries, was being replaced. New well-schooled general practitioners could perform all these functions.

When Lydgate arrives in Middlemarch with his modern techniques and visions of building a modern hospital for the poor, the medical establishment greet him with jealousy and suspicion. Lydgate’s practice therefore develops very slowly. His marriage to Rosamond, a woman used to a rich lifestyle, quickly depletes his savings.

Facing bankruptcy and the loss of his disappointed wife, Lydgate receives an unexpected loan from Bulstrode, a wealthy landowner. Soon after, Bulstrode is charged with murder and Lydgate is accused of having a hand in it; Middlemarch sees the loan as a payoff. Disgraced, Lydgate cannot fight back. He becomes a doctor who toadies to the wealthy and abandons his revolutionary dreams. He dies at 50.

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Summary:

Schiebinger’s historical analysis looks at the role of women and female nature in modern science in four places. These are: institutional organizations (when and how did medical schools and fraternities allow or disallow female participation?), individual biographies (who were trendsetters in the history of science?), scientific determinations of female nature (how did scientists decide what makes woman woman?), and cultural meanings of gender.

Chapter Seven is an especially disruptive chapter, analyzing drawings of female skeletons at the turn into the nineteenth century. Earlier, female skeletons had been drawn in the same way as male skeletons. At this point, however, they became thin-boned and wide-hipped. Sexual difference became far more central.

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Doctor Yashvin sits with his colleagues and admits, "I have killed a man." The story of his resistance activity during the Bolshevik revolution ensues. The young doctor was called to serve as the personal physician of an enemy colonel. In this command the doctor witnesses horrible atrocities against common people as well as resistance fighters, the last straw being the brutal beating of a woman who comes demanding to know why her husband has been shot. Called upon to attend to a knife wound sustained by the colonel and finding the latter in a vulnerable position, Yashvin takes advantage of the moment, shoots the colonel dead, and escapes.

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The author selected 48 works of art, famous and obscure, which are presented in chronological order as full-page color plates. On the facing page of each piece is a brief essay which includes information such as artist, date and current location of the work. The essays, as well as the introduction by the author, are insightful, well-written, and demonstrate the author’s vast knowledge as a medical historian. Selections include the "Oath of Hippocrates", Studies of the Fetus by da Vinci, The Anatomy Lesson of Nicolaes Tulp by Rembrandt, The Dwarf Sebastian de Morra by Velazquez, "Muscle-Man from Vesalius" by van Calcar, and First Operation Under Ether by Hinckley (see art annotation in this database).

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Miss Armistead is a nurse in the surgical division of a hospital. She is being courted by two men, Dr. Joe Trask, the chief resident, and Dr. Mort Baker, an established and very successful surgeon. Everyone in the division is taking bets on her choice. Most assume she will choose Baker, the wealthier, more powerful doctor.

Then Miss Armistead develops appendicitis and requires emergency surgery. Joe Trask is on duty and has to begin the operation before Baker arrives, but experiences a terrible crisis of confidence, becoming helpless with fear. Baker arrives and completes the operation.

Everyone assumes that this will clinch Baker’s victory, but when Joe tells her how he was unable to operate on her, Miss Armistead takes this inability to see her as just another patient to be proof of the depth of his love for her, and agrees to marry him.

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The New Medicine and the Old Ethics, in Albert Jonsen’s own words, is a "secular aggadah." Jonsen explains that one Talmud reviewer defined aggadah as "a magical rabbinic mode of thought in which myth, theology, poetry and superstition robustly mingle" (4). The book begins with a personal essay entitled "Watching the Doctor." Jonsen establishes his premise that the moral history of Western medicine is best understood as a paradox between altruism and self-interest, a paradox alive and well entering the 21st Century.

He then takes the reader on his "secular aggadah," blending history, myths, and stories that trace important moral developments in the practice of Western medicine. In "Askelepios as Intensivist," we learn of the early Greek values of competence in shaping medical practice. Through the influence of the Church in the medieval period, Western medicine incorporates the value of compassion through the Biblical Good Samaritan, struggles with problems of justice in the care of the poor, and further elaborates the meaning of benefit.

In "The Nobility of Medicine," Jonsen describes the contribution of Sir William Osler and other knighted medical men of the 19th Century who established the ethics of noblesse oblige in the medical profession. He traces this noble tradition to the medieval Knights Hopitallers of Saint John of Jerusalem, a group of religious who provided hostels for pilgrims to the Holy Land and cared for the sick. With essays on John Locke and Jeremy Bentham, Jonsen brings us to the 20th Century and the play of individual rights and utilitarian values in the moral life of Western medicine.

In the final essays, Jonsen describes the mingling of these traditions as a means to establish a moral frame for Western medicine in our current times where technology and science have achieved and threatened so much. Ethics, he argues, "is disciplined reflection on ambiguity" (130). In the last essay, "Humanities Are the Hormones," Jonsen brings his "secular aggadah" full circle.

He argues that the paradox of altruism and self-interest that runs through the moral history of Western medicine must continually be vitalized and examined through the Humanities. The Humanities are "the chemical messengers that course through the complicated institution of medicine and enable it to respond to the constantly changing scientific, technological, social, and economic environment" (147).

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After working with the Parisian physiologist, François Magendie, Dr. John Leggate returns to England to practice in the town of Middlethorpe in the late 1840s. He is obsessed with making a research discovery that will help humanity and establish his name. He falls in love with the intelligent and gifted Marian Brooks who aspires to a career as a concert pianist after study in Leipzig with Felix Mendelsohn. They marry and find happiness at first, but she is troubled by discovery of his past affair in France, and he is troubled by her abandoning music simply to be the type of wife he never wanted.

Leggate has a theory about the origins of cholera, but his painstaking work shows him two things: 1. his original idea is mistaken, and 2. the disease is spread by water. He does not publish, though he announces his intentions to do so. Intimidated by skeptical colleagues, he is unable to write, and the problem is exacerbated by a newspapermen who makes unwarranted accusations because he holds a grudge against Leggate’s wife.

Marian wants to help him, but he rejects her offers and retreats into himself. Their marriage is threatened. Just as cholera returns and the town learns from Leggate’s insights, John Snow publishes his famous observations on cholera. Leggate is scooped. He and Marian migrate to Canada where he is accepted for his skills and desire to be of service and she establishes a conservatory of music. Their marriage is restored.

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Hans Castorp makes a visit to the International Sanitarium Berghof in the Swiss Alps to rest and visit his cousin, Joachim Ziemssen. There he meets other patients from around Europe, all with different opinions about life and its meaning. Before his three week visit is up, Hans develops tuberculosis and ends up staying seven years. He leaves only when the Sanitarium gets news of the assassination of the Archduke that will begin World War One.

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Laqueur argues that in the course of medical history there has been a shift from the one-sex to the two-sex model. Prior to the seventeenth century, scientists of all kinds believed that there was only one kind of human body. Men and women were the same.

In drawings made during dissections, for example, scientists from Aristotle to Galen identified female genitalia as male genitalia which were simply inside the body rather than outside of it. Thus, the vagina was identified as penis and the uterus as testes. Women’s organs were internal, it was believed, because they were colder (and therefore inferior). It was possible for a woman to turn into a man if she over-exerted herself and became hot. After the seventeenth century, this one-sex model slowly transformed into the two-sex model popular today according to which men and women have different bodies and different attributes that follow from those bodies.

Laqueur does not think that earlier scientists were mistaken. They carefully performed dissections and recorded what they saw. Their drawings are correct. However, because their world view did not allow for two sexes, the parts are identified differently. In later centuries it became politically necessary to create a greater, natural distinction between men and women, a distinction that could not be remedied by greater heat. The material evidence of the body was thus interpreted differently.

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