Faith, Reason, and the Plague in Seventeenth-Century Tuscany

Cipolla, Carlo

Last Updated: Dec-31-2020

Teagarden, J. Russell

Primary Category: Literature / Nonfiction

Summary:

Carlo Cipolla chronicles the 1630 bubonic plague outbreak in Northern Italy. At various places in the text, he refers to his compact volume as an “essay,” a “tale,” and a “book.” Readers during the 2020 coronavirus pandemic could call it a “prologue,” a “warning,” or a “horror story foretold.”

The plague ravaged much of Northern Italy from 1630 to 1631. Cipolla focuses on a particular village, Monte Lupo, because “so exceptionally rich is the documentation of [its] story that it allows the historian to recapture emotions, attitudes, and behavior of common people.” The documentation led him to uncommon detail “on the relationship between Faith and Reason, Church and State at a social level” (p. ix).

Reading like an historical essay, Cipolla first sets up the tensions arising between the Church and State Church during the plague epidemic. The “scientific revolution” had advanced enough by 1630 that regional Health Magistrates acted based on experience rather than faith. Most clergy and their followers still “preferred to believe rather than observe…[and] had not the slightest doubt: processions and similar ceremonies were the only way to placate divine wrath and put an end to the scourge” (p. 7). But, the divide between Church and State in this case is not so clear as that, Cipolla notes, because some of the senior Health Magistrates served as high-ranking church leaders themselves.

Cipolla points to public health measures taken in Northern Italy before the 1630 plague outbreak that might have, ironically, heightened tensions, even though they were born from the terror and suffering epidemics caused during the previous two centuries. The changes that resulted were, in Cipolla’s view, “a strange mixture of brilliant intuition, sound common sense, and absurd prejudice” (p. 12). However rational these measures seemed, “they caused great misery and severe privations [through] the segregation of entire families in their homes, the separation of kindred in the horror of the pesthouses, the closing of markets and trade, the consequent lack of work and wide-spread unemployment, the burning of furnishings and goods” (p. 13). By the time the plague took hold in 1630, necessary public health measures were already unpopular.

Cipolla uses the walled-village Monte Lupo as his case study. Around 150 families lived inside its walls when the plague struck during the summer of 1630. He details how Health Magistrates struggled to gain control of the outbreak while facing open rebellion fueled by “ignorance, egoism, avarice, and bullying” (p. 14). He names and profiles key figures and describes various events.

The central event in Cipolla’s tale is a “procession” in Monte Lupo featuring a crucifix people believed had “miraculous properties” (p. 41). The Health Magistracy took aggressive actions to prevent and then stop the procession. Alas, Cipolla reports: “All this was in vain. It was like preaching to the wind: the church was soon packed with men and women, boys and girls, who had come to gaze at and adore the crucifix,” (p. 47). Festivities carried into the evening and on to a neighboring town (San Miniatello). Mayhem, illness, and death ensued.

The last death in Monte Lupo occurred on August 11. Cipolla follows the subsequent investigations searching for people encouraging exposure to a lethal, contagious disease, and for people who became infected and died as a result. He reflects on the juxtaposition of epidemiological methods used to stop the epidemic and the fight religious leaders and followers waged against them. He muses about “emotions, attitudes, and behavior of all segments of a society in a period distant in many ways from our own” (p. 85). Written in 1977, the objects of his musing were only four decades distant from becoming evident again.

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House on Fire: The Fight to Eradicate Smallpox

Foege, William

Last Updated: Dec-14-2020

Zander, Devon

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

House on Fire: The Fight to Eradicate Smallpox is a memoir written by William H. Foege, the physician best known for developing the strategy of ring-vaccination in the eradication of smallpox. Concisely put by New Scientist, his book is “a mixture of memoir, dry public health guide, and riveting tale of an all-consuming mission.”

Though a brief read, House on Fire is comprehensive on each of these fronts. Foege walks us through his life, starting first with his upbringing in Washington state and ending with his role in India as part of the smallpox eradication team there. Notably, the book’s narrative ends before Foege’s tenure as CDC Director in the late 1970s and early 1980s, focusing explicitly on his involvement in combating smallpox. Using his career in public health as a framework, he details how he became involved in global health and how each deployment around the world, whether for the CDC, WHO, or Peace Corps, added to his understanding of contagious disease and of how to better approach smallpox containment. Ever the epidemiologist, Foege does not shy away from including graphs and charts to emphasize his points, especially as they relate to public health data collection. He takes the reader behind the scenes of conferences, regular meetings, and everyday discussions to show the collaboration necessary for global health work, the planning needed, and the good-natured humor and guile it often requires. At times, his interactions seem like a who’s who of American public health: throughout his career, he works with D.A. Henderson, Alexander Langmuir, David Sencer (who also writes the book’s foreword), and Don Francis.

Outside of his own history, Foege acknowledges that in order to understand smallpox and to understand the mission of eradication it is necessary to understand the disease’s complex history. He begins the book with the history of smallpox and details the development of the vaccine from its crude precursor, variolation, to Edward Jenner’s early version derived from cowpox. As he progresses through his story, he notes important historical moments in the battle against smallpox: the development of the jet injector and bifurcated needle as ways to better administer the vaccine, the elimination of the virus first from countries and then whole continents, and, most poignantly, the final cases of smallpox ever recorded.

Though the book necessitates some level of public health knowledge, or at least a comfort with viral disease and baseline public health interventions, it consolidates its role as a basic public health guide at the appendix. In the last pages, Foege reflects on what to do if there were ever a bioterror attack with smallpox, complete with a diagram on how to administer the smallpox vaccine.

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Which Country Has the World’s Best Health Care?

Emanuel, Ezekiel

Last Updated: Dec-05-2020

Teagarden, J. Russell

Primary Category: Literature / Nonfiction

Genre: Treatise

Summary:

The author, Ezekiel J. Emanuel, says his book title “is a terrible question” (p. 1), because “it is not possible to select the best health care system overall.” However, he continues, “it is possible and reasonable to make judgments about better and worse systems” (p. 351), such as considering “which country has the best consumer choice,…the most innovative health care system,…or best addresses the needs of chronically ill patients” (p. 7). And, that’s what he does.

Emanuel and his research partners compare eleven, high-income countries: United States, Canada, United Kingdom, Netherlands, Norway, France, Switzerland, Canada, Australia, Taiwan, and China. They examine eight content areas: history; coverage; financing; payment; the delivery of care; prescription drug regulation; human resources; and future challenges. These content areas serve as the subject headings for the chapters covering each country. In the penultimate chapter, “Who’s the Best?,” Emanuel assesses and judges each content area across countries. (Spoiler alert: the United States does not fare well.) The concluding chapter is built around “six lessons for improving the US health care system” (p. 385), followed by a coda where Emanuel considers how his findings relate to the coronavirus pandemic.

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Ask Me About My Uterus: A Quest to Make Doctors Believe in Women's Pain

Norman, Abby

Last Updated: Jul-10-2020

Grogan, Katie

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

In her memoir Ask Me About My Uterus, science writer Abby Norman tells two intertwined stories: one about her fraught relationship with her own chronically ill body, and another about the fraught relationship between women and medicine. Norman is a sophomore at her dream college when a sudden, unrelenting abdominal pain sends her to the emergency room—and into a revolving door of medical appointments for years to come. Thus begins her diagnostic odyssey, protracted by an infuriating obstacle: not only must she endure excruciating pain, she must convince doctors that it’s real.

Norman is eventually diagnosed with endometriosis but has several frustrating clinical encounters along the way. Her symptoms are repeatedly minimized or disbelieved by doctors of various identities and specialties. One actually says the words that have long been inferred to Norman and so many women before her: “This is all in your head.” Finally receiving an accurate diagnosis provides some measure of clarity about Norman’s pain but little in the way of relief. She learns firsthand that medical knowledge about endometriosis is desperately lacking—a troubling realization given its prevalence. A commonly cited statistic suggests one in ten women have endometriosis but, as Norman notes, most studies have excluded marginalized communities, so the incidence is likely higher. Norman ultimately becomes an expert on the condition, setting her on a path to advocate for herself and others with endometriosis—and to write about it.

The memoir is organized chronologically, beginning with the onset of Norman’s symptoms about seven years prior to the book’s publication, with occasional flashbacks that draw connections between her current crisis and her difficult childhood. She opens several chapters with descriptions of famous case studies and experiments, situating her own experience within a long and disturbing lineage of women dismissed, misdiagnosed, and mistreated by medical professionals.

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Hidden Valley Road

Kolker, Robert

Last Updated: Jun-15-2020

Glass, Guy

Primary Category: Literature / Nonfiction

Genre: Biography

Summary:

The Galvins of Hidden Valley Road, just outside Colorado Springs, appear to be the kind of wholesome, all-American family that others might envy. The tragic fact is that six of the twelve children go on to develop schizophrenia, a situation that is practically unprecedented. In Hidden Valley Road, journalist Robert Kolker gives us the tale of the deterioration of six afflicted children and the traumatization of six healthy ones in an improbable, bucolic setting. As one after the other reaches young adulthood in this “funhouse-mirror reflection of the American dream” (p. xxi) and inexorably succumbs to madness, the family struggles to cope.

In their search for answers, the Galvins’s extraordinary circumstances come to the attention of researchers. Ultimately, although there is no cure, the family makes a contribution through their genes to our understanding of schizophrenia, as a mutation is discovered that is shared by the afflicted children.

Hidden Valley Road follows the travails of this “multiplex schizophrenia” family over so many years that there is a sea change in our understanding of the disease’s origins. At first, it is taken for granted to be the result of a faulty upbringing at the hands of “schizophrenogenic” parents. Later, biological explanations prevail. Finally, a more balanced view is attained, with nature and nurture each thought to play a role.

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The Estrogen Elixir: A History of Hormone Replacement Therapy in America

Siegel, Elizabeth

Last Updated: May-05-2020

Teagarden, J. Russell

Primary Category: Literature / Nonfiction

Genre: History

Summary:

Elizabeth Siegel Watkins reports on the use of estrogen alone and in combination with progestin for women during menopause and after menopause from the 1890s until the book was published in 2007. She concentrates on the sixty years between 1942 and 2002. The event Watkins uses to mark 1942 as an important moment is the U.S. Food and Drug Administration (FDA) approval for the estrogen product Premarin as hormone replacement therapy (HRT) in women with menopause symptoms. The event she uses to mark 2002 is the release Women’s Health Initiative (WHI) findings that showed estrogen is not the “elixir of life” that many thought it was then.

Watkins builds her story off the trajectory of estrogen use during this sixty-year period, which spanned two peaks followed by two crashes. The estrogens for HRT first crested in the early 1970s before its use dropped dramatically in 1975 on uterine cancer fears. Estrogen use began to rise in the early 1980s on regained confidence from combined use with progestin to reduce uterine cancer risk and from hopes that bone loss could be prevented and even reversed. This resurrection continued through the 1990s as estrogen use during and after menopause became “associated with reduced risk of colon cancer, prevention of tooth loss, lower incidence of osteoarthritis, increase in bone mass, reduced risk of Alzheimer’s disease, and lower rates of death from all causes” (p. 241).

Based on surveys of prescribers and prescription data during this time, Watkins concludes that “physicians who saw menopausal women as patients were…enthusiastic prescribers of HRT” (p. 244). They remained enthusiastic, making Premarin the most prescribed pharmaceutical product through much of the 1990s and until 2002 when the WHI trial was stopped three years early because it showed that HRT failed to produce the expected benefits, and even worse.

Women who took the estrogen–progestin pills, as compared with those in the control group who took placebo pills, increased their risk of breast cancer by 26 percent (relative risk of 1.26), coronary heart disease by 29 percent (1.29), stroke by 41 percent (1.41), and pulmonary embolism (blood clot) by 213 percent (2.13). (p. 271)

The investigators advised clinicians based on these results, that HRT “should not be initiated or continued for the primary prevention of coronary heart disease” (p. 271). Watkins quotes an editorial from the Journal of the American Medical Association that went further in saying that the trial “provides an important health answer for generations of health postmenopausal women to come—do not use estrogen / progestin to prevent chronic disease” (p. 273). HRT prescriptions plummeted.

These clinical inputs into the trajectory of estrogen are just the bare bones of estrogen history. Watkins fills in the story:

The story of estrogen is woven from several strands: blind faith in the ability of science and technology to solve a broad range of health and social problems, social and cultural stigmatization of aging, shifting meanings and interpretations of femininity and female identity, and the pitfalls of medical hubris in the twentieth century. (p. 1)

Watkins weaves these strands into the story of estrogen, which she tells in a chronological fashion, often as the subjects of individual chapters. Some include: the implications of rising feminism; pharmaceutical company promotional activities; the roles of patient advocacy organizations; FDA requirements for patient information about prescription drugs; generational differences in views of menopause; evolving research methods and evidence standards; and cultural shifts and mainstream media influences.

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5B

Haggis, Paul; Krauss, Dan

Last Updated: Apr-17-2020

Teagarden, J. Russell

Primary Category: Performing Arts / Film, TV, Video

Genre: Film

Summary:

5B is a documentary about the special unit created at San Francisco General Hospital (Ward 5B) in 1983 to take care of people with AIDS. Three years later, it moved to the larger Ward 5A, where it remained in operation until 2003 after the introduction of treatments effective enough to drastically reduce the demand for hospitalization and standards of care for AIDS patients were in place throughout the hospital. The documentary covers the medical, social, and political considerations surrounding the opening of Ward 5B, and the AIDS epidemic during that time.

The story is told from various perspectives through interviews with key figures in its development and operation, and archival footage of the ward and AIDS activism in the community. The most prominent among the key figures is Cliff Morrison, a clinical nurse specialist who spearheaded the idea for the unit and then managed it. Several other nurses who served in staff and supervisory positions are featured. Participating physicians include Paul Volberding, an oncologist at the time who became pivotal in the development of effective HIV treatments, and Julie Gerberding, a physician treating patients on the unit who later became the Director of the Centers for Disease Control (CDC). Lorraine Day, the chief of orthopedic surgery at the hospital when the unit opened is heard often as an opposing voice. Hank Plante, a local television news reporter also appears frequently to offer his perspectives on many of the social and political issues swirling around the unit. Among other participants are AIDS activists, volunteers, and family members of patients on the unit.

Several storylines frame the documentary including how nurses drove the unit’s inception and then were instrumental in running it. “Nurses were in charge,” said Volberding, admiringly. Interwoven throughout the film are the experiences of the patients and individual nurses, including one nurse who was infected with HIV from a needle stick. “Those nurses were the real heroes,” said one activist.

The unit and those who worked there also encountered opposition from inside the hospital. The nurses of this unit practiced in ways they considered safe but not in such a manner that would preclude them from touching patients or require that they don so much protective gear they become unseeable. Nurses and other clinicians from other parts of the hospital objected and did not want to be compelled to adopt practices they thought endangered them on the occasions they took care of AIDS patients. The film follows this story through union grievances and public debates to their conclusion, which sided with the unit nurses and their advocates.

The story is told against a backdrop of gay rights activism in the 1970s that led to AIDS activism with its influence on how the unit operated. Also getting attention is the fear AIDS struck in society and the resulting social backlash at a time of federal government insouciance. This fear continued up to the time the federal government recognized the epidemic and began taking action, relieving some of the tension but never eliminating it. The documentary ends with key participants reflecting on their experiences with the unit; most were proud, some bitter, and a few a little of both.

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The Ballad of Typhoid Mary

Federspiel, J. F.

Last Updated: Apr-07-2020

Belling, Catherine

Primary Category: Literature / Fiction

Genre: Novel

Summary:

The novel's narrator is a widowed 58-year-old Swiss-born physician, Howard J. Rageet, who lives in New York City. His son is a pediatrician, his daughter a medical student. Rageet himself is terminally ill. He is writing a "little biography," of Mary Mallon, the infamous "healthy carrier" also known as Typhoid Mary. Rageet's grandfather, also a doctor, had kept a journal about Mary and his rivalry with his friend, (the real) George A. Soper, whose life's work became tracking Mary and proving that she was responsible for the typhoid outbreaks. Elaborating on the journal, Rageet recounts Mary's life in America.

Born Maria Anna Caduff in the same part of Switzerland as Rageet's ancestors, she arrives in New York Harbor in 1868, aged 13, on a crowded immigrant ship, a fifth of whose passengers had died en route from Europe. The dead include Mary's family. She had been taken care of by the ship's cook, who evidently both taught her to cook and used her for sex. When the ship docks, Mary tries to jump overboard, but is stopped by a physician, Dorfheimer, who smuggles her through Ellis Island and takes her home with him. He is also a pedophile, and he has sex with her. Rageet calls this kidnapping a "humane, benevolent crime." Not long after, Dorfheimer dies of typhoid fever.

Rageet's "ballad" then traces Mary's various positions as a cook (and, often, sexual object), most of which end quickly when the household is infected. She has two relationships that do not lead to the disease. One is with a small girl who has Down Syndrome. Once her connection to typhoid is suspected, the child's family hire Mary to live alone with the child and care for her, hoping the child will be infected and die. The child never becomes ill. The other is with a disillusioned anarchist, Chris Cramer. She lives with him and falls in love with him, but he is not sexually interested in her.

Soper encounters Mary when he is asked by a wealthy Oyster Bay family, her former employers, to investigate a typhoid outbreak in their household. He manages to track her down and eventually, after much resistance, she is arrested, tested, and quarantined. She escapes and continues to work as a cook until her re-arrest. Promising to try and imagine Mary's motives, Rageet breaks off his narrative. He is dying. The novel ends with a postscript written by Rageet's daughter. Implying that her father committed suicide, she tells of Mary's stroke and the last years of her life as a paraplegic, and she provides a final document, the menu for one of the very elaborate meals Mary would have cooked.

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BPM (Beats per Minute)

Campillo, Robin

Last Updated: Feb-20-2020

Zander, Devon

Primary Category: Performing Arts / Film, TV, Video

Genre: Film

Summary:

BPM is a fictional, French film about ACT UP Paris in the 1990s. Directed by Robin Campillo, himself a veteran of Paris’s ACT UP, the film details the realities of being an HIV/AIDS political action group during an era of governmental inaction and lack of recognition of those most impacted by HIV and AIDS. Initially, BPM focuses on the collection of individuals who make up ACT UP Paris and how they organize themselves to protest and advocate for greater media attention, better sexual education, and more access to new pharmaceutical data, among a myriad of other causes. The film eventually shifts its focus from ACT UP as a group to two of its members, a couple, one of whom, Sean, is struggling with AIDS and Nathan, his partner, who supports him together with the the rest of ACT UP.

In addition to its presentation of HIV activism, BPM documents what it meant to be HIV positive in a world without highly active antiretroviral therapy and where those most affected were largely ignored or even viewed with disdain. Historical references ground the film firmly in the 1990s, including allusions to France’s infected blood scandal when hemophiliacs were knowingly given infected blood products, discussions that led to the initial development of protease inhibitors, and ACT UP Paris’s 1993 protest on World AIDS Day when a large pink condom covered the obelisk in the Place de la Concorde. Contrasting with these larger historical references are daily moments of living with HIV in this era. Members of ACT UP are shown taking AZT and DDI around the clock (including ensuring to pack water during a protest, in case of arrest, when they may need to take medication in jail), regularly attending the funerals of friends who died of AIDS, and enduring moments of homophobia from those outside of ACT UP.

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Elderhood: Redefining Aging, Transforming Medicine, Reimagining Life.

Aronson, Louise

Last Updated: Oct-07-2019

Carter, III, Albert Howard

Primary Category: Literature / Nonfiction — Secondary Category: Literature /

Genre: Treatise

Summary:

Louise Aronson, a geriatrician, argues that we should create Elderhood as the third era of human aging, joining the earlier Childhood and Adulthood. This new concept will allow us to re-evaluate the richness of this later time, its challenges as body systems decline, and, of course, the choices of managing death. This important and valuable book is a polemic against modern medicine’s limits, its reductive focus, and structural violence against both patients and physicians. She argues for a wider vision of care that emphasizes well-being and health maintenance for not only elders but for every stage of life.

Aronson argues that contemporary society favors youth and values of action, speed, and ambition, while it ignores—even dislikes—aging, older people, and the elderly. She says ageism is more powerful than sexism or racism—as bad as those are. Medical schools ignore the elderly, focusing on younger patients, especially men, and medical students perceive geriatrics as boring, sad, and poorly paid. Primary care, in general, seems routine and dull. By contrast, medical treatments, especially high-tech, are exciting and lucrative. In medical schools a “hidden curriculum” focuses on pathophysiology, organ systems, and drugs, ignoring patients’ variability as well as their suffering and pathos. Further, business and industrial models make “healthcare” a commodity, and nowadays “doctors treat computers, not people” (p. 237). Aging has become “medicalized” as a disease. Medicine fights death as an enemy, often with futile treatment that may extend a dying process.

Instead, Aronson says we need to bring back the human element, putting care of people at the center, not science. She calls for a new paradigm with ten assumptions (p. 378). Number 2 reads: “Health matters more to both individuals and society than medicine.” Number 9 claims, “As an institution, medicine should prioritize the interests of the people over its own.”

Many practical changes would follow, from redesigned “child-proof” drug containers to buildings and public spaces that are more congenial to older people—and, in fact, to everyone else. We should change our attitudes about old age. For example, we might use the adjective “silver” for a medical facility that is friendly to and usable by older people. Changing our attitudes about aging can help all of us imagine more positive futures for each one of us and for all of our society.

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