Summary:

This posthumously published collection of essays by Dr. Klawans, an eminent neurologist and writer, explores the interactions between patient, family and neurologist and the implications of specific neurologic diseases. Klawans's special interest in neurology is movement disorders, such as Huntington's chorea and Parkinson's disease, but his outside interests range from evolutionary biology to classical music. His essays, therefore, focus on single patients or families, but the author weaves thoughts about his other interests into each "case."

The book is divided into two sections, "The Ascent of Cognitive Function" and "The Brain's Soft Spots: Programmed Cell Death, Prions, and Pain." In a brief preface, Klawans declares that this book is "more than just a set of clinical tales about interesting and at times downright peculiar patients" from his 35 years of practice, but rather it "humbly grapples with the 'whys' of our brain, not the 'hows.'" (pp. 9-10) In the preface, as well as in one essay, Klawans acknowledges the work and impact of fellow neurologist-writer Oliver Sacks ("Oliver is truly the father of us all." p 12).

The title essay concerns a six-year-old girl who was found, locked and completely speech-deprived, in a closet. Because she is still within the window of opportunity for language acquisition, "Lacey" quickly learns to speak, unlike Victor, the Wild Boy of Aveyron, whose story was immortalized in the François Truffaut film, L'enfant Sauvage. Klawans uses these stories as a launch pad to discuss the evolution of language, including a proposal that the cavewoman, not the man, was responsible for development of the human species as she taught her offspring language.

Other chapters focus on patients with epilepsy, Parkinson's disease, localized and hemispheric stroke, "painful-foot-and-toe syndrome, " and Creutzfeldt-Jakob disease. Two particularly memorable chapters concern Huntington's chorea and Refsum's disease. The chapter, "Anticipation," explores the profound ethical concerns of genetic testing for Huntington's chorea as applied to three generations of one particular family. In the chapter, "The Hermit of Thief River Falls," Klawans recollects his first year as a neurology resident, and his care of a reclusive patient with a rare eponymous illness, Refsum's disease--just in time for a visit by Refsum himself, a famous Norwegian neurologist.

The book concludes with a speculative "afterthought" about genetics, evolution, and the importance of extended "juvenilization" --the protracted post-natal development of Homo sapiens. This essay intertwines some of the threads regarding speech development and evolutionary biology, particularly brain development, that were introduced earlier in the text.

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This sketch is teeming with images: in what appears to be a science lab, two researchers stand in the background, surrounded by gray lab equipment; one peers into a microscope. In the bottom of the frame a horse and cow flank three sheep. At the center stands a muscular baby, loosely draped in a white cloth and held up by a nurse in a white apron and cap. To his left stands a rather grim looking doctor, who holds the baby's arm with one hand and injects a vaccine with the other.

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A woman in apron, cap, and long skirts stands at a small table, the long handle of a pot resting on her left arm. She appears to be shelling an egg for, presumably, an invalid. On the table before her is a plate with another egg on it, a loaf of bread, and a pitcher and goblet. The background is dark, and the image of the nurse and the table seem to glow warmly in contrast. The woman is intent on her task and appears unhurried.

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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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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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Between April 1795 and September 1801, 306 bodies were pulled from the river Seine in Paris. A register of these deaths, indicating, sex, age, hair colour, wounds (if any) and a description of clothing (if any) was kept by two mortuary clerks, Citizen Bouille and Citizen Daude. If witnesses came forward in the days that followed, the names, occupations of the "silent guests" and the witnesses would be added together with the circumstances of the deaths. In most cases the cause of violent death was unknown, or unrecorded--be it "accident, misadventure, suicide, or murder." Bouille and Daude would not speculate.

This artistic documentary uses a male narrator and an eloquent text to present 23 out of the 306 cases: traveling clerks, hearty horsemen, children, mothers, mistresses, aged widows, and a laundress with her little daughter drowned together. These people had lived through the Revolution, the Terror and the early Consultate and it seems reasonable to wonder if the political circumstances they had experienced were somehow connected to their demise. On the other hand, the occupations--tobacco-pouch maker, carter, delivery clerk--invoke the continuity of daily life in the great city despite the political turmoil.

Each case is presented with the site and details of the discovery of the body, followed by a description of the external anatomy as the camera moves slowly and clinically upward over the naked corpse from the feet to head. The shadowy antics of the crude yet sympathetic bureaucrats Bouille and Daude appear throughout, as they retrieve bodies, wash them, label them, and arrange for the witnesses to view them with enforced respect. But we know less about Bouille and Daude than we do about their "guests."

The narrator reminds us how memory rarely survives more than three generations. Who will remember us, he asks, or these actors who lay very still? And as the register ends, the Revolutionary calendar that governed it ended too. These people who no longer exist could be said to have lived in a time that also no longer exists, because it is no longer measured.

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The story opens on the day that Ridgeon, a prominent research doctor, is knighted. His friends gather to congratulate him. The friends include Sir Patrick, a distinguished old physician; Walpole, an aggressive surgeon; Sir Ralph Bloomfield Bonington, a charismatic society doctor; and Blenkinsop, a threadbare but honest government doctor. Each one has his favorite theory of illness and method of cure. These are incompatible--one man's cure is another man's poison. Nonetheless, they all get along.

A young woman (Mrs. Dubechat) desperately seeks help for her husband from Ridgeon, who has evidently found a way to cure consumption by "stimulating the phagocytes." Ridgeon initially refuses, but changes his mind for two reasons--Dubechat is a fine artist and Ridgeon is smitten with his wife.

When the doctors meet Dubechat, however, they find that he is a dishonest scoundrel. Ridgeon eventually decides to treat Blenkinsop (who also has consumption) and refer the artist to Bloomfield Bonington, this insuring that he will die. In the end Ridgeon justifies his behavior as a plan to let Dubechat die before his wife find out what an amoral cad he actually was. This, in fact, happens and Dubechat's artistic reputation soars.

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This is a collection of medically related stories and poetry, most of which were previously published in medical journals like JAMA (Journal of the American Medical Association), Annals of Internal Medicine, and the American Journal of Medicine. "Country Doctors of Humble Pie," "Boss Cow," and "Discipline" are humorous tales about small town medical practice. "Second Opinions," "Net Worth," and "Making Friends" are stories of patients and their idiosyncrasies.

"Hafiz Ali Goes Home" concerns a dying man who wishes to return to his home village to die, rather than dying in the sterile confines of the hospital. The story details the misadventures of Hafiz Ali's two sons as they attempt to carry out his last request.

Many of the poems deal with clinical diagnoses ("Zoster" and "Lupus Erythematosis") or the history of medicine ("Towne of Guy's" and "The Turning"). "Doing Post-Mortems" is a thoughtful poem about the war (or relationship?) between the sexes in medicine.

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