Summary:

This history of western medicine in the nineteenth century chronicles the lives of some men and women who were innovators in the field of medicine. Williams begins the book in the 1700s with the life of John Hunter and his influence on nineteenth century medical practice and research.

The book consists of 16 chapters, many of which, like the one on Hunter are biographic. For example, Williams writes of the contributions, education, and lives of Florence Nightingale, Hugh Owen Thomas (orthopedics), Marie Curie, Joseph Lister, Ignaz Semmelweis (maternal health), Patrick Manson (tropical medicine), Jean-Martin Charcot, and William Conrad Röntgen. Other chapters are more theme-oriented, such as body-snatchers, discovery of anesthesia, homeopathic medicine, blood transfusion, and medical use of spas.

Black and white illustrations, such as Mrs. Röntgen's hand in an X-ray photograph help the reader to appreciate the advances in medical knowledge in the nineteenth century.

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This is the 17th of Patrick O'Brian's novels about the adventures of Captain Jack Aubrey of the British Navy, and his friend, Stephen Maturin, the ship's surgeon and secret intelligence agent. Aubrey is a large, hearty, cheerful man who loves music and astronomy, and whose fortunes wax and wane as O'Brian follows him through numerous engagements and exploits around the world, roughly from 1800 to 1815. (While the early books in this series place Aubrey in some of the actual sea battles of the British war against Napoleon, "real time" gets suspended in the later novels.)

Maturin is small, dark, and secretive; of Irish and Basque descent; and a Roman Catholic. Nonetheless, he hates Napoleon so much that he becomes an agent for the British, working under the intelligence chief, Sir Joseph Blaine. Maturin is also a famous physician and naturalist, and he plays the cello to Aubrey's violin. The two men are the closest of friends, despite their many differences; in fact, this series of novels is the story of two complex and engaging characters and their years of friendship, as much as it is a series of sea yarns and adventures.

In The Commodore, Aubrey and Maturin have returned to England after a protracted trip around the world that occupied the previous four novels. Aubrey happily spends time with his wife and children, but Maturin discovers that his wife, Diana, has disappeared and his young daughter appears to be autistic.

Shortly, Aubrey receives orders to lead a squadron of ships to the west African coast, where he is to harass the slavers and, on the return voyage, to engage a French squadron being sent (secretly) to attack Ireland. Maturin joins the squadron after carrying his daughter to safety in Spain. They successfully knock off some slaving ships and terrorize the Coast of Guinea, before hurrying back to the southwestern coast of Ireland where they catch up with the French ships and defeat them.

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This history of western medicine focuses on British life in the eighteenth century. Williams begins his treatise by wondering if "we realize sufficiently what we have escaped by being alive in the twentieth, not the eighteenth, century." He then catalogues in the subsequent 12 chapters the agonies not only of illness but also of medical treatment in the 1700’s.

Topics are wide-ranging and include blood-letting, parturition, infant malnutrition, rampant infectious diseases, maltreatment of the insane, surgery prior to anesthesia, water therapy, and military medicine. Primary source quotations interspersed in the narrative add to the drama. For example, the deposition of a widower (his wife died while pregnant) is quoted: " . . . Being taken ill of a paine in her right side under her short ribb together with a great difficulty of breathing having but 14 weeks to go with Child Mr Hugh Chamberlen Senr was sent for to take care of her, who thereupon gave her in the space of nine days four vomitts, four purges, and caused her to be bled three times to the quantity of eight ounces each time: Then gave her something to raise a spitting after which swellings and Ulcers in her mouth followed . . . . " (p. 31)

A few medical advances at the close of the century are also described, notably the smallpox vaccine developed by Jenner and the administration of First Aid to wounded soldiers at the frontlines (developed by Larrey). The text is accompanied by black and white illustrations, such as an inside view of Bedlam (Bethlehem Hospital) by William Hogarth (A Rake’s Progress, plate VIII).

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Many of the poems in this volume bring historical figures to life; these include figures as varied as "Wallace Stevens, Walking," "The Death of Shelley," "Rembrandt's Head," "Immanuel Kant," and "David Hume and the Butterfly." Some, such as "The Miracle," "Dr. Beaumont's Miraculous Hole," and "The Corpse in the White House," focus on specifically "medical" aspects of history. Dr. Young also includes a number of poems that arise from his own experience as a practitioner; e.g. "The Rodeo Queen," "The Medusa," and "Night Call."

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This is a fascinating book on the relationship of science, medicine, and medical education to the rise of modernism in literature. Crawford uses Williams' work to connect the worlds of literature and medicine. He discovers in Williams' early poems and stories the dominant themes of clarity, cleanliness, objectivity, and authority; these themes also characterize early 20th century science. In Williams' later work, Crawford shows how the poet moved toward a more subjective and relativistic aesthetic, a change that reflects subsequent developments in science, especially physics, and signifies the emergence of "post-modernism" in literature.

Williams' first principle was clarity. As a physician, it was important that he observe human reality with a clear eye so that he could intervene to transform it. Direct apprehension of reality was also for him the source of poetry. He found beauty in the concrete experience of everyday life, but was skeptical of theories and abstractions. Along with clarity, cleanliness and objectivity also characterize Williams' worlds.

But clarity is not, in reality, so clear. To see clearly in a medical way, the physician must first learn to observe the world in a specialized manner in the "theater of proof," a metaphorical extension of the stage on which professors demonstrate anatomical structures or surgeons demonstrate operations. Like medical educators, the poet also creates a theater of proof. While the reader may experience clarity and simplicity in the poem, these effects are actually staged by the poet, who chooses "clean" words and manipulates reality to achieve the desired simplicity. In both medicine and poetry, the practitioner unveils the truth by using manipulative and authoritarian techniques.

In the last chapter, Crawford shows that Williams' later work presages a post-modern, relativistic world. While the earlier Williams speaks of clarity, simplicity, science, and authority, Patterson and the post-World War II poems reveal complexity, fragmentation, and subversion.

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Dr. Papper, a revered figure in the field of anesthesiology, questioned why it took so long for anesthesia to be "discovered": after all, pain and suffering existed long before the mid-nineteenth century. This book is a result of Papper’s graduate studies in literature and history and explains his thesis that "societal concern with pain and suffering, and the subsequent development of surgical anesthesia in the Romantic era . . . are outgrowths of Romantic subjectivity."

The book provides biographies of scientists, physicians and poets, such as Humphry Davy, Thomas Beddoes, Sr., Samuel Taylor Coleridge and Percy Bysshe Shelley, along with analyses of Romantic poetry as related to pain and suffering. Papper theorizes that the exchange of ideas amongst these intellectuals and the political upheavals of the time paved the way for society to recognize that the pursuit of happiness could include the relief of pain.

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This novel was inspirational for several generations of pre-medical and medical students. It follows the hero, Martin Arrowsmith, from his days as a medical student through the vicissitudes of his medical/scientific career. There is much agonizing along the way concerning career and life decisions. While detailing Martin’s pursuit of the noble ideals of medical research for the benefit of mankind and of selfless devotion to the care of patients, Lewis throws many less noble temptations and self-deceptions in Martin’s path. The attractions of financial security, recognition, even wealth and power distract Arrowsmith from his original plan to follow in the footsteps of his first mentor, Max Gottlieb, a brilliant but abrasive bacteriologist.

In the course of the novel Lewis describes many aspects of medical training, medical practice, scientific research, scientific fraud, medical ethics, public health, and of personal/professional conflicts that are still relevant today. Professional jealousy, institutional pressures, greed, stupidity, and negligence are all satirically depicted, and Martin himself is exasperatingly self-involved. But there is also tireless dedication, and respect for the scientific method and intellectual honesty.

Martin’s wife, Leora, is the steadying, sensible, self-abnegating anchor of his life. In today’s Western culture it is difficult to imagine such a marital relationship between two professionals (she is a nurse). When Leora dies in the tropics, of the plague that Martin is there to study, he seems to lose all sense of himself and of his principles. The novel comes full circle at the end as Arrowsmith gives up his wealthy second wife and the high-powered, high-paying directorship of a research institute to go back to hands-on laboratory research.

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Jordanova posits that medicine and science "contain implications about matters beyond their explicit content." Namely, they have historically made assumptions about women and their relation to science/medicine. Jordanova explores this relation through seven chapters.

Particularly interesting is Chapter Three, "Body Image and Sex Roles." Here Jordanova discusses the wax models used by medical students in the nineteenth century to learn about anatomy. These models were almost always female and sometimes even had flowing hair, pearl necklaces, and other realistic details. Jordanova argues that this gendering was no accident. The route to knowledge is historically associated with looking deep into the bodies of women.

Chapter Five pursues this theme, commenting on how nature is often configured as a female whose secrets will be revealed by masculine science. The final two chapters address twentieth century representations, including the gendered nature of drug advertisements in in-house medical magazines.

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This poem is in the voice of a faith healer who calls upon the reader to witness the marvels of God's healing power, a holy power that shows the terrible evil embodied in the theory of evolution: "Darwin's demon apes of hell / howl the name of blasphemy." The narrative centers on a young boy with diabetes, whose father brings him to be healed. He and his father prayed and their faith grew strong; "he threw away the pills, those ugly / relics of his doubt-- / and the boy cried out, rejoicing!"

Later, though, during the night, the boy became ill again and begged his father for the pills. But the congregation prayed and the father's faith held . . . and the boy died. The healer rejoices, though, because "he is not dead--the boy / only sleeps in the Lord." The healer believes the child died because " Darwin's great beast" rose that night and "passed his hand over the boy's / sick faith."

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This long poem tells a story within a story. The framing story is Charles Darwin falling asleep and thinking, "as he always does, of animals . . . . " His dream turns into the story of the Deluge and Noah and his ark. Poor Noah is a bumbling 600 year old man, who much against his own inclinations, is told by God to build the ark and, later, to stuff it with a pair of every kind of animal. Well, Noah's sons think this whole project is stupid, but they eventually go along with it.

The most difficult part was finding and capturing the animals, two of every species, including in the end, "sixteen thousand hungry birds / lusting for the eighteen hundred thousand insects, / and the twelve thousand snakes and lizards / nipping at the seven thousand mammals, / and everyone slipping and sliding around / on the sixty-four thousand worms / and the one hundred thousand spiders--." When the deluge began and the waters rose, the ark floated past all the desperate, dying people, until the last woman "holding her baby over her head" went under "and God was well pleased."

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