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The idea for her second novel came to Sarah Perry in a flash (Ref. 1) as her husband was telling her about the 1699 sighting of a serpent or dragon in Henham, a village slightly to the northwest of the town of Essex, where Ms.Perry was born in 1979. The late 19th century events of the novel occur primarily in Aldwinter, a fictional fishing village on the Blackwater estuary.  Divided into 4 books (with titles derived from a 1669 pamphlet on the Serpent), each with subdivisions by month, further subdivided into chapters, the story takes place over 11 calendar months, from New Year's Eve to November, 1892. Although the story does not feel complicated and should not be difficult to describe in a synopsis, it is a tribute to the novelist's Dickensian talents  that in fact it is somewhat complex, involving four couples and their various children and friends and their increasingly intricate relationships, all revolving around the palpable feeling in Aldwinter that the famous Essex Serpent has returned, resurfaced, or decided to re-animate all the lives therein. The protagonist is Cora Seaborne,  a recently widowed free-thinker, adept in biology and natural sciences, and mother of an adolescent boy, Francis, who would nowadays probably receive the label "autistic." After the death of her abusive husband from oropharyngeal cancer, Cora becomes emotionally involved with Luke Garrett, the treating surgeon, an idiosyncratic, brilliant man, who has a bosom buddy, George Spencer (simply called "Spencer"), a very wealthy former medical school classmate. With an introduction from her friends Charles and Katherine Ambrose, Cora and Martha - her intimate companion - visit William (often referred to as just "Will") and his wife Stella Ransome in Aldwinter, where Will is the parish minister and father to three children. The eldest is Joanna, a precocious adolescent girl one imagines, alongside a younger Cora, as a younger version of this novel's author, who describes herself as vibrantly curious of all her surroundings while growing up in Essex as a young girl. (Ref. 2)

With the arrival of Cora and Martha in Aldwinter, the narrative begins in earnest with the development of the mounting anxiety over the mysterious events (a missing boat, unexplained drownings) attributed to possibly a resurgent Essex Serpent besetting Aldwinter; Luke's miraculous operation saving a man named Edward Burton from a knife wound to the heart; the increasingly romantic relationship between Cora and Will, to Luke's dismay; Stella's rapidly progressive pulmonary tuberculosis; the disappearance of Naomi Banks, a friend of Joanna; and an attack on Luke by the same man who had knifed Edward Burton. By novel's end, without spoiling the plot, most loose ends have been cauterized, left more neatly dangling or deftly retied.  

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“Few hospitals are more deeply embedded in our popular culture” than Bellevue, David Oshinsky writes in the introduction to his new book Bellevue: Three Centuries of Medicine and Mayhem at America's Most Storied Hospital.  What follows, however, is not just an account of the (in)famous hospital, but a history of New York City, of disease and medicine and of America itself. Thus, the pages of Bellevue take us from Revolutionary War to Civil War, from Miasma Theory to Germ Theory, from the Spanish flu epidemic to the AIDS epidemic and from the disaster of 9/11 to the devastation of Hurricane Sandy. Along the way, the reader is introduced to giants of the medical and political world, many of whom were connected intimately to the hospital.  In Oshinsky’s telling, Bellevue is a hospital of firsts. The hospital with the first ambulance corps, first in-hospital medical school, first pathology lab. It is—at the same time—a hospital rooted in tradition. It is startling in reading Bellevue, for example, to realize that halfway through the book, the doctors who are being celebrated as central to the hospital’s longevity still subscribed to Miasma theory and could do little more for their patients than bleed them and give them alcohol.  Bellevue is also—and in Oshinsky’s eyes this seems most important—a hospital of immigrants. It was and is, a hospital where those for whom no one else would care could come, where no one would be turned away. Over the years, this has meant that Bellevue has opened its doors to Irish immigrants who were thought to be causing the Typhus epidemic, to Jews who were thought to be causing tuberculosis outbreaks and to homosexuals who were thought to be causing the AIDS epidemic. The demographic of patients who come to Bellevue has changed drastically throughout its history, but the underlying ethos of the hospital has been unwavering. 

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The therapeutic benefits of music are well known, but the theory that music might be harmful to our health, unless it is so obviously loud it injures our eardrums, comes as a surprise.  In this volume, historian of medicine James Kennaway traces the idea of pathological music from antiquity to the present.  The book’s introduction considers whether music really can create illness, whether it be of a physiological or a psychological nature.  We learn, for example, of arrhythmias and seizure disorders that are set off by music, not to mention the so-called Stendhal Syndrome, a psychosomatic reaction to great works of art.

The second chapter describes how, during the 18th century, disease was thought to result from excessive stimulation of the nerves, and how that created a theoretical framework for the “medical dangers of music” (p. 23) as being rooted in the nervous system. The example of the glass harmonica is given. This musical instrument, invented by Benjamin Franklin, had its status elevated when Mozart composed two pieces for it.  However, its success became its undoing, as it was feared the tones would “make women faint, send a dog into convulsions, [and] make a sleeping girl wake screaming through a chord of the diminished seventh” (p. 45). Special gloves were devised so that a performer might, by avoiding direct contact with the apparatus, spare his nerves. 

In the following chapter, Kennaway explores how Wagner dominated 19th-century discourse on pathological music in that his work’s eroticism and novel harmonies were thought to produce neurasthenia (a popular catch-all term for an array of anxiety disorders). Listeners were brought to an unhealthy state of ecstasy, and singers, being driven to the abyss, went insane. Women who had recklessly allowed themselves to become “Wagnerized” were punished with a “lack [of] children, or, in the most bearable cases, men” (p. 74).

Moving into the 20th century, the author describes how ideas about pathological music acquired a political connotation.  In Germany, the perceived threat of avant-garde Jewish composers (eg. Schoenberg) to public health culminated in the so-called Degenerate Music exhibition of 1938. And in  the United States, African American-influenced jazz was credited with the power to “change human physiology, damaging the medulla in the brain” (p. 121).

Finally, the book concludes in the present day with music for brainwashing (e.g. a consideration of whether subliminal messages hidden in rock songs could lead to suicide), and the use of painfully loud or abrasive music as sonic weapons in warfare, or for torture.  The author’s verdict is that the notion of music as bad for your health, though emerging in new forms, is more topical than ever.

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On February 7, 1649 –one week after the execution by decapitation of Charles I, his royal physician, William Harvey (1578-1657), discoverer of the circulation of the blood, writes to his cousin, Edward Francis, a lawyer, once his friend but now firmly in the camp of Cromwell. Harvey muses on how his responsibilities as physician to the king must place him in the royalist camp. But as a doctor he will tend to anybody – Every Body—because all bodies are governed by the same natural laws. He wonders what his place will be in the new political order. And he wonders if his cousin noticed him when he stood by the king in battle – and if they will ever meet again in friendship.  

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The book offers a detailed account by one of the nation’s leading cancer researchers of developments in chemotherapy over the past several decades, as well as the recent history of surgical and radiation treatments in the “war on cancer”—a term he resisted at first but finally embraced with full understanding of its implications.  The narrative touches on many of the writer’s own struggles over economic, political, and moral implications of what a NYT reviewer described as a “take-no-prisoners” approach to cure.  He also includes stories about disagreements with other researchers that give some insight into the acrimony that is part of high-stakes science.  At the NIH and later as head of the National Cancer Institute, DeVita faced many decisions about distribution of resources, how much to put patients at risk, and whom to include in clinical trials.  He provides his own point of view on those controversies frankly.  Not much mention is made of the causes of cancer, of nutritional or other complementary approaches, or the environmental factors in the spread of cancer. The strong focus on the book is on the development of chemotherapeutic treatments that have succeeded in raising survival rates, though few current statistics are cited.

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Those who are familiar with the Mütter Museum of the College of Physicians of Philadelphia, best known for its anatomical oddities, may have wondered about the institution’s namesake.  The author of this book, a poet and native of Philadelphia, endeavors to place Thomas Dent Mütter within the context of 19th-century American medicine.  

We learn here that notwithstanding being “medicated” with wine, surgical patients emitted such agonized screams that observers were known to vomit and pass out in their seats. We learn that Philadelphia was a cesspool of infectious disease for which there was no effective treatment.  We learn too of the rivalry (including behavior that would be considered unprofessional today) between the well-established school of medicine at the University of Pennsylvania (Mütter’s alma mater) and upstart Jefferson (whose faculty Mütter would join).  

In an era before the germ theory of disease became widely accepted, there was of course no concept of sterile technique.  To suggest that a surgeon should wash his hands was to imply he was not a gentleman because “all gentlemen were clean” (page 104).  Resistance to anesthesia was based not so much on concerns about potential danger but on the notion, when it came to obstetrics, that pain was a punishment for the sins of Eve.  Doctors could be downright sadistic to their patients, to the point of beating them like livestock.  That there was no concept of surgical aftercare meant that patients would be sent home immediately following an amputation. Victims of grotesque tumors and disfiguring accidents were considered “monsters” who lived lives of unimaginable misery.  

Enter Mütter, whose importation of plastic surgery from Paris to America brought hope to thousands of incurables.  He had an intuitive sense of the role of cleanliness in reducing morbidity and mortality.  He was a passionate advocate for anesthesia when it was seen as little more than a fad.  He abandoned traditional teaching methods that held a professor should be distant and unapproachable, and became beloved by generations of Jefferson students.    

In short, Mütter emerges as not just a likeable guy, but the forerunner of a whole new concept of what a good doctor should be, a sort of cross between P.T. Barnum and Mother Teresa.    

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Beginning in 1992, Mark Duxbury and Dean McClellan are high-flying salesmen for Johnson and Johnson, Ortho branch – happily promoting the drug Procrit, (or Epogen -- erythropoietin), for anemia. The drug stimulates the bone marrow to produce more red blood cells. Developed by fledging company Amgen, it was licensed to Ortho for specific uses. Their careers take off, and they earn bonuses and stature, peaking in 1993. Soon, however, Duxbury realizes that he is being encouraged to promote the drug for off-label uses and in higher doses that will enhance sales and profits through kickbacks. He soon realizes that the drug is not safe when used in these situations. People are dying because their unnaturally thickened blood results in strokes and heart attacks.

He raises objections with his employer. For voicing concerns he is ostracized and then fired in 1998. Along with the stresses of his work, the financial difficulties and emotional turmoil, Duxbury’s home life is in tatters; his marriage falls apart and he worries about his daughter Sojourner (Sojie). He develops multiple health problems, including sleep apnea and dependency on drugs and alcohol.

Enlisting the help of the famous lawyer Jan Schlictmann (A Civil Action), whistleblower Duxbury launches a qui tam lawsuit in 2002 against his former employer. This is a civil action under the False Claims Act, which can offer cost recovery should the charges prove warranted. The lengthy process is still going. The last ruling issued in August 2009 allowed the case to proceed. But Duxbury soon after died of a heart attack in October 2009 at age 49.

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When nine-year-old Rob Cole, child of poor 11th-century English farmers, loses his mother, he is consigned to the care of a barber-surgeon who takes him around the countryside, teaching him to juggle, sell potions of questionable value, and assist him in basic medical care that ranges from good practical first-aid to useless ritual.  When, eight years later, his mentor dies, Rob takes the wagon, horse, and trappings and embarks on a life-changing journey across Europe to learn real medicine from Avicenna in Persia.  Through a Jewish physician practicing in England, he has learned that Avicenna’s school is the only place to learn real medicine and develop the gift he has come to recognize in himself.  In addition to skill, he discovers in encounters with patients that he has sharp and accurate intuitions about their conditions, but little learning to enable him to heal them.  The journey with a caravan of Jewish merchants involves many trials, including arduous efforts to learn Persian and pass himself off as a Jew, since Christians are treated with hostility in the Muslim lands he is about to enter.  Refused at first at Avicenna’s school, he finally receives help from the Shah and becomes a star student.  His medical education culminates in travel as far as India, and illegal ventures into the body as he dissects the dead under cover of darkness.  Ultimately he marries the daughter of a Scottish merchant he had met but parted with in his outgoing journey, and, fleeing the dangers of war, returns with her and their two sons to the British Isles, where he sets up practice in Scotland.

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