Summary:

The author, a Canadian physician-historian-educator, blows the dust off the shelves of medical history with this fascinating text designed for medical students, educators, and those with an interest in history of medicine. Duffin begins this survey of the history of Western medicine with a glimpse at a pedagogical tool designed to spark the interest of even the most tunnel visioned medical students: a game of heroes and villains. In the game, students choose a figure from a cast of characters selected from a gallery of names in the history of medicine.

Using primary and secondary sources, the students decide whether the figures were villains or heroes. The winner of the game is the student who first recognizes that whether a person is a villain or hero depends on how you look at it. This philosophy imbues the entire book, as this treatise is not a tired litany of dates, names and discoveries, but rather a cultural history of the various times in which medical events occurred.

The book is organized by topics which roughly follow a medical school curriculum: anatomy, physiology, pathology, pharmacology, health care delivery systems, epidemiology, hematology, physical diagnosis and technology, surgery, obstetrics and gynecology, psychiatry, pediatrics, and family medicine. The last chapter, entitled "Sleuthing and Science: How to Research a Question in Medical History," gives guidance to formulating a research question and searching for source material. Fifty-five black and white illustrations are sprinkled throughout the book, as well as 16 tables.

Direct quotes from historical figures, such as Galen and Laennec, as well as excerpts from writings of eyewitnesses of events, anecdotes and suggestions for discussion, appear in boxes within the chapters. Many of the chapters contain discussion about the formation of professional societies. Each chapter ends with several pages of suggested readings and the third appendix delineates educational objectives for the book and individual chapters. The other two appendices list the recipients of the Nobel Prize in Physiology or Medicine, and tools for further study, including titles of library catalogues, and resources in print and on-line.

Although the book is a survey covering multiple eras and topics, each chapter contains choice tidbits of detail. For instance, the chapter on obstetrics and gynecology includes the story and photograph of Dr. James Miranda Barry, the mid-nineteenth century physician, surgeon and British military officer, who was discovered to be a woman at the time of her death. The impact of the stethoscope on the practice of medicine is explored in depth in the chapter, "Technology and Disease: The Stethoscope and Physical Diagnosis."

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The author of this memoir is a poet and writer who developed systemic lupus erythematosis (SLE) during her first year at the University of Pennsylvania. Initially, her condition was difficult to diagnose, which led to her first negative encounters with physicians and the health care system. Later, Ms. Goldstein developed unusual neurological manifestations of SLE. Once again, she had trouble convincing her doctors that her symptoms were not only real, but also disabling. She was fortunate enough to come across a few good physicians who respected her as a person and earned her trust.

Despite her chronic illness, Ms. Goldstein thrived throughout college and graduate school. She approached each new challenge with such a positive attitude that some of her doctors considered her emotionally unstable. (I guess they thought it would be more "normal" for her to lose hope and turn herself into an invalid.) Her graduate work in literature focused on the new field of literature and medicine.

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Joe and Mary Wilson live an isolated life in the outback of New South Wales. Their infant son Jim begins to "take convulsions." Jim turns into a sickly child who appears to be "too old fashioned" to survive in this word. After the three-year-old boy has spent a month with his mother's sister, he and Joe begin the two-day trek home. The boy becomes ill while they are camping overnight, and Joe, terrified that his son is going to die, carries him to "Brighten's sister-in-law," who lives in the only homestead in the area. She nurses the boy, who survives.

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Prince Myshkin is an epileptic returning from a sanitarium. On the train, he meets Rogozhin and they become friends. Myshkin visits his distant relatives, the Epanchins, a fashionable family. General Epanchin gives him a job and he fascinates Madame Epanchin and her daughter, Aglaya, with his innocence and awkwardness.

The Prince boards with Ganya, a schemer who wants to marry Aglaya for her money. Ganya is also involved with Natasya; though innocent, she is a kept woman. Myshkin pities Natasya; in their innocence they are two of a kind. He offers to marry her, but as she is worried about ruining his name, she runs off with Rogozhin. Shortly afterward, she runs away from Rogozhin and disappears. Rogozhin assumes she has run to Myshkin and with Ganya plots the Prince's death.

Meanwhile, Aglaya has fallen in love with Myshkin, but his bizarre talk disturbs the family and when he falls into a fit at a party they ban him from the house. Aglaya also grows increasingly jealous of Natasya. The two women meet and Aglaya resolves to give up the Prince. At last, Natasya agrees to marry Myshkin but on their wedding day, she elopes with Rogozhin, who murders her. Myshkin returns to the sanitarium.

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This is a collection of stories and sketches by a practicing neurologist. Most of the material is clinical and autobiographical. In "Mrs. Bachman" a new patient enters the doctor's office, carrying a thick stack of medical records. It all started in 1946 and no doctor has ever found the explanation of her condition. Meanwhile, the doctor is wearing contact lenses for the first time. His eyes begin to tear. Mrs. Bachman thinks that he is crying over her misfortune. She consoles him, "I want you to know that you are the kindest, most sympathetic man I have ever met."

In "Intensive Care" an elderly woman is agitated after a seizure. The staff try unsuccessfully to calm her. Finally, her husband approaches and kisses her. She settles peacefully and they hold hands.

The doctor in "Continuing Medical Education" finally discovers metastatic breast cancer as the cause of a psychotherapist's neck pain, long after he and other physicians had told her again and again that the "driving mechanism" of her chronic pain was "unresolved anger and frustration." In a longer essay, "The Narrow Bridge," the author reflects on the meaning of healing, "Healing helps us find a place in this world for ourselves and for each other."

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A woman, Rose, describes her childhood during the depression as she struggled with issues of her own identity and her jealousy toward her younger sister, Sophie, who suffers from cerebral palsy and seizures. Rose watches as Sophie is born, as her parents argue, as Sophie is held closely by their mother during her seizures, and as Sophie is given two birthday parties each year. She fantasizes about how life might be if her sister were dead, and imagines her sister hanging from a rack like the animals at the slaughterhouse. Finally, she discovers that Sophie actually needs her and loves her.

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Although he could be a court physician in Macedonia, Hippocrates has returned to the island of Cos, at least temporarily, to take over his dead father's practice. He is summoned to the villa of a wealthy citizen to consult on the fits of a daughter of the house. Using precise clinical observation, he diagnoses hysteria instead of epilepsy. Then, he relates the girl's psychological problems to the neglect of her selfish and adulterous mother, Olympias, who prefers her handsome, athletic, but rather dense (and as it turns out, illegitimate) son, Cleomedes.

A marriage is to be arranged with Cleomedes's obsession, Daphne, the exquisitely beautiful and intelligent daughter of a physician from Cnidus. But Daphne falls in love with Hippocrates, and he with her. In between solving clinical problems, including a real case of epilepsy, a botched abortion, and a broken hip in his own grandmother, Hippocrates is led along a tangled path of intrigue, seduction, and false accusations.

A fire destroys the medical library of Cnidus, killing Cleomedes, who, for once in his life had risen to heroism in attempting to save an invalid woman and her son. When the newly orphaned child reveals that Olympias and her old lover have committed arson, Olympias leaps from the highest wall to her death. Hippocrates is now free to marry Daphne. Adopting the child as their own, they return to the island of Cos.

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