Summary:

Janis Caldwell, who practiced emergency medicine for five years before getting her Ph.D. in English, examines the philosophy and practice of nineteenth-century British literature and medicine in this book. In an erudite introduction, she explains what she means by the "double vision" of "Romantic materialism," "Romantic because [physicians and authors] were concerned with consciousness and self-expression, and materialist because they placed a particularly high value on what natural philosophy was telling them about the material world" (1). These writers' intellectual context, influenced by natural theology, was dualist, including both the Book of Scripture and the Book of Nature. Their methodology "tacked back and forth between physical evidence and inner, imaginative understanding" (1), giving rise to the two-part "history and physical exam" familiar to physicians today.

The book examines this dual hermeneutic in six influential sites over the course of the century. In Chapter Two, Caldwell reads early-nineteenth-century debates over vitalism in the context of Mary Shelley's Frankenstein, arguing against the materialist-spiritualist divide so often cited in that period. She also brings readings of the novel into line with contemporary theories of physiologic sympathy. Next, she turns to the enormously influential sage Thomas Carlyle, arguing that he broadens the body/soul model to include both natural and supernatural aspects of the world. Again rejecting the notion of a philosophical dualism that prohibits mixing differing approaches, she argues, both Carlyle and the anatomist Richard Owen enthusiastically endorse a more heterodox vision of the world, in which we learn from both natural and spiritual enquiry.

The fourth chapter reads Emily Brontë's Wuthering Heights in the context of contemporary popular treatises on children's health and child-rearing. Caldwell argues that Brontë's image of the Romantic child, as emblematized in Cathy and Heathcliff, and characterized as "a more social, empirical, physical, literal version of childhood," derives in part from the "domestic medical texts which function as a sort of secular scripture in the Brontë household" (74). She suggests that the dualist language of natural theology, which combined spiritual and natural interpretation, and which was well-known in the Bronte household, influenced Emily's mixture of religious and medical concepts in her portrait of Romantic childhood.

Chapter Five contrasts Emily Brontë's version of childhood to that of her sister, Charlotte Bronte, in Jane Eyre and Villette. Charlotte Brontë, argues Caldwell, inclines more to the professional version of medicine, less suspicious of physician authority and more likely to experiment (in her fiction) with alternative medical theories such as phrenology. In an extended discussion of theories of literalization and metaphor, using Ricoeur to argue that the literalization of a metaphor returns us to the fact but also reinvigorates the metaphor through its dissonance with the fact. Caldwell proposes that the supposed "coarseness" of Brontë's novels is linked to her use of literalization.

A chapter on Darwin posits that "Darwin's thought arises directly out of ... Romantic materialism" (117). Although by the end of his life Darwin had renounced literary reading, the "dialectic of Romantic materialism" (shaped by Romantic literature as well as science) appears in "Darwin's preferred scientific method," in his rhetoric, and in the narrative structure of his scientific autobiography (123-24).

Caldwell's final chapter provides a significant new reading of the genre of the medical case history, by studying George Eliot's Middlemarch in the light of the bipartite structure of "the patient's narrative and the physical exam" (143). Emphasizing the negotiations between doctors and patients in the mid-nineteenth century, and calling for similar negotiations today, Caldwell navigates the differing critical positions on George Eliot's novel, weighing whether the narrator "participates in the systematic, totalizing knowledge of the pathologist" or undercuts that knowledge (156). Caldwell concludes that the narrator of Middlemarch practices a "hermeneutic circling" that shuttles back and forth between incommensurate perspectives, part and whole, nature and spirit, seeking "a partial and provisional, rather than absolute or positive, knowledge" (160). The book ends with a call to return the term "clinical" to its full meaning, not just of detachment, but of engaged practice.

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This book could perhaps have been called "Pathology and Identity in the Medical Case History and the British Novel." Tougaw here examines the mutual fascination of both nineteenth-century medicine and the British novel with pathology: that both "novels and case histories require a suffering body at narrative's center" (8), and that both "put into circulation a model of identity whereby the subject is always caught in a double bind... between health and pathology" (9). He examines developments in the medical case history, as a narrative, and argues that both this and the novel permitted an escape from "the nineteenth-century zeal for classification" (2). He reads the doctor-patient relationship as analogous to the reader-novel relationship, and argues that both genres must balance competing modes of approach: diagnosis and sympathy.

The book focuses on "controversial or marginalized maladies" (18), with each chapter acting as, itself, a case study. The first chapter, however, sets up Tougaw's critical terms of diagnostic and sympathetic reading, alternatives that help readers negotiate their discomfort with controversial conditions. The second chapter examines how the rhetoric of disability helps provide cover for "scientific scrutiny" (19) in cases of breast cancer, which bring to the foreground concerns over the limits and gendering of privacy and the body. Chapter Three builds on Peter Logan's work on the nervous narrator, examining Jane Austen's use of indirect discourse to finesse questions of hypochondria, compulsive storytelling, and early-nineteenth-century medical knowledge.

The fourth chapter focuses on the mid-century debate over mesmerism and anesthesia, reading cases alongside relevant novels by Wilkie Collins, Sheridan Le Fanu, Robert Louis Stevenson, and Mary Elizabeth Braddon. It traces Victorians' interest in altered consciousness and the effects of drugs on agency, and it argues for an analogy between the intersubjective relations of mesmerist/subject, doctor/patient, and narrator/reader. The final chapter reads Freud's "Rat Man" and "Wolf Man" against three novels by William James. Tougaw sees both these authors as putting forward a complex epistemology based on interpretation and intersubjectivity rather than assertion or individuality. The Afterword reframes Tougaw's arguments in the context of contemporary debates over the doctor-patient relation and the patient narrative; that "the real work of autobiography is the establishment of an intersubjective rapport between writer and reader" (21).

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In 1868, a man named Eben Frost redeems a medal from a pawn shop and delivers it to a widow, Elizabeth Morton (Betty Field). Twenty years earlier her late husband W.T. Morton had used anesthesia on Frost for a dental procedure.

Flashback two decades, Morton (Joel McCrea) and his wife marry and he struggles in dentistry. Learning of Letheon (ether) from fellow dentist Horace Wells (Louis Jean Heydt), he successfully applies it in his practice for painless tooth extraction. Surgeons are interested but skeptical and want to know the composition. In keeping the simple formula a secret, Morton could become wealthy, but he is prompted to reveal its composition when confronted with a little girl bravely awaiting an operation.

Losing the prospect of gain from ether, he sets his financial hopes on his patented invention of a glass inhaler for administering it. Congress votes him a reward of $100,000, but his patent is infringed and rivals conspire to block justice and rewards. Morton dies young, poor, and unknown.

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A beautiful elderly couple are forced to confront Fiona’s (Julie Christie) problems with memory. Always stylish and active, she begins to neglect her appearance and do odd things. She loses her way while cross-country skiing in a familiar terrain; at nightfall, Grant (Gordon Pinsent) finds her frightened and frozen. She decides that she must go into a nursing home, but Grant is horrified to learn that, in order for her to adapt, he may not visit for an entire month. When he finally returns, bearing a bouquet of flowers and hoping for her warm affection, he is stunned to find Fiona pleasant but indifferent to his presence. Instead, she is preoccupied, even infatuated with Aubrey (Michael Murphy), who silently occupies a wheelchair. Fiona is able to interpret Aubrey’s moods and desires.

At first, Grant is hurt and jealous, but gradually he accepts Fiona’s need to be important for someone. Haunted by guilt over an affair with a student years ago, Grant wonders if Fiona is somehow retaliating. When Aubrey’s wife Marian (Olympia Dukakis) brings Aubrey home because she cannot afford the care, Fiona is despondent. He approaches Marian about returning Aubrey to the center. Thrown together by their absent yet present spouses, Marian and Grant indulge in a half-hearted affair. By the time, Aubrey returns, Fiona may have forgotten him, but she still knows Grant and appears to recall his distant infidelity though so much else is lost. But he still loves her and together they can find reasons to laugh.

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Summary:

Bonjour Tristesse is a novel about a seventeen-year-old girl, Cécile, written by an eighteen-year-old, Françoise Quoirez (pen name Sagan). Published in 1954 in France and 1955 in the United States, the story was an immediate success.

Cécile's mother died when the girl was two, and she lives with her forty-year-old father, Raymond. Raymond enjoys parties, young women, drink and easy conversation. He, Cécile and his latest girlfriend, Elsa, sojourn on the southern coast of France, where Cécile meets and toys with a young law student. Cécile is mercurial in her thoughts, but once a true rival for her father's affections arrives at the summer house, her jealousy surfaces fully. Anne had been a friend of Cécile's mother, and, unlike Raymond's other love interests, is intelligent and similar in age.

Tragedy ensues from Cécile's plotting and her father's weaknesses, and the question remains whether suicide or an accident occurred.

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Madame Raquin, a widowed haberdasher, lives with her son, Camille, who has a history of poor health and is weak and uneducated, and her niece, Thérèse, conceived in Algeria by Madame’s soldier brother and a “native woman,” both of whom are now dead. Raised by her aunt as companion to the invalid Camille, Thérèse is a model of repression. When Thérèse turns twenty-one, she and Camille marry, and the three move from the country to Paris. One day Camille brings home an old friend, Laurent. He and Thérèse become lovers and decide to murder Camille so they can marry. On an outing they go boating and Laurent drowns Camille.

The murder replaces their mutual passion with guilt, remorse, and evenutally, hatred. The two must wait before they can marry without arousing suspicion; they are both increasingly haunted by memories of Camille and visions of his corpse. When the aging and still-bereft Madame Raquin actually helps arrange for them to marry (to ensure that they will take care of her), they torture each other with their proximity, and they torture Madame Raquin, now immobilized and silenced by a stroke, by allowing her to learn that her trusted caregivers killed her son. The three live in torment until, finally, Thérèse and Laurent kill each other.

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Within the first few pages of this novel, the reader is thrust into the midst of a family--their past history, their present tragedy, and their future healing.  Kitty Duvall, a middle-aged woman living in Baltimore, Maryland, receives a phone call informing her that her son, soldier Vincent Duvall, has been injured in Viet Nam and now lies, severely burned, in the Intensive Care Unit of Brooke Army Medical Center.  Kitty packs her bags and rushes to his bedside.  Thus begins this straight forward and yet complex story, one that weaves between past and present, one that examines the lives of caregivers, especially nurses; the lives of patients, particularly those young men and women sacrificed to war; and the lives of the parents who must, as Kitty does, find their places alongside their dying or healing children, always wondering how best to help them. 

Although this book is a novel, it reads like a memoir.  Indeed, the events of the novel seem so right and so accurate because the author served as a lieutenant in the Army Nurse Corps at Brooke Army Medical Center during the Vietnam War.  Her own experience as a nurse, her own memories of the burned and wounded men, inform this novel and bring to it an accuracy and an urgency that takes the reader behind the scenes into unforgettable images of war and recovery.  Although set in the Vietnam era, this story is especially relevant today, when once again soldiers and their families must deal with the physical and emotional wages of battle.

 

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The movie opens with a shot of a young man stitching up a laceration in his own knee. Another describes how he had to select which of two severed fingers would be re-attached because he could not afford both operations. They are among the millions of Americans without health insurance. But, the narrator says, the movie is not for them; rather it is for the majority of U.S. citizens who do have medical insurance and believe themselves protected.

Through a series of riveting vignettes, for-profit health care is shown to tyrannize the well, ruin the ill, and destroy families. It also erodes the psychological and moral fiber of the people working in the industry. Excursions to England, Canada, France and Cuba are presented in a series of encounters with physicians and patients, none of whom believe that they would be better off in the United States. A French doctor opines that he earns an adequate salary for a good quality of life. Even those seated in a Canadian waiting room profess satisfaction with the care given and understanding about delays. When asked why anyone would accept to pay the expenses of others, an elderly golfer explains patiently that it is what we do for each other in a caring society. Ex-pat Americans gather at a bar to describe their positive experiences with foreign health and maternity care.

Interviews with emotionally distraught people who have worked in the insurance industry reveal the relentless pressure to deny coverage and its reward system that favors those who generate the biggest savings. Special attention is given to Dr. Linda Peeno who testified before Congress in 1996, confessing that she had harmed people for the economic benefit of the insurance industry.

Moore gathers up a group of people whose sorry dilemmas within the U.S. system have left them with serious health problems. He escorts them to Cuba where physicians and nurses are only too pleased to diagnose and treat their illnesses– for free. The movie ends with an exposé of the superior health care given prisoners at Guantanamo and Moore’s stunt at trying to bring the unhappy Americans there for treatment.

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Born with aortic stenosis in 1984, Adam Ferrara Jasheway died suddenly at age nineteen of cardiac arrest. Dedicated to the memory of her son, this collection poignantly charts a mother's trajectory of grief. The poems are divided/organized into six sections paralleling the process of alchemy: calcinatio (burning by fire), solutio (dissolving in water), sublimatio (rising in air), coagulatio (falling to earth), mortificatio (decaying), and transmutatio (healing).

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Two hospice nurses describe their work with dying patients, especially with the special forms of communication typical of dying patients. The authors define "Nearing Death Awareness" as patients' knowledge and expression about their own dying. What doctors and family members may assume is the patient "losing it" or "hallucinating" actually is often a kind of symbolic communication dying patients typically use, either to describe their dying experiences or to request something they need for a peaceful death (such as seeing a loved one). By dismissing the patient as "confused," caregivers miss the opportunity to help the patient and may also alienate and frustrate both patient and family. By being aware of what is going on, caregivers can be more responsive and comforting to the patient and the family.

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