Summary:

St. Luke’s Hospital was founded in 1750 to provide free care to the impoverished mentally ill. It mixed benevolence with "unconscious cruelty" in the treatments used by the "practitioners of old," from restraints and drugs to swings and a key to force-feed recalcitrant patients. Dickens describes this gloomy edifice as he saw it on December 26, 1851, although he notes a "seasonable garniture" of holly.

The inhabitants of St. Luke’s largely sit in solitude. Dickens decries the absence of "domestic articles to occupy . . . the mind" in one gallery holding several silent, melancholy women, and praises the comfortable furnishings--and the relative "earnestness and diligence" of the inmates--in another. He uses statistics to show the prevalence of female patients, "the general efficacy of the treatment" at St. Luke’s, and the unhealthy weight gain of the inhabitants due to inactivity. Dickens describes the behavior of various distinctive inhabitants during the usual fortnightly dance, the viewing of a Christmas tree, and the distribution of presents.

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This tightly researched documentary opens with the tragic auto accident in which Ms. Kowalski is rendered comatose. During the early period of her prolonged hospitalization, tensions arise between Kowalski's domestic partner and the patient's parents, leading to a highly contentious battle for the rights not only to visit, but also to assume long term care responsibilities. As the patient regains consciousness and limited physical and cognitive skills, the drama moves from the hospital and nursing care facility to the courtroom.

For ten years, the battle for custody and the ultimate care of Ms. Kowalski rages. Drawing on trial transcripts, medical records, newspaper archives, and personal interviews, Casey Charles's work brings to life emotions and personalities that dominated the courtroom dramas and illuminates the highly contested judgments emerging from supposedly objective authorities in journalism, medicine, and the law.

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In this memoir, subtitled "One Woman's Search for the Perfect Sperm Donor," lesbian author and academic Harlyn Aizley confronts her approaching fortieth birthday by deciding to have a child. She and her partner, Faith, begin the process of choosing its biological father. The first major decision: a known or unknown sperm donor? Eventually they choose an unknown one, from a sperm bank with an identity-release program that will allow their child the option of meeting her biological father after she turns eighteen.

Aizley narrates, in absorbing and often very funny detail, the eight months it takes her to conceive, and then the nine months of pregnancy culminating in the birth of a daughter. Sad but telling counterpoints to this narrative are the terrorist attacks in September 2001, which occur during Aizley's pregnancy, and the experience of her mother, who dies three months after the baby's birth, of ovarian cancer.

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In 1869, national and medical attention was focused on a poor family in Wales. The daughter, twelve year-old Sarah Jacob, was bedridden with a strange ailment characterized by paralysis, staring fits, and anorexia. Yet she did not waste away. On the contrary, she seemed to survive comfortably with only few drops of water daily. Credulous folk came to visit, knowing that such abstinence had been the practice of many Christian saints; they would leave a few coins as an offering, although the family protested that money had never been requested. Others claimed it was a hoax.

Eventually the doctors and vicars became curious. An initial investigation upheld the family’s position that the girl did not eat. A more rigorous second investigation was designed by medical professors from Guy’s Hospital in London and carried out by trained nurses who sat knitting at the bedside. It resulted in the girl’s death.

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This book, "a humanistically oriented sociocultural history of medicine" (p. x), focuses on the interactions between patient and doctor in western medicine from the nineteenth century through contemporary times. Furst, a Professor of Comparative Literature at the University of North Carolina at Chapel Hill, uses literary works to chronicle the changing patterns of medical practice, the social positions of doctors, and effects of medical education as they relate to "the doctor-patient alliance." (p. x) By "mapping cultural history in and through literature" (p. x), Furst enriches our understanding of the development of various roles and expectations of doctors and patients since approximately 1830.

The first chapter details the concept of the book and clarifies its purpose. Most histories of medicine concern famous discoveries, introductions of new technologies, and lives of renowned physicians and researchers, yet they neglect to examine patients' perspectives. Furst's mission is to reinstate patients into medical history and contemporary analysis. She chooses to focus on everyday-type of medicine, and more specifically, "to chart the evolution of the changing balance of power in the wake of the advances made in medicine in the nineteenth and twentieth centuries, drawing on literary texts as sources." (p. 17)

The other seven chapters are topic oriented and placed in general chronological order. The chapters vary in the number of sources examined. For example, Chapter 2, "Missionary to the Bedside" is a comparative analysis of Anthony Trollope's Doctor Thorne (see this database) and Elizabeth Gaskell's Wives and Daughters, and Chapter 3, "Seeing-and Hearing-is Believing" almost exclusively concerns Middlemarch by George Eliot (see this database).

Other chapters, however, include commentary on more sources. A chapter on twentieth century hospital-based practice and medical education, "Eyeing the Institution," begins with a review of various films, television shows, and novels and follows with an in-depth comparative analysis of three autobiographical accounts of medical education and training: A Year-Long Night by Robert Klitzman, A Not Entirely Benign Procedure: Four Years as a Medical Student by Perri Klass (see this database), and Becoming a Doctor by Melvin Konner.

Furst examines the effect of gender on patient and physician experiences and expectations. In Chapter 4, "A Woman's Hand," five novels about "doctresses" (a term used for women doctors in the late nineteenth century) are compared. How and why the protagonists became doctors, what sacrifices they made, how patients viewed having a woman doctor, the range of solutions to career and/or marriage choices, and the personalities of the protagonists are some of the comparisons made. These novels are placed in historical context with information about the lives and attitudes of physicians such as Elizabeth Blackwell and Mary Putnam Jacobi.

Other topics include evaluations of the nineteenth century hospital, the role of research and the laboratory (Sinclair Lewis's Arrowsmith annotated by Felice Aull, also annotated by Pamela Moore and Jack Coulehan --see this database--and A. J. Cronin's The Citadel), and the impact of contemporary changes in reimbursement and management on the power relations in medicine. A sensitivity to the effects of language on power relations is a theme throughout the book, and is more fully examined in the final chapter, "Balancing the Power." After an analysis of several books by Oliver Sacks , and his attempts to truly understand his patients' perspectives, Furst concludes, "The balance of power cannot be even, but it must at least strive to be fair." (p. 251)

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This memoir reconstructs event by event the hospitalization of the author’s husband, Elliot Gilbert, for prostate surgery, his death in the recovery room, and the efforts of his wife and family to find out why he died. The account of those efforts over the ensuing months, which involved friends and lawyers, raises numerous legal, social, and medical questions about how medical mistakes occur; how the medical establishment may seek to protect itself; patients’ and families’ rights to information about norms and procedures; and the vulnerability of both patients and doctors in a litigious environment. The book also reflects on the process of mourning, and begins with an acknowledgment that the writing of it has constituted part of that process.

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After seven years of research on children and adolescents diagnosed as "juvenile delinquents," psychiatrist Wertham concluded that crime comic books (mysteries, thrillers, horror, and police stories) are a harmful influence on young minds. In fourteen chapters, rife with the logic of comparison from the adult world, he analyzed the problem literature, its artwork, its advertising, and the so-called "educational messages" it contained.

Against the evidence of various "experts" and the champions of civil liberties, numerous anecdotes demonstrate how comic books glorify violent crime, link sexual love with physical abuse, permit illiteracy, and invite imitation. A series of vignettes demonstrates that violent child crime is on the rise and that actual crimes--even murder--have been connected to the reading of comics.

Wertham also provided statistics on comic book publishing, finances, and influence. A penultimate chapter is devoted to television. Emphasizing the public initiatives and legislative controls brought against American comics in other countries, such as Canada, Britain, Italy, Mexico, and Sweden, he demands action before yet another generation of youth is ruined.

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A philosopher and a clinical ethicist conduct an analysis of the practice of assisted suicide. They begin with the premise that health care providers may at times be assisting with suicide now, whether or not it is legal and whether or not the ethical dimensions have been solved. They contend that assisting a suicide might be morally right, but only when the patient’s choice is rational and free.

Referring to an earlier publication by Prado (Last Choice: Preemptive Suicide in Advanced Age, 1990; 2nd ed. 1998), they devote a chapter to each of three criteria used to determine the "rationality" of a choice for suicide, and another chapter to the "slippery slope" argument. A final chapter summarizes their contribution to this topic.

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This biography, written by a second party in conjunction with the person whose story is portrayed, is the tale of a black lay-midwife working in the southern United States during the mid to latter part of the 20th century. Gladys Milton, mother of seven children herself, is called to midwifery training by the Health Department in a rural county in Florida.

After an introductory chapter that sets the stage for the ultimate challenge to Gladys, the following few chapters follow her through some of the high points of her childhood and early years of motherhood. The remainder of the work describes broadly the career--with its ups and downs--of Gladys as midwife, doing home deliveries and working in the birthing center she has established in her own home. The final chapters deal with the legal efforts and ultimately the hearing in which the Health Department attempts to revoke Gladys's license to deliver babies.

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In Rethinking Life and Death: The Collapse of Our Traditional Values, Peter Singer argues that "the traditional western ethic has collapsed" as we enter "a period of transition in our attitude to the sanctity of life" (pp. 1). The book begins with the tale of Trisha Marshall, a twenty-eight year old woman, who in 1993 was seventeen weeks pregnant when a gunshot to her head left her in an intensive care unit, her body warm, her heart beating, a respirator supporting her breathing. However, she was brain dead.

Her boyfriend and her parents wanted the hospital to do everything possible so that the baby would be born. The ethics committee of the hospital supported the decision. For the next 100 days, Trisha Marshall continued to be supported in the ICU until her baby was delivered by cesarean birth. After a blood test showed that the boyfriend was not the father, and after three weeks in the intensive care unit, the baby went to live with Marshall's parents.

Singer uses this introduction to pose the many ethical questions that are raised because of medicine's ability to keep a "brain dead" body warm for an extended period of time. "How should we treat someone whose brain is dead, but whose body is still warm and breathing? Is a fetus the kind of being whose life we should make great efforts to preserve? If so, should these efforts be made irrespective of their cost? Shall we just ignore the other lives that might be saved with the medical resources required?

Should efforts to preserve the fetus be made only when it is clear that the mother would have wanted this? Or when the (presumed?) father or other close relatives ask for the fetus to be saved? Or do we make these efforts because the fetus has a right to life which could only be overridden by the right of the pregnant woman to control her own body--and in this case there is no living pregnant woman whose rights override those of the fetus?" (pp. 17-18).

In the chapters that follow, Singer argues that whether western society will acknowledge it or not, we have, in our actions and decisions, moved to an ethic where "quality of life" distinctions trump "sanctity of life" positions. Yet, many continue to raise the "sanctity of life" position when it is clear that our legal and ethical positions in western society have embraced the "quality of life" stance. For Singer, this paradox results in an incoherent and illogical approach to the ethical challenges presented by modern medicine.

Throughout his book, Singer presents evidence for his argument through ethical and historical analysis of brain death, abortion, physician assisted suicide and euthanasia, organ donation, and the nature of persons. For those uncomfortable with Singer's position on "infanticide," this book allows one to follow Singer's argument and his recommendations in the last chapter for a coherent approach to these "quality of life" decisions.

He closes his book with the recommendation that a new ethic should embrace five new commandments to replace the old "sanctity of life" commandments. His commandments are: 1) Recognize that the worth of human life varies; 2) Take responsibility for the consequences of our decisions (in end of life care); 3) Respect a person's desire to live or die; 4) Bring children into the world only if they are wanted; and 5) Do not discriminate on the basis of species.

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