The Science of Starving in Victorian Literature, Medicine, and Political Economy

Mangham, Andrew

Last Updated: Sep-26-2022

Galbo, MA, MILS, Sebastian

Primary Category: Literature / Nonfiction

Summary:

Andrew Mangham’s The Science of Starving in Victorian Literature, Medicine, and Political Economy examines how Victorian writers drew upon the era’s medicine and physiology to represent the physical realities of starvation. Wondering readers, at first glance, might ask if starvation can be described in any terms other than a physical experience; however, Mangham argues that prevailing nineteenth-century political economy theorized population growth and food scarcity in ways that radically obscured the corporeal suffering wrought by starvation. Undergirding Victorian-era political economy was the influential work of the British cleric-economist, Thomas Malthus, and the rise of statistics. Malthus’s well-entrenched theories maintained that starvation, or large-scale famine, was a natural (and therefore inevitable) response to overpopulation. “In Malthus’s thinking,” Mangham clarifies, “hunger is the greatest tragedy in human economics: in the worst of times it rises up as a horrible check on those nations whose resources have been overrun by improvident birth rates” (1). These theories further solidified within religious contexts, which produced the peculiar notion of “salutary starvation” (26) or “the providential law of starvation” (30)—an understanding of famine and other disasters as just consequences for exceeding the material capacities of God’s “natural system” (26). Malthus’s theories, imbued with religious interpretations, were pernicious and far-reaching, seeping into how the British government and affluent classes viewed and (mis)understood poverty. Mangham also maintains that Malthus’s theories were augmented by the emergence of statistics during the first several decades of the century, which enabled the government to measure and evaluate epidemiological patterns, demographic data, and other information about human populations (53). He notes that while statistics were used to collect data about starvation, the data were frequently presented in ways that skewed the prevalence of malnutrition, food scarcity, and diseases and mortality rates related to starvation (56). Using a range of literary and primary sources, Mangham underscores that support for statistics was far from monolithic, that for all the scientific certitude that government officials invested in the discipline, there were critics who vociferated about how statistics were often reductive representations of human experience. In other words, masses of tabulated numbers created a cold, mathematical distance between government authorities and those human lives suffering starvation (56–57). Overall, Mangham outlines a bleak picture of Victorian political economy and its views of material privation.

For Mangham, then, one of the most injurious consequences of political economy was its failure to observe starvation (and its manifold health complications) as a material, indeed physiological, experience. As noted, political economists viewed starvation as anything but a form of bodily suffering, using theories instead to explain the naturalness and necessity of hunger and thus blaming the poor, not government and industry, for their problems (31). While political theorists were preoccupied with these explanations, Mangham traces the era’s concurrent developments in medicine that examined the physiology of hunger and digestion. The gastrointestinal research of Italian Lazzaro Spallanzani influenced Victorian physicians, namely John Hunter, Charles Thackrah, George Henry Lewes, Thomas Southwood Smith, and others, who sought to describe the anatomical workings of the stomach and explain the bodily sensations of hunger (36). Against this backdrop, Mangham argues that Charles Kingsley, Elizabeth Gaskell, and Charles Dickens—united in their “antipathy towards Malthusianism” (17)—recognized the power in articulating starvation using physiological terms, and turned to science to limn “. . . the material sufferings of the starving and, more importantly, on detailed analysis of what it means to go hungry and to observe and to write about it in a way that seeks to be truthful” (16). In chapters that individually examine each author’s literary works, Mangham demonstrates how “. . . physiological ideas offered both an alternative way of thinking about hunger and an exploration of the ways in which it might be interpreted” (47). This volume’s close readings of these authors’ various novels, journalism, and speeches reveal that medical science offered a language that could undermine theories that misunderstood human starvation and the sociopolitical conditions that perpetuate it. Kingsley, Gaskell, and Dickens used new science to depict not only physiologically accurate but humanized renderings of the poor.

View full annotation

Stuck

Larson, Heidi J.

Last Updated: Sep-20-2022

Coulehan, Jack

Primary Category: Literature / Nonfiction

Genre: Medical Anthropology

Summary:

Stuck was published shortly before the Covid pandemic when the American vaccine wars, with all their hostility, misinformation, and political baggage, lay more than a year in the future. In Stuck, Heidi J. Larson, Professor of Anthropology and Director of the Vaccine Confidence Project at the London School of Hygiene & Tropical Medicine, approaches vaccine rejection as a complex moral and cultural phenomenon, rather than as a simple issue of ignorance or a marginal point-of-view. In a sense, anti-vaccine rumors are the tip of an iceberg, reflecting and perpetuated by deep underlying concerns, like perceived threats to personal or cultural values, distrust of government, misperception of risks and benefits, or a combination of these. The claim that compulsory immunization violates personal freedom is especially prominent today.

Rumor is a major source of vaccine rejection. The author discusses in detail the case of Andrew Wakefield and his contention that MMR (measles, mumps, rubella) vaccine causes autism. This belief, based on a 1998 paper in The Lancet (later retracted) has been shown to be false by numerous large-scale studies, but is accepted by perhaps millions of people throughout the world.

View full annotation

Rx/Museum: 52 Essays on Art and Reflection in Medicine

Levy, Aaron; Hoy, Lyndsay

Last Updated: Sep-12-2022

Lam, MD, Gretl

Primary Category: Literature / Nonfiction

Genre: Collection (Essays)

Cancer Confidential: Backstage Dramas in the Radiation Clinic

Hayter, Charles

Last Updated: Aug-23-2022

Duffin, Jacalyn

Primary Category: Literature / Nonfiction

Genre: Autobiography

Summary:

All the [medical] world’s a stage! In elegant prose, with Felliniesque flights into whimsical metaphor, physician-historian-playwright Charles Hayter describes his encounters with cancer, as a doctor and as a son, and how the experience changed him as a person.

Just as he finishes his residency training as a cancer specialist, his stoic physician father develops cancer. The story of that family illness is interwoven with vivid case histories of patients, recounted personally rather than clinically. These patients display many of the characteristic reactions and behaviors of his own father.

Several other themes are prominent: the losing battle against death – or rather Death--who is a character lurking in the corners of the consultation rooms; the tensions of a son trying to please his difficult parents with advice and understanding that they seem not to want; the bravery of a gay man coming out to his wife and children to find a new place in the world.

These struggles are placed on a background of the nebulous status of radiation therapy, a maligned and misunderstood specialty.

View full annotation

Vanished in Hiawatha: The Story of the Canton Asylum for Insane Indians

Joinson, Carla

Last Updated: Aug-08-2022

Galbo, MA, MILS, Sebastian

Primary Category: Literature / Nonfiction

Genre: History of Medicine

Summary:

In 1902, an unusual structure was erected on South Dakota’s windswept prairies. It was not a silo, farmhouse, or barn—buildings that would be perfectly commonplace in that corner of the state. This conspicuously odd edifice, a “two-story building, with its jasper granite foundations,” was called the Canton Asylum for Insane Indians, a first-of-its-kind and federally managed institution based outside of Canton, South Dakota (Joinson 24). The asylum, which operated from 1902 to 1934, was designed to incarcerate and treat Indigenous peoples deemed ‘mad’ by powerful political authorities, such as reservation superintendents and the Bureau of Indian Affairs. According to the historian and disability studies scholar, Susan Burch, the facility “ultimately held four hundred men, women, and children from seventeen states and nearly fifty tribal nations.”

In Vanished in Hiawatha: The Story of the Canton Asylum for Insane Indians, Carla Joinson provides an incisive institutional history of the Canton Asylum, examining the political motivations for its establishment, its different periods of (mis)management, and, ultimately, its demise in the early 1930s due to inspection findings and Indigenous affairs advocacy spurred by John Collier. In writing the book, Joinson seeks to answer her chief research question: “why an institution like this asylum could exist for so many years, and what made it tick as a viable part of the Interior Department” (2). Her research explores the mechanics of institutional longevity, specifically how, despite government inspection reports that revealed appalling evidence of neglect and abuse, the facility remained in operation for over three decades. Joinson’s book also corroborates the staggering fact that many of the asylum’s patients were not, in fact, ‘insane,’ but sent to the institution only so that the federal government could detain and surveil people who may have experienced difficulties with reservation authorities back home. Other Indigenous peoples, such as those with epilepsy and ‘feeblemindedness,’ were also deemed ‘mad’ and in need of medical detention. Many instances of abuse are chronicled: unhygienic conditions, patient restraint, fraudulent diagnoses and misdiagnoses, suicide, and failure to quarantine tubercular patients. Joinson also unearths decades-long dysfunction among the facility’s administration: staff backbiting and high turnover rates, lack of medical treatment, poor medical training and recordkeeping, and refusal to employ translators to communicate with Indigenous patients and understand their different cultures. Vanished in Hiawatha documents that Canton’s patients suffered years of neglect, and those who would have potentially benefitted from psychiatric treatment never received it because the facility was little more than a rural prison for unwanted, troublesome, and chronically ill Indigenous peoples.

View full annotation

The End of Her: Racing against Alzheimers to solve a murder

Hoffman, Wayne

Last Updated: Aug-01-2022

Duffin, Jacalyn

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

The author’s beloved Jewish mother is a great storyteller. A favorite tale describes how her grandmother was shot dead while sitting on the family’s Winnipeg porch nursing her baby. An accomplished investigative journalist, author Hoffman assumes it is fiction but decides to investigate. He is astonished to discover that, indeed, his great-grandmother was murdered, although the details deviate slightly from the family tradition.

Through official records, the Census, and newspaper accounts he pieces together the circumstances of her life and death and the frustrated search for her killer. In the process, he learns a great deal about his ancestors and the world of Jewish immigrants in early twentieth-century Canada. Eager to share his findings, he is confronted by his mother’s decline into dementia and the poignant difficulties of grasping and reshaping memories, both collective and individual.

View full annotation

The Death of Innocents: A True Story of Murder, Medicine, and High-Stakes Science

Firstman, Richard; Talan, Jamie

Last Updated: Jul-14-2022

Palusci, Vincent

Primary Category: Literature / Nonfiction

Genre: Longform journalism

Summary:

The Death of Innocents offers an unbelievable but true tale that fulfills the promise of its tagline: Murder, medicine, and high-stakes science. Following prosecutor Bill Fitzpatrick in Onondaga County, New York, journalists Richard Firstman and Jamie Talan unravel the tale of Sudden Infant Death Syndrome, otherwise known as SIDS, in upstate New York in the 1970s. They first reveal the details of the case of Stephen Van Der Sluys, a father convicted of murdering his child for insurance money, establishing that parents don’t always have the best interests of their children at heart; this then lays the groundwork for the story of the successful prosecution of a mother whose children’s deaths had been considered as the basis for the theory of prolonged apnea as the cause of recurrent SIDS. With the prodding of Fitzpatrick, the prosecutor in nearby Tioga County then investigated and called in a slew of local and state investigators and national experts. Waneta Hoyt confessed to and was convicted of the murders, upending the research based on the prolonged sleep apnea theory, millions of dollars of NIH-funded research, and the careers of several research scientists. Although nurses and other pediatricians questioned Waneta’s maternal attachment and even suggested that the deaths were not natural, their voices went unheard. Politicians like Walter Mondale and Ronald Reagan jumped onto a bandwagon led by parents angry that the federal government had not done more to find out why their babies had died without explanation. National conferences on SIDS were held where theories were expounded based on published cases starring the “H” children. And commercial interests entered the stage as apnea monitors, which had never been used at home, became an unproven (and lucrative) recommendation for parents to prevent SIDS.

In addition to Waneta and Tim Hoyt and their five children (who ranged in age from 1 to 28 months) who were murdered between 1965-1971, there is a cast of characters out of a Hollywood script. The leading player is Alfred Steinschneider, MD, PhD, a pediatrician and researcher at Upstate Medical University in Syracuse, New York. Others include Drs. Michael Baden, Milton Halpern, Janice Ophoven and Marie Valdes-Dapena. Pediatric luminaries such as Abe Bergman, Jerold Lucey, Frank Oski, and even T. Berry Brazelton played roles.

The book takes us through the story using court and medical records, interviews, television and audio recordings, conference notes, publications and other publically available information, some of which the authors painstakingly retrieved and obtained through the Freedom of Information Act. We hear the sad story of Waneta and Tim, from high school sweethearts to life partners in rural poverty, and of their family members who tried to help but were often rebuffed. The story takes us to early pregnancy and early death, with inadequate evaluations, lack of autopsies or of more than cursory investigation, and wishes to not upset the Hoyts or their community with insinuations of murder. We hear about the years after the deaths, with the Hoyts’ attempts at adoption, mental health treatment and eventually their confession to heinous acts. We also hear about Steinschneider’s rise, fall and eventual ostracism by the medical community.

View full annotation

Editing Humanity

Davies, Kevin

Last Updated: Jun-28-2022

Coulehan, Jack

Primary Category: Literature / Nonfiction

Genre: History of Medicine

Summary:

Editing Humanity explores the history, biology, sociology, and ethical import of CRISPR (“clustered regularly interspaced short palindromic repeats”), the major new DNA technology indicated in the book’s subtitle, “The CRISPR Revolution and the New Era of Genome Editing.” Using CRISPR, researchers can manipulate the DNA of animals, plants and microorganisms with extremely high precision. In particular, scientists now have the potential to customize the human genome.

What is CRISPR? To quote Davies, “CRISPR is a small subsection of the bacterial genome that stores snippets of captured viral code for future reference, each viral fragment (or spacer) neatly separated by an identical repetitive DNA sequence.” (p. 23) When the cell is reattacked by a virus, an RNA copy of that virus’ stored “signature” forms a DNA-splitting complex that destroys the incoming virus. In 2012, Jennifer Doudna, of the University of California, Berkeley, and Emmanuelle Charpentier, of the Max Planck Institute, Berlin, demonstrated that CRISPR could be engineered to edit any gene. One could, for example, replace a disease-causing mutation in any DNA segment with the healthy variant, thus preventing genetic disease.

The author, Kevin Davies is a geneticist and science writer whose previous books include Cracking the Genome and DNA: The Story of the Genetic Revolution. In Editing Humanity, he discusses an array of actual and potential applications of CRISPR technology, including human disease prevention by altering susceptibility of animal vectors, improving farm productivity, and even resurrecting extinct species. However, the most powerful and controversial topic is genetic manipulation of the human embryo. Davies devotes several chapters to the cautionary tale of the young Chinese scientist He Jiankui who engineered the world’s first gene-edited babies, and the scandal and disgrace that followed. (He was convicted in China of “illegal medical practice” and sentenced to prison.)

View full annotation

Crying in H Mart: A Memoir

Zauner, Michelle

Last Updated: Jun-23-2022

Schilling, Carol

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

While Michelle Zauner’s remarkable memoir is an expression of her profound grief after her mother died, her story simultaneously reflects on her complicated relationship with the woman she called Umma and with her own Korean-American identity. The H Mart of the title, an Asian grocery chain, provided the ingredients for the dishes that suffused their relationship, her identity, and her grief. Food and memory animate the memoir itself.

Zauner was 25 when her mother was diagnosed with an aggressive late-stage, mid-life cancer. Also the only daughter of a white American father, Zauner was a rebellious child, resentful of Umma’s version of tough love. Growing up the lone Asian student in her Oregon community, she felt both othered at school and an outsider among her Seoul relatives. Just as she was beginning to appreciate her Korean heritage and understand her mother’s love, she learned about Umma’s diagnosis.

The first half of the memoir exuberantly brings to life scenes from Zauner’s childhood and her brief post-college years in New York City, interrupted by her dedicated caregiving. Attempting to save her mother, Zauner at times overwhelmed her with her native foods. “I would radiate joy and positivity,” Zauner pledged. “I would learn to cook for her—all the things she loved to eat, and I would single-handedly keep her from withering away” (69). Her optimistic culinary efforts produce a poetry of exacting descriptions of the flavors and textures and preparation of those foods. It’s grimly ironic that the chemotherapy her mother endured wiped out her ability to taste or digest Zauner’s loving offerings of health.

The second half turns from living with Umma to living without her. Wishing to sustain her bond with her mother as Zauner grieved, she continued to prepare her Korean family’s recipes. Walking down H Mart’s redolent isles generated “waves” of sorrow that mark the enduring ebb and flow of her grief. Unsuccessful with conventional therapy, she found cooking a preferable form of self-care. “Every dish I cooked exhumed a memory. Every scent and taste brought me back for a moment to an unravaged home. Knife-cut noodles in chicken broth took me back to lunch at Myeongdong Gyoja . . . The kalguksu so dense from the rich beef stock and starchy noodles it was nearly gelatinous. My mother ordering more and more refills of their famously garlic-heavy kimchi” (212-213). As if miraculously, a few years after Umma died, Zauner’s itinerant music career ignited. The band she has fronted, Japanese Breakfast, recorded an album, Psychopop (with a song she wrote about her mother, “In Heaven”). Then they toured the U.S. and South Korea. Although her mother was skeptical about a musical career, Zauner imagined that Umma would be “glad that I had finally found a place where I belonged” (233).

View full annotation

The Inkblots

Searls, Damion

Last Updated: Jun-14-2022

Madsen, Danielle

Primary Category: Literature / Nonfiction

Genre: Biography

Summary:

Damion Searls’ The Inkblots: Hermann Rorschach, His Iconic Test, and the Power of Seeing is a comprehensive history of Rorschach’s life and an overview of the use and influence of his psychiatric test over the past century.

Rorschach grew up in Switzerland, the son of a widowed middle school art teacher who would die while Rorschach was a teenager after suffering from years from neurological disease caused by lead paint exposure. Rorschach debates whether to study drawing and become a teacher or attend medical school and pursue a career in neurology. The book follows his career across three countries after choosing to do the latter, until he becomes a practicing psychiatrist at a rural Swiss institution. It traces his psychiatric influences—Bleuler and then Jung as professors while at the University of Zurich and Freud via their influence—as well as his artistic ones—Ernst Haeckel, the pre-modernist galleries of Zurich, then Russian Futurism. It also provides an overview of the field of psychiatry at the time: schizophrenia was considered an unremittable condition named dementia praecox, psychiatric institutions included patients with tertiary syphilis, and increasing neurologic knowledge and psychiatric techniques improved diagnostics but not treatments.

The earliest inkblots of Rorschach’s are temporary creations made with a local schoolteacher and administered to patients and pupils, formulated as one of dozens of strategies to gain insight into people. Rorschach’s patients see much in these inkblots, but the schoolboys little, and the experiment is abandoned. He returns to the idea a decade later, with greater stress placed on the image. He requires that they look organic rather than made, imply movement, and have multiple foreground/background interpretations. After creating a set of ten products, he starts to categorize results. He codes whether the answers are seen in the whole image or a detail; whether they are based on form, color, or movement; whether the figures seen in the image are well- or poorly-defined; and how many and what category of answers are seen. The coded results enable Rorschach to give accurate blind diagnoses and he begins to gain traction in psychiatric community. However, he dies before his inkblots become popular.

The book follows the test as it travels to America and gains acclaim with psychologists. It is used in clinic and hospitals and becomes a standard part of psychology training. The inkblots are part of military personnel assessments and scientific studies. They are referenced in criminal trials and family court. They are applied in anthropology and education. They show up on movie posters and in fashion shows and become a household name. As it details these broad applications, the book explains the battle over how the test should be given and whether analysis of the results should be open-ended interpretation or a standardized scoring method. It also details society’s constantly shifting belief as to whether psychological testing is a valid diagnostic tool.

View full annotation